State Charities Aid Association FIRST AID TO THE 
INJURED 
BY 
PETER SHEPHERD, M. B„ 
Surgeon Major, Army Medical Department; Associate of the 
Order of St. John of Jerusalem 
Revised and Added to at the request of the First Aid 
to the Injured Association of New York 
BY 
BOWDITCH MORTON, 
New York 
G P. PUTNAM'S SONS 
27 and 29 West 2 3D Street 
1882 PREFACE. 
This brief Manual is simply intended for non-profes- 
sional readers. There is no attempt made to popularize 
Medicine or Surgery; the object is to furnish a few plain 
rules which may enable any one to act in cases of injury or 
sudden illness, pending the arrival of professional help. 
London, 30th October, 1878. 
At the request of the First Aid to the Injured Associa- 
tion of New York, I have revised and made such additions 
to the original form of this little book as seemed necessary 
to make it suitable to this country and to the needs of the 
Association. The book is strictly one for emergency. 
No attempt has been made to prepare a manual of nurs- 
ing. 
15 East 45TH Street, Jan. 21, 1882. CONTENTS. 
PART I. 
Anatomical and Physiological Outlines. 
PAGE 
Section I. The Skeleton 4 
II. The Muscular System .... 8 
III. The Nervous System 9 
IV. The Organs of Special Sense 11 
V. The Blood and Orgr.ns of Circulation 13 
VI. The Organs of Voice and Respiration 23 
VII. The Organs of Digestion 26 
VIII. The Organs of Secretion 27 
IX. The Organs of Excretion 28 
PART II. 
Medical and Surgical Outlines. 
CHAPTER I. 
Insensibility: 
Causes of 30 
Method of Examination of persons found Insensible 31 
Important Symptoms and their Indications 32 IV 
CHAPTER II. 
Important Diseases and Injuries of the Head: 
PAGE 
Intoxication..... 33 
Apoplexy 34 1 
Convulsions 34 
Epilepsy 34 
Blood Poisoning. 35 
Opium Poisoning 35 
Shock or Collapse 35 
Concussion of Brain 36 
Compression of Brain 36 
CHAPTER III. 
Treatment of Cases of 
Drowning.. 37 
Hanging 40 
Suffocation by Gases 40 
Sunstroke 40 
CHAPTER IV. 
Haemorrhage or Bleeding: 
General treatment of V. 41 
Arterial, treatment of 42 
Venous, treatment of 42 
Capillary, treatment of 43 
Internal, treatment of ,. 43 V 
Situation of the Main Arteries of the Body, 
AND THEIR TREATMENT WHEN WOUNDED; 
PAGE 
Haemorrhage from Head and Face and Neck 44 
" " Armpit 45 
" " Upper Arm 45 
" " Fore-Arm 45 
" " Palm 46 
" " Thigh 46 
" " Ham 46 
" " Back of Leg 46 
" " Front of Leg and Instep 47 
" " Sole of Foot 47 
. CHAPTER V. 
Fractures : 
Varieties of 47 
Signs of 48 
General treatment of 48 
Fractures of Skull 49 
" " Lower Jaw 50 
" " Collar-Bone 50 
" " Ribs 50 
" " Upper Arm t 51 
" " Fore-Arm 51 
" " Wrist and Hand 51 
" " Thigh 52 
" " Knee-Cap 52 VI 
PAGE 
Fractures of Bones of Leg 52 
" " Foot and Ankle 53 
CHAPTER VI. 
Wounds: 
Incised, treatment of 53' 
With Protruding Internal Organs ; treatment of... 54 
Contused and Lacerated; treatment of 54 
Foreign Bodies in the Eye 54 
Foreign Bodies in the Ear 55 
Croup 55 
Choking 55 
Burns and Scalds: Treatment of 56 
Frost Bite: Treatment of 56 
Bed Sores: Treatment of. 57 
Bites from Rabid Animals: Treatment of 57 
Signs of Madness in Dogs 58 
CHAPTER VIL 
Material and Appliances for the Relief of the 
Sick and Injured : 
The Order of St. John Litter 58 
Stretchers, and How to use Them 59 
" Rules for Carrying 60 
Splints 60 
Pads 60 
Bandages 60 VII 
PAGE 
Dressings 62 
Stimulants 62 
Poultices 63 
Leeches 63 
CHAPTER VIII. 
Disinfection : 
Definition of 04 
Disinfectants 64 
Rules for Disinfecting U-noccupied and Occupied 
Rooms 65 
Rules for Preventing Spread of Infectious Diseases 67 
CHAPTER IX. 
Baths: 
Cold 68 
Cool . 69 
Temperate ... 69 
Hot 69 
CHAPTER X. 
Poisons : 
Definition of 70 
Classes of 70 
General treatment of 70 
Emetics 70 
Substitute for Stomach Pump 71 
Arsenic 71 VIII 
PAGE 
Antimony 72 
Acids . 72 
Alkalies 72 
Phosphorus 72 
Mercury 72 
Nitrate of Silver 72 
Gases••*•«••••«•• , 72 
Prussic Acid. 73 
Strychnia. 73 
Narcotics 73 
Alcohol 73 
CHAPTER XI. 
Death : 
Cases of Sudden 73 
Causes of 74 
Appearances of 74 
INDEX 81 PART I. 
Anatomical and Physiological Outlines. 
THE HUMAN BODY. 
I. Skeleton, or bony framework. 
II. Muscular System: the organs of motion. 
III. Nervous System: brain, spinal marrow, nerves of 
sensation and motion, and sympathetic nerves. 
IV. Organs of Special Sense: eye, ear, tongue, nose, 
and skin. 
V. Blood and Organs of Circulation: heart and blood- 
vessels. 
VI. Organs of Voice and Respiration: larynx, lungs, 
and windpipe. 
VII. Organs of Digestion: pharynx, gullet, stomach, 
and intestines. 
VIII. Organs of Secretion: salivary glands, liver, and 
pancreas. 
IX. Organs of Excretion: kidneys and skin 4 
The skeleton is divided into three parts : head, trunk, and 
limbs. 
I.-THE SKELETON. 
skull-cap. 
face. 
a. head. 
back-bone and breast-bone, 
ribs. 
Skeleton 
b. trunk. 
c. limbs. 
shoulders and arms, 
haunches and legs. 
The Head contains the brain, and the organs of sight, 
hearing, taste, and smell. 
The Chest contains the organs of circulation and respira- 
tion. 
The Belly contains the digestive apparatus, organs of 
secretion and excretion, etc. 
The Upper Limb consists of shoulder, arm, fore-arm, 
wrist, and hand, and is the organ of prehension. 
The Lower Limb consists of haunch, thigh, leg, ankle, 
and foot, and is the organ of support and progression. 
The Skull is composed of eight, and the Face of fourteen 
bones. 
The Facial bones, except the lower jaw, are firmly joined 
together, and form cavities for the reception of the organs 
of sight, taste, and smell. 
The Trunk is divided into- 
a. Thorax or chest. 
b. Abdomen or belly. 
c. Pelvis. 5 
The Thorax is a bony cartilaginous cage of a conical 
shape ; it contains the organs of circulation and respiration 
-heart and lungs, and many great blood-vessels and nerves. 
The bones of the thorax are- 
a. Spine (behind}. 
b Sternum or breast-bone (in front}. 
c. Ribs and their cartilages (at sides}. 
The Spine is a hollow flexuous column, and is divided 
as follows : 
'Cervical or neck portion, 7 bones. 
Dorsal or back portion, 12 bones. 
Lumbar or loin portion, 5 bones. 
Sacrum, rump-bone, 5 bones fused into one. 
k Coccyx. 
Spine 
The Sternum, or breast-bone, forms the front of the chest; 
it has attached to either side a collar-bone and the cartilages 
of the seven upper ribs. 
The Ribs are twelve pairs of bony arches forming the 
walls of the chest. They are all attached behind to the 
spine. The upper seven are termed true ribs, being fixed 
to the breast-bone by their cartilages ; the lower five are 
termed floating or false ribs, having no attachment in front. 
The Abdomen is supported behind by the lumbar spine, 
and below by the bones of the pelvis'. Its contents are as 
follows : 
Liver. 
Stomach and intestines. 
Pancreas or sweetbread. 6 
Spleen. 
Kidneys. 
Many large blood-vessels and nerves. 
The Pelvis is the basin-shaped cavity which forms the 
lowest portion of the trunk ; and contains the bladder, the 
internal organs of generation, part of the intestine, and sev- 
eral great blood-vessels and nerves. The pelvis is com- 
posed of four bones :- 
2 Innominate or haunch-bones. 
1 Sacrum or rump-bone. 
1 Coccyx. 
The Innominate or haunch-bones with the lower portion 
of spine (sacrum and coccyx), form the lowest portion of 
the trunk. The innominate bones on their outer surfaces 
have cup-like depressions for the reception of the heads of 
the thigh-bones. 
The Shoulder is formed by the clavicle or collar-bone and 
scapula or blade-bone. 
The Clavicle, or collar -bone, has a double curve ; it marks 
the line dividing neck and chest. 
The Scapula, or blade-bone, lies on the back of the chest, 
is of a triangular shape, and forms the socket for the hu- 
merus or arm-bone. 
I Humerus, arm-bone. 
2 Radius and Ulna, fore-arm. 
8 Carpus, wrist. 
5 Metacarpus, palm. 
14 Phalanges, finger-bones. 
Upper Limb 7 
The Humerus, or bone of upper arm, extends from the 
shoulder to the elbow ; above, it is jointed to the scapula, 
and below to the bones of the fore-arm. 
The Ulna is the larger bone of the fore-arm, lies on the 
inside, and extends from elbow to wrist. 
The Radius lies on the outside of the fore-arm. 
The Carpus is a double row of small bones which help to 
form the wrist-joint. 
The Metacarpus consists of five bones, and form the 
body of the hand. 
The Phalanges are the fourteen finger-bones. 
The Lower Limb is composed as follows :- 
■ I Femur-thigh-bone. 
I Patella-knee-cap. 
2 Tibia and Fibula-leg-bon^s. 
7 Tarsus-ankle-bones. 
5 Metatarsus-instep-bones. 
14 Phalanges-toe-bones. 
Lower Limb 
The Hip Joint is a ball-and-socket joint, and is some- 
what similar to the joint at the shoulder. 
The Femur, or thigh-bone, extends from hip to knee 
joint, both of which joints it helps to form. 
The Patella (knee-tap') is the small oval bone which forms 
the prominent point of knee. 
The Knee Joint is formed by the lower end of the femur, 
the patella, and the upper end of the tibia. 
The Tibia is the main bone of the leg, and extends from 
knee to ankle, on the inside of the limb. 8 
The Fibula is the small bone on the outride of the limb : 
the lower ends of the tibia and fibula form prominent pro- 
jections at the sides of the ankle. 
The Tarsus, ankle-bones, are seven irregularly shaped 
bones, firmly united together ; above, they are attached to 
the tibia and fibula, and in front to the metatarsus. 
The Metatarsus forms the instep, and together with the 
tarsus the arch of the foot. 
The Phalanges, bones of the toes, are fourteen in num- 
ber, two for the great toe, and three for each of the others. 
The Muscles are the active organs of locomotion ; they 
are formed of bundles of reddish fibres ; they are the lean 
flesh. Their fibres can be well seen in a piece of overdone 
meat. 
Muscular tissue is divided into two varieties : striated 
and nxm-striated, or voluntary and involuntary ; the former 
is under the control of the will; the latter acts independ- 
ently. 
The Voluntary Muscles form a fleshy covering to the 
skeleton. Each muscle consists of bundles of fibres en- 
closed in a covering, or sheath, and two extremities or ten- 
dons for its attachment to the bones. 
All muscles have the power of contraction under stimu- 
lation, and it is by this property that motion is given to the 
various levers of the body. 
The Involuntary, or non-striated muscles, are found in 
IL-THE MUSCULAR SYSTEM 9 
such organs as the stomach and intestines, and do not act 
in obedience to the will, but obey the sympathetic nervous 
system. 
III.-THE NERVOUS SYSTEM. 
The nervous system is composed as follows :- 
-1. Brain and 9 pairs of 
nerves. 
2. Spinal cord and 31 
pairs of nerves. 
(a) Cerebro-Spinal Axis 
(5) Sympathetic System-3. Ganglia and nerves. 
The Brain is the largest and most important mass of ner- 
vous matter : it is subdivided into- 
1. Cerebrum 
2. Cerebellum. 
3. Medulla oblongata. 
The Cerebrum, or brain proper, consists of two similar 
ovoid masses, divided above by a deep groove, and con- 
nected below by a transverse commissure. 
It is the seat of the intellect, the emotions, and the will. 
The Cerebellum, or little brain, lies at the back of the 
head ; its function is to regulate the movements of the body. 
The Medulla Oblongata is the upper enlarged part of 
the spinal cord: it is in this portion that some crossing of 
the nervous fibres takes place, whereby the route of com- 
munication of nervous influences is changed from one side 
to the other ; and this fact accounts for a blow, injury, or 10 
disease on one side of the head producing paralysis on the 
opposite side of the body. 
The Cerebral Nerves consist of nine pairs ; they are 
motor, sensory, or compound in their functions. A motoi 
nerve conveys an impulse from the brain to some muscle or 
organ. A sensory nerve receives and conveys an impres- 
sion or sensation to the brain. A compound nerve con- 
tains motor and sensory fibres, and is consequently pos- 
sessed of a double function. 
The Spinal Cord is a cylindrical column of soft nervous 
tissue, extending from the base of the skull to nearly the 
lower end of the vertebral canal; it is about eighteen inches 
in length. It is both a nervous centre and a conductor of 
nervous influences ; it gives off thirty-one pairs of nerves 
from its sides. If the cord is cut, all parts of the body below 
are paralyzed. 
The Spinal Nerves are thirty-one in number, on each 
side ; they arise from the spinal cord by two roots, an an- 
terior or motor, and a posterior or sensory. They act as 
conductors, to and from the spinal cord. 
The Sympathetic Nervous System consists of a double 
chain of small nervous centres or ganglia, which lie along 
the sides of the spinal column ; their branches communicate 
freely with the cerebro-spinal system. They supply the 
involuntary muscles; and their function is to control the in- 
voluntary muscular tissue ; they govern the blood-supply, 
the nutrition of the body, and the secreting and excreting 
organs. Paralysis of these nerves produces enlargement 11 
of the blood-vessels of the parts to which they are distrib- 
uted. 
The organs of special sense are : 
I. Eye. 
2. Ear. 
3 Nose. 
4. Tongue. 
5. Skin. 
The Special Senses have been termed The Five Gateways 
of Knowledge, from the fact that they receive and transmit 
to the brain impressions regarding surrounding objects 
through their nerves. 
The Eye is an optical instrument, and consists essentially 
of three coatings or tunics, and three humors or refracting 
media. These transparent media are so constructed that 
images of objects are focussed on a delicate sheet of ner- 
vous matter at the back of the eye. 
The tunics are- 
1. Sclerotic, behind ; Cornea, in front. 
2. Choroid, behind ; Iris, in front. 
3. Retina. 
The Sclerotic is the outer fibrous white covering ; behind, 
it is perforated by the optic nerve and blood-vessels ; to its 
sides are fixed the muscular apparatus ; in front it is joined 
to the cornea. 
IV.-THE ORGANS OF SPECIAL SENSE. 12 
The Cornea is the clear portion of the eyeball; it is at- 
tached to the sclerotic in front like the glass of a watch. 
The Choroid lies beneath the sclerotic, forms the middle 
coat, and is very freely supplied with blood-vessels. 
The Iris is continuous with the choroid. It is a thin 
colored curtain surrounding the pupil, the size of which it 
governs, and thereby regulates the admission of light. 
The Retina is a most delicate semi-transparent sheet of 
nervous matter, lying in the inside and back of the eye. 
The Transparent Media, by which the rays of light are 
refracted before they form images on the retina, are- 
Aqueous humor. 
Crystalline lens. 
Vitreous humor. 
The Cornea is also a transparent refracting medium. 
The Aqueous Humor lies in front, between the lens and 
the cornea. 
The Crystalline Lens lies behind the pupil; it is a double 
convex lens. 
The Vitreous Humor lies behind, in front of retina, and 
occupies about four fifths of the eye. 
The Pupil varies in size; it contracts in a bright light, 
and dilates in darkness. 
The Ear, the organ of hearing, is composed of three por- 
tions : an External, Middle, and Internal. The external ear 
consists of a funnel, canal or tube, and a drum or membrane 
at its inner end. The drum divides the outer and middle 
portions. 13 
The middle portion or tympanum communicates with the 
mouth. The internal ear is the part where the filaments of 
the nerves are spread out to receive the vibrations or sounds. 
Blows on the external ear, and concussions from gunshot 
and other explosions, are apt to rupture the tympanum or 
drum. 
The Nose, or organ of smell, is a double-chambered cav- 
ity, lined with a mucous membrane, over which is spread 
numerous nerve filaments, branches of the olfactory nerves, 
for the reception of odoriferous impressions. 
The Tongue, or organ of taste, is situated in the floor of 
the mouth. It is mainly composed of muscular tissue, and 
is freely supplied with blood-vessels and nerves. Its upper 
surface is studded with papillae. The nerve filaments are 
spread out over the surface of the tongue and back portions 
of the mouth. 
The Skin, or organ of touch, is the entire covering of the 
body ; the modified skin {mucous membranes') lining passages 
also possesses this property. The nerve filaments end in 
small loops inside the papillae. The sense of touch is most 
delicate about the tips of the fingers and lips. 
V.-THE BLOOD AND ORGANS OF CIRCULATION. 
The Blood, or " river of life," is the most important and 
abundant fluid in the body ; it is contained in the arteries, 
veins, and capillaries-is everywhere present-provides the 
tissues with nourishment, and removes their waste products. 14 
The total quantity of blood is estimated at about one twelfth 
to one eighth of the weight of the body. Its color in the 
arteries is bright red ; in the veins dark purple. 
Great loss of blood produces death ; so also does any con- 
siderable change in its composition. 
Blood removed from the body separates into two portions 
-a red clot and a clear fluid. Its temperature in the body 
is from 98 degrees to 100 degrees. Its composition is as 
follows: 
Water. 
Corpuscles-red and white cells. 
Albumen. 
Fibrine. 
Fatty matter. 
Gases. 
Blood 
The organs of circulation are: 
(a) Heart. 
Arteries. 
Capillaries. 
. Veins. 
(£) Blood-vessels 
The Heart is a hollow muscular organ, situated between 
the twoJungs, and enclosed in a sac called the pericardium. 
It is about five inches long, and three and a half inches 
broad, and is divided into two halves-a right and a left- 
each side or half having two chambers, an auricle and a 
ventricle. 
The right side receives the venous blood, and drives it to 
the lungs to be purified and returned to the left. From 
Leg j 
From 
Trunk 
From 
Arm 
From 
Head 
VENOUS SYSTEM. 
Digital 
Plantar 
Tibial 
Popliteal 
Femoral 
Saphenous 
' lliacs 
Mesenteric 
Gastric 
Portal 
. Abdominal 
' Radial * 
Ulnar 
Brack1 al 
Axillary 
, Subclavian 
Jugular 
Innominate 
TABULAR VIEW OF CIRCULATION. 
V. Cava 
V, Cava 
- Heart 
Side 
Righty 
Lung 
Lung 
Left^-^^Side 
Hearts-Aortas- 
Femoral 
Popliteal 
Tibials 
Peroneal 
Digital 
• Plantar 
Aorta; 
Thoracic branches; 
Innominate 
Left Carotid 
" Subclavian 
Abdominal branches: 
Gastric 
Hepatic 
Mesenteric 
Renal 
lliacs 
Subclavian 
Axillary 
Brachial 
Radial or Ulnar 
r Carotids 
Vertebral 
ARTERIAL SYSTEM. 
To 
Leg 
To 
Trunk 
. To 
Arm 
To 
Head 16 
The left side receives the arterial blood, and forces it 
through the arteries to every region of the body. 
The openings between the chambers and the mouths of 
the large vessels leading into or out of the heart are guarded 
by valves or trap-doors to prevent regurgitation. 
Action of the Heart.-The heart acts by alternately con- 
tracting and dilating, at the rate of seventy to eighty times 
per minute. The two auricles contract and dilate simul- 
taneously, and so do the ventricles, but the former alter- 
nately with the latter. 
Circulation.-The impure blood returns from the body 
through the veins, and enters the right auricle ; the right 
auricle contracts and forces the blood into the right ventricle ; 
the right ventricle then contracts and forces the blood on to 
the lungs, where it becomes purified. After being purified 
it returns to the other side of the heart, to the left auricle, 
which contracts and drives it into the left ventricle ; the left 
ventricle now contracts and drives the blood through the 
arteries to the system generally, where it is conveyed by 
the capillaries into the veins. 
The preceding is a rough tabular view of the course of the 
blood. 
THE ARTERIES. 
The arteries are the vessels which convey the blood from 
the heart to every part of the body. 
The Pulmonary Artery arises from the right ventricle of 
the heart, and carries venous blood directly to the lungs, 17 
from whence it is returned by the pulmonary veins to the 
left auricle. This constitutes the lesser or pulmonic circula- 
tion. The Aorta arises from the left ventricle, and carries 
through its subdivisions arterial blood to the body generally. 
This constitutes the greater or systemic circulation. The 
aorta and its branches resemble a highly ramified tree. The 
larger trunks are usually found in the most protected situa- 
tions ; the arteries terminate in the capillaries, and the veins 
begin in them. 
Differences between Arteries and Veins : 
I. The arteries carry blood away from the heart 
towards the extremities. 
2. The veins carry blood towards the heart from 
the extremities. 
3. Arteries carry red blood. Veins carry dark 
purple blood. 
4. The walls of the arteries are stronger and more 
elastic, and have no valves except where they leave 
the heart. 
5. The walls of the veins are thin, and have valves 
on their inner wall, which prevent blood from flow- 
backwards. 
6. Some veins are quite superficial ; the arteries lie 
more deeply. 
7. The current is slower in the veins. 18 
PRINCIPAL ARTERIES. 
The Aorta arises from the left ventricle of the heart; it 
ascends for a short distance, arches backwards, and de- 
scends along the left side of the spine, through the chest 
and abdomen, until it is opposite the fourth lumbar verte- 
bra, where it divides into the two iliacs. 
The Innominate Artery, a short trunk arising from the 
arch of aorta, extends upwards for about an inch and a 
half, and divides into the right carotid and right subclavian. 
The Right Common Carotid is a branch of the innominate 
artery ; the Left Common Carotid is a branch of the aorta. 
These two vessels ascend the neck, one on each side of the 
windpipe, to about an inch below the angle of the jaw, 
where they divide into the external and internal carotids. 
The course of each vessel is indicated by a line drawn from 
the joint of the collar and breast bones {sterno-clavicular 
articulation), to a point midway between the angle of the 
jaw and a prominence of bone behind the ear (mastoid pro- 
cess). 
The Internal Carotid commences at the division of the 
common carotid, opposite the upper border of the thyroid 
cartilage, and proceeds upwards to the base of the skull, 
which it enters and supplies the brain. 
The External Carotid is the outer branch of the common 
carotid ; it proceeds upwards towards the ear, in front of 
which it passes on to the temple. It supplies various 
branches to the face, temple, and back of head. 19 
The Subclavian, on the right side, is a branch of the in- 
nominate artery ; on the left side it is a branch of the aorta. 
They leave the cavity of the chest by passing under the 
collar-bones and over the first ribs, and terminate in the 
armpit by becoming the axillaries. 
The Axillary is a continuation of the subclavian ; begins 
at lower border of first rib ; and, after crossing the armpit, 
ends in the brachial at the margin of the anterior fold of the 
armpit. 
The Brachial is a continuation of the axillary; it lies well 
on the inside of the upper arm, and extends from the an- 
terior fold of armpit to about an inch below the elbow, 
where it divides into the radial and ulnar. 
The course of this vessel is indicated by a line drawn from 
outer side of axillary space to a point at the middle of the 
bend of the elbow, or by the inner border of the biceps 
muscle failing these guides, by its pulsation. 
The Radial extends downwards along the radial or outer 
side of the fore-arm, from a little below the bend of the 
elbow to the wrist; it here winds round to the back of the 
metacarpal bone of thumb ; passes through between the 
thumb and forefinger to the palm ; and forms the deep 
palmar arch. 
The Ulnar is the larger of the two divisions of the brachial. 
It descends along the ulnar or inner side to the wrist; and 
then, entering the palm, forms the superficial palmar 
arch. 
The Common Iliac Arteries are formed by the bifurca- 20 
tion of the aorta ; they pass downwards and outwards to the 
brim of the pelvis, where they divide into external and in- 
ternal iliacs. 
The External Iliac commences at the bifurcation of the 
common iliac, passes along the brim of the pelvis, and makes 
its exit from the abdomen at the middle of the fold of the 
groin. 
The Internal Iliac is the inner division of the common 
iliac; it descends into the pelvis and supplies the organs 
there. 
The Femoral, the continuation of the external iliac, de- 
scends along the inside of the thigh for two-thirds of its 
length, and then passes to the back of the thigh to become 
the popliteal. The course of the artery is indicated by draw- 
ing a line from the middle of the fold of the groin to the 
inside of knee-joint. 
The Popliteal, a continuation of the femoral, extends 
along the back of the lower third of the thigh to a little be- 
low the knee-joint; it runs down the middle of the ham ; 
and divides into the anterior and posterior tibial. 
The Anterior Tibial, a branch of the popliteal, passes to 
the front between the two bones of the leg and descends to 
the instep, where it divides into branches for the toes. A 
line drawn from head of fibula to a point midway between 
the two projecting ankle-bones (malleoli) will be parallel to 
this artery. 
The Posterior Tibial is the other branch of the popliteal; 
it runs down the back of the leg, and, passing along the de- 21 
pression behind the inner ankle-bone, supplies branches to 
the sole of the foot. 
The Peroneal arises from the posterior tibial, passes 
down on the outside of the back of the leg, and divides into 
branches around the heel and outer ankle. 
THE VEINS. 
The veins are the vessels which serve to return the blood 
from the capillaries throughout the different parts of the 
body to the heart. 
The Pulmonary Veins are four in number ; two for each 
lung. They carry arterial blood from the lungs to the heart. 
The Systemic Veins return the dark impure venous 
blood from the body generally to the right side of the heart. 
Most veins are provided with valves to prevent the reflux 
of blood. 
Veins are divided into superficial and deep ; the former 
can be readily seen under the skin, the latter lie deeply and 
accompany arteries. The current in the veins flows towards 
the heart, exactly the reverse of what obtains in the arteries. 
The veins starting in the capillaries unite again and again 
till they form two large trunks, which empty themselves in 
the right auricle. 
Veins of Head and Neck.-The jugulars, formed by 
numerous branches from the head, face, and neck, pass 
down from about the angle of the jaw to the inside of the 
chest, and, uniting with the subclavian, form the innominate 
vein. 22 
Veins of Upper Extremity are divided into a superficial 
and a deep set. 
The deep set correspond to and lie alongside the arteries. 
The superficial set are the radial, ulnar, median, basilic, and 
cephalic. The brachial receives the cephalic and forms the 
axillary. The axillary crosses the armpit, and becomes the 
subclavian at the lower border of first rib. 
The Subclavian vein is a continuation of the axillary, 
lies behind the collar-bone, crosses from outer edge of first 
rib to behind sterno-clavicular joint, and joins the internal 
jugular, to form the innominate. 
The Innominate Veins are two large trunks placed one 
on each side of the root of the neck; they unite together 
and form the upper vena cava. 
The Superior Vena Cava, formed by the main vessels 
from the upper half of the body, empties itself in the right 
auricle. 
Veins of the Lower Extremity are divided into two 
sets, superficial and deep. 
The superficial are the internal and external saphenous. 
The former begins about the instep and ascends on the inner 
aspect of leg and thigh, is joined by numerous branches on 
its way, and joins the femoral just below the fold of the 
groin; the latter ascends the back of leg to join the popliteal 
in the ham. The popliteal passes up through the ham, and 
then through the substance of the thigh to become the 
femoral. The femoral lies alongside the artery in front of 
the thigh in its upper two-thirds. 23 
The External Iliac is the continuation of the femoral, 
and terminates by uniting with the internal iliac to form the 
common iliac. 
The Internal Iliac collects the blood from the organs in 
the pelvis. 
The Common Iliacs, formed by the junction of the ex- 
ternal and internal iliacs, terminate by uniting to form the 
inferior vena cava. 
The Inferior Vena Cava returns the blood to the right 
side of the heart {right auricle) from all parts below the 
midriff. It is formed by the union of the two common iliacs, 
and joined by branches from the liver, kidneys, and other 
viscera. 
VI.-THE ORGANS OF VOICE AND RESPIRATION. 
The organs of voice and respiration are : 
Larynx. 
Trachea. 
Bronchi. 
Lungs. 
The Larynx is the upper portion of the air-passage, and 
the organ of voice. It is situated between the trachea and 
base of the tongue in the upper and fore-part of the neck; 
on either side are the large blood-vessels of the neck, and 
behind is the gullet. The larynx is a cartilaginous tube ; 
and inside this tube are placed two narrow fibrous bands, 
which are attached before and behind, with a chink between 24 
them for the passage of the air. The vibration of these 
bands by a forced expiration produces the voice. 
The Trachea, or windpipe, is a cartilaginous and mem- 
branous tube, extending from the lower part of the larynx 
downwards to its division into the right and left bronchus ; 
it lies in front of the neck, anterior to the gullet. 25 
The Bronchi, right and left, one to each lung, are formed 
by the division of the trachea. 
The Lungs are the essential organs of respiration ; they 
are two in number, one in each side of the chest, separated 
by the heart, blood-vessels, bronchial tubes, and gullet. 
The lungs are enclosed in double sacs or coverings, termed 
pleurce, and are composed of a light spongy texture for the 
ramifications of the bronchial tubes, the pulmonary arteries, 
and the pulmonary veins. 
The bronchial tubes, after dividing and subdividing, ter- 
minate in minute air-cells, over which is spread a network 
of blood-vessels. It is in these minute blood-vessels that 
purification of the blood takes place, venous being converted 
into arterial blood. Carbonic acid and watery vapor pass 
from the blood into the air-cells, and oxygen passes from 
the air-cells into the blood. 
Mechanism of Respiration.-During an inspiration the 
chest is enlarged by elevating the ribs and depressing the 
diaphragm; and during an expiration the chest is diminished 
by depressing the ribs and elevating the diaphragm. The 
object in artificial respiration is to imitate the natural action. 
The average capacity of the lungs is 250 cubic inches. 
The amount of air (tidal air) taken in and passed out with 
each respiration is about 30 cubic inches. 
Respiration takes place about 18 times per minute. 
The Vital Capacity is the greatest volume of air that 
can be expired after the deepest possible inspiration. 
The difference in the vital capacity between a person 26 
dressed and undressed is probably about 60 cubic inches in 
favor of the latter. This is an important fact to recollect in 
employing artificial respiration. 
VIL-THE ORGANS OF DIGESTION. 
The organs of digestion consist of the Alimentary Canal 
and certain accessory organs. The Alimentary Canal is a 
musculo-membranous tube, about thirty feet in length, and 
comprises the following parts: 
Mouth. 
Pharynx (back of throat). 
CEsophagus (gullet). 
Stomach. 
Small intestines. 
Large intestines. 
The Mouth, an oval-shaped cavity, contains the teeth, 
tongue, palate, and ducts of the salivary glands. 
The Pharynx lies at the back of mouth and top of gullet, 
behind the root of the tongue and larynx. 
The CEsophagus, or gullet, extends from pharynx to 
stomach, and is about nine inches long; it lies behind the 
windpipe, and in front of the spine. 
The Stomach is a pouch-like enlargement of the alimen- 
tary canal; it lies on the left side of body, under the dia- 
phragm, with the liver on its right and the spleen on its left 
side. The stomach is the chief organ of digestion. 
The Small Intestine is the continuation of the tube be- 27 
.yond the stomach; is a very tortuous canal; and is joined 
below to the large intestine. 
The Large Intestine is a continuation of the small intes- 
tine; it ascends from a point near the right haunch-bone on 
the right side, crosses the abdomen under the liver and 
stomach, and then descends on the left side 
Secretion is the process of elaborating special products 
from the blood, as saliva, bile, pancreatine, etc., to be fur- 
ther used in the economy. The Organs of Secretion are: 
Liver. 
Pancreas. 
Salivary glands. 
The Liver is a large reddish-brown organ, situated chiefly 
under the false ribs on the right side of the body; its weight 
is about three to four pounds. 
It is made up of lobes, lobules, and cells; it has a duct for 
conveying its secretion to its reservoir-the gall bladder. 
The Gall Bladder is the reservoir for the bile; it lies 
under the right lobe, and communicates with the intestinal 
canal below. 
VIII.-THE ORGANS OF SECRETION. 
FUNCTIONS OF THE LIVER. 
i. Secretes bile, which aids digestion and acts as a purga- 
tive. 
2. Purifies the blood. 
3. Elaborates fat and sugar. 28 
The Pancreas, or sweetbread, is situated behind the 
stomach, in front of the spine ; is made up of a number of 
small lobes; is about seven inches long; and weighs about 
four ounces. Its duct leads into the intestinal canal. The 
pancreatic juice aids digestion. 
The Salivary Glands are situated about the sides of the 
face, neck, and tongue, and their ducts enter the cavity of 
the mouth. Their function is to secrete saliva, which keeps 
the mouth moist, and assists in the process of swallowing 
and digestion. 
The Spleen is a ductless gland which lies on the left side 
under the false ribs; its function is connected with the blood 
in some way which has not yet been determined. 
IX.-THE ORGANS OF EXCRETION. 
Excretion is the process of elaborating special products 
from the blood to be thrown out of the system as useless. 
Such are carbonic acid, urea, and urid acid. The Organs of 
Excretion are: 
Lungs. 
Skin. 
Kidneys. 
The Lungs have been already described; their excretory 
function is to throw off carbonic acid and watery vapor. 
The Skin is the general covering of the body; it is com- 
posed of two layers; 
Epidermis, Cuticle, or outer layer. 
Derma, or true skin. 29 
The skin is porous, contains sweat and fatty glands, and 
a free supply of nerves and blood-vessels. 
The skin excretes the sweat, and is the organ of touch. 
In health it possesses a temperature of 98 deg. 
The Kidneys are two in number, one situated in each 
loin {small of baclz). Externally is a fibrous layer or cover- 
ing; internally is a cavity communicating with an excretory 
duct (ureter). The substance of the body consists of bundles 
of minute tubes. The ducts or ureters descend along the 
back wall of the abdomen, to terminate in the bladder. The 
bladder is the reservoir for the urine. 
The function of the kidneys is to excrete urine, and to re- 
move certain impurities from the blood, such as carbonic 
acid, urea, and uric acid. PART II. 
Medical and Surgical Outlines. 
CHAPTER I. 
INSENSIBILITY. 
Insensibility is the suspension of the functions of animal 
life, except those of respiration and circulation. 
Chief Causes of Insensibility: 
Injuries to brain, compression from fracture. 
Diseases of brain, apoplexy, epilepsy, etc. 
Poisoning by narcotics-opium, morphia, 
chloroform. 
Blood poisoning from kidney disease. 
The above forms of insensibility are liable to be mistaken 
for drunkenness, and it ought to be remembered that these 
conditions may be complicated with each other and with the 
effects of drink, and that no single sign can be relied on in 
forming a conclusion on the condition of the patient. 31 
EXAMINATION OF A PERSON FOUND 
INSENSIBLE. 
When a person is found insensible the following directions 
are to be most carefully followed : 
I. Note the position of the body and its surroundings. 
2. Obtain all information possible as to the cause. 
3. Place the body on the back, with the head inclined 
to one side, the arms by the sides, and extend the 
legs. 
4. Compare the two sides of the body. 
5. In examining the head, pass the fingers gently over 
the surface, and search for wounds, bruises, swell- 
ings, or depressions. 
6. Open the eyes, and ascertain if the surface of the 
eye-balls is sensitive to the touch, if the pupils 
become small when exposed to light, and whether 
the pupils are large or small, and of the same size. 
7. Observe the state of the respiration, whether easy 
or difficult; the presence or absence of stertor; 
and the odor of the breath. 
8. Notice the condition of the pulse, whether strong or 
weak. 
9. Observe the general appearance and position of the 
limbs; and mobility, crepitus, shortening or 
lengthening of the bones of the limbs. 
10. Note the state of the ribs and collar-bones. 32 
IMPORTANT SYMPTOMS AND THEIR 
INDICATIONS. 
Convulsions occur in apoplexy, epilepsy, and kidney dis- 
eases ; and in digestive disorders, and teething in chil- 
dren. 
Shivering Fits usher in fevers, and indicate danger during 
illness. 
Pulse is weak in cases of fainting, shock, collapse, and 
haemorrhage. 
Irregular in heart diseases. 
Slow and laboring in cases of apoplexy and dis- 
eases causing pressure on brain. 
Pupils of the Eyes are fixed and dilated in paralysis and 
apoplexy. 
Unequal in size in serious disease or injury affect- 
ing one side of brain. 
Contracted in cases of opium poisoning, and con- 
gestion or inflammation of the brain. 
Violent Fits indicate insanity, drunkenness, hysteria, or 
epilepsy. 
Haemorrhage from Ear, or from Mouth, Nose, or Eyes 
indicates fracture of base of skull. 
Flushed Face occurs in intoxication, apoplexy, and epilepsy. 
Giddiness indicates stomach, liver, kidney, or brain dis- 
orders. 
Stertorous Breathing is found in apoplexy and compres- 
sion of brain. 33 
Difficulty in Breathing is a symptom of lung diseases, 
heart diseases, broken ribs, obstruction in air-passages, 
or injury to the nervous supply of these organs. 
Cough is a symptom of lung and heart diseases-irritation 
of air-passages, and pressure on lungs or on their nerves. 
Drawing of Face to One Side, 
Squinting, 
Fixed Condition of Pupils (dilated), 
Irregularity in the Size of Pupils, 
Twitching of the Muscles on One Side 
of Body, 
Are evidence 
of Paralysis, 
from disease or 
injury of the 
nervous s y s - 
tem. 
Staggering Gait indicates disease or injury of the brain or 
spinal cord ; or intoxication. 
CHAPTER II. 
IMPORTANT DISEASES AND INJURIES OF 
THE HEAD. 
The following conditions are of such frequent occurrence 
that their symptoms and treatment should be clearly under- 
stood and remembered. 
Intoxication.-Cause: Excess in drink. 
Symptoms: Odor of liquor in breath. Insensibility 
usually not complete. Patient can 
usually be roused. No stertorous 
breathing. Pupils of equal size, and 
usually dilated (large). Cornea sensi- 34 
tive to touch. Temperature of body 
2° to 30 below normal. Pulse soft and 
frequent. No difference between sides 
of body, both being equally helpless. 
Treatment: Emetics ; cold water applied to head ; 
warmth to surface of body and ex- 
tremities. 
Apoplexy.-Cause: Effusion of blood producing pressure 
on the brain. 
Symptoms: Patient becomes suddenly insensible. 
Face flushed or very pale. 
Pulse full. 
Breathing stertorous. 
Convulsions. 
Paralysis. 
Treatment: Place body in lying-down position, with 
the head raised. Undo clothing around 
neck. Apply iced or cold water to head. 
Act on the bowels. 
Convulsions or Fits in Children. 
Treatment: Put the child into a warm bath. 
Epilepsy.- Cause: Disease or disorder of brain. 
Symptoms: Convulsions. 
Foaming at mouth. 
Biting tongue. 
Partial insensibility. 
Breathing and pulse normal. 
Treatment: Prevent patient injuring himself. 35 
Blood Poisoning from kidney disease. 
Symptoms: Convulsions-insensibility 
Twitching of muscles. 
Delirium. 
Breath has a urinous odor. 
Signs of dropsy.' 
Treatment: Hot air or vapor bath. 
Active purgatives. 
Ice to head. 
Opium or Morphia Poisoning. 
Symptoms: Stupor ; contracted pupils ; progressive 
insensibility, which is seldom complete 
till convulsions or death occurs. 
Treatment: Emetics-cold douche to head and chest 
-walking exercise-strong coffee-arti- 
ficial respiration. 
Shock or Collapse. 
Cause: Injuries to nervous system by blows, 
operations, fright, grief, lightning. 
Death may be instantaneous ; recovery 
may be slow or rapid. 
Symptoms: Face pale and pinched, eyes dull. 
Pulse almost imperceptible. 
Breathing very feeble ; the functions of 
respiration and circulation are reduced 
to a minimum. 
Treatment: Place patient in horizontal position, restore 
circulation and respiration, remove tight- 36 
fitting clothing from neck, apply warmth 
to surface of body and extremities ; 
stimulants may be given cautiously in 
small quantities. 
Concussion of Brain.-Causes: Blows or falls on head. 
Symptoms: External bruises, etc. 
Confusion of ideas. 
Sickness. 
Fainting ; patient lies pale and shivering. 
Stupor and partial insensibility. 
Treatment: Place patient on his back, with head 
slightly raised, in a dark, quiet room- 
apply warmth to surface of body and 
extremities. 
Compression of Brain. 
Causes : Pieces of bone or haemorrhage pressing 
on substance of the brain. 
Symptoms: Those of apoplexy, following some injury 
to head, such as fracture of the skull. 
Treatment: The same as in apoplexy. 37 
CHAPTER III. 
TREATMENT OF CASES OF DROWNING, HANG- 
ING, SUFFOCATION BY GASES, SUNSTROKE.* 
J. Drowning.-Send immediately for medical assistance, 
blankets, and dry clothing, but proceed to treat the patient 
instantly, securing as much fresh air as possible. 
The points to be aimed at are-first, and immediately, the 
restoration of breathing ; and secondly, after breathing 
is restored, the promotion of warmth and circulation. 
The efforts to restore life must be persevered in until the 
arrival of medical assistance, or until the pulse and breath- 
ing have ceased for at least an hour. 
Rule I. To maintain a Free Entrance of Air into the Wind- 
pipe.-Cleanse the mouth and nostrils ; open the mouth ; 
draw forward the patient's tongue with a handkerchief, 
and keep it forward: an elastic band over the tongue atid 
under the chin will answer this purpose. Remove all 
tight clothing from about the neck and chest. 
Rule 2. To adjust the Patient's Position.-Place the patient 
on his back on a flat surface, inclined a little from the feet 
upwards ; raise and support the head and shoulders on a 
TREATMENT TO RESTORE NATURAL BREATHING. 
* The above directions are chiefly Dr. H. R. Silvester's method of 
restoring- the Apparently Dead or Drowned, and have been approved 
by the Royal Medical and Chirurgical Society. 38 
small firm cushion or folded article of dress placed under 
the shoulder-blades. 
Rule 3. 7b imitate the Movements of Breathing.-Grasp the 
patient's arms just above the elbow, and draw the arms 
gently and steadily upwards, until they meet above the 
head (this is for the purpose of drawing air into the lungs); 
and keep the arms in that position for two seconds. 
Then turn down the patient's arms, and press them gently 
and firmly for two seconds against the sides of the chest 
(this is with the object of pressing air out of the lungs. 
Pressure on the breast-bone will aid this). 
Repeat these measures alternately, deliberately, and perse- 
veringly, fifteen times in a minute, until a spontaneous 
effort to respire is perceived, immediately upon which 
cease to imitate the movements of breathing, and proceed 
to INDUCE CIRCULATION AND WARMTH. 
Should a warm bath be procurable, the body may be placed 
in it up to the neck, continuing to imitate the movements 
of breathing-. Raise the body for twenty seconds in a 
sitting position, dash cold water against the chest and face, 
and pass ammonia under the nose. The patient should 
not be kept in the warm bath longer than five or six 
minutes. 
THE MICHIGAN METHOD. 
' ' The other methods given have the disadvantage of requiring 
more than one person to operate, owing to the tendency 
of the tongue to fall back and obstruct breathing. 
" Place the patient on his face. Bestride the body. Grasp 39 
the clothing over the shoulders; if the body is naked, 
thrust your fingers into the arm-pits, clasping your thumb 
over the shoulders. Raise the chest as high as you can 
without lifting the head from the ground, and hold it long 
enough to count one, two, three. Then let the body rest 
on the ground, the forehead on the flexed arm, the neck 
straight, the mouth and nose free. Place your elbows 
just inside of your knees, and your hands on the sides of 
the chest just over the lower ribs. Then press downward 
and inward with increasing force long enough to count one, 
two. Suddenly let go, grasp the shoulders, and raise the 
chest, as before. Repeat these movements alternately 
with regularity ten or fifteen times a minute until natural 
breathing begins."* 
Rule 4. 7b excite Inspiration.-During the employment of 
the above method excite the nostrils with snuff or smell- 
ing-salts, or tickle the throat with a feather. Rub the 
chest and face briskly, and dash cold and hot water alter- 
nately on them. 
TREATMENT AFTER NATURAL BREATHING HAS BEEN 
RESTORED. 
Rule 5. To induce Circulation and Warmth.---Wrap the 
patient in dry blankets and commence rubbing the limbs 
upwards, firmly and energetically. The friction must be 
continued under the blankets or over the dry clothing. 
Promote the warmth of the body by the application of hot 
* Wilder's " Emergencies," p. 26. 40 
flannels, bottles or bladders of hot water, heated bricks, 
etc., to the pit of the stomach, the armpits, between the 
thighs, and to the soles of the feet. Warm clothing may 
generally be obtained from bystander. 
On the restoration of life, when the power of swallowing 
has returned, a teaspoonful of warm water, small quanti- 
ties of wine, warm brandy and water, or coffee should be 
given. The patient should be kept in bed, and a disposi- 
tion to sleep encouraged. During reaction large mustard 
plasters to the chest and below the shoulders will greatly 
relieve the distressed breathing. 
II. Hanging.-Remove all constrictions from the neck. 
Push the finger back of the tongue and clear the mouth of 
any mucous that may be there. Dash cold water on neck 
and chest. If not successful employ artificial respiration, 
as in case of drowning. 
III. Suffocation by Gases.-Remove the patient into fresh 
air, undo clothing, dash cold water on the face and neck, 
and employ artificial respiration, as in drowning. 
IV. Sunstroke or Heatstroke.-Working in a heated 
atmosphere is likely to cause it, either with or without ex- 
posure to the sun's rays. Most cases are preceded by 
headache, sense of weakness at pit of stomach, and weak- 
ness of the knees, and sometimes vomiting and disturbed 
vision. Unconsciousness follows these symptoms, or may 
occur suddenly. The face and head are hot, and the face 
is red or even purple. Breathing slow and labored. Pulse 
full but weak. 41 
Treatment: Put patient in cool place. Apply ice-water and 
pounded ice in cloths to the head, back of neck, and 
spine. 
In a certain number of instances the symptoms are more 
those of exhaustion. The face is not as much flushed, and 
may even be pale. Pulse frequent and feeble, and no 
difficulty in breathing. In these cases give stimulants 
gradually and be sparing of the ice and cold water. 
CHAPTER IV. 
HEMORRHAGE. 
Hzemorrhage, or bleeding, is the result of the opening of 
a blood-vessel by a wound or otherwise. It may be external 
or internal. 
Haemorrhage is divided into-I. Arterial, where the 
blood flows in jets in great force, and is of a bright red 
color. 2. Venous, where it flows slowly-wells out- 
and is of a dark purple hue. 3. Capillary, where there 
is a general oozing from the surface. 
General Treatment of H/emorrhage.-Pressure is 
the most powerful means of arresting external haemorrhage; 
and to use it effectively, it is important that the pressure 
should be directed against some bone as a point of resistance. 
In bleeding from the extremities place the patient on the 
back and raise the extremity that is bleeding. Press the 42 
thumb or a piece of folded cloth dipped in iced or cold 
water on to the wound and bind it on. In cases of emer- 
gency the finger may even be pressed into the wound and 
held there. If not successful then compress the arteries. 
In all portions of the body where special treatment is not 
specified, direct pressure to the wounded part will be suffi- 
cient to arrest haemorrhage till further assistance can be 
procured. 
Arterial Haemorrhage is the most important and the most 
dangerous form of bleeding, and not a moment ought 
to be lost in giving help. 
Treatment: i. Expose and examine wound. 2. Wash 
with cold water. 3. Elevate the bleed- 
ing part, but place body in the lying- 
down position. 
4. Apply pressure with the fingers directly 
over the mouths of the bleeding vessels 
till you can get further help. 
5. Apply pressure to the main artery on 
the heart side, with the fingers or with 
a pad and bandage (tourniquet). 
6. Apply a pad and bandage over wound 
as an additional safeguard. 
Venous Haemorrhage may occur along with arterial, or by 
itself. A superficial wound is more likely to divide 
veins than arteries. Dangerous venous bleeding often 
takes place where the patient has varicose veins and 
ulcers on the lower limbs. 43 
(The direction of the flow of blood-towards the heart 
-just the reverse of what obtains in the arteries, is a 
fact which bears on the treatment.) 
Treatment: I. Expose and examine wound. 2. Wash 
well in cold water. 3. Elevate limb, 
keeping body in lying-down position. 
4. Apply a pad and bandage on both 
sides of wound. 5. Remove any pres- 
sure or restriction to the circulation on 
the heart side, such as tight clothing 
(this cannot be done where arterial 
bleeding has also to be treated). 
Capillary Haemorrhage is easily controlled. 
Treatment: I. Direct pressure to the bleeding surface. 
2. Application of ice, or of styptics, 
such as alum, steel drops, caustics, etc. 
Internal Haemorrhage is seldom so rapid, except in cases 
of bursting of an aneurism, as not to give time for 
skilled aid. 
Treatment: 1. Place patient in an easy recumbent 
position. 2. Apply ice to, or as near 
as possible to, the part affected. 
3. Sucking ice is useful in bleeding about 
mouth, throat, or air-passages. 44 
SITUATION OF THE MAIN ARTERIES IN THE 
DIFFERENT REGIONS OF THE BODY, AND 
THEIR TREATMENT WHEN WOUNDED* 
REGIONS. 
SITUATION OF VESSELS. 
TREATMENT. 
Head. 
Temporal, in front of ear. 
Compress over 
Neck. 
P. A uricular, back of ear. 
Occipital, back of head. 
Carotid Arteries ascend in 
the wound, and 
bandage. 
Digital compres- 
Nose. 
a line from inner ends 
of collar-bones to angles 
of jaw. 
1 
sion in line of 
vessels above 
and below the 
wound, or di- 
re ct 1 y into 
wound on the 
mouths of the 
bleeding ves- 
sels. 
Keep head erect. 
Apply ice or 
cold water to 
the bridge of 
the nose and 
back of the 
neck. Snuff up 
* Wounded veins should be treated according to rules laid down 
under "Venous Haemorrhage." 45 
REGIONS. 
SITUATION OF VESSELS. 
TREATMENT. 
Armpit. 
Axillary Artery lies across 
cold water with 
alum dissolved 
in it. Take long 
and successive 
inspirations 
with head 
thrown back. 
Compress sub- 
hollow space of armpit. 
Upper Arm. Brachial Artery lies on 
clavian artery 
behind middle 
of collar-bone, 
or digital pres- 
sure into the 
wound. 
Compress artery 
Fore-Arm. 
inner side of arm, in a 
line with seam on coat 
sleeve-from inner fold 
of armpit to middle of 
bend of elbow. 
Radial and Ulnar Arteries 
by a tourniquet, 
above wound. 
Compress bra- 
begin a little below the 
chial artery in 
middle of bend of elbow, 
and descend one on each 
side of the front of the 
arm to the wrist. 
the upper arm 
by a tourni- 
quet, or place a 
pad in hollow 
of elbow and 46 
REGIONS. 
SITUATION OF VESSELS. 
TREATMENT. 
Palm of 
Radial and Ulnar Arteries 
bend fore-arm 
against arm. 
Apply two small 
Hand. 
give a number of 
firm pads to ar- 
Thigh. 
branches, which spread 
out and supply the palm. 
Femoral Artery, from mid- 
teries at wrist, 
or forcibly close 
and fix hand 
over a piece of 
stick or hard 
substance, and 
bandage. 
Pressure at mid- 
Ham. 
dle of fold of groin runs 
down the inside of thigh 
in its upper two-thirds. 
Popliteal Artery lies along 
dle of fold of 
groin, with the 
fingers or by 
tourniquet, 
above wound. 
Compress popli- 
Back of 
middle of ham. 
Post. Tibial, and Peroneal 
teal artery 
above wound, 
or compress 
femoral artery 
in front of 
thigh by tour- 
niquet. 
Compress at ham 
Lego 
Arteries descend the back 
or in front of 47 
REGIONS. 
SITUATION OF VESSELS. 
TREATMENT. 
and outside of leg from 
below ham, passing be- 
hind ankle-bones. 
thigh or double 
leg on thigh 
with a pad in 
the ham. 
Front of 
Anter. Tibial Artery de- 
Compress artery 
Leg and 
Instep. 
scends along middle of 
front of leg and instep. 
above wound. 
Sole of 
Post. Tibial and Peroneal 
Compress by a 
Foot. 
descend behind ankle- 
bones; the former sup- 
plies branches, which 
spread out on sole of 
foot. 
pad behind in- 
ner ankle-bone; 
if this fails, 
place pads be- 
hind outer 
ankle-bone and 
on middle of 
front of ankle. 
CHAPTER V. 
FRACTURES. 
Fractures, or broken bones, may be divided into four 
classes: 
I. Simple Fracture; a simple break. 
2. Compound Fracture; a flesh wound communi- 
cating with the broken ends of the bone. 
3. Complicated Fracture; injuries to soft parts, 
blood-vessels, nerves, or internal organs. 48 
4. Comminuted Fracture; smashing of bone into 
pieces. 
A fracture may take place transversely, obliquely, or 
longitudinally. 
Fractures are caused by violence. 
The symptoms of fracture are: 
I. Alteration in shape and general appearance. 
2. Unusual mobility at seat of fracture. 
3. Crepitus or cracking on placing one hand over the 
broken part, and creating motion with the other. 
4. Shortening of limb. 
5. Some inequality felt on running the fingers along 
the surface of the injured bone. 
Fractures are distinguished from dislocations as follows: 
SYMPTOMS OF FRACTURE. 
Fractures. 
Crepitus. 
Unnaturally movable. 
Easily replaced. 
Limb often shortened. 
Seat of injury in the shaft 
or body of the bone. 
Dislocations. 
No crepitus. 
More or less fixed. 
Replaced with difficulty. 
Limb may be shortened or 
lengthened. 
Seat of injury at a joint. 
TREATMENT OF FRACTURES. 
I. Reduce the fractured ends or portions to their 
natural position. 49 
2. Retain them immovably in their proper places till 
nature has effected a permanent cure. 
There is no urgency about treating a broken limb pro- 
vided no attempt is made to move the person, but if it is 
imperative that the patient be moved in the absence of a 
surgeon, it is an absolute necessity to secure the safety of 
the limb by putting it in splints before removal. 
A stretcher is the only safe means of conveyance for cases 
of fracture. 
Unskilful handling may cause either serious mischief or 
even loss of life; the dangers are, pressing the sharp ends 
through the flesh, blood-vessels, nerves, or into some inter- 
nal organ, such as the lungs. 
SPECIAL FRACTURES. 
Fracture of the Skull. 
Cateses: Blows or falls. 
Symptoms: External signs not always present. In 
fracture of the base there may be 
haemorrhage from ear, mouth, or nose; 
red patches of blood under conjunctivae 
of eyes ; and oozing of watery fluid 
from the ears. 
Accompanying these there may be symp- 
toms of concussion, or symptoms of 
compression. 
Treatment: Place patient in a dark and quiet room 
on his back, with head slightly raised. 50 
Apply cold to head as soon as reaction 
sets in and patient gets hot and feverish. 
Fracture of Lower Jaw. 
Causes: Direct blows; falls on chin. 
Symptoms: Irregularity in the line of the teeth and 
the outline of the lower margin of bone; 
inability to move jaw. 
Treatment: Fix lower jaw to upper jaw by a bandage. 
Fracture of Collar-Bone. 
Causes: Blows on shoulder ; falls on elbow or 
hand. 
Symptoms: Shoulder drops. 
Arm is helpless. 
Irregularity on drawing finger along sur- 
face of bone. 
Treatment: Place a pad in armpit, bind arm to side 
just above elbow, and sling fore arm. 
Fracture of Ribs. 
Causes: Blows, falls, weight passing over chest or 
back. 
Symptoms: Pain and difficulty in breathing, and the 
usual signs of fracture. 
Treatment: Apply a broad roller bandage firmly 
round chest, so as to prevent all move- 
ment ; or strap the injured side with 
adhesive plaster. If there be spitting 
of blood, keep patient quiet and give 
no stimulants. 51 
Fracture of the Humerus. 
Causes: Direct blows; falls on elbows. 
Symptoms: Mobility at seat of fracture. 
Crepitus. 
Shortening, usually present when fracture 
is oblique. 
Treatment: Apply a roller bandage from hand to 
elbow, abduct arm and apply three or 
four splints from shoulder to elbow. 
Support arm in a sling. 
Fracture of the Fore-Arm. 
Causes: Direct violent blows; falls. 
Symptoms: Crepitus. 
Mobility. 
Alteration in shape of arm. 
Treatment: Semiflex fore-arm with thumb pointing up- 
wards. Apply two splints, one in front 
from bend of elbow to the tips of the fin- 
gers,and one behind from elbow to wrist. 
The splints should be well padded. Place 
arm in sling. 
Fractures about Wrist and Hand. 
Causes: Blows or other injuries. 
Symptoms: Pain, swelling. 
Irregularity in the outline of the bones. 
Crepitus. 
Treatment: Bandage to a flat board or splint, and 
support by sling. 52 
Fracture of Femur or Thigh-Bone. 
Causes: Blows, falls. 
Symptoms: Pain and loss of power. 
Crepitus. 
Shortening. 
Broken ends may be felt. 
Foot turned out. 
Treatment: Extend the limb, apply a long splint on 
outside along the whole side, from the 
armpit to the outside of the heel, and 
another on the inside of the thigh, from 
top of the inside of the thigh to the knee. 
Fracture of Patella or Knee-Cap. 
Causes: Blows, or excessive muscular action. 
Symptoms: Inability to stand upon leg. 
Fragments can be felt. 
Treatment: Raise limb to a position at right angles 
to body, and apply a figure-of-eight 
bandage around the knee, including the 
fragments. Put long splint on the back 
of the leg. 
Fracture of Bones of the Leg. 
Causes: Blows ; falls ; crushing weight, such as 
wheels, passing over the limb. 
Symptoms: Pain and loss of power. 
Alteration in shape. 
Crepitus. 
Broken ends may be felt. 53 
Treatment: Apply two splints, one inside and one 
outside the limb. 
Elevate limb. 
Fractures about Foot and Ankle. 
Causes: Blows or other injuries. 
Symptoms: Pain, swelling. 
Alteration in outline of bones. 
Crepitus. 
Treatment: Elevate foot ; apply cold water. 
N. B.-It must be remembered that the treatment for 
fractures here given is only temporary, to enable the patient 
to be moved without further injuries, which might result in 
the loss of the limb or even life, till a surgeon can be sent 
for. 
The treatment for dislocations is purposely omitted, as 
being dangerous, except in the hands of a surgeon. 
CHAPTER VI. 
WOUNDS. 
Incised Wounds. 
Treatment: I. Wash the part carefully with water. 
2. Arrest the haemorrhage. 
3. Adjust the edges and fix in a natural 
position. 54 
4. Place patient in an easy position, so 
as to avoid straining the parts. In 
wounds of throat, sand-bags are 
good supports for fixing head and 
neck. 
5. Apply cold-water dressing, or strips of 
adhesive plaster. 
Incised Wounds, with Protrusion of Internal Organs. 
Treatment; Wash the parts carefully, and return, 
unless they are much injured, and place 
patient in a thorough state of rest. 
In incised wounds about the face it is very important to 
replace the wounded portions with as little delay as possible. 
Contused and Lacerated Wounds are more dangerous 
and troublesome to heal, besides being liable to ery- 
sipelas, gangrene, etc. 
Treatment: Wash. 
Arrest haemorrhage. 
Replace parts in their natural position. 
Apply cold-water dressings or poultices. 
Lacerated and contused wounds about the head are very 
liable to erysipelas. Cold-water dressings, when .carefully 
attended to, and not allowed to dry, are very suitable where 
there is bleeding. If there is no tendency to bleeding^ 
poultices are probably the safer remedy, as they do not allow 
the wound to become dry and inflamed. 
Foreign Bodies in the Eye.-If the foreign body is under 
the upper eye-lid, seat the patient in a chair, and stand- 55 
ing behind, place a pencil over the lid; lay hold of the 
eye-lashes, and evert the lid. Then, having exposed 
the substance, brush it off with the corner of a handker- 
chief or a camel's-hair brush. If it is under the lower 
eye-lid, simply depress this, and proceed as above with 
handkerchief or brush. 
Foreign Bodies in the Ear.-The canal leading to the 
inside of the ear is about an inch and a quarter in 
length, and at the inner end of this canal is placed the 
drum of the ear, a very thin, delicate membrane, resem- 
bling a piece of tissue paper. 
A blow on the ear with the open hand, or the concussion 
from the discharge of firearms, is quite sufficient to rupture 
and destroy this membrane. No interference, therefore, 
with the ear, beyond using a syringe, should be attempted, 
except by a surgeon. Such substances as accumulations of 
wax, pieces of slate-pencil, insects, etc., may be removed by 
syringing with tepid water. It will be well, however, to re- 
member that peas and porous substances would be rendered 
more difficult of removal after the use of the syringe. 
Croup.-Give half a teaspoonful of syrup of ipecac every 
few minutes, followed by draughts of warm water. 
When vomiting begins put child in a warm bath; dry 
well and put to bed. 
Choking.-Hold the head low. Slap the back. Put the 
finger into the throat, and try to dislodge the substance. 
Put one hand on each side of the chest, and suddenly 
compress it, thus producing a blowing out of the air. 56 
When a person's clothes are on fire, as from kerosene, 
smother the flame with a table-cover, blanket, or coat. 
Burns and Scalds.-A burn is caused by concentrated heat, 
fire directly applied to surface, or chemical agents, de- 
stroying the skin and the-tissues underneath. 
A scald is produced by hot or boiling liquids touching the 
skin ; the cuticle or scarf skin is raised and destroyed, and 
the true skin reddened and inflamed. 
Besides their local action, burns and scalds are apt to 
produce dangerous effects by congestion of internal or- 
gans 
treatment of Burns.-Apply a mixture of oil and 
lime-water, olive oil, castor oil, or castor 
oil and collodion ; and wrap up the part 
in cotton wool, wool, or flannel. 
Treatment of Scalds.-Apply a strongly alkaline 
solution made with the carbonate of 
soda, cooking soda, lime, or magnesia ; 
and enclose the limb, or part, in cotton 
wool, excluding air as far as possible. 
N.B.-Troublesome contracting scars, causing deformity, 
often follow burns ; it is therefore important to make the 
patient lie in a natural position, and avoid twisting the neck 
or doubling up the limbs. 
Frost-Bite.-Frost bite is the result of exposure to severe 
cold. The vitality of the part is reduced to a very low 
point, loses its natural color, and becomes blue or pur- 
ple. 57 
Treatment: Bring about reaction gradually by friction. 
Place the patient in a room without a 
fire, and avoid heat. Rub the part with 
snow or other cold application, and ad- 
minister brandy in water carefully in 
small quantities. If a person is found 
insensible from cold he must be kept 
away from the heat. Remove the cloth- 
ing and rub thoroughly with snow or 
cloths wrung out in cold water. Con- 
tinue the friction, especially to the ex- 
tremities, until signs of recovery appear. 
Artificial respiration may be necessary. 
Give brandy and beef tea in small quan- 
tities. 
Bed Sores are the result of pressure from lying in one 
position. They may be prevented by hardening the skin 
by rubbing it with brandy, salt and water, etc., apply- 
ing adhesive plaster spread on leather, or the use of 
air- or water-cushions. 
Bites of Rabid Animals. 
Treatment: If possible immediately apply a ligature 
on the side nearest the heart; suck the 
wound ; bathe it with warm water, so as 
to encourage bleeding; scarify around 
the wound to the depth of a quarter of 
an inch ; use caustics, such as nitrate of 
silver or carbolic acid. 58 
The internal use of brandy and ammonia is advisable. 
" Signs of Madness in Dogs.-There is agitation and rest- 
lessness ; the dog turns himself continually in his ken- 
nel. If he is at liberty he goes and comes, and seems 
to be seeking something ; then he remains motionless, 
as if waiting; he starts, bites the air, seems as if he 
would catch a fly, and dashes himself barking and howl- 
ing against the wall. The voice of his master dissipates 
the hallucinations ; the dog obeys, but slowly, as if 
with hesitation and as if with regret. " * 
* Wilder's " Emergencies," p. ix. 59 
CHAPTER VII. 
MATERIAL AND APPLIANCES FOR THE RELIEF 
OF THE SICK AND INJURED. 
Stretchers.-A stretcher is simply a light portable bed for 
carrying the sick ; it is composed of a framework of 
poles, with a piece of canvas stretched between them as 
a mattress. 
A variety of things will answer as substitutes for a 
stretcher, such as doors, window shutters, ladders, or 
hurdles. 
To PLACE A MAN ON A STRETCHER WITH THREE BEARERS. 
i. The three men fall in facing the feet of the injured 
man, and are numbered off from the right. 
2. Put the foot of the stretcher at the man's head, in a 
line continuous with his body. 
3. Nos. 1 and 2, one at either side, locking hands 
underneath the shoulders and hips, raise the pa- 
tient ; carry him forward over the stretcher ; and 
then lower him on to it. 
4. No. 3 takes charge of the injured portion (limb or 
head), and steadies it with a hand on either side of 
the wound. 
5. Nos. 1 and 2 then take their places at head and foot 
of stretcher, lift and carry off, while No. 3 walks 
at the side of the stretcher as a safeguard to the 
patient, and as a relief to No. 1 or 2 if necessary. 60 
Rules for carrying a stretcher. 
I. Carry stretcher in hands, or suspend it by straps 
over the bearers' shoulders. 
2. Never allow the stretcher to be placed on the 
shoulders. 
3. Bearers to march in broken step, and not in time. 
4. Avoid all jolting, crossing fences, ditches, etc. 
5. Pace to be about 20 inches. 
6. In ascending, patient's head to be in front, and in 
descending, behind. 
Splints.-Splints are appliances used in treating fractures, 
for supporting the bones in their natural position till 
a cure is effected. 
The materials chiefly used for making splints are 
wood, iron, pasteboard, leather, gutta-percha, felt, wire, 
tin, and bark. Extemporized splints may be formed 
with umbrellas, walking-sticks, cigar boxes, folded 
newspapers, policemen's truncheons, and soldiers' 
weapons, such as rifles, swords, or bayonets. 
Paus.-Splints should be well padded with wool, cotton 
wool, tow, flannel, or lint. 
Bandages are usually made from unbleached calico, flannel, 
linen, webbing, etc. 
Bandages are used- 
1. As supports to the different parts of the body. 
2. As means of applying pressure. 
3. For fixing splints, dressings, etc. 
4. To allay muscular action. 61 
The chief kinds of bandages are the roller bandage and 
the triangular bandage. 
A combination of splint and bandage is made by saturat- 
ing ordinary bandages with plaster of Paris, glue, starch, 
starch and gum, chalk and gum, or silicates of soda and 
potash (glass splint'). 
These bandage-splints, being put on moist, and allowed 
to dry, whilst they are kept in position, have the advantage 
of being very immovable, and well adapted to the surface of 
the parts to which they are applied. 
Roller Bandages have certain convenient sizes, according 
to the part of the body for which they are required, as 
follows :- 
For the fingers, f inch wide and i yard long. 
" arm, 2-j inches wide and 3 to 6 yards long. 
" leg, 3 inches wide and 6 to 8 yards long. 
" chest, 4 to 5 inches wide and 8 to 12 yards long. 
" head, 2^ inches wide and 4 to 6 yards long. 
In applying a roller bandage. 1. Begin from below and 
work upwards. 2. Insure that the pressure is uniformly 
and evenly applied. 3. Avoid wrinkles. 4. Bandage from 
within outwards. 5. Reverse on the fleshy side of the limb, 
and not over the sharp edges of a bone. 6. Where the limb 
is of uniform thickness use the simple spiral; where the limb 
thickens use the reverse spiral; and at joints use the figure- 
of-eight. 
The application of bandages is best learnt by a practical 
lesson. 62 
Esmarch's Triangular Bandage is a triangular piece of 
cloth ; the lower border measures 4 feet, and the two 
side borders 2 feet 10 inches each.* 
It can be applied in thirty-two different ways ; it answers 
every purpose for temporary dressings or field work ; and 
the means of making one are always at hand, namely, a 
pocket-handkerchief cut diagonally in two. 
Its application is so easy, that a look at the diagram will 
enable any one to use it in the manner indicated. 
Materials Used in Dressing Wounds are adhesive plas- 
ters, oiled silk, gutta-percha tissue, lint, charpie, oak- 
um, tow, cotton wool, etc., etc. 
Adhesive plasters are used for keeping the edges of wounds 
in position, and for fixing dressings in lieu of bandages. 
Oiled silk and gutta-percha tissue are used over other dress- 
ings to retain moisture, to prevent the escape of liquid ap- 
plications, and to protect the part from any external im- 
purities. 
The stimulants in ordinary use are: internally, tea, beef 
tea, brandy, and coffee. Externally, friction, smelling-salts 
to nostrils, mustard to extremities, cold affusion, and slap- 
ping the face with a wet towel. 
STIMULANTS. 
* A triangular bandage, with figures illustrating its use, can be ob- 
tained from the Order of St. John. 63 
POULTICES. 
The use of poultices is to apply and retain heat and moist- 
ure, clean foul wounds, allay pain, draw the circulation of 
the blood towards the surface from internal organs, and to 
encourage suppuration in abscesses. 
They may be made from bread, linseed, or other meals; 
charcoal, mustard, carrots, onions, etc., etc. 
LEECHES. 
In applying leeches, observe the following rules ■ 
i. Thoroughly clean the part. 
2. Use an inverted wine-glass ; or, if to the inside 
of the mouth, use the leech-glass made for that 
purpose. 
3. If it is necessary, bleeding may be further en- 
couraged by using a poultice afterwards. 
4. Take care that bleeding does not become too 
abundant, an event which may happen with 
children. If it does, the haemorrhage may be 
arrested by exposing the part to the air, and 
applying cold or pressure. 64 
CHAPTER VIII. 
DISINFECTION. 
The terms infectious and contagious (catching} applied to a 
disease signify that it is communicable from the sick to the 
healthy. 
The following are the principal infectious diseases : 
Eruptive fevers-measles, small-pox, and scarlet fever. 
Continued fevers-typhus, typhoid, relapsing and yellow 
fevers. Diphtheria, erysipelas, whooping-cough, and 
cholera. 
Disinfectants are materials used for the purpose of purify- 
ing the air, water, scil, etc., by removing or rendering 
inert certain noxious substances ; they may be divided 
into- 
a. Volatile or gaseous. 
b. Solid or liquid. 
Chlorine. 
Bromine. 
Iodine. 
Sulphurous acid. 
Nitrous acid. 
Fresh air. 
Oxygen. 
Ozone. 
Camphor. 
Extreme heat or cold. 
Volatile or gaseous, 65 
Chlorides of metals, alkalies. 
Sulphates " " 
Nitrates. 
Carbolic acid and carbolates. 
Tar acids. 
Charcoal. 
Salt. 
Dried earth. 
Solid or liquid. 
The most common patent disinfectants are : 
Condy's fluid. 
Burnett's fluid. 
Ledoyen's fluid. 
Dougall's powders. 
Sirel's compounds. 
RULES FOR DISINFECTING AN UNOCCUPIED ROOM. 
I. Close every door and window, and stop up every open- 
ing or crevice with old rags or tow. 
2. Fumigate by any of the following methods : 
(i.) By Chlorine.-Place a few saucers in different 
parts of the room, containing a mixture of one part 
of common salt, one part of black oxide of man- 
ganese, and two parts of oil of vitriol. 
(2.) By Iodine.-Place two drachms of iodine in a metal 
cup or vessel, and place a lamp or burning candle 
underneath it till it evaporates. 
(3.) By Sulphurous Acid.-Burn sulphur in saucers. 
(4.) By Nitrous Acid fumes.-Place several cups into 66 
saucers or basins containing hot water, and inside 
the cups put two ounces of nitrate of potash and 
one ounce of sulphuric acid. 
(5.) By Carbolic Acid.-Place some pure carbolic acid 
in shallow vessels around the room. 
3. Furniture and floors to be well washed or scrubbed 
with a solution of chloride of lime ; the latter may be 
sprinkled with the powdered chloride of lime or Dougall's 
powder. 
4. Papers to be stripped from the walls, and the walls 
and ceilings to be white-washed. 
5. All clothing to be disinfected by washing, boiling, 
baking in an oven, or exposure to the sun or before a fire, 
if a disinfecting establishment is not available. 
6. Curtains and carpets are best disinfected by exposure 
to a heat of from 2000 to 4000. 
7. In extreme cases, destroy by fire all clothing, bedding, 
carpets, etc. 
RULES FOR DISINFECTING AN OCCUPIED ROOM. 
i. Maintain a proper state of ventilation by doors, 
windows, and outer openings. 
2. Keep up a good fire in the room. 
3. Use Condy's fluid, Burnett's fluid, or solutions of 
chloride of lime for utensils in room, closets, etc. 
4. Disinfect all clothing, linen, etc., before it leaves the 
room, as laid down (in rule 8 for preventing spread 
of diseases). 67 
5. Fumigate room cautiously with either chlorinated 
lime or carbolic acid, placed in saucers in different 
parts of the room. 
Be careful not to use gases or vapors too freely, as they 
are liable to cause inconvenience to the patient, by irritation 
of his lungs or air-passages. 
RULES FOR THE PREVENTION OF THE SPREAD OF INFEC- 
TIOUS DISEASES. 
I. After the removal of the infected person, fumigate 
and disinfect rooms occupied (yide instructions for 
disinfecting unoccupied rooms). 
2. If a case for treatment at home, clear the house as 
far as possible of all inmates except the attendants 
on the sick. 
3. Remove carpets, curtains, and all superfluous furni- 
ture. 
4. If small-pox, vaccinate every one in any way ex- 
posed to infection. 
5. Allow as much fresh air as possible without creating 
draughts, and keep a good fire burning day and 
night in the room. 
6. Use disinfectant solutions in all utensils and slop 
pails. Place soiled clothes and linen in a disinfec- 
tant solution, or boil with soda for several hours 
before they are taken from the room. 
7. Open doors or windows are to be curtained with 
sheets kept moist with carbolic acid and water. 68 
8. Drains, sinks, and closets to be flushed at least once 
a day with disinfectants. 
9. Every room that has been occupied by an infected 
person should be thoroughly purified before it is re- 
occupied. 
10. During convalescence patients should have tepid or 
warm baths, medicated with some suitable dis- 
infectant, such as Condy's fluid. This is very use- 
ful in cases of scarlet fever. 
CHAPTER IX. 
BATHS. 
The following are the principal kinds of baths :- 
Water 
Vapor 
Air 
Ba. til. 
Degrees. 
Degrees. 
Degrees. 
The Cold 
... 33 to 
65 
Cool 
... 65 to 
75 
Temperate 
... 75 to 
85 
Tepid 
... 85 to 
92 
90 to IOO 
96 to I06 
Warm 
... 92 to 
98 
IOO to 115 
106 to 120 
Hot 
... 98 to 
112 
115 to 140 
120 to 180 
The Cold Bath chills the surface, contracts the blood- 
vessels, forces the circulation from the surface to the inter- 
nal regions, and checks perspiration ; when not too pro- 
longed, and the individual is in robust health, these effects 
are followed by a reaction, and a plesant feeling of warmth. 
Its general effect on the system is bracing and tonic. 
The dangers are congestions of internal organs. 69 
Shower Bath is similar to the cold bath in its effects ; prob- 
ably somewhat more bracing. 
Cold Affusion is the application of a stream of cold water 
from a height; it produces a sudden and violent stimu- 
lating effect, and is useful for rousing persons from 
states of insensibility, suffocation, drunkenness, hysteria, 
and poisoning. It is sometimes useful for producing 
sleep in delirium tremens or drunken mania. 
The Wet Compress acts as a local bath, and gives a com- 
bination of effects ; it first acts as a cold bath, and 
secondarily as a prolonged warm bath ; its effects are 
very soothing. 
Ice and Iced Water applied locally produce contraction of 
the blood-vessels, and drive the blood away from the 
part. They are useful for reducing swelling and in- 
flammation, and arresting haemorrhage. 
The Tepid, Warm, and Hoth Baths act as stimulants ; 
they increase the circulation in the surface of the body, 
relieve congested internal organs, and promote secre- 
tion and excretion. The repeated or prolonged use of 
hot baths has a very weakening effect on the body ; 
they relax the tissues and weaken the nervous system. 
Hot Fomentations are simply local hoth baths, and act in 
a similar way , they are useful for relieving pain. 
N. B.-Persons in delicate health who cannot bear a cold 
bath may manage to do so by getting into warm or tepid 
water, and then gradually lowering the temperature ; by this 
plan a sudden chilling of the surface is avoided, and the bene- 
fits of a combined hot and cold bath are obtained with safety. 70 
CHAPTER X. 
POISONS. 
Poisons are substances capable of destroying life. They 
are divided into classes, according to their action on the 
body. 
I. Irritants destroy the tissues, and produce nerv- 
ous shock. 
2. Narcotics produce insensibility by their action 
on the brain. 
3. Narcotico-irritants combine the action of narcot- 
tics and irritants. 
Treatment.-The points to be kept in view in poisoning are 
1. To get rid of the poison by encouraging vomit- 
ing. 
2. To counteract the effects of the poisons by 
antidotes, which will mechanically or chemic- 
ally render the poison harmless. 
3. To remedy the effects produced, and obviate 
the tendency to death by stimulants, artificial 
respiration,and exciting the excretory organs. 
Emetics.-Emetics are remedies used for the purpose of 
causing vomiting. The safest and readiest are- 
irritating back of throat with the finger or a feather ; 
large draughts of tepid water combined with a table- 
spoonful of salt or mustard ; one or two tablespoonfuls 
of wine of ipecac in water; and twenty grains of sul- 
phate of zinc in water. 71 
Acids and Alkalies form antidotes to each other. 
The acids suitable for the purpose are vinegar, lime 
juice, and orange juice, mixed with water. 
The alkalies are soda, potash, lime, and magnesia 
diluted with water. 
Albumen and Oils will protect the gullet and walls of the 
stomach in poisoning by irritants. White of egg, milk, 
flour and water, salad oil, and castor oil may be used. 
The Stomach Pump cannot be used except by a surgeon, 
but a very good substitute can be found in a piece of 
gutta-percha tubing, provided the patient is not in an 
insensible condition. Take three yards of elastic gutta- 
percha tubing, about half an inch in diameter, make the 
patient swallow about 20 to 25 inches of it; raise the 
free end above his head, and pour down a pint of water, 
or as much as the stomach will receive. Then lower 
the free end, and it will empty itself ; repeat the filling 
and emptying as often as you think necessary. This 
remedy is perfectly safe and effectual; it has been used 
by German physicians for disorders of the stomach 
with considerable success. The swallowing of the tube 
can be done with the greatest facility, without assist- 
ance and without danger. 
POISONS. 
Arsenic {Rat Poison, Sheet's 
Green). 
ANTIDOTES. 
Emetics ; milk ; peroxide of 
iron ; raw eggs ; castor oil; 
salad oil. 72 
POISONS. 
Antimony {Butter of Anti- 
mony and Tartar emetic). 
Mineral Acids {Oil of Vit- 
riol, Aqua fortis, Spirit of 
Salt). 
Oxalic Acid. 
Carbolic Acid. 
Alkalies {Caustic Potash, 
Soda or Lime). 
Phosphorus {Rat Poison, 
Matches). 
Mercury Salts {Corrosive 
Sublimate, Calomel). 
Salts of Lead {Sugar of lead, 
paint). 
Nitrate of Silver 
Caustic. 
Irritant Gases {Chloroform). 
ANTIDOTES. 
Encourage vomiting. Milk; 
tea ; tannic acid. 
Encourage vomiting. Alka^ 
lies-solutions of soda ; 
potash ; lime ; magnesia ; 
whiting ; wall plaster. 
Emetics ; lime water ; chalk ; 
magnesia ; whiting. 
Lime water ; sweet oil; stim- 
ulants. 
Acids-vinegar and water ; 
lime juice ; orange juice in 
water ; emetics ; salad oils. 
Encourage vomiting by large 
draughts of water. 
Large doses of magnesia in 
water. 
Avoid oils. 
Encourage vomiting; white of 
eggs; flour and water; milk. 
Emetics and Epsom salts. 
Common salt and water. 
Fresh air ; loosen dress ; arti- 
ficial respiration ; dash cold 
water about face and neck. 73 
POISONS. 
Prussic Acid (Cyanide of 
Potassium). 
Strychnia (Nux Vomica)... 
Narcotics (Opium, Morphia-,' 
Laudanum, Paregoric). 
Alcohol 
ANTIDOTES. 
Cold douche; smelling salts 
to nostrils ; artificial respi- 
ration ; brandy and am- 
monia. 
Emetics; chloroform to re- 
lieve spasms; cold affu- 
sion; artificial respiration; 
brandy and ammonia; mor- 
phia; rectal injections of 
tobacco. 
Emetics ; strong coffee ; cold 
affusion; forced walking 
about. 
Emetics ; cold affusion ; 
warmth to surface of body; 
a dessertspoonful of vine- 
gar in water. 
CHAPTER XL 
Death may occur in three different ways, according as it 
begins in the heart, lungs, or head. 
I. Heart-by asthenia, as in hcemorrhage. 
2. Lungs and air-passages-by asphyxia, as in drowning. 
3. Head-by coma, as in apoplexy. 
MODES OF DEATH. 74 
SIGNS OF DEATH. 
The most obvious signs of death are- 
Cessation of breathing; no movement of chest; no 
moist breath to dim a looking-glass placed before 
mouth. 
Cessation of heart's action ; no impulse against side or 
pulse beating in arteries. 
Eyelids half closed, eyes dim and glassy, pupils dilated. 
Jaws clenched. 
Tongue appearing between teeth. 
Frothy mucus about nose and mouth. 
Fingers half closed. 
Surface of body pale and cold. 
Body rigid after a time. 
CAUSES OF SUDDEN DEATH. 
The chief causes of sudden death are- 
Apoplexy. 
Aneurism. 
Heart disease. 
Suffocation. 
Shock. 
Injuries to the nervous system. 
Sunstroke. 
Struck by lightning. 
Poisoning. 75 
DIRECTIONS FOR RESTORING THE APPA- 
RENTLY DROWNED. 
The leading principles of the following Directions for the 
Restoration of the Apparently Dead from Drowning are 
founded on those of the late Dr. Marshall Hall, and are the 
result of extensive inquiries which were made by the Royal 
National Lifeboat Institution in 1863-4 amongst Medical 
Men, Medical Bodies, and Coroners throughout the United 
Kingdom. These Directions have been extensively circu- 
lated by the Institution throughout the United Kingdom and 
in the Colonies. They are also in use in Her Majesty's 
Fleet, in the Coastguard Service, and at all the Stations of 
the British Army at home and abroad. 
I. 
Send immediately for medical assistance, blankets, and 
dry clothing, but proceed to treat the Patient instantly on 
the spot, in the open air, with the face downward, whether 
on shore or afloat; exposing the face, neck, and chest to 
the wind, except in severe weather, and removing all tight 
clothing from the neck and chest, especially the braces. 
The points to be aimed at are-first and immediately, the 
Restoration of Breathing ; and secondly, after breathing is 
restored, the Promotion of Warmth and Circulation. 
The efforts to restore Breathing must be commenced im- 
mediately and energetically, and persevered in for one or 
two hours, or until a medical man has pronounced that life 76 77 78 
is extinct. Efforts to promote Warmth and Circulation, 
beyond removing the wet clothes and drying the skin, must 
not be made until the first appearance of natural breathing; 
for if circulation of the blood be induced before breathing 
has recommenced, the restoration to life will be endangered. 
II.-To Restore Breathing. 
To Clear the Throat.-Place the patient on the floor 
or ground with the face downwards, and one of the arms 
under the forehead, in which position all fluids will more 
readily escape by the mouth, and the tongue itself will fall 
forward, leaving the entrance into the windpipe free. 
Assist this operation by wiping and cleansing the mouth. 
If satisfactory breathing commences, use the treatment 
described below to promote Warmth. If there be only 
slight breathing-or no breathing-or if the breathing fail, 
then- 
To Excite Breathing.-Turn the patient well and in- 
stantly on the side, supporting the head, and excite the 
nostrils with snuff, hartshorn, and smelling salts, or tickle 
the throat with a feather, etc., if they are at hand. Rub the 
chest and face warm, and dash cold water, or cold and hot 
water alternately, on them. If there be no success, lose 
not a moment, but instantly- 
To Imitate Breathing.-Replace the patient on the 
face, raising and supporting the chest well on a folded coat 
or other article of dress. Turn the body very gently on the 
side and a little beyond, and then briskly on the face, back 79 
again, repeating these measures cautiously, efficiently, and 
perseveringly, about fifteen times in the minute, or once 
every four or five seconds, occasionally varying the side. 
{By placing the patient on the chest, the -weight of the body 
forces the air out; -when turned on the side, this pressure is 
removed, and air enters the chesti) 
On each occasion that the body is replaced on the face, 
make uniform but efficient pressure with brisk movement, 
on the back between and below the shoulder-blades or bones 
on each side, removing the pressure immediately before 
turning the body on the side. During the whole of the 
operations let one person attend solely to the movements of 
the head and of the arm placed under it. 
{The first measure increases the expiration-the second com- 
mences inspiration.} The Result is Respiration or Natural 
Breathing; and if not too late, Life. 
Whilst the above operations are being proceeded with, 
dry the hands and feet, and as soon as dry clothing or 
blankets can be procured, strip the body, and cover or 
gradually reclothe it, but taking care not to interfere with 
the efforts to restore breathing. INDEX. 
Acid, carbolic, antidotes to, 
72 
" oxalic, antidotes to, 72 
" prussic, antidotes to, 
73 
Acids, mineral, antidotes to, 
72 
Acids and alkalies, 71 
Adhesive plasters, 62 
Affusion, cold, 69 
Air, water, soil, etc., mate- 
rials for purifying, 64 
Albumen and oils, 71 
Alcohol, antidotes to, 73 
Alimentary canal, 26 
Alkalies, antidotes to, 72 
Alkalies and acids, 71 
Anatomical and Physiologi- 
cal Outlines, 3 
Animals, bites of rabid, 57 
Ankle and foot, fractures 
about, 53 
Antidotes to poisons, 71 
Antimony, antidotes to, 72 
Apoplexy, 34 
Arm (fore), fracture of, 51 
Arsenic, antidotes to, 71 
Arterial haemorrhage, 42 
Arteries, 16 
" situation of, and 
treatment when wound- 
ed, 44 
Arteries and veins, differ- 
ence between, 17 
Bandage and Splint, com- 
bination of, 60 
Bandages, 60 
" sizes of, 61 
Baths, cold, 68 
" shower, 69 
" tepid, warm, and hot, 
69 
" temperatures of, 68 82 
Bearers, how to place a man 
on a stretcher with three, 
59 
Bed sores, 57 
Bites of rabid animals, 57 
Blood, composition of, 14 
Blood and organs of circula- 
tion, 13 
Blood poisoning from kid- 
ney disease, 35 
Body, the human, 3 
Bones, broken, 47 
" of leg, fracture of, 52 
Brain, 9 
" compression of, 36 
" concussion of, 36 
Breathing, difficulty in; a 
symptom of, 33 
Breathing, stertorous, 32 
Broken bones, 47 
Burns and scalds, 56 
Canal, alimentary, 26 
Capacity, vital, 25 
Capillary hsemorrhage, 43 
Carbolic acid, antidotes to, 
72 
Caustic, antidotes to, 72 
Chill, how to avoid in use of 
bath, 69 
Chloroform, antidotes to, 
72 
Circulation, organs of, 13 
tabular view of, 
15 
Cold affusion, 69 
" bath, 68 
Collapse, 35 
Collar-bone, fracture of, 50 
Comminuted fracture, 48 
Complicated fracture, 47 
Compound fracture, 47 
Compress, wet, 69 
Compression of brain, 36 
Concussion of brain, 36 
Congestion of internal or- 
gans apt to follow burns 
and scalds, 56 
Contused and lacerated 
wounds, 54 
Conveyance, stretcher only 
safe means in cases of 
fracture, 49 
Convulsions, 32 
Cough, a symptom of, 33 
Croup, 55 83 
Death, cases of sudden, 73 
" causes of sudden, 74 
" signs of, 74 
Difficulty in breathing, a 
symptom of, 33 
Digestion, organs of, 26 
Diseases, infectious, 64 
" " rules 
for preventing spread of, 
67 
Diseases and injuries of the 
head, 33 
Disinfectants, 64 
Disinfecting an occupied 
room, rules for, 66 
Disinfecting an unoccupied 
room, rules for, 65 
Disinfection, 64 
Dislocations distinguished 
from fractures, 48 
Dislocations, treatment of, 
dangerous except in 
hands of surgeon, 53 
Dressings for wounds, 62 
Drowning, 37 
Drunkenness, insensibility 
liable to be mistaken 
for, 30 
Ear, danger of interference 
with, 55 
" foreign bodies in, 55 
Emetics, 70 
Epilepsy, 34 
Erysipelas, wounds about 
head, liable to, 54 
Esmarch's triangular band- 
age, 62 
Excretion, organs of, 28 
Eye, foreign bodies in, 54 
Eyes, pupils of : indications 
from, 32 
Face, flushed, 32 
Femur, fracture of, 52 
Flushed face, 32 
Fits, shivering, 32 
" violent, 32 
Fomentations, hot, 69 
Foot and ankle, fractures 
about, 53 
Fore-arm fracture of, 51 
Foreign bodies in the ear, 55 
" eye, 54 
Fracture, comminuted, 48 
complicated, 47 
" compound, 47 84 
Fracture, simple, 47 
stretcher only safe 
means of conveyance in 
cases of, 49 
Fracture, symptoms of, 48 
of collar-bone, 50 
of bones of leg, 52 
of femur or thigh- 
bone, 52 
" of fore-arm, 51 
of humerus, 51 
of lower jaw, 50 
of patella or knee- 
cap, 52 
" of ribs, 50 
" of skull, 49 
Fractures, 47 
Fractures about foot and 
ankle, 53 
" about wrist and 
hand, 51 
" distinguished 
from dislocations, 48 
" treatment of, 48 
Frost-bite, 56 
Gases, irritant, antidotes to, 
72 
Gases, suffocation by, 40 
Giddiness, a symptom of, 32 
Gutta-percha tissue, 62 
Hand and Wrist, fractures 
about, 51 
Handling, unskilful: danger 
of, in cases of fracture, 
49 
Hanging, 40 
Haemorrhage, arterial, 42 
capillary, 43 
from ear, 
mouth, nose, or eyes ; 
indications of, 32 
Haemorrhage, general treat- 
ment of, 41 
Haemorrhage, internal, 43 
venous, 42 
Head, diseases and injuries 
of, 33 
Heart, 14 
Hot bath, 69 
" fomentations, 69 
Human body, 3 
Humerus, fracture of, 51 
Ice and Iced Water, 69 
Incised wounds, 53 85 
Incised wounds, with pro- 
trusion of internal or- 
gans, 54 
Infectious diseases, 64 
" " rules for 
preventing spread of, 
67 
Injuries and diseases of the 
head, 33 
Insensibility, 30 
" causes of, 30 
" examination of 
a person found insensi- 
ble, 31 
Insensibility: important 
symptoms and their in- 
dications, 32 
Insensibility liable to be mis- 
taken for drunkenness, 
30 
Internal haemorrhage, 43 
" organs, diagram of, 
24 
Intoxication, 33 
Irritant gases, antidotes to, 
72 
Jaw, lower : fracture of, 50 
Kidney Disease, blood 
poisoning from, 35 
Kidneys, 29 
Knee-cap, fracture of, 52 
Lacerated and contused 
wounds, 54 
Lead, salts of, antidotes to, 
72 
Leeches, 63 
Leg, fracture of bones of, 52 
Litter, Order of St. John, 58 
Liver, functions of, 27 
Lungs, 25, 28 
Material and appliances 
for the relief of the sick 
and injured, 58 
Medical and Surgical Out- 
lines, 30 
Mercury salts, antidotes to, 
72 
Mineral acids, antidotes to, 
72 
Morphia, antidotes to, 73 
" or opium poison- 
ing, 35 
Muscular system, 8 86 
Narcotics, antidotes to, 73 
Nervous system, g 
Nitrate of silver, antidotes 
to, 72 
Oiled Silk, 62 
Oils, 71 
Opium, antidotes to, 73 
" or morphia poison- 
ing, 35 
Organs, internal, diagram 
of, 24 
of circulation, 13 
of digestion, 26 
" oi excretion, 28 
of secretion, 27 
of special sense, 11 
of voice and res- 
piration, 23 
Oxalic acid, antidotes to, 72 
Pads, 60 
Paralysis, indications of, 33 
Patella, fracture of, 52 
Phosphorus, antidotes to, 72 
Plasters, adhesive, 62 
Poisoning, blood, from kid- 
ney disease, 35 
Poisoning, opium or mor- 
phia, 35 
" treatment of, 70 
Poisons, classification of, 70 
" and antidotes, 71 
Poultices, 63 
Prussic acid, antidotes to, 73 
Pulse, indications of, 32 
Pump, stomach, substitute 
for, 71 
Pupils of eyes, indications 
from, 32 
Purifying air, water, soil, 
etc., materials for, 64 
Rabid Animals, bites of, 57 
Rat poison (phosphorus), 
antidotes to, 73 
Respiration, organs of, 23 
Ribs, fracture of, 50 
Roller bandages, 61 
Room, rules for disinfecting 
an occupied, 66 
Room, rules for disinfecting 
an unoccupied, 65 
Salts of Lead, antidotes 
to, 72 87 
Scalds and burns, 56 
Scars, causing deformity, 
often follow burns, 56 
•Secretion, organs of, 27 
Sense, organs of special, 11 
Shivering fits, 32 
Shock or collapse, 35 
Shower bath, 69 
Silk, oiled, 62 
Silver, nitrate of: antidotes 
to, 72 
Simple fracture, 47 
Skeleton, description of, 4 
* ' diagram of, 2 
Skin, the, 28 
Skull, fracture of, 49 
Sores, bed, 57 
Special sense, organs of, 
11 
Splint and bandage, com- 
bination of, 61 
Splints, 60 
" extemporized, 60 
Staggering gait, indications 
from, 33 
Stertorous breathing, 32 
Stimulants, 62 
Stomach, 26 
Stomach pump, substitute 
for, 71 
Stretcher, how to place a 
man on with three bear- 
ers, 59 
Stretcher only safe means of 
conveyance in cases of 
fracture, 49 
Stretcher, rules for carrying, 
60 
Stretchers, 59 
Strychnia, antidotes to, 73 
Sudden death, cases of, 73 
" " causes of, 74 
Suffocation by gases, 40 
Sunstroke, 40 
System, the muscular, 8 
" the nervous, 9 
Tepid Baths, 69 
Thigh-bone, fracture of, 52 
Triangular bandage, 62 
Unskilful Handling, dan- 
ger of, in cases of fra 
ture, 49 
Veins, 17, 20 88 
Veins and arteries, differ- 
ence between, 17 
Venous haemorrhage, 42 
Vital capacity, 25 
Voice and respiration, or- 
gans of, 23 
Warm Baths, 69 
Water, iced, 69 
Wet compress, 69 
Wounds, 53 
Wounds, contused and lacer- 
ated, 54 
" incised, 53 
" " with pro- 
trusion of internal or- 
gans, 54 
Wounds, materials used in 
dressing, 62 
Wrist and hand, fractures 
about, 51