'POLICE HEALTH MANUAL COPYRIGHT, 1924 
BY 
NEW YORK POLICE DEPARTMENT POLICE DEPARTMENT 
-CITY OF NEW YORK- 
HYGIENE, PREVENTION OF 
DISEASE AND FIRST AID 
BY THE 
NEW YORK POLICE SURGEONS 
RICHARD E. ENRIGHT 
-POLICE COMMISSIONER- INTRODUCTION 
■p DUCATION in matters of Hygiene and 
Disease Prevention offers rewards exceeding 
those to be won by similar activity in almost any 
other field of thought. 
Yet, if we are to judge from every-day experi- 
ence, the average person is rather poorly informed 
upon these important subjects. 
This is greatly to be regretted, especially in view 
of the facts that increasing concentration of popula- 
tion in large centers and the rising complexity and 
speed of existence have enormously increased the 
hazards of life. 
It is certain, moreover, that a widespread appli- 
cation of easily practicable methods of disease 
prevention, based upon the priceless discoveries of 
medical science, will obviate much human misery 
and add many years to the present average span. 
The Surgeons of the Department, in their desire 
to place before their fellow members the best avail- 
able information, have drafted the following pages 
containing a brief exposition of the principles of 
Hygiene and information concerning the causes 
and methods of prevention of the common forms ol 
disease. 
A policeman is frequently called upon to apply 
life-saving measures at the scene of an accident and 6 
INTRODUCTION 
there has been added, therefore, a short treatise 
on First Aid in Emergencies. It is hoped that the 
efforts to achieve compactness have not caused the 
text to be anywhere too obscure, and that the few 
unavoidable technical terms used may require only 
occasional recourse to a dictionary. 
In appreciation of innumerable acts of kindness 
to stricken members of the Police Department this 
small volume is respectfully dedicated to Police 
Commissioner Richard E. Enright. 
NEW YORK CITY, DECEMBER, 1924, CONTENTS 
PAGE 
Introduction ------- 5-6 
Contents ------- 7-8 
Personal Hygiene and Sanitation - - - 9-15 
Common Diseases and Methods of Prevention 15-21 
Diseases of the Eye, Ear, Nose, and Throat - 21-29 
Cancer - ------- 30-31 
Diseases of the Mouth ----- 31-33 
Diseases of the Lungs ----- 33-36 
Diseases of the Heart and Blood-Vessels - 36-40 
Diseases of the Stomach and Intestines - 40-49 
Diseases of the Kidney and Bladder - - 49-52 
Diseases of Nutrition ----- 52-54 
Disorders of the Legs and Feet - - - 55-67 
Diseases of the Nervous System - - - 67-73 
Diseases of the Joints ----- 74 
Infectious Diseases - 74-82 
Suffocation ------- 83 
Method of Artificial Respiration - - - 83-84 
Medical and Surgical Emergencies - - 84-87 
Hemorrhage or Bleeding - 87-92 
Wounds ------- 92-94 
Burns and Scalds ------ 94-95 
Bruises or Contusions - 96 
To Summon Medical Aid - - - - 96-97 8 
CONTENTS 
PAGE 
Shock -------- 98-99 
Fainting ------- 99-101 
Fits or Convulsions - 101-103 
Hysterical Unconsciousness - - - - 103-104 
Sunstroke - - - - - - - 104-106 
Suffocation by Drowning - - - - 106-108 
Frostbite ------- 108 
Suffocation by Illuminating Gas - - - 109-110 
Suffocation by Choking ----- 110 
Drugs - - ' - - - - - 111 
Poisons ------- 112-114 
Contusions, Sprains and Fractures - - 115-116 
Index - - - - „ - - - - 117 HYGIENE, PREVENTION OF DISEASE 
AND FIRST AID 
PERSONAL HYGIENE AND SANITATION 
Throughout the life of an individual there is a constant 
change taking place in all parts of the body. The cells, 
which are the microscopic forms of the material of which 
the different organs are made, increase in size, divide, 
multiply, cease their existence, and are eliminated from 
the body. Although the cells which make the different 
parts differ in the material of which they are made, they 
are all subject to the same laws of regeneration, reproduc- 
tion, and decay. Upon these laws depend the growth of 
the body, the efficiency of its functions, its deterioration 
and decay. To attain proper growth, to prevent prema- 
ture degeneration, to sustain the body in all its parts at 
its highest power are the purposes of all rules of health 
and right living. Too easily are habits of carelessness, 
thoughtlessness, and neglect acquired which are serious 
enough to make good health impossible and keep lowered 
the resisting powers to disease. During the formative 
period of early life is this especially apparent and such 
defects in mental or bodily development are corrected- 
later only by great effort. 
To a police officer there is little need to mention the 
value of a sound mind in a sound body. The special ex- 
perience of his daily life, his recollections of the physical 
examinations he has had to pass, the knowledge of the 
strenuous physical training of his probation period, and 
the physical requirements necessary for promotion to 
higher ranks have convinced him early of this need. 
The sound mind and body can not be sustained, can not 
functionate efficiently unless properly nourished. Upon 
the food which is absorbed into the blood, not simply 
taken into the body, does each individual cell thrive. 
Foods are usually classified as : 
Proteids, or meaty group, including meats, fish 
and eggs, etc. ; 
Starches, (Carbohybrates) or vegetable group, 
of which all the vegetables, the cereals, fruits, 
and bread are prominent members ; 10 
POLICE HEALTH MANUAL 
Fats, including butter, oil, cream, as well as fat 
of meat, and water and salt. 
This classification of food-stuffs is made here because 
it represents the elements of the human system necessary 
for replacement. Hardly any food is entirely in one 
group, but is made of elements of two or more groups. 
No one group is sufficient. All are needed, though not 
in equal proportions. The amount required varies with 
the size of the individual and his physical work. 
Foods may be taken into the body cooked or uncooked. 
Cooking may be regarded as a first step in the digestive 
process, and though it is usually a very important step 
it has some disadvantages. Too frequently it removes 
from the food certain active ingredients which are of 
utmost value. These substances (vitamins) exist in 
abundance in the fruits, vegetable, milk, etc., which may 
be taken raw and which impose very little burden on 
digestive organs. In the mouth the food must be 
thoroughly broken into fine particles between which 
the saliva finds its way, exercising its special chemical 
action, and through its moisture making easier the work 
of the stomach. 
In the stomach the food is kept in motion, "churned" 
for hours, mixing all the while with the juices from the 
stomach walls. The length of time that food remains 
in the stomach is from one to six hours, depending on 
the food taken. Milk remains little more than one 
hour, vegetables two to three hours, eggs two to three 
hours, meats four to five hours, and pork five to six 
hours. 
Taking another supply of undigested food into a 
stomach containing incompletely digested food, prevents 
the digestion of either portion and is a cause of serious 
digestive diseases. As the food is passed into the intes- 
tines, the bile from the liver and gall bladder, (nearly 
three pints daily) and secretions from other glands is 
also poured in. Digestion stops at once and absorption 
begins. As the intestinal contents worm their way 
along the twenty-five feet of its length, blood and lymph 
vessels of the intestinal wall take up the greater part 
of these contents and convey it to the general system. 
The part of the intestinal contents not so absorbed is 
passed to the rectum to await discharge from the body. PERSONAL HYGIENE AND SANITATION 
11 
The simplest and most easily available standard of how 
much food the body needs and how much is actually 
going to the general system is the body weight. 
The following is a table of the height, weight, and 
chest requirements for male candidates for the position 
of patrolman : 
Height 
Weight 
Expanded Chest 
Mobility Chest 
5 
ft. 7% 
in. 
140 pounds 
36% in. 
3 
in. 
5 
ft. 8 
in. 
140 pounds 
37 
in. 
3 
in. 
5 
ft. 9 
in. 
145 pounds 
37% in. 
3 % 
in. 
5 
ft. 10 
in. 
150 pounds 
38 
in. 
3 % 
in. 
5 
ft. 11 
in. 
155 pounds 
39 
in. 
3% 
in. 
6 
ft. 0 
in. 
160 pounds 
39 
in. 
4 
in. 
6 
ft. 1 
in. 
165 pounds 
39% in. 
4 
in. 
6 
ft. 2 
in. 
170 pounds 
39% in. 
4 
in. 
6 
ft. 3 
in. 
175 pounds 
39% in. 
4 
in. 
6 
ft. 4 
in. 
180 pounds 
40 
in. 
4% 
in. 
6 
ft. 5 
in. 
185 pounds 
40 
in. 
4% 
in. 
(Note-Candidates whose height falls between any of the above figures 
must meet the requirements of the lower figure.) 
Far more people eat too much than eat too little. 
Obesity (fatness), in the absence of actual disease, is a 
disproportion between the amount of food taken and the 
physical exercise performed. In plain language it is an 
expression of laziness. 
It is hardly necessary to say that food should be pure, 
uncontaminated by foreign matter and free from the 
germs of disease and decay, and that it should be taken 
into the stomach at regular intervals, as ones duties 
permit. Too long a space between meals as well as too 
short a time are harmful. A full meal before going 
on tour, a very small lunch at the middle, another 
full meal two hours after that duty should be sufficient. 
When fatigued or about to retire for sleep a very full 
meal should not be taken. Foods which have been 
known to cause indigestion to the individual-highly 
spiced, greasy, or over sweetened, pastry, and creams 
or insufficiently cooked foods-easily disturb digestion. 
In summer time less food should be taken and that 
of the more easily digested kind. Uncooked, fully 
ripened fruits, uncooked vegetables, and salads are valu- 
able-but any food in large quantities and frequently 
repeated are bad. 12 
POLICE HEALTH MANUAL 
Water serves in the body fluids as the medium of 
transportation for nutritive materials to the tissues and 
as a means of carrying off waste products. It is essen- 
tial to maintain the blood circulation, the respiration, 
and, in fact, the proper functioning of all tissue cells. 
The daily allowance of water should be from eight to 
twelve glassfuls, some of which might well be taken in 
the form of buttermilk or fermented milk. Large quan- 
tites of fluid should not be taken with meals-nor within 
two hours of mealtime. Teas, coffees, sweetened drinks, 
especially in summertime-are only harmless in very 
small quantities. 
Bowel Regulation is closely associated with the ques- 
tion of food. Regular habits of evacuation are ordinarily 
acquired by slight effort. Most cases of constipation 
result from delay in responding to the natural desire for 
evacuation due to the descent of the intestinal waste into 
the rectum ; neglect in this regard throws into disorder 
the whole natural mechanism of evacuation. 
The bowels should move satisfactorily once or twice a 
day. Favorable periods are shortly after arising from 
bed and after each meal-usually a habit is established 
for one or other of these periods. Fruits, cereals, and 
vegetables assist proper bowel action ; sweet milk and 
cheese are apt to cause constipation. 
Obstinate cases of constipation require the use of 
cathartics, but they should not be used continuously 
except by direction of a physician. 
On account of the great variations in temperature and 
humidity in the climate of New York City clothing used 
during the course of the year is subject to many adjust- 
ments. 
Underwear. In summer months the underwear 
should be light-weight durable cotton fabrics ; in winter 
months medium-weight wool suits. Underwear should 
be frequently changed. 
Socks. Heavy woolen socks should be worn in win- 
ter. Proper care of the feet demands that the socks 
should be changed daily ; twice a day if feet are inclined 
to sweat excessively and become foul. 
Clothing PERSONAL HYGIENE AND SANITATION 
13 
Shoes. The shoes should be modeled to conform to 
the last approved by the United States Army, the Mun- 
son last, or similar shoe. The shoes worn in the winter 
must be roomy enough to accommodate the feet clothed 
in heavy socks. 
The outer garments, uniform and overcoat, are varied 
for the seasons according to the Department Regulations. 
It is important, for sanitary reasons as well as for 
neatness, that the clothes be brushed clean regularly and 
stains carefully removed. 
Dwellings 
Sleeping rooms. Windows should be opened widely 
to permit a copious supply of fresh air to the sleeping 
occupants. 
Living rooms. During the winter months over- 
heating and underventilating are common faults. The 
temperature of the living rooms should not be allowed 
to rise above 72 degrees Fahrenheit. Habitually over- 
heated living quarters will create a dangerous suscepti- 
bility to " colds." 
Exercise 
The policeman's occupation makes rather peculiar 
demands upon his physical equipment. For days at a 
time he is only moderately active, yet he must be pre- 
pared at all times for exertion of an extreme type. A 
fair amount of fitness can only be maintained with the 
help of exercise in addition to that incidental to a tour 
of patrol. 
Daily setting-up and deep-breathing exercises are very 
valuable. When time permits regular sports, such as 
running, hand*ball, weight-throwing, boxing, baseball, 
soccer, and swimming, will be found immensely valuable 
for the man who desires to keep fit. 
Sleep. An average of from 7 to 9 hours sleep per day 
is required to keep the human machine at the highest 
point of efficiency. Bed-clothing should only be suf- 
ficient to permit comfortable warmth and the bedroom 
should always be properly ventilated. 
A heavy meal should not be taken within two hours of 
retiring. 14 
POLICE HEALTH MANUAL 
Bathing 
Certain parts of the body require extra care in the way 
of bathing because of the activity of the sweat glands 
in such areas. The armpits, groins, crotch, and feet 
should be well cleaned with warm water and soap daily, 
the feet often require bathing more than once a day. 
The hands should be washed frequently, always before 
meals, because of the ease with which they may be con- 
taminated and transfer infectious matter to eyes, nose, 
and mouth. 
The general bath for cleansing purposes is most satis- 
factorily accomplished by the use of the warm shower, 
shampooing the body with soap lather ; after the soap 
has been rinsed off with warm water, the bath should be 
terminated by a not-too-brief cold shower. 
The cold shower counteracts the relaxing effect of the 
hot bath and renders the bather less susceptible to chill- 
ing and acute catarrhs. 
The tonic bath, cold water applied by shower under 
good pressure for three to five minutes, followed by 
vigorous rubbing with a coarse towel, is invaluable as a 
preventive for "colds," and is an excellent daily habit. 
If the cold bath is not followed by a comfortable 
reaction, a feeling of general warmth, it should not be 
persistently used without medical advice. 
Excellent shower baths are now regular installation in 
flats and station-houses and failure to use them is inex- 
cusable. 
Special bathing measures may be applied for the 
purpose of cleansing the eyes and nose, which are likely 
to be fouled with street dust, especially during tours 
on windy days. Borax solution (one teaspoonful of 
chemically pure Sodium Biborate to one cupful of warm 
sterile water) may be used in an eye-cup or sprayed into 
the nose by means of an atomizer. 
Sanitary Rules 
Devised for the use of the individual for the purpose 
of preventing transmission of infectious disease: 
Spitting is prohibited except into vessels provided for 
that purpose or into toilet bowls. If spitting on the COMMON DISEASES-PREVENTION 
15 
street is unavoidable, use the sewer openings, or the 
gutter close to such openings. Tuberculosis, influenza, 
and probably infectious sore throat may be transmitted 
by sputum. 
Do not cough or sneeze without covering the nose and 
mouth with a handkerchief. 
Make a rigid practice of washing the hands carefully 
before meals. 
Do not use towels, wash cloths, sponges, napkins, etc., 
that are used by others. 
Avoid the use of drinking cups or glasses that are 
used in common. 
Evacuation of bowels and voiding of urine must be 
confined to accommodations provided for such purposes. 
When on vacation in the rural sections, be careful not 
to drink indiscriminately from springs, wells, or streams 
-these waters are often badly contaminated, typhoid 
fever or dysentery may result and cause many weeks of 
illness. 
COMMON DISEASES AND METHODS 
OF PREVENTION 
In the following discussion we have endeavored to 
throw some light upon the nature and causes of certain 
physical and mental disorders that are common in the 
region of New York City, or have proved to be prolific 
sources of temporary and permanent disability in the 
Police Department of that city. 
The arrangement used groups the various affections as 
they are grouped for special treatment. 
It must be kept in mind that the information presented 
can bear only upon the most important features of the 
diseases discussed, and that additional advice will be 
required in almost every case of illness. 
Skin disorders may be due to a variety of external 
and internal causes. Numerous types of local infection, 
chemical and mechanical irritation, the presence of small 
parasitic insects, unsuitable foodstuffs, poisoning by 
internal use of certain chemicals, poisons of a number 
Diseases of the Skin 16 
POLICE HEALTH MANUAL 
of infectious diseases, are all common causes of skin 
eruptions. 
Proper bathing habits will prevent many of the cases 
due to local infection ; pimples, boils, carbuncles and 
some forms of eczema. (See the preceding section on 
Personal Hygiene.) 
Pimples (Acne) usually affect the face, shoulders, 
neck and back. The ailment itself is too well known to 
require description. Mild cases are improved greatly by 
special attention to cleansing the skin of the affected 
area, by the use of salt laxatives and the avoidance of 
excessive eating. Severe grades will require appropriate 
treatment by a physician. 
Boils (Furuncles; Furunculosis) is the name of an 
infection of the skin by a persistent germ that forms pus. 
There is a decided tendency to the development of 
boils in some individuals, a constitutional state which 
renders them liable to infections due to pus throughout 
the whole system, and which may require special treat- 
ment with vaccines. 
Commonly, boils are associated with unsatisfactory 
conditions in the bowels, intestinal fermentation and 
putrefaction and constipation. Chronically infected 
teeth have also been known to be, in an indirect way, 
the cause of a series of boils. 
Recurring attacks of boils should lead to an examina- 
tion of the urine, for it is frequently found that the 
victim is suffering from diabetes. 
To prevent the formation of boils in those who have 
shown a tendency to this form of skin infection, careful 
bathing habits will be found helpful, also attention to 
conditions in the bowels and sensible eating habits, 
examination of the teeth, tonsils, and other sources of 
possible chronic infection, elimination if found, and, 
where desirable, the use of vaccine. 
When an infection has occured and the boil is com- 
mencing to form, frequent application of ice-water 
compresses will often check the inflammation and cause 
the boil to subside without pus formation. The ice-water 
treatment should be supplemented by a brisk purge, 
solution of magnesium citrate or other form of "salts." COMMON DISEASES-PREVENITON 
17 
If it is obvious at the end of twenty-four hours that 
the boil is progressing, cold applications should be 
stopped and moist heat used instead. The application 
of moist heat will encourage pus formation, " ripening," 
and the boil will be quickly prepared for lancing. 
The most acceptable plan for applying moist heat to a 
boil is by means of compresses of folded gauze wrung 
out in a very hot dilute solution of mercuric bichloride, 
a dilution of one part to 20,000, the compress being kept 
hot by a covering of oiled muslin or rubber cloth, with a 
hot-wrater bottle overlying the whole dressing. 
When a boil has softened and been lanced, or if it has 
opened itself, great care is required to prevent the pus 
from infecting the adjacent skin, directly, or indirectly 
through soiled clothing, and initiating a new series of 
boils. The pus is known to contain the infecting germ 
in large numbers, and it not infrequently happens that 
a discharging boil, on the neck for instance, smears the 
collar of the tunic or overcoat and the pus reinfects the 
neighboring skin with painful results. 
Carbuncle. This is an infection of the skin similar to 
that causing boils, but is more extensive and involves 
more or less of the tissues under the skin. It is a serious 
infection and is occasionally fatal. 
Self-treatment for carbuncle is extremely dangerous ; 
the condition requires special surgical attention, and the 
sufferer should place himself promptly under the care of 
a physician. 
Eczema. Eczema, a superficial inflammation of the 
skin, may be either acute or chronic. It causes consider- 
able discomfort by reason of the severe itching which is 
characteristic of the affection. When extensive and pro- 
longed, it is possible for the sufferer to experience serious 
exhaustion by reason of the constant irritation and loss 
of sleep. 
Eczema may be due to some form of local irritation, 
but probably is just as frequently due to poisonous sub- 
stances derived from the food and carried to the skin by 
the blood. 
Examples of eczema due to local irritation are the 
varieties caused by the itch-mite (scabies), eczema of the 
feet due to decomposing sweat, and eczema of the anus. 18 
POLICE HEALTH MANUAL 
Examples of eczema due to substances derived from 
foodstuffs are the forms seen after the eating of eggs, 
cheese, milk, and meats. Victims of eczema of this class 
are individuals who have developed a constitutional 
state which gives rise to a reaction in the skin whenever 
one particular foodstuff is eaten, in one person eggs, in 
another, cheese, etc. 
The prevention of eczema in those who exhibit a ten- 
dency to this affection requires careful investigation to 
learn if any particular article of diet is the offending 
agent, and the exclusion of such a substance from the 
diet if it is detected. 
Certain local forms of eczema are common and exceed- 
ingly troublesome-eczema of the feet and eczema of 
the anus. 
Eczema of the Feet. Involves the toes chiefly, partic- 
ularly the webbing between the toes. It is a common 
affection in people who suffer from excessive sweating 
of the feet. The soggy sweat-soaked skin swarms with 
bacteria whose activity causes putrefactive changes and 
the formation of irritants that cause the eczema. The 
inflamed skin is easily removed, exposing the sensitive 
under layer, cracking and itching result, and infection 
may lead to deep inflammation of the foot. 
If the feet perspire excessively, and particularly if 
there is a foul odor present, they should be bathed twice 
daily, socks changed, and a suitable dusting powder used 
to prevent the smell. In many cases it is necessary to 
provide also for a change of shoes during the day. 
In addition to the use of dusting powders, measures 
should be taken to keep the toes apart, to prevent soft- 
ening of the skin and removal of the under layers by 
inserting a thin layer of absorbent cotton between the 
toes after the foot bath. Other measures should be un- 
dertaken only by direction of the physician. 
Anal Eczema. A frequent accompaniment of piles 
(Hemorrhoids.) The itching regularly occurs when one 
is relaxing for sleep and is frequently intolerable ; the 
inevitable scratching results in the scraping and crack- 
ing of the skin and aggravates the eczema. 
Supervision of the diet, daily use of "salts" for a 
week or so, and scrupulous care to cleanse the parts COMMON DISEASES-PREVENTION 
19 
about the anus with soap and warm water after each 
bowel movement, will often give complete relief. It is 
necessary in many cases to apply local treatments of 
various kinds before the condition is cured, but they can 
be applied by a physician only. 
Eczema of the crotch and of the armpits are fairly 
common in people who perspire freely. They usually 
require only a little extra attention in the way of local 
bathing, and protection from friction by the clothing. 
The " Itch " (Scabies) is a contagious skin affection 
caused by the presence of an minute insect, the itch 
mite. This insect gives rise to a peculiar form of eczema, 
beginning usually on the fingers. The disease is fairly 
common in school children and may be carried into the 
home to infect several members of the household. The 
itching is severe at times, but the disease is readily 
cured by appropriate treatment. 
Louse Infestation (Pediculosis) is also a contagious 
affection of the skin caused by the presence of lice. 
Three varieties of lice are commonly found upon the 
human, one infests only the hair of the scalp, another 
infests only the hair of the lower abdomen and the eye- 
lashes, the third variety inhabits the seams of the under- 
clothing. The insect causes great discomfort by means 
of its poisonous bites and the severe itching which follows. 
Disinfection of clothing, clipping and shaving of the 
hairy parts, and the use of antiseptic washes of various 
kinds are the regular means of getting rid of this form 
of vermin. 
The louse has been found to be the regular carrier 
of typhus fever (not typhoid) in much the same way 
that the mosquito carries malaria. 
Erysipelas is a special form of infection of the skin 
in which there is general poisoning of the system, as in- 
dicated by chills, fever, and more or less prostration. 
This condition is moderately contagious and is prob- 
ably most often the result of hand contamination, the 
virus being conveyed on the fingers to some vulnerable 
point, most often the nose. 
The form most frequently encountered is erysipelas of 
the face. This usually begins as a swelling at the root 20 
POLICE HEALTH MANUAL 
of the nose, extending gradually out over the cheeks, 
forehead, and scalp, and perhaps farther. The swelling 
is boggy, slightly tender, and moderately reddened ; blis- 
ters are likely to form on the infected skin. 
Erysipelas is a serious disease, sometimes invading 
the system and causing general poisoning and death ; it 
must, consequently, be carefully treated by a physician. 
Repeated attacks of facial erysipelas usually indicate 
a persistence of the infection in the tissues of the nose 
and adjacent openings, and calls for special treatment. 
Prevention rests upon measures that are taken to dis- 
infect the hands if known cases of erysipelas have been 
handled, as may happen while on ambulance duty. 
Skin Cancer. In early stages this appears as a small 
chronic ulcer in certain favored sites-in the margin of 
the nostrils, the cheeks, lower lip, nipples, and any- 
where following a wart. Chronic ulcers in such loca- 
tions must be considered cancerous until proven to be 
otherwise. Diagnosis is extremely important, and the 
early detection of the lesion will save much suffering 
and loss of life. 
Sunburn. An inflammation of the skin caused by 
exposure to rays of the sun. Exposure of areas of skin 
usually covered by clothing, if only for a short time, may 
result in painful burns. Many of the worst cases of burn 
are acquired on cloudy summer days; the victims hav- 
ing neglected all precautions against sunburn under the 
impression that it could not occur to any great extent in 
the absence of strong sunlight. 
Preventive measures are obvious. During the bath- 
ing season it is advisable to subject the exposed skin to 
a mild burn daily for a few days, establishing thereby a 
fair amount of immunity to the effects of prolonged 
exposure. 
If one has suffered a burn it will be found that applica- 
tions of ice or iced compresses for 15 to 30 minutes 
several times a day wflll give considerable relief. Be- 
tween applications of ice one should rub on some cocoa- 
butter. 
If the skin blisters to any extent the blisters should be 
punctured by nicking the raised skin with the point of 
a sterile knife or scissors. EYE, EAR, NOSE, AND THROAT 
21 
It occasionally happens that the burned and blistered 
skin becomes infected. In such a case treatment with 
antiseptics and soothing ointments are required under 
the direction of a physician. 
Chilblain and Frost=bite are skin disorders resulting 
from exposure to cold. 
Mild forms, resulting from exposure to dampness 
and moderate degrees of cold, usually affecting the 
hands and feet are known as chilblains. Chilblains 
appear as reddened patches of skin that burn and itch. 
Severe forms, affecting the ears, nose, cheeks, fingers, 
and toes, and appearing as more or less extensive 
blanched patches of skin, are termed frost-bite. The 
frost-bitten skin is insensitive ; it is only when the in- 
flammation of the stage of reaction begins that the victim 
complains of pain. 
It is possible for the freezing process to affect consid- 
erable tissue to an extent that results in ulceration and 
gangrene of ears, nose, toes, and fingers. 
During severe winter weather ear-laps should be worn 
to protect the ears ; the feet should be kept wTarm and 
dry with woolen socks and weather-proof shoes or boots. 
A word of caution in the matter of winter foot-gear: 
the shoes must be large enough to accomodate the feet 
encased in bulkier socks without undue compression; 
shoes that are even moderately snug may check the 
circulation in the feet sufficiently to invite a frost-bite. 
If chilblains or frost-bite have occurred, the proper 
treatment is massage w'ith cold application, for instance 
snow or cold water, until circulation is normal. Heat 
in any form must not be applied. When the circulation 
is restored, dress the part in cotton wool and place at rest 
in a comfortable position. Any ulceration of the frost- 
bitten area requires surgical treatment. 
DISEASES OF THE EYE, EAR, NOSE, AND THROAT 
Defective, Diminished, or Impaired Vision 
The most common cause of impaired vision is dis- 
tortion of the tissues within the eyeball that are con- 
cerned with focussing images upon the retina. These 22 
POLICE health MANUAL 
are the cases in which the unconscious effort to obtain 
satisfactory clearness of vision brings on the condition 
known as "eye-strain." 
Eye-strain is a frequent cause of headaches, dizziness, 
styes, and chronic congestion of the eyelids. 
The impairment of vision described above falls into 
three classes, near-sightedness, far-sightedness and 
astigmatism, all three of which require correction with 
glasses, except the very mild cases. 
Other forms of impaired vision are due to diseased 
conditions affecting the tissues in the interior of the eye- 
ball-lens, retina, etc.-and disease of the optic nerve, 
and are usually discovered through the examination of 
the eye that is undertaken when a patient complains of 
impaired vision of a type that can not be ascribed to 
errors of refraction. 
Syphilis, rheumatism, chronic nasal infections, gout, 
chronic Bright's disease, tobacco, and alcohol, may cause 
the various types of vision impairment due to disease of 
the eye. 
It is a curious fact that impairment of vision in one 
eye may progress to an extreme degree without being 
detected by the patient. 
Much of the general need for corrective glasses is due 
to downright abuse of the eyes. The following rules 
will be found of great assistance when using the eyes 
for close work : Avoid too little or too bright illumina- 
tion ; sit so that the light falls on the work from a 
source above and to the rear of the head ; avoid reading 
very fine print unnecessarily ; lift eyes from the printed 
page every ten minutes and relax the accommodation of 
the eyes by looking at a number of distant objects ; do 
not read newspapers while riding in moving vehicles. 
Cold in the Eye (Conjunctivitis) is an acute inflam- 
mation of the membrane covering the eye-ball and 
the inner surfaces of the eyelids, ordinarily due to 
infection. The infectious matter may be street dust; 
poisonous matter conveyed to the eye by soiled fingers, 
handkerchief or other linen ; or the eye may be infected 
by extension of an inflammation of the nasal passages 
during the course of a Cold." EYE, EAR, NOSE, AND THROAT 
23 
The inflammation may affect one or both eyes, and is 
accompanied by more or less discharge, swelling of the 
lids, and varying degrees of pain. 
Some cases quickly become serious, and occasionally 
the damage caused by extension of the inflammation to 
the deep structures results in complete loss of the eye. 
Prevention depends largely upon care to avoid infect- 
ing the eye through contact with soiled fingers or con- 
taminated linen. 
Slight irritation due to street dust or similar particles 
may be overcome by the regular use of bland eye-washes. 
It is very unsafe to attempt any method of ' ' home 
treatment ' ' for eye inflammation. Report to a physician 
for advice. 
Foreign Body in the Eye. Very fine particles of street 
dust may lodge in the eye on windy days without causing 
anything more than slight irritation ; large particles of 
coal, stone, wood, ash, etc., may enter the eye and give 
rise to great discomfort and may even be responsible for 
considerable damage. 
The pain caused by a foreign body in the eye is prac- 
tically wholly due to friction of the particle against the 
sensitive cornea. If this be remembered when the 
particle enters the eye, one can usually ease off the dis- 
comfort by rolling the eyeball to a position where the 
irritation is not severe, and then proceed to remove the 
offending fragment. 
Rubbing the eye must be avoided at all costs because 
such a procedure is fairly certain to embed the particle 
in the lid, where every movement will cause it to scratch 
the cornea ; or, what is worse, to embed it in the cornea 
where more or less damage is sure to result from the 
efforts necessary to dislodge it. 
If non-professional assistance is not successful in re- 
moving the particle from the eye, or if there is any un- 
certainty as to its complete removal, one should seek 
the services of a physician. 
An excellent method for relieving the slight irritation 
caused by fine street dust is the use of a borax eye-wash. 
A teaspoonful of chemically pure Sodium Biborate dis- 
solved in a cupful of warm sterile water and applied to 24 
POLICE HEALTH MANUAL 
the eye by means of an eye-cup once or twice a day will 
be found to be very comforting. 
Styes. An infection of the hair follicles of the lidsr 
usually terminating in the formation of minute abscesses. 
Styes are frequently associated with eye-strain and 
are also known to occur as part of the same tendencies 
associated with the eruption of boils. 
Constipation, intestinal fermentation, diseased tonsils, 
chronic infections of the nose, abscesses of the teeth have 
all been designated as causes for styes as well as for boils. 
Ear 
Wax Accumulation (Impacted Cerumen). The wax- 
like substance that is secreted in the canal of the ear is 
sometimes formed in excessive quantities and fails to drop 
out as it ordinarily should. The accumulated ' 'wax' ' may 
completely stop up the canal and cause considerable deaf- 
ness on the affected side, the patient sometimes being 
unaware of defective hearing until both ears are affected. 
The cerumen is sometimes actually packed into the 
canal through misdirected efforts to clean the ear by 
using the corner of a towel or wash-cloth. Quite fre- 
quently the "wax" dries and hardens into a stone-like 
mass that may cause dizziness and ringing in the ears 
through pressure against the drum membrane. 
One should never attempt to remove the wax from the 
ear by using scoops, tooth-picks, hair-pins, or similar 
weapons, for serious damage to the canal or drum may be 
inflicted. The only permissible method is syringing 
with a warm solution of borax or sodium bicarbonate in 
water (two teaspoonfuls of either to a cupful of warm 
w'ater); a soft rubber syringe with a soft rubber nozzle 
should be used, syringing forcibly, but with care to keep 
the nozzle of the syringe to one side of the ear canal so 
as to allow free egress of the water. 
If cerumen regularly accumulates and plugs the ear it 
is a good plan to syringe the ears once every three or 
four weeks. 
Hardened masses of cerumen may be softened by 
dropping ten or twelve drops of warm olive-oil into the 
ear an hour or more before syringing; it may not be EYE, EAR NOSE, AND THROAT 
25 
possible otherwise to remove the plug without using in- 
struments. Quite often it is necessary to resort to a 
physician to have the cerumen removed. 
Earache (Abscess of the Middle Ear). Earache is 
the outstanding symptom of acute inflammation of the 
(middle) ear. This middle-ear inflammation is usually 
a complication of acute catarrhal inflammations of the 
nose and throat, especially those of influenza. The in- 
flammation regularly results in the formation of an 
abscess which, if left to run its course, will rupture the 
drum of the ear and discharge by way of the canal. 
During the bathing season of the summer months 
many cases of middle-ear abscess arise from the entry of 
contaminated water into the ear by way of the nasal 
passages. 
It must be remembered that the water of the beaches 
within easy reach of any city is sure to be considerably 
fouled by sewage. Diving and other maneuvers that 
carry the head under the water are sure to force water 
into the nasal passages, from which one is inclined to 
attempt to expel it by violent blowing, thereby forcing 
it through the Eustachian tube and into the middle 
ear. It is probable that diving may also induce ear 
inflammation through sudden variations of pressure upon 
the ear-drum when the head is plunged forcibly under 
water. The use of plugs of non-absorbent cotton in the 
ear canals or bathing caps that cover the ears is advisable 
when bathing, particularly wrhen diving. It is also im- 
portant to avoid violent blowing of the nose to dislodge 
water which has found its way into the nasal passages. 
Occasionally an abscess of the ear develops quickly 
and ruptures through the drum within a few hours, but 
ordinarily this is not the case. Unless lanced, the drum 
will remain intact for several days, damming back the 
pus and greatly increasing the danger of an infection of 
the mastoid cells and the formation of a mastoid abscess. 
The gravity of an acute infection of the ear rests upon 
the possibility of infection of the mastoid and important 
neighboring structures, and when these are involved the 
results are not infrequently fatal. 
Avoid violent nose blowing when suffering from an 
acute catarrh of the head or sore throat, also avoid the 26 
POLICE HEALTH MANUAL 
use of nasal douches that cause even slight pressure 
when treating an acute inflammation of the nose. 
An earache should not be allowed to persist for more 
than a few hours before being reported to a physician. 
Chronic Discharging Ear (Chronic Inflammation of 
Middle Ear). This is usually due to persistent chronic 
inflammatory conditions in the throat and nose, with or 
without marked obstruction of the nasal passages. 
There is nearly always a history of an acute abscess of 
the ear which has been allowed to rupture. 
The discharge is more or less intermittent, but the in- 
fection of the ear is always present and the danger of 
mastoid infection is equally persistent. 
Special treatment of the ear and nose is required and 
should not be neglected. 
Deafness. Deafness may be caused by the stoppage of 
the ear canals by " wax by chronic pus formation in 
the middle ear (chronic discharging ear); by disease of 
the nerve of hearing; but most frequently it is caused 
by a peculiar chronic inflammation that is associated 
with chronic catarrh of the nose and throat. 
Much deafness can be prevented by the proper treat- 
ment of chronic nasal catarrh, particularly in the early 
stages. 
Boils in Ear (Furuncles in Canal of Ear) are in- 
fections of the skin lining the canal of the ear, usually 
resulting in the formation of abscesses. This is a very 
painful condition and one to which certain individuals 
seem particularly liable. 
Hot irrigations and the application of alcohol to the 
skin of the canal will ordinarily give relief ; in some cases 
it is necessary to lance the boils under an anesthetic. 
Repeated attacks indicate a chronic source of infec- 
tion, tonsils, teeth, nose, etc. 
Nose 
Nosebleeds - Hemorrhage from Nose (Epistaxis). 
Hemorrhage from the nose, in addition to the varieties 
caused by injuries to the nose and skull, are caused by 
acute congestion of the nose, ulceration in the nose, and 
the rupture of diseased blood-vessels. EYE, EAR, NOSE, AND THROAT 
27 
An isolated nosebleed usually is of no great signifi- 
cance ; as a rule it is due to a temporary congestion and 
serves automatically to relieve the condition. 
Repeated attacks require investigation ; they may be 
caused by the high blood-pressure of Bright's disease, or 
by arteriosclerosis-hardening of the arteries; less im- 
portant causes of repeated hemorrhages are simple ulcers 
and varicosities (dilated blood-vessels). 
Moderate hemorrhages may be checked by the applica- 
tion of iced compresses to the face and by avoidance of 
any efforts to clear the nasal passages of clots for an hour 
or so. Severe hemorrhages may require treatment of the 
bleeding points and the use of packing-measures that 
can be applied only by a physician. 
Chronic Nasal Obstruction is caused by a deformity 
or overgrowth of structures within the nose, or by the 
presence of new growths. A chronic inflammation of 
the mucus membrane of the nose always accompanies 
this condition, and deafness regularly results from it. 
Persistent recourse to operative treatment is the only 
remedy. 
Hay Fever is a more or less severe inflammation of 
the air passages and the eyes caused by air-borne dust 
(pollen) derived from certain plants during the flowering 
season. It afflicts individuals who are peculiarly subject 
to the affection. 
In the region of New York City the disease occurs 
from the latter part of May to about the middle of 
October. 
The offending plants include several varieties of grasses 
and the ragweeds. 
Some people are attacked in the early weeks of the 
summer, some only in the early fall, while others again 
are afflicted during both periods. 
The symptoms are smarting and redness of the eyes, 
flowing of tears, sneezing, coughing, discharge from 
nose, and occasionally attacks of bronchial asthma. 
Preventive vaccines are now in common use and those 
who suffer regularly from this disease can obtain more 
or less relief by vaccine treatment during the three or 
four weeks Preceding the usual onset of the attack. 28 
POLICE HEALTH MANUAL 
Chronic Nasal Catarrh. This is characterized by a 
swelling of the membrane lining the nose and by an 
excessive secretion of mucus, acting together to cause 
more or less of an obstruction of the nasal passages. 
The condition is very common in New York City and 
is ascribed to the irritating effect of inhaled street dust, 
tobacco smoke, the prevalence during winter months of 
contagious colds, the humidity of the climate, the ex- 
cessive heating of dwellings and work-rooms, and an 
excess of sugars and starches in the diet. 
The seriousness of the affection rests upon the fact 
that it is really a chronic infection of the nose and may 
at any time give rise to troublesome inflammations of an 
acute nature by affecting the neighboring structures, the 
middle-ear, the mastoid sinus, accessory sinuses of the 
nose, etc. 
Deafness may also be an indirect result of a chronic 
nasal catarrh through chronic affection of the middle-ear, 
as already noted. 
Prevention depends chiefly upon the routine cleansing 
of the nose effectively to remove street dirt and infec- 
tious matter that have been inhaled during the day. 
This cleansing is best accomplished by the use of a mild 
alkaline solution applied in the form of an atomized 
spray. A solution of chemically pure Sodium Biborate, 
one teaspoonful to a cupful of warm sterile water; or 
Alkalol diluted with an equal part of sterile water, may 
be used without causing irritation of the nose. 
Nasal douches are not advisable because of the pos- 
sibility that the pressure of the douche or incidental 
gagging may drive infectious matter into the middl-e-ear 
and cause an abscess. 
The proper regulation of temperatures in living rooms 
and places of business will help materially in the pre- 
vention of chronic nasal catarrh. There is good reason 
for believing that gastro-intestinal fermentation (heart- 
burn) from excessive eating of starches and sugars 
plays considerable part in causing chronjc catarrh of the 
head. 
The treatment of chronic nasal catarrh requires special 
skill. Self-treatment with various advertised cures is EYE, EAR, NOSE, AND THROAT 
29 
dangerous, especially because of the many complications 
that may, and usually do, exist in cases of long standing. 
Pimples in Nostrils (Furunculosis of the Nostrils). 
This is caused by infection of the hair-follicles of the 
nostrils. It is common in late winter and in spring 
months. The condition is an expression of the consti- 
tutional tendency which is common to skin boils, styes, 
boils in ear, etc. 
Careful cleansing of the nostrils, especially if there is 
a tendency for nose secretions to crust about the hairs, 
and the prompt use of yellow mercurial ointment if signs 
of hair-follicle infection arise, are usually sufficient to 
prevent the development of the pimples. 
If infection gets well under way great relief will be 
experienced through the use of ice-water compresses, 
spraying the nostrils with Alkalol in half dilution, and 
the application of generous amounts of the mercurial 
ointment (yellow oxide of mercury ointment, 2%). The 
mercurial ointment should be continued for a week to 
ten days after the inflammation has apparently sub- 
sided. 
Throat 
Enlarged Tonsils (Hypertrophied Tonsils). Enlarged 
tonsils are the result of chronic infection; are, in fact, 
chronically infected tonsils. The enlargement of the 
tonsil may cause considerable disturbance because of 
mechanical interference with nasal breathing, but by far 
the greater damage to the afflicted individual is caused 
by chronic poisoning through absorption from the in- 
fected cavities. 
Chronic infection of the tonsils frequently gives rise 
to attacks of acute inflammation of the throat, poisoning 
the system and possibly causing inflammation of the 
joints, heart, kidneys, nerves, or causing abscesses of the 
skin and various organs. 
Chronic infection of the tonsil practically always 
originates in youth. Prevention consists in careful 
treatment of the acutely inflamed tonsil incidental to 
acute infection of the throat. 
The proper treatment for the condition, when it is 
once established, is the removal of the tonsils at the 
earliest practicable date. 30 
POLICE HEALTH MANUAL 
CANCER 
The actual cause of cancer is unknown at present, 
although much has been learned concerning the con- 
ditions under which it is liable to develop, the points of 
attack, and the varying degrees of malignancy and cure. 
The most favoring cause of cancer, chronic irritation, 
on the contrary, has been well understood. Recogniz- 
able chronic irritation is usually present far in advance 
of the appearance of the cancer, preparing the soil for 
the growth of the characteristic cancer cell. 
Abrasions from the clay pipes of former days, repeated 
minute burns of the lips, scratch wounds of the cheeks 
and lips caused by sharp edges of decayed and broken 
teeth, chronic ulcers of all kinds, scars of old burns, 
constant smoking, inhalation of ground stone or flour in 
certain occupations, simple warts and moles subjected to 
frequent irritation, and the prolonged presence of foreign 
bodies in the tissues, all frequently result in cancer. 
Many other forms of chronic irritation have been 
known to precede the development of cancer, but it 
would be impossible in the limited space available to 
present a more complete list of favoring injuries. 
The commonest sites for the growth of cancer in men 
are the mouth (lips, gum, and tongue); the skin of face, 
scrotum, and extremities; the bones; the stomach and 
intestines ; the bladder; lymph glands, and the central 
nervous system. 
The commonest sites in women are the breast, womb 
and nearby organs, stomach and intestines, and the 
bladder. 
Preventive measures consist solely in the elimination 
of the various chronic forms of irritation outlined above. 
Every chronic ulceration or small tumor should be 
considered as possibly cancerous, and every means, in- 
cluding the use of the microscope, should be exercised to 
establish the innocent or malignant character of the 
injury. 
Although X-rays and radium have been found to be 
of great value in the treatment of cancer, by far the main 
reliance as yet is surgery, and surgery applied before 
the cancer has reached an advanced stage. CANCER-DISEASES OF MOUTH 
31 
The only hope for successful treatment of cancer 
rests upon early diagnosis. Apply for medical advice 
promptly if suffering from a persistent ulceration of 
skin or mouth, or from tumor formations in any loca- 
tion. 
Stomach cancers give rise to persistent pain and loss 
of weight; cancers of the intestine cause pain and the 
passage of blood in the stools ; cancer of the bladder 
causes painful urination and the passage of blood in the 
urine. 
DISEASES OF THE MOUTH 
Decayed Teeth are traceable to several causes-defec- 
tive diet, ill health in childhood, but chiefly to the con- 
stant presence in the mouth of fermenting and putrefy- 
ing food fragments. The process begins as a slight 
erosion of the tooth (Fig. 1) which in time extends 
through the enamel (Fig. 2) and attacks the softer 
tissue beneath, invading the pulp (Fig. 3). 
FIGURE ONE 
FIGURE TWO 
FIGURE THREE 
If unchecked the tooth crumbles and breaks until 
nothing is left but the roots embedded in the gum. 
Putrefying food lodged in the cavity of the decayed 
tooth swarms with bacteria that cause irritation and 
inflammation of the soft tissues in the immediate neigh- 
borhood-pulp of tooth, nerves of the roots, and the 
gums-resulting in acute and chronic abscesses about the 
tooth roots and in pyorrhea. 
Decayed teeth also give rise to various types of diges- 
tive disorders through the inability to chew the food 
properly and through the swallowing of putrefying par- 
ticles dislodged from cavities. 32 
POLICE HEALTH MANUAL 
To prevent tooth decay it is absolutely essential to 
free the teeth of particles of food lodged around and 
between them after meals. It is true that many indi- 
viduals possess teeth that are very resistant to bacterial 
products and seem able to neglect them to almost any 
extent without causing decay, but this is far from true 
for the average man. 
The best practise is to use a serviceable tooth-brush 
on arising, after each meal, and before retiring. A tooth- 
powder or paste, with chalk as the chief ingredient, will 
serve to remove the discoloring film from the teeth. 
It should not be forgotten that a tooth-brush wears 
out after a time and may become practically useless as a 
cleansing agent. 
If food regularly lodges in wide spaces between the 
teeth, dental floss should be used twice a day to clear it 
away. Toothpicks should not be used for this purpose 
as they are likely to scratch the thin membrane of the 
gums near the teeth and permit infection. 
In spite of all precautions the average person will 
suffer from a certain amount of erosion of the teeth, but 
with careful attention at intervals of six months the 
erosions may be checked while still insignificant and the 
teeth saved from serious decay. One should report to a 
competent dentist twice a year for an inspection of the 
teeth and the treatment of whatever cavities may be 
found. At a small annual expense the foregoing plan 
will be found to give large returns in health, comfort, 
and freedom from burdensome dentists' bills. 
Chronic Mouth Infection. Neglect of the mouth re- 
sulting in tooth decay, if continued, is sure to result in a 
form of mouth infection known technically as chronic 
oral sepsis. In this condition we usually find numerous 
infected areas about the teeth, the most common and 
troublesome of which are pyorrhea and chronic root 
abscesses (apical abscesses.) The gravity of these con- 
ditions rests upon the proved fact that by invading the 
general system the bacteria derived from the abscesses 
may cause acute and chronic inflammations of the joints, 
heart, kidneys, nerves, and other organs. 
Examination by X-ray is essential for the detection 
of root abscesses and should be utilized in every case of DISEASES OF LUNGS 
33 
pyorrhea. Mouths that contain crown and bridge work 
of some years standing, even if apparently in good con- 
dition, should be X-rayed at intervals to determine 
whether or not any root infection is present. 
Chronic oral sepsis requires vigorous and persistent 
treatment by a competent dentist. 
Cancer of the Mouth. The most frequent sites of 
cancer of the mouth are the lower lip, side of tongue, 
and less frequently the gums and the inner surfaces of 
the cheek. 
There is usually a history of irritation from the sharp 
fragment of a decayed tooth or the friction of a pipe 
stem, but cancer may occur without any such history of 
irritation. 
The cancerous growth may begin as a small ulcer, or 
it may start as flat wart-like patch which ulcerates later, 
and progresses as a chronic ulcer upon an indurated 
(hard) tumor mass. 
Chronic ulcers of the mouth, persisting for more than 
a month, or chronic patches on the tongue or cheek, 
should be reported to a physican for careful observa- 
tion, and should be considered as cancerous until proven 
otherwise. The treatment is surgical. 
DISEASES OF THE LUNGS 
Pneumonia and Pulmonary Tuberculosis are dis- 
cussed in the section on Infectious Diseases. 
Bronchitis 
Acute Bronchitis is an acute inflammation of the 
membrane lining the bronchial tubes. It is due to infec- 
tion, and is practically always an extension of similar 
inflammation from the nose and throat as part of an 
acute catarrhal " cold." 
The symptoms are cough, expectoration, and "sore- 
ness " about the upper chest. 
Bronchitis is serious only because the infection may 
extend to the lung tissue proper and result in pneu- 
monia ; a condition that happens fairly frequently in 
older persons. 34 
POLICE HEALTH MANUAL 
The prevention of bronchitis depends upon prompt 
care of acute catarrhs of the nose and pharynx. 
Chronic Bronchitis. As a result of frequent attacks 
of acute bronchitis or because of some chronic affection 
of the lung tissue the lining membrane of the bronchial 
tubes may be damaged to an extent that permits a 
chronic infection. Victims are usually over forty years 
old ; they are rarely free from a distresssing cough except 
during the summer months. 
Many people with chronic bronchitis also suffer from 
chronic disease of the heart, chronic Bright's disease, 
or gout. Chronic diseases of the nose and throat, chronic 
nasal obstruction, enlarged tonsils, etc., may favor the 
development of chronic bronchitis. 
A tendency to chronic bronchitis should prompt a 
careful physical examination to exclude the possibility 
of a pulmonary tuberculosis. Such an examination will 
also disclose the presence of conditions mentioned in the 
last paragraph that might favor the persistence of a 
chronic infection. 
Individuals who suffer from chronic bronchitis are 
particularly susceptible to body chilling. They should 
therefore exercise great care to insure proper protection 
during the cold damp months of the year. 
Vaccine treatment is often of great benefit, in con- 
junction with other methods. 
Unchecked cases of chronic bronchitis result ultimately 
in serious affections of the lung tissue. 
Asthma 
Asthma is an affection of the bronchial tubes charac- 
terized by paroxysms of difficulty in breathing. 
The labored breathing (dyspnoea) is present whether 
the patient is moving about or is at rest; the victim is 
distressed by inability to take in or expel the air from 
the lungs satisfactorily ; in moderately severe attacks he 
is compelled to rest in a sitting posture-lying down in- 
creases the difficulty. 
There is usually more or less cough ; the expectoration 
is thick and tenacious, and difficult to dislodge. DISEASES OF LUNGS 
35 
Bronchial asthma is sometimes confused with attacks 
of difficult breathing that are due to diseases of the heart 
and kidney. While the dyspnoea of heart or kidney 
disease is usually brought on by exertion and asthma is 
not, yet the diagnosis is difficult at times, and is import- 
ant enough to demand the best judgment of a physician. 
The exact cause of many cases of asthma must often 
remain in doubt, but it is known that a number of cases 
are caused by the inhalation of plant dust (pollen-hay- 
fever asthma), animal dust (stable dust, dust from 
woolen blankets, feather pillows), smoke and trade dusts, 
bacterial infection of the bronchial tubes, and the eating 
of certain foods by individuals who are peculiarly sus- 
ceptible to particular proteins. 
To determine the cause of any one case of asthma re- 
quires patient research, as yet too often rewarded by 
complete disappointment. 
Bronchial asthma due to the inhaling of pollen and to 
bacterial infection are greatly relieved by vaccine treat- 
ment. 
Cases due to the inhaling of dust, animal and trade, 
can be prevented by avoiding exposure to such irritants. 
The asthma arising from sensitiveness to certain foods 
(protein) is best relieved by omitting the offending food 
from the diet. The food responsible for these cases may 
be determined by resorting to simple skin tests-eggs, 
milk, pork, crab meat, fish, and other food substances 
have been found to be the cause in various cases. 
A family tendency to bronchial asthma has been fre- 
quently noticed. 
Pleurisy 
Pleurisy is an inflammation of the delicate tissues 
(pleura) surrounding the lung. 
Acute Pleurisy is characterized by a stabbing pain in 
the chest aggravated by movements of the chest during 
breathing. 
Pleurisy, for the sake of safety, should lead to the 
suspicion of pneumonia or tuberculosis in every case. It 
is a common experience that the inflammation that affects 
the pleura almost always involves the lung tissue beneath 
it. 36 
POLICE HEALTH MANUAL 
Repeated attacks of acute inflammation of the pleura 
are very certain to be tuberculous in origin. 
Pleurisy is accompanied by an accumulation of fluid in 
the chest on the affected side; if this fluid is pus, the 
condition is known as empyema (abscess of the lung). 
The bacteria that cause the infection and inflammation 
of pleurisy are those that cause pneumonia and tubercu- 
losis, and the attack is usually hastened by exposure and 
chilling. 
Chronic pleurisy is practically always a tuberculous 
process. 
DISEASES OF THE HEART AND BLOOD-VESSELS 
High Blood-Pressure and Arteriosclerosis 
The flow of blood in the vessels throughout the body 
is maintained by a more pr less constant pressure, the 
product primarily of the pump action of the heart. 
This normal pressure is higher in men than in women 
and increases slowly with age. 
The arteries of the body are capable of expanding un- 
der various influences, thereby diminishing the resistance 
to the flow of blood and lowering the blood-pressure ; on 
the other hand contraction, either temporary (spasm) or 
permanent (sclerosis), of the small arteries increases the 
resistance to the flow of the blood and raises the general 
blood-pressure. 
There is no great need for discussing low blood- 
pressure ; high blood-pressure, on the contrary, is a topic 
of tremendous importance. 
During the early stages the sufferer from high blood- 
pressure (hypertension) rarely complains of significant 
symptoms, the condition is discovered during the course 
of a general physical examination. In the more ad- 
vanced stages the patient complains of chronic headache, 
shortness of breath on exertion, dizziness, and rapid 
physical exhaustion at ordinary daily tasks. 
Poisonous substances derived from the food, chiefly 
the meat elements, are responsible for blood-vessel spasm 
and increased tension of the arteries ; immoderate eaters 
and drinkers, especially heavy meat eaters, form the 
greatest percentage of victims of hypertension. DISEASES OF HEART AND BLOOD-VESSELS 
37 
A very injurious form of high blood-pressure is ob- 
served in cases of Bright's disease of the kidney, and 
very often is the first clue obtained of a fatal affection. 
Long-standing cases of hypertension are certain to 
develop a disease of the arteries throughout the body 
commonly known as ' ' hardening of the arteries ' ' 
(arteriosclerosis). 
Arteriosclerosis may also be due to the action of 
certain poisons circulating in the blood and may itself 
be the cause of a very intractable form of high blood- 
pressure. 
Excessive eating and drinking, alcohol, syphilitic and 
other chronic infection, and metallic poisons are the chief 
causes of " hardening of the arteries." 
The symptoms of arteriosclerosis vary a good deal and 
depend largely upon the organs that happen to be most 
extensively involved. Degeneration of the small arteries 
of the kidneys gives rise to a malignant form of Bright's 
disease-headaches, disturbances of vision, emaciation, 
vomiting, loss of appetite, uremic convulsions, and coma. 
Disease of the small arteries that supply the heart-muscle 
causes neuralgia of the heart (angina pectoris) and heart- 
failure. If the small arteries of the brain are involved 
the patient complains of headaches, dizziness, rapid 
fatigue by brain effort, disturbances of speech, ultimately 
weakness dr paralysis of limbs or face. 
Prevention of arterial hypertension and arteriosclerosis 
requires temperate habits of eating and drinking, the ab- 
staining from excessive use of alcohol (this means com- 
plete abstinence for many individuals), avoidance of ex- 
cessive use of tobacco, and the removal of any syphilitic 
or other form of chronic infection. 
Owing to the subtle character of hypertension and the 
necessity for early detection of arteriosclerosis, blood- 
pressure readings should be made at least once a year in 
all persons over thirty-five. The instrument required 
for this purpose is in general use and has become almost 
as indispensable as the clinical thermometer. 
Treatment of high blood-pressure and of ' ' hardening 
of the arteries" requires special attention to diet and 
supervision of innumerable details of the patient's daily 
routine; it taxes the best efforts of the physician. 38 
POLICE HEALTH MANUAL 
Angina Pectoris is a grave heart affection caused by- 
contraction and hardening of the small arteries that 
supply the heart-muscle. The disease is characterized 
by agonizing attacks of pain about the heart, the left 
shoulder, and the arm. 
The disease may run a very rapid course resulting in 
complete heart-failure in a few weeks or it may last for 
several years. In between attacks of pain there are 
usually definite symptoms of heart trouble, pulse irregu- 
larity and shortness of breath on exertion. 
Valvular Heart=disease. Inflammation of the lining 
membrane of the heart causes distortion of the heart 
valves, rendering them incapable of their normal action 
and increasing, to a varying extent, the work required 
from the heart to maintain efficient circulation. 
Infection with bacteria is the cause of the inflamma- 
tion and the organisms chiefly responsible are those that 
cause acute rheumatism of the joints, syphilis, scarlet 
fever, tonsilitis, pneumonia, septic poisoning (poisoning 
from the absorption of pus), and gonorrhoea. 
Valvular disease of the heart in the early stage also 
fails to give rise to symptoms that would warn the victim 
of his predicament, it can be detected only by a careful 
physical examination. 
When the disease has progressed to a point where the 
efficiency of the heart mechanism is seriously diminished, 
the patient complains of symptoms of heart-strain 
(palpitation, irregularity of pulse, and discomfort or pain 
in the chest). There are evidences that the general cir- 
culation is disturbed (faintness, dizziness, shortness of 
breath on exertion, swelling of legs), and chronic con- 
gestion of the lungs causes a persistent cough. 
Repeated physical examinations are extremely valu- 
able for the early detection of valvular disease of the 
heart, and any one who has suffered from one or more 
attacks or acute articular rheumatism (rheumatism of 
the joints) should report for careful physical examina- 
tion of the heart once or twice a year. 
There is one reassuring fact about valvular heart- 
disease and it should be made known to all those found 
to be suffering from this condition : it is that the heart 
may sustain a very serious valve injury and yet may DISEASES OF HEART AND BLOOD-VESSELS 
39 
succeed in adjusting itself to the extra work required and 
to a degree that will permit the patient to pursue a prac- 
tically normal existence in safety for a great many years. 
There is no justification for the hysterical attitude of 
the average man toward valvular heart-disease. 
When the physical examination reveals a heart with 
one or more defective valves, the patient should be 
frankly informed of the condition, and instructed to 
avoid excessive eating and drinking, and the use of 
alcoholic liquors, and tobacco in excess, all of which are 
likely to damage the heart-muscle ; he should also be 
told to avoid strenuous exertions, competitive athletics- 
weight throwing, tug-of-war, rowing, etc.-and in- 
structed in the saving qualities of sufficient physical rest. 
If there have been repeating attacks of rheumatism, 
the teeth, tonsils, appendix, etc., should be scrutinized 
for a possible source of repeated infections. If the 
patient has had syphilitic infection in the past, careful 
investigation is demanded to determine the possibility of 
a persistent chronic syphilis. 
The problem of prevention of valvular disease of the 
heart is practically the same as that for the prevention 
of the infectious diseases of which it is a complication 
and result, chiefly acute articular rheumatism and 
syphilis. (See Infectious Diseases.) 
Affections of the Nervous Mechanism and the Muscle 
of the Heart 
Alcoholic Heart. Acute poisoning of the heart by 
alcohol causes a rapid pulse and of shortness of breath on 
exertion. Continuous use of alcohol causes degenera- 
tion of the heart-muscle and hardening of the vessels of 
the heart-chronic myocarditis-and in advanced cases 
results in heart-failure of a hopeless type. 
Tobacco Heart. Tobacco poisoning of the heart is 
exhibited in two common forms in adults-irritable 
heart with fluttering and irregular heart action, and short- 
ness of breath on exertion and neuralgia of the heart 
characterized by attacks of pain in the region of the heart. 
Heart of Obesity. The heart-muscle is weakened by 
fat deposits ; moderate exertion causes rapid pulse and 
shortness of breath. 40 
POLICE HEALTH MANUAL 
Influenza Heart. The poison of influenza, less com- 
monly other infectious diseases, frequently attacks the 
heart-muscles and causes a severe grade of muscle weak- 
ness and irritability. For weeks and months after the 
patient is convalescent from his attack of influenza, slight 
exertion causes a marked rapidity and irregularity of the 
pulse, and a sense of breathlessness. 
Preventive measures for the foregoing conditions are 
obvious. 
Treatment in all cases calls for measures to relieve the 
heart of all strain and to restore the soundness of the 
heart-muscle by measures appropriate to each type of 
disorder, abstaining from alcohol and tobacco, and 
treatment for removing excess fat. 
In connection with the disorders due to the poisonous 
effects of alcohol and tobacco it is necessary to under- 
stand that the poisonous dose of either is very variable. 
In some, the heart-muscle is badly affected by very 
trifling addiction. The rule for any one man is not the 
measure necessarily for any other. 
DISEASES OF THE STOMACH AND INTESTINES 
Acute Indigestion (Acute Dyspepsia) is characterized 
by a group of acute symptoms originating from the 
inability of the stomach to accomplish the normal diges- 
tion of its contents. 
Distention of the stomach, caused by gas from fer- 
menting contents, and irritation of the lining membrane 
of the stomach, caused by poisonous substances produced 
in spoiled food, give rise to pain in the abdomen ranging 
in severity from mild discomfort to agonizing colic. 
Efforts of the stomach to rid itself of the offending 
material cause the familiar nausea and vomiting. When 
the stomach is emptied by vomiting the pain and nausea 
usually subside. 
In some cases an active catarrhal inflammation of the 
stomach is set up by the offensive contents. Such an 
inflammation, more or less serious, is called gastritis. 
The common causes of acute indigestion are : 
Eating hastily, without properly chewing one's 
food. DISEASES OF STOMACH AND INTESTINES 
41 
Eating excessive quantities of food, especially 
before retiring. 
Eating a meal while the stomach contains remnants 
of a previous meal. A four-hour interval is advisable 
after a meat meal. 
Improperly cooked foods (greasy, fried meats and 
vegetables, freshly baked breads, etc.) 
Spoiled foods. (Cold meats, shellfish, crab meat, 
soup stock, etc., spoil easily in warm weather.) 
Chilling of stomach at meals or during digestion 
(ice cream, iced water and other cold drinks.) 
Excessive use of sugar in various forms at meal 
or during digestion. 
Excessive use of coffee and tea. 
Eating of certain foodstuffs difficult of digestion 
for certain individuals (pork, veal, cooked cabbage, 
pastry, etc.) 
Stomach constantly fouled by indulgence in 
candies, fruit syrups, and other vehicles of sugar 
(common "acid stomach.") 
Excessive use of sweet milk at meat meals and as 
a beverage between meals. 
Arrest of digestion as result of emotion, anxiety, 
anger, grief, etc. 
Preventive measures consist in avoidance of unreason- 
able abuse of that long-suffering organ, the stomach. 
The man who can "eat anything, at any time," and 
demonstrates liberally, always finds it necessary, sooner 
or later, to dance to another tune. (See section on 
Personal Hygiene,'Foods.) 
When an attack of indigestion begins the stomach 
should be emptied by vomiting promptly. Several glass- 
fuls of tepid water and tickling the throat with the finger 
tips will usually start the process nicely (a teaspoonful of 
English mustard flour added to a glass of water will add 
considerably to its effectiveness.) 
Semi-starvation for a few days after a dyspeptic attack 
will be found of great assistance in restoring the stomach 
to normal ability. 42 
POLICE HEALTH MANUAL 
Acute pain in the region of the stomach requires care- 
ful consideration to distinguish between the pain of acute 
indigestion and the pains of ulcer of the stomach, acute 
appendicitis, gallstones, heart affections, and inflamma- 
tion due to certain poisons. 
Gastritis is an inflammation of the lining membrane 
of the stomach. (The Greek word for stomach is 
gastron. ") 
Acute Gastritis. The acute form of inflammation of 
the stomach may develop subsequent to an attack of 
acute indigestion ; from acute alcoholic poisoning ; from 
the eating of contaminated foods (stale milk, spoiled 
soups, etc.); as part of a general infection; from in- 
fluenza ; and occasionally as the result of metallic poison- 
ing (criminal cases.) 
Chronic Gastritis (Chronic Catarrh of the Stomach) 
is a chronic inflammation of the lining membrane of the 
stomach. The symptoms are loss of appetite, fermenta- 
tion of the stomach contents, and more or less nausea 
in the morning. 
The commonest cause of chronic gastritis is strong 
liquor-whiskies, brandy, rum, and gin. 
Gastritis 
Diarrhoea 
The symptoms of diarrhoea are bowel evacuations of a 
fluid type caused by inflammation of the lining membrane 
of the lower bowel. 
The inflammation of the bowel may be due to the 
presence of irritants in spoiled food ; to infection of the 
bowel by bacteria present in contaminated foods and 
drinks, or to infection brought about 'by the chilling of 
the abdomen. 
The inflamed and irritable bowel hurries the fluid con- 
tents through to evacuation, resulting in the frequent 
fluid stools characteristic of the condition. The stools 
may occur at intervals of a few minutes for hours in 
severe cases ; in mild cases the affection is often relieved 
after the expulsion of one or two stools. 
Colicky pain is a common incident during the attack 
and varies greatly in frequency and severity. DISEASES OF STOMACH AND INTESTINES 
43 
The need for precautions against the eating of spoiled 
food and contaminated foods and beverages is obvious. 
During the summer months, especially the later weeks, 
sleeping without sufficient body covering is responsible 
for many cases of diarrhoea. 
As soon as the nature of the attack is realized valuable 
time will be saved by taking an adequate dose of castor- 
oil, sufficient to empty the intestine thoroughly-one 
and a half to two ounces; there is, however, nothing to 
be gained by resorting to a whole series of assorted 
cathartics. 
For twenty-four hours after taking the castor-oil, food 
should be taken very sparingly-one quart of boiled 
milk, or a similar quantity of butter-milk is enough. 
If the diarrhoea persists beyond twenty-four hours, 
a physician should be sought for advice. 
Gallstones 
This disease is produced by the formation in the gall 
bladder of "stones" derived from the bile. 
In studying this disease and its causes we once more 
cross the trail of the '' hearty eater ' '; gall-stone disease 
is very rare in people of temperate table habits. 
The typical pain of the condition, gall-stone colic, is 
caused by the passage, or attempted passage, of the stone 
from the gall-bladder to the intestine. The attack of 
pain is usually severe ; it affects the region of the stomach 
and right upper abdomen, recurring at intervals for a 
day or two, during which time the sufferer is completely 
incapacitated. The pain is accompanied by nausea and 
vomiting, and frequently is followed in a day or so by 
an attack of jaundice (' yellow janders"). 
The presence of stones in the gall-bladder disposes this 
organ to inflammation and occasionally results in the 
formation of an abscess that causes symptoms and in- 
volves dangers very similar to those of appendicitis. 
A tendency to gall-stone disease must be combated by 
moderation at the table, by attention to the bowels, and 
by following the very good habit of drinking water. 
The treatment of gall-stones is largely surgical. 44 
POLICE HEALTH MANUAL 
The Stomach 
Ulcer of the Stomach (Peptic Ulcer) is an ulcera- 
tion of the lining membrane of the stomach. (Ulcera- 
tion of the lining membrane of the small intestine, close 
to its junction with the stomach, gives similar symptoms 
and is caused by the same conditions that cause the 
stomach ulcer.) , 
Many people with peptic ulcer are found to be suffering 
also from concealed chronic infections, teeth abscesses, 
infected tonsils, chronic appendicitis, etc., and apparently 
the ulcer of the stomach is a remote result. 
The use of very hot foods and drinks, spices, and the 
habit of taking food at very short intervals, have all 
seemed to predispose to ulceration of the stomach. 
The pain characteristic of this affection occurs from 
two to four hours after meals; it is boring in type and is 
relieved sometimes by taking food ; but it is important 
to know that peptic ulcer may run its course with practi- 
cally no pain. 
Another characteristic symptom is the vomiting of 
blood, either fresh bioodor "coffee ground" material, 
and the passage of tarry masses of altered blood in the 
stools. 
Persistent pain of the type described above, or the 
occurrence of a hemorrhage of the stomach, calls for 
immediate physical examination to ascertain the nature 
and extent of the lesion-an X-ray examination is almost 
indispensable. 
Perforation of a peptic ulcer may occur and result in 
peritonitis, confronting the victim with a grave surgical 
emergency. 
The treatment of any but the most simple, uncompli- 
cated types of ulcer is surgical. 
Chronic gall-bladder inflammation and cancer of the 
stomach are sometimes confused with peptic ulcer. 
Cancer of the Stomach probably in all cases develops 
upon the site of chronic ulcer of the stomach. 
The symptoms vary a good deal according to the par- 
ticular location of the cancer, but chronic dyspepsia, loss DISEASES OF STOMACH AND INTESTINES 
45 
of weight, more or less constant pain in the region of 
the stomach, vomiting of undigested food and flakes of 
altered blood, and vomiting of blood are common symp- 
toms. 
An early diagnosis is essential for successful treatment 
and any two or more of the above symptoms occurring 
in a man over the age of forty demand a most careful and 
rigid examinat'm to exclude the possibility of cancer. 
The prevention of cancer of the stomach is summed 
up in the measures cited for the prevention of ulcer 
of the stomach. The treatment of stomach cancer is 
surgical. 
Appendicitis 
This is an inflammation of the vermiform appendix, a 
small off-shoot of the intestine located ordinarily in the 
right lower section of the abdomen. The inflammation 
may be acute or chronic. 
Acute Appendicitis begins very suddenly as a rule with 
pain about the navel or on the right side of the abdomen. 
The pain may be colicky at first, later boring in type. 
The right side of the abdomen becomes tender; there 
may be vomiting ; chills and fever are regularly present, 
though slight in some cases. 
Inflammation of the appendix is caused by infection 
with various bacteria ; the attack is often preceded by a 
period of constipation. In some cases there is a history 
of tonsilitis or acute catarrhal cold just previous to the 
onset of the appendicitis. 
The acutely inflamed appendix may become gangrenous 
in a few hours, or may perforate, in either case peritoni- 
tis results and only the most energetic surgical treatment 
will save the victim's life. Treatment other than surgical 
is very risky ; the delay may, and frequently does, carry 
the patient far past the point of safety. 
An early diagnosis, within twenty-four hours, is 
urgent. 
Preventive measures consist in careful regulation of 
the bowels. 
Acute appendicitis is sometimes mistaken for gall- 
stone disease, acute gastritis, ulcer of the stomach, etc. 46 
POLICE HEALTH MANUAL 
It is possible to have brief attacks of inflammation of 
the appendix so mild that they pass unnoticed by the 
patient, until repeated and increased severity result in a 
chronic inflammation. 
Chronic Appendicitis. The symptoms are moderate 
tenderness of the abdomen in the region of the appendix 
with more or less pain. The symptoms are intermittent, 
and usually assert themselves during or after a bowel 
upset, intestinal indigestion, diarrhoea, or constipation, 
and when generally fatigued. 
A persistent chronic appendicitis is dangerous for many 
reasons-an acute gangrenous or perforating inflamma- 
tion may occur at any time and progress with great 
rapidity; peritonitis of a chronic type causes bowel 
adhesions in the region of the appendix which may 
ultimately cause obstruction ; or the chronically infected 
appendix may serve as a port for general infection of the 
types that cause chronic arthritis, valvular disease of the 
heart, and stomach ulcer. Treatment is surgical. 
By this we mean the failure of the bowel to discharge 
waste matter promptly and completely. 
Constipation is caused by the habitual use of foods 
that leave small amounts of residue after digestion 
(meats, breadstuff's); by foods that have a peculiar con- 
stipating effect (milk, cheese); by the habitual neglect in 
responding to the call to empty the bowel; by the 
presence of pain about the anus ; by neglect to drink 
adequate quantities of water ; by abuse of cathartics, and 
by drug habits. 
Correction of a tendency to constipation requires per- 
sistent efforts to invite bowel movements at favorable 
periods-shortly after arising and after each meal; 
drinking two to three quarts of water a day (8 to 12 
glassfuls); increasing the amount of vegetables, fats, 
cooked and uncooked fruits, and gelatine dishes in the 
diet; treatment of hemorrhoids, fissures, eczema, fistula, 
and boils about the anus to permit painless movements; 
avoidance of milk, cheese, iron preparations, and medi- 
cines containing opium. 
If laxative medicines are required they should be 
taken according to the directions of a physician. 
Constipation DISEASES OF STOMACH AND INTESTINES 
47 
Treatment of severe types of constipation may require 
bowel irrigations, abdominal massage, and other meas- 
ures. 
Piles (Hemorrhoids) 
By this name we refer to a swollen condition of the 
veins in the lower part of the bowel (internal piles), and 
about the anus (external piles). 
Bleeding- Piles are caused by the rupture of small 
swollen veins in the lower end of the bowels (the 
rectum). 
Inflamed piles ?re hemorrhoids in which the blood has 
clotted and the vein inflamed. Internal piles may be 
squeezed out past the cut-off muscles at stool and 
strangulated, a condition of maximum discomfort. 
Itching Piles are caused by cracks in the skin about 
the anus. Many of these cases are misnamed, as there 
may be no swollen, or varicose, veins present. 
Hemorrhoids are due to an obstruction of the blood 
circulation in the lower bowel; a result of constipation, 
diseases of the abdominal organs, heart-disease, and, in 
women, pregnancy. 
Prevention rests largely with measures to insure the 
satisfactory operation of the bowels. 
If the piles strangulate, squeeze past the cut-off, or 
sphincter, muscles and swell, they should be gently 
urged back into place. Replacement should be attempted 
as soon as the bowels are found to have pushed out. 
The method is to apply a generous coating of vaseline, 
followed by compresses of iced water for a few minutes, 
then the mass is pressed back through the opening 
gently until if has passed the cut-off muscle. If the 
patient himself is unable to accomplish replacement after 
a few efforts, he should report to a physician for treat- 
ment. 
Avoidance of constipation is the chief element in the 
treatment of piles ; local applications should be attempt- 
ed only upon advice of a physician. In advanced cases 
the treatment is surgical. 
Remember that hemorrhage from the bowel is not 
always due to "bleeding piles," various ulcerative con- 
ditions may cause it. 48 
POLICE HEALTH MANUAL 
Fistula (Fistula in ano) 
This condition describes a small discharging canal 
extending from the lower bowel, past the sphincter, and 
opening upon the skin surface usually close to the anus. 
It forms as a result of local inflammation, usually per- 
sisting after an abscess. 
The symptoms are constant moisture about the anus, 
skin irritation, and intermittent soreness due to a recur- 
ring inflammation along the route of the fistula. Treat- 
ment is surgical. 
Fissures of the Anus and Eczema 
The skin immediately about the anus is subject to 
eczema as a result of local irritating conditions. 
Under such conditions the skin splits readily when the 
parts are stretched during a bowel movement and such 
cracks or fissures tend to persist indefinitely. 
The fissures give rise to intolerable itching, almost 
continuous in severe cases, and are especially aggravating 
after stool and upon retiring to bed. 
The pain accompanying one's efforts at stool when 
fissures are present causes more or less spasm of the 
cut-off muscle, and this in turn results in constipation, 
congestion of the veins of the rectum and hemorrhoids ; 
the eczema and fissuring are thereupon made worse, and 
the whole day of the victim is one round of trouble. 
The eczema, fissures, constipation, and spasm of the 
cut-off muscle may all require treatment before the 
patient is satisfactorily relieved. 
Mild cases yield to laxatives and extra care to insure 
cleanliness about the anus ; other cases require consider- 
able local treatment by a physician. 
Hernia as ordinarily observed, is a varying sized tumor 
under the skin of the abdomen in either groin, about 
the navel or about the scar of an abdominal operation, 
or in the scrotum. 
The tumor is composed of intestine or other abdominal 
tissue that has forced its way through an opening in 
the deep layer of muscles in the abdominal wall. When 
Rupture (Hernia) DISEASES OF KIDNEY AND BLADDER 
49 
the patient lies down the tumor tends to disappear, 
spontaneously or with slight pressure, owing to the 
return of its contents to the abdominal cavity-the 
tumor in this case is said to be "reducible." 
A hernia that can not be ' ' reduced ' ' is the more dan- 
gerous variety because it is more liable to result in 
strangulation." 
Strangulation of a rupture means that the intestine 
in the hernia is obstructed and its blood supply shut off 
by pressure at the point where it passes through the 
abdominal muscle. If unrelieved by prompt and suit- 
able surgical measures the contents of the rupture become 
gangrenous and the patient dies from blood poisoning 
and exhaustion.' 
Supposed ruptures should be reported as soon as 
noticed so that appropriate examination may determine 
the nature of the tumor. 
The treatment of hernia is surgical by choice; trusses 
are advisable only when heart-disease or other organic 
trouble renders an operation too hazardous. 
DISEASES OF THE KIDNEY AND BLADDER 
Examination of the urine is invaluable in the diagnosis 
of diseases of the kidney and bladder, characteristic 
findings being present even in the very early stages of 
disease. 
In Bright's disease the urinary findings frequently 
disclose the disease before the patient complains of any 
symptoms that may be referred to kidney disorder, and 
the fortunate patient is enabled to take measures neces- 
sary to cure, or at least check, the disease in the most 
favorable stage. 
(Diabetes also may be detected by an examination of 
the urine long before complaints characteristic of the dis- 
ease indicate the condition.) 
The grave disability due to Bright's disease when in an 
advanced stage and the hopelessness of efforts at curative 
treatment emphasize most forcibly the necessity for peri- 
odical urine examinations at stated intervals. Certainly 50 
POLICE HEALTH MANUAL 
everyone over the age of forty should arrange for a care- 
ful examination of the urine twice a year ; younger in- 
dividuals should have the examination made once a year 
at least. 
Bright's Disease of the Kidney (Acute and Chronic 
Nephritis) 
An inflammation of the kidney, may be either acute or 
chronic. The chronic cases are by far the more im- 
portant because many of them escape detection until they 
are far advanced; the gland tissue of the kidney is de- 
stroyed to a greater or less extent, and the kidney is un- 
able to eliminate various poisonous substances that form 
in the body. 
Sufferers from advanced Bright's disease complain of 
persistent headaches, nausea and vomiting in the morn- 
ing, swellings of the face and extremities, defective vision, 
and shortness of breath upon exertion. 
Pain in the back is rarely present although this com- 
mon complaint is exploited in advertisements for various 
patented "kidney" remedies. 
Bright's disease is caused by the action upon the kid- 
neys of bacteria, their products, and other poisonous 
substances that may circulate in the blood. 
The poisons of various infectious diseases, scarlet fever, 
pneumonia, septic sore throat; poisons absorbed from 
chronically infected tonsils, teeth roots and appendix ; 
lead and alcohol poisoning, are all recognized as causes 
of Bright's disease. 
Exposure to cold and dampness are important contri - 
buting causes ; excessive eating of meat is probably also 
a contributing cause. 
Prevention of Bright's disease calls for the avoidance of 
alcohol and excessive meat in the diet; the use of cloth- 
ing that affords suitable protection during the cold 
damp months of the year; treatment of infected teeth, 
tonsils, and appendix ; and regular examinations of !he 
urine. 
If Bright's disease is detected in any stage, careful 
treatment by rest and diet under a physicians supervi- 
sion is required. DISEASES OF KIDNEY AND BLADDER 
51 
Kidney Stone 
Stones of various sizes may form in the sac of the 
kidney, known as the pelvis, ranging from fine sandlike 
material, ordinarily called "gravel," to single hard 
masses as large as a peach pit. 
The formation of stone, in the kidneys is favored by the 
high concentration of urine, a condition noted regularly 
in those who eat heavily of meat and neglect to drink 
sufficient quantities of water. There are other factors in 
the formation of kidney stone but they are not closely 
related to the habits of the individual. 
Gravel and small stones regularly find their way into 
the bladder and may be passed in the urine. The de- 
scent of the gravel or stone into the bladder gives rise to 
characteristic attacks of pain known as kidney colic 
(renal colic.) Renal colic occurs as severe cutting pains, 
intermittent, starting in the flank that corresponds to the 
affected kidney, and shooting down toward hip and thigh. 
It frequently causes nausea and vomiting, and is accom- 
panied by more or less aching of the side between the 
attacks. During the attacks of colic there may be an 
urgent desire to urinate at short intervals. 
Large stones often give rise to attacks of congestion 
of the kidney, usually indicated by soreness in the flank 
and possibly also by the passage of urine of a muddy 
brown color (caused by the presence of blood). 
The habit of drinking an abundance of water, two or 
three quarts daily, is an excellent preventive of stone 
formation, especially when combined with a diet that 
contains a very moderate amount of meat. 
Catarrh of the Bladder (Cystitis) 
An inflammation of the lining membrane of the 
bladder, which may be acute or chronic, is called 
catarrh of the bladder. 
The characteristic symptom is the passage of cloudy 
urine. In the acute cases urination may be extremely 
frequent and painful; in the chronic cases the frequency 
is more noticeable at night, disturbing the sleep. 
From time to time it is advisable to note the character 
of the urine passed and to report to the physician any 52 
POLICE HEALTH MANUAL 
variations noted-for instance, the passage of urine in 
exceptionally large quantities; painful urination ; fre- 
quent urination ; the passage of cloudy, foul, muddy 
brown, or blood-tinged urine; the passage in the 
urine of gravel-like fragments, blood clots, or jelly-like 
masses. 
Cancer of the bladder is uncommon in persons under 
forty-five. The prominent symptoms are frequent pain- 
ful urination, and the passage of blood-tinged urine and 
blood clots. 
The occurrence of any of the above symptoms, 
especially in an individual of forty-five or over, should 
lead to a careful examination. 
Cancer of the Bladder 
DISEASES OF NUTRITION 
The weight of the body is the practical indication of 
the state of nutrition. Marked departures from a stan- 
dard weight-for-height scale are classed as over or under 
nutrition. 
Normal nutrition depends primarily upon the complete 
digesting and absorbing of appropriate food. (See the 
section on Hygiene.) 
Cases of over-nutrition range from moderate cases of 
over-weight to obesity (fatness). Inasmuch as a con- 
sideration of obesity will cover the points involved in 
the lesser cases these will not be specified. 
Obesity 
With few exceptions fatness is due to gross over-eat- 
ing, especially of starchy foods and fats. 
The accumulation of fat is often very gradual at first, 
and may be ,a source of great self-satisfaction to the 
individual, but in a short time a dislike for physical ac- 
tivity is exhibited and the weight mounts rapidly. 
Life insurance companies have learned to know the 
fat man as a bad risk, experience having taught them 
that he is apt to develop diabetes, Bright's disease, gout, 
diseases of the heart and blood-vessels, and the number- 
less complications that attend these serious ailments. DISEASES OF NUTRITION 
53 
The general physical inefficiency of the fat individual 
is increased enormously by the development of crippled 
feet-painful flat feet-caused by the strain of bearing 
the excessive weight. 
Preventive measures are obvious. A man should 
balance food quantities and exercise so that his weight 
will not rise above a reasonable figure. 
Treatment of obesity means more exercise and less 
food. It does not make much difference how the food is 
cut-diminished rations of fats, starch, and sugars; 
a general cut in the quantities of all foods used ; the 
substitution of bulky cereal and vegetable foods of low 
nutritive value ; or treatment by cathartic-each of these 
methods act by diminishing the amount of food prod- 
ucts available in the intestine. 
It is advisable to note here that there are isolated cases 
of a rapid increase in body weight not caused by the 
accumulation of fat. Cases of advanced Bright's dis- 
ease, heart disease and cirrhosis of the liver frequently 
show a rapid increase in weight due to accumulations of 
fluids (dropsy). 
Undernutrition (Malnutrition) 
Loss of weight below reasonable limits as indicated by 
weight-for-height standards is termed malnutrition. 
Malnutrition is practically always secondary to other 
diseased conditions, such as chronic diseases of the 
stomach and intestines, tuberculosis, diabetes, Bright's 
disease, cancer, thyroid poisoning, chronic alcohol and 
drug addiction. 
The important point to remember is that continuous 
loss of weight may be a symptom of a serious disease ; 
hence one should not delay long before consulting a 
physician as to the cause. 
There are two diseases that must be considered at this 
point, gout and diabetes, because they are directly asso- 
ciated with diet and nutrition. 
Gout 
Gout is a chronic poisoning of the system caused by 
an accumulation in the blood and tissues of substances 
derived from meat. 54 
POLICE HEALTH MANUAL 
The term is ordinarily applied to attacks of inflamma- 
tion of the small joints, but this is really only one of the 
disturbances that may be caused by the poisoning ; gout 
is also shown by chronic headaches, skin eruptions, 
neuralgias, and neurasthenia. 
Excessive meat eating by persons who lead inactive 
lives is the usual cause of gout, especially if alcohol 
also is used. It is recognized that some individuals are 
particularly susceptible to gout and develop symptoms 
even when taking only a moderate amount of meat. 
Preventive measures depend upon the restricted use 
of meat, moderation in the quantity of all food taken, 
abstinence from alcohol, regular exercise, and the proper 
regulation of bowel action, using cathartics by advice of 
the physician when necessary. 
Diabetes 
The characteristic symptom of diabetes is sugar in 
the urine. The sugar which is present in the urine is a 
normal product of the digestion of the starch and sugar 
in the food, but which, owing to a diseased state, 
can not be properly utilized by the tissues, accumulates 
in the blood, and is thrown out by the kidneys as 
waste. 
Diabetes is caused by the failure of a ferment in the 
body which normally changes the sugar into a substance 
that is stored in the tissues; this ferment is known as 
insulin. 
Unless the disease has been discovered in the early 
stages by a timely urine examination, the patient usually 
complains of the passage of large quantities of urine, 
severe thirst, increased appetite, weakness and loss of 
weight in spite of taking large quantities of food. 
Inasmuch as practically all cases of diabetes exhibit 
a tendency to heavy eating, sometimes with starch and 
sugars in the lead, the important ' ' ounce of prevention 
is moderation at the table, especially in the matter of 
bread-stuffs and sugar. 
Periodical urine examinations are as valuable in the 
early detection of this disease as they are for Bright's 
disease, sugar ordinarily being found in the urine in 
small quantities long before the disease becomes serious. DISORDERS OF LEGS AND FEET 
55 
DISORDERS OF THE LEGS AND FEET 
Varicose Veins of the Leg-. The veins of the legs just 
below the surface of the skin are apt to become per- 
manently swollen in persons whose occupations require 
them to work for many hours on their feet. 
The swollen veins operate very poorly and the circula- 
tion in the leg and foot is more or less injured. 
In moderately severe cases it is impossible for the af- 
fected person to work more than a few hours on his feet 
before swelling of ankles and vague pains in the feet are 
noticed. 
Swelling of the ankle and foot caused by varicose 
veins is usually confined to one foot, but may involve 
both feet if both legs show such veins. The swelling 
disappears during the night's rest. 
The defective leg circulation due to the presence of 
varicose veins regularly causes the skin of the leg to 
become irritable and thinned, so that slight wounds 
result in infection and ulcers. 
When this tendency to chronic swelling of the leg 
veins is noticed, steps should be taken to give the veins 
extra support. In early cases it may be sufficient to 
resort to a stockinet roller bandage which is wrapped 
like a wound puttee before leaving home. In marked 
cases firmer support will be required-elastic thread 
stocking-or the veins may require removal by surgical 
means. 
Chronic Leg Ulcer is most commonly due to the infec- 
tion of a slight scratch on the unhealthy skin associated 
with varicose veins of the leg. It may, however, be due 
to certain chronic types of infection, of which syphilis 
and tuberculosis are the most important. 
Great care must be taken to avoid injury to any patches 
of withered skin on legs that exhibit swollen veins ; and 
if any scratches occur they must be carefully cleaned with 
dilute peroxide solution, and a clean antiseptic ointment 
applied. 
A chronic leg ulcer of any extent requires complete 
rest of the leg as the first measure of treatment, and 56 
POLICE HEALTH MANUAL 
whatever applications are made must be under the advice 
of a physician. In very obstinate cases vigorous surgical 
treatment is necessary. 
The Feet 
The bones, joints, and ligaments of the foot are 
arranged in the form of two arches, a longitudinal arch 
(lengthwise of the foot), and a transverse arch (in the 
line of the bases of the toes). 
These arches, as may be seen from a study of the nor- 
mal foot-print, afford a three-point weight-bearing base, 
the heel, the ball of the great toe, and a broad cushioned 
area composed of the bases of the three outer toes and 
the nearby outer margin of the sole. 
The arches are reinforced by the muscles of the foot 
and by tendons extending from certain muscles in the 
calf; they are very ' ' springy ' ' in the normal foot, and 
together with the fat under the skin of the sole, consti- 
tute a very effective " shock-absorber " which eases the 
load on the bony structure during the acts of walking, 
running, and jumping. 
The numerous joints of the foot permit of considerable 
flexibility so that the sole maybe adjusted to inequalities 
without weakening the duties of the arches. 
Bad habits in posture and 
incorrectly shaped shoes 
have a bad effect upon the 
normal freedom of the foots 
giving rise to deformitie, 
that may become permanent. 
The strongest type of feet 
are those that are formed so 
that the line of pressure, in 
the act of walking, passes 
vertically through the center 
of the ankle, mid-point of 
heel, and the base of the 
second toe. Foot gymnastics, 
walking exercises and shoe 
design should all aim at de- 
velopment of feet of this 
type. (Fig. 1.) 
FIGURE ONE DISORDERS OF LEGS AND FEET 
57 
During the act of walking the body weight is borne 
alternately by each foot, and if the foot action is correct 
the thrust of the weight is passed successively through 
the ankle to the heel (rear point of arch), to the forward 
part of the outer border of the sole and the bases of the 
outer toes (outer point of transverse arch), and to the 
ball of the great toe (forward point of arch), the foot 
finally being raised from the ground and the body 
propelled forward by a thrust of the great toe. 
Toeing out (a) 
FIGURE TWO Toes straight ahead (b) 
Footprints made of the right foot at different angles. Note in 
(a) how when the toes are turned out, the Longitudinal Arch is 
strained to such an extent that it touches the ground, while in (b) 
when the toes are correctly thrown straight ahead, the arch is 
relieved of the strain and does not touch the ground. 
When standing at rest the toes are ordinarily turned a 
few degrees outward and the foot eased off by relaxing 
the arch ; in weakened conditions of the foot this position 
is easily exaggerated and further disability invited. 
(Fig, 2.) 58 
POLICE HEALTH MANUAL 
Normal foot action depends upon correct anatomical 
relations of the bones ; sound condition of the bones. 
FIGURE THRhB 
Showing the incorrect way of walking, toes turned out. Note 
that the Longitudinal Arches have practically disappeared. 
FIGURE FOUR 
Correct method for standing and walking 
joints, ligaments, tendons, muscles, and other soft 
parts of the foot; and upon normal action of the ankle 
joint. DISORDERS OF EEGS AND FEET 
59 
The most frequent causes of disordered foot action are 
habitually incorrect use of the feet in standing and walk- 
ing (Figs. 3 and 4), weakness of the muscles of the legs 
and feet due to general debilitating conditions, improp- 
erly shaped and ill-fitting shoes, rheumatic and gouty ail- 
ments of the feet and ankles, sprains of the small joints, 
fractures of the bones of the foot, obesity, varicose veins 
of the leg, painful ailments of the feet-corns, callouses, 
bunions, blisters, ulcers, cracks, and "ingrowing" toe- 
nails. 
Prolonged use of feet deformed by ill-shaped shoes, or 
feet used in abnormal positions in an effort to avoid the 
discomfort of painful ail- 
ments, will result in acute 
and chronic foot strain, 
flat-foot, and neuralgia of 
the ankle. 
Shoes 
It might be appropriate 
at this point to state a few 
rules by which one may be 
assisted in the choice of a 
correctly fitting shoe. 
Sole, should be suffi- 
ciently thick and rigid to 
protect the foot from in- 
equalities that might cause 
stone-bruise ' '; should be 
shaped so that the inner 
border nearly parallels a 
line drawn touching the 
inner surface of the heel 
and the inner surface of 
the ball of the great toe (to 
allow for full play of the 
great toe) (Fig. 5); should 
extend forward to a little 
more than a fingers-breadth 
beyond the tip of the great 
toe ; should have sufficient 
width to extend beyond the 
outer border of the foot, 
when the foot is fully spread in bearing the weight of 
the body. 
FIGURE FIVE-Sole shaped for 
a normal foot. (Whitman.) 60 
POLICE HEALTH MANUAL 
Upper, should be fitted while the feet are bearing the 
full weight of the body ; must be long enough to extend a 
fingers-breadth beyond the tip of the great toe ; spacious 
enough to allow for the lateral spread of the foot without 
discomfort and at the same time not loose enough to 
permit the formation of heavy creases that might chafe 
the toes. The material should be easily pliable ; should 
FIGURE SIX 
An X-Ray picture show- 
ing the foot in a pointed 
shoe. 
Note how cramped the 
toes are. 
X-Ray showing the foot in an 
orthopedic shoe. Note the 
straight inner border and the 
broad tip of the shoe, enabling 
the toes to spread out normally. 
fit the heel comfortably, and should be laced. A Blucher 
style of upper permits of better fitting than any other 
cut. 
Shank, should not be rigid. 
Heel, should be broad and should raise the heel about 
one-half an inch. DISORDERS OF LEGS AND FEET 
61 
Acute Foot Strain. Feet that are crippled by im- 
properly shaped or fitted shoes, or by painful local condi- 
tions, or feet that are weak and unaccustomed to bearing 
the weight for any lengthy periods, will develop symp- 
toms of acute foot strain from comparatively moderate 
use. 
The feet become increasingly painful after a few hours 
of patrol duty, the pain usually affecting the region of 
the instep and sometimes involving the calf of the leg. 
The pain lets up when the feet are put at rest, but the 
feet are found usually to have stiffened and need to be 
limbered up ' ' when walking is again attempted. 
If proper measures are not taken, and the condi- 
tions causing the acute foot strain continue, chronic foot 
strain results. 
Chronic Foot Strain (Painful Weakfoot). The pain 
and the stiffening under chronic foot strain are quite 
pronounced ; attempts at a normal use of the feet in 
walking are so filled with discomfort that the victim 
assumes an unnatural gait, walks off the side of his foot 
to avoid the pain caused by strain of the structures of 
the long arch, rolls the ankle in and eventually suf- 
fers a break-down of the arch and flat-foot. Sufferers 
regularly describe this condition as ' ' rheumatism of the 
feet." 
Prevention of acute and chronic foot strain depends 
upon the use of proper shoes in the first place; relief of 
painful local affections of the foot (corns, callouses, 
bunions, " ingrowing toe-nails," etc.); walking exercises 
to correct improper walking habits ; and foot gymnastics 
and baths to strengthen the structures of the foot. 
Foot-baths. Tonic foot-baths to relieve symptoms of 
foot-strain should be used twice daily, spraying the feet 
alternately with hot and cold water. The bath should 
continue for twelve to fifteen minutes, and should be 
followed with a massage of the foot, using cocoa-butter 
or olive-oil. 
Walking Exercises. (1) Walk at a brisk gait with the 
feet in a parallel position or with toes slightly turned-in ; 
rise on toes in a slightly exaggerated way at the end of 
each step. (2) Walk with heels kept just clear of the 62 
POLICE HEALTH MANUAL 
ground, walking with an exaggerated ankle action, 
bending the foot at the ankle to the limit of flexion and 
extension. 
Foot Gymnastics. Remove shoes and socks; with 
legs extended turn soles of feet strongly towards each 
other (Fig. 7) ; turn soles strongly outward, away from 
each other ; describe circles with great toe in as wide an 
arc as possible; flex toes strongly as if in the effort to 
grasp an object ; extend toes forcibly, pointing up; 
stand with feet parellel and lift the body on the toes 
(Fig. 8) ; stand with feet parallel and lift toes from 
floor carrying weight of body on heels; rock foot side- 
ways so that weight rests on outer border (Fig. 9). 
Repeat. 
FIGURE SEVEN 
Turn the foot so that the sole faces as far as possible inward 
Standing at Rest. To diminish the amount of strain 
resulting from the use of weak feet one should sit at fre- 
quent intervals, taking the weight off the feet, and relax 
the legs and feet. If unable to relieve the feet by resting 
in a sitting posture, some relief may be obtained by 
standing with the toes slightly pointed in, rolling the 
ankles outward a trifle so that the weight of the body 
is resting chiefly on the outer borders of the feet, a DISORDERS OF LEGS AND FEET 
63 
position that will be found comfortable for fairly long 
periods. 
FIGURE EIGHT 
Stand with bare feet on a firm level surface with toes pointing 
inward. Rise as far as possible on the toes and stand so for half a 
minute. Then slowly lower the heels. Repeat for five minutes. 
FIGURE NINE 
Stand with feet parallel and six inches apart. Raise the inner 
side of the foot throwing the weight on the outer border. Repeat 
fifty times. 
Special Shoes. The tendency that a weak foot shows 
to roll inward, allowing the arch to fall, may be combated 64 
POLICE HEALTH MANUAL 
to some extent by altering the shoe. In such a shoe the 
sole and heel are raised somewhat along the inner border, 
wedging up the inner border of the foot and throwing the 
body weight over toward the outer border of the foot. 
All the measures mentioned,with the possible exception 
of the shoe alteration, will be needed to correct practically 
every case of foot strain; mild cases may respond so 
quickly to intelligent care, however, that the whole treat- 
ment might consist simply in the use of properly shaped 
shoes, with foot exercises daily for a month or two. 
It is important to remember that the feet, in the normal 
act of walking, are kept approximately parallel, the toes 
pointing directly forward. 
FIGURE TEN 
A chronic anterior arch displacement complicated with hammer 
toes. 
Flat-foot (Splayfoot). The conditions that cause 
chronic foot strain if uncorrected may result eventually 
in a break-down of the arch, and flat-foot. 
A flat-foot is absolutely incapable of meeting the 
demands of a policeman's occupation ; the afflicted man 
is a cripple and rarely ever obtains adequate relief from 
any amount of treatment. Flat-foot should be treated in 
the weak-foot stage, when the symptoms of chronic foot 
strain give warning of the impending break. 
The alteration in the shape of the foot, the change in 
the character of the footprint, the tenderness in the region DISORDERS OF LEGS AND FEET 
65 
of the instep and mid-sole, and pains in the feet and leg 
under forced use are all familiar symptoms. 
The preventive measures are those enumerated above 
for the treatment of foot-strain. 
The correction of flat-foot, when once established, is 
tedious and requires special skill. Arch supports are 
advisable in very few cases. 
Metatarsalgia is a painful affection of the foot caused 
by alteration of the relations of the bony parts entering 
into the formation of the transverse arch of the foot. 
(Fig. 10.) 
Deformed feet caused by ill-fitting shoes. Note the large bunions. 
figure eleven 
The pain, located about the base of the second toe, 
may be intermittent, and in severe caseswill not permit 
the bearing of the body weight upon the forepart of the 
foot. 
This condition is caused by persistent use of improper 
shoes; occasionally by accidental sprain of the small 
joints in the forefoot. Treatment by specially devised 
supports is required. 
Bunions. Shoes that are modeled with a taper in such 
a wav that the great toe is bent outward are the cause of 
bunions. (Fig. 11.) The great toe joint is subjected 66 
POLICE HEALTH MANUAL 
to abnormal pressure, the soft parts about the joint be- 
come inflamed, the irritated bone near the joint tends to 
painful enlargement, and the great toe is unable to play 
a normal part in the mechanism of the foot. 
This deformity of the foot frequently has its inception 
in childhood and young manhood due to ignorance in 
the selection of the shoe. 
In the earlier stages, a good deal may be accom- 
plished by correct shoeing and by the judicious use of 
splinting apparatus to check the out-bending of the great 
toe and encourage its return to a normal location and 
function. 
Hammer Toe is an angular deformity of the toes, 
usually the second, third, or fourth, which causes the 
tip to press sharply against the sole of the shoe ; the 
outer joint of the toe is fixed in a bent position. This 
deformity is caused by ill-fitting shoes. 
The affection is painful at times due to the formation 
of a callus on the tip of the toe and corns on the upper 
surface of the bent joint. 
Hammer toe will never occur in properly shod feet. 
Ingrowing Toe=Nail practically always affects the great 
toe. It is really an infection of the groove of the nail. 
Improper trimming of the toe-nail and carelessness in 
the matter of cleanliness about the toe-nail are the usual 
causes. 
The toe-nails should be kept reasonably short, a little 
shorter than the fleshy tip of the toe, and should be 
trimmed straight across. The groove on either side of 
the nail should be carefully freed of dirt and flaking 
skin every day, using a small cotton swab wrapped on a 
tooth-pick and taking care not to cause any cuts. 
If the infection gets under way it must be treated with 
applications of hydrogen peroxide solution and the flesh 
lifted away from the nail by packing with absorbent 
cotton. 
In long standing or recurring cases it may be necessary 
to remove the infected tissue by surgical means. 
Corns and Calluses. A corn is a small, hard lump on 
the skin resulting from pressure. A callus is a diffuse DISEASES OF NERVOUS SYSTEM 
67 
patch of thickened skin resulting from undue pressure. 
Both conditions may be very painful and prevent proper 
action of the feet in walking. 
Treatment consists of measures to relieve the faulty 
pressure and the removal of the corn or callus by appro- 
priate means. 
Chafing and Blistering of the Feet usually result from 
wearing new shoes, the stiff uppers of which press upon 
unaccustomed skin points and damage the skin. 
The chafed areas must be protected by cotton pads or 
by strips of rubber adhesive plaster. 
If blisters form they should be opened with a sterile 
implement and carefully dressed and protected from any 
further pressure. 
Sweating of the Feet. Excessive sweating of the 
feet is frequently an indication of a serious and weaken- 
ing disease. Any one so afflicted should report to a 
physician for a general examination. 
The excessive sweating may be accompanied by an 
offensive odor which is the result of germ action in the 
soggy thickened skin. 
Treatment should be directed by a physician. 
Fissures of the Feet occur as a part of an eczema of 
the skin of the feet. The under surface of the toes and 
the web between the toes are the usual locations. 
Prevention and treatment is the same as for eczema 
of the feet. (Refer to the section on Diseases of the 
Skin.) 
DISEASES OF THE NERVOUS SYSTEM 
Headache. Headache is, of course, a symptom and 
not a disease. However, as it happens frequently that a 
serious disease escapes detection because this symptom is 
ignored until the disease has reached an advanced stage, 
it seems advisable to call attention to the significance of 
various types of headache. 
Acute headaches due to constipation, digestive dis- 
turbances, exhaustion, and infectious diseases (influenza, 68 
POLICE HEALTH MANUAL 
septic sore throat, etc.) are familiar to every one, and 
as their causes are fairly obvious they will receive no 
further comment. 
There is one variety of acute headache, however, that 
deserves special consideration, the headache of Migraine. 
Migraine (sick headache, megrim, bilious headache). 
The headache, the outstanding symptom of this affection, 
begins usually as a boring pain confined to a small area, 
extends gradually and finally involves a considerable part 
of one side of the cranium ; the headache is accompanied 
by dizziness, flickering spots in the field of vision, nausea, 
vomiting, somnolence-the attack being usually termin- 
ated by sleep. The pain may persist from twelve to forty- 
eight hours. 
Migraine regularly recurs and may attack the sufferer 
as often as three or four times a month. 
This disease appears to be related to epilepsy, for they 
have many features in common, and the most effective 
preventive measures and treatment are practically the 
same for both diseases. 
Diagnosis is important and the sufferer should report 
to a physician for examination and advice. 
Chronic Headaches may be due to a number of causes, 
some are rare and others of comparatively slight import; 
but it will be helpful to know that persistent headache 
is often the chief complaint of persons suffering from 
chronic Bright's disease, high blood-pressure, syphilis 
of the brain, chronic infection of the sinuses about the 
nasal passages, and chronic eye-strain. 
All the diseases mentioned, with the exception, of 
chronic eye-strain, are classed as serious. They regularly 
produce the most hopeless states of invalidism, and can 
rarely be treated successfully except in the earliest 
stages. 
Neuritis is a painful affection of the large nerves, and 
is commonly caused by a form of infection allied to 
rheumatism. 
The nerves most frequently affected are those of the 
lower back (causing lumbago), the thigh and leg (caus- 
ing sciatica), and the shoulder and arm. DISEASES OF NERVOUS SYSTEM 
69 
Neuritis is regularly preceded by an infection of the 
nose or throat, and the attack is usually precipitated by 
wetting or chilling. 
The prevention of neuritis involves persistent and 
thorough treatment of acute infections of the nose and 
throat, and the avoidance of fatigue and exposure during 
convalescence from such inflammations. Repeated at- 
tacks of neuritis demand a careful search for chronic 
sources of infection. 
Paralysis, in the generally accepted meaning, indicates 
a more or less complete loss of muscular power in one or 
several limbs. 
The familiar ' ' stroke ' ' of paralysis is due to a sudden 
alteration of the blood supply in, or sudden pressure 
applied to, the part of the brain that controls the move- 
ments of the limb paralyzed-the blocking of a small 
blood-vessel in some cases, in other cases a rupture of a 
blood-vessel and hemorrhage. 
Paralysis is an accident in the course of a chronic 
disease of the blood-vessels or heart-arteriosclerosis 
(hardening of the arteries), chronic Bright's disease, 
and valvular disease of the heart. 
Prevention is the same as for the diseases mentioned 
and is discussed in the sections devoted to them. 
Locomotor Ataxia (Tabes Dorsalis; Tabes) is a disease 
of the spinal cord caused by syphilis. This disease 
frequently reaches an advanced stage before the diag- 
nosis is made and treatment commenced. 
The cause is syphilis, and abundant evidences may be 
found, even in the earliest stage, by blood and spinal- 
fluid examinations, to indicate the nature of the infec- 
tion. 
Numbness of the feet, awkwardness and stumbling 
when walking in the dark, and severe neuralgic pains in 
the legs and abdomen are fairly early symptoms, and 
when occurring in a person who has a history of syphilitic 
infection they should cause him to report to a physician 
for examination without delay. 
It is important to note that locomotor ataxia may not 
develop for ten to twenty years after infection with 
syphilis. 70 
POLICE HEALTH MANUAL 
When treatment is commenced in the early stages 
there is a good chance of arresting the disease before 
severe disability occurs. 
Prevention is the prevention of infection with syphilis. 
Among men who have a history of syphilitic infection 
repeated examinations of the blood and spinal-fluid are 
the only safe insurance, and this rule applies even in cases 
where the syphilis has been "cured." 
Insanity. In a great many forms of insanity a pre- 
disposition is found in the form of an inherited nervous 
defect, as shown by the unusual number of cases of 
neurasthenia, eccentricity, and epilepsy that adorn the 
family history. It is this inherited tendency to mental 
disease that has given substance to the popular belief that 
insanity itself is hereditary. 
Other causes of insanity acting with, possibly without, 
the special tendency mentioned, are syphilis, alcohol, 
toxins of infectious diseases, worry, anxiety, narcotic 
drugs, diseases of the heart, blood-vessels and kidneys, 
and, to a slight degree, sex problems. 
Syphilis is mentioned first because it results in a per- 
sistent and serious form of insanity known as General 
Paresis. 
Paresis (G. P., Paralysis of the Insane) is a fairly 
common type of insanity, it is caused by infection with 
syphilis, and leads to rapid mental and physical deterio- 
ration and death in a few years. 
Heredity plays practically no part in the development 
of this type of insanity. 
Prevention requires the complete eradication of the 
syphilitic infection. Fortunately the examination of the 
blood by the Wasserman test has been found to be a 
thoroughly reliable check upon the activities of the poison 
of syphilis ; and, if made at reasonable intervals, in cases 
known to have been infected, it is a reliable safeguard 
against the unsuspected development of paresis. 
It is important to know, however, that numerous cases 
of paresis are found in which there is no knowledge of 
an infection with syphilis. The original injury was not 
suspected because it was not venereal in origin or type, 
or because a frank infection was improperly diagnosed, DISEASES OF NERVOUS SYSTEM 
71 
or a syphilis with indications so mild that it was over- 
looked. An important fact also is that paresis may not 
develop for fifteen or twenty years after syphilitic infec- 
tion. 
A second important cause of mental disease is the habit- 
ual use of alcohol. 
Alcohol not only directly causes a typical form of in- 
sanity, alcoholic insanity, but also acts indirectly as a 
factor in the development of a number of forms of mental 
impairment. 
Alcoholics are often morphine and cocaine addicts as 
well, and in these cases the mental deterioration is likely 
to be very rapid. 
Overwork is often spoken of as a cause of insanity, 
but a case resulting from this cause alone is rarely seen ; 
there is usually an accompaniment of exhaustion from 
lack of proper rest, irregular and improper meals, exces- 
sive use of tobacco and alcohol, and general physical 
neglect before the nervous breakdown occurs. 
Good mental habits are very important factors in the 
preservation of a sound mind. Discontent, jealousy, un- 
sociability, over-sensitiveness, tendencies to brooding, 
constant suspicion of being imposed on and similar 
mental states are conducive to mental distortion and 
insanity. 
There is a mental hygiene as important as the physi- 
cal-to have a serious aim in life, to work incessantly but 
sensibly for its attainment, to give to trifles the attention 
they warrant, and to remember that the mind works best 
in a sound body, are rules that will suffice amply for the 
average individual. 
Sex problems are sometimes the cause of nervous break- 
downs, but not as often as sometimes claimed. Ignor- 
ance of sex physiology, and the worry it inflicts, is the 
cause of some mental disturbance, especially in young 
adults. Parents should instruct their children tactfully 
at the proper age as to the nature of sexual indications 
and should not allow them to get misinformation from 
street companions. , 
Epilepsy 
Epilepsy is a disease of the nervous system character- 
ized by attacks of unconsciousness and convulsions. The 72 
POLICE HEALTH MANUAL 
attacks may occur in sleep, the afflicted individual on 
awakening finds himself possessed of a lacerated tongue 
or lip and an unaccountable feeling of exhaustion. 
Heredity plays a prominent part in this disease, prob- 
ably in much the same way that it acts as a factor in in- 
sanity, by the passing on of a defective nervous system. 
Epilepsy as a rule develops in childhood, but late- 
developing cases are encountered occasionally and con- 
stitute a serious disability. 
The excessive use of alcohol and excessive meat eating 
are prominent exciting causes for the convulsive attacks, 
and must be rigorously avoided by those who have ex- 
perienced an attack at any time. 
The prevention and cure of this condition are so de- 
pendent upon the life habits that no general rules, other 
than those mentioned above, can be laid down ; advice 
by a competent physician is necessary. 
Nervous Exhaustion (Neurasthenia) 
Neurasthenia is the name of a disease of the nervous 
system that reduces all forms of nervous energy-psychic, 
motor and organic. 
The commonest causes are over-work, worry, anxiety, 
alcohol, tobacco, narcotics, and injuries (especially to 
the head or spine). 
The symptoms of this condition are very numerous, 
and many of them fleeting and trivial, but in all cases 
there is a tendency to rapid mental and physical fatigue 
and mental irritability ; headache, spineache, insomnia, 
and dyspepsia are regular complaints. 
Mild cases yield to proper rest and food, and abstain- 
ing from alcohol, tobacco, and coffee; severe cases may 
require, in addition to dietary and rest treatment, a 
complete change in occupation. 
The mental disorders of neurasthenia, if uncontrolled, 
may lead to the development of delusions and outright 
insanity. 
Sound habits of life, training in self-discipline, sensi- 
ble adjustment to the hardships of average existence, 
moderation in the use of alcohol and tobacco, and atten- 
tion to healthy bodily needs will prevent the develop- 
ment of many cases of neurasthenia. DISEASES OF NERVOUS SYSTEM 
73 
Sunstroke and Heat Prostration 
These invite consideration in company with the various 
nervous disorders because they are occasionally cited as 
the initial upset in various chronic nervous affections, 
especially neurasthenia and epilepsy. 
Sunstroke occurs during the summer months and is 
due to over-exposure to the sun's rays. The symptoms 
are high fever and coma. Over-eating and alcohol are 
contributing causes. 
Prevention consists in the proper protection of the head 
and spine from the sun, moderation in eating during the 
hot w'eather, abstaining from alcohol, and the use of a suf- 
ficient amount of drinking water to promote perspiration. 
Heat Prostration is a state of physical exhaustion, the 
product of a number of factors brought into play during 
a prolonged spell of tropical weather. Prominent con- 
tributing causes are lack of proper rest through inability 
to sleep during the hot summer nights, the nagging 
effect of heavy clothing, indigestion and impaired nutri- 
tion due to ill-advised efforts to obtain relief from the 
heat by resorting to ice-cream, iced water, and other cold 
foods and drinks. 
It is possible to carry on the regular daily routine 
with a reasonable amount of comfort in even the hottest 
weather of the summer months if one takes a few pre- 
cautions. 
The most important item is suitable clothing. On very 
hot days one should discard about every thing that the 
regulations permit; exercise regularly in the cool of the 
morning or evening hours ; drink sufficient cool, not iced, 
water to promote a moderate amount of perspiration ; 
cool the body by resorting to tepid or cool showers once 
or twice a day, a cool or tepid bath before retiring may 
give a restful night's sleep on the hottest night; change 
underclothing once or twice a day if perspiring freely ; 
eat moderately, very sparingly of meat (the food require- 
ments of the body are very much less in summer than in 
winter); ice-cream and other cold dishes must be used 
cautiously. 
Mild cases of heat prostration improve rapidly when 
rest is assured, severe cases may require careful medical 
supervision, especially if complicated by digestive dis- 
turbances. 74 
POLICE HEALTH MANUAL 
DISEASES OF THE JOINTS 
Inflammation of the joints may be acute or chronic. 
Acute Inflammation (Acute Arthritis) may result from 
injury to the joint by a bruise or sprain, and is known as 
traumatic arthritis; or it may be due to an infection of 
the joint, familiar in the form of acute rheumatism, less 
frequently seen as a complication of gonorrhea, tuber- 
culosis, pneumonia, erysipelas, etc.; and it may also be 
caused by gout. Other varieties of acute joint inflamma- 
tion occur so infrequently that they need not be discussed 
here. 
Prevention of acute arthritis, other than the traumatic 
form, is covered by the preventive measures advised in 
the articles on gout, rheumatic fever, and other infectious 
diseases which it may complicate, 
Chronic Inflammation of the Joints (Chronic Arth- 
ritis. ) Excluding the cases directly traceable to an injury 
of the joint (chronic traumatic arthritis) the cases in this 
class are commonly known as " chronic rheumatism." 
There are a number of varieties of chronic arthritis, 
and also, at present, there is considerable uncertainty as 
to the exact cause in many of them, though a large 
number of cases have been found to be due to chronic 
infection in other parts of the body, the tonsils, canals 
about the nose, the teeth, the appendix, etc. 
When there is a tendency to chronic inflammation of 
the joints, an effort should be made to rid the body of all 
chronically infected tissues ; the diet should be adjusted 
by restricting the amount of meat soups, meat, and 
sugars ; clothing should be planned to give sufficient 
protection against dampness and cold; and the bowels 
should be properly regulated. 
The special form of joint inflammation constituting the 
" bunion" is discussed in the section on Disorders of the 
Legs and Feet. 
INFECTIOUS DISEASES 
Diseases of this class are caused by living micro- 
scopic organisms that invade the body tissues. 
It is known that the body has a varying ability to 
resist the attacks of bacteria and is only infected, as a INFECTIOUS DISEASES 
75 
rule, when the local or general resistance is greatly- 
lowered. 
The section on personal hygiene deals in a general 
way with the means necessary to maintain at greatest 
efficiency the natural resistance to infection, and should 
be read in conjunction with the following information 
regarding the special infectious diseases prevalent in the 
region of New York City. 
Colds 
Acute inflammations of the lining membrane of the 
nose, throat, bronchial tubes, occasionally of the intes- 
tines, are called ' ' acute catarrhs ' ' and are usually caused 
by an invasion of the bacteria regularly found upon the 
surface of these membrane, in the healthy adult. 
Some of the acute catarrhs of the nose and throat are 
acquired by contact with persons suffering from similar 
inflammations, that is, they are contagious in type and 
are classed as ' ' influenza. ' ' 
To prevent colds it is necessary that the general 
resistance to infection be kept at the highest possible 
point (see personal hygiene); the nasal passages should 
be cleansed regularly w7ith a non-irritating wash ; cold 
baths daily are advisable to keep the skin circulation 
well toned ; suitable clothing should provide the neces- 
sary adjustment to the rapid changes peculiar to our 
climate; there should be careful regulation of the tem- 
peratures and humidity in living and work rooms ; if the 
body has been subjected to chilling through unavoidable 
exposure and wetting, prompt corrective measures should 
be taken-hot drinks, application of heat externally, 
and dry clothing. 
Repeated colds may indicate an unusual susceptibility 
to catarrhal infections that can be relieved by the skil- 
ful use of suitable vaccines. 
Persistent infection in the tissues about the nasal pas- 
sages may cause frequent attacks of acute catarrh and 
would require special treatment. 
Long or repeated attacks of bronchitis should lead to 
a suspicion of pulmonary tuberculosis and demand very 
careful physical examination. 76 
POLICE HEALTH MANUAL 
Septic Sore Throat 
Such is the general name of an acute inflammation of 
the throat affecting the tonsils and adjacent tissues 
(tonsilitis, faucitis, quinsy sore throat). 
The organisms responsible are regularly found in the 
mouths and throats of fairly healthy people, especially 
when decayed teeth or chronic mouth infection are 
present. 
Ordinarily these cases occur during the cold wet 
weather of winter and are brought on by a chilling of 
the body. 
Epidemics of this infection have been traced to con- 
taminated milk. 
It is possible for the poison of septic sore throat to in- 
vade the general system and attack the joints, kidneys, 
and heart, particularly when repeated attacks have 
brought about a condition of chronic infection of the 
tonsils. 
Prevention calls for measures to eliminate infection of 
the teeth, gums, and tonsils, and general measures to in- 
sure maximum resistance by the system. 
Influenza 
A severe general infection, usually with well marked 
catarrhal symptoms, fever, and prostration, is termed 
influenza. 
The disease was epidemic in New York and elsewhere 
in 1918 and cases have been occurring since with more 
or less frequency. 
Influenza is contagious, and prevention requires that 
contact with known cases be avoided if possible. 
Pneumonia 
Pneumonia is characterized by an inflammation of the 
lungs. The bacteria that cause this disease are regularly 
found in the mouths and throats of healthy persons. 
Pneumonia is induced by chilling the body, by ex- 
haustion from lack of rest or from disease, by the inhal- 
ing of irritating gases, and by chest injuries. 
The chief symptoms of the beginning attack are chill, 
followed by fever, pain in the chest usually limited to INFECTIOUS DISEASES 
77 
the affected side, and cough. These symptoms may 
occur with great suddenness, and in severe cases the 
patient may also complain of nausea and vomiting, 
general muscular pains and headache. 
If the foregoing symptoms should occur one should 
get into bed at once and send for the doctor. Influenza 
may have a similar violent onset and should be dealt with 
in the same manner. 
Vaccines designed to provide protection against pneu- 
monia are at present on trial and it is possible that the 
near future will reveal something of value along this line. 
Pleurisy is characterized by a severe stabbing pain on 
one side of the chest, especially when the patient takes a 
deep breath. 
Tuberculosis 
Tuberculosis commonly occurs in the form of a 
chronic inflammation of the lung (consumption), a pro- 
longed fever with progressive loss of weight and strength. 
The bacteria causing this disease are found in large num- 
bers in the spittle of persons suffering from this affec- 
tion, and the inhaling of the dried spittle in the form of 
dust and contamination with fresh spittle are probably 
the only means by which an individual is infected. 
Tuberculosis may not be evident for some years after 
actual infection, the disease remaining latent until the 
infected person suffers a weakened resistance through an 
exhaustion from illness, under-nourishment, or over- 
work, from chronic poisoning as in alcoholism and dia- 
betes, or from exposure. 
Owing to the prevalence of tuberculosis it is practi- 
cally impossible to escape contact with infected indivi- 
duals, and prevention must depend chiefly upon the 
development of a high grade of resistance by the system 
through sane habits of living. 
Great care must be exercised to avoid close association 
with known cases of tuberculosis, especially when they 
are coughing and expectorating. 
Early diagnosis is of the utmost importance for suc- 
cessful treatment of pulmonary tuberculosis. Continued 
loss of weight, persistent cough with or without expecto- 
ration, blood in expectorated matter even in slight 
quantities, loss of appetite, and chronic exhaustion are 78 
POLICE HEALTH MANUAL 
common complaints in the first stage of pulmonary tuber- 
culosis. The existence of any one or several of these 
symptoms demands a careful physical examination by a 
competent physician. 
The disease is curable ; when detected in the early 
stages it can be arrested very promptly and with moder- 
ately good care a cure will result in a reasonably short 
time. Moderately advanced cases require longer treat- 
ment, but they also are frequently cured. 
There are men doing full duty at present in the Police 
Department who without question are fully cured cases 
of pulmonary tuberculosis. 
Rheumatism ; Rheumatic Fever 
The infecting bacteria that cause rheumatism appar- 
ently gain entrance to the system chiefly through in- 
fected teeth sockets, tonsils, and appendix, or through 
diseased tissues of the canals about the nasal passages. 
The germs of rheumatism usually attack the joints, 
but it is important to remember that they may also attack 
the heart and nerve trunks. 
Preventive measures consist in treatment directed to 
the removal of the infected areas mentioned above (teeth 
sockets, tonsils etc.) and to the cultivation of good habits 
of personal hygiene. 
The germ that causes malaria is conveyed by the bite 
of an infected mosquito. The parasite invades the blood 
through the bite puncture, attacks and destroys the red 
blood cells, and incidentally causes the characteristic at- 
tacks of chills and fever. 
Prevention consists in avoiding attacks of the mos- 
quitos by screening rooms and beds during the season 
when these pests abound, and by destroying mosquito 
breeding places. 
Malaria 
Syphilis 
Syphilis is a chronic infectious disease usually classed 
as venereal in origin. The germ is found in the secre- 
tions of the mouth, nose, throat, genitals, blood, and skin 
sores of persons suffering from the disease. INFECTIOUS DISEASES 
79 
Infection usually occurs through intimate contact with 
infected individuals. 
In connection with this disease it is important to know 
that uncured or unrecognized cases may progress un- 
known for years to result finally in the hopeless invalid- 
ism of various forms of insanity, paralysis, blindness, or 
diseases of the heart and blood-vessels. 
Children of syphilitic parents may be diseased from 
birth and develop all the infirmities that afflict the adult 
who has acquired the disease. 
Prevention requires avoidance of contact with known 
or suspected cases, and the use of appropriate means of 
disinfection if unavoidable contact has occurred. 
The possibility of passing this disease on through 
contaminated drinking vessels and table utensils is the 
reason for the rigid enforcement of the Health Depart- 
ment rules for the abolishment of the drinking cup for 
common use, and for the sterilization of table utensils in 
restaurant service. 
The unfortunate late results of syphilis, locomotor 
ataxia, paresis, blindness, epilepsy, valvular heart disease, 
aneurism, and break-down of the arteries, nearly always 
give one of the following histories : 
1. An ulcer on the genitals and subsequent skin 
eruption on the body correctly diagnosed as syphil- 
itic ; treatment started and continued more or less 
faithfully for several months; patient seemingly 
cured, drops all treatment on own responsibility or 
may be told by doctor that he is cured ; no blood ex- 
aminations in the several years immediately follow- 
ing the supposed cure ; no suspicion for years that 
there is any persisting syphilitic infection until 
symptoms of one or other of the above disastrous 
affections have appeared. 
2. A venereal ulcer or urethritis diagnosed as 
non-syphilitic; no anti-syphilitic treatment adminis- 
tered ; no blood examinations at any time ; symptoms 
of locomotor ataxia or other grave conditions appear 
and indicate for the first time that the individual has 
suffered a syphilitic infection. 
3. No history of ulcer or skin eruption of sus- 
picious type at any time; no suspicion of syphilitic 80 
POLICE HEALTH MANUAL 
infection until serious symptoms indicate the con- 
dition. Cases with this history are comparatively 
rare and are instances where the symptoms of in- 
fection in the primary stage were so slight that they 
escaped observation. 
A person infected with syphilis must submit to careful 
observation and treatment for years. During the first 
year he is a serious menace to the community because of 
the ease with which he may transmit the disease to 
others ; supervision in after years is required for the 
purpose of detecting relapses and, by appropriate treat- 
ment, preventing the development of paresis, locomotor 
ataxia, heart-disease, etc. 
Blood examinations are regularly required as controls 
for successful treatment, and in certain cases it is 
necessary to tap the spine and obtain fluid for examina- 
tion. Cases discharged without repeated blood examina- 
tions are improperly treated. 
Typhoid 
Typhoid is a general infection characterized, as a rule, 
by symptoms of intestinal inflammation. 
The bacteria gain entrance to the body by means of 
contaminated food and water. 
Health Department supervision of food and water 
supplies has successfully controlled typhoid in most cities, 
but scattered cases and small epidemics still occur in the 
rural districts, and it is usually while visiting such dis- 
tricts that the individual becomes infected. 
Typhoid convalescents harbor the bacteria for long 
periods and throw them off in their excretions in great 
numbers. Some of these individuals are listed as typhoid 
carriers and frequently originate epidemics if they are 
employed as food handlers. 
Prevention consists in avoiding untreated water and 
raw foods while traveling in suspected places ; avoiding 
contact with the person and secretions of known cases of 
typhoid ; carefully disinfecting the hands if a case of 
typhoid is unavoidably handled; and the use of typhoid 
vaccine. 
- Typhoid Vaccine. The use of this vaccine is strongly 
advised for persons about to visit infected localities or INFECTIOUS DISEASES 
81 
whenever typhoid is epidemic. The administration of 
typhoid vaccine is usually devoid of unpleasant feat- 
ures and the freedom conferred by its use is practically 
complete for two years, and more or less complete for 
several years longer. 
Diphtheria 
This is a contagious form of inflammation usually of 
the tonsillar region, and is membranous in type. 
The germ is found in the mouths and throats of persons 
suffering from the disease or who have recently recovered 
from an attack, and infects healthy individuals through 
the contamination of linen, table utensils, drinking ves- 
sels, and by personal contact. 
Prevention consists in avoiding of contact with known 
cases and with articles used by them, and in prompt dis- 
infection of the hands and injection of diphtheria antitoxin 
when unavoidable exposure has occurred. 
It should also be generally known that it is now possible 
to immunize against diphtheria by injection of a special 
serum and that this form of prevention has proved of 
great value for school children and others frequently ex- 
posed. 
Lockjaw (Tetanus) 
The infecting germ of this disease is found in garden 
soil, particularly where animal droppings are used as 
manure. Infection occurs chiefly through the contami- 
nation of punctured, lacerated, and gunshot wounds. 
Prevention consists in the prompt use of tetanus anti- 
toxin in all cases of gunshot wound, and in all wounds 
of the legs and feet. 
Hydrophobia (Rabies) 
The virus of this disease is found in the mouth secre- 
tions of rabid animals; man is usually infected through 
bites inflicted by rabid ("mad") dogs. Horses, cats, 
and rats may also be infected with rabies and transmit 
the disease to man. 
Prevention of rabies consists in precautions to avoid 
infection through the bites or slobbering of suspected 
animals. 82 
POLICE) HEALTH MANUAL 
If bitten by a dog the animal should be captured and 
delivered to the Health Department for examination, 
alive or dead, but preferably alive. 
If the Health Deparment reports the animal to have 
been rabid, Pasteur treatment must be commenced at 
once. 
If the attacking animal has escaped, it must be pre- 
sumed to have been rabid, and in this case also the 
Pasteur treatment is imperative. 
Smallpox ; Scarlet Fever; Measles ; Chickenpox 
These are infectious diseases with characteristic erup- 
tions, and are contagious in type. The germs apparently 
reside in the secretions of the nose and throat and in the 
skin sores of affected individuals. 
Prevention of smallpox depends upon vaccination, and 
revaccination at intervals of seven years. 
Prevention for the other diseases of this class depends 
generally upon avoiding of contact with known cases 
and disinfecting the hands, etc., if contact has unavoid- 
ably occurred. 
A serum for the prevention of measles may now be 
obtained from the New York City Health Department 
for use in children under three years of age who are 
known to have been exposed to contagion with measles. 
Erysipelas 
Repeated attacks of erysipelas of the face indicates a 
persistence of the germs in the tissues about the nose. 
Special treatment is indicated for its eradication. 
Typhus Fever 
The disease is not common in New York City, but 
may be encountered while assisting on ambulance cases. 
Infection is conveyed by lice that infest the individual 
suffering from the disease. 
Prevention, when exposed to infection, consists in 
bathing the person and in disinfecting the clothing to 
destroy lice that may have been transferred from the 
infected person. SUFFOCATION-ARTIFICAL RESPIRATION 
83 
Suffocation or asphyxiation is a form of unconscious- 
ness caused by an insufficient supply of oxygen to the 
lungs. 
It may be the result of many things : it may be caused 
by constriction of the neck-by hanging or choking; 
the presence of a foreign body in the air passages may 
be the cause, or, the oxygen of the air may be replaced 
by poisonous gases, as illuminating gas, smoke, etc., or 
by water. 
Suffocation by Smoke. In attempting to rescue a 
person from a room filled with smoke, a moist cloth 
covering the mouth and nose will make the smoke less 
irritating. 
Near the floor the smoke is less dense, hence crawl- 
ing will be safer than walking erect. 
Before entering the room, the lungs should be filled 
with fresh air-and the work of rescue be quickly per- 
formed. 
If the person has been suffocated but a short time, the 
moment he is brought into the fresh air he will revive. 
If he is unconscious and breathing efforts are poor, it 
will be necessary to begin artificial respiration at once. 
All constricting clothing should be loosened and his 
body massaged firmly to stimulate blood circulation. 
Bronchitis and pneumonia are likely to follow exposure 
'to the irritation of smoke fumes, and protection of the 
body against chilling is essential. 
SUFFOCATION 
METHOD OF ARTIFICIAL RESPIRATION 
Suffocation or asphyxiation due to carbon monoxid 
gas poisoning has increased fatalities in recent years. 
The illuminating gas jet, the gas stove, the coal stove 
and furnace, the coke stove, the charcoal stove, and 
lately the automobile exhaust in badly ventilated gar- 
ages have all caused fatal asphyxiation, both accidental 
and suicidal. 
In New York City the Chief Medical Examiner in 
his statistics shows that five hundred (500) deaths 
occurred in one year from this cause, exclusive of those 84 
POLICE HEALTH MANUAL 
in factories, etc. This poison causes faintness, stupor, 
dizziness, and coma. 
To relieve a case of gas poison : 1st. Shut off the gas 
at the jet and meter. 2d. Remove the patient from 
the poisonous atmosphere to another room. 3d. Open 
windows and doors. 4th. Send for an ambulance. 
While awaiting the arrival of the doctor loosen the 
clothing about the neck and waist. 5th. Listen to the 
patient's heart beat; if any sound is heard start to use 
the Schaeffer Method of Artificial Respiration, as taught 
by the Instructors in the Police Training School for 
Recruits. The Schaeffer Method has received the 
endorsement of the scientific schools as the best system. 
Schaeffer Method 
The patient is laid stomach down, in a prone position, 
arms folded under the head, face to one side, the mouth 
opened and locked with the tongue pulled to one side of 
the cheek. Kneel astride the patient at about the hips 
facing down toward the head; place the hands on the 
ribs so that the little fingers press the last ribs. The 
fingers are joined, the thumb alongside the fore-finger. 
Commence respiration by pressure downward on the 
ribs, thus forcing all air out of the lungs. Release the 
hands quickly relieving the pressure on the ribs. This 
will cause the air to rush in and fully inflate the lungs, 
which will take up the work of a bellows. Repeat the 
maneuver at the rate of your own breathing, sixteen to 
eighteen times a minute. 
Do not attempt to use a pulmotor or lungmotor; this 
should be left to a skilled physician-even then it may 
be dangerous, owing to defects in the mechanism. 
MEDICAL AND SURGICAL EMERGENCIES 
1. In the presence of an accident, or an emergency 
of any kind, the first thing to do is " To Keep Cool." 
2. Always remember that the person injured is ex- 
tremely anxious, and suffers to some extent from shock. 
A noisy and officious bystander attempting to give First 
Aid, will often by his excitement and lack of knowledge 
do more harm than good. Nothing is more soothing or 
quieting to the injured than a cool manner upon the part 
of those attempting to assist him. MEDICAL AND SURGICAL EMERGENCIES 
85 
3. A knowledge of the proper course to follow in the 
various emergencies, will enable one to approach a case 
with an assured manner that will serve to quiet the 
anxiety of the victim. 
4. Excitement and haste must be controlled, but 
action which is prompt and well thought out will fre- 
quently save a life or a limb. 
5. On being summoned in an emergency, whether 
medical or surgical, sendfor a doctor immediately ; never 
take full responsibility. Remember whatever you do is 
purely to be applied as an "Aid" between the time of 
your arrival and the coming of trained medical attention. 
Never feel that you have mastered the art of healing or 
can always read the * ' Handwriting on the Wall " simply 
because you have had training in First Aid. 
6. The first thing that usually happens in any emer- 
gency in a large city, is the collection of a crowd of people, 
curiosity seekers only, and not interested in helping. 
See that the crowd is dispersed in an orderly and quiet 
manner, and give the patient plenty of air. Never move 
a patient until some inspection of the injury has been 
made and you feel sure that none of the large bones 
has been broken, or a severe injury to the chest wall or 
abdomen has not been sustained. 
7. The plan of action can be decided upon best after 
a survey of the surroundings and the type of accident. 
When it seems apparent that no immediate treatment is 
to be commenced, the patient should simply be placed in 
as comfortable a position as possible until medical aid 
arrives. 
8. A sick or injured person should always be made to 
lie down, with his lower limbs extended, and his arms 
by his side. If the patient seems faint, his head should 
be low, without any pillow or rest; if faintness is not 
present, the head may rest on a low improvised pillow, 
such as a folded coat or some such device. If he seems 
to be sick and inclined to vomit, always turn his head 
on the right side, so that the material which comes from 
his stomach will run out, otherwise it may collect in his 
throat and block his wind-pipe. This procedure is very 
important, and when an injured person,whether conscious 
or unconscious, is vomiting, great care should be taken 86 
POLICE HEALTH MANUAL 
to roll him very slightly to one side, in order to prevent 
the material from entering the air passages. 
9. All clothing should be loosened-belts, collars, etc. 
-which seem to interfere with breathing or circulation. 
The popular idea that the first thing to do for the 
injured is to give them stimulation or stimulants, is 
wrong. There are many cases in which stimulation 
will really do harm-such as an injury accompanied by 
bleeding. If the bleeding has stopped, stimulation will 
increase the rate and force of the heart beat, and dislodge 
the clot, resulting in more bleeding. 
10. If thirst is present, water is the best thing to use 
-always to be given slowly and in very small amounts. 
In the winter it should be given warm in the form of tea 
or coffee, for warm water is sometimes disagreeable. 
These are vastly superior to alcoholic drinks. 
11. When coming upon a person who has been in- 
jured, and particularly if he is unconscious, the individ- 
ual and the surroundings should be observed with great 
care for legal reasons, for the case may come into the 
courts and the information obtained may be very im- 
portant. 
12. The time of discovering an injured or unconscious 
person should be noted, also whether one's attention was 
attracted to the spot by others or if the person was ob- 
served purely during routine patrol. 
13. The relation of the injured to the surrounding 
buildings must be noted, and the position in which he 
was when discovered, (sitting position, unsupported 
or supported, and by what, as building, fire escape, 
barrel, etc.) The condition of his clothing, as to the 
presence of tears or ripping or soiling as might happen 
as a result of a scuffle, the condition of his collar and 
shirt, both of which are usually disarranged. Evidence 
of blood on the exposed parts, such as the hands or face 
should be noted. 
The presence of ladders or fire escapes should be par- 
ticularly noted, and the relation of the injured one to 
these structures noted, for a fall from any one of these 
might explain the accident. 
14. Any articles lying near should be carefully noted, 
with a view to the possibility that they had been used HEMORRHAGE OR BLEEDING 
87 
as missiles - an empty whisky flask might point to 
intoxication; a bottle labeled bichlorid of mercury, 
morphine or laudanum would create a suspicion of 
poison; a pistol lying nearby would make one sus- 
picious of a gun-shot wound, or a knife would indicate 
the possibility of a stabbing. 
15. Medical Emergencies: Frequently an emergency 
arises, not as the result of an accident, but the first in- 
dication of disease, and often the unfortunate individual 
is afflicted quite suddenly. 
Certain signs or appearances point toward the exist- 
ence of certain diseases. 
A person struggling-seized with a convulsion-with 
a flushed or bluish red color of face, frothing at the 
mouth, with tongue protruding, signifies an epileptic 
seizure. A flushed face may be the symptom or sign 
of fever, apoplexy, or intoxication. On the other hand 
a pale face indicates failing circulation, fainting, or 
bleeding. 
Bleeding from mouth, nose and ears may be taken as 
a sign of fractured skull; frothy blood coughed up in 
considerable quantities-bleeding from the lungs. 
HEMORRHAGE OR BLEEDING 
Bleeding' means the escape of blood from the blood- 
vessels. 
Types of Bleeding 
1. Arterial Bleeding. The blood is pumped by the 
heart to the several parts of the body, through a system 
of blood vessels, called Arteries. When an artery is 
cut, the blood which escapes is bright red in color and 
comes in spurts ; each spurt following a heart beat. 
2. Venous Bleeding. The blood is returned to the 
heart through a system of blood-vessels, called Veins. 
When a vein is cut the blood which escapes is dark 
red in color, and seems to flow slowly and steadily. 
3. Capillary Bleeding. The arteries and veins are 
connected by a system of minute blood-vessels, called 
Capillaries. The capillary system is very extensive, and 
these blood-vessels are very small. Blood escaping from 88 
POLICE HEALTH MANUAL 
the capillaries is red, bright, or dark, oozing slowly 
from the exposed surface of a wound. 
Symptoms of Bleeding. Where there is a wound 
there is the appearance of blood. The amount of blood 
will depend upon the type of wound : 
a. Lacerating wounds cause profuse bleeding. 
b. Scratch wounds-slight bleeding. 
Nearly all bleeding is accompanied by more or less 
shock-this depends on the nature of the accident and 
the temperment of the patient. 
Sometimes the patient becomes weak and faint, the 
face becomes pale and covered by a cold perspiration. 
The body becomes cold and the patient may complain of 
dizziness, roaring in the ears, and difficulty in breathing, 
and in some cases the patient faints. 
These symptoms may all occur, when the bleeding is 
very slight, as the sight of blood, following an accident, 
may be enough to bring about shock in some patients. 
Treatment of Bleeding 
1. Summon a surgeon immediately. 
2. Make the patient lie down. 
3. Expose the wound, and determine how severe the 
bleeding is. 
4. Lift up the wounded part if possible. 
5. Press firmly with a compress of sterile gauze, or 
freshly laundered handkerchief or towel, on the wound 
to control the bleeding temporarily. 
6. Dress the wound with a clean compress (gauze or 
linen) and firmly bandage. 
7. If the wound continues to bleed, and the dressings 
become saturated-reinforce the original dressings with 
more compresses and bandage firmly. Elevate the 
wounded part if possible. 
8. If the wound is in the arms or legs, and the 
hemorrhage continues, apply a bandage torn from 
clothing, a belt, or suspender strap, or piece of rope 
tightly about the limb above the wound. 
Appliances for arresting the circulation in a limb by 
tightly compressing it in this way are called Tourniquets. HEMORRHAGE OR BLEEDING 
89 
The Tourniquet can be made more effective by the use 
of a stick or baton, or the hand or revolver, thrusting it 
beneath the tourniquet. By using such a lever and 
twisting it about it is possible to cause pressure enough 
to stop the circulation completely. In this way the 
blood supply to the part injured can be controlled. After 
this is done the wound can again be inspected, and a 
firm compress of gauze or linen can be packed into the 
wound-reinforced by more dressing, and again firmly 
bandaged. 
After the wound has been redressed and the tourni- 
quet has been in place fifteen minutes, the tourniquet 
should be slowly released and the effect of the returning 
blood supply to the wounded part noted on the bandage. 
If the wound continues to bleed, the tourniquet should 
be tightened again for from twenty to thirty minutes, and 
again released, and so on until surgical aid is obtained. 
Treatment of Bleeding from Special Regions 
1. Bleeding from a Wound of the Scalp. The scalp 
is abundantly supplied with blood-vessels, and wounds 
of the scalp bleed freely. 
Always remember that a little blood will make a big 
show. Locate the wound, by carefully inspecting the 
scalp. Part the hair and make firm pressure directly on 
the edges of the wound with the fingers, or better still, 
make firm pressure directly upon the wound with a com- 
press of gauze or any available soft material. The pres- 
sure must be continuous, until material is available for a 
firm bandage or surgical aid arrives. 
2. Bleeding from Wounds of the Temple. Occasion- 
ally wounds in the region of the temple bleed greatly 
even in spite of firm pressure and a well applied band- 
age. In such a case, pressure by the finger directly in 
front of the ear, which is the location of the artery which 
supplies the temple, will control the bleeding until surgi- 
cal aid arrives. 
3. Bleeding from Wounds of the Face. Direct pres- 
sure upon a wound of the face by a compress will usually 
control the bleeding. Temporary control of bleeding of 
the lips or cheeks may be obtained by placing the thumb 
in the mouth and grasping the cheek between the thumb 
and first finger below the wound. 90 
POLICE HEALTH MANUAL 
4. Bleeding from Wounds of the Neck. When 
vessels of the neck are injured, as in "cut throat" 
or other wounds, the emergency is urgent. 
When blood is gushing from the large vessels of the 
neck, without an instant delay the thumb should be 
applied directly over the vessel and pressure made 
against the spinal column, and continued until surgical 
aid arrives. Never apply a tourniquet about the neck. 
5. Bleeding from Wounds of the Arms. If a severe 
accident should result in a large laceration of the shoulder 
joint and soft tissue, the bleeding is profuse, and must 
be controlled by pressure upon the artery. 
This artery can be located by deep and firm pressure, 
just behind the collarbone, about its center. This pres- 
sure must be continuous until surgical aid arrives. 
6. Bleeding from Wounds of the Arm and Hands. 
Wounds of the arm and hand usually can be controlled 
by direct pressure with a compress of soft material and 
a firm bandage. Occasionally, however, one of the 
main arteries is injured, and it is impossible to control 
the hemorrhage by pressure applied to the wound, it is 
then necessary to apply a tourniquet to control the 
bleeding until surgical aid arrives. 
7. Bleeding from Wounds of the Legs and Feet. 
In a wound high up on the thigh, and of a punctured 
variety, often the main vessel or one of its largest 
branches is injured, and the bleeding is uncontrollable 
by direct pressure. It is necessary to control such 
bleeding by thumb pressure in the groin, about the mid- 
line of the thigh. Pressure necessary to control such 
bleeding must be very great, and one is bound to become 
fatigued unless relief is provided. 
In wounds of the lower thigh, direct pressure with a 
compress and bandage usually is sufficient to control the 
bleeding. The large vessels are deeply placed, and only 
in severe lacerating and tearing wounds is it necessary 
to apply a tourniquet to control the bleeding. 
Wounds of the lower leg and foot are controlled usually 
by the simple process of direct pressure with compress and 
firm bandage, but occasionally it is necessary to control 
the blood supply to the injured part by a tourniquet for 
a short time until the wound can be inspected. HEMORRHAGE OR BLEEDING 
91 
8. Bleeding from Wounds of the Chest and Abdo= