Medical Compend 
FOR COMMANDERS 
OF NAVAL VESSELS 
1942 MEDICAL COMPEND 
For 
Commanding Officers of Naval Vessels to 
Which no Member of the Medical Department 
of the United States Navy Is Attached 
To accompany Medicine Box 
PUBLISHED BY THE 
BUREAU OF MEDICINE AND SURGERY 
UNDER THE AUTHORITY OF THE 
SECRETARY OF THE NAVY 
REVISED, APRIL 1942 
UNITED STATES 
GOVERNMENT PRINTING OFFICE 
WASHINGTON : 1942 
For sale byflthe Superintendent of Documents, Washington, D. C. ••••• - - - Price 60 cents Bureau of Medicine and Surgery, 
Navy Department, 
Washington, D. C., July 7, 19^1. 
This Medical Compend for commanding officers of naval vessels 
to which no member of the Medical Department of the United States 
Navy is attached, is published for their aid in the knowledge and 
use of the contents of the Medicine Box, United States Navy, as well 
as to be a general guide in the preservation of the health of the per- 
sonnel under their command. 
Ross T McIntyre, 
Surgeon General, United States Navy. 
II CONTENTS 
Page 
Chapter I. Introduction 1 
Contents of medicine boxes 3 
The medicine box 3 
The supplemental medicine box 4 
The medical boat box 5 
Directions for the use of medical supplies 7 
Chapter II. First aid 13 
Chapter III. Special diseases 39 
Chapter IV. Venereal diseases and prophylaxis 71 
Chapter V. Hospitalization 77 
Chapter VI. Deaths 81 
Chapter VII. Personal hygiene 87 
Chapter VIII. Preventive medicine 89 
Chapter IX. Quarantine, disinfection, bills of health 95 
Glossary 123 
Index... 127 
Ill Chapter I 
MEDICAL SUPPLIES 
Introduction 
This Medical Compend, ■which accompanies the medicine box, is 
published primarily for the use of commanding officers of naval 
vessels to which no representative of the medical department is 
attached. In its preparation, an endeavor has been made to cover, 
in nontechnical language, the recognition and emergency treatment 
of those injuries and diseases commonly met with on board ship, as 
well as to provide directions for the management of quarantinable 
diseases and those cases beyond the ability of the ship’s force to 
handle. 
It is not intended that use of these instructions shall replace the 
services of a medical officer or civilian doctor whenever one can be 
contacted, nor take the place of liospitalization whenever or wherever 
such facilities are available. On the contrary, it is desired that com- 
manding officers of naval vessels to which no member of the medical 
department of the Navy is attached, consult freely with medical and 
dental officers of the Navy, whenever opportunity offers, both ashore 
and afloat, regarding the care and treatment of the sick, as well as 
the general health of the crew and the sanitation of the ship. The 
medical and dental officer of a yard or station will be found at the 
dispensary, where, with the approval of the commandant, assistance 
and advice in the treatment and care of the sick may be received. 
So far as possible the treatment outlined in this compend has been 
restricted to the employment of those agencies supplied in the medi- 
cine box or which may be obtained in the customary ship’s stores. 
Suggestions as to any special agencies which are mandatory, and 
which should be obtained ashore at the earliest opportunity, are so 
indicated. 
In addition to first-aid measures and the treatment of special 
diseases, there have been included chapters on hospitalization, pre- 
ventive medicine, personal hygiene, quarantine and bills of health, 
and the disinfection and fumigation of ships, as well as the action to 
be taken in cases of death which may occur on board. At the end 
of the volume is a glossary containing some of the terms used in the 
text which will aid in interpreting the instructions given. 2 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
The outfits of medicines and medical supplies furnished consist, 
as listed, of either (a) the Medicine Box, Navy standard, or (6) the 
Medical Boat Box, Navy standard. The Supplemental Medicine 
Box, containing additional medical supplies in an ordinary packing 
case, is obtainable on requisition as needed. 
Medical stores should be obtained in advance of actual need. They 
may be requisitioned separately by items or in the form of the 
Supplemental Medicine Box, complete, as listed. Certain items have 
been designated as deteriorative, such as rubber goods, etc., and these 
should be checked occasionally and replenished when unserviceable. 
Medical supplies may be procured, as required, on the Medical Sup- 
ply Depot Requisition and Invoice (NMS Form 4). Requisitions, 
when approved by the Bureau, will be filled by the naval medical sup- 
ply depot most convenient to the ship; that is, if in Atlantic waters, 
by the depot in Brooklyn, N. Y., and if in Pacific waters, by the depot 
at Mare Island, Calif. 
A supply of the requisition forms may be obtained from any supply 
depot, but if this form is not available on board the ship, a request 
for additional supplies may be made by letter addressed to the Bu- 
reau of Medicine and Surgery. Requisitions should be restricted to 
the items listed and should correspond in amounts with the packages 
as indicated. 
Advantage should be taken of opportunities when in the vicinity 
of a naval medical supply depot, or when at navy yards or in dry- 
dock, to replenish the stock of medicines and medical supplies, but 
if the need is urgent the stock may be replenished from the medical 
stores of any yard, station, or other ship. The Medicine Box, United States Navy. Plywood case and contents shown. 
The Medicine Box, United States Navy. Illustration shows stowing of contents 
of Box. Shelves are detachable. Contents of Medicine Boxes 
The Medicine Box 
(Case, Tablets) 
Alkaline and Aromatic (Seiler) bottle— 1 
Aspirin (Acetylsalicylic acid) 5 grains do 1 
Azochloramid saline mixture tablets do 1 
Bismuth Subnitrate (powdered) do 1 
Borax (powdered) do 1 
Brown Mixture, 1 dram do 1 
Calomel, % grain do 1 
Cascara Sagrada, 4 grains do 1 
Cathartic, vegetable do 1 
Coryza do 1 
Dover’s Powders, 5 grains * do 1 
Iron, Quinine, Arsenic, and Strychnine do 1 
Phenacetin, 5 grains do 1 
Phenobarbital, IVj grains do 1 
Quinine Sulfate, 3 grains do 1 
Soda Mint, 5 grains do 1 
Sodium Salicylate, 5 grains do 1 
Case, Tablets, U. S. N., empty 1 
(Medicines, Dressings, Etc.) 
Adhesive Plaster, 2 inches by 5 yards (deteriorative) spool 1 
Bag, hot water (deteriorative) 1 
Bag, ice (deteriorative) 1 
Bandage, gauze, 1 inch dozen 1 
Bandage, gauze, 2 inch do 2 
Bandage, gauze, 3 inch do 1 
Bandage, suspensory 2 
Basin, dressing 1 
Box medicine, empty 1 
Castor Oil tin 1 
Catheter, soft rubber, No. 10 F (deteriorative) 1 
Catheter, soft rubber, No. 12 F (deteriorative) 1 
Catheter, soft rubber, No. 14 F (deteriorative) 1 
Catheter, soft rubber, No. 16 F (deteriorative) 1 
Catheter, soft rubber, No. 18 F (deteriorative) 1 
Catheter, soft rubber, No. 20 F (deteriorative) 1 
Collodion, flexible bottle 1 
Colloidal Silver (argyrol) do 1 
Cotton, absorbent roll 1 
Dentalone bottle__ 1 
Epsom salt tin__ 1 
Eye Bath 2 
3 4 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
The Medicine Box—Continued 
(Medicines, Dressings, Etc.)—Continued 
First-aid Packet 6 
Forceps, hemostatic 2 
Formaldehyde Solution bottle— 1 
Fountain Syringe (deteriorative) 1 
Gauze, plain, absorbent roll— 1 
Iodine Tincture, 3 vials in package package— 2 
Lint, absorbent roll 1 
Medicine Glass 2 
Muslin yard— 5 
Ointment, Boric Acid tube 2 
Ointment, Sulfur jar 1 
Ointment, Yellow Oxide of Mercury tube 3 
Ointment, Zinc Oxide jar 1 
Pencil, hair 2 
Pins, Scissors, and Dressing Forceps (set, in case) set 1 
Prophylactic Tubes tube 100 
Soap Liniment bottle 1 
Soda Bicarbonate carton 1 
Spatula, 3 inch 1 
Spirit of Ammonia, aromatic bottle 1 
Suture, surgical gut, untreated, boilable, No. 2, threaded in needle tube 6 
Suture, surgical gut, mild treatment, boilable, No. 2, threaded in 
needle tube— 6 
Syringe, penis, rubber (deteriorative) 2 
Tannic Acid Jelly tube 4 
Thermometer, clinical 2 
Tourniquet, instant, (rubber), (deteriorative) 2 
Vaseline tin 1 
Wire Mesh (for splints) piece 3 
Medical Compend ■ book 1 
The Supplemental Medicine Box 
(Tablets) 
Alkaline and Aromatic (Seiler) bottle 1 
Aspirin, (Acetylsalicylic acid), 5 grains do 1 
Brown Mixture, 1 dram do 2 
Cascara Sagrada, 5 grains do 1 
Cathartic, vegetable do 1 
Phenacetin, 5 grains do 1 
Quinine Sulfate, 3 grains do 3 
Sodium Salicylate, 5 grains do 1 
Sulfadiazine 
(Medicines, Dressings, Etc.) 
Adhesive Plaster, 2 inches by 5 yards spool 2 
Bandage, gauze, 1 inch dozen__ 1 
Bandage, gauze, 2 inch do 2 
Bandage, gauze, 3 inch do 1 MEDICAL SUPPLIES 
The Supplemental Medicine Box—Continued 
(Medicines, Dressings, Etc.)—Continued 
5 
Bandage, suspensory 6 
Bismuth Subnitrate (powdered) bottle 1 
Castor Oil tin— 3 
Collodion, flexible bottle— 4 
Colloidal Silver (argyrol) do 5 
Cotton, absorbent roll 2 
Epsom salt tin 3 
Eye Bath 2 
Formaldehyde Solution bottle 2 
Gauze, plain, absorbent roll 2 
Iodine Tincture (3 vials in package) package 2 
Lint, absorbent do 2 
Medicine Glass 2 
Ointment, Boric Acid tube 2 
Ointment, Yellow Oxide of Mercury tube 3 
Pencil, hair 4 
Prophylactic Tubes tube 100 
Soap Liniment bottle 2 
Soda Bicarbonate carton 2 
Sulfanilamide 
Syringe, penis, rubber 12 
Tannic Acid Jelly tube 6 
Thermometer, clinical 2 
Tourniquet, instant (rubber) (deteriorative) 2 
Vaseline tin 4 
The Medical Boat Box 
Jelly of Tannic Acid 4-ounce tube— 3 
Spirit of Ammonia, aromatic, tube and paper cup 4 in package— 3 
Acid, Acetylsalicylic, 5 grains 100 in bottle 1 
Colocynth and Jalap Compound, N. F do 1 
Soda Mint, 5 grains do 1 
Sodium Chloride, 10 grains (for sodium chloride dispensers) do 1 
Tincture of Iodine, Mild, 10 cc. applicator vial 3 in package 4 
Bandage Compress, 2 inch 4 in package— 2 
Bandage Compress, 4 inch 1 in package— 2 
Bandage, gauze, compressed, 1 inch 6 
Bandage, gauze, compressed, 2 inch 6 
Bandage, gauze, compressed, 3 inch 6 
Bandage, triangular, compressed 2 
Cotton, absorbent, compressed l-ounce package— 6 
Gauze, plain, compressed do 6 
Packet, first-aid 6 
Pins, safety, large dozen— 1 
Splint, wire mesh for, 5 by 36 inches piece— 1 
Tourniquet, Web package— 1 
Shears, 6 inch—, 1 
Boat Box, empty 1 Directions for Use of Medical Supplies 
Tablets, Pills, and Powders 
Alkaline and Aromatic (Seiler) (tablet). A mild, soothing antiseptic; for 
sore throat and rhinitis. 
Dose.—Dissolve two tablets in half a glass of warm water, and use 
as gargle or nasal douche every 3 to 4 hours. 
Aspirin (Acetylsalicylic acid) (5-grain tablet). An anodyne and analgesic; 
for headache, neuralgia, rheumatism, and fever. May also be used as a 
gargle in painful sore throat. 
Dose.—For headache: One tablet, preferably followed by a half teaspoon- 
ful of sodium bicarbonate (baking soda), repeated in 1 hour if necessary. 
For sore throat: One tablet dissolved in one-fourth glass of warm water. 
Bismuth Subnitrate (powder). An astringent; for diarrhea. Should be mixed 
with equal parts of sodium bicarbonate (baking soda). 
Dose.—One-half teaspoonful of mixture in water every 2 hours until 
relieved. 
Borax (powder). A mild antiseptic and astringent; to be used in making eye 
lotion. 
Dose. (See under Eye, diseases of.) 
Brown Mixture (1-dram tablet). An expectorant; for coughs and bronchitis. 
Dose.—One tablet dissolved in the mouth every hour. 
Warning.—Limit, 20 tablets in 24 hours. 
Calomel (%-grain tablet). A cholagogue and cathartic; used for constipation 
and biliousness; also in some fevers. 
Dose.—One tablet every hour until five are taken. Should be followed 
in a few hours or the next morning by a dose of Epsom salt (magnesium 
sulfate), one tablespoonful dissolved in a small quantity of hot water. 
Cascara Sagbada (4-grain tablet). A mild laxative; preferable for chronic 
constipation. 
Dose.—One or two tablets at bedtime. 
Cathartic, vegetable (pills). An active purgative. 
Dose.—One to three pills, preferably at bedtime. 
Coryza (tablet). An antispasmodic and sedative; for beginning colds in the 
head. 
Dose.—One tablet every 15 minutes until four tablets have been taken; 
then one tablet every 30 minutes for four doses; and then one every 
hour for four doses. 
Warning.—Limit, not more than 12 tablets taken as directed. Stop when 
dryness of the nose and mouth1 is experienced. 
Dover’s Powder (5-grain tablets) (Poison). A diaphoretic and sedative; used 
in the beginning of head colds and bronchitis to produce sweating and reduce 
fever. 
Dose.—One tablet. (5 grains.) 
Warning.—Should be used with care. Should not be taken on an empty 
stomach as nausea may result. 
Iron, Quinine, Arsenic, and Strychnine (tablet). A tonic; for anemia, loss 
of appetite, and run-down condition. 
Dose.—One tablet after meals. 
7 8 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
Petrolatum. (See Vaseline.) 
Phenacetin (5-grain tablet). An analgesic and antipyretic; for headache, neu- 
ralgia, and fever. 
Dose.—One tablet with a glass of water, repeated in 1 hour if necessary. 
Phenobarbetal (1%-grain tablet). A sedative and hypnotic; for producing 
sleep and quieting restlessness. 
Dose.-—One tablet with a warm drink a half hour before bedtime, may be 
repeated with caution. 
Warning.—Limit, five tablets in 24 hours. An occasional individual is 
allergic to this drug. In such cases, patients may develop skin rash, 
high fever and mental confusion. 
Quinine Sulfate (3-grain tablet). Antimalarial; for prevention and treatment 
of malarial fevers. 
Dose.—One to three tablets every 4 hours. 
Warning.—Limit, 12 tablets in 24 hours. An occasional individual is 
allergic to this drug. In such cases, patients may develop itching and skin 
rash, ringing in the ears, nausea, and vomiting. Administration of the drug 
should be discontinued on the first appearance of any of these symptoms. 
Soda Mint (5-grain tablet). Antacid; for sour stomach, indigestion, and 
heartburn. 
Dose.—One or two tablets every hour dissolved in the mouth. 
Sodium Salicylate (5-grain tablet). Analgesic and antirheumatic; for rheu- 
matism and rheumatic pains. 
Dose.—Two tablets every 4 hours. 
Warning.—Limit, 12 tablets in 24 hours. Watch for symptoms of drug in- 
toxication, such as ringing in the ears, nausea, vomiting, and deafness. 
Administration of the drug should be discontimied on the first appearance 
of symptoms. 
Sulfadiazine (1 gram tablet). A chemical substance which, when SWALLOWED, 
destroys or prevents the growth of certain bacteria in the body. These tablets 
are given ONLY to persons having open wounds of the flesh, bones, brain, etc. 
Dose.—4 tablets by mouth—at once. Water can be given to help swallow- 
ing. After the initial dose of 4 tablets, if delay is experienced in getting the 
patient to a doctor, give 1 table (AND ONLY 1) every 6 hours. 
Warning.—Do not give these tablets any longer than 2 days. 
Adhesive Plaster (2 inches by 5 yards, spool) (deteriorative). For securing 
dressings to skin, and for minor abrasions. 
Azochloramid Saline Mixture Tablets. A mild antiseptic for the treatment of 
infected wounds. To prepare, place one tablet in 2 ounces of water, crush 
and stir. Do not use this solution in the eyes, mouth, or nose. 
Bag, Hot Water (rubber) (deteriorative). Fill to one-half its capacity with 
hot water, expelling the air before screwing down the stopper; then hold 
the bag upside down to be sure there is no leakage. Wrap bag in a bath 
towel and place over the desired area. 
Warning.—Watch carefully to see that hag is not too hot, especially with 
an unconscious or delirious patient. 
Bag, ice (rubber) (deteriorative). Break ice into small pieces by pounding 
it in a piece of canvas. Fill the bag to three-quarters of its capacity, expel 
the air, replace cover, and wrap bag in a towel. 
Warning.—Never put the rubber directly on the skin. 
Bandage, gauze (1, 2, and 3 inch). For retaining dressings. 
Warning.—Do not bandage too tightly. 
Medicines, Dressings, Etc. MEDICAL SUPPLIES 
9 
Bandage, suspensory. For supporting painful testicles, and retaining dressings 
in cases of orchitis. 
Basin, dressing. For bathing patients and preparing solutions. 
Castok Oil (cathartic). Useful for emptying the bowel in beginning diarrhea. 
Dose.—One to two tablespoonfuls. First wet the mouth with a hot liquid 
(milk, coffee, or tea), then take the oil and follow with some more of the 
liquid. 
Catheter (soft rubber, sizes 10 to 20 French) (deteriorative). To be used 
for drawing off the urine in an unconscious patient or one with an ob- 
structing stricture of the urethra. Boil for 10 minutes before use, and handle 
only with sterile hands. Lubricate with sterile oil or vaseline before passing 
and use the utmost gentleness. Try the larger sizes first. 
Collodion, flexible. For securing small dressings to the skin, especially the 
scalp. May be applied with a hair pencil. Keep the bottle securely closed 
to prevent evaporation. 
Colloidal Silver (argyrol, crystals). A mild antiseptic; for use in inflamma- 
tions of the eyes and as a preventive and treatment of gonorrhea (clap). 
Prepare a 10-percent solution by sprinkling one part of the crystals on the 
surface of 10 parts of boiled, distilled water; later, agitate until completely 
dissolved. 
Warning.—Solutions should be prepared only in small amounts as needed 
and should not be used after standing more than 1 or 2 days, as the 
drug tends to deteriorate rapidly in solution. Stains may be removed with 
bichloride solution. 
Cotton, absorbent (roll). For dressings, wipes, and for padding under band- 
ages. 
Warning.—Do not place in contact with wounds (use sterile gauze). 
Dentalone (solution). Analgesic for toothache. Apply in cavity on small 
pellets of cotton after first touched to another piece of cotton to remove excess 
fluid, and after cavity has been cleaned out and dried. 
Epsom Salt (magnesium sulfate, crystals). A quick acting cathartic; for 
constipation. 
Dose.—One to two tablespoonfuls, preferably dissolved in a small quan- 
tity of hot water. Should be taken on an empty stomach. Excellent also 
as a wet dressing and hot soak. (25 percent solution for inflamed areas 
and wounds). 
Eye Bath (glas§.). To be used in bathing the eyes. Should be sterilized before 
using. (See Eye Wash under Eye, diseases of.) 
First-Aid Packet. Sterile dressings sealed in tin. For emergency treatment 
of wounds. 
Forceps, hemostatic. For catching the ends of bleeding vessels until they are 
tied (ligated), and for use as a needle holder. Boil, with scissors and 
dressing forceps, for 15 to 20 minutes before using, and handle only with 
sterile hands. Dry well after use. 
Formaldehyde Solution (Poison). Disinfectant; for use as disinfectant only. 
Should be kept well stoppered and in a cool place. Two tablespoonfuls of this 
solution to 1 quart of water serves as an excellent disinfectant for knives, 
forks, cups, etc. (See Disinfectants.) 
Warning.—The escaping vapor is very irritating to the eyes, nostrils, 
and lungs. 
Fountain Syringe (rubber) {deteriorative). For giving enemas, washing ears, 
etc. Fluids flow by gravity and bag should not be elevated more than 2 
or 3 feet above the nozzle. 10 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
Gauze, plain, absorbent (roll). For dressings, etc. Should not be placed in 
contact with wounds until sterilized. Cut in pieces as desired. 
Iodine, Tincture (Poison) (mild tincture, in applicator vials). Antiseptic for 
wounds. Unscrew cap of vial and apply according to instructions or swab 
out wound with moistened cotton applicator. 
Warning.—Applied to skin may cause blisters especially when covered 
by a dressing. Never use iodine in connection with bichloride of mercury. 
Lint, absorbent (roll). Used as wet dressing and as padding over surgical 
dressings. 
Medicine Glass. Graduated in teaspoons and tablespoons, for measuring doses 
of medicine. Keep clean. 
Muslin (5-yard piece). Cut as desired for supportive dressings, slings, and 
for special bandages. 
Ointment, Boric Acid (tube). For dressing healing wounds, and for protecting 
the skin. Apply on lint, and then bandage. 
Ointment, Sulfur (jar). For itch and ringworm. Rub on affected part thor- 
oughly. (See Itch, treatment of.) 
Ointment, Yellow Oxide of Mercury (tube). For styes and other inflamma- 
tions of the eyes and lids. Apply to lids with cotton wrapped on matchstick. 
Ointment, Zinc Oxide (jar). For eczema, sunburn, etc. Apply locally and 
bandage. 
Pencil, hair. For applying collodion to dressings. Clean brush well after use 
to prevent hardening. 
Pins, Scissors, and Dressing Forceps (set in case). For applying surgical 
dressings; the forceps for holding edges of wounds while suturing, and scissors 
for cutting sutures and dressings. 
Prophylactic Tubes. For venereal prophylaxis. To be used in accordance with 
accompanying instructions. 
Soap Liniment. Use with massage for lumbago, painful muscles, sprains, etc. 
Warning-External use only. 
Soda Bicarbonate (powdered). Antacid; for indigestion and heartburn. Also 
for use with Bismuth Subnitrate (see above), and for jmeparing eye wash 
(see Eye, diseases of). 
Dose.—For indigestion; one-half to one teaspoonful in water. 
Spatula (3 inch). For mixing and spreading ointments on dressings. 
Spirit of Ammonia. Aromatic (bottle). Antacid and diffusible stimulant; for 
faintness. 
Dose.—By mouth: one-half teaspoonful well diluted with water; by 
inhalation: from saturated gauze or handkerchief. 
Sulfanilamide (sterile powder in 5 gram package). A special antiseptic for 
severe wounds of muscle, bone, brain, chest, and abdominal organs. 
Dose.—Dust the powder evenly into the deep recesses of and over entire 
wound (or wounds). 
Warning.—Do not apply powder too thickly. Do not give by mouth. Do 
not use in connection with iodine or any other chemical substance. 
Suture, surgical gut, untreated (boilable, No. 2, threaded in needle) (tube). 
For ligating blood vessels which must be buried. Place tube in formaldehyde 
solution, or boil with instruments. Break at file mark in sterile gauze, and 
handle only with sterile hands. Use hemostatic forceps as needle holder. 
Suture, surgical gut, mild treatment (boilable, No, 2, threaded in needle) (tube). 
For suturing wounds. Handle as above. MEDICAL SUPPLIES 
11 
Sybinge, penis (rubber) (deteriorative). For injection of argyrol solution into 
urethra as preventive and treatment of gonorrhea (clap). Do not inject more 
than IMs teaspoonfuls at a time. 
Tannic Acid Jelly (tube). Antiseptic and astringent for burns. Spread 
lightly over affected area and, if necessary, cover loosely with bandage. Do 
not use grease or oil. Apply fresh dressing daily. 
Thermometer, clinical (in case). For taking patient’s temperature. (See note 
under Fevers.) 
Warning.—Fragile. 
Tourniquet, instant (rubber) (deteriorative). For control of hemorrhage. To 
be wrapped around limb above bleeding point enough to stop the bleeding 
until other means can be taken. Do not tie, but secure end by placing a 
loop under one of the turns. Use with caution. (See under Hemorrhage.) 
Vaseline (tin). Protective ointment and lubricant. Apply locally for sun- 
burn, chapped hands, etc. May be used as a lubricant for catheters, rectal 
tubes, etc. 
Wire Mesh, for splints (roll). For immobilizing fractured limbs and disloca- 
cations. Cut to desired size with heavy shears and mold to affected part 
after thorough padding. Secure with bandage. Chapter II 
FIRST AID 
General Instructions 
Do not attempt to rival the doctor, but aid him through emer- 
gency measures, and thus put the patient into his hands with a better 
chance of recovery than would have been the case if prompt and effi- 
cient emergency treatment had not been rendered. 
In the presence of an accident the person giving first aid must take 
charge, if the services of a doctor cannot be obtained, and he should 
observe the following general rules: 
1. Be quiet and cool, don’t get excited, and do the best possible with 
the facilities at hand. 
2. Give the patient plenty of air; keep the crowd from gathering 
around, many of whom will be there only for curiosity. Keep only 
those around whose assistance may be needed. 
3. Lay the patient on his back, with head lower than the body, ex- 
cept in cases with marked flushing of the face or with difficulty in 
breathing, when the head may be raised a little on folded clothing or 
other suitable material, 
4. If there is vomiting, turn the head to one side so the vomited 
matter may easily escape from the mouth. This eliminates the risk 
of vomitus going into the windpipe and choking him. 
5. If the patient is unconscious, do not try to force him to drink, 
for he cannot swallow and may choke. 
6. Do not move patient from place of injury unless his condition 
justifies it. Often the injury will have to be attended to before it 
is safe to move him. 
7. Loosen tight clothing which may be present around the neck, 
chest, abdomen, legs, and ankles, such as collar, belt garters, and 
shoelacings. 
8. If stimulants are needed, whisky and brandy are not always 
indicated. In fact, there are conditions in which they do harm. 
Aromatic spirit of ammonia, if on hand, is safer for general use. 
9. In order to treat the injury the part has to be exposed and the 
clothing in some cases has to be removed. This should be done in 
such a manner as to disturb the patient as little as possible. The 
outer clothing should be ripped up the seam; the underclothing torn 
or cut. The uninjured side should be undressed first. In removing 
457944°^—42 2 
13 14 
MEDICAL COMPBND FOR COMMANDERS OF NAVAL VESSELS 
the shoes it is often necessary to cut them off when they cannot 
be removed otherwise without causing great pain or increasing the 
injury. 
10. An injured person often wants a drink of water. If conscious 
and able to swallow, a few sips of cold water will be very refreshing. 
11. If several injuries are present, care for the most severe one first. 
12. Don’t put fingers into the wound; they carry germs, and will 
infect the wound. 
Injuries 
SHOCK 
As almost all injuries cause a certain amount of shock, it is well 
to know what it is and how to treat it. It is a profound depression 
of the nervous system and is sometimes called collapse, exhaustion, 
or prostration. In this condition the face is pale, expression is anx- 
ious, eyes dull, and pupils enlarged, skin cold and clammy; patient 
is listless and takes no interest in surroundings; pulse is rapid and 
weak; breathing may be gasping, spasmodic, or feeble. 
Treatment.—Place on back with head low, administer stimulants: 
hot coffee, tea, aromatic spirit of ammonia, whisky, or brandy. Keep 
up body heat, wrap in warm blankets, apply hot-water bags, and 
rub extremities toward body to stimulate circulation. If patient is 
unconscious, do not give anything by mouth. 
BRUISES 
These are conditions where the soft tissues below the skin are in- 
jured and torn, the skin itself remaining intact. There is hemor- 
rhage under the skin but the blood does not escape. 
Symptoms.—Pain, loss of function, swelling, and discoloration. 
A recent bruise is usually red, purple, or black, later turning to green 
or yellow. 
Treatment.—Put the part at rest. Apply cold applications, and 
keep the injured part at rest. 
WOUNDS 
These are usually divided into the following classes: 
Incised.—Incised wounds are those caused by sharp instruments, 
such as a razor, sharp knives, glass, etc. 
Lacerated.—Lacerated wounds are those caused by a blunt instru- 
ment, by machinery, a falling block, etc. 
Punctured.—Punctured wounds are those caused by long pointed 
instruments, such as a nail, dagger, bayonet, etc. 
Poisoned.—Poisoned wounds are those caused by bites of animals, 
stings of insects, etc. 15 
FIRST AID 
Gunshot.—The term “gunshot wound” is self-explanatory. 
Symptoms of wounds.—Local—(1) pain; (2) hemorrhage; (3) 
loss of function; (4) gaping of edges. General—shock. 
The dangers from wounds are hemorrhage and infection. As has 
been stated, grave hemorrhage is usually rare, and a compress and 
bandage is usually all that is necessary to check it. Infection is the 
main danger. By this is meant the introduction into the wound of 
germs, which will cause pus and later trouble. The main effort in 
treating wounds is to prevent infection. 
Treatment of Wounds 
Prevent infection.—Do not touch the wound with dirty fingers and 
do not let the patient do so. If wound is not extensive and there is 
very little bleeding or dirt or foreign particles in it, apply into and 
for about 1 y2 inches distance around the wound tincture of iodine. 
Then apply to the wound a sterile gauze compress and hold it in place 
by a snug bandage. 
If the part injured is a hairy part of the body, the hair should be 
shaved off before treatment. If iodine is to be used, it would be better 
to shave the part dry, as iodine is less active on a moist surface. 
Before dressing a wound the dresser should see that his hands are 
surgically clean. To render them so, scrub for at least 10 minutes with 
a nail brush, hot water, and soap. Rinse off soap with hot water, and 
do not put the fingers into the wound unless absolutely necessary. 
These are the two essential features of aseptic work.* 
If foreign particles are in the wound they may be picked out with 
a pair of sterile forceps. If it becomes necessary to wash a wound 
to get the dirt out, use sterile hot water, soap, and a pad of sterile 
gauze as a sponge. A boiled common-salt solution (1 teaspoonful 
to a pint of water) is a very good one with which to wash and dress 
wounds. Be sure the water is sterile before applying it to the wound. 
(Should be boiled at least 20 minutes.) 
The dressing contained in the first-aid packet, although intended 
for a gunshot wound of small caliber, makes an excellent dressing 
for any wound it will cover and may be applied after the wound has 
first been treated with tincture of iodine. 
SEVERE WOUNDS 
In case of shell injuries, gunshot wounds, or any jagged and deep 
wounds with the edges separated, remove any foreign particles if pos- 
sible, and clean the wound as has been previously described. Open one 
♦Azochloramid solution may also be used as a wet dressing or hot soak. To prepare it, 
place one tablet in 2 ounces of water, crush and stir. Do not use this solution in the 
eyes, mouth or nose. 16 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
small packet marked Sulfanilamidef and dust the powder evenly over 
the entire wound.** If one packet of powder does not cover the area 
completely, another may be used. 
Now open a package of tablets marked Sulfadiazine and give him 4 
tablets. If there is a delay in getting the patient to a doctor, open 
another package of sulfadiazine, and give him 1 tablet (AND ONLY 
1) every 4 hours during the day. Do not give these tablets any longer 
than 2 days. These tablets taken by mouth help to prevent infection. 
It is better for the layman not to sew a wound, but at some time 
or other it may be necessary. Sometimes in wounds of the scalp 
the best way to check the hemorrhage is to bring the edges of the 
wounds together by suture. Usually, however, a bandage or tourni- 
quet carried around the forehead just above the eyebrows, then just 
above the ears, and continued low down on the back of the head to 
the starting point and drawn tight will stop bleeding of the scalp. 
A stitch may prevent marked scarring. However, this should not 
be given much consideration by the one giving first aid, except for 
cosmetic purposes on exposed parts of the body. If necessary to su- 
ture a wound, remember that the hands, needles, all instruments, etc., 
that come in contact with the wound should be sterile. 
The stitches should pierce the skin about one-eighth inch from 
the edge of the wound, and they should be placed about one-half 
inch apart, tied, and cut off. They should not be tied too tightly, 
only sufficient barely to bring the edges together. Knots should be 
on the outside of the wound. It is better not to close the wound en- 
tirely, but to leave a little opening at its lower end, where a little 
wick of sterile gauze may be inserted for drainage. If after stitch- 
ing a wound it becomes red, swollen, and painful, or there is other 
evidence of pus forming, the stitches should be removed and the 
wound left open. Carry the needle through the entire thickness of 
the skin. Remember that occasions will be few where a layman will 
have to stitch a wound. 
In all wounds, put the part at rest and treat shock if present. 
To treat gunshot wounds, see instructions in first-aid packet. 
Sterilizing dressings.—An easy and convenient way is by boiling 
in plain water for about 20 minutes. If a dry dressing is desired, it 
can be sterilized by placing in a hot oven for about 20 minutes and 
removed just before scorching. Sterile dressings can be bought. The 
contents of a first-aid packet are sterile. 
Sterilizing instruments.—The scissors, forceps, knives, needles, etc., 
used in dressing wounds should be sterilized by placing them in 
tSulfanilamide can be used with sterile water or with sterile salt solution BUT MUST 
NOT BE USED with azochloramid, Iodine, salts of mercury or any other antiseptic sub- 
stance, in the treatment of wounds. 
** Sulfanilamide powder may be used on the spinal cord or on open wounds of the head 
even when the brain is exposed. It may also be used on nerves if exposed in the wound. FIRST AID 
17 
water that has been brought to a boiling point and boiling them for 
15 to 20 minutes. If on hand, a little soda added to the water will 
greatly assist the sterilization and protect the instruments. It is 
better to protect the blade of the knife by wrapping a little cotton 
around it before boiling. 
Remember in dressing wounds to apply the pad of sterile gauze, 
then the bandage. In large wounds, or those from which there is 
liable to be considerable oozing, it is probably better after the pad of 
sterile gauze has been applied to apply several layers of absorbent 
cotton, then the bandage. Do not put the cotton next to the wound. 
Exposure—Thirst-Starvation 
As a result of climatic heat and cold, storms, or loss of ships at sea, 
personnel are frequently found suffering from the effects of exposure, 
thirst and starvation. The condition of the patients can be extreme. 
They may show pneumonia (with or without temperature), hysteria 
or coma, bleeding and ulceration of the skin, great loss of flesh, feeble 
pulse and respiration, and exhaustion. Some cases will have un- 
treated and infected injuries—some of long duration. 
Those suffering the extreme effects could be expected to be found 
among people rescued at sea. 
Treatment.—Careful handling of the patient, absolute rest, control 
of hemorrhage and shock, dressing of wounds, reduction and splinting 
of fractures, application of heat, stimulation of circulation by gentle 
massage and administration of hot, nutritious liquids, in frequent 
though very small amounts at first and very gradually increased. 
Cases mildly exposed to wet and cold.—Remove wet clothing, mas- 
sage body with towel, give hot, stimulating drinks (black coffee and 
whiskey), rest, and observe in a warm protected place for several 
hours. 
Bites From Animals 
Animal bites may transmit rabies through the saliva if the animal 
has the disease. Most warm-blooded animals are susceptible to rabies 
but responsibility for its presence and propagation rests mainly upon 
the dog. Bites on the head, neck, and upper extremities, being nearer 
the brain, are the most dangerous. 
It is a common error to assume that a dog with fits is mad or 
rabid. As a matter of fact, fits resulting from worms, from acute 
indigestion, and from exposure to excessive heat are common in 
dogs. On the other hand, the so-called “dumb rabies” occurs with- 
out fits and is common. In “dumb rabies” there is usually increased 
affection, as if imploring help; the animal cannot close its mouth, 
the tongue protrudes, and saliva flows in excess. It is this condi- 
tion which leads many sympathetic people to imagine the dog has 18 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
a bone in its throat and to try to remove it. In doing so, their hands 
become covered with infectious saliva. While no one but a skilled 
veterinarian is competent to judge from the symptoms that an 
animal has rabies, any unexplained change in behavior followed 
by excitability or paralysis should be looked upon as due to this 
disease. Until proved to the contrary, any biting animal should 
be suspected as being rabid and any unidentified animal should be 
regarded as rabid. 
When a person is bitten by an animal suspected of being mad, it is 
not only important to treat the patient, but to take steps to ascertain 
positively whether the bite was dangerous or not, as a long time 
may elapse before any symptoms develop and this period might be 
fraught with needless and terrible anxiety for the patient. Keep the 
animal under observation to see whether or not it shows signs of 
madness. If it dies, decapitate the animal, pack the head in ice, 
and send it to some laboratory for examination. Unless to pro- 
tect others, it should never be killed. If the animal appears nor- 
mal and remains so for a period of from 10 to 14 days, the possibility 
of infection may be dismissed. In the meantime the person bitten 
should be transferred to the nearest naval or civilian hospital ac- 
companied by a complete report of the circumstances involved in 
the injury. 
Wounds inflicted by an animal suspected of being rabid or of 
having rabies are to be treated in the following manner: The wound 
should be enlarged with a knife, if necessary, and encouraged to 
bleed by milking the part, or by applying a tourniquet lightly above 
it for a short time. It should be mechanically cleansed with soap and 
water and painted with tincture of iodine. A red-hot needle may be 
used to cauterize the wound. Do not use silver nitrate or phenol for 
cauterizing these wounds as they coagulate the albumin in the 
tissues thereby producing the conditions necessary for infective or- 
ganisms and retarding their destruction. The wound should then 
be dressed with an antiseptic dressing. The Pasteur treatment must 
be given if there is any question of rabies. 
Bites From Insects 
Poisoned wounds due to causes other than bites of poisonous snakes 
include ordinary insect bites', such as those produced by mosquitoes, 
fleas, ants, and bees. These bites require but little treatment. As 
the poison of insects is composed chiefly of an acid, the local applica- 
tion of some alkali should be employed; either ammonia water or a 
solution of washing soda affords great relief. Bites' of the more 
poisonous spiders, centipedes, tarantulas, and scorpions require 
prompt treatment. (See under Snake Bites.) FIRST AID 
19 
Tie a ligature or tourniquet about the injured part between the 
wound and the heart to prevent the absorption of the venom into 
the general circulation; enlarge the bite by making an incision at 
its site, suck out the wound to produce bleeding, and apply tincture of 
iodine. If there be abrasions or open lesions in the mouth it is not 
advisable to suck the wound. Meanwhile, give stimulants such as 
coffee or tea and get the person to a doctor as soon as possible. The 
tourniquet should be loosened about every half hour to allow restora- 
tion of the circulation, but should be tightened up immediately if 
symptoms of general poisoning occur. Apply a dressing to the wound 
and treat shock which sometimes occurs in these cases. There are anfi- 
venin serums available for the treatment of poisoning by snake bite. 
They are injected hypodermically or intravenously and are very effec- 
tive if properly used. 
Bites From Poisonous Snakes 
HEMORRHAGE 
The heart may be considered as a pump, which by its beats' forces 
the blood to all parts of the body through a series of tubes. The 
arteries carry the blood from the heart; the veins return the blood 
to the heart. The capillaries are a network of smaller vessels sit- 
uated between and connecting the arteries and veins. 
Remember that in the character of wounds that ordinarily will be 
encountered death from bleeding is1 very rare. Bleeding is dangerous 
when a large artery is injured. In the majority of cases of bleeding 
all that will be necessary to do is to put a gauze compress over 
the wound and hold it in place by a firm, snug bandage; put the 
injured part at rest; if arm or leg, elevate; keep the patient quiet 
and give plenty of fresh air. 
If, however, bleeding is profuse and life seems endangered, it may 
be necessary to apply some kind of tourniquet. Arterial bleeding is 
most dangerous and is recognized by the fact that the blood is bright 
red in color and is expelled in jets. 
In venous bleeding the blood is dark and flows in a constant stream. 
Capillary bleeding occurs as a general oozing and is of a brick 
color. 
Tourniquets may be improvised, as a clean handkerchief bandage, 
soft-rubber tubing, or other similar material, encircling the limb, 
and tied sufficiently tight to stop the flow of blood. 
Tourniquets in the hands of laymen are extremely dangerous and 
should not be used unless absolutely necessary, which is rare. When 
used, the part should be carefully watched, and if signs of extreme 
swelling or bluish color of the skin appear the tourniquet should be 
loosened. A tourniquet should not be left on at one time more than 20 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
one-half hour. It should then be loosened and, if necessary, re- 
tightened. The arms and legs are the only parts to which tourni- 
quets should be applied. 
Arterial hemorrhage.—Apply the tourniquet between the heart and 
the wound; generally speaking, above the wound. Place a compress 
over the wound and hold by snug bandage. Put part and patient at 
rest. 
Venous hemorrhage.—Apply tourniquet on far side of wound from 
heart; generally speaking, below the wound. Then treat as for ar- 
terial hemorrhage. 
Capillary oozing.—Pressure by compress and bandage applied over 
the wound is all that is usually necessary. 
Bleeding can often be stopped by pressure from the thumb, or 
anything else suitable, over the injured artery or vein. The pressure 
should not be made in the wound. 
It is often difficult to determine whether the blood is from an 
artery or vein. In such a case, if a tourniquet is necessary, apply it 
above the wound; and if injury is in arm or leg, apply the compress 
over the wound, hold it with a snug bandage, and put part at rest, 
elevated. Remember that tourniquets, as a rule, are condemned and 
should not be used by the layman unless necessary. 
The main arteries in the body which play a part in external hem- 
orrhage are four, namely the carotid, which supplies the head; the 
subclavian, supplying the middle of the shoulder; the brachial, run- 
ning along the inner side of the arm and supplying the arm, fore- 
arm, and hand; and the femoral, running along the inner side of the 
thigh and supplying the thigh, leg, and foot. The pulsations in these 
arteries should be studied, as pressure at the correct spot on them 
will often check external hemorrhage in the extremities, neck, or head. 
Internal hemorrhage.—Caused by wounds usually of abdomen or 
chest. No external evidence of bleeding. Symptoms are those of 
shock and possibly vomiting of blood, rigid abdomen. Treatment: 
Rest in bed; ice bag or cloth to chest or abdomen. Do not give 
stimulants unless patient becomes very weak. Contact a doctor 
immediately. 
Nose bleeding.—Place patient in chair with head thrown back. 
Apply cold cloths to back of neck. Place a small wad of paper well 
up between the upper lip and gum. Finely crushed ice on gauze or 
thin cloth applied to bridge of nose is often effective. If it still 
persists, small strips of gauze with ends hanging out may be pushed 
up the nostrils. Keep patient quiet and instruct him to breathe 
through the mouth. He should be cautioned not to pick off or blow 
out the clots as they form in the nostrils. FIRST AID 
21 
BURNS 
Burns result from exposure of the body to dry heat, while scalds 
follow exposure to moist heat, as hot water, steam, etc. These are 
very serious accidents, attended, at times, with marked shock, and 
their danger to life depends more upon the extent of the body involved 
than the degree. 
For convenience burns are classed in three degrees, as follows: 
First degree.—Reddening of the skin. 
Second degree.—Reddening of the skin with formation of blisters. 
Third degree.—Charring and destruction of the deeper tissues. 
There is usually considerable pain with burns and, if burn is ex- 
tensive, marked shock. 
Treatment.—In other than minor burns, the bowels must be kept 
open, plenty of water given by mouth and also at times by rectum, so 
that the kidneys will continue to act. The greater the area burned 
the more necessary is this treatment. Air must be excluded from the 
burned part which may be done by means of tannic acid jelly dress- 
ings, or by a paste made with water and baking soda, starch, or 
flour. If the burn has been caused by a caustic such as an acid or 
an alkali, the acid should be neutralized with bicarbonate of soda 
(ordinary baking soda), and the alkali by a weak solution of acetic 
acid (ordinary vinegar) before the burned area is covered. When- 
ever possible burns should first be treated by the tannic acid jelly. 
If a person is extensively burned, the quickest temporary means of 
excluding air is to immerse the part or the entire body in lukewarm 
water, then, having everything in readiness, carefully cut away the 
clothing, leaving such as may be sticking to the burned skin. The 
application of tannic acid jelly dressings should then follow and the 
patient put to bed. In case the supply of tannic acid jelly is inad- 
equate, a satisfactory tannic acid solution can be made by pouring 
one quart of boiling water over 2y2 ounces of tea leaves. Allow to 
steep for at least 15 minutes, then strain. This solution can be ap- 
plied to the burned area by means of an atomizer or sterile cotton 
applicators. Several coats of the tannic acid solution are applied 
while an assistant fans the areas to promote the tanning process. 
The tannic acid unites with and “tans” the tissues in the raw areas. 
When “tanning” is complete, the burned areas have become dark 
brown in color, and when they have dried they are covered with a 
hard, leathery crust of a dark brown or black color. Unless infection 
occurs beneath it, the crust should not be disturbed until it begins to 
curl up at the edges and to peel off of its own accord, when the loos- 
ened parts may be cut away with sterile scissors. 
The effectiveness of this method of treating bums is seriously in- 
terfered with if oils, ointments, or other greasy substances have pre- 22 
MEiDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
viously been applied to the burned areas. Any oil, ointment, or 
grease that is present must be gently but thoroughly removed witli 
a sterile swab and the area sponged with a weak solution of sodium 
bicarbonate before the tannic acid treatment is begun, even though 
it may cause considerable suffering. 
If tannic acid is not available an excellent dressing is a solution 
of ordinary baking soda (2 tablespoonfuls in a pint of boiled water). 
A salt-solution dressing is also good (a teaspoonful of common salt 
to a pint of boiled water). Do not use strong antiseptics on bums. 
Soaking the part in lukewarm water is itself good and is very often 
useful to soak off clothing sticking to a burned surface. If blisters 
have formed and are painful, they may be opened by passing a sterile 
needle through them and allowing the fluid to escape. Do not de- 
stroy the skin raised by a blister. The needle used may be sterilized 
by burning in a flame. Do not put cotton next to a burn; it sticks 
and causes trouble. In dressing burns take a pad of sterile gauze, 
soak in the solution, apply to part, and hold in place by bandage. In 
removing the dressings it is often necessary to soak them off, and 
warm water or one of the solutions mentioned may be used for this 
purpose. 
The burned part should be put at rest and if there is much pain 
phenobarbital and aspirin tablets may be given. There is liable to 
be considerable shock so don’t forget to treat it. A person badly 
burned should be seen by a doctor as soon as possible. 
EFFECTS OF COLD 
Freezing.—If expecting to be exposed to the cold for a long time, 
endeavor to prevent any ill effects therefrom, but if freezing does 
occur there is marked depression and cautious treatment is necessary. 
Wind velocity and moisture are factors which predispose to frost-bite. 
Wet clothing, shoes and socks favor chilling by conduction of heat 
away from the body. 
Treatment.—The object is to restore gradually the body warmth. 
The patient should at first be in a moderately cold room, and with 
woolen cloths soaked in cold water or snow, the limbs should be 
gently and systematically rubbed toward the body. When the cir- 
culation becomes active, the cloths should be soaked in warmer and 
warmer water. When patient can swallow, give stimulants, such as 
hot coffee or tea, whisky, brandy, or aromatic spirits of ammonia. 
The patient should not be brought into a warm room, placed before 
an open fire, etc., until the circulation of the blood has been reestab- 
lished and is active, as evidenced by increased force of the pulse, 
increased warmth, and color to the skin. FIRST AID 
23 
Frostbite.—Parts most involved are those where circulation is slug- 
gish, as ears, nose, tips of fingers and toes, etc. 
Treatment.—Gradually restore normal temperature. Soak part in 
cold or ice water. Apply with woolen cloth soaked in cold water, 
ice water, or snow. Gradually increase warmth of water as circula- 
tion becomes reestablished and active in part, as evidenced by more 
warmth to skin and better color. If the frostbite is an old one and 
the skin has turned black or commenced to scale off, it is dangerous to 
attempt to restore the vitality by friction; just apply a little cotton 
and hold in place by a bandage; apply heat externally. 
A condition caused by overstretching the muscles. The muscles of 
the back and shoulders are the ones most often involved. 
Symptoms.—Pain, stiffness, lameness, and sometimes swelling. 
Treatment.—Rest, hot applications, gentle massage with liniment. 
STRAINS 
SPRAINS 
A condition caused by a momentary dislocation of a joint with 
tearing or stretching of the ligaments and capsule about the joint. 
At times it is hard to distinguish from a fracture and should be 
cautiously handled. It often takes a long time for complete recovery. 
The joints most often involved are the ankle, knee, wrist, elbow, 
and shoulder. 
Symptoms.—Pain, redness, swelling, loss of function, and often 
shock. 
Treatment.—Soak the joint in water either as hot as patient can 
stand or as cold as it can be made; tepid water is valueless. If it is 
a joint of the lower extremity, put patient to bed and elevate the 
limb on a pillow or other support and apply hot or cold compress 
until pain has subsided. 
If joint is bandaged, do this loosely, because there is liable to be 
considerable swelling, which may cause damage. When pain and 
swelling have subsided, gently massage the joint. Let patient get 
about gradually on crutches. If sprain is in upper extremity, the 
treatment is the same, except the patient need not stay in bed. The 
joint is put at rest and supported either by a sling or splint. If 
shock is present, it should be treated. 
DISLOCATIONS 
These are injuries to joints; the head of a bone has slipped out 
of its socket. 
Causes.—(1) From a blow or fall; (2) muscular action. 
Symptoms.—Shock, pain, swelling, loss of function, limited motion, 
and the head of the bone may be seen out of its usual place. The limb 24 
MEiDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
may seem lengthened or shortened, according to the way in which 
the dislocation has taken place. 
Treatment.—The proper treatment is reduction and retention by 
some means of immobilization. It is better for a layman not to at- 
tempt reduction except, perhaps, in dislocations of the fingers and 
the lower jaw. By unskilled attempts at reduction a layman may 
cause considerable damage to the nerves, vessels, and soft parts. 
Put the part in the position most comfortable to the patient. The 
joint should be surrounded with cotton and a bandage applied, not 
too tight, and then supported. The patient should be kept as quiet 
as possible. If the joint involved is the shoulder, elbow, hip, knee, 
or ankle, the patient should be kept in bed. If the joint is painful 
and greatly swollen, hot or cold applications may be applied. A 
sling makes a good support to the shoulder, elbow, and wrist joints. 
If shock is present, treat it. Have patient see a doctor as soon as 
possible. 
FRACTURE (BROKEN BONE) 
Causes.—(1) Direct violence, (2) indirect violence, (3) muscular 
action. 
Symptoms.—(1) History of injury, (2) pain, (3) swelling, (4) loss 
of function of parts, (5) usually shortening, (6) excessive mobility 
(movement) where there should be none, (7) crepitus or grating of 
the ends of bone, (8) deformity. 
Varieties.— 
Simple fracture, where the skin is intact and there is no external 
wound. 
Compound fracture, where the skin is broken and the external 
wound communicates with the fractured bone. 
Complete fracture, where the break extends through the entire bone. 
Incomplete fracture, where the break is not entirely through the 
bone. 
Treatment.—The thing to do is to set the bone and hold it in place 
by means of splints. A broken limb should be handled as gently as 
possible. It is usually best not to move the patient, especially if the 
break is in a lower extremity, until a splint has been applied. In 
handling a fracture the limb should be grasped above and below the 
site of fracture. 
To treat a fracture of the arm or leg, grasp the limb above and 
below the site of break, make gentle extension and counterextension 
(pulling in one direction on one fragment and pulling in the opposite 
direction on the other) in the line of the body, and while held in 
that position by an assistant, splints should be applied. Observe the 
precautions mentioned under the heading of “Splints.” After appli- 
cation of splints the limb should be supported and elevated over pil- FIRST AID 
25 
lows, clothes, sheets, etc. After application do not remove splint 
unless it becomes loose or shows evidence of being too tight, etc. Have 
the patient see a doctor as soon as possible. 
Compound fracture.—This is the most serious of all fractures in 
that the broken bone has been exposed to the air and infection. Clean 
carefully around the broken skin using the method described on page 
15, and follow the same procedure in dusting on sulfanilamide powder 
and the taking of sulfadiazine by mouth. Reduce the method de- 
scribed in the previous paragraph. Dress the wound, then apply the 
splint. The splint should be so arranged that the wound can be dressed 
if necessary. In all fractures you may have to treat shock. Remem- 
ber the one great thing in treating fractures is to keep the bone at rest, 
so do not move the limb or let the patient move it without reason. This 
fracture is very serious and the patient must immediately be taken to a 
doctor. 
SPECIAL FRACTURES 
Fracture of skull.—These are very serious injuries. Apply sterile 
dressing to wound. Place patient in lying position with head slightly 
elevated. Shock may have to be treated, but do not give stimulants 
unless patient is very weak. 
Whenever a man is unconscious from overindulgence in alcohol, 
it is well to bear in mind the possibility of fractured skull and brain 
injury also. This is especially true where there is any mark of a 
blow or cut, however slight, on the head. With such a complication 
the gentlest treatment is necessary. 
Fractivre of nose.—Treatment: Put bones in natural position. Put 
small compress of gauze on each side of nose, then a piece of adhesive 
plaster across nose from cheek to cheek. If adhesive plaster is not 
at hand, put bandage across nose and around head. Do not tie too 
tightly. 
Fractured hack.—Keep patient still and quiet on his back. Treat 
shock. 
Fractured lower jaw.—Treatment : Raise the broken bone and bring 
lower teeth against upper and hold there by a bandage carried under 
the chin, tied over the head and maintained in position by pinning to 
another bandage running horizontally around forehead and back of 
head. The mouth should be kept clean by a little warm water, plain, 
or to which a little soda or salt is added if on hand. The patient will 
have to subsist for a while on liquid food through a tube. 
Fractured collar hone.—Apply a pad of gauze in the armpit of the 
injured side. Support the arm in a sling with the forearm at right 
angles to the arm and across the chest. 
Fracture of rib.—Keep patient quiet in bed. With arms over head 
and chest emptied of air, apply snugly a wide roller bandage or 26 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
adhesive straps around chest. To apply adhesive straps first tear 
off strips of adhesive plaster 2 or 2y2 inches wide and long enough 
to reach around the injured side from the far side of the spine behind 
to just beyond the midline of the chest in front. Apply the first 
strip well below the fracture and gradually work up to above the 
fracture. Each strip should be applied with firmness, at the end 
of a forced exhalation, from behind to front, and should overlap 
one-third of the one below. 
Fracture of the upper arm.—Straighten so as to put in natural 
position. Secure two splints (flat wood shingle, cardboard, etc.), one 
to extend from shoulder to elbow, the other from armpit to elbow. 
Pad well with cotton, apply one to inner and one to outer side of 
arm, secure by bandage, and support in sling. 
Fracture of forearm.—Straighten so as to put in natural position; 
secure two splints as above to extend from a little below elbow to 
middle of hand. With forearm across chest and thumb up apply 
padded splints, one to outer and the other to inner side of forearm; 
then support in sling. 
Fractured wrist.—Treat like fractured forearm. 
Fractured finger,—Draw gently into natural position. Apply 
narrow padded splint to palm surface of finger, hold in place by 
narrow bandage, and support forearm and hand in a sling. 
Fractured hand.—Apply padded palm splint as wide as the hand 
and to extend from above the wrist to beyond tips of fingers; hold 
in place by a bandage and support forearm and hand in sling. 
Fracture of thigh.—By gentle extension and counterextension pull 
parts into natural position. While limb is held by an assistant, apply 
a well-padded outer splint to extend from armpit to below foot. 
Then apply a well-padded inner splint to extend from crotch to below 
foot. Hold splints in place bjr a snug bandage. 
If nothing else is at hand, the injured leg may be splinted by band- 
aging it to the other leg. 
Fracture of lower leg.—An excellent splint can be made by placing 
the leg on an ordinary pillow and tying the pillow around it; fasten- 
ings above and below should be well away from point of fracture. 
Wooden splints may be applied on the outside of the pillow, extend- 
ing from above the knee to below the ankle. The wooden splints 
well padded, may be applied without the pillow. 
Fractured kneecap.—Straighten leg. Pad well a wooden splint as 
wide as the thigh and long enough to extend from middle of thigh 
to middle of lower leg. Apply splint to back of thigh and leg, 
with center opposite bend of the knee. Secure by strips of bandage. 
Do not bandage directly over break, but apply one strip above and 
one below knee. FIRST AID 
27 
Fractured foot.—Apply a well-padded splint as wide as foot from 
heel to toes. Elevate and support. 
RUPTURE (HERNIA) 
As encountered by the layman this is usually a swelling in the 
groin. Rupture makes its appearance suddenly after exertion and 
is evidenced by pain and swelling. 
Treatment: Let patient take a hot bath and go to bed, lying on his 
back with thighs bent. By so doing, the rupture will often reduce 
itself. Keep patient in bed for several days and do not let him move 
until he has seen a doctor. 
If the rupture does not reduce itself it may be damaged by rough 
or unskilled handling. The patient should see a doctor as soon as 
possible, as the condition, if unrelieved, may cause gangrene of the 
bowel and death. 
BANDAGING 
Those bandages most frequently used are the— 
1. Roller bandage. 
2. Triangular bandage. 
3. Many-tailed bandage. 
Bandages are used (1) to hold dressings in place, (2) to hold 
splints in place, (3) to check hemorrhage, (4) as slings. 
Materials most commonly used for bandages are (1) gauze, (2) 
muslin, (3) flannel, (4) plaster. The gauze and muslin bandages 
are the two that the layman will be called upon to use, generally 
gauze. Good bandaging comes by practice, and all that will be 
expected of the layman is the application of the bandage so it will 
accomplish its object, be comfortable to the patient, and do no dam- 
age. Bandage uniformly, firmly, but not tightly. In bandaging an 
arm or leg commence from below and bandage up. Leave the tips 
of fingers and toes unbandaged, so the effect of the bandage on the 
circulation can be watched. In bandaging a part that is liable to 
swell, bandage loosely, so if the part should swell the bandage will 
not be too tight and constrict. Do not apply a bandage when wet, 
because when it dries it will shrink. In bandaging apply the band- 
age to the part in the position in which the latter is to be carried 
during treatment. A bandage should not be put on under a splint, 
but always over it. A dressing may be applied under a splint, as it 
is not to be changed until the temporary splint is removed. The 
triangular bandage is probably the easiest for general application by 
the person giving first-aid, but as the roller bandage is supplied, it is 
the one that probably will be most used. The triangular bandage is 
usually made from unbleached cotton cloth, though any strong cloth 
will do, such as bed sheets, pillow covers, napkins, handkerchiefs, etc. 28 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
A triangular bandage is extremely useful because of its simplicity. 
It can be used as a tourniquet, as a sling for arm or forearm, and to 
retain a dressing. The blue-jacket’s black-silk neckerchief furnishes 
a good triangular bandage, or one can be made by cutting in two, 
diagonally, a square of muslin or sheeting about 36 inches on each 
side. 
To use the triangular bandage as a sling or tourniquet, bring the 
apex or point of the triangle over to the base and then fold the whole 
again on itself. If the ends are now knotted at the back of the neck, 
the hand or forearm can be passed through and supported by the loop 
thus made. Or fold the triangular bandage with its base up and 
down (vertically) along the front of the body from collar bone to 
thigh, with the apex or point of the triangle pointing to the injured 
side. Bring the forearm to be supported across the bandage. Next 
bring up the lower end of the base in front of the injured forearm 
and knot the two ends of the base behind the neck. The apex is then 
folded inward across the arm above the elbow and pinned to the 
front and back portions of the sling. 
To hold a dressing in place on hand or foot, or to protect them, 
proceed as follows: Fold the base over on itself a couple of inches. 
Lay this folded base of the triangle under the wrist or under the 
sole of the foot a few inches back of the heel. Bring the point or 
apex up over the fingers to the wrist or over the toes to the instep 
and ankle. Next, wrap the long ends of the base round and round 
the wrist or ankle and tie them. The point or apex caught by the 
circular turns is then folded back over the knot and pinned. The 
same principle can be used on almost any part of the body. For 
example, to cover over the scalp, lay the apex or point on the center 
of the forehead, extending down on the nose, while the base lies on 
the back of the head and neck. Bring the ends of the base forward 
and upward just above the ears and tie them low down over the cen- 
ter of the forehead. The apex or tip is then folded back over the 
knot and secured with a safety pin. 
Roller bandages.—These are furnished already prepared, but in an 
emergency where none are at hand they can be improvised from 
sheets, pillow covers, muslin, flannel, etc. Those that are furnished 
come in different widths and lengths. The size to be used depends 
upon the part to be bandaged. 
For the fingers and toes the one about 1 inch wide should be used. 
For the arm and head use one about 2 inches wide. 
For the leg and thigh use one about 3 inches wide. 
For the chest and abdomen use one about 4 inches wide. 
For general use the most serviceable bandage is about 2 inches 
wide and about 4 yards long. 
The roller bandage is applied by holding the roller in the right FIRST AID 
29 
hand and the free loose end in the left, and the outer side of the 
bandage is applied on the place where it is desired to start the 
bandage. In securing the bandage the free end is turned back and 
pinned, preferably with a safety pin, or the end may be ripped up 
the middle a sufficient distance, then a knot tied to prevent further 
ripping, and the ends carried around the limb in opposite directions 
and tied. 
SPLINTS 
After considering fractures it is necessary to state something about 
splints, the correct application of which is so essential in the treat- 
ment of fractures. 
A splint is a more or less stiff support that will immobilize a frac- 
tured bone or a joint. It can be made from pieces of wood, broom 
handles, cardboard, wire netting, rolls made of blankets, pillows, 
rifles, swords, bayonets, etc. The material should be rigid enough 
to keep the parts in position. The splints should be long enough to 
prevent movements in the nearest joints and as wide or wider than 
the limb to which applied, so that the bandages which hold them in 
place will not press on the limb. They should be well padded with 
cotton or other soft material, as wool, oakum, flannel, etc., before 
being applied. The padding should extend well over the side of the 
splint. After a splint has been well padded and applied to the limb 
it is held in place by a snug bandage. The bandage should not be 
applied too tight, and if pain and swelling occur it should be loosened. 
Unconsciousness 
The common causes for unconsciousness are asphyxiation, bleeding, 
shock, electric shock, heat exhaustion, freezing, sunstroke, epilepsy 
or fits, apoplexy and injury to the brain, alcoholism and certain other 
poisons, hysteria and uremia (deficient secretion of urine). In all 
cases of unconsciousness strenuous efforts should be made to bring 
the patient under the care of a medical officer as soon as possible. 
If the person is unconscious and the cause is unknown, let him 
rest flat on his back. If he is pale and the surface of his body 
is cold, apply heat to the body and hold smelling salts or a little 
ammonia under his nose. If the surface of the body is very hot, 
cold water and ice bag should be applied to the head. 
Patients who have been rendered unconscious because of injuries 
should, in general, be treated for shock and kept as quiet as possible 
until medical aid can be obtained. 
FAINTING 
This results from diminution of blood in the brain, due to many 
causes. The person gets paler and paler, there is a sinking feeling, 
and he falls unconscious. This often can be prevented by placing 
457944°—42 3 30 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
the patient in a chair with his head forward between his legs, lower 
than his hips. But after its occurrence, the patient should be laid 
flat on his back with head low; loosen clothes and give plenty of 
fresh air; a little ammonia held under the nose will often revive him. 
After recovery, give whisky or aromatic spirit of ammonia. 
The patient usually utters a cry, falls suddenly unconscious, has 
convulsions, foams at the mouth, and bites his tongue. After con- 
vulsions cease, he passes into a deep sleep and remains in that state 
for several hours. 
During the convulsions, the only thing to do is to try to prevent 
him from hurting himself. Something suitable (a piece of wood or 
cork covered with a handkerchief) should be put between his back 
teeth to keep his mouth open so he cannot bite his tongue, taking care 
that it does not fall down his throat. When consciousness has com- 
pletely returned, a cathartic may be given, because in those subject 
to epilepsy clogging up of the bowels often brings on an attack. 
If some time must elapse before medical aid can be obtained or the 
epileptic discharged, give one tablet of phenobarbital (iy2 grains) 
three times a day. The tablet should be crushed or chewed and taken 
with a half tumbler of water. A man known to have fits should not 
be retained aboard ship. He is unfit for the service and may injure 
himself seriously by falling down a hatchway or into the machinery, 
etc. 
EPILEPTIC FITS 
Resuscitation 
RESUSCITATION OF THE APPARENTLY DROWNED 
The indications in treating one apparently drowned are to remove 
the water from the upper air passages, to make the patient breathe, 
and to stimulate the weak heart. Every minute and second counts, 
so waste no time. Have bystanders move away to give the victim 
all the air possible. Loosen clothing about neck, chest, and abdomen. 
Gently swab out the mouth and throat to remove mud, mucus, or 
other material. Turn the patient over, face downward, place the 
hands under the abdomen, one on either side, and lift the patient, in 
an endeavor to drain the lungs and stomach, then with a large roll of 
clothing under the abdomen, and by making firm pressure upon the 
loins, continue the efforts to expel the water from the lungs and 
stomach. If the individual then does not breathe, proceed immedi- 
ately with artificial respiration. It is well at the same time to try 
to stimulate respiration by having an assistant hold ammonia or 
smelling salts to the nostrils. 
Artificial Respiration.—JSTo reliance should be placed upon any 
special mechanical apparatus, as it is frequently out of order and Figure 1 
Figure 2 
Figure 3. FIRST AID 
31 
often is not available when most needed. The patient’s mouth should 
be cleared of any obstruction such as chewing gum or tobacco, false 
teeth, or mucus so that there is no interference with the entrance and 
escape of air. To KEEP THE PATIENT WARM DURING ARTIFI- 
CIAL RESPIRATION IS MOST IMPORTANT AND IT MAY BE NEC- 
ESSARY TO COVER HIM WITH BLANKETS AND WORK THROUGH 
THEM, AS WELL AS TO APPLY HOT-WATER BOTTLES, HOT BRICKS, 
ETC. 
There are several accepted methods of applying artificial respira- 
tion but the best and probably the least dangerous is the prone pres- 
sure or Schaefer's method, which is as follows: 
Position 
1. Lay the patient on his belly, one arm extended directly overhead, 
the other arm bent at elbow and with the face turned outward and 
resting on hand or forearm, so that the nose and mouth are free for 
breathing. (See Inset fig. 1.) 
2. Kneel straddling the patient’s thighs with your knees placed 
at such a distance from the hip bones as will allow you to assume 
the position shown in Figure 1. 
Place the palms of the hands on the small of the back with fingers 
resting on the ribs, the little finger just touching the lowest rib, with 
the thumb and fingers in a natural position, and the tips of the 
fingers just out of sight. (See fig. 1.) 
First Movement 
3. With the arms held straight, swing forward slowly, so that 
the weight of your body is gradually brought to bear upon the 
patient. The shoulder should be directly over the heel of the hand 
at the end of the forward swing. (See fig. 2.) Do not bend your 
elbows. This operation should take about two seconds. 
Second Movement 
4. Now immediately swing backward, so as to remove the pressure 
completely. (See fig. 3.) 
5. After two seconds, swing forward again. Thus repeat deliber- 
ately twelve to fifteen times a minute the double movement of com- 
pression and release, a complete respiration in four or five seconds. 
Continued artificial respiration without interruption until natural 
breathing is restored. Do not get discouraged at the slow results 
that sometimes happen when resuscitating the apparently drowned. 
Efforts often have to be continued a long time before signs of life 
are apparrent. Do not discontinue the efforts until certain that all 32 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
chance is lost. Sometimes, even after several hours’ work, recovery 
takes place. 
Do not give any liquids whatever by mouth until the patient is 
fully conscious. 
To avoid strain on the heart when the patient revives, he should 
be kept lying down and not allowed to stand or sit up. Give some 
stimulant, such as one teaspoonful of aromatic spirits of ammonia 
in a small glass of water or a hot drink of coffee or tea, etc. Con- 
tinue to keep the patient warm and at rest. 
As a general rule he should not be moved until he is breathing 
normally of his own volition and then moved only in a lying posi- 
tion. Should it be necessary, due to extreme weather conditions, 
etc., to move the patient before he is breathing normally, resuscita- 
tion should be carried on during the time that he is being moved. 
A brief return of natural respiration is not a certain indication 
for stopping the resuscitation. Not infrequently the patient, after a 
temporary recovery of respiration, stops breathing again. The pa- 
tient must be watched, and if natural breathing stops, artificial 
respiration should be resumed at once. 
In carrying out resuscitation it may be necessary to change the 
operator. This change must be made without losing the rhythm of 
respiration. The relief operator should kneel behind the one giving 
the artificial respiration and at the end of the movement, the oper- 
ator crawls forward while the relief takes his place. By this pro- 
cedure no confusion results at the time of change of operator, and 
a regular rhythm is kept up. 
Alternate Method 
In cases of injuries of the back, such as burns, lacerations and 
blisters of the skin, which would interfere with the Schaefer method 
of resuscitation, as an alternative the Sylvester method can be 
employed. 
Sylvester method.—(Note that the mouth and throat are clear of 
foreign objects and tongue is pulled well forward.) 
1. Place patient on back, with head turned slightly to one side. 
2. Kneeling in back of head, grasp wrists (or forearms if wrists 
are injured) and pull arms back, fully extended. 
3. Bending trunk forward from hips, return arms to chest, placing 
hands of patient on both sides of chest on top of the lowest ribs, and 
apply sufficient pressure with arms and trunk to expel air from lungs. 
4. Ke-extend arms to back of head; return arms to chest position 
and apply pressure alternately, 14 to 16 times per minute. Other- 
wise follow the details of resuscitation previously explained. FIRST AID 
33 
In order to prevent drowning, every person should learn the art 
of swimming and how to keep afloat for a sufficient length of time 
to allow assistance to effect rescue. In rescuing a drowning person, 
the rescuer himself should be a fairly strong swimmer and have a 
knowledge of the different conditions that he will have to encounter. 
If possible, he should remove most of his clothes, especially the shoes. 
He should reassure the drowning man that help is at hand and ap- 
proach him from the rear. To prevent being seized himself, the 
rescuer should dive, seize the drowning man by both hips, then by 
both sides of the chest, by both shoulders and finally as he emerges 
place one arm around his neck with the bend of the elbow in front 
of his throat. With the man held firmly on his side the rescuer 
swims for the shore or until a boat or other assistance comes to him. 
If the drowning person struggles, it may be necessary to render him 
unconscious by a blow in the face before he can be handled. 
Artificial respiration may also be required for persons asphyxiated 
by gases, fumes, or noxious vapors, and anesthetics, electric shock, 
shock or collapse, freezing or exposure to extremes of heat or cold, 
cases of poisoning, etc. In other words, in all cases in which breath- 
ing is temporarily suspended, artificial respiration is indicated. 
RESUSCITATION FROM GAS FUMES 
In treating this condition the patient needs plenty of fresh air. 
Artificial respiration as described under drowning should be started 
at once. Stimulants and rubbing are helpful. Oxygen, if available, 
should be administered with a face mask or from a rubber tube held 
in front of the nose. (See also p. 37.) 
A person accidentally shocked by electricity is not necessarily 
killed. Pie may be only stunned or the breathing be stopped momen- 
tarily. The following instructions should be followed: 
1. Break the circuit immediately. 
2. Separate the victim from the live conductor by quick motion, 
using some nonconductor, as dry rope, dry coat, or dry board. The 
victim’s clothes, if dry, may be used to pull him from the live wire 
Use nothing wet or metallic. 
3. Beware of touching the heels or soles of his shoes. 
4. Do not touch his body with the hands unless they are covered 
wdth rubber gloves, mackintosh, dry clothing, or other nonconductor 
material. 
5. If necessary to cut a live wire, use an ax or hatchet with a dry 
wooden handle, or insulated pliers. 
After removing patient from wire, institute artificial respiration 
RESUSCITATION FROM ELECTRIC SHOCK 34 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
by the Schaefer method. Attend to the burns as described under 
treatment for burns. Apply warmth to body, rub skin and muscles, 
and give stimulants if patient can swallow. 
Poisons 
Prevention.— Keep all poisonous drugs and solutions locked up. 
Label all bottles with their contents and a Poison label. See that 
all bottles are properly labeled and no drug is put in them that does 
not belong there. 
In treating patients for poisoning the indications are: 
1. To neutralize the poison (give antidote). 
2. To get rid of the poison from the stomach (produce vomiting 
and preserve material for chemical examination). 
3. To prevent further absorption into the system of the poison 
that may have remained in the stomach (oils, etc., except in case of 
phosphorus poisoning). 
4. To cause elimination from the system of the poison that may 
already have been absorbed (large drafts of water, purgatives, etc.). 
5. In case of collapse, to sustain and support the body strength 
(by stimulants, external application of heat, etc.). 
Unknown poison.— Produce vomiting. This can be done by giving 
2 teaspoonfuls of mustard in a cup of warm water; can also be 
induced by 2 teaspoonfuls of common salt in a cup of warm water; 
soapsuds; encourage patient to put fingers down throat. Syrup of 
ipecac, 1 tablespoonful in cup of tepid water, is also a good emetic. 
After vomiting, give whites of raw eggs, or milk, or flour in water. 
If signs of collapse are present, give hot tea, coffee, and other stimu- 
lants. Keep the body warm and rub the extremities. 
Bichloride of mercury.— Give whites of two raw eggs. If these 
are not on hand give milk, or raw meat chopped finely in water or 
milk, or give soap and water. Then cause vomiting and later give 
strong tea, flour in water, flaxseed tea, or barley water. Keep the 
patient warm, and, if stimulants are necessary, give strong coffee. 
Cases must be treated with as much haste as a severed artery. 
Strong metallic acid (as nitric, sulfuric, hydrochloric, etc.).— 
Give no emetic. Neutralize the poison by giving alkalies, such as 
large quantities of water, milk of magnesia, or milk with borax, chalk, 
or limewater (plaster). Baking soda and soapsuds may be given to 
neutralize hydrochloric acid only. Follow with olive oil or other 
demulcent drinks as for carbolic acid. Place patient in recumbent 
position and keep body warm. Give aromatic spirit of ammonia 
and other stimulants. 
Carbolic acid (Cresol, phenol).— The treatment indicated is to 
immediately give a strong solution of Epsom salt in warm water and FIRST AID 
35 
induce vomiting by giving mustard and water, salt and water, or 
putting fingers down throat. Then give demulcent drinks such as 
milk, flour in water, egg whites, flaxseed tea, or barley water, fol- 
lowed by hot tea, strong coffee, or other stimulants. Keep body 
warm. Alcohol may be used for local burns. If breathing stops, 
apply artificial respiration. 
Alkalies (lye, etc.).— The treatment indicated is to give mild acids, 
such as vinegar, lemon or orange juice, hard cider. Whites of eggs 
may be given later, then give something soothing, such as oil, gruel, 
barley water, milk, butter, or lard. Place patient on back; apply 
heat externally; fresh air; strong coffee or other stimulants. 
Opium, laudanum, paregoric, heroin, morphine.— Give an emetic. 
The best emetic in this case is mustard and hot water. Some- 
thing irritating is needed to start vomiting, as the nerves of the 
stomach are dulled by the opium. Give strong tea or coffee, if 
patient is unable to swallow, inject into bowel. Keep patient awake 
by applying cold water to head and face, slapping him with wet 
towel, and walking him about, but do not exhaust patient by over- 
doing this. Give no wines or liquors. When respiration is slow and 
irregular, apply artificial respiration. 
Arsenic, Paris green, rough on rats.— The best antidote, if it can 
be obtained, is two teaspoonfuls of magnesia, one tablespoonful of 
tincture of iron in a cup of water; take as one dose. Give an emetic; 
the whites of raw eggs and a large amount of greasy or salty water 
may be given. Lime water, or plaster in water may be given. Later 
gruel, sweet oil, starch and water, and castor oil (1 ounce) may be 
given. 
Strychnine (nux vomica).— Give strong tea, then administer an 
emetic until free vomiting is induced. Give Epsom salt. Apply 
artificial respiration if necessary. Remove patient to a dark room, 
keep quiet, avoid sudden noises. Give phenobarbital to control 
spasms to the limit indicated under that drug. 
Trinitrotoluene (TNT) poisoning.— Because of the extensive use 
of this substance on board ships and in naval magazines ashore, 
poisoning caused by it is not uncommon. 
The poison may be removed from the skin with a solution of 
sodium hyposulfite. Remove the patient from the vicinity of the 
substance, provide absolute rest, fresh air, and simple diet. Large 
amounts of water -with large doses of sodium citrate and sodium 
bicarbonate should be given. Restrict the meat intake, give small 
doses of iron daily, and regulate the bowels. 
Gasoline, benzine, wood alcohol and naphtha poisoning.— This 
usually results from inhalation of fumes or accidental swallowing in 
siphoning, etc. Symptoms from the ingestion of gasoline resemble 
POISONS 36 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
those caused by acute alcoholism, the patient is very apt to develop 
mania and later become unconscious. 
Remove the patient to the open air, remove all gasoline, benzine, 
or naphtha-soaked clothing, apply external heat if necessary. Ad- 
minister stimulants and treat as for carbon-monoxide poisoning. 
Carbon monoxide*—Most frequently results from exposure to ex- 
haust fumes of gasoline motors particularly in confined spaces and 
after entering airtight compartments closed for some time. (See 
section on ventilation.) 
The treatment indicated is: (1) Remove the patient from atmos- 
phere containing monoxide; (2) administer oxygen as quickly as 
possible and in as pure a form as is obtainable, preferably from a 
cylinder of oxygen through an inhaler mask; (3) if breathing is 
feeble, start artificial respiration at once by prone-pressure method; 
(4) keep the patient flat, quiet, and warm; (5) afterward give 
plenty of rest. 
Chloral hydrate (“knock out” drops).— Overdose renders person 
suddenly helpless. Symptoms start with burning sensation in throat, 
nausea, vomiting and pain in stomach. Later, patient becomes cold, 
relaxed, comatose and blue. May die from paralysis of the respira- 
tory center. 
The stomach should be emptied by an emetic, patient kept warm 
and artificial respiration administered if necessary. Strong black 
coffee is valuable as a stimulant, if patient is conscious and stomach 
has been evacuated. 
Barbital (veronal), luminal, nembutal, sulphonal, etc.— The 
symptoms of poisoning are headache, mental confusion, staggering 
gait, difficult breathing, stupor and coma. There may be skin erup- 
tions and paralysis of various types. 
Vomiting should be induced. Stimulation and artificial respira- 
tion should be used according to need. 
Iodine.— Poisoning may be caused when the Tincture of Iodine is 
applied too heavily or when swallowed. The vapor is irritating to 
the eyes and respiratory system. When swallowed, the mouth and 
lips are corroded and stained and there is pain, thirst, vomiting, sup- 
pression of urine, diarrhea, and collapse. 
Administer starch in water, freely; induce vomiting, apply external 
heat and establish absolute rest. 
CHEMICAL WARFARE AGENTS 
Emergency Treatment of Cases Caused by Common Gases 
General Rules.—The sooner first-aid treatment is administered, 
the greater are the chances of early recovery. THERE MUST BE 
NO DELAY—QUICK ACTION IS PARAMOUNT. FIRST AID 
37 
Each chemical produces certain damaging effects which require 
special treatment. Certain general principles are applicable to all, 
which, if carried out as soon as possible, will give relief. These in- 
clude (a) fresh air, (b) rest, (c) warmth, (d) careful handling, and 
(e) removal and neutralization of chemical. 
The elementary phases of first aid in applying the above general 
principles are: 
1. Remove patient immediately from the gas-contaminated area to 
a pure fresh atmosphere. 
2. Remove all gas-contaminated clothing and equipment as soon 
as possible. 
3. Remove the chemical from the exposed parts of the body with 
water. It is important to keep parts of the body burned with 'phos- 
phorus particles COVERED WITH WATER if possible. An 
extremity may be immersed. A wet dressing may be used where it 
is impracticable to immerse the part of the body in water. 
Note.—2 percent copper sulphate should be applied as a wet dressing if available, 
4. Cover patient with clean blankets to keep warm. 
5. If the casual has inhaled large quantities of phosgene, chloropic- 
rin, chlorine or any other lung-irritant gas (including the “vesicant” 
gases—mustard and lewisite), KEEP PATIENT IN RECLINING 
POSITION AND DO NOT PERMIT TALKING, SMOKING, 
OR EXERTION. If patients become “blue” and respirations are 
labored and difficult, artificial respiration in fresh air should be carried 
out. If available, oxygen should be administered. A rubber tube 
from an oxygen tank may be put under a hat or cap placed over the 
face, and a small amount of gas allowed to flow from the tube, mixing 
with the air in front of the face. 
6. Transfer casualties as quickly as possible to hospital, or hospitol 
ship, where proper medical attention can be given, 
7. In cases exposed to “lacrimator” (tear) gas {chloro-acetophe- 
none and hr omob employanide) the effects will ordinarily disappear 
after exposure to fresh air. Chapter III 
SPECIAL DISEASES 
Communicable Diseases 
In this chapter will be discussed the symptoms, treatment, and 
methods for control of a number of diseases that may occur on board 
ship. 
Communicable diseases are caused by animal and plant microor- 
ganisms which are communicated by man to man or by animals or 
insects to man. A person suffering with a communicable disease is 
said to be infected with that disease and for that reason the com- 
municable diseases are often termed infectious diseases, and some- 
times as infectious fevers. 
In general, the communicable diseases are usually sudden in onset 
and may be classified as general infections which affect the body as 
a whole or as localized infections which primarily affect some par- 
ticular system of the body, such as the skin, the lungs and respiratory 
passages, or the digestive organs. 
Those diseases which affect the body as a whole are characterized 
by generalized symptoms, such as headache, fever, weakness, loss of 
appetite, chills, or a chilly sensation, and muscle aches and pains. 
Frequently these may be accompanied or followed by symptoms of a 
local nature such as sore throat, cough, or a skin rash. 
Diseases which chiefly affect some particular system of the body 
usually also cause some generalized symptoms, such as those men- 
tioned above, in addition to the localized symptoms of the infection. 
The differentiation between these two types of diseases depends upon 
whether the symptoms are predominantly general or local. In the 
course of an illness its type may change. For instance, an attack 
of influenza may localize as a pneumonia or an infected wound may 
develop into a general septicemia, commonly called blood poisoning. 
Only by careful search for symptoms and observations of these 
symptoms during the progress of the illness can the correct diagnosis 
be made and the proper treatment be given. 
The season of the year, the geographical location, and the environ- 
mental conditions are also factors to be considered in the diagnosis 
of an illness. For instance, dengue, malaria, and yellow fever are 
diseases transmitted by certain species of mosquitos. Consequently, 
39 40 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
these diseases may be found where mosquitos harboring these diseases 
are prevalent. Cholera, dysentery, and typhoid fever are associated 
with defective sewage disposal and contaminated food and water sup- 
ply. Typhus fever and plague are transmitted by fleas, lice, and 
ticks which are prevalent under conditions of crowding with poor 
bathing and washing facilities. 
When the body is invaded by the microorganisms of a disease there 
is a general disturbance of the health which is usually accompanied 
by a rise in the heat, or temperature, of the body that is known as 
fever. There are three common types of fever known as continuous, 
remittent, and intermittent. 
A continuous fever is one in which the temperature is continuously 
elevated during each 24 hours and it does not come down to normal. 
The fever accompanying pneumonia belongs to this type. 
In a remittent fever the temperature varies from high to low but 
does reach normal during each 24 hours. The highest point is usually 
reached in the evening, the lowest in the morning. Typhoid fever 
is an example of this type. 
In an intermittent fever there is a great range between the highest 
and lowest points of temperature in 24 hours. It may rise suddenly 
to 104° or 105° F. and as suddenly fall, to normal or below. A 
typical example of this type is malarial fever. 
The termination of fevers occurs in one of two ways: By crisis, 
when it drops suddenly to normal or below, never again rising to any 
considerable extent unless there is a relapse or a complication sets 
in, or by lysis, when it gradually comes down to normal. Pneu- 
monia, influenza, measles, and typhus fever are examples of diseases 
in which the fever terminates by crisis, most other fevers terminating 
by lysis. 
Body temperature is measured by means of the clinical thermom- 
eter, a small glass cylinder, the center of which is a slender hollow tube 
dilated at its lower end into an oblong or round bulb and containing 
mercury. When heat is applied to the bulb the mercury expands and 
is forced as a silvery, thread-like line to a height in the tube depend- 
ing on the amount of heat applied to the base. The front aspect 
of the glass tube is conical which, by the refraction of light, magni- 
fies or broadens the image of the mercury column so that it is easily 
seen. On the tube is a scale which, in this country, is usually marked 
in degrees and tenths of degrees Fahrenheit, and ranges from 92° 
to 110°. To read the temperature the conical edge of the tube is 
held toward the reader, the thermometer is rotated slightly in the 
fingers until the flash of the magnified metallic column is seen, and 
then held in that position while the degree on the scale at the top 
of the column is read. SPECIAL DISEASES 
41 
A special marking on the scale indicates the normal degree of 
temperature, 98.6° F., and one should be familiar with its location. 
Before taking the temperature the mercury in the thermometer 
should always be below that mark, usually at about 95° F. To get 
the mercury below the normal mark hold the upper end of the 
thermometer firmly, but not stiffly, between the thumb and the first 
and second fingers of the hand, and, with the wrist relaxed, shake the 
mercury down by quick swings repeated as long as necessary. 
Temperature taken by mouth is considered as the standard, but it 
may also be taken by rectum or in the armpit. When taken by rec- 
tum it is roughly 1° higher and in the armpit 1° lower than when 
taken by mouth. The thermometer should be left in the mouth about 
3 minutes, in the rectum for 3 to 5 minutes, and in the armpit for 5 
to 7 minutes before reading. 
In taking temperature by mouth the thermometer is placed in 
a slanting position in the mouth with the bulb under the tongue 
and the tube against the corner of the mouth, and the lips kept 
closed. 
After use clean the thermometer in cold water (hot water will 
break it), immerse it for 20 minutes in 1-20 solution of carbolic 
acid, rinse in cold water and dry. 
Before considering the communicable diseases separately it is 
necessary that certain matters pertaining to and terms employed in 
dealing with them be briefly discussed. 
A rash is a temporary eruption that appears on the surface of 
the skin. It occurs in the following communicable diseases: Measles, 
German measles, chicken pox, scarlet fever, smallpox, cerebrospinal 
fever, typhoid fever, and typhus fever. In each of these diseases, 
the character of the rash and the time of its appearance are very 
important factors in making the diagnosis. In describing a rash 
the following terms are used: 
A papule (or pimple) is a small, red, solid elevation of the skin. 
A macule is a small spot of congested skin; it is larger and flatter 
than a papule. It is not elevated above the skin. 
A vesicle is a small collection of serum under the skin; e. g., a 
water blister. 
A bulla or hleb is a large blister. 
A pustule is a small collection of pus under the skin, or an infected 
papule. 
A scab is an irregular mass of dried serum or pus, usually brown 
in color. 
A scale is a particle of dried skin that peels off. 42 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
CONTROL OF COMMUNICABLE DISEASES 
In dealing with communicable or infectious diseases certain terms 
are frequently used and a few of them will be next explained. 
Cleaning.—This term signifies the removal by scrubbing and wash - 
ing, as with hot water, soap, and washing soda, of organic matter 
on which and in which germs may find favorable conditions for 
living; also the removal, by the same means, of germs adherent to 
surfaces. 
Contact.—A “contact” is any person or animal known to have been 
sufficiently near to an infected person or animal to have been pre- 
sumably exposed to the transfer of infectious material directly or by 
articles freshly soiled with such material. 
Incubation 'period.—This is the period of time which elapses 
between the date of infection with a communicable disease and the 
appearance of the first symptoms of the disease. During this period 
the germs of the disease are growing and multiplying in the body. 
Isolation.—This is the period of time during which a patient 
suffering with a communicable disease is kept by himself and sepa- 
rated from others in order to prevent the conveyance of infectious 
material to them. 
Quarantine.—This is the time during which the freedom of move- 
ment of apparently healthy persons who have been exposed to com- 
municable diseases is restricted and they are kept under observation 
to see if they develop the disease to which they have been exposed. 
The period of quarantine is generally 2 or 3 days longer than the 
incubation period. This term is also applied to animals and plants. 
Spread of Infection 
The infection of communicable diseases is spread or transmitted 
in various ways—by actual contact, by the air (droplets of saliva or 
germ-carrying dust), food, or drink, clothing, books, utensils, in- 
sects, etc. The most infectious part of a patient may be discharges 
from the mouth, throat, nose, or ears, the urine, or the feces. 
Prevention of Spread of Infection 
1. Isolation.—As soon as a case is suspected of being infectious the 
patient should be kept away from other persons. On board ship 
any suitable place may be employed, such as a spare cabin, chain 
locker, a boat roofed over with tarpaulin, any compartment which 
can be afterwards thoroughly disinfected and where the individual 
will not come in contact with the rest of the crew. The patient 43 
SPECIAL DISEASES 
should be sent to a hospital as soon as the proper authority has 
been obtained from the quarantine officer of the port or other per- 
son authorized to land him. The person detailed to attend an in- 
fectious case must not mingle with other people. The patient must 
have his own separate utensils—cup, plate, knife, fork, spoon, etc., 
and use a commode and urinal instead of the general head. Isola- 
tion must be complete, so that there is no possible way by which 
infection can be carried to others. 
2. Disinfection.—By disinfection is meant the killing of the germs 
of the disease. This is carried out by heat, by chemicals, or by fresh 
air and sunlight. 
Disinfection by heat: Boiling in water is the best and surest method 
of disinfection, but it cannot, of course, be used for every infected 
article. For bedding and clothing a steam disinfector is used. Ha- 
bitual disinfection of the mess gear of all the crew by boiling water 
should be meticulously observed after each meal and particularly 
upon the appearance of a communicable disease. (See also chapter 
on Quarantine and Disinfection; and instructions under specific 
diseases.) 
3. Disinfesting.—By disinfesting is meant any process, such as the 
use of dry or moist heat, gaseous agents, poisoned food, trapping, 
etc,, by which insects and animals known to be capable of conveying 
or transmitting infection may be destroyed. 
4. Fumigation.—By fumigation is meant a process by which the 
destruction of insects, as mosquitoes and body lice, and of animals, 
as rats, is accomplished by the employment of gaseous agents. 
TREATMENT OF COMMUNICABLE DISEASES 
The fundamental principles of the treatment of communicable 
diseases are: 
Rest.—Should be actual rest, in a comfortable bed, placed in a 
quiet, well-ventilated compartment, and every means exercised to 
relieve the patient from anxiety and concern, and to promote sleep. 
Diet.—Should be liquid or semisolid, such as milk, raw or soft- 
boiled eggs, tapioca, cornstarch; chicken, beef, or mutton broths 
seasoned and thickened with rice. Food should not be urged, in 
the early hours or days of a disease, against the patient’s disinclina- 
tion to take food. However, when the patient has lost his aversion 
for food, it should be appreciated and the appetite catered to as 
far as may be consistently done, keeping in mind the general diet 
of liquids or semisolids as given before. Water, or such drinks as 
lemonade, limeade, orangeade, or carbonated water should be given 
frequently and offered to the patient, not waiting for his request, 44 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
because frequently there is a mild delirium, and the patient’s state 
of mind will not cause him to ask for water though he needs it in 
abundance to keep the bowels and kidneys and skin active. 
Fresh air.—Means of supplying abundant fresh air, preferably cold 
air, should be provided. If practicable, all cases of fever should be 
treated in the open air on deck, but if the weather is particularly 
cold, the patient should be kept warm, covering the bed clothing with 
a rubber blanket and all tucked well in under the mattress to prevent 
the cold air getting under the bed clothing; a hot-water bottle placed 
at the feet gives great comfort in treating the patient in the open. 
Hydrotheiupy.—Tepid sponge baths may be given once a day 
at evening to bring down a temperature if high, and to add to the 
comfort of the patient. 
Drugs.—Aspirin in 5-grain doses may be given during a fever or 
for the relief of headaches and muscular pains. 
Careful nursing is an essential in the treatment of all disease; 
and while it is not to be expected that the nursing available on board 
ships to which no member of the medical department is attached, 
will be as efficient as that which may be had from persons trained 
in the art of nursing, much may be done to aid the sick if attention 
is given to providing for their wants and promoting their comfort. 
A sick man should have a man detailed to wait on him and watch 
him. This makes rest possible for the patient. Fever patients often 
get delirious, and if not watched, may injure themselves, jump over- 
board, etc. 
Keeping the patient’s face, hands, and body clean and the nose and 
mouth clear and moistened (a little glycerine and water, to which 
may be added a little lemon juice or a small pinch of soda, is useful 
to wet the lips, tongue, and inside of cheeks) makes him feel fresher 
and renders him better able to combat the germs and toxins of disease. 
Instructions for the Person Nursing a Communicable-Disease Patient 
1. Wash your hands as soon as possible after touching the patient, his 
clothing, or bedding, also after handling the bedpan, urinal, thermometer, etc. 
2. Wash your hands carefully before eating your meals. 
3. Never use cups, plates, spoons, knives, forks, etc., which have been used 
by the patient. Keep your own utensils in a separate place so that you will 
know that you are always using the same articles. 
4. See that your patient does not come in contact with the other people of 
the ship. 
5. On no account are you yourself allowed to mingle with others of the 
crew, etc. 
6. Never eat your meals with the patient. 
7. Wear white clothes, as these can be washed and boiled more easily. SPECIAL DISEASES 
45 
General Infections 
INFLUENZA (GRIP) 
Symptoms.—Incubation period—short, usually 24 to 72 hours. The 
onset is fairly sudden with fever and signs of a bad cold, but the 
patient feels much more ill than with an ordinary cold, and has 
severe prostration and pains in the back, limbs, and head. In some 
forms, the lungs are mostly affected and pneumonia or bronchitis 
may complicate the disease. In others, the heart may suffer, causing 
palpitation and difficult breathing; while in others, again, diarrhea 
and vomiting may be the chief symptoms. The acute illness lasts 
about a week but convalescence may be very prolonged and 
complicated. 
Treatment.—In the beginning of the disease a laxative may be 
given if the patient is constipated. Keep the patient in bed and 
force fluids by mouth. Give 5 grains of Dover’s powder at night. 
If the headache and pain in the limbs and back continue and are 
severe, give aspirin, 5 grains every 3 hours. Do not continue this 
treatment more than 2 days. Coryza tablets may be given after 
Dover’s powder if there is much secretion in the nose, throat, or 
chest, and followed by aspirin. For sore throat, use one of the gar- 
gles described under scarlet fever. 
Methods of control—Isolation.—During acute stage of the dis- 
ease, especially in severe cases and those complicated by pneumonia. 
Quarantine.—None, but visiting the patient should be discouraged. 
General measures.—Disinfect discharges from the nose and 
throat of the patient. Avoid crowds and crowding of beds. 
Symptoms.—Incubation period—2 to 3 weeks. The rash appears 
on the first day of the illness and consists of vesicles, which dry and 
form scabs. The vesicles come out in crops, mostly on the trunk, 
face, and scalp and only a few on the limbs. There is usually very 
slight fever, and the patient does not feel very ill. The vesicles may 
be so few as to escape observation. 
Treatment.—Put to bed if there is fever, otherwise not necessary. 
No change of diet unless there is fever, then exclude solids. Give 
water freely. For itching, wash parts gently with a solution of 
sodium bicarbonate, 1 tablespoonful to a pint of water. Keep mouth 
clean with alkaline and aromatic solution. Keep bowels open with 
Epsom salt. 
Methods of control—Isolation.—Avoidance of contact with non- 
immune persons should be made effective. 
CHICKENPOX 
457944°—42 4 46 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
Quarantine.—None. Contacts should be observed daily for a pe- 
riod of 24 days. 
General measures.—Disinfection of articles soiled by discharges 
from lesions. Investigate source of infection (may be mistaken for 
smallpox). Thorough cleaning of compartment after recovery or 
removal of patient. 
SMALLPOX 
Symptoms.—Incubation period—8 to 16 days, commonly 12 days. 
The beginning is sudden with a chill, headache, and pain in the back. 
The headache and backache are very severe and quite characteristic. 
The temperature may rise rapidly to 103° or 104° F. The eruption 
appears 1 to 5 days after the onset of fever on the forehead, scalp, 
forearms, legs, and trunk. At first the eruption consists of papules 
which are small and red and feel like shot under the skin. About 
the sixth day, the papules become vesicles; about the eighth day, 
pustules, and about the tenth day scabs form, which in time fall off, 
leaving, finally, deep white pitted scars. When the papules appear, 
the temperature falls but rises again when the pustules are forming. 
The patient’s skin has usually a very foul odor. The severity of the 
disease may vary from a mild form, with a few discrete pustules, to 
a severe form with hemorrhages into the skin, which is fatal in 1 to 
2 days. 
Treatment.—The body may be sponged twice daily with warm 
water or warm baths given when the patient is strong enough. The 
mouth must be kept clean and the eyes washed with borax eye solu- 
tion. (See Diseases of the Eye.) The eruption should usually be 
covered with some oily dressing, such as vaseline, or with cold-water 
compresses covered with oiled silk or muslin. An arrangement to 
relieve the patient of the weight of bedclothes is often necessary. 
Feeding may become difficult, owing to the condition of the mouth. 
Delirium is common and the patient must be carefully watched. 
Report the suspected case by radio if possible. 
Methods of control—Isolation.—Strict isolation until the period 
of infectivity (disappearance of all scabs and crusts), is passed. 
Quarantine.—Until vaccinated and height of take has passed, 
otherwise 16 days. 
General measures.—Disinfection of all articles before leaving sur- 
roundings of patient. Thorough cleaning and disinfection of com- 
partment after recovery or removal of patient. In all cases of small- 
pox, every effort should be made to obtain medical assistance and the 
earliest vaccination of all members of the crew, regardless of ex- 
posure, is necessary. Investigate the source of infection as many 
cases of chicken pox are mistaken for smallpox. SPECIAL DISEASES 
47 
Symptoms.—Incubation period—8 to 14 days. The disease com- 
mences like a common cold, with sneezing, running at the eyes and 
nose, headache, cough, and slight fever. On the fourth day the rash 
appears on the face and thence spreads downward to the neck, chest, 
abdomen, and limbs. It consists of dull, red macules which run to- 
gether, forming various patterns and lasts about 3 days. The lining 
of the mouth and throat appears of the same bright red color, dotted 
by minute white spots which appear before the skin eruption and 
are diagnostic of measles. The temperature falls at the end of the 
fifth day and the symptoms disappear, but the cough may remain 
for some time. 
Treatment,—Along general lines. Guard against chilling, as the 
complications, bronchitis and pneumonia, may prove fatal. 
Methods of control,—Isolation.—During period of communica- 
bility, a minimum period of 9 days: from 4 days before to 5 days 
after the appearance of the rash. 
Quarantine.—7 days. 
General measures.—Disinfection of all articles which have been 
in contact with patient and all articles soiled by his discharges. 
Thorough cleaning of compartment after recovery or removal of 
patient. Investigation of source of infection (carrier). Immuniza- 
tion of exposed susceptibles when possible. 
MEASLES 
german measles 
Symptoms.—Incubation period—14 to 21 days, usually about 16 
days. These symptoms are usually very mild, consisting of sore 
throat, headache, very mild fever, lasting only a day or two, and 
enlargement of the glands of the neck. The rash appears on the 
third or fourth day on the face and chest, spreading to the trunk and 
limbs; consists of red papules larger and duller than in scarlet fever, 
smaller and brighter than in measles, and lasts about two da^s. 
Treatment.—Along general lines. Beyond keeping the patient 
isolated for a few days and avoiding a chill, no treatment is usually 
necessary. 
Methods of control.—Isolation.—Of no practical value. 
Quarantine.—N one. 
General, Measures.—Disinfection of discharges from nose and 
throat of patient and articles soiled by discharges. Airing and 
cleaning of compartment after recovery or removal of patient. In- 
vestigate source of infection (may be mistaken for scarlet fever in 
early stages). 48 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
scarlet fever 
Symptoms.—Incubation period—2 to 7 days, usually 3 to 4 days. 
Symptoms come on suddenly, the most marked being fever and sore 
throat with nausea and vomiting. The rash appears on the second 
or third day and consists of bright red papules set very close to- 
gether, which gives the skin its scarlet hue. It is seen first on the neck 
and then spreads to the chest, arms, abdomen, and legs. It is usually 
most marked on the neck, the flanks, the buttocks, the bend of the 
elbows, and on the inner side of the thighs and knees, but may not 
appear on the face in mild cases. It usually lasts about 5 days. 
The throat remains sore for some days, the tonsils are red and 
swollen and often covered with yellow patches. The tongue is at 
first covered with white fur through which the red papillae show, 
giving it the appearance of a strawberry. Later when the fur dis- 
appears, the tongue becomes very red. The fever is usually high 
and lasts about a week and may cause some flushing of the face, 
which must not be mistaken for the rash. Desquamation, or peeling 
of the skin, commences as the rash disappears and is first noticed 
on those parts of the body where the rash was most marked. It 
commences as small white spots in the center of which holes appear. 
From this center, circular scales separate. This pinhole peeling is 
characteristic of scarlet fever. The scales may be small or may 
come away in large flakes. The last parts to peel are the palms of 
the hands and the soles of the feet. 
Treatment.—The patient should be kept in bed even in the mildest 
cases on account of possible inflammation of the kidneys, which is 
the most serious complication of this disease. The body may be 
sponged daily during the fever with water in a warm room, 
under a blanket, exposing one part of the body after another. The 
diet should be restricted to milk, giving two quarts a day during 
the fever. If milk is not available, gruels made from cereals, ar- 
rowroot, cornstarch, barley flour, or tapioca may be substituted. 
Feed at two-hour intervals but do not interrupt sleep at night. Wa- 
ter, lemonade, orangeade, limeade, etc,, sweetened, should be given 
freely. Soft food should be given during convalescence. Particu- 
lar care should be given to the nose and mouth and they should be 
frequently cleansed with salt solution (1 teaspoonful of common 
salt dissolved in a pint of tepid water), or alkaline and aromatic 
solution. The patient should be under treatment for 6 or 7 weeks, 
or until peeling is completed. The case, of course, should come to 
the attention of a medical officer as soon as possible. To relieve 
the pain of the sore throat, apply the ice bag or cloths wrung out SPECIAL DISEASES 
49 
in cold water to the neck and have the patient gargle with alkaline 
and aromatic solution, dissolving four of the tablets in a pint of 
warm water, or dissolve a half teaspoonful of soda bicarbonate, 
or a teaspoonful of table salt in a tumbler of hot water and use as 
gargle. To allay itching and when the skin commences to peel, 
the patient may be rubbed with olive oil or a simple ointment to 
prevent the scales floating about, or a daily hot bath may be given. 
The infection is most potent in the secretions of the nose and 
throat during the first 5 days of the disease. 
Methods of control.—Isolation.—If medical inspection is not 
available, isolation for 21 days from onset for uncomplicated cases. 
Quarantine.—7 days. 
General measures.—Disinfection of all articles which have been 
in contact with patient and all articles soiled by his discharges. 
Thorough cleaning of compartment after recovery or removal of 
patient. Investigation of source of infection (carrier). 
MUMPS 
Symptoms.—Incubation period—12 to 26 days, most commonly 18 
days. The patient complains of pain and stiffness on moving the 
lower jaw, and there will be swelling of one or more of the salivary 
glands. His temperature is raised, often to 104° F. The fever lasts 
about a week and the swelling about 10 days. Orchitis, or inflam- 
mation of the testicles, is very liable to occur in about 25 percent 
of cases at the end of the first week. The temperature rises rapidly 
and the testicle is found to be painful, tender, and swollen. This 
condition does not usually last more than a week but is very painful 
and usually results in atrophy of the affected testicle, and possible 
sterility, if both are affected. 
Treatment.—Along general lines. Isolate the patient, keep the 
bowels well open, and for the pain, hot water bags may be used 
applied to the swelling. Strict bed treatment and avoidance of 
exercise and chilling is absolutely necessary to avoid complications. 
If orchitis occurs the testicles should be supported by a suspensory 
bandage or a broad strip of adhesive plaster, with gauze or cotton 
between testicles and support, applied across the upper part of the 
thighs in such a manner that the testicles will be thoroughly sup- 
ported. The ice bag should be applied to relieve the pain and the 
bowels freely opened with Epsom salt—2 tablespoonfuls dissolved 
in water. 
Methods of control.—Isolation.—3 weeks; 1 week must have 
elapsed since all swelling has subsided. 
Quarantine.—None. All contacts, however, should be inspected 
daily for a period of 3 weeks from date of last exposure. 50 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
General measures.—Disinfect all articles soiled by discharges of 
nose and throat of patient. Investigate source of infection (e. g., 
recent cases of swollen jaw or orchitis). 
MALARIA 
Symptoms.—Incubation period—usually 14 days in the tertian vari- 
ety. This is a recurrent fever caused by malarial parasites which 
are carried by certain anopheline mosquitoes and injected into the 
body when the insects bite. The disease is not infectious except 
through the bite of a mosquito which has bitten malaria patients 
or carriers at some time during its life. The disease consists in at- 
tacks of fever which recur at regular intervals. Each attack may 
be divided into three stages: (1) The cold stage: The patient shivers 
and feels cold when his temperature is rapidly rising. He goes to 
bed and covers himself with extra blankets. This stage lasts about 
half an hour. (2) The hot stage: He begins to feel warm and re- 
moves most of the bed clothes. The skin feel hot and dry, and he 
suffers from severe headache. The temperature will now be 105° 
F. or higher. This stage last 3 or 4 hours. (3) The sweating stage: 
During this stage the patient perspires freely, the headache and flush 
disappear, and the temperature returns to normal. This stage lasts 
about 2 hours. These attacks occur every day, every other day, or 
every third day, according to the species of malarial parasite with 
which infected, and each lasts about 6 hours. There are other types 
of malaria in which the fever is continuous, and somewhat resembles 
the fever of typhoid. Frequently this type of malaria can be di- 
agnosed only by the aid of a microscope, and therefore requires the 
attention of a medical officer. 
Treatment.—During the attack, treat along general lines. Qui- 
nine, 10 grains three times a day (total: 30 grains daily), should 
be given by mouth for a week followed by 10 grains every night upon 
retiring for 8 weeks. 
Methods of control.—Isolation.—The individual with malarial 
parasites in his blood should be protected from the bites of mos- 
quitoes. With the exception of this simple precaution, isolation and 
quarantine are of no avail. 
Quarantine.—None. (See Isolation.) 
General measures.—The malarial mosquito bites preferably at dusk 
or at night, therefore when in malarial countries everyone should 
sleep under mosquito nets. A dose of quinine, 10 grains every day, 
tends to prevent the disease and should be given when in ports where 
malaria is prevalent. Investigation of source of infection. Breeding 
places should be sought for and larvae and mosquitoes destroyed 
when and where possible. SPECIAL DISEASES 
51 
DENGUE 
Symptoms.—Incubation period—3 to 10 days, most often 5 or 6 
days. Sudden onset, intense headache, joint and muscle pains (break- 
bone fever), and irregular eruption. 
Treatment.—Along general lines as for influenza. 
Methods of control.—Isolation.—The patient must be kept in a 
screened room. 
Q uarantine.—N one. 
General measures.—Protection against, and elimination of mos- 
quitoes. 
UNDTJLANT FEVER 
Symptoms.—Incubation period—6 to 30 days or more. Onset grad- 
ual with irregular fever of prolonged duration; profuse sweating, 
chilliness, pain in joints and muscles. This disease, also called un- 
dulant or Mediterranean fever, is transmitted from infected cattle 
and goats chiefly through unpasteurized milk or by direct contact 
with infected animals (including swine) or animal products. 
Treatment.—On general lines. Patient will probably need pro- 
longed care and should be hospitalized. Give phenacetin, 5-grain 
tablets, which should be chewed by the patient or crushed, three 
times a day for headache or high fever, and aspirin for pain. 
Methods of control.—Isolation.—None, 
Quarantine.—N one. 
General measures.—Pasteurization of milk, whether from cows or 
goats. Investigation of source of infection. 
PLAGUE 
See description under “Quarantine.” As this disease probably 
will not be encountered aboard naval vessels and in order to avoid 
confusion, symptoms and treatment are purposely omitted. It should 
be remembered that this disease is usually rat-bome. The best means 
of control, therefore, is by rat surveys and eradication. 
YELLOW FEVER 
Symptoms.—Incubation period—3 to 6 days, rarely longer. When 
a susceptible individual is bitten by an infected mosquito, there de- 
velops, after the period of incubation, a rapid rise of fever, with 
marked congestion of the face and severe pains of the back and head. 
Vomiting, first of mucus and bile, comes on very early. The tem- 
perature remains fairly high for 3 or 4 days, but notwithstanding 
the high temperature, the pulse rate becomes less, and by the third 
or fourth day will have decreased by 20 to 40 beats from its initial 52 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
rate. This is a very important symptom. On the fourth day the 
temperature falls and the face loses its congested appearance, and 
it is now that the most characteristic feature of yellow fever appears; 
namely, jaundice, a yellow discoloration of the skin, mucus mem- 
branes, eyeballs and secretions. Vomiting of material resembling 
coffee grounds is common. This is an important epidemic disease 
of the West Coast of Africa. There has been no case of the urban 
type in North or Central America or the West Indies for many 
years. Outbreaks of the so-called jungle type have occurred in recent 
years in South America, in Colombia, Brazil, and Bolivia. The 
virus is contained in the blood of infected patients only during the 
first 3 days of the disease, and the disease is transmitted By the bite 
of a mosquito, Aedes aegypti formerly known as Stegomyia fasciata 
or calopus, which has fed on the blood of an infected person about 
12 days previously. As it is important to be able to recognize the 
mosquito, a brief description of it follows: The insect is almost 
black and has white bands on its back resembling a lyre or jew’s 
harp, and the legs also have white bands. If deprived of water, 
the adult insect only lives about 5 days. It is essentially a house 
mosquito and rarely travels more than 75 feet from the house where 
it has been feeding, and it is probable that it is brought aboard 
ships in connection with coaling or provisioning rather than blown 
aboard by prevailing winds. 
Treatment.—During the first 3 days of the disease, no nourishment 
whatever should be given. The patient should be allowed an abun- 
dance of fluid, of which the best is Vichy or soda water, unflavored, 
giving a couple of ounces every 10 minutes, iced or just cool, as the 
patient prefers. If Vichy is not available, water to which has been 
added a teaspoonful of sodium bicarbonate (baking soda) to the 
quart, is a good substitute. It is of vital importance to put the 
patient to bed and keep him quiet. When vomiting is severe, cracked 
ice may be of value, or rectal instillations (retention enema) of 
salt solution. Stimulants every 3 hours should be given if the 
patient shows signs of collapse. Large quantities of citrus fruit 
juice may be given throughout the course of the disease. After 
3 to 7 days, light foods may be given if the patient’s condition will 
permit. Immediate hospitalization is essential. 
Methods of control.—Isolation.—Necessary during first 4 days of 
fever in a mosquito-free room. 
Quarantine.—None. 
General measures.—Any receptacle, tank, double bottom, or other 
place where fresh water may be collected should be thoroughly 
screened and frequently inspected in order to prevent the breeding 
of mosquitos. SPECIAL DISEASES 
53 
Systemic Diseases 
Diseases of the Respiratory Tract 
When a person has a cough that lasts more than 2 weeks, even 
though the symptoms are mild, the case is serious enough to require 
an examination by a medical officer, which should be done at the first 
opportunity. A cold often marks the beginning of an acute in- 
fectious disease, such as measles, scarlet fever, etc. 
Symptoms.—A case of bronchitis or bad cold usually begins with a 
cough, sometimes starting with an irritation in the throat, which 
gradually travels down into the lungs. The cough is at first usually 
dry, but later there is a free discharge from the nose and the cough 
becomes loose and considerable mucus is raised from the lungs. This 
sputum may at first be white and later yellowish. With this there 
will be soreness over the upper and front part of the chest, and if 
the cough is violent there will be considerable soreness of the muscles 
between the ribs. 
Treatment.—Colds may often be headed off, certainly benefited, 
if at the beginning the patient’s bowels are opened with Epsom 
salt or cathartic pills. After either of these has acted, he is given 
a hot bath, put to bed, given a drink of hot lemonade, and is covered 
with blankets until a good perspiration is induced. Wliile in this 
condition care should be taken not to get the body chilled and make 
the cold worse. Dover’s powder, 5 grains, should be taken on going 
to bed. Aspirin, coryza tablets or phenacetin may be given the next 
day. 
COUGHS AND COLDS 
TONSILLITIS ( SORE THROAT) 
All cases of tonsillitis and. sore throat should be promptly isolated 
because of the possibility of their being diphtheria, and the conse- 
quent probability of an epidemic of that disease should such be the 
case. Sore throat often accompanies a bad cold and is common where 
ventilation is imperfect. 
Symptoms.—Patient complains of rawness and difficulty in swal- 
lowing and the tonsils are swollen and red. There are headaches, 
general muscular and joint pains, and the fever is often high. Small 
beads of yellow pus are seen on the red, swollen tonsils, and in some 
cases abscesses may form. If there is a grayish-white tenacious 
membrane formed in the throat, which bleeds readily when touched, 
the case should be regarded as diphtheria and the individual promptly 
and completely isolated, and a medical officer consulted as soon as 
possible. 54 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
Treatment.—Isolate all cases of sore throat. Rest in bed; if con- 
stipation is present, open bowels with Epsom salt or cathartic pills, 
make patient gargle every half hour with alkaline and aromatic 
solution (made by dissolving four tablets in a pint of warm water) 
or by gargling with one-half teaspoonful of soda bicarbonate dis- 
solved in a tumbler of hot water. Apply ice bag to the neck, or cold 
cloths if an ice bag is not available. Give liquid and soft diet; avoid 
hot and highly seasoned food which will burn and irritate an already 
inflamed throat. As rheumatism of the joints is a frequent sequel 
of tonsillitis, it is well to give antirheumatic medication during and 
for about a week after the attack. Aspirin, 5 to 10 grains three 
times a day after meals, should be administered, or if this is not avail- 
able, a pinch of soda bicarbonate in one-half teacupful of water four 
times a day. 
PNEUMONIA 
This is an acute infectious disease beginning suddenly with a chill 
followed by fever, often pain in the chest, usually a cough, with 
labored and rapid breathing accompanied by an expiratory grunt. 
Symptoms.—Incubation period: usually 1 to 3 days, not well deter- 
mined. Sudden onset as noted. Sputum is usually abundant and 
frothy, soon becoming tenacious or jelly-like, blood-streaked and 
later brownish-red. 
Treatment.—Along general lines as for influenza. Absolute rest 
in bed with plenty of fresh air. Placing the patient in bed on deck in 
many cases is a life-saving measure. Hospitalization as soon as possible 
so that serum and other specific treatment may be administered. 
Methods or control.—Isolation.—Until sputum diminishes and no 
longer carries virulent germs. 
Quarantine.—N one. 
General measures.—Avoidance of overcrowding, chilling, and fa- 
tigue. Disinfect all articles soiled by nose and throat discharges of 
patient. 
DIPHTHERIA 
This is an acute infectious disease characterized by the formation 
of a membrane in the throat and on the tonsils and soft palate. It 
is caused by the diphtheria bacillus and all secretions from the nose 
and mouth are infectious. 
Symptoms.—Incubation period—usually 2 to 5 days, occasionally 
longer. Symptoms come on gradually with general indisposition, 
sore throat, headache, enlarged glands in neck, and moderate fever. 
There is a creamy-white deposit formed on the tonsils, which spreads 
to the uvula and soft palate. This membrane may form on other SPECIAL DISEASES 
55 
adjacent parts and block the breathing tubes, in which case there 
is great danger of asphyxia. In addition to the symptoms caused 
by blocking of the air passages by the formation of the membrane, 
the patient suffers greatly from an overwhelming intoxication due 
to the formation of a poison by the diphtheria bacillus located in 
the membrane. 
Treatment.—Along general lines. The patient should be seen at 
the earliest possible moment by a medical officer. Keep the patient 
closely isolated and the throat clean by frequent gargling with warm 
alkaline and aromatic solution—four tablets dissolved in 1 pint of 
water, or with the soda bicarbonate solution described under scarlet 
fever. All secretions from the nose and mouth are very infectious, 
and these should be particularly taken care of. The attendant may 
become infected by the patient coughing in his face. To prevent this 
kind of infection, the attendant should at once wash his mouth out 
with alkaline and aromatic solution and bathe his eyes with borax 
eye lotion, or better still, wear a face mask of gauze and goggles in 
addition, while attending the patient. 
Methods of control.—Isolation.—Until two cultures from nose 
and throat are negative, or not less than 16 days, if cultures are not 
possible. 
Quarantine.—12 days. 
General measures.—Disinfection of all articles which have been in 
contact with patient or soiled by his discharges. Thorough disinfec- 
tion and airing of compartment after recovery or removal of patient. 
Immunization of susceptible contacts. Investigate source of infec- 
tion (milk, carriers, and pasteurization of milk supply). 
acute abdominal conditions 
The most common, serious, acute abdominal conditions are acute 
appendicitis, perforating ulcers of the stomach or duodenum, intes- 
tinal obstruction, gallstone colic, kidney stone colic, and poisoning 
by infected food or by other poisons. Pain and tenderness in the 
abdomen, general or localized or both, nausea and vomiting, and 
more or less shock are symptoms common to these conditions. All 
cases presenting symptoms of abdominal pain or nausea and vomit- 
ing, particularly when associated with more or less shock, should be 
brought under the care of a medical officer as soon as possible. 
One always should suspect more than ordinary indigestion or con- 
stipation if there is much prostration, shock, or elevated temperature, 
or if the symptoms persist for any length of time. Many a person 
suffering from acute appendicitis or obstruction of the bowels will 
ascribe the condition to something that has been eaten, but do not 
be deceived by such a statement. Get all the information possible 56 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
as to how the attack started, history of previous attacks, and symp- 
toms prior to the present attack, whether the patient has vomited 
blood or not, and when the bowels last moved; take the temperature 
and pulse rate; lay the patient flat with the abdomen bared and deter- 
mine by gentle and careful palpation where the pain and tenderness 
are most marked. 
ACUTE APPENDICITIS 
Symptoms.—Appendicitis is an inflammation of the appendix. A 
patient frequently complains for several days before the attack of 
indigestion, loss of appetite, constipation or diarrhea, and uneasiness 
in the abdomen, or the attack may come on suddenly. The pain 
may start in the pit of the stomach, then become generalized over the 
abdomen, and finally, after several hours, become localized in the 
right lower quadrant of the abdomen with marked tenderness on 
pressure and rigidity of muscles over that point. Vomiting gener- 
ally comes on 3 or 4 hours after the beginning of the attack. The 
temperature may be subnormal from mild shock or be elevated to 
100° or 101° F. In acute appendicitis the appendix becomes full of 
pus and the danger lies in its rupture with resulting peritonitis. 
Treatment.—Place the patient under the care of a surgeon as soon 
as possible. In the meantime put to bed, giving nothing by mouth, 
not even hot water, and put a hot-water bag over the appendix. 
Do not use an ice bag. In case no medical officer is available for 
some time, liquids in small amounts may be given after 48 hours. 
Never give a cathartic to a person suspected of having acute 
appendicitis. 
Symptoms.—In this condition, a loop of bowel becomes constricted, 
resulting in the inability of the intestinal contents to move beyond 
the point of constriction and cutting off the blood supply to the loop 
of the bowel with resulting gangrene or death to the bowel. This 
condition is followed by absorption of poisons from the intestine, 
peritonitis, and death if the condition is not relieved. Two very 
common ways for the bowel to become constricted are by means of 
adhesions within the abdomen and by a loop of bowel becoming 
strangulated in a hernia, or rupture, as it is commonly called. The 
symptoms are inability to pass gas or feces by the rectum, pain in 
the abdomen, vomiting becoming more and more frequent, and in- 
tense shock. The abdomen may be distended above the point of con- 
striction and be flat below that point. The bowel must be relieved 
of its constriction or death will ensue. 
Treatment.—Place the patient under the care of a surgeon at the 
earliest possible moment. In the meantime, take the following meas- 
ACUTE INTESTINAL OBSTRUCTION SPECIAL DISEASES 
57 
ures: (1) If the obstruction is due to a strangulated hernia, and the 
case has not gone too far, put the patient in a hot tub with the 
buttocks elevated in order to relax the inguinal ring, and exert 
gentle pressure over the tumor; (2) put the patient to bed, give a 
soap and water enema, and nothing by mouth. Never give a person 
suspected of suffering from obstruction of the bowels a purgative. 
PERFORATED GASTRIC OR DUODENAL ULCER 
Symptoms.—Generally, though not always, a person suffering from 
perforated ulcer of the stomach or duodenum gives a long history 
of stomach trouble. Acute pain “in the pit of the stomach,” asso- 
ciated with more or less shock, is suddenly felt. The pain is sudden 
and intensely violent, which is greatly increased by swallowing fluids, 
by vomiting, by turning the body, by coughing, by respiration, and 
by pressure. This pain may radiate throughout the abdomen, but 
the chief tenderness is in the region of the stomach. Vomiting oc- 
curs in about one-half the cases at the time of perforation. Shock 
may be severe following the perforation, but, as a rule, does not last 
long. A board-like rigidity of the muscles of the abdomen is present, 
and the temperature is usually normal or subnormal. The danger 
from perforated ulcer of the stomach or duodenum is peritonitis, due 
to the escape of stomach or duodenal contents into the peritoneal 
cavity. 
Treatment.—Bring the patient under the care of a surgeon as soon 
as possible before peritonitis sets in; in the meantime, put the patient 
to bed, give absolutely nothing by mouth, and put an ice bag over 
the stomach; and treat shock if present. 
gallstone colic 
Symptoms.—Gallstone colic is due to the passage, or the attempt 
at passage, of a gallstone from the gallbladder to the intestines. 
Depending on the location of the stones, a person with gallstones 
may or may not be jaundiced. The patient frequently gives a his- 
tory of stomach trouble with or without jaundice and may give a 
history of previous gallstone colic. The colic consists of spasmodic, 
excruciating pain over the stomach and liver, radiating upward over 
the right half of the thorax, frequently up under the right shoulder 
blade. The patient is very nauseated, and usually vomits, and often 
the vomiting is violent. The abdomen is distended and a condition 
of collapse soon comes on. The respirations are shallow, the patient 
groans, cries out, or flings about the bed, often assuming strange 
contorted positions, trying to obtain relief, frequently holding one 
hand over the liver region. The duration of an attack is from 4 to 
20 hours, although it may last much longer. The temperature is 
usually normal or subnormal. 58 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
Treatment.—Bring the patient under the care of a medical officer 
as soon as possible. In the meantime, place a hot-water bag over 
the liver at the lower border of the ribs. 
KIDNEY STONE COLIC 
Symptoms.—This condition is due to a small stone from the 
kidney entering into the ureter, which it blocks, tears, or distends. 
The pain is gradual or sudden in onset, is fearful in intensity and 
runs from the lumbar region down the corresponding thigh and 
testicle and into the abdomen and back. There are nausea, vomiting, 
collapse, and sometimes unconsciousness or convulsions. Frequent 
attempts at urination result in pain but little urine. The urine is 
often smoky or red from injury to the ureter. After a time the 
pain vanishes, due to the stone falling back into the pelvis of the 
kidney or to its passing on into the bladder. 
Treatment.—Bring the patient under the care of a medical officer. 
In the meantime, put patient to bed, give plenty of water by mouth 
to increase the flow of urine, place a hot-water bag on the affected 
side of the abdomen. 
Diseases of the Intestinal Tract 
Symptoms.—This is a term applied to abdominal pain occurring 
in paroxysms of varying degrees of severity. The pain is usually 
located in the region of the navel; that is, in the middle of the belly. 
Colic is often preceded by constipation and accompanied by vomiting. 
The causes are various and the pain often may be a symptom of 
serious trouble. For example, abdominal pain is almost always the 
first and most pronounced symptom of appendicitis, intestinal ob- 
struction, perforating ulcers of the stomach and intestines, gallstone, 
kidney stone, the well-knoAvn cramps of lead poisoning (painter’s 
colic), and poisoning by infected food or other poisons. Besides 
being a symptom of these conditions, colic is most frequently due 
to overindulgence in food and drink. 
Treatment,—Place the patient in bed and apply a hot-water bag 
to the abdomen, interposing a cloth between the bag and the skin or 
wrapping it in a towel to protect the skin from being burned or 
blistered. No food or drink should be allowed until the colic has 
subsided. 
Never give a purgative or a cathartic to a person suspected of 
having appendicitis or intestinal obstruction and give absolutely 
nothing by mouth to a person suspected of having a perforated ulcer 
of the stomach or intestine, but bring him under the care of a medical 
officer at once. 
colic 59 
SPECIAL DISEASES 
An individual suffering with colic is vastly better off with nothing 
in the stomach and such a person can easily go without food for 2 or 
3 days, but must ha ve water, which should be given in small amounts. 
If the patient’s bowels have not moved, an enema (injection into the 
rectum) consisting of a pint of warm water and soapsuds, should be 
given and repeated in half an hour if there has been no result. 
After all pain has subsided, the patient may be given liquid or 
semisolid foods, such as clear soups, custards, milk, milk-toast, or 
soft-boiled eggs. This diet may be cautiously and gradually in- 
creased to solid foods as the pain and vomiting subside and do not 
return. 
DIARRHEA 
Symptoms.—Frequent watery and straining stools accompanied by 
loss of appetite, nausea, and sometimes vomiting and abdominal 
cramps. Commonly it is an acute condition caused by some inflam- 
mation or irritation of the intestine. It is one of the main symptoms 
of typhoid fever, cholera, and dysentery. It is termed simple diar- 
rhea when it occurs independently of any appreciable disease. It 
may be caused by exposure to cold or by eating unripe and indiges- 
tible vegetables and fruits, or decomposed or improperly cooked meat, 
fish, and shell fish. Drinking large quantities of cold water when 
the body is overheated is a frequent cause. 
Treatment.—The patient should be encouraged to take fluids by 
mouth to the extent of his ability. A hot-water bag should be ap- 
plied to the abdomen and the patient kept at rest in bed. 
While the diarrhea is acute, the less food taken the better. During 
convalescence he should be given salty soups to relieve muscle cramps 
incident to the loss of salt in the evacuation and he should be kept 
on a smooth, bland diet until all symptoms have disappeared. No 
medicine ordinarily should be given. Small quantities of soda bi- 
carbonate, 10 grains or 15 grains, in a little hot water may be given 
three or four times a day. 
FOOD POISONING (PTOMAINE) 
Symptoms.—Sudden onset (2 to 6 hours after the food has been 
eaten) with violent diarrhea, vomiting, abdominal cramps, prostra- 
tion, and dizziness, occurring usually in epidemic form. The severity 
of symtoms will vary with different individuals. In most cases the 
acute symptoms will be over in 12 to 24 hours, leaving for several 
days a marked weakness, loss of appetite, and abdominal discomfort. 
Recovery is usually complete in 48 hours. 
Outbreaks are caused by bacterial contamination of foodstuffs that 
have been prepared and allowed to remain at room temperature for 
varying periods of time prior to being served. The most common 60 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
foodstuffs are: Meat, sausage, and meat mixtures; salads; milk and 
cream preparations such as cream puffs, custards, and pies. 
Treatment.—A cathartic, such as Epsom salt, should be given 
immediately to rid the intestinal tract of any remaining irritant. 
Give water freely. The patient should be placed in bed and a hot 
water bottle applied to the abdomen. Food should be withheld until 
24 hours after cessation of the acute symptoms. There should be a 
slow return to a full diet. 
Methods or control.—Isolation.—Not required. 
Quarantine.—N one. 
General measures.—Sources of infection can be eliminated only by 
freedom from disease and a high standard of personal hygiene in all 
food-handlers, particularly their attention to the important detail of 
washing their hands after visiting the toilet, by serving footstuff 
promptly after its preparation, and by maintaining a high standard 
of sanitation in the galley and butcher shop. 
DYSENTERY 
Dysentery, or bloody flux, as it is sometimes called, is an inflamma- 
tion and ulceration of the large bowel caused by an infection. 
It occurs in different degrees of severity and may be either acute 
or chronic. Its severest form is met with in tropical countries, where 
it frequently occurs in widespread endemics and may attack a whole 
ship’s company. 
It is caused by specific microorganisms which enter the system with 
contaminated food or drink. 
Symptoms.—The disease may begin suddenly or gradually. The 
first stools may be like those of ordinary diarrhea, and after a day 
or two, or maybe a few hours, the stools contain slime and blood. 
Later they may become shreddy and brownish or greenish in color. 
The patient complains of cramps and “colicky” pains in the belly, 
with a burning sensation in the rectum, accompanied by a feeling as 
if something must be expelled, and a constant desire to go to stool. 
The number of bowel movements may be from 10 to 50 a day, or 
even 100, depending upon the severity of the case, but the quantity 
expelled with each movement may not exceed a teaspoonful. 
Treatment.—The patient should rest in bed, and if possible use the 
bedpan, so as to insure the greatest amount of rest, which is of great- 
est importance. Keep the patient warm, apply hot-water bag or 
cloths wrung out in very hot water to abdomen, and stop all solid 
food. In the tropical form of the disease, ipecac, or its active prin- 
ciple emetine, acts as a specific, but it is required that it should be 
administered by skilled hands and is only mentioned here to impress SPECIAL DISEASES 
61 
the fact that a person suffering from dysentery should come under 
the care of a medical officer as soon as possible. 
In countries where dysentery is prevalent no fruit or uncooked 
vegetables should be allowed, and all foods, both cooked and un- 
cooked, should be protected from flies, which carry the contagion. 
Nothing but distilled or boiled water should be used for drinking 
or cooking purposes. 
TYPHOID FEVER 
This important disease is now very rare in the naval service be- 
cause of antityphoid inoculation used throughout the Navy. 
Symptoms.—These come on very gradually with loss of appetite, 
general indisposition, and headache; there may be also some cough, 
diarrhea, and bleeding from the nose. 
It is a disease in which the fever lasts about 4 weeks. During the 
first week the temperature gradually rises until the beginning of 
the second week, when it reaches its height, and then continues until 
about the end of the third week, when it gradually begins to fall, 
ending by lysis at the end of the fourth week. 
The rash appears on about the seventh day on the abdomen, back, 
and lower part of the chest. It consists of fairly large, raised rose- 
spots, which fade on pressure. They are usually few in number and 
come out in crops. Each spot lasts about 4 days and the rash lasts 
about 14 days. As the fever progresses the patient becomes very 
weak; he loses weight; his cheeks are slightly flushed; he is drowsy; 
and he is not capable of any exertion. He suffers from thirst; unless 
carefully attended, his lips and teeth become covered with scabs and 
crusts. Delirium is common. 
Treatment.—Along general lines.—The patient needs careful nurs- 
ing and should be removed to a hospital at the very first opportunity. 
When the fever is high, sponge baths should be given both night 
and morning, or oftener if necessary. Careful feeding is quite neces- 
sary in the treatment of typhoid fever. The chief articles of diet 
in typhoid fever are: milk, cream, well-cooked cereals, such as rice, 
grits, cream of wheat, strained oatmeal, etc.; soft boiled, soft 
poached, hard boiled or soft scrambled eggs; toast or crackers; 
fruit juices; stewed apples, peaches, or apricots, apple float, butter, 
soups thickened with rice or barley flour, creamed soups, mashed or 
baked potatoes, scraped meats or finely minced meat. Simple des- 
serts such as boiled custard, ice cream, bread or tapioca pudding, 
junket, cup custard, blanc mange, eggnog, and jellies are allowed. 
Food should be given a little at a time and at frequent intervals—2 
or 3 hours. 
Drugs are of little use. The patient must be carefully watched 
and all his wants given attention. Diarrhea is rather common at 
457944°—42 5 62 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
first. Later on, if there is constipation move bowels by enemas, 
not by cathartics. 
Method of control.—Isolation.—In fly-proof compartment. Re- 
lease from isolation should be determined by a medical officer. 
Quarantine.—N one. 
General measures.—Disinfection of all bowel and urinary dis- 
charges and articles soiled by them. Dishes and soiled linen should 
be boiled. Thorough cleaning of compartment after recovery or 
removal of patient. Immunize all members of crew, who are not 
protected. Investigate source of infection (water, milk, shellfish, 
and other food supplies), and carriers of the disease. Serve no raw 
milk or food until sure of its safety. Eliminate flies. 
The germ of the disease enters the body through the mouth in 
infected foods or drinks, of which water and milk are the com- 
monest, and, after that, food contaminated by flies, thus showing the 
importance of protecting all foods, both cooked and uncooked, from 
flies. 
CHOLERA (ASIATIC) 
An acute diarrheal disease transmitted by food, flies, water, and 
contact with infected persons. 
Symptoms.—Sudden onset with headache, prostration, diarrhea, 
and colic; later vomiting, purging, high fever, cold, clammy, 
shrunken and livid skin, rapid wasting of body, thirst, muscular 
cramps, watery (rice water) stools, with collapse. 
Treatment.—Isolation, absolute quiet, application of external heat. 
Force fluids if possible. See a doctor immediately. (See dysentery.) 
Methods of control.—Isolation.—In hospital or screened room 
during period of communicability, usually 7 to 14 days. 
Quarantine.—Until stools are negative; contacts for 5 days from 
last exposure, or longer if the stools are found to contain the cholera 
vibrio. 
General measures.—Thorough disinfection of all discharges from 
the bowels and vomited matter. Investigate source of infection. 
Use only boiled water and cooked foods and protect against flies 
and human handling. Immunization of contacts by vaccine, and 
of all personnel in presence of an epidemic. 
Diseases of the Skin 
This is an itching disease (known as the 7 years’ itch, etc.) found 
among people living in unclean surroundings and habits. The 
cause of scabies is the itch mite. It is therefore a contagious disease 
and may be passed from one to the other by close contact. The itch 
mite travels from one patient to another through the medium of the 
THE ITCH (SCABIES) SPECIAL DISEASES 
63 
clothing, the towels, the bed clothing, personal articles, etc. The 
most common way of passing the disease from one to another is in 
having two or more persons using the same bed and same clothing. 
Treatment.—All clothing and bedding belonging to or used by 
the patient which has been in contact with the skin, whether freshly 
laundered or soiled, such as underwear, pajamas, and socks, should 
be collected and sterilized by heat (steam or boiling water). 
Woolen clothing may be sterilized by thorough steaming with a hot 
iron and wet cloth as in pressing, or may be dry-cleaned. Before 
retiring, the patient should take a hot bath with plenty of soap. 
The surface of the skin, particularly in the vicinity of the eruption 
should be thoroughly scrubbed. Following this bath, an ointment 
consisting of sulfur and lard, commonly known as the official sulfur 
ointment (in Medicine Box) in the proportions of about 1 teaspoon- 
ful of sulfur to 1 ounce of lard, is now rubbed thoroughly into the 
skin from the collarbone entirely over the body to the soles of the 
feet, particularly in the vicinity of the eruption between the fingers, 
between the toes, and in the folds. There is no occasion to apply the 
ointments above the collarbone, as the disease seldom attacks that 
portion of the body. Whenever an application of sulfur ointment is 
applied at night, a hot bath with much soap must be taken the next 
morning. The sulfur-ointment bath should be repeated once a day 
preferably just before retiring until the eruption and itching have 
subsided, when it may be assumed that the patient has been cured. 
All clothing used by the patient during the preceding 24 hours should 
be collected each day and sterilized. The patient may use two sets 
of clothing, underwear, socks, pajamas, sheets, etc., changing each 
day and sterilizing that worn or used the day before. Laundering 
each day is desirable but not necessary. Should the eruption con- 
tinue and the itching remain unabated, a second series of treatments 
as described should be given. Too long an application of these 
treatments, however, is not advisable as the sulfur tends to cause an 
irritation of the skin which may cover up the scabies. If the skin 
gets very rough and generally red from irritation, limit treatment to 
anointing the body with vaseline or zinc ointment. 
Any locker or other place used by the patient in storing clothes, 
should be disinfected with the Navy standard (pyrethrum) insecti- 
cide. This may not be used in treatment, however, as actual contact 
is required and the insects like termites, being within the layers of 
the patient’s skin, cannot be reached. 
RINGWORM 
This is a highly infectious disease of widespread prevalence, par- 
ticularly in the Tropics and subtropics and during a hot, humid 
summer in the temperate zone. In adults it affects all parts of the 64 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
body, though rarely the scalp. On the face it is commonly called 
“barber’s itch,” in the crotch “dhobie itch,” and on the feet “athlete’s 
foot.” The cause is a fungus or mould, parts of which break off and 
infect the clothing. When well developed, it tends to form circles 
(ringworm) or parts of circles. Itching is a prominent symptom. 
In some cases, concentric circles develop or rings form upon one 
another, making various patterns. The spreading border is red or 
reddish and more scaly than the central portion which may appear 
normal to the unaided eye. It may begin as a few or numerous small 
red patches with scaling vesicles and crusts. It may be transferred 
from one part of the body to another by scratching the bare skin. 
Treatment.—The fungus is very partial to dark, damp places, such 
as swimming pools, wash and bath rooms, and the inner recesses of 
deck swabs. As the infection frequently starts on the feet, members 
of the crew as well as the patient should be advised not to go bare- 
footed but to wear some sort of a sandal, particularly in going to and 
from the shower, and to dry the toes thoroughly after bathing. Mac- 
eration of the skin in hot, moist weather favors spread. After bath- 
ing and while wearing shoes, the use of a good antiseptic powder on 
the feet and between the toes is advised. Such a powder, which may 
be obtained at any naval medical activity, consists of: Salicylic acid, 
5 gm., menthol, 2 gm., camphor, 8 gm., boric acid, 50 gm., and starch, 
35 gm. It may also be used in the treatment of the disease. The 
floors of shower baths, washrooms, etc., should be swabbed daily and 
mops should be dried in the sunshine. The patient should see a medi- 
cal officer. The more intractible cases may require treatment by the 
ultraviolet light or by X-ray. 
LICE (VERMIN) 
There are three forms of lice, which vary in size and somewhat in 
appearance. 
The condition is contagious, as these parasites can be conveyed 
from one person to another through the medium of comb and brush, 
using the same bed and sleeping clothes, the use of the same outer 
garments, the presence of the vermin within the quarters inhabited 
by all the crew, and in other ways. The eggs are attached to the 
hairs by a covering which is soluble in acids such as vinegar (acetic 
acid). 
The irritated appearance of the skin is caused largely by scratch 
marks. The main symptom is that of itching. 
The scalp.—Little lumps are seen along the shafts and at the ends 
of the hairs. These are the nits or eggs of the parasite. The hair 
should be cut short. Thoroughly anoint scalp with vaseline which 
should be left on for about 1 hour. Then scrub head with soap and SPECIAL DISEASES 
65 
water and comb with a fine-tooth comb wet with vinegar. The egg 
cases or “nits” are soluble in acids and the vinegar tends to dissolve 
or destroy them. This treatment should be repeated in 3 or 4 days in 
order to “mop up” any remaining “nits” or adults that may have 
escaped the first treatment. 
The genitals.—The louse which lives in the hair around the genitals 
is a small, round parasite commonly known as the crab louse. It 
deposits nits upon the hair, as does the louse of the scalp. In treat- 
ing the crab louse it is first necessary to trim the hairs short around 
the genitals and to cut the hairs in the arm pits where there is a 
possibility of the infection spreading. The area is thoroughly 
scrubbed with soap and water and a thin coating of vaseline is thor- 
oughly rubbed in and allowed to remain for 24 hours. These areas 
are then scrubbed again with more soap and water and ordinary 
table vinegar is applied several times during the day. This treat- 
ment must be repeated a day or two later. 
The body.—The body louse is the largest of the three varieties. 
It inhabits the clothing of the patient and usually seeks the seams 
of garments. The treatment consists of changing the entire outer 
and under clothing after taking a bath and scrubbing the person 
thoroughly with a liquid soap. Infected clothing should be boiled. 
The patient’s mattress cover and blankets should likewise be dis- 
infected, preferably by heat. 
Diseases of the Nervous System 
HEADACHE 
Headache is a symptom of disease of some part of the body. It 
generally accompanies the acute- fevers, is associated with constipa- 
tion, disorders of the stomach, liver, kidneys, and genital organs. 
Eye strain is a frequent cause. 
Treatment.—Remove the cause if possible. Open the bowels with 
a dose of castor oil or Epsom salt and give 10 grains of aspirin or 
5 grains of phenacetin, and repeat in 3 hours if necessary. A little 
hot tea and toast should be given with this medicine to prevent 
nausea. A medical officer should be consulted if this does not benefit 
the patient. 
CEREBROSPINAL FEVER 
Symptoms.—Incubation period—2 to 10 days, commonly 7. Onset 
is sudden with symptoms of an acute cold, fever, headache which may 
be almost unbearable, nausea, rigidity of neck and insomnia followed 
by delirium or coma. In some cases marked drowsiness and headache 
and presence of an acute cold are the only symptoms. Frequently 
appears during epidemic of acute colds. A rash of dusky red spots, 66 
MEDICAL COMP END FOR COMMANDERS OF NAVAL VESSELS 
not vanishing upon pressure first appears upon the chest, abdomen, and 
back. It may be slight in mild cases but prominent in severe cases. 
Treatment.—Absolute quiet in a cool, dark room. As administra- 
tion of serum is required to prevent serious disability or death, the 
patient must be placed under the care of a doctor at the earliest possible 
moment. 
Methods of control.—Isolation.—Isolation of infected persons until 
14 days after onset of the disease. Isolate immediate contacts. 
Quarantine.—N one. 
General measures.—Disinfection of articles soiled by discharges from 
the nose and throat. Prevent overcrowding, chilling, fatigue, and 
undue strain. Thorough cleansing of compartment after recovery 
or removal of patient. 
Delirium tremens occurs as an incident in the life of persons addicted 
to the excessive use of intoxicating liquors. 
Symptoms.—Loss of appetite, sleeplessness, or a marked mental de- 
pression are the chief symptoms of the first stage of the affliction known 
among drunkards as “the horrors.” As the disease advances the patient 
talks incoherently, has a wild expression, his mind wanders from one 
thing to another. He answer questions in a rambling manner and 
fancies he is being pursued by wild animals, or that he sees rats, snakes, 
and other animals crawling on the walls around his bed. The delirium 
is always worse at night, but the patient requires watching at all times, 
for he may try to jump overboard or commit suicide in some other way. 
Delirium tremens may be confused with the delirium of acute fevers. 
Pneumonia is a frequent complication of delirium tremens and in fatal 
cases may be the direct cause of death. It may, in drunkards, follow 
a fracture or other injury. 
Treatment.—The patient requires constant attendance. In all cases 
the symptoms are aggravated by the lack of food, which the patient has 
been either unable or unwilling to take. Careful feeding is of the 
utmost importance. Thick, nourishing soup constitutes the best food 
in this condition and should be given every 2 hours and the patient 
encouraged in every way to take food. Arrangements should be made 
for a medical officer to assume charge of the case as soon as possible. 
Give hot beef extract. This, and the soups are rendered more effective 
and palatable by addition of pepper as seasoning. The serious symp- 
toms are largely due to sleeplessness, and if several hours of sound 
sleep can be produced, improvement is almost sure to follow. To this 
end, phenobarbital in doses should be given with water 
every 3 hours for 4 doses. Sometimes by wrapping the patient in a 
sheet and blankets wrung out in very hot water and at the same time 
DELIRIUM TREMENS SPECIAL DISEASES 
67 
applying cold to the head, a sedative or quieting effect is produced 
and the patient gets rest, even if no sleep. 
Diseases of the Eye 
INFLAMMATION 
In all inflammations of the eye, ascertain at once if the individual 
has gonorrhea. If he has, the chances are that you are dealing with 
a very severe condition which should be brought to the attention of a 
medical officer immediately. Treatment of this condition (gonorrheal 
ophthalmia) is discussed in the next chapter. Simple inflammation is 
caused by irritation, such as exposure to the wind or dust, by foreign 
bodies in the eye, and frequently by the fumes of turpentine contained 
in paint used in confined places as when painting double bottoms, etc. 
Symptoms.—The eye is bloodshot and watery, the patient complains 
of pain; the sensation of sand in the eye, and heat. A thin watery 
discharge appears which tends to stick the lids together. 
Treatment.—Turn back the upper lid, pull down lower lid, remove 
all small particles of dust and dirt by gently wiping the lid with cotton 
loosely wound about a match stem. To turn back the upper lid, have 
the patient look downward then lay a match stem lengthwise along 
the middle of the lid, press down gently and at the same time pull up 
on the lashes. Have the patient look in all directions, for by this means 
particles of irritating matter which do not at first appear may be 
brought to view. After having removed all the irritating particles, 
wash the eye with warm borax solution using a small piece of cotton 
saturated with this solution held very closely to the inner angle of 
the eye. Do not drop solution on the eyeball. 
Eye wash (or borax lotion).—A simple, soothing and antiseptic eye 
wash may be made as follows: To 2 quarts of boiled, distilled water in 
a large bottle, add 1 level teaspoonful each of borax, sodium chloride 
(table salt), and sodium bicarbonate (baking soda). Dissolve hy 
shaking, and let stand until clear. Pour off the clear fluid and bottle. 
Use in the eye bath freely, either cold or warm. This solution is 
alkaline, nonirritating, and is much superior to boric acid solution. 
stye 
A stye is a pustule which forms on the margin of the eyelid around 
an eyelash. The lid is inflamed, painful, and has the general appear- 
ance of a small boil. 
Treatment.—Pain may be relieved by applying squares of gauze 
wrung out of hot salt solution. When the stye ruptures, keep the lid 
clean with frequent washings with salt solution or borax solution in 
order to prevent recurrence of styes. Yellow oxide of mercury oint- 
ment painted on the margins of both lids of both eyes upon retiring 68 
MEDICAL COMP END FOR COMMANDERS OF NAVAL VESSELS 
will assist in the cure and act as a preventative. Recurring styes may 
be a symptom of defective vision. In such cases, the patient’s eyes 
should be refracted by a medical officer when the schedule of the ship 
will permit. 
Diseases of the Ear 
EARACHE 
Earache is due to so many different causes that a medical officer 
should be consulted as soon as possible. To relieve pain, if very severe, 
give aspirin (5 grains) two or three times at intervals of 4 hours, 
and one Dover’s powder (5 grains) at night if pain persists. 
Diseases of the Teeth 
TOOTHACHE 
This condition is usually due to an inflamed pulp which has become 
infected or irritated through a cavity in the tooth, the congestion com- 
pressing the pulp against unyielding sides of pulp cavity causing pain. 
To give relief, remove particles of food from cavity and insert a small 
piece of cotton moistened with dentalone or eugenol after first touched 
to another piece of cotton to remove excess fluid. Excess fluid may 
burn the gums. This treatment should be renewed every day or two 
until dental attention is available. Should swelling of soft tissue 
occur, apply heat and administer sedatives. 
Other Conditions 
SUNSTROKE HEATSTROKE 
Sunstroke is an attack of illness caused by exposure to the rays of the 
sun; but the same condition may be produced in hot weather by exposure 
to high temperatures not in the direct rays of the sun, particularly if 
the person is engaged at hard work in close quarters. Men working in 
the fire and engine rooms are sometimes affected by the heat in those 
spaces. Men debilitated from or addicted to the excessive use of stimu- 
lants are more apt to suffer than those of temperate habits. 
Sunstroke occurs in two forms—heat stroke (heat fever), in which 
the temperature of the body is very high, and heat prostration or heat 
exhaustion, in which the surface of the body is cool. The difference is 
very important because of the different treatment required. 
In severe cases of heatstroke the person may be stricken down and die 
in a few hours. In other cases there may be intense headache, dizziness, 
marked restlessness, nausea and vomiting, and hot, burning skin. The 
clinical thermometer may register 105° F. Pulse is strong and may be 
slow or fast, and breathing is difficult. The patient soon becomes SPECIAL DISEASES 
69 
unconscious, and if left untreated the unconsciousness deepens and 
death may follow within 24 hours. 
In heat prostration the surface of the body is cool, the pulse weak 
and rapid, and the patient feels exhausted. There may be only slight 
nausea and vomiting, and under treatment the patient may rapidly 
recover; or, on the other hand, there may be complete loss of conscious- 
ness and a rapid and fatal termination from exhaustion. This prostra- 
tion is often accompanied by muscular cramps, particularly in persons 
who have been doing hard work while exposed to high temperatures. 
These cramps are extremely painful, and the attacks may last from 12 
to 24 hours. The muscles may remain sore and the patient weak and 
listless for several days after the seizure, although the attacks vary from 
a slight cramp in the abdomen or limbs to general cramps in all the 
muscles. Muscle cramps are due to loss of salt through excessive 
perspiration. 
Treatment.—In heat stroke (heat fever) the temperature of the 
body should be reduced as rapidly as possible. Place the patient in 
a tub of cool water, add ice, and rub the body briskly with the hands; 
keep an ice bag to the head, and continue the treatment until the tem- 
perature is reduced to 100° F., as shown by the thermometer inserted 
in the rectum. 
In heat prostration, with cool skin, stimulate the patient and rub 
his body and limbs. Hot rich soup or tomato juice, each well salted, 
given -with the patient at rest in bed has proven very useful in this 
condition. It is necessary that the soup should be hot; and even when 
there has been vomiting, administering hot soup both stimulates the 
patient and stops the vomiting. This should be repeated as soon as 
the patient feels at all hungry, and in the meantime hot tea should be 
given. In the more severe cases, hot food and drink will not suffice 
and then the patient should be given stimulants (aromatic spirits of 
ammonia), kept warm by blankets and hot-water bags, and a mustard 
plaster placed on the abdomen; and if the cramps are severe, the muscles 
should be vigorously rubbed. Salt should be given in all fluids, includ- 
ing water, but not in amounts sufficient to cause nausea or vomiting. 
Heat prostration may be prevented, in a large measure, by supply- 
ing men exposed to high heat with salinized water. Chapter IV 
VENEREAL DISEASE 
GONORRHEA 
On all small craft any person developing an acute active case of 
gonorrhea should not be retained as a member of the crew, but should 
be transferred to a naval hospital as soon as possible. Until that time 
the following treatment should be used. 
Gonorrhea is an inflammation of the urethra due to micro-organisms 
called gonococci. It usually occurs in from 3 days to 2 weeks after 
exposure, oftenest during the first week. First there is noticed an 
itching sensation, with a slight puffiness and redness about the lips 
of the opening. This is soon followed by a creamy discharge. There 
may be marked burning and difficulty in urinating. 
Some facts regarding this disease are as follows: (1) Gonorrhea 
is a disease in which the germs reach depths in the tissues far out 
of reach of drugs applied locally. (2) Cure is brought about by the 
patient’s own tissue response which can be aided by the direct appli- 
cation of mild chemical solutions. (3) Cure will be greatly delayed 
or even rendered impossible by the use of alcoholic beverages, inhala- 
tion of fumes of alcohol, any sexual excitement, prolonged physical 
exertion, and use of too strong, too frequent, or irritating treatment, 
(4) Cooperation of the patient is imperative. The greater it is, the 
gentler the treatment, the milder and shorter is the disease and the 
fewer its complications. 
The disease usually subsides in from 1 to 3 months. It is often 
difficult to tell absolutely when it is cured. The gonococci may in- 
vade the blood stream and attack numerous organs of the body. 
Treatment.—If any of the complications are present, rest in bed 
is absolutely necessary. The patient should drink plenty of water, 
avoid stimulants (alcohol, tea, coffee), and be regular in eating and 
sleeping. He should avoid eating greasy food and should keep his 
bowels well open and bathe frequently in hot water, if practicable. 
A 5 to 10 percent colloidal silver solution (argyrol) is an excellent 
injection. This solution deteriorates slowly, consequently a fresh 
solution should be prepared for each case. Before injection, urinate, 
then run the solution into the canal from a penis syringe and hold solu- 
tion in canal from 5 to 10 minutes before allowing to escape. Not more 
71 72 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
than 7.5cc (2 teaspoonfuls) should be used at a time and one or 
two injections in 24 hours are usually of greater benefit than a 
larger number. If it causes an increased flow of pus lasting more 
than an hour or two, or undue pain, the solution is too strong and 
should be diluted. 
The penis should be kept clean, thoroughly bathed in hot water 
or hot salt solution (1 teaspoonful of common salt to a pint of 
w’ater). Do not put cotton over the head of penis or use cotton 
in a tobacco bag, but use a piece of gauze cut about 4 inches square, 
with a slit in the center through which the head of the penis is 
passed until the gauze rests in the groove behind the head. The 
foreskin then is drawn down over the gauze which protrudes from 
the orifice of the foreskin and catches the pus as it is discharged 
from the urethra. This dressing should be changed several times 
daily, according to the amount of the discharge. If the foreskin is 
too short to hold such dressing in place, the end of the penis can 
be covered by a tobacco bag into which some gauze is placed. If 
urination causes pain or burning, immerse penis in a basin of hot 
water and allow urine to flow. Increase the intake of water and 
add to each tumbler a pinch of soda. To allay local pain and inflam- 
mation, the penis should be immersed several times a day in hot 
water. The testicles must be supported by a well-fitting suspensory 
bandage which does not press upward on the urethra at the junction 
of the penis with the scrotum and thus interfere with the free 
drainage of the urethra. This may prevent a swollen and painful 
testicle. 
COMPLICATIONS OF GONORRHEA 
Choedeb (painful erection).—This condition occurs especially at 
night. If it occurs, apply cold applications. Avoid too warm bed 
clothing. Keep bowels open. Keep mind clear of sexual thoughts. 
Empty bladder before turning in. Sleep on side. 
Phimosis.—The foreskin is elongated and contracted down over 
the head of penis. 
Treatment.—Soak in hot water or salt solution, if there is no relief 
try cold water. 
Paraphimosis.—-A condition where the foreskin is swollen, rolled 
back, and tight. 
Treatment.—About the same as for phimosis. Patient should be 
put to bed in treating the above complications. Get a doctor. 
Bubo ( “blueballs” ).—Swollen glands in the groin. 
Treatment.—The most important thing is rest in bed. Cold appli- 
cations are effectual at the outset, but later hot ones are better. If 
suppuration occurs (pus forms), an incision may be necessary. This VENEREAL DISEASE 
73 
should not be done by a layman. In time the abscess will break 
of itself. Wash out with sterile, warm, plain water or salt solution, 
apply wicks of gauze in the opening for drainage, and dress. Should 
be redressed as often as dressing becomes soiled. Burn all soiled 
dressings and wash your hands after dressing a bubo. 
Orchitis (swollen testicle).—A frequent complication of gonor- 
rhea. 
Treatment.—Rest in bed most important. Support and elevate 
the testicle. Apply cold or hot applications; hot is probably more 
agreeable. Keep bowels open. 
Stricture of urethra.—Usually a late complication of gonorrhea 
which probably will not have to be treated on a ship without a mem- 
ber of the Medical Department on board. Sometimes, however, it does 
not occur in the early stages of gonorrhea and the patient is in great 
pain and unable to pass his urine. Induce him to void his urine by 
applying hot applications over the bladder or placing him in a hot 
bath. If the condition is urgent, and a doctor cannot be gotten, as the 
last resort attempt to pass a catheter, if one is at hand. It should be 
sterile (boiled) and well greased with oil, albolene, glycerin, etc. It 
should be manipulated gently and with as little force as possible. 
Gonorrheal inflammation of the eye.—This condition is usually 
found in patients who have the clap and is caused by the individual 
rubbing or touching his eye after handling the penis and not having 
washed his hands. The inflammation spreads very rapidly and i ~ery 
severe. The lids are swollen as are the inner parts of the e ; nd 
thick pus soon begins to discharge. 
Treatment.—The sound eye should at once be protected by a shield 
consisting of a watch-glass crystal fixed over the eye with ac, ive 
plaster. The infected eye should then be washed frequently with ic- 
acid solution, and a little vaseline applied to the edges of the 1 is so 
they will not stick together and retain the pus. Cold applic.it ions 
should then be applied to the infected eye, and this may be dc lo by 
placing small pieces of cloth on a cake of ice and transferring th m to 
the eye, making the changes frequently. A doctor should be con cited 
at once. In all cases of inflammation in the eye the patient should be 
kept in a dark place, or the eye protected from the light by a shi Id. 
syphilis 
Syphilis is a communicable infection that frequently causes danger- 
ous constitutional disease and is usually acquired during sexua con- 
tact. It may rarely, however, be contracted otherwise. The pri rnary 
lesion of syphilis is a sore called a chancre, and starts at the po nt of 
inoculation, particularly where there has been a slight injury to the 74 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
skin or mucous membrane. If due to sexual contact, it is found upon 
the penis. It may start upon the lips, tongue, or tonsils. It usually 
appears from 8 to 6 weeks after exposure. However, the sore may not 
develop for 90 days after exposure. The average is about 1 month. It 
may appear as early as 10 days. It usually starts as a papule or 
pimple, which breaks in the center and forms an ulcer with hardened 
edges. This is soon followed by enlargement of the glands in groins 
and neck. In about 1 or 2 months the skin eruption appears. There 
may be sores on the lips, tongue, or cheeks, and a general sore throat. 
The hair may fall out and the patient may complain of headache, 
general muscular and bone pains and fever. 
Treatment.—Syphilis can be cured if treatment is begun promptly 
and taken under proper medical supervision. Consequently, a man 
with a sore on the penis or a sore elsewhere that does not heal promptly 
should see a doctor at once. The sore should be protected with a 
loose gauze dressing which should be changed twice daily. This 
gauze dressing should be kept moist with a warm salt solution (1 tea- 
spoonful of common salt to a pint of water). Antiseptics should never 
be used on a sore on the penis or on any sore that may be venereal 
in origin. Use of antiseptics may delay the making of an accurate 
diagnosis for weeks or even months and thereby prevent the patient 
from receiving early treatment which is so important for his cure. 
CHANCROID 
A soft chancre, venereal ulcer upon the penis. Usually occurs from 
2 to 10 days after exposure. Is sometimes hard to differentiate from 
hard chancre—primary stage of syphilis. Sore may be mixed—both 
chancre and chancroid. Keep sores clean with soap and warm water, 
then wash with warm salt solution (1 teaspoonful of common salt 
to a pint of water). This should be done several times daily. The 
same general rules about attention to the cleaning of hands after 
handling penis apply here as in gonorrhea. Also attention to towels, 
etc., of patient, to prevent its spread to others. The man should be 
seen by a medical officer as soon as a sore develops. 
LYMPHOGRANULOMA 
This so-called fourth venereal disease resembles chancroid and bubo 
in many respects and is accompanied in many cases with fever, loss 
of appetite and weight and prostration. It is transmitted by direct 
contact (sexual intercourse) and the discharges from the sores and 
buboes are infectious. Treatment is the same as for chancroid and the 
patient should be placed under the care of a medical officer. VENEREAL DISEASE 
75 
Because of their prevalence, ready transmissibility, and far-reach- 
ing effects, the venereal diseases are a menace to home and to family 
life. In one way, and one only, can infection with venereal disease 
be prevented and that is by completely avoiding promiscuous sexual 
intercourse. Clean living, the indulgence in athletic sports which pro- 
mote health and occupy the mind, and the avoidance of alcohol during 
hours of relaxation are important factors in the prevention of venereal 
disease. 
The use of both chemical and mechanical prophylactics against 
venereal infection has been advocated in the Navy for many years. 
The effectiveness is high when these measures have been used early 
and properly. Those who expose themselves to the danger of con- 
tracting a venereal disease should be urged to use immediate prophy- 
laxis. The oldest and best prophylactic measure is the mechanical 
appliance known as the sheath or condom which is usually made of 
rubber. In the use of a condom it is essential that some space remain 
at the end to prevent any chance of undue stress or strain on the 
rubber. Upon removal care must be exercised so as not to increase the 
chance of contamination from* the sheath. Then immediate washing 
of the penis and surrounding parts and the proper application of the 
contents of a prophylactic tube or 33-percent calomel ointment will 
prevent many a case of venereal infection. Prophylactic tubes, often 
called sanitubes, are supplied in the medicine box. 
Medicinal or chemical prophylactic treatment used immediately 
or within the first hour after exposure is very efficacious in prevent- 
ing the development of venereal infection. Although its value rap- 
idly diminishes from then on and is greatly reduced after 8 hours 
have elapsed, men returning to the ship or station within 8 hours 
following exposure should be urged to avail themselves of chemical 
prophylaxis. 
A careful record should be kept showing the name and rating 
of the person treated, the hour of treatment, the hour and place of 
exposure, and the name and address of consort. 
The Navy prophylactic tube consists of a pliable, metal tube 
with a tip which can be inserted into the urethra. One-half of the 
contents is injected into the urethra and the other half is used 
externally. Use of the contents immediately before cohabitation is a 
valuable preventive measure. 
The method of prophylaxis used in most Navy prophylaxis sta- 
tions is to have the man urinate and then thoroughly wash the penis, 
scrotum, and pubic region with liquid soap and warm water. One- 
PROPHYLAXIS 76 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
half a syringeful of 1-percent solution of strong protein silver 
(protargol) or 10-percent solution of mild protein silver (argyrol, 
silvol) is injected gently into the anterior urethra and allowed to 
flow out; the remainder is then injected and held in the urethra for 
5 minutes. When parts that were washed have thoroughly dried, 
the penis, scrotum, thighs, and pubic region are liberally anointed 
with 38 percent calomel ointment in lanolin. The ointment should 
be well rubbed in for at least 10 minutes, paying special attention 
to the fold between the head and foreskin. The clothing should be 
protected with a temporary dressing and the ointment allowed to 
remain for 12 hours. 
It should always be remembered that diseases that have attacked 
more than half the men of the country during youth, diseases that 
bring misery to thousands of children and suffering to hundreds of 
thousands of women innocently infected, and that are incurred al- 
most exclusively through promiscuous sexual intercourse, are dis- 
eases to be avoided. It should also be remembered that the man 
who practices promiscuous cohabitation almost invariably contracts 
one of the venereal diseases, sooner or later, in spite of every pre- 
caution. And, if sufficient moral stamina to resist sexual temptation 
is not possessed, then it must be remembered to take prophylactic 
treatment as soon as possible after exposure. Chapter V 
HOSPITALIZATION 
Sick, wounded, or disabled officers and enlisted men of the Navy, 
or Marine Corps are entitled to the benefits of medical and dental 
attendance by naval medical and dental officers either within or 
without a naval hospital, and to hospitalization within naval hos- 
pitals so long as they remain sick, wounded, or disabled (N. R. 1187, 
1191). 
In the absence of naval hospital facilities, the hospitals of the 
United States Army, the Public Health Service (including hospitals 
under..contract), or the Veterans’ Administration shall be utilized 
for hospitalization of the personnel of the Navy and Marine Corps 
subject to the following conditions: 
1. Where naval hospitals are not available. 
2. Hospitalization must be authorized by the commanding officer, 
or the senior officer present. 
3. The consent of the officer-in-charge of the hospital must be 
obtained. 
Patients may be hospitalized in civil hospitals subject to the fol- 
lowing conditions: 
1. Facilities of naval or other Government hospitals are not avail- 
able. 
2. Patient must be in a duty status. 
3. Immediate hospitalization is required for the proper care and 
treatment of the patient, 
4. Hospitalization must be authorized by the commanding officer, 
or by the senior officer present; and, when not an emergency, by the 
Bureau of Medicine and Surgery. 
Attention is also invited to instructions in articles 1143 and 1203, 
N. R., concerning patients transferred to other than a naval hospital, 
particularly in a foreign port. 
The public health officer of the port, if present, should be consulted 
regarding hospital facilities, and admission of the patient should be 
made with his approval and under his directions. A list of the Public 
Health Service hospitals as well as its contract stations will be found 
in the annual circular, Contracts for the Care of Seamen, etc., issued 
by the Public Health Service. 
77 
457944°—42 6 78 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
Bills for treatment in Government hospitals other than naval are 
submitted to the Bureau of Medicine and Surgery for payment through 
the respective heads of the activities concerned or direct to the Bureau, 
in the case of civil hospitals, and no payment by the commanding 
officer of the ship is therefore required. 
Claims for dental expenses will be allowed only when such expenses 
have been incurred in emergencies by personnel of the Navy and Marine 
Corps to whom the services of a naval dental officer were not available, 
and when the approval of a naval medical officer, if available, has been 
secured. 
The term “in emergencies” is intended to be applied to treatment 
rendered to alleviate suffering or to prevent suffering which will 
obviously occur before the approval of the Bureau of Medicine and 
Surgery can be obtained. Emergency treatment will not include the 
furnishing of prosthetic appliances or the use of precious metals. 
Attention is invited to article 1189, Navy Regulations, in which are 
stated the conditions under which medical expenses may be allowed, 
and especially to the requirement that payment of such expenses is 
contingent upon the prompt reporting of illness or in jury to the Bureau 
of Medicine and Surgery. 
Upon completion of treatment, unless authorized in advance by an 
approved requisition, itemized certified bills shall be submitted to the 
Bureau of Medicine and Surgery in duplicate, and shall show the cost 
of each item of expense and the dates on or between which the services 
were rendered; for dental treatment they shall also show in detail 
which teeth were treated, the nature of the treatment rendered and 
the materials used. Bills of other Government hospitals will be sub- 
mitted through their respective headquarters. 
Receipt of the services by the party receiving treatment or by the 
officer authorizing same shall be acknowledged either on the face of the 
bills or by separate certificate. 
When requisitions for civilian medical, dental, nursing, or hospital 
treatment of service personnel are approved by the senior officer pres- 
ent in advance of the Bureau’s approval, Form U report shall be ac- 
companied by a copy of the requisition and a copy of each public 
voucher covering payment. 
Ordinarily, naval personnel on leave are not in a duty status and are 
not, therefore, entitled to medical or hospital treatment at Govern- 
ment expense. When leave is canceled or extended, the status remains 
the same and commanding officers are without authority to authorize 
treatment for them at Government expense. Personnel who have 
been granted liberty for a period of 24 hours or less are considered as in 
a duty status provided that during the period of liberty it would be HOSPITALIZATION 
79 
fairly practicable to secure their return for the performance of duty 
should their presence be required. 
Commanding officers are responsible for bringing this information 
to the attention of all officers and enlisted men about to go on leave 
of absence and to the personnel under their charge when on detached 
duty. Personnel on leave of absence may be hospitalized in Gov- 
ernment hospitals other than naval on authority of the Bureau of 
Medicine and Surgery. 
A report on NMS—Form U shall be immediately forwarded in 
duplicate to the Bureau in each case of any sickness or injury of per- 
sonnel of the Navy or Marine Corps where treatment is received 
from other than the Medical Department of the Navy. This report 
is required in all cases where medical, dental, or hospital treatment 
is furnished by civilian physicians, civilian dentists, civil hospitals, 
or Government hospitals other than naval to personnel of the Navy 
and Marine Corps, active or inactive, on duty or on liberty or leave, 
under circumstances that eventually may be used as the basis of 
a claim against the Navy Department. This report should be pre- 
pared by a naval medical officer when practicable, and in the absence 
of such officer, by the senior officer present, or by the individual 
concerned as soon as able. 
If printed forms are not available, a typewritten report may be 
made in duplicate giving the following information: Name and rank 
or rating; date and place of birth; station or vessel to which attached; 
diagnosis; prognosis; status (duty or not). If on liberty, state exact 
period for which granted and the hours and dates from and to; cir- 
cumstances ; disposition; give dates on or between which services were 
rendered; by whom were the services rendered. Were the services 
necessary and authorized, and by whose authority ? Where authority 
is given in writing, a certified copy of same should be attached to 
this form. Where authority is given verbally, a certificate of the 
officer granting same should be attached and should show when and 
how the services were authorized. Were the services of a naval 
medical (or dental) officer or a naval hospital available? In the 
case of an officer, the date of his orders and the name of the Supply 
Corps officer carrying his accounts shall be stated. When an officer 
is admitted to a hospital for treatment, statement shall also be made 
as to whether or not hospital ration notice (S. & A. Form No. 35-M) 
has been issued. 
Due to the uncertainty of the movements of naval vessels, the 
personal effects of an officer or man of the service are sent with him 
whenever he is transferred to a hospital for treatment (N. R. 1143. 
1187). Chapter VI 
DEATHS 
The commanding officer shall cause to be entered in the log book 
the name and rank or rating of any person who may die on board, 
with a statement as to the exact time and cause of death (N. R. 
908 (1)). 
When death occurs while the ship is at a port within the conti- 
nental United States, the commanding officer shall report the same to 
the Secretary of the Navy by dispatch, giving the following infor- 
mation: (a) full name; (b) rank or rating and service number; 
(c) branch of service; (d) in the case of a reservist, whether or not 
on active duty; (e) date, place, and cause of death; (f) line of duty 
and misconduct status; (g) full name and relationship of next of 
kin; (h) address of next of kin; (i) whether or not next of kin has 
been notified; (j) what disposition has been or will be made of 
remains, or where the remains are being held; (k) pay per month; 
(1) full name and address of beneficiary; (m) whether or not the 
deceased carried United States Government life insurance and date to 
which premiums have been paid. In case full information under any 
of the foregoing headings must await later investigation or deter- 
mination, the dispatch shall be sent with whatever data are avail- 
able, and supplemented with complete information at the earliest 
possible date. In such cases he shall also inform (by dispatch) the 
nearest relative or legal representative of the deceased (unless living 
outside of continental United States) and request him to communi- 
cate by telegram with the Bureau of Medicine and Surgery, Navy 
Department, or the Commandant, Marine Corps, Washington, D. C., 
regarding disposition of the remains. If practicable, the body shall be 
transferred immediately to the nearest naval hospital or to the medi- 
cal department of the nearest navy yard or station for embalming, 
preparation, and retention for such further disposition as may be 
directed by the Bureau of Medicine and Surgery. Otherwise the body 
shall be embalmed and retained on board until directions for disposi- 
tion are received (N. R. 908 (2)). 
When death occurs at sea or in a port outside the continental 
United States, the commanding officer shall not notify the next of 
kin by dispatch but shall make report by dispatch to the Secretary of 
the Navy, giving the information specified in the preceding para- 
81 82 
MEDICAL COMP END FOR COMMANDERS OF NAVAL VESSELS 
graph, and request instructions for disposing of the body. When- 
ever practicable, the remains shall be embalmed and retained on 
board awaiting instructions from the Bureau of Medicine and Sur- 
gery, and burial shall not be made in a foreign port or at sea in 
advance of receipt of such instructions, except when preservation 
or retention of the body is impossible (N. R, 908 (3)). 
Whenever loss of life occurs from accident or under peculiar or 
doubtful circumstance3, a court of inquiry or a board of investigation 
should be ordered to investigate fully and report on the circum- 
stances and facts, and also to give an opinion and to make such 
recommendation as may be appropriate. The court of inquiry or 
board of investigation is held in accordance with the provisions of 
chapter X, Naval Courts and Boards. 
In all cases of death occurring in the Navy under unnatural or 
suspicious circumstances, or where the cause of death is obscure or not 
apparent and a decision as to origin affecting pension or gratuity is 
involved, the commanding officer should have such post mortem exam- 
ination or autopsy as may be required in determining the exact cause 
of death performed by a medical officer, or, if none is available, by a 
competent civilian physician. In all cases the autopsy must be 
performed in a manner requiring no more disfigurement of the body 
than is necessary to obtain the evidence necessary. The results of all 
autopsies shall be fully recorded in the reports of death and health 
records. 
When burial is necessarily made in a foreign country, the health reg- 
ulations as to disinterment shall be ascertained and reported by letter 
to the Bureau of Medicine and Surgery, together with information as 
to date, place, and other circumstances of burial. 
Payment of expenses in connection with burial in a foreign country 
may be arranged through the nearest United States consul in the 
same manner as payment of bills for hospital treatment, reimburse- 
ment to be made by the Navy Department to the State Department 
upon presentation of receipted vouchers. Such expenses, so far as 
practicable, should be limited to the lowest amount consistent with 
decent preparation and encasement in accordance with Navy Regula- 
tions, or to meet the requirements of laws governing transportation. 
Whenever the services of a civilian undertaker are required within 
the United States or any of its possessions, the same limitations will 
be observed and itemized bills properly certified will be forwarded to 
the Bureau of Medicine and Surgery for settlement. 
Cremation of remains will be permitted at Government expense only 
when authorized in advance by the Bureau of Medicine and Surgery. 
The necessary and proper funeral expenses of officers and enlisted 
men of the Navy and Marine Corps at naval stations within the DEATHS 
83 
United States will be provided for by annual contracts, and elsewhere 
within the United States will be allowed when approved by the Bureau 
of Medicine and Surgery, or by such officers as may be designated by 
the Commandant, Marine Corps, respectively. 
The amounts paid for funeral expenses, including preparation, en- 
casement, and interment of remains, shall not exceed $200 each, unless 
due regard for decent burial renders greater expense necessary, which 
fact must be certified on all copies of the public voucher by the officer 
ordering the payment of the bill. 
The remains of naval dead shall be prepared for interment or for 
shipment to their homes under the supervision of an officer who shall 
determine by final inspection in each instance that the work of embalm- 
ing, cleansing, shaving, and dressing have been competently performed, 
and that the encasement, clothing, etc., meet all the requirements of the 
occasion and comply with the terms of the contract. 
Each body shall be dressed in a clean, presentable, and complete 
uniform (except for cap and shoes) of the proper rank or rating. 
A cap may be placed inside of the casket. When a body is sent to a 
hospital or hospital ship for embalming and further disposition, 
suitable uniform for burial shall be sent with it. Where available 
clothing belonging to a deceased officer or enlisted man is not suf- 
ficient in quantity or of proper kind or quality, or is too much worn, 
new clothing (outer and under) shall be obtained as may be neces- 
sary from the Supply Department and charged to the appropriation 
“Care of the dead.” 
Especial care shall be exercised that the evidences of autopsies 
shall not cause unnecessary distress to parents, and that the wounds 
so made shall be neatly closed, and that packings and dressings em- 
ployed shall be of clean and suitable material. 
Navy (or Army) standard caskets, when available, shall be used 
for transportation of remains of officers and enlisted men. 
When transportation of remains of naval or Marine Corps per- 
sonnel is to be effected, the shipment if by rail will be either on 
tickets procured by transportation request or by express on Govern- 
ment bill of lading; and, if by commercial steamship, on minimum 
first-class fare. One copy (fifth) of the bill of lading, on which 
transportation of remains of the dead is effected, shall be securely 
pasted on top of the shipping casket with a dextrin paste, similar to 
that used by the express company, and then covered with shellac or 
varnish. A special label, prohibiting collection of express charges 
from consignee, should be obtained from the local express agent and 
attached to the outside case, in addition to the copy of the bill of 
lading. If Government bills of lading are not available, the civilian 
undertaker should include transportation charges in his bill, sub- 84 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
mitting receipts from the transportation company. Under no 
circumstances should a body be sent “collect.” 
Personal effects of active-duty personnel not to exceed 150 pounds 
may be forwarded with the body when shipped either by express or on 
transportation request without additional charge. When personal 
effects exceed 150 pounds, any excess should be delivered to the supply 
officer for shipment, such excess being chargeable to the appropria- 
tion “Instruments and supplies, Bureau of Navigation,” for Navy 
personnel and “General expenses, Marine Corps,” for Marine Corps 
personnel. 
The next of kin, family, legal representative of the deceased, or 
the consignee, should the body be sent to other than the preceding, 
shall be informed by telegram of the time and method of forwarding 
and, if practicable, the routing and scheduled time of arrival at des- 
tination; also of any special attending circumstances, such as com- 
municable disease and the advisability or inadvisability of opening 
the casket for the purpose of viewing the remains. Copies (original 
and sixth) of the bill of lading will be promptly forwarded to the 
consignee, under special-delivery stamp, and accompanied by an 
explanatory memorandum. Investigation has determined that in 
most instances where the express company attempts to collect express 
charges from consignee, the difficulty has been due to failure of the 
bill of lading to arrive in advance of the body, or to a misunder- 
standing on the part of consignee as to its purpose. 
The senior officer present is authorized to issue a national flag 
(United States national ensign No. 7) to accompany all bodies of 
naval or Marine Corps personnel forwarded or delivered to the next 
of kin or relatives for private interment, in order that the flag may 
be available for use at the time of burial. Request for such issue 
shall be construed as included in application for the body. The flag 
shall be inclosed in a suitable canvas bag or sack and securely attached 
to the casket, or placed inside the shipping box, in which case the 
box shall be labeled “FLAG INSIDE” or the consignee otherwise 
notified. The act of May 26, 1928, authorizing the Secretary of the 
Navy to furnish an escort to place of burial for the naval dead who 
have lost their lives in the naval service, permits the selection of 
a relative or other person not a member of the Navy or Marine Corps 
to be sent as such escort at Government expense. The expenses so 
authorized include subsistence en route and sleeping-car accommoda- 
tions to place of burial and return therefrom when necessary. Upon 
request of the next of kin or family of the deceased, a service or 
civilian escort of one person may be assigned to accompany the re- 
mains to place of burial. The escort, if of the service, shall be of 
the equivalent rank or rate of the deceased so nearly as may be prac- DEATHS 
85 
ticable and, when possible, a friend or associate. United States Navy 
Travel Instructions contain full instructions relative to travel allow- 
ances and outline the details to be followed in sending an escort to 
accompany to place of burial the remains of officers and enlisted 
men who have lost their lives in the naval service. The travel of the 
escort may be from point of shipment to place of burial and return, 
or from the place of prospective burial to the point of shipment and 
return, the amount of travel involved in either case being the same. 
When the remains are returned to the United States from points 
outside the continental limits, a relative may travel as escort to point 
of reshipment within the United States. One first-class passage at 
minimum rate will be furnished such civilian escort. From this point 
the commandant of the yard or station shall arrange for escort to 
final destination of remains as in other cases. 
All transportation and travel expenses of the escort to the prospec- 
tive place of burial and return therefrom will be a charge to “Pay, 
subsistence, and transportation or general expenses, Marine Corps,” 
as the case may be. The only charge to be lodged against the appro- 
priation “Care of the dead,” when remains of naval dead are shipped 
on transportation requests, is for the cost of the corpse ticket. In 
the case of Marine Corps dead, the cost of both escort and corpse 
ticket is a charge to “General expenses, Marine Corps.” 
The commanding officer shall, upon the death of any person on 
board the ship under his command, cause all of the effects of the 
deceased to be collected and inventoried. If the deceased was an 
officer, this shall be done by two officers of the ship; if a member 
of the crew or other person, by the officer of his division or one de- 
tailed for the purpose. The inventories shall be made out in dupli- 
cate, duly attested and signed by the officers making them. Upon 
the completion of the inventory the effects, if not of a perishable 
nature, shall be put up in packages of a convenient size and sealed 
with the seal of the ship. The commanding officer shall retain one 
copy of the inventory himself, and shall deliver the other to the 
supply officer, who shall also take charge of the effects for safe- 
keeping (N. R. 908 (4)). 
If any of the effects of a deceased person are perishable and de- 
teriorating, they shall be immediately sold at auction, and the pro- 
ceeds of sale shall be disposed of in the same manner as other money 
found in his effects (N. R. 908 (5)). 
All moneys, articles of value, papers, keepsakes, and other similar 
effects shall be forwarded to the legal representative, or in default 
of such, the heirs at law of the deceased. Should it be impossible 
to ascertain the existence of the legal representative or of heirs at 
law, the articles mentioned and other similar effects shall be sent to 86 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
the Chief of the Bureau of Navigation or to the Commandant of the 
Marine Corps, as the case may be, for safekeeping. Should the 
above-described property be unclaimed for a period of 2 years after 
the death of the owner thereof, all articles and effects so deposited 
shall be sold at auction to the highest bidder, and the proceeds of 
such sale shall be deposited in the Treasury as miscellaneous receipts 
(N. R. 908 (6)). 
If at any time during the 2 years such above-described property is 
in the custody of naval authorities the legal representative of the 
deceased person shall apply for his effects, all shall be delivered to 
him (N.R. 908 (7)). 
The commanding officer shall exercise his discretion in causing the 
effects of deceased enlisted men to be sold at auction at the mast, or 
retaining them for transmission to the heirs, relatives, or friends. 
In exercising this discretion, he sha*!l be governed by the wishes 
of the heirs, relatives, or friends, if possible to learn them. If sold 
at auction, the proceeds of sale shall be disposed of in the same 
manner as moneys found in their effects (N. R. 908 (8)). 
He shall cause the accounts of all deceased persons to be closed 
as soon as possible and forwarded to the General Accounting Office, 
together with the will, if any can be found. These accounts must 
be examined and approved by the commanding officer (N. R. 908 (9)). 
He shall advise the heirs or next of kin of a deceased officer, nurse, 
or enlisted man to communicate with the Bureau of Supplies and Ac- 
counts relative to the submission of claim for arrears and pay due. 
Payment of death gratuity will be made by the Bureau of Supplies and 
Accounts (N. R. 908 (10)). For additional information pertaining to 
deaths and resultant duties, the reader is referred to articles 908 and 
1841, United States Navy Regulations, and chapter 19, Manual of the 
Medical Department, 1939. Chapter VII 
PERSONAL HYGIENE 
By personal hygiene is meant any measure taken by the individual 
by which he can avoid disease and promote his health and strength. 
Such measures include the eating of the proper amount and kind of 
food, drinking the proper kind and amount of water, the wearing of 
proper clothing to suit the temperature, the breathing of wholesome 
air, all of which tend to heighten resistance; the avoidance of habits 
and practices which are liable to contract or transmit infectious dis- 
eases such as those borne by the mouth, nose, intestinal, venereal dis- 
charges, etc.; the proper use of the eyes, etc. Cleanliness of the person 
and the clothing is one of the first requisites for good health. The 
entire body, if practicable, but at least the feet, armpits, and genitals 
should be bathed daily, and the exposed parts of the body, face, and 
neck as often as necessary. The hair should be kept cut short, and the 
finger and toe nails kept trimmed and clean. Dirty bodies and dirty, 
infected clothing are very often the cause of skin and other diseases. 
A moderate amount of exercise in the open air should be taken regu- 
larly. With proper exercise the elimination of waste products from 
the body is increased through deeper breathing, and more perspiration; 
the muscles and heart become better nourished and a better circulation 
improves all the other functions of the body; the digestion is im- 
proved; and resistance to certain diseases is increased. The bowel 
should move daily, otherwise poisonous substances are absorbed into 
the system. If proper food is eaten and proper exercise taken, the 
bowel generally will look after itself. The mental state may affect the 
health and a cheerful state of mind promotes and benefits all the func- 
tions of the body and vice versa. 
Not only is the practice of personal hygiene one of the greatest 
factors in the prevention of disease, but also it is one of the chief 
aids to the sanitarian in destroying or preventing the transmission 
of the agents which cause the communicable diseases. Infective dis- 
charges from the respiratory tract can be readily transferred to 
others by promiscuous coughing, sneezing, and expectorating, or by 
the use in common of towels, drinking cups, and eating utensils. 
Good personal hygiene will prevent many of the air-borne and hand- 
to-mouth infections. 
87 88 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
Following is a summary of the principles of personal hygiene 
which are adaptable to naval life: 
1. Keep the body clean. Bathe the entire body, or as much of it 
as possible daily. 
2. Keep the hands clean. Always wash them before eating and 
after leaving the toilet. Keep the fingers away from the nose and 
mouth, and the fingernails clean and cut short. 
3. Keep the feet clean and the toenails cut short and straight 
across, 
4. Change the underwear and socks frequently. Wear socks that 
are 1% or 2 sizes larger than the shoe size and shoes that have been 
fitted carefully. 
5. Brush the teeth every morning and evening or after each meal 
if possible. Have the teeth examined by a dentist at least every 6 
months. 
6. Eat slowly a moderate amount of nutritious food regularly and 
drink plenty of pure water. 
7. Be regular in going to the toilet for bowel actions, 
8. Take a moderate amount of exercise in the open air regularly. 
Breathe deeply at all times. 
9. Sleep in a well-ventilated place with plenty of fresh air. 
10. Avoid excesses of any kind, but especially alcoholic drinks 
and promiscuous sexual intercourse. If exposed to venereal infec- 
tion immediately use prophylaxis. 
11. Avoid persons with colds or coughs and keep away from 
others when suffering with one. Cough and sneeze in a handkerchief. 
12. Avoid unnecessary exposure to extremes of weather. Change 
into dry clothes as soon as possible after getting wet, and dry the 
wet clothing before stowing it away. Clothing wet with perspira- 
tion should be dried and, if possible, washed before being stowed 
away. 
13. Avoid using the toilet or other personal articles of others and 
do not allow others to use one’s own. 
14. Be cheerful. 
The precautions regarding the care of the hands and fingers are 
of particular importance for the majority of infections are taken 
into the body through the mouth, and the hands are responsible for 
a large number. Likewise the principle pertaining to “colds” should 
be closely observed. Finally, if there is one basic law, it is to avoid 
excesses of any kind (Handbook, Hospital Corps, 1939). Chapter VIII 
PREVENTIVE MEDICINE 
In general, preventive medicine has for its objective the control or 
prevention of disease and the conservation and maintenance of health. 
In the Navy it is similar in its scope to public health activities of 
civilian communities, except insofar as it is modified, of necessity, by 
conditions peculiar to the Navy. These modifying conditions are 
mainly those resulting from factors of environment accompanying 
naval activities under restrictions imposed by the nature of the service. 
The following references in the Navy Regulations pertain to the 
duties of the commanding officer of a naval vessel in relation to 
preventive medicine: 
1. Provisions (art. 20 (7),N. R.). 
2. Health of crew (art. 20 (8), N. R.). 
3. Care of crew (art. 843, N. R.). 
4. Service on unhealthy stations (art. 901, N. R., see art. 741, N. R.). 
5. Effects destroyed to prevent spread of disease (art. 916, N. R.). 
6. Cleanliness (art. 1319 (1),N. R.). 
7. Precautions as to health of the crew (art. 1319 (2), N. R.). 
8. Clothing (art. 1319 (3), N. R.). 
9. Bedding (art. 1319 (4), N. R.). 
10. Allowance of water (art. 1319 (5), N. R.). 
11. Inspection and use of fresh food, etc, (art. 1320 (2), N. R.). 
12. Food and water (art. 1320 (5), N. R.). 
13. Athletic exercises (art. 1323 (1),N. R.). 
14. Bumboats and traffic (art. 1323 (3), N. R.). 
15. Harbor water (art. 1324, N. R.). 
16. Disposal of refuse (art. 1337, N. R.). 
17. Leave to enlisted men (art. 1731 (1), N. R,). 
18. Unserviceable and unsanitary articles (art. 1910 (1), N. R.). 
19. Clothing and personal effects of officers and men (art. 1925, 
N. R.). 
HEALTH RECORDS 
These records, if aboard, should be checked at intervals, once each 
quarter, to see that there is one for each member of the crew, that they 
have received the required protective inoculations against smallpox 
and typhoid fever, and that any belonging to men who have been trans- 
ferred are forwarded to the proper activity. 
89 90 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
FOOD 
Regular inspections should be made of the issue room, galley, etc., 
to observe and correct any unsatisfactory condition regarding the 
storage, handling, preparation, and serving of food, special attention 
being given to foods liable to become culture media for bacteria—meats 
and meat products, fish and shellfish, milk and milk products, salad 
ingredients, and cream fillers. 
FOOD HANDLERS 
Cooks, butchers, bakers, helpers, and messmen must be required to 
keep their hands, as well as utensils and implements used in the prepa- 
ration and serving of foods, scrupulously clean. Sufficiently close 
supervision should be maintained over the health of food handlers to 
insure prompt detection of infectious disease, including venereal 
infection. 
UTENSILS AND MESS GEAR 
Cooking utensils should be washed thoroughly with hot water and 
soap or other cleansing agent after use and after application of me- 
chanical or chemical polishing agents. Mess gear should, after each 
meal, be washed sufficiently to remove adherent particles of food and 
mouth secretions, sterilized, and allowed to dry without wiping. The 
minimum safe sterilization requirement is submersion in, or equivalent 
exposure to, water at a temperature above 180° F. for not less than 
1 minute. 
WATER 
The evaporation of water, either at atmospheric or reduced pres- 
sures and temperatures, is a physical separation of water from its dis- 
solved and suspended constituents, including bacteria. Low pressure 
and temperature evaporation can produce even from contaminated 
water as reliable and sterile an effluent as high temperature distilla- 
tion if raw water does not prime or leak into it. The salinity of the 
distilled water may be watched as an index of operation and the stand- 
ard of 0.25 grain per gallon should be maintained if possible. If the 
salinity exceeds 0.5 grain per gallon the water should be discarded and 
not pumped into the ship’s tanks. When reliable information regard- 
ing the sanitary quality of water taken aboard at a dock or from a 
water boat is not available the water should be passed through the 
ship’s distiller. Water from Gatun Lake or other fresh-water lake in 
the Canal Zone should always be so treated. 
The average minimum actual consumption of fresh water per 
person on board ship required in the interests of personal hygiene PREVENTIVE MEDICINE 
91 
is about 12 gallons per day. Arbitrary limitation of hours during 
which washrooms are open, for use, or restriction of members of the 
crew to definite small quantities of water for bathing and washing 
clothes tend to result in serious breaches of hygiene. If unusual 
circumstances require drastic restrictions in the use of fresh water 
the allowance should be not less than two full buckets per man 
per day for the general crew and not less than four buckets for men 
of the engine room, fireroom, and shop forces. 
Scuttle-butt terminals should be kept in good condition and at 
a slight angle so that water does not fall back on the outlet. Valve 
handles, like door knobs, may be an important indirect means of 
transmitting the causative agents of communicable disease. This 
can be obviated by the use of a foot-controlled valve. Under 
epidemic conditions they should be frequently disinfected and dis- 
infectant solution provided for hands. In places where sanitary 
scuttle-butts are not available suitable arrangements must be made 
to prevent the use in common of drinking cups or glasses. 
VENTILATION 
Living compartments, offices, and work spaces are to be kept in 
the comfort zone insofar as weather conditions permit. Ventila- 
tion ordinarily is effected by supply and exhaust blowers, electric 
fans, and by natural means. 
In cool and cold weather adequate ventilation requires a sufficient 
quantity of air flowing through a given space to keep the air reason- 
ably free from harmful substances and disagreeable odors. In hot 
weather the volume of air required for the removal of excess heat 
is so great that other ventilation factors usually become incon- 
sequential. Exhaust-system blowers are required for rapid removal 
of overheated or malodorous air from compartments in which good 
ventilation connot otherwise be maintained. Both supply and ex- 
haust systems are considerably reduced in efficiency by accumulation 
of dirt in ducts and upon screens. 
Compartments which have been closed for some time, or those 
which have been sealed, should not be entered until after they have 
been well ventilated and the air tested by a lighted candle. If the 
flame is extinguished the air is unsafe. Men should not descend 
into such compartments without having a life line attached to them 
and carefully guarded. 
GARBAGE 
Garbage is unsightly and usually malodorous. By attracting flies 
or rats it may indirectly menace health. When prompt disposal is 
not possible cans with well-fitting covers should be used. With an 92 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
unusual number of cans in use it is difficult to keep them in satisfac- 
tory sanitary condition. To avoid nuisance base-force arrangements 
should be made in advance for daily disposal. 
Accumulations of refuse below decks increase fire hazards and have 
a certain bearing on health by inviting expectoration (article 1337 
N. R.). Dock garbage and refuse platforms must be properly used 
and kept clean by ship’s forces. Good sanitary condition at all hours 
is necessary to limit numbers of flies, roaches, and rodents. 
SEWAGE DISPOSAL 
Disposal of ship sewage overboard by salt water carriage offers no 
sanitary problem except the pollution load added to harbor water 
about the ship. When conditions are otherwise favorable and swim- 
ming is permitted, discharge of sewage from the side on which men 
are in the water should be discontinued at least one-half hour 
before swimming call is sounded. 
LIGHTING 
Hygienic lighting connotes adequate illumination, general and 
focal, with freedom from glare, troublesome shadows, and annoying 
high lights, to permit reading, writing, required work, or other 
activity to be performed without avoidable eyestrain. The most 
important single fundamental factor in lighting is brightness con- 
trast. Adequate general illumination permits sufficiently deep vision 
into shadows in all parts of the room or compartment so that in 
glancing up from work the iris will not dilate widely and contract 
suddenly upon turning back to the work in hand. Moving shadows 
and flickering light should be prevented. Glare is direct when a 
source of light comes within the field of vision with the eyes focused 
upon work, and indirect when light from source is reflected to the 
eyes by the work or some adjacent object. In general, glare is 
troublesome if the work itself is not brighter than other objects in 
the field of vision. Focal lights while undesirable are often neces- 
sary. Such lights should ordinarily be placed directly over the 
work if the plane of work is horizontal; otherwise the location should 
be such as to afford the best view of the details of the work, while 
avoiding as much as possible under illumination, glare, and trouble- 
some shadows. Too great concentration at one point in the work 
field will result in tremendous eyestrain from glare, shadows, and 
high lights. Places where falls may occur should be adequately 
illuminated. Focal illumination should be provided for band saws, 
lathes, grinders, and cutting, mixing, and chopping machines. A 
sufficient number of lights of adequate candlepower should be main- PREVENTIVE MEDICINE 
93 
tained in crew’s compartments for reading and writing. Individual 
lights used in focal illumination should be so placed that light rays 
will not enter directly into the eyes of the worker. 
ACCIDENT PREVENTION 
The majority of accidents are avoidable. Accidents usually occur 
because someone fails to observe simple precautionary rules or fails 
to employ well-known safety measures. Dangerous machinery and 
electric appliances should have adequate safeguards. All passage- 
ways should have adequate illumination. Ladders should have hand- 
rails or lines and open hatches should have substantial guards. The 
Bureau of Ships’ Construction and Repair Manual contains much val- 
uable information on safety measures and appliances. 
SWIMMING 
Caution should be taken, especially when the temperature of the 
water is below 70° F., to recall men who, not reacting well in the water, 
develop cyanosis and severe shivering. In the Tropics care should be 
taken to prevent swimmers from developing severe sunburn. Swim- 
ming should not be permitted in water contaminated with sewage. 
457944°—42 7 Chapter IX 
QUARANTINE, DISINFECTION, AND BILLS OF 
HEALTH 
Quarantine 
The term “quarantine” has its origin from the Italian quaranta, 
meaning 40, this figure representing the number of days for which 
vessels, beginning early in the fifteenth century, were held under 
observation on account of the frequent invasions of plague. 
The term now means any limitation placed upon the freedom or 
movement of exposed or contact persons or animals with the object 
of preventing or controlling the spread of communicable disease. The 
expression “quarantine methods” is often used to cover all restrictive 
measures instituted by health officials for the purpose of limiting 
the spread of disease on land as well as at sea. There is community 
quarantine when one city or town imposes restrictions upon travelers 
from some other place in the same country, and border quarantine 
when the aim is to prevent the introduction of disease over land or 
across a river from a foreign country. Interstate quarantine is en- 
forced by the Federal Government through the agency of the United 
States Public Health Service, and consist of routine and special activi- 
ties planned to limit the spread of disease incident to interstate travel 
and traffic. 
Maritime quarantine includes all measures undertaken by the Gov- 
ernment to prevent the introduction of disease through seaports. 
The first quarantine station was established at Venice in 1403, on a 
small island adjoining the city, and had as its basic idea the blind 
application of the theory of isolation to prevent the spread of plague. 
Today quarantine stations are to be found in the principal ports of the 
world at which scientific and accurate periods of detention are in use 
to prevent the ingress of certain threatened diseases. From the earliest 
days until the determination of the exact modes of transmission and 
periods of incubation of the quarantinable diseases, quarantine con- 
sisted in more or less rigorous periods of detention, even up to 100 days, 
with the expectation that in this time the disease, if present, would 
“wear itself out,” or that the “effluvium” would be removed by the in- 
fluence of sun, rain, frosts, or snows. This haphazard quarantine 
was extremely expensive, proceeding at times even to burning the entire 
ship and cargo. 
95 96 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
Modern methods of quarantine both on land and sea are based upon 
known modes of transmission and periods of incubation of certain 
diseases which are classed as quarantinable. The studies of the last 
30 years have established that many diseases, including all of those 
known as quarantinable, are due to certain microorganisms or viruses 
with definite habits of life and capable of growth and multiplication. 
These so-called pathogenic (disease producing) organisms or viruses 
may be carried from individual to individual by direct contact with a 
person sick of the disease or by a carrier, a “carrier” being a person 
who harbors a pathogenic organism without showing evidence of the 
disease; they also may exist a relatively short time in or on other 
than living material as in water, milk, or other food, or they may be 
transmitted from one human being to another by an intermediary 
living agent or “vector,” as the body louse in typhus, the mosquito 
in yellow fever, and the flea in transmitting plague to the human 
being from an infected rat. 
After having invaded or attacked a healthy individual, the germs 
either die or survive. If the latter, a certain number of days must 
elapse before they have multiplied to sufficient numbers to produce 
symptoms of disease. This interval of time is known as the period 
of incubation. This period of incubation varies in length for the 
different diseases, as well as for the same disease within certain 
well-defined limits. The period of detention or observation in quar- 
antine is based upon the maximum number of days within which 
experience has shown the suspected disease will manifest itself if 
present. 
The absence of sickness in the personnel of a vessel does not neces- 
sarily mean an absence of infection aboard the vessel. This can be 
readily understood when it is remembered that a healthy person may 
carry or harbor the germs of a disease in his body, as, for instance, a 
cholera carrier, or that the intermediary host may be present without 
actually coming in contact with the crew, as, for instance, plague- 
infected rats in cargo under battened hatches. In either event possible 
contact with an individual on ship or ashore might mean the beginning 
of an epidemic. It is therefore clear why a vessel may be detained 
in quarantine, even though there be no sickness among crew or 
passengers. 
The United States Government has declared the following diseases 
to be quarantinable and subject to quarantine under the provisions 
of the United States quarantine laws and regulations of the Federal 
Security Agency, enforced by the United States Public Health Service: 
1. Cholera, period of incubation 1 to 5, usually 3 days. 
2. Yellow Fever, period of incubation, 3 to 6 days. 
3. Smallpox, period of incubation 8 to 16 days. QUARANTINE 
97 
4. Typhus Fever, period of incubation 5 to 20 days. 
5. Leprosy. If the patient is an alien, not permited to land; if a 
citizen, the case is dealt with according the State laws of the port of 
entry. 
6. Plague, period of incubation 3 to 7 days. 
7. Anthrax, period of incubation 7 days. 
REQUIREMENTS AT FOREIGN AND INSULAR PORTS 
Vessels leaving foreign ports and ports in the possessions or other 
dependencies of the United States for ports in the United States or 
its possessions or other dependencies are subject to inspection by the 
officer issuing bills of health whenever, in his opinion, such inspection 
is necessary to the issuance of a bill of health. United States Quaran- 
line Laws and Regulations require that an inspection be made of— 
(a) All vessels from ports at which cholera, yellow fever, or plague 
in men or rodents prevail, or at which smallpox or typhus fever pre- 
vails in epidemic form, and at which a medical officer is detailed. 
(h) All vessels carrying steerage passengers; but if sailing from a 
healthful port, the inspection need include only such passengers and 
their living apartments. (See paragraph under General Requirements 
of the United States Public Health Service at foreign and insular 
ports.) 
Inspection of the vessel is such an examination of the vessel, cargo, 
passengers, crew, personal effects of same, including examination of 
manifests and other papers, food and water supply, the ascertain- 
ment of its relations with the shore, the manner of loading, and 
possibilities of invasion by rats and insects as will enable the inspect- 
ing officer to determine if these regulations have been complied with. 
When an inspection is required, it should be made by daylight, as 
late as practicable before sailing. The vessel should be inspected 
before the passengers go aboard, the passengers just before embark- 
ation, and the crew on deck, and no communication should be had 
with the vessel after such inspection except by permission of the 
officer issuing the bill of health. 
Vessels, prior to stowing cargo or receiving passengers, should be 
mechanically clean in all parts, especially in the hold, forecastle, 
and steerage, and loose dunnage in unladened compartments shall be 
so arranged as to prevent harborage of rodents. 
Any portions of the vessel liable to have been infected by any 
communicable disease should be disinfected before the issuance of 
the bill of health. 
The air space, ventilation, food and water supply, hospital accom- 
modations, and all other matters mentioned therein promotive of the 
health and comfort of the passengers must be in accordance with the 98 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
provisions of the act of Congress approved August 2, 1882, entitled 
“An act to regulate the carriage of passengers by sea.” 
Bedding, upholstered furniture, soiled wearing apparel, personal 
effects, and second-hand articles of a similar nature coming from a 
district known to be infected with smallpox or as to the origin of 
which no positive evidence can be obtained, and which the consular 
or medical officer has reason to believe is infected, should be disin- 
fected prior to shipment. Articles similar to the above mentioned, 
if from a district infected by plague or typhus, should be inspected, 
and, if necessary, treated to destroy vermin. 
Articles from an uninfected district shipped through an infected 
port may be accepted without restriction if not exposed to infection 
in transit. 
Nothing in these regulations shall be construed to modify or nul- 
lify in any way existing restrictions promulgated by the Secretary 
of the Treasury at the instance of the Secretary of Agriculture for 
the prevention of the introduction of diseases of animals. 
Any article shipped from or through an infected port or place 
which the consul or medical officer has reason to believe infected, 
should be disinfected. 
Any article presumably infected which cannot be disinfected should 
not be shipped. 
Passengers, for the purpose of these regulations, are divided into 
two classes, cabin and steerage. 
So far as possible passengers should avoid embarking at a port 
where quarantinable disease prevails, and communication between 
the vessel and the shore should be reduced to a minimum. In such 
a port the personnel of the vessel should remain on board during their 
stay. 
No person suffering from a quarantinable disease, or scarlet fever, 
measles, diphtheria, poliomyelitis (infantile paralysis), influenza, 
chicken pox, or cerebrospinal meningitis should be allowed to ship. 
Passengers and crews, merchandise, and baggage, prior to shipment 
at a noninfected port but coming from an infected locality should be 
subject to the same restrictions as are imposed at an infected port. 
REQUIREMENTS AT SEA 
The master of a vessel should observe the following measures on 
board his vessel: 
{a) The water closets, forecastle, bilges, and similar portions of 
the vessel liable to harbor infection should be frequently cleansed and 
disinfected. 
(b) Free ventilation and rigorous cleanliness should be maintained QUARANTINE 
99 
in all portions of the ship during the voyage and measures taken to 
destroy rats, mice, fleas, flies, mosquitoes, and all vermin. 
(c) A patient sick of a communicable disease should be isolated and 
one member of the crew detailed for his care and comfort, who, if 
practicable, should be immune to the disease. 
(d) Communication between the patient or his nurse and other 
persons on board should be reduced to a minimum. 
(e) Used clothing, body linen, and bedding of the patient and nurse 
should be immersed at once in boiling water or in a disinfecting 
solution. 
(/) The compartment from which the patient was removed should 
be disinfected and thoroughly cleansed. Articles liable to convey 
infection should remain in the compartments during the disinfection 
when gaseous disinfection is used. 
(g) Any person suffering from malaria or yellow fever should be 
kept under mosquito bars and the apartment in which he is confined 
closely screened with mosquito netting. All mosquitoes on board 
should be destroyed by fumigation. Mosquito larvae (wigglers or 
wiggle tails) should be destroyed in water barrels, casks, and other 
collections of water about the vessel by the use of petroleum (kero- 
sene) ; where this is not practicable, the receptacle should be covered 
by mosquito netting to prevent the exit of mosquitoes from such 
breeding places. 
(h) In the case'of bubonic plague, special measures must be 
taken to destroy rats, mice, fleas, and other vermin on board, and in 
case of pneumonic plague, the patient should be isolated, the body 
discharges disinfected, especially' sputum, and the attendant should 
wear a mask. 
(i) In the case of typhus, special measures should be taken to 
destroy vermin. 
(j) In the case of cholera, typhoid fever, or dysentery, the drink- 
ing water should be boiled and the food thoroughly cooked. The 
discharges from the patient should be immediately disinfected and 
thrown overboard. 
An inspection of the vessel, including the steerage, should be made 
once each day. 
Should cholera, yellow fever, smallpox, typhus fever, plague, or 
any other communicable disease appear on board a ship while at 
sea, those who show symptoms of these diseases should be immedi- 
ately isolated in a proper place; the captain should note the same 
in his log, and all of the effects liable to convey infection which have 
been exposed to infection should be destroyed or disinfected. In 
the case of smallpox, the entire personnel should be vaccinated. 100 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
The compartment used for isolation should be cleansed as soon as 
it becomes vacant. 
The dead, except those dead of yellow fever, should be enveloped 
in a sheet saturated with one of the strong disinfecting solutions, 
without previous washing of the body, and at once buried at sea or 
placed in a coffin hermetically sealed. (See ch, VI.) 
A complete clinical record shall be kept of all cases of sickness on 
board and the record delivered to the quarantine officer at the port 
of arrival. 
The following disinfecting solution is recommended for use at sea: 
Formula for disinfecting 
Formalin or Formaldehyde (5 Percent) 
Formaldehyde solution 50 
Water 950 
REQUIREMENTS AT UNITED STATES PORT 
Every vessel subject to quarantine inspection, entering a port of 
the United States, its possessions or dependencies, shall be con- 
sidered in quarantine until given free pratique. Such vessel shall 
fly a yellow flag at the foremast head and shall observe all the other 
requirements of vessels actually quarantined. (See arts. 1451, 1452, 
1453, N. E.) 
Vessels arriving at ports of the United States under the following 
conditions shall be inspected by a quarantine officer prior to entry: 
(a) Vessels from a foreign port shall be inspected only at first 
port of call in the United States, except vessels from ports sus- 
pected of yellow fever arriving during the active quarantine season 
at southern, via northern, ports. 
(5) Any vessel with sickness on board. 
(c) Vessels from domestic ports where cholera, plague, or yellow 
fever prevails, or where smallpox or typhus fever prevails in epi- 
demic form. 
The inspection of vessels required by these regulations shall be 
made between sunrise and sunset, except in case of vessels in distress. 
Exception may also be made in the case of vessels carrying perish- 
able cargoes, and regular line vessels under regulations approved by 
the Secretary of the Treasury. 
In making the inspection of a vessel the bill of health and clinical 
record of all cases treated during the voyage, crew and passengers’ 
lists and manifests, and, when necessary, the ship’s log shall be 
examined. The crew and passengers shall be mustered and examined 
and compared with the lists and manifests and any discrepancies QUARANTINE 
101 
investigated. The clinical thermometer should be used in the 
examination of the personnel of vessels under suspicion. When a 
freight manifest shows that articles requiring disinfection under 
these regulations are carried by the vessel, a certificate of disinfec- 
tion, signed by a United States consul or a mediqal officer of the 
United States, shall be exhibited and compared with same. If no 
certificate of disinfection is produced the collector of customs at 
the port of entry shall be notified of same by the quarantine officer, 
The collector of customs shall then hold such consignment in a 
designated place, separate from other freight, pending the arrival 
of the certificate of disinfection; and in the event of its nonarrival 
the articles shall be disinfected as hereinbefore prescribed, or shall 
be returned by the common carrier conveying same. 
Medical officers of the United States duly clothed with authority 
to act as quarantine officers at any port or place within the United 
States, when performing the said duties, are hereby authorized to 
take declarations and administer oaths in matters pertaining to the 
administration of the quarantine laws and regulations of the United 
States (Act of March 2, 1901, sec. 12). 
No person, except the quarantine officer, his employees, or pilots, 
shall be permitted to board any vessels subject to quarantine inspec- 
tion until after the vessel has been inspected by the quarantine 
officer and granted pratique, and all of such persons so boarding such 
vessel shall, in the discretion of the quarantine officer, be subject 
to the same restrictions as the personnel of the vessel, or otherwise 
action may be taken as provided for in section 10, act of March 
2, 1901, provided, however, that the United States customs officials 
may be permitted to board a vessel that has been inspected and held 
in quarantine for detention or treatment, they being subject to the 
same restrictions as the personnel of the vessel. 
When a vessel arriving at quarantine has on board any of the 
communicable but nonquarantinable diseases the quarantine officer 
shall promptly inform the local health authorities of the existence of 
such disease aboard and shall make every effort to furnish such 
notification in ample time, if possible, to permit of the case being 
seen by the local authorities before discharged from the vessel. 
QUARANTINE DETENTION 
Vessels arriving under the following conditions shall be placed 
in detention: 
(a) With quarantinable disease on board or having had such dis- 
ease on board during the voyage. 
(&) Any vessel which the quarantine officer considers infected with 
quarantinable disease. 102 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
(c) A vessel arriving at a port south of the southern boundary 
of Virginia in the season of active quarantine, April 1 to November 
1, from a port infected or suspected of infection with yellow fever. 
(d) Vessels arriving at ports north of this line and south of the 
southern boundary of Maryland between May 15 and October 1, if 
from a port infected or suspected of infection with yellow fever. 
(e) In the case of vessels arriving at a northern port without 
sickness on board from ports where yellow fever prevails the per- 
sonnel shall be detailed under observation at quarantine to complete 
six days from the port of departure. 
(/) Towboats and other vessels having had communication with 
vessels subjected to quarantine shall themselves be quarantined if 
they have been exposed to infection. 
The duration of detention of vessels or personnel herein contem- 
plated will depend upon the quarantinable disease involved and will 
hereinafter be specifically provided for. 
requireiments relating to naval vessels 
Vessels of the United States Navy which carry a medical officer, 
upon entering United States ports from foreign ports, are exempt 
from quarantine inspection provided that such vessels have not sailed 
from a port infected with cholera, yellow fever, or plague, or in which 
typhus or smallpox is epidemic, and further provided that no cases of 
these quarantinable diseases have occurred on board en route. 
Vessels of the United States Navy may be subjected to quarantine 
inspection upon arrival at ports of the United States, its possessions, 
or dependencies when coming from a port known or suspected to be 
infected with cholera, plague, or yellow fever, or where smallpox, or 
typhus fever is present in epidemic form, and may be detained in 
quarantine for such disinfection or disinfestation as may be required 
by reason of disease aboard or exposure to quarantinable disease at the 
port of departure or call. By arrangement with the Treasury De- 
partment, ships of the Navy to which medical officers are attached 
are ordinarily exempt from quarantine (inspection. A certificate 
furnished by the ship’s medical officer as to the sanitary condition of 
the vessel and record of communicable diseases is accepted by the 
quarantine officer in lieu of actual inspection. In case pratique is 
granted by radio communication the medical officer upon arrival in 
port must forward the bill of health in duplicate to the quarantine 
officer, together with a statement as to sanitary condition, including 
number of cases of any communicable disease on board. 
Vessels of the United States Navy having entered the harbors of 
infected ports but having held no communication which is liable to 103 
QUARANTINE 
convey infection may be exempted from the disinfection and deten- 
tion imposed on merchant vessels from such ports. 
Vessels of the United States Navy not carrying a medical officer 
shall, upon arrival at ports of the United States from foreign ports, 
be subject to the same provisions of these regulations as apply to 
merchant vessels. 
No vessel from a foreign port is permitted to enter any port of 
the United States until pratique has been granted by a United States 
quarantine official. Until pratique has been granted the vessel is in 
quarantine and can hold no unauthorized communication with the 
shore. A merchant vessel cannot enter at the customhouse without 
presenting the certificate of pratique which shows that the vessel has 
been released from quarantine. 
BILL OF HEAI/TH 
Masters of vessels clearing from or leaving any foreign port or 
any port in the possessions or other dependencies of the United 
States for a port in the United States or its possessions or other 
dependencies must obtain a bill of health, in duplicate, signed by 
the proper officer or officers of the United States as provided for by 
law, unless there is no such officer at the port of departure, excepting 
vessels operating during the absence of quarantinable disease in the 
foreign ports of call, exclusively between ports in the United States 
and ports in Canada, and exclusively between ports in Florida south 
of 28° north latitude and ports in the Bahama Islands and ports in 
Cuba. The provisions of this section shall not apply to vessels 
plying between foreign ports on or near the frontiers of the United 
States and ports of the United States adjacent thereto; but the Sec- 
retary of the Treasury is hereby authorized, when, in his discretion 
it is expedient for the preservation of the public health to establish 
regulations governing such vessels. Vessels sailing originally from 
other foreign ports and merely calling at Canadian ports enroute to 
the United States are not exempt from the provisions of section 2 of 
the act approved February 15, 1893. During the prevalence of any 
of the quarantinable diseases at the foreign port of departure, ves- 
sels above referred to are required to obtain from the consular officer 
of the United States, or from the medical officer of the United States, 
when such officer has been detailed by the President, a bill of health, 
in duplicate, in the form prescribed by the Secretary of the Treasury. 
Guantanamo Bay, Cuba, is considered under the law as a foreign 
port. A bill of health is required and may be obtained from the 
medical officer prior to departure. (See art. 1172 N. R. and G. O. 
25.) Naval vessels clearing from one United States port for another 104 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
United States port do not ordinarily procure a bill of health for 
presentation at the port of arrival. Local or State authority at 
the port of arrival may, however, require the exhibition of a bill of 
health under special circumstances, such as when some epidemic 
disease exists at the port of departure, and under such circumstances 
it is advisable to procure a bill of health. 
A naval vessel departing from a port in the continental United 
States for a port in the Canal Zone or United States possessions is 
not required to procure a bill of health or port sanitary statement at 
such port of departure, except when plague, cholera, or yellow 
fever exists, or typhus fever or smallpox prevails in epidemic form, 
in the port of departure. 
A naval vessel departing from a port in the possessions or depen- 
dencies of the United States for a port in the Canal Zone or other 
United States possessions is required to procure a bill of health in 
duplicate at each port of departure. 
Bills of health or port sanitary statements are issued in United 
States ports by medical officers of the Public Health Service where 
available; otherwise by the collector of customs. 
Naval vessels sailing from a United States port to a foreign port 
shall always procure a bill of health from the proper authorities 
and have it visaed by the consular or other representative of the coun- 
try or countries of ports of call, if such ports can be determined upon 
prior to sailing. It is sometimes advisable to secure bills of health for 
several ports to which the vessel might go, when definite informa- 
tion of the exact destination is not procurable. A naval vessel sailing 
from a foreign port to another foreign port shall likewise procure 
and have visaed a bill of health. 
A vessel leaving a foreign port for a home port shall obtain a bill 
of health from a port official and also a United States consular bill 
of health, at a port where the issue of consular bills of health is cus- 
tomary, or from the United States Public Health Officer, if one be 
stationed there. 
The form, United States of America bill of health, sets forth under 
hand and seal of the officer authorized to sign, certification that the 
vessel has complied with quarantine rules and regulations and leaves 
the port of issue bound for stated port of the United States via the 
designated port of call, if any, under circumstances described, in- 
cluding the name of the vessel; nationality; master’s name; gross 
tonnage; net tonnage; medical officer’s name; number of officers; 
number of crew, including petty officers; number of officers’ families; 
number of passengers destined for the United States; number of 
first cabin, second cabin, and steerage passengers; names of ports 
visited during the preceding 4 months; statement as to the location QUARANTINE 
105 
of the vessel while in port—wharf, open bay, distance from shore; 
character of communication with shore; time the vessel was in port; 
sanitary condition of the vessel; sanitary measures, if any, adopted 
while in port; sanitary condition of the port and vicinity; and the 
names of diseases prevailing at the port and in the vicinity. The 
form also calls for enterng the number of cases and number of deaths 
from each of the quarantinable diseases during the most recent fort- 
night for which statistics are available, as well as the date of the 
last case within the preceding year. 
Vessels clearing from a foreign port or from any port in the pos- 
sessions or other dependencies of the United States for any port in 
the United States, its possessions, or other dependencies, and entering 
or calling at intermediate ports, must procure at all such ports a bill 
of health in duplicate signed by the proper officer or officers of the 
United States. 
Bills of health for naval vessels and indorsement by consular offi- 
cers are usually extended gratis. Any expense involved in procur- 
ing bills of health or in quarantine is a charge against appropria- 
tions not under the Bureau of Medicine and Surgery Quarantine 
expenses (bills of health and pratique) are a charge against “Instru- 
ments and supplies, Bureau of Navigation.” (For decision as to the 
liability of a naval vessel for the payment of quarantine charges 
growing out of a State law, see Official Opinions of the Attorney 
General, 1906, vol, 25 p. 234.) 
In the United States a bill of health is procured by applying in 
person to the medical officer of the Public Health Service where 
available, otherwise to the collector of customs. 
In foreign ports request for a bill of health should be made at the 
office of the captain of the port (Bureau du Capitaine du Port, Offizio 
dell Capitano dell Porto, Capitania del Puerto). 
The person applying for the bill of health should take with him bills 
of health from last port of departure and be prepared to furnish the 
necessary data therefor. 
If epidemic or contagious diseases are present in the port at the time 
of making the request, a visit should also be made to the consul of the 
nationality of the next port of call, particularly in the Mediterranean, 
for his visas. 
On entering port, in addition to the bill of health, the ship shall be 
prepared to furnish the quarantine officer, if required, with a statement 
relative to the health conditions prevailing on board ship. Certain 
diseases of a communicable or infectious character, not included among 
the quarantinable diseases under the quarantine laws and regulations 
of the Treasury Department, such as the exanthemata, diphtheria, 
cerebrospinal fever, etc., will ordinarily be viewed by local or State 106 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
authorities as constituting quarantinable diseases and their presence 
on board should be considered as rendering the vessel subject to quar- 
antine restrictions. All such diseases should be fully reported to the 
inspecting health officer. 
The officer issuing the bill of health to vessels leaving foreign ports 
and ports in the possessions or other dependencies of the United States 
for ports in the United States or its possessions or other dependencies 
is required to satisfy himself, by inspection if necessary, that the 
conditions certified to therein are true. He is authorized, in accord- 
ance with law, to withhold the bill of health until he is satisfied that 
the vessel, the passengers, the crew, and the cargo have complied with 
all the quarantine laws and regulations of the United States. 
Special Quarantine Measures 
CHOLERA 
This disease is caused by a germ, the vibrio comma, when introduced 
into the gastrointestinal tract. Food or water indirectly contaminated 
is the chief means by which the disease is conveyed, but on board ship 
direct contact or the immediate pollution of alimentary substances 
by “carriers” or acute cases are to be considered the more common 
means by which the cholera infection is transmitted. The possibility 
of water ballast being infected or constituting a probable source of 
spreading the disease is so remote as to be negligible, and the same 
applies in a general way to cargo and ship supplies. Accurate knowl- 
edge that none of the personnel is harboring cholera organisms in his 
gastrointestinal tract is the most important feature in the treatment 
of cholera-infected vessels. 
In cholera the control of the human host and the safe disposal of 
the excreta therefrom, the destruction of contaminated food or water, 
or their sterilization—cooking, boiling, etc.—are the essential features 
in preventive measures. Fumigation or place disinfection is not 
called for in cholera preventive measures. Where a case of cholera 
has resulted in soiling the bedding, as an added precaution such 
effects should be sterilized and the floors and walls of the compart- 
ment washed down with formaldehyde solution. The cholera vibrio 
has practically no resistance to drying, however, and under natural 
conditions it is improbable that soiled linen or an infected place will 
result in the spread of the disease. While bathing and personal 
cleanliness is to be encouraged at the quarantine station, it is not to be 
assumed that disinfection of wearing apparel and personal effects of 
the contacts or the disinfection of the body has any material effect in 
preventing the spread of the infection. The control of the personnel 
and the assured safe disposal of body discharges and protection of QUARANTINE 
107 
food and water supply are the important features to be observed in the 
prevention of cholera. 
Measures Against Cholera at Foreign and Insular Ports 
At ports where cholera prevails special care should be taken to pre- 
vent the water and the food supply from being infected. The drinking 
water, unless of known purity, should be boiled and the food thor- 
oughly cooked and protected against contamination by flies, etc. 
The latrines of vessels must be so arranged that they, including 
their discharge pipes, can be made and kept mechanically clean. 
Certain food products that are ordinarily consumed in an uncooked 
state coming from cholera-infected localities or through such locali- 
ties, if exposed to infection therein, should not be shipped. Vege- 
tables ordinarily eaten in an uncooked state when grown in districts 
where cholera prevails shall not be shipped. Fruits grown on trees 
or on shrubs may be shipped. 
The baggage of steerage passengers shall be inspected, and no food 
shall be taken aboard in such baggage. 
Steerage passengers and crew coming from cholera-infected dis- 
tricts should be subjected to bacteriological examination or otherwise 
detained 5 days in an environment known to be free from any source 
of infection. 
Steerage passengers and crew from districts not infected with 
cholera, shipping at a port infected with cholera, unless passed 
through without danger of infection, should be treated as those in 
the last paragraph. 
Cabin passengers coming from cholera-infected districts should 
produce satisfactory evidence as to their exact place of abode during 
the 5 days immediately preceding embarkation. If it appears that 
they have been exposed to infection, they shall be detained under medi- 
cal supervision a sufficient time to cover the period of incubation since 
last exposure, or otherwise be subjected to bacteriological examination. 
Should cholera appear in the barracks or houses in which passen- 
gers are undergoing detention, no passengers from said houses or 
barracks who have been previously exposed to this new infection 
should embark until they have been determined free of the infection 
by bacteriological examination or otherwise isolated for a period of 
6 days. 
Measures Against Cholera at Domestic Ports 
Special measures shall be employed against vessels and persons 
from a cholera-infected place, as likewise when cholera has appeared 
on board during the voyage. 
All steerage passengers arriving at ports in the United States, its 
possessions or dependencies, from ports or places where cholera pre- 108 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
vails, shall be subjected to bacteriological examination and shall not 
be admitted to entry until it has been determined by said examina- 
tion that they are free from cholera vibrios. 
All persons on vessels upon which cholera has appeared during 
the voyage shall upon arrival at quarantine be detained until it has 
been determined by bacteriological examination that they are free 
from cholera vibrios. 
Persons in detention who are proven by bacteriological examina- 
tion (performed not less than 24 hours after removal from exposure 
to infection in cholera case or carrier) to be free from cholera 
organisms may be discharged from quarantine without further 
detention. 
In lieu of bacteriological examination (and then only when it is 
impracticable) persons exposed to infection in a cholera case or car- 
rier shall be detained in quarantine five days after being isolated 
from such case or carrier. 
If a case clinically diagnosed as cholera has occurred on voyage, or 
if bacteriological examination should reveal the presence of infec- 
tion in any person on board, such infected person or persons should 
be removed and isolated. All contacts should be segregated in small 
groups, and no material capable of conveying infection shall be be 
removed from the ship. 
Fruits and vegetables from an infected ship, that are ordinarily 
consumed in an uncooked state, shall be destroyed or rendered harm- 
less by cooking. 
The food served to persons in quarantine, unless from a source 
known to be free from cholera infection, shall be cooked. 
The water supply of a vessel detained in quarantine on account of 
cholera infection, unless determined by bacteriological examination 
to be free from cholera organisms or the organism E. coli, shall be 
sterilized. Otherwise it shall be discharged after disinfection. 
The dejecta of all persons in quarantine on account of cholera shall 
be disinfected before final disposition, and special precautions shall 
be exercised in order to prevent the contamination of food or water 
supply or the spread of the infection through the agency of flies or 
other insects. 
Personal effects contaminated by dejecta from a cholera case or 
carrier shall be disinfected. 
Any part of the ship that has been contaminated by dejecta from 
a cholera case or carrier shall be washed down with a solution of 
formaldehyde solution. 
Carriers or recovered cases shall not be released from quarantine 
detention until three bacteriological tests performed on consecutive 
days shall have been proven to be negative. QUARANTINE 
109 
Inoculation with cholera vaccine of persons liable to be exposed 
should be considered because active artificial immunity for about 1 
year is probable. 
The causative agent of this disease is a filtrable virus, ordinarily 
transmitted to man by a species of mosquito; i. e., Aedes aegypti and 
this only after an intrinsic cycle of development in the body of such 
mosquito, which requires about 12 days. It has been found that a 
number of mosquitos other than A. aegypti are capable of trans- 
mitting yellow fever by bite under certain environmental conditions 
found in and near tropical forests in the complete absence of 
A. aegypti, and it is then called jungle yellow fever. The mosquito 
can acquire the virus by sucking blood from a patient ill with yellow 
fever only during the first 3 days of the disease. 
Immunes are those who have had yellow fever. One attack confers 
lasting active immunity for life. Children often have a mild unrec- 
ognized attack and are immune thereafter. Passive immunity of 
brief duration may be conferred by convalescent serum, and artificial 
active immunity of prolonged duration is now being practiced by the 
subcutaneous injection of a living virus modified by prolonged 
passage through chick embryos. 
The only procedure that is called for in preventing the spread of 
yellow fever (aside from the control of the human host) is that for 
the destruction of mosquitoes, and this is best accomplished by 
fumigation with sulfur dioxide or hydrocyanic acid gas. Bactericidal 
measures have no place in the prevention or destruction of yellow- 
fever infection. 
YELLOW FEVER 
Measures Against Yellow Fever at Foreign and Insular Ports 
For the purpose of these regulations 6 days shall be considered 
as the period of incubation of yellow fever. 
It is advisable that at ports where yellow fever prevails precau- 
tions should be taken to prevent the introduction of mosquitoes, 
A. aegypti, on board the vessel. Water tanks, water buckets, and 
other collections of water about the vessel should be guarded in such 
a manner that they shall not become breeding places for mosquitoes. 
Where the vessel has lain in such proximity to the shore at such places 
as to render it liable in the opinion of the inspecting officer, to the 
access of A. aegypti measures should be taken to destroy mosquitoes 
that may have come on board. 
Passengers and crew who, in the opinion of the inspecting officer, 
have been definitely exposed to the infection of yellow fever (i. e., as 
from a house or locality known to be infected) should not be allowed 
4575)44°—42 8 110 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
to embark for 6 days after said exposure. Those immune to yellow 
fever are exempt from this provision. 
Measures Against Yellow Fever at Domestic and Insular Poets of Arrival 
A vessel aboard which a case of yellow fever has occurred at any 
time during the voyage shall be treated as follows: 
(a) Careful visual and thermometric inspection of all persons. 
(b) The sick are to be immediately disembarked, protected by 
netting against the access of Aedes mosquitoes, and transferred to a 
place of isolation. 
(<?) Other persons should be disembarked, if possible, and detained 
under observation for 6 days, dating from the day of last possible 
exposure. 
(d) Persons under observation presenting an elevation of tem- 
perature above 37.6° C. (99.7° F.) shall be isolated in a screened 
apartment. 
(e) The ship shall be moored, if possible, at least 200 meters from 
the inhabited shore. 
(/) The ship shall be fumigated for the destruction of mosquitoes 
before the discharge of cargo, if possible. If a fumigation be not 
possible before the discharge of the cargo, the discharge of cargo 
shall be under the supervision of the quarantine officer and may be 
permitted as follows: By (1) the employment of immune persons 
for discharging the cargo; or (2) if nonimmunes be employed, they 
shall be kept under observation during the discharging of cargo and 
for 6 days, to date from the last day of exposure on board. 
A vessel which has lain in such proximity to the shore of a port 
known to be infected as to render it liable to the access of Aedes 
mosquitoes shall be fumigated and the personnel held in detention 
under observation for 6 days. 
A vessel arriving at a southern port (either direct or by way of a 
northern port of the United States) which, although coming from 
an infected port or suspected port, has had neither death nor case 
of yellow fever on board, either before departure, during the voyage, 
or at the time of arrival, and which the quarantine officer is satisfied 
has not lain in such proximity to the shore as to render it liable to the 
access of Aedes mosquitoes, or which has been fumigated under the 
supervision of an accredited medical officer of the United States im- 
mediately before sailing, may, upon arrival at a port of destination 
in the United States with good sanitary history and in good condition 
(including the absence of any exposed collection of water in which 
A. eagypti might breed) be subjected to the following treatment: 
(a) If arriving in 6 days or less, she may be admitted to pratique 
with or without fumigation, in the discretion of the quarantine QUARANTINE 
111 
officer, and without further detention than is necessary to complete 
the 6 days. 
(h) If arriving after 6 days, she shall be immediately fumigated 
(unless previously fumigated at a northern port) and may be ad- 
mitted without detention. 
Vessels from ports infected or suspected of infection with yellow 
fever, calling at ports south of the southern boundary of Virginia, 
April 1 to November 1, or at a port north of that line and south of 
the southern boundary of Maryland, between May 15 and October 1, 
for bunker coal or supplies during the active quarantine season, may 
be allowed to take on such cargo after fumigation, provided the vessel 
be anchored in a place inacessible to Aedes and the crew or passengers 
be detained on board. 
Traffic without detention may be allowed during the active quaran- 
tine season from ports infected or suspected of infection with yellow 
fever to ports in the United States south of the southern boundary 
of Maryland under the following conditions: 
(a) The vessel must lie at approved moorings in the open harbor; 
the crew must not be allowed ashore at the port of departure. Every 
possible precaution must be taken to prevent the ingress of Aedes 
mosquitos and their access to the crew. 
(h) The officer who must go ashore to contact authorities in an 
infected port must be immune to yellow fever. Passengers unless 
immune to yellow fever must have been free from possible exposure 
to yellow fever for 6 days immediately prior to embarking. 
((?) All the above conditions to be certified to specifically by an 
accredited medical officer of the United States. 
All persons who can prove their immunity to yellow fever or who 
have not been exposed to possible infection of yellow fever may be 
permitted to land at once. 
PLAGUE 
This disease is caused by the Pasteurella, pestis. The bubonic type 
(called bubonic plague) is the most common form of the disease and 
is transmitted to man through the agency of rats and mice and 
their ectoparasites; i. e., fleas. It is primarily and essentially a 
disease of rodents. It is only accidentally transmitted to the human 
by means of the fleas which have fed on an infected rodent host 
and which, having become dislodged and finding no other preferred 
host available, perforce turn to the human as the only source of 
blood supply. It is alleged that the bedbug may transmit the disease. 
In any event, the bedbug would cause only individual cases of the 
disease and would not be productive of an epidemic or operate to 
the widespread dissemination of the disease. The bubonic type is 
not communicable from person to person. 112 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
From the foregoing, therefore, it is evident that the treatment 
of plague-infected vessels calls for the definite destruction of all 
rodents and their parasites and bedbugs where there have been 
septicemic types of the disease. While fleas normally have their 
habitat on their preferred host, it must be borne in mind that these 
parasites may occasionally be dislodged and temporarily be found 
in the environment. When rodent infection has actually been demon- 
strated on board a vessel, consideration should be given to the destruc- 
tion of rats, mice, and fleas in all parts of the vessel by some dis- 
infecting agent which will penetrate to all parts of the vessel and 
will be toxic both to animal and insect life. Sulfur dioxide and 
hydrocyanic acid gas are best adapted for this purpose. When 
human cases are found on vessels that have acquired their infection 
en route, indicating the dispersal of infected fleas, it may be advisable 
that the clothing and personal effects of the passengers and crew 
be treated for the destruction of any fleas that may have become 
lodged thereon. 
Disinfection for the purpose of destroying bacteria for the preven- 
tion of bubonic plague is irrational and unnecessary. General pre- 
ventive measures also include: Methodical destruction of rats and 
other rodents living in the wild state in area of endemic rodent 
infection; examination of carcasses for the detection of plague; rat- 
proofing of buildings and elimination of breeding places; guarding 
of grains and other food materials against access to rats; investiga- 
tion of all deaths during an epidemic, with autopsy and laboratory 
examination when indicated. Passive immunity of 3 to 4 weeks’ 
duration is conferred by antiplague serum. Plague vaccine usually 
confers active immunity of about 6 months’ duration. 
The pneumonic type (called pneumonic plague} is intensely com- 
municable during the course of the disease; susceptibility is general; 
it is transmitted solely through personal contact in the same fashion 
as pneumonia or other respiratory diseases. Neither the flea nor 
other insects are concerned in the direct transmission of pneumonic 
plague. From an epidemiological standpoint and as to the applica- 
tion of preventive measures, pneumonic plague and bubonic plague 
are to be considered wholly separate diseases. 
Measures Against Plague at Foreign and Insular Ports 
At ports or places suspected of plague infection in rodents every 
precaution shall be taken to prevent rats, mice, and fleas from getting 
aboard. 
Vessels sailing from such ports shall be simultaneously fumigated 
in all parts, preferably when empty, for the destruction of rats. QUARANTINE 
113 
Lighters should be free of rats, and this is best accomplished by 
periodic fumigation. 
If the vessel lies at a dock all connecting lines should be guarded 
by inverted cones or disks not less than 3 feet in diameter and so fixed 
as to be always at a right angle to the line to which it is attached. 
Articles which harbor or are liable to harbor rats or rat fleas should 
not be shipped until freed of such vermin, either by the use of chem- 
icals, fumigation, or by preventing the access of rats. The nature 
of the merchandise and the place and method of stowing prior to 
shipment must be considered in determining its liability to be a rat 
or vermin carrier, thus: Crated cargo, bags of grain, etc., so stowed 
as to be used as nesting places for rats would be flea, and might be 
rat, carriers, and cargo should preferably have been previously stored 
in ratproof warehouses. Articles of cargo in open crates should be 
carefully inspected to determine freedom from rats and, at the dis- 
cretion of the inspector, may be rejected for shipment if considered 
as rodent infested. When the cargo of a vessel consists of grain or 
other rat food, extra precautions should be taken to prevent rats 
from going aboard. 
Measures Against Plague at Port of Arrival 
Ships on which plague has occurred in men or rodents shall be de- 
tained in quarantine, the sick, if any, shall be removed and isolated, 
and the destruction of rats shall be effected as soon as practicable. 
A plague-infected ship shall be fumigated simultaneously in all 
parts for the destruction of rats, including those that may be within 
articles of cargo, and other precautions shall in the meantinme be 
observed to prevent the escape of rats from the ship. 
All rodents destroyed on vessels at quarantine, shall when practi- 
cable, be bacteriologically examined. 
All persons sick of plague shall be detained in quarantine until 
well, but no detention of healthy contacts is contemplated (except in 
the pneumonic type of the disease), other than is incidental to the 
treatment of vessels or cargo. 
If pneumonic plague has occurred on board ship during the voy- 
age, the sick shall be removed and isolated and all crew and passen- 
gers that have been exposed to the infection shall be detained in 
quarantine for a period of 7 days, or, at the discretion of the quaran- 
tine officer, until their secretions shall be proved to be free from 
P. pestis. 
The quarantine officer, before granting pratique to a vessel that 
has been detained in quarantine on account of plague infection, shall 
assure himself that the vessel is free from rats and vermin. 114 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
The personal effects in use and the belongings of crew and passen- 
gers which in the opinion of the quarantine officer are considered 
as infected shall be disinfected and rendered free from vermin. 
Vessels from foreign ports or ports in the possessions or depend- 
encies of the United States or domestic ports that are known or 
suspected of being infected with plague may, when loaded with 
cargo the nature of which or manner of storage precludes effective 
fumigation, be permitted to enter subject to the terms of a provi- 
sional pratique. When lying alongside wharf or dock at United 
States ports such vessels shall take proper precautions to prevent the 
passage of rodents. The vessel shall be fended off from wharf or 
dock not less than 4 feet, and on all connecting lines shall be fixed 
rat guards of sheet metal of an approved design not less than 3 feet 
in diameter. All cargo nets and similar devices extending between 
the vessel and shore structures shall be removed at night unless in 
actual use, as likewise gangways and ladders, unless guarded. Any 
vessel so entering and neglecting to effectively apply such measures 
may, at the discretion of the Surgeon General, be remanded to the 
quarantine station for discharge of cargo or required to discharge 
cargo at anchor well removed from the wharf. 
Vessels from ports known to be infected with plague in man or 
rodents which have docked or which have not taken precautions 
necessary to prevent the ingress of rats and on which effective meas- 
ures have not been taken to destroy the same under the supervision 
of an accredited medical officer of the United States Government 
shall, upon arrival at a port in the United States, be fumigated for 
the destruction of rats. 
All vessels engaged in trade with foreign ports shall be fumigated 
not less than once every 6 months for the purpose of destroying rats. 
This is best done when the vessel is empty. The periods may be 
extended for vessels plying regularly between ports not infected with 
plague and for vessels whose construction does not favor harborage 
of rats. 
A certificate signed or visaed by an accredited medical or consular 
officer of the United States may be accepted by the quarantine offi- 
cer as competent evidence as to the last fumigation, provided such 
certificate contains the same, or substantially as complete informa- 
tion as contained in Certificate of Fumigation, United States Public 
Health Service, Form 1939 or Form 1945. 
In applying plague-preventive measures vessels without cargo 
shall be fumigated simultaneously in all parts with sulfur-dioxide 
gas, not less than 3 pounds per 1,000 cubic feet, for 6 hours’ exposure, 
or by hydrocyanic-acid gas in the proportion of 5 ounces of sodium 
cyanide per 1,000 cubic feet of space (or equivalent amount of potas- QUARANTINE 
115 
sium cyanide) for 2 hours. If the vessel be loaded, the time of 
exposure shall be doubled. 
When necessary in the treatment of infected vessels, the quaran- 
tine officer may require the master to partially discharge cargo for 
the purpose of effective performance of fumigation. 
SMALLPOX 
The causative agent of this disease is a specific filtrable virus and 
for all practical purposes it may be considered that more or less 
intimacy of contact is essential for the spread of the disease. It 
should also be borne in mind that immune contacts or convalescents 
may transmit the virus in either their clothing, their personal effects, 
or possibly in the body secretions. 
Measures Against Smallpox at Foreign and Insular Ports 
For the purpose of these regulations 14 days shall be considered as 
the incubation period of smallpox. 
Passengers and crew coming from districts where smallpox pre- 
vails in epidemic form, or who have been exposed to smallpox, should 
be vaccinated before embarkation, unless they show satisfactory evi- 
dence of having acquired immunity to smallpox by previous attack, 
or successful vaccination within 1 year, and their baggage inspected 
and, if necessary, disinfected. 
Measures Against Smallpox at Port of Arrival 
Vessels arriving with smallpox on board, or having had smallpox 
on board during the voyage, shall be treated as follows: 
{a) The sick shall be removed and detained until recovered. 
(&) All persons who in the opinion of the quarantine officer have 
been exposed to the infection shall be vaccinated, unless protected 
by a previous attack of smallpox, and detained in quarantine until 
the vaccination is protective against said exposure or, if they refuse 
vaccination, detained in quarantine for 14 days after last exposure 
to the infection. 
(c) Those persons that have not been exposed to the infection may 
be released. 
(d) All personal effects of passengers and crew that have been 
exposed to infection shall be disinfected. All compartments that 
have been exposed to the liability of infection shall be disinfected. 
TYPHUS FEVER 
The causative organism of this disease is believed to be a microor- 
ganism known as the Rickettsia prowazek. The transmitting agent 116 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
of typhus, however, is the louse, both the body louse and the head 
louse, chiefly the former, and in some outbreaks, fleas. 
Eats, as well as infected persons, may be a transmission factor and 
their destruction is therefore an indicated general measure of pre- 
vention, along with the operation of facilities for the delousing of 
persons, clothing, and premises. No other natural means of trans- 
mission of typhus infection has been accepted. 
The important feature in typhus-preventive measures is the as- 
sured destruction of all vermin on the person, clothing, and personal 
effects of those actually sick with typhus and those who have been 
in contact with typhus-infected persons. In this latter group are to 
be included those persons from a known typhus-infected area. The 
destruction of lice on clothing is best effected by heat, steam under 
pressure by preference, but flowing steam without pressure will 
suffice, provided the articles to be disinfected are not closely packed. 
Dry heat is likewise effective. Body lice and head lice can very 
well be destroyed by mechanical cleaning—soap and hot water. Then 
follow the treatment given in the paragraph on the treatment of 
vermin. The treatment of personal effects and baggage of verminous 
persons is necessary, but in the case of those individuals who are 
passed free of vermin and not requiring disinfection their baggage 
likewise should be passed without treatment. Bactericidal measures 
are not called for in typhus prevention. The question is solely that 
of the destruction of lice and rat fleas and the detention in quarantine 
for a period of 12 days of those persons who have been intimately 
exposed to typhus infection and who presumably may develop the 
disease, as well as those actually sick. 
Measures Against Typhus Fever at Foreign and Insueab Ports 
For the purpose of these regulations 12 days shall be considered 
as the period of incubation for typhus fever. 
Passengers and crew from ports infected with typhus shall not 
be allowed to embark unless demonstrably free from vermin, or 
otherwise treated for the destruction of vermin. The personal effects, 
wearing apparel, and baggage of those infested with vermin shall 
be disinfected. 
Passengers from localities where typhus prevails embarking at a 
port not infected with typhus shall be treated as in the preceding 
paragraph. 
Passengers and crew who, in the opinion of the inspecting officer, 
have been definitely exposed to infection (from a house, barracks, 
or other building in which has occurred a case of typhus) shall not 
be allowed to embark until 12 days after removal from the infected 
environment. QUARANTINE 
117 
Measures Against Typhus Fever at Port of Arrival 
Vessels on which typhus infection has occurred shall be detained 
in quarantine and the sick, if any, removed and isolated. The cloth- 
ing, personal effects, and baggage of those infected and of those not 
demonstrably vermin free shall be treated for the destruction of 
vermin. 
All persons found to be vermin (louse) infested shall be treated 
for destruction of lice. 
All passengers and crew that have been exposed to the infection 
shall be detained under observation for a period of 12 days from 
last exposure to infection. 
Those of the personnel that are demonstrably free from vermin 
and have not been exposed to the infection may be released without 
detention or disinfection of baggage. 
Vessels on which typhus has appeared shall be detained and fumi- 
gated for destruction of vermin. 
Cargo compartments of typhus-infected vessels need not be fumi- 
gated unless there be exceptional conditions that may render them 
vermin infested. 
Sulphur dioxide and hydrocyanic acid gas are effective agents for 
the destruction of lice when used in proper strength and exposure, but 
must only be used under the supervision of the U. S. Public Health 
Service or a naval doctor. 
The causative agent of this disease is believed to be Mycobacterium 
leprae, which is an “acid fast” bacillus found in the tissues of persons 
having the disease. 
The incubation period is long and may extend to several years. 
The conditions and circumstances under which transmission occurs 
are not completely understood and preventive measures are confined 
almost entirely to the isolation and segregation of the leprous persons. 
For the prevention of the spread of leprosy, the chief and practically 
the only measure called for is the isolation of the patient, either in 
a national or State leprosarium. When in temporary confinement at 
the quarantine stations, when traveling, or under other conditions 
that would entail contact with the public, especial precautions would 
include the sterilization of eating utensils used by the leper and the 
disinfection of bedclothes. Terminal disinfection consists of thorough 
cleansing of the patient’s living premises. No immunization method 
is recognized and quarantine of contacts is not contemplated. 
Alien lepers are not permitted to embark at a foreign port for a 
port of the United States, its possessions or dependencies, either as a 
passenger or as a member of the crew, or if discovered on board, the 
LEPROSY 118 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
case shall be certified as a leper and reported to the nearest commis- 
sioner of immigration. If the leper be a citizen of the United States, 
the case shall promptly be reported to the Navy Department, if trans- 
portation in a naval vessel is involved. 
ANTHRAX 
Quarantine regulations contemplate that anthrax is primarily a 
disease of animals, not transmitted from man to man, and that re- 
sponsibility for exclusion of the disease rests upon the United States 
Bureau of Animal Industry. It was designated a quarantinable dis- 
ease to afford additional protection from infection from imported 
animal products, especially hair and bristles for shaving brushes. It 
is required that shaving brushes destined for shipment to the United 
States be made only from hair or bristles known to be free from 
anthrax spores, or that such hair or bristles before being made into 
brushes shall be disinfected by one of three methods: (1) Boiling for 
3 hours; (2) autoclaving for 30 minutes at 15 pounds pressure with 
preliminary vacuum of at least 10 inches; and (3) exposure to stream- 
ing steam for 6 hours. 
Disinfection and Fumigation 
The distinction between disinfection and fumigation must be kept 
clearly in mind. Disinfection properly applied is of great value in 
the prevention of communicable diseases. With the destruction of 
infective discharges and the exercise of great care and cleanliness 
throughout the course of a communicable disease there is less need for 
terminal disinfection. The boiling of sheets, pajamas, towels, and 
similar articles and a thorough scrubbing of the surfaces with hot 
water and soap, and disinfecting of bedding with steam is a more 
effective method of disinfection than by the use of one of the gaseous 
agents. Gaseous fumigation for the bacterial viruses had been dis- 
continued as a sanitary measure. Gases, such as formaldehyde, are 
uncertain in practice and have the merest surface action but they can- 
not be depended on against tuberculosis or diphtheria. Fumigation 
has its place in preventive medicine and is used principally for the 
destruction of rodents in the control of plague, the extermination of 
insects, especially bedbugs, and, in exceptional instances, for the ex- 
termination of mosquitoes as a disease-prevention measure. 
The agents used in disinfection are of two types, physical and 
chemical. 
PHYSICAL DISINFECTANTS 
Cleansing with soap and loafer.—The liberal and energetic use of 
soap and hot wrater will mechanically remove a high percentage of QUARANTINE 
119 
bacteria from the hands as well as from contaminated articles such 
as furniture, door knobs, bed frames, and all washable materials. 
Consequently, this measure is always to be carried out thoroughly 
preliminary to or in connection with other methods of disinfection. 
Exposure to direct sunlight in fresh outdoor air.—Such exposure 
for several hours is always desirable, particularly for clothing and 
bedding and other articles which may not, or in the particular in- 
stance need not, be treated more energetically. Bright sunlight which 
has not penetrated a glass window, and hence had the ultra violet 
rays filtered out, -will kill the common disease producing bacterial 
organisms in a few hours. Also these organisms cannot withstand 
the complete drying that takes place in the fresh air. The tubercle 
bacillus, the virus of chickenpox, the virus of smallpox, and, in 
general, all spore-bearing bacteria are more resistant to sunlight and 
drying. Thirty hours of sunning is usually required to kill an 
anthrax spore. 
Burning.—Of unquestioned efficacy, but seldom required. 
Boiling.—Very efficient and of wide range of applicability. The 
articles must be wholly immersed for not less than 10 minutes in water 
actually boiling (100° C.). The addition of 1 percent of carbonate 
of soda renders the process applicable to polished steel, cutting instru- 
ments, or tools. 
Steam.—(a) Flowing steam (not under pressure) : Flowing steam 
when applied under suitable conditions is an efficient disinfecting 
agent. The exposure must be continued 30 minutes after the tem- 
perature has reached 100° C. 
(6) Steam under pressure without vacuum: Steam under pressure 
will sterilize, provided that the process is continued 20 minutes after 
the pressure reaches 15 pounds per square inch. The air must be 
expelled from the apparatus at the beginning of the process. If im- 
practicable to obtain the designated pressure, a longer exposure will 
accomplish the same result. 
(c) Steam under pressure with vacuum: Steam in a special appara- 
tus with vacuum attachment is the best method of applying steam 
under pressure, the object of the vacuum apparatus being to expel 
the air and to promote the penetration of the steam. The process is 
to be continued for 20 minutes after the pressure reaches 10 pounds 
to the square inch. 
Clothing, fabrics, textiles, curtains, hangings, etc., may be treated 
by any of the above methods as circumstances may demand. 
Articles injured by steam, such as leather, furs, skins, rubber, trunks, 
valises, hats and caps, bound books, silks, and fine woolens should 
not be disinfected by steam. Such articles should be disinfected by 
formaldehyde gas or any of the chemical disinfecting agents men- 120 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
tioned next which may be applicable thereto. Those which will be 
injured by wetting should be disinfected by a gaseous agent. 
Textiles which are soiled with discharges of the sick or which are 
presumably deeply infected must be disinfected by one of the follow- 
ing methods: (1) Boiling, (2) steam, (3) immersion in one of the 
germicidal solutions. 
Cooking and eating utensils should always be disinfected by immer- 
sion in boiling water or by steam. Chloride of lime may be used in 
an emergency. 
Chemical disinfectants not supplied in the medicine box may be 
obtained from the supply officer for general use aboard naval vessels. 
Cresol.—Cresol, a mixture of cresols derived from coal tar, in the 
strength of 5 percent may be substituted for bichloride of mercury, 
and should be employed in the disinfection of contaminated clothing 
or fabrics, on swabs for sides and decks of cabins and living spaces of 
ships to obviate injurious action on metal surfaces, bright work, etc., 
and for feces, urine, sputum and spitkits. Exposure should be 1 hour. 
Fingers should not be immersed in this solution for any length of 
time as numbness will result and if immersion is continued gangrene 
may follow. Its action is similar to carbolic acid. 
Formaldehyde solution (formalin).—Formaldehyde, a watery solu- 
tion, containing about 40 percent of formaldehyde gas, may be used in 
a 5-percent solution as a substitute for bichloride of mercury or 
carbolic acid and is useful for the disinfection of surfaces, dejecta, 
fabrics, and a great variety of objects, owing to its noninjurious 
character. It is an excellent deodorant. Formaldehyde solutions act 
harshly upon the hands. 
Chlorinated lime.—Chlorinated lime in a 5- or 6-percent solution 
freshly made from the powder which has been kept free from dete- 
rioration in a small sealed can or tightly stopped colored bottle 
is efficient and useful in the disinfection of sewage, stools, glass 
and earthen ware, and materials or articles which will not be dam- 
aged by its bleaching and corrosive action. When the package con- 
taining the chlorinated lime is opened there should be a strong odor 
of chlorine. It can be used for washing painted surfaces and scrub- 
bing floors, in water-closet bowls or urinals, and in shower baths to 
prevent the spread of ringworm. It serves as a deodorant as well 
as a disinfectant. It may be used by attendants upon the sick to 
disinfect their hands. In disinfecting dejecta, stools should be com- 
pletely covered with the solution, thoroughly mixed and allowed 
to stand for at least 30 minutes. The powder may be sprinkled 
over the stool, taking care to add sufficient in excess so that a 5-per- 
cent solution will result when thoroughly mixed. 
CHEMICAL DISINFECTANT SOLUTIONS QUARANTINE 
121 
In making a solution for use, one-half pound of commercial chlo- 
rinated lime or “bleach” is to be dissolved in a gallon of water. The 
insoluble residue sinks to the bottom; the solution above contains 
about 6 percent of chlorinated lime which is equivalent to 2 percent 
of chlorine, the active disinfecting agent. Chlorinated lime cannot 
be depended upon to kill the tubercle bacillus. 
Disinfection of drinking water hy chlorination.—Dissolve the sol- 
uble portions of 1 gram of chlorinated lime of tested chlorine strength 
in a small volume of water and add this to 40 gallons of the water 
to be disinfected; mix thoroughly and allow to stand for at least 
1 hour before using for drinking purposes. 
FUMIGANTS 
If it should be considered necessary to fumigate, facilities of the 
United States Public Health quarantine station should be sought, or 
similar public health facilities, if in a foreign port. In their absence, 
contact should be made with a naval vessel having a regular medical 
department. 
FUMIGATION OF VESSELS 
All spaces to be fumigated must be made as nearly airtight as pos- 
sible. In fumigating the holds of vessels the hatches should be cov- 
ered over with their regular waterproof tarpaulins and tightly bat- 
tened down, leaving a corner that can be opened as a vent for the escape 
of the fumes. All air slits, scuttles, and chain ports should be closed. 
Doors should be sealed by means of strips of paper pasted over the 
cracks left between the frame and the door. All machinery and bright 
metal should be wiped over with vaseline in advance. All possible 
care should be observed to see that dead space in the vessel is opened 
up and all practical measures should be taken to aid in the diffusion 
of the fumigating gas, and this is especially important when sulfur 
dioxide is used. Pipe casings should be opened up and from one end 
of the vessel to the other there should be a certain number of limber 
boards removed so as to permit of penetration of the gas into the 
bilges. Any planked-over space between the outer and the inner 
sheathing of a vessel should also be freely opened, and wherever there 
is dead space it should be opened up so that there will be free circula- 
tion of the gas. Careful attention should be given to lifeboats, which 
are often infested with rats which resort to these places for water. 
Preferably, lifeboats should be cleaned and flooded by water prior to 
fumigation. Very close attention should be given to the poop deck, 
which is a space frequently containing a heterogeneous collection of 
litter and is generally badly rat infested. In general, the engine room 122 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
and fireroom do not harbor rats, but in the treatment of a vessel in- 
fested with plague-infected rats they should be fumigated. Be sure 
all personnel have been removed from the area to be fumigated or 
likely to be exposed to the fumes. 
DISINFECTING PLANTS 
The following-named quarantine stations of the United States 
Public Health Service are prepared to perform disinfection and fumi- 
gation when called upon. At some of the smaller stations a reasonable 
length of notice should be given in order that the fumigating materials 
may be procured. The fact that some of the stations are not provided 
with wharfage facilities is not an index to the capacity of the stations 
for performing disinfection: 
Station 
Depth of 
water at 
dock, feet 
Detention 
facilities 
(barracks), 
persons 
Hospital 
beds 
Astoria, Oreg _ 
Baltimore, Md.1 __ _ _ _ 
8 
100 
12 
65 
Boston, Mass.1 _ 
15 
1, 400 
Brownsville, Tex.1 
Wilmington, N. C.2_ _ 
Charleston, S. C.1. 
22 
80 
5 
El Paso, Tex.1 _ _ 
Fort Monroe, Va. (Craney Island) L 
Galveston, Tex.1. ___ _ 
10 
25 
1, 000 
69 
20 
25 
15 
10 
31 
Gulf, Miss.2- 
7 
Honolulu, T. H.1 
18 
1, 000 
Laredo, Tex.1 
Los Angeles, Calif. _ 
35 
6 
Marcus Hook, Pa. (Reedy Island) 1_ 
Miami, Fla 
18 
Mobile, Ala__ _ 
35 
65 
15 
30 
New Orleans, La.1 
25 
200 
New York, N. Y_ _ _ 
Pensacola, Fla.2 
Portland, Maine2 
Port Townsend, Wash.1. 
12 
200 
200 
25 
15 
40 
18 
10 
8 
Reedy Island, Del.1 
6 
Sabine Pass, Tex.1 _ 
30 
San Diego, Calif.1, 2 
22 
80 
600 
75 
San Francisco, Calif'1 
19 
San Juan, P. R.1 
12 
Savannah, Ga.2 . _ _ 
Substations: 2 
Beverly, Mass. 
Lynn, Mass. 
Perth Amboy, N. J. 
Salem, Mass. 
San Ysidro, Calif. 
Tampa Bay, Fla 
12 
30 
10 
1 Stations having disinfecting plants. 
3 Stations having fumigating service obtainable from other principal stations. GLOSSARY 
ABDOMEN.—That part of the body which lies below the chest as far as the 
pelvis and contains stomach, liver, intestine, etc.; the belly. 
ALBUMINOUS.—Containing albumin or protein: e. g„ meat, egg, milk, etc., and 
certain materials in bodies of plants and animals. 
ANALGESIC.—A medicine that relieves pain. 
ANESTHETIC .—A medicine used to produce local or general insensibility. 
ANODYNE.—A medicine that soothes irritated nerves. 
ANTACID.—A medicine correcting or neutralizing acidity. 
ANTIDOTE.—A medicine given to counteract some action in another, or to 
neutralize the effect of a poison. 
ANTIMALARIAL.—Curing or preventing malaria. 
ANTIPYRETIC.—A remedy for fever. 
ANTIRHEUMATIC.—Relieving or px-eventing rheumatism. 
ANTISEPTIC.—A substance which prevents or retards the growth of organisms, 
especially of the septic variety, thus hindering putrefaction. 
ANTISPASMODIC.—An agent that relieves nervous irritability and minor 
spasms. 
ASPHYXIA.—Suspension of respiration and animation; suffocation, as in 
drowning or from breathing poisonous gases. 
ASTRINGENT.—An agent that arrests bodily discharges by shrinking mucus 
membranes. 
AUTOCLAVE.—An apparatus for sterilization by steam under pressure. 
BACILLUS.—A rod-shaped microorganism. 
BACTERIA.—Microscopic vegetable organisms of many varieties, some of which 
produce disease. 
BILL OF HEALTH.—A document which must be obtained by the master of a 
vessel from a consul before his vessel may sail; a health clearance. 
BLEB.—A blister. 
BUBONIC.—Relating in any way to a bubo. Bubonic plague, the most common 
form of the plague, characterized by the occurrence of buboes in the groin or 
armpit. 
CAPILLARIES.—The smallest blood vessels of the body which connect the 
veins and arteries. 
CARRIER.—A person who harbors in his body disease-producing germs without 
actually suffering from or showing symptoms of the disease. 
CATHARTIC.—An agent causing active movements of the bowels. 
CATHETER,—A slender tubular instrument, generally of soft rubber or of 
silver, used chiefly for passing through urethra into bladder to draw off the 
urine. 
CAUTERIZE.—To burn or scar with caustics or a hot iron. 
CHOLAGOGUE.—Causing increased evacuation of bile, 
CLEANING.—Removal by scrubbing and washing of material contaminated 
by disease-producing germs. 
CLINICAL.—Relating to the course of a disease. Clinical thermometer, a 
self-registering thermometer for taking the bodily temperature. 
123 124 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
COMMUNICABLE.—As of disease, capable of being passed from one individual 
to another. Commonly referred to as “contagious,” if readily communicable, 
as by the air; “infectious,” if not readily communicable, as by contact, 
water, food, etc. 
CONTACT.—Any person or animal who has been sufficiently close to an infected 
individual to contract the disease. 
CONTAGION.—The communication of disease from person to person by con- 
tact, direct or indirect. 
CORYZA,—Acute rhinitis; cold in the head. 
DEJECTA.—The matter passed from the bowel; feces. 
DELIRIUM.—A temporary mental derangement, occurring in fevers, etc., charac- 
terized by incoherent and wandering talk, illusions, etc. 
DELOUSING.—The killing of lice or their eggs on the person or clothing of an 
individual. 
DEODORANT.—A substance which destroys or hides foul odors. 
DIAPHORETIC.—A medicine that increases perspiration. 
DISINFECTANT.—A substance used to destroy the germs of infectious and 
contagious diseases. 
DISINFECTION.—The act or process of disinfecting; purification from infect- 
ing matter. 
DISLOCATION.—Where the bones forming a joint do not occupy their usual 
relation to each other. 
EMETIC*—An agent which causes vomiting. 
ENDEMIC.—A disease constantly present in a community, as distinguished 
from epidemic. 
ENEMA.—A fluid injected into the rectum for the purpose of clearing out the 
bowel, or of administering drugs or food. 
EPIDEMIC.—The extensive prevalence in a community of a disease brought 
from without, or a temporary increase in number of cases of an endemic 
disease. 
EPIDIDYMITIS.—Inflammation of the seminal ducts of the testicle. 
ERUPTION.—A breaking out, especially the appearance of changes in the 
skin; a rash. 
EXPECTORANT.—A medicine that promotes expectoration. 
FEBRIFUGE.—Medicine which lessens fever. 
FECES.—The matter discharged from the bowels during defecation. 
FOUNTAIN SYRINGE.—One which has no pistons, but is hung up and acts 
by gravity. 
FRACTURE.—A break, usually of a bone. 
FUMIGATION.—The destruction of germs, insects, and rodents by means of 
chemical gases and fumes, as that of formaldehyde and sulfur. 
FUNGUS.—A cellular vegetable organism of low order, feeding on organic 
matter; such as mushrooms, toadstools, yeasts, and molds. 
GERM.—A microbe or pathogenic bacillus. 
GERMICIDE.—An agent which is destructive to germs and microbes. 
HEMOSTATIC.—An agent which stops the flow of blood, especially internal. 
HERNIA.—Rupture. The protrusion of tissue through an abnormal opening. 
Most common is “inguinal,” the protrusion of a loop of gut through an opening 
in the belly wall at the groin. 
HYPNOTIC.—A drug that induces sleep. 
IMMOBILIZATION.—The act of rendering a part immovable or of preventing 
all possibility of movement in a part; especially applied to fractured bones. GLOSSARY 
125 
IMMUNITY.—Security against any particular disease; “active,” when resulting 
from an attack of the disease, or from “vaccination”; “passive,” when produced 
by injection of serum of an immunized animal. The former is prolonged, 
the latter temporary. 
INCUBATION PERIOD.—The period between exposure of an individual to and 
the onset of symptoms of a communicable disease. 
INFECTION.—Communication of disease, as by entrance of pathogenic germs 
into an organism in any manner. 
INSECTICIDE.—An agent which kills insects. 
ISOLATION.—Limitation of the movement of known sick or “carrier” indi- 
viduals or animals. 
LAXATIVE.—A remedy which assists the movement of the bowels which move 
sluggishly. A laxative is useless where the bowels have been clogged for 
several days, in which case a cathartic is necessary. 
LIGATURE.—A thread for tying a blood vessel. 
MACERATION.—Softening by the action of a liquid. 
MACULE.—A discolored spot on the skin not elevated above the surface. 
METABOLISM.—Tissue change; consists of “anabolism” (building up), and 
“catabolism” (breaking down of tissues). It is the process of nourishing the 
tissue cells, and their production of heat and energy. 
MICROBE—A microscopic organism, especially a bacterium. 
MICROORGANISM.—A microscopic living organism1 of the animal or vegetable 
kingdom; bacillus, bacterium, microbe, germ. 
ORCHITIS.—Inflammation of the testicle; a common complication of mumps. 
ORGANIC.—Having an organized structure, or a substance derived from living 
organisms. 
PALPITATION.—Rapid and perceptible beating of the heart, which may be 
regular or irregular. 
PARASITICIDE.—A chemical agent which destroys the various animal and 
vegetable parasites. 
PATHOGENIC.—Productive of disease. 
PLEURA.—A thin membrane which lines the inside of the chest wall and 
covers the lungs. 
PNEUMONIC.—Relating to pneumonia. Pneumonic plague, a particularly fatal 
form of plague, with marked lung involvement 
PRATIQUE.—A license or permission granted by the authorities of a port 
to the master of a vessel, especially after sanitary inspection or quarantine, 
to hold communication with the shore. 
PROPHYLAXIS.—The prevention of disease. 
PROTOZOA.—The lowest division of the animal kingdom, including the uni- 
cellular organisms, such as the malarial parasite. 
PURGATIVE, PURGE.—A medicine that moves the bowels actively. 
PURULENT.—Consisting of pus, or matter. 
PUS.—The matter from a sore or abscess. 
PUSTULE.—A small circumscribed inflamed elevation on the skin, containing 
pus. 
QUARANTINE.—Limitation of movements of persons exposed to communicable 
disease, or of those who have been in contact with persons ill with such 
disease. 
RABIES.—A disease affecting certain animals, especially dogs, from which 
hydrophobia is communicated to man. 
RASH.—An eruption on the skin. 
457944°—42 9 126 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
RECTUM.—The lowest part of the large intestine, opening at the anus. 
RENOVATION.—Rendering a space or room sanitary, in addition to cleaning, 
as by painting. 
RHINITIS.—Inflammation of the mucus membrane of the nose. 
SANITATION.—Employment of measures designed to promote health and pre- 
vent disease through proper care of surroundings and things. 
SEDATIVE.—A medicine which allays irritation and quiets the nerves. 
SEPTIC.—Produced by or due to putrefaction. 
SHOCK.—A condition of collapse or profound prostration sometimes following 
hemorrhage, injury, anesthetic, and operation. 
SOPORIFIC.—A hypnotic. 
SPATULA.—A broad-bladed instrument like a knife with blunt edges for 
spreading ointments. 
SPECIFIC.—A medicine which has a direct curative influence on a particular 
disease; as quinine in malaria. 
STAPHYLOCOCCUS,—A bead-shaped microorganism occurring in clumps. 
STERILE.—Free from pathogenic bacteria or other microorganisms; aseptic. 
STIMULANT.—A medicine having power to excite organic action or to increase 
the vital activity of an organ, as heart stimulant, respiratory stimulant. 
STREPTOCOCCUS.—A bead-shaped microorganism occurring in chains. 
STRICTURE.—A narrowing of a passage or canal in the body due to disease or 
injury. 
STYPTIC.—Medicine or application to control external hemorrhage. 
SUSCEPTIBLE.—A person or animal who is not immune to a specific disease. 
SUTURE.—A stitch used to draw together the edges of a wound. 
TONIC.—An agent which tends to restore normal tone to the body. 
TOURNIQUET.—An instrument for stopping the flow of blood through an 
artery by means of strong compression. 
TOXIN.—A poisonous substance of undetermined chemical nature, elaborated 
during the growth of pathogenic microorganisms. 
URETHRA.—The canal by which the urine is conducted from the bladder and 
discharged. 
URINATION.—The act of discharging the contents of the bladder. 
UVULA.—The small, fleshy body which hangs from the soft palate over the root 
of the tongue. 
VARICOSE.—Having an unnatural enlargement or dilation, knotty and irregu- 
ular in shape, as often seen in the veins of the lower extremities. 
VENEREAL.—Pertaining to sexual intercourse or caused by it. 
VERMICIDE.—A medicine which causes the death and expulsion of intestinal 
worms. 
VIRUS, FILTRABLE.—The causative agent of some diseases, differentiated 
from other agents such as bacteria, protozoa, or molds; is ultramieroscopic, and 
passes through the finest filters. The cause of smallpox, yellow fever, and 
many other diseases. INDEX 
Page 
Accident prevention 93 
Acid; 
Carbolic, disinfection by 120 
Poisoning by 34 
Strong, poisoning by 34 
Acute abdominal conditions 55 
Acute appendicitis 56 
Acute intestinal obstruction 56 
Appendicitis 56 
Air, fresh 44 
Alkalis, poisoning by 35 
Anthrax 118 
Arm, fracture of 26 
Arsenic, poisoning by 35 
Arterial hemorrhage 20 
Arteries, main, location of 20 
Artificial respiration 30 
Athlete’s foot 64 
Azochloramid saline mixture tablets 15 
Autopsy 81-83 
Back, fracture of 25 
Bandaging 27 
Bichloride of mercury: 
Poisoning by 34 
Bills of health 103 
Bites: 
Animal 17 
Insect 18 
Snake 19 
Blister 21, 22, 41 
Boiling, disinfection by 1 119 
Borax solution 67 
Box: 
Boat 5 
Medicine, contents of 3, 4, 5 
Bruises 14 
Bubo 72 
Bulla 41 
Burial, at sea 82 
Burns 21 
Capillary oozing 20 
Carbolic acid; 
Poisoning by 34, 35 
Carbon monoxide poisoning 36 
Cats, bites from 17 
Cerebrospinal fever 65-66 
Chancroid 74 
127 128 
INDEX 
Chemical: Page 
Disinfectants 120 
Gases, disinfection by 121 
Chemical warfare agents (war cases) 36-37 
Chickenpox 45 
Chills and fever 50 
Chlorinated lime 120 
Chlorination of water 121 
Cholera 62, 106 
Chordee 72 
Clap 71 
Clinical thermometer 40 
Cold, effects of 22, 23 
Colds and coughs 53 
Colic;, 
Gallbladder 57 
Intestinal 58 
Kidney 58 
Collarbone, fracture of 25 
Communicable diseases; 
General treatment of 43 
Fever 40 
Incubation period 42 
Compound fracture 25 
Continuous fever 40 
Convulsions 30 
Coughs and colds 53 
Crabs 64-65 
Cremation 82 
Cresol 120 
Crisis as termination of fever 40 
Death; 
At port 81 
At sea 81 
From accident 82 
Delirium tremens 66-67 
Dengue 51 
Dental treatment 68 
Diarrhea 59 
Diet 43 
Diphtheria 54-55 
Diseases; 
Infectious, general treatment of 43 
Eye 67 
Nervous system 65 
Respiratory system 53 
Skin 62-63 
Stomach and intestines 58 
Special 37 
Venereal 71 
Disinfectants 118-122 
Chemical 120 
Death: 
Diseases; 129 
INDEX 
Disinfectants—Continued. p«g0 
Gaseous, agents 121 
Physical 118-119 
Disinfecting plants 122 
Disinfection 118 
By: 
Boiling 119 
Chemical gases 120 
Chlorinated lime 121 
Chlorination of water 121 
Cresol 120 
Formaldehyde solution 120 
Formalin 100, 120 
Steam 119 
Dislocations 23, 24 
Dogs, bites from 17 
Dressings, sterilization of 16 
Drowned, resuscitation of the apparently 30 
Drowning, method of handling, in water 33 
Drugs 44 
Duodenal ulcer 57 
Dysentery 60 
Earache 68 
Electric shock, resuscitation from 33 
Embalming 82-84 
Emergency measures 13 
Epileptic fits 30 
Expenses; 
Funeral 82 
While in hospital 77-78 
Exposure 17 
Eye; 
Diseases of 67 
Inflammation of 67 
Wash 67 
Fainting 29 
Fever; 
Cerebrospinal 65 
Continuous 40 
Infectious *. 40 
Intermittent 40 
Malarial 50 
Remittent 40 
Scarlet 48 
Typhoid 61 
Typhus 115-116 
Undulant 51 
Yellow 51, 109 
Fevers 51, 109 
Terminations of 40 
Types of 40 
Finger, fracture of 26 
First aid 13 130 
INDEX 
Page 
Fits, epileptic 30 
Food: 
Handlers 59, 90 
Inspection 90 
Poisoning 59 
Foot, fracture of 27 
Forearm, fracture of 26 
Formaldehyde solution 120 
Formalin 100, 120 
Disinfection by 100, 120 
Fractures 24 
Special 25 
Freezing 22 
Fresh air 44 
Frostbite 23 
Fumigation of vessels 121 
Fumigants 121 
Funeral expenses 82 
Gall bladder stone 57 
Garbage disposal 91 
Gas poisoning, resuscitation from 33 
Gases, war 36—37 
Gastric ulcer 57 
German measles 47 
Glossary 123 
Gonorrhea 71-72 
Gonorrheal inflammation of eye 73 
Grip 45 
Hand, fracture of 26 
Headache 65 
Health, bills of 103 
Records 89 
Heat; 
Exhaustion 68-69 
Stroke 68-69 
Hemorrhage 19 
Hernia 27 
Heroin, poisoning by 35 
Hospital: 
Expenses while in 77-78 
Facilities 77 
Hospitals: 
Naval 77 
Public Health Service 77 
Hydrochloric acid, poisoning by 34 
Hydrophobia, prevention of 17 
Hydrotherapy 44 
Hygiene, personal 87 
Incubation period 42 
Infection, prevention of spread of 42 
Inflammation of eye 73 
Influenza 45 
Injuries 14 
Hospital: 
Hospitals: INDEX 
131 
Page 
Insensibility 29 
Inspection of food 90 
Instruments, sterilization of 16 
Intestinal obstruction 56 
Intermittent fever 40 
Internal hemorrhage 20 
Intestines, and stomach diseases of 58 
Isolation period 42 
Itch 62 
Jaw, fracture of 25 
Kidney stone 58 
Kneecap, fracture of 26 
Laudanum, poisoning by 34 
Leg, fracture of 26 
Leprosy 117 
Lice 64 
Lighting 92 
Lye, poisoning by 35 
Lymphogranuloma 74 
Lysis, as termination of fever 40 
Macule 41 
Malaria 50 
Malta fever 51 
Measles 47 
German 47 
Medicine box, contents of 3, 4, 5 
Medicines, directions for 7, 8, 9, 10, 11 
Mediterranean fever 50 
Mercury, bichloride of; 
Poisoning by 34 
Morphine, poisoning by 35 
Mumps 49 
Naval: 
Hospitals 77 
Medical supply depots 2 
Nervous system, diseases of 65 
Nitric acid, poisoning by 34 
Nose: 
Bleeding 20 
Fracture of 25 
Nursing 44 
Nux vomica, poisoning by 35 
Opium, poisoning by 35 
Orchitis 73 
Papule 41 
Paraphimosis 72 
Paregoric, poisoning by 35 
Paris green, poisoning by 35 
Pay while in hospital 77 
Personal hygiene 87 
Phimosis 72 
Physical disinfectants 118-119 132 
INDEX 
Page 
Plague 51 
Pneumonia 54 
Poisoning: 
By: 
Alkalis 35 
Arsenic 35 
Barbital (veronal) 35 
Benzine 35 
Bichloride of mercury 34 
Carbon monoxide 36 
Chloral hydrate 36 
Food 59 
Gasoline 35 
Heroin 35 
Iodine 36 
Hydrochloric acid 34 
Laudanum 35 
Luminal 36 
Lye 35 
Morphine 35 
Naphtha 35 
Nembutal 36 
N itric acid 34 
Nux vomica 35 
Opium 36 
Paregoric 35 
Paris green 35 
Ptomaines 59 
Rough-on-rats 35 
Strong acids 34 
Strychnine 35 
Sulphonal 36 
Sulphuric acid 34 
Trinitrotoluene 35 
Unknown poison 34 
Wood alcohol 35 
Gas fumes, resuscitation from 33 
Prevention of 34 
Poisons 34 
Postmortem 82-83 
Precautions, sanitary 90, 98 
Prevention of infection 42 
Preventive medicine 87 
Procedure, quarantine 92 
Prophylaxis, venereal 75 
Ptomaines, poisoning by 59 
Public Health Service hospitals 77 
Pustule 41 
Quarantine: 
Detention 101 
Diseases requiring 96-97 
Period 42, 96, 97 
Procedure 95 INDEX 
133 
Quarantine—Continued. Page 
Requirements at sea 98 
Requirements at foreign ports 97 
Special measures 106 
Stations, list of 122 
Use of disinfectants in 118 
Rat; 
Extermination 112, 113, 114 
Guards 114 
Remittent fever 40 
Requisitions: 
For medical stores 2 
Forms 2 
Rescuing the drowning 30, 33 
Respiratory system, diseases of 53 
Rest 43 
Resuscitation: 
From; 
Drowning 30 
Electric shock 33 
Gas fume poisoning 33 
Method: 
Alternate 32, 33 
Schaefer 31 
Sylvester 32 
Rib, fracture of 25 
Ringworm 63, 64 
Roller bandage 27 
Rough-on-rats, poisoning by 35 
Rules for first aid 13 
Rupture 27 
Ruptured ulcer of duodenum 57 
Ruptured ulcer of stomach 57 
Sanitary precautions 90, 98 
Scab 41 
Scabies 62, 63 
Scalds 21 
Scale 41 
Scarlet fever 48 
Schafer method of artificial respiration 31 
Scuttle butt terminals 91 
Sewage disposal 91 
Shock, electric, resuscitation from 33 
Skull, fracture of 25 
Smallpox 46, 103 
Sore throat 53 
Special diseases 39 
Splints 29 
Sprains 23 
Starvation 17 
Steam, disinfection by 118 
Sterilization of dressings and instruments 16 
Stomach and intestines, diseases of 55 
Stomach ulcer 57 134 
INDEX 
Stone; Page 
In gall bladder 57 
In kidney 58 
In ureter 58 
Strains 23 
Stricture of urethra 73 
Stroke: 
Heat 68, 69 
Sun___ 68, 69 
Strychnine, poisoning by 35 
Stye 67 
Sulfanilamide 5, 10, 15, 25 
Sulfadiazine 4, 8, 16, 25 
Sulfur; 
Dioxide 114, 117 
Disinfection by 114, 117 
Sulfuric acid, poisoning by 34 
Sunstroke 68 
Supplies: 
Medical and surgical 2 
Requisitions for 2 
Supply depots, naval medical 2 
Swimming 73 
Syphilis 73, 74 
Temperature, taking of 40 
Testicle, swollen 73 
Thermometer, clinical 40 
Thigh, fracture of 26 
Thirst 19 
Throat, sore 53 
Tonsilitis 53 
Toothache 68 
Tourniquets, application of 19 
Treatment of infectious diseases 43 
Triangular bandage 27 
Typhoid fever 61 
Typhus fever 115, 116, 117 
Ulcer: 
Duodenum 57 
Stomach 67 
Unconsciousness 29 
Undulant fever 51 
Urethra, stricture of 73 
Utensils and mess gear, washing of 90 
Venereal diseases 71 
Venous hemorrhage 19 
Ventilation 91 
Vermin 64 
Vesicle 41 
War gases 36, 37 
Water, treatment of 90, 121 
Wounds 14, 16 
Wrist, fracture of 26 
Yellow fever 51 CHEMICAL WARFARE AGENTS 
SYMBOL 
NAME 
CLASS 
ODOR 
TACTICAL 
CLASS 
PHYSIOLOGI- 
CAL EFFECT 
PROTEC- 
TION 
FIRST AID 
COLOR AND STATE 
PERSISTENCE 
TACTICAL USES 
FIELD NEU- 
TRALIZATION 
Loaded 
Released 
H 
S 
MUSTARD. 
Di-Chlordiethylsulfide. 
Gas. 
Garlic. 
Horseradish. 
Mustard. 
Burns skin or 
membrane. 
Remove clothing. Wash 
affected parts of body 
with soapy water. Do not 
bandage eye injuries. 
Heavy, dark, 
oily liquid. 
Liquid 
slowly 
evaporates. 
Open, 1 day. 
Woods, 1 week 
to all winter. 
To neutralize areas. 
Counter-battery. 
Attack on Personnel. 
Cover with bleaching 
powder and earth 
3% sol. of Na2S. 
M 
■1 
LEWISITE. 
Chlorvinyldichlorarsine. 
Gas. 
Geraniums. 
Irritates nasal 
passages. Later 
skin burns; poison. 
Apply 2% to 5% sol. hydrogen 
peroxide to skin; wash with soap 
and water. Wash eyes with l/2% 
to 1% sol. of hydrogen peroxide. 
Heavy, dark, 
oily liquid. 
Liquid 
slowly 
evaporates. 
Open, 1 day. 
Woods, 1 week. 
KmI • 
Similar to Mustard. 
Wash down with water. 
Cover with earth. Alcohol. 
NaOH spray. 
ED 
ETHYLDI- 
CHLORARSINE. 
Gas. 
Biting. 
Stinging. 
Causes blisters; 
sores. 
ill 
Same as for Lewisite. 
Clear, oily 
liquid. 
Evaporates 
at medium 
rate. 
1 hour. 
Counter-battery. 
Preparation fire. 
Harassing fire. 
p ' wQoIif B 
Cover with earth, caustic 
NaOH solution. 
P 
S 
CHLORPICRIN. 
Nitrochloroform. 
Gas. 
Fly paper. 
Anise. 
Causes severe 
coughing, crying; 
lung edema. 
g 
Wash eyes, keep quiet and 
warm. Do not rub eyes. 
Yellow, oily 
liquid. 
Evaporates 
like water. 
Open, 6 hours. 
Woods, 12 hours, 
Harassing fire. 
Na2S03—Sodium Sulfite 
in alcohol solution. 
DP 
DIPHOSGENE. 
Trichlormethyl 
Gas. 
Ensilage. 
Musty hay. 
Causes coughing, 
breathing hurts; 
n 
Keep quiet and warm. Give 
coffee as a stimulant. 
Colorless 
liauid. 
Evaporates 
like water. 
30 minutes. 
Harassing fire. 
Alkali. 
C 
G 
PHOSGENE. 
Carbonyl Chloride. 
Gas. 
Musty hay. 
Green corn. 
Ensilage. 
Irritates lungs. 
& 
Keep quiet and warm. Give 
coffee as a stimulant. 
Colorless 
liquid. 
Colorless 
gas. 
10 to 30 minutes. 
Surprise attacks; projectiles. 
Gas cloud release. For quick 
physical effect. 
Alkali. 
C 
L 
CHLORINE. 
Gas. 
Highly 
pungent. 
Intense imme- 
diate choking. 
g 
Remove from gassed area. 
Keep quiet and warm. 
Coffee as stimulant. 
Yellow 
liquid. 
Yellow-green 
gas. 
10 minutes. 
Surprise attacks (cloud). 
Alkaline solution. 
CN 
*(CNS) 
CHLORACETO- 
PHENONE. 
Gas 
Solution. 
Apple 
blossoms. 
Makes eyes smart, 
shut tightly, tears 
flow. Temporary. 
g 
Wash eyes with water or boric 
acid. Do not rub or bandage. 
Wash skin with Na2S03, 4% sol. 
in 50% alcohol. 
Brown 
crystalline 
powder. 
Cloud of 
small, solid 
particles. 
10 minutes. 
Training. Mob control. 
CNS used in counter-battery 
to force mask wear. 
Strong, hot solution of 
Sodium carbonate. 
c 
A 
BROMBENZYL- 
CYANIDE. 
Gas. 
Sour fruit. 
Eyes smart, shut, 
tears flow. Effect 
lasts some time. 
g 
Wash eyes with boric acid. Do 
not bandage. Breathe small 
amounts of Chlorine. 
Dark brown, 
oily liquid. 
Slowly 
evaporates. 
Seyeral days 
(weeks in 
winter). 
To neutralize areas. 
Counter-battery. 
Alcoholic Sodium 
hydroxide spray. 
D 
M 
ADAMSITE. 
Diphenylamine 
Chlorarsine. 
Gas. 
Coal smoke. 
Causes sneezing, 
sick, depressed 
feeling. 
g 
Remove to pure air and keep 
warm and quiet. 
Yellow-green 
granular solid. 
Yellow 
smoke. 
10 minutes. 
Gas cloud attacks. 
Mob control. 
Bleaching powder 
solution. 
D 
A 
DIPHENYL- 
CHLORARS1NE. 
Gas. 
Shoe polish. 
Causes sneezing, 
sick, depressed 
feeling. 
g 
Remove to pure air; keep quiet. 
Sniff chlorine from bleaching 
powder bottle. 
White 
crystalline 
solid. 
Vapor or 
fine smoke. 
Summer. 10 
minutes. 
Harassing fire. 
Bleaching powder 
solution. 
H 
1C 
HC MIXTURE. 
Smoke. 
Sharp-acrid. 
Harmless. 
None 
needed. 
Produces no effect 
requiring treatment. 
Gray solid. 
White to 
gray smoke. 
While burning. 
To screen small operations 
in own lines and for 
training purposes. 
None needed. 
F 
s 
SULPHUR 
TRIOXIDE. 
In Chlorsulfonic Acid. 
Smoke. 
Burning 
matches. 
Liquid burns skin 
if allowed to 
remain. 
g 
Wash with soda solution. 
Clear to 
brown liquid. 
Dense white 
smoke. 
5 to 10 minutes. 
Airplane spray for screen 
on broad front. 
Alkaline solution. 
F 
M 
TITANIUM 
TETRACHLORIDE. 
Smoke. 
Acrid. 
Harmless. 
None 
needed. 
Produces no effect 
requiring treatment. 
Yellowish to 
brown liquid. 
White 
smoke. 
10 minutes. 
Screening operations. 
None needed. 
1A 
fP 
WHITE 
PHOSPHORUS. 
Smoke. 
Burning 
matches. 
Burning pieces 
adhere to skin, 
clothing. 
None 
available. 
Immerse in water or wet with 
CuS04, 2% solution. 
Pale yellow 
solid. 
Burns to 
white smoke 
in air. 
10 minutes. 
To screen advancing troops. 
Cause incendiary effects, losses. 
Harass enemy observers. 
Burns out. 
1 
H 
THERMIT 
(Thermite). 
Magnetic Iron Oxide and 
Aluminum Powder. 
Incen- 
diary. 
Odorless. 
a&y 
5,000 degrees F. 
heat ignites 
materials. 
Cover with 
earth, sand. 
Treat for burn. 
Metallic 
powder. 
White-hot 
metal. 
5 minutes. 
Destruction of materiel. 
Quickly cover with 
earth or sand. 
*CNS, a 
tThe fill! 
solution of CN in Chlorof 
ng of a Magnesium bomb 
orm and Chic 
which serve; 
>rpicrin, frequent! 
to ignite the me 
y used for shell fii 1 it 
■al magnesium casir 
tffy'zSr 
O. S. GOVERNMENT PRINTING OFFICE : 1942 0 - 457944 
Revised and printed by the Bureau of Medicine and Surgery, Navy Department, through the courtesy of the Chemical Warfare Service, War Department.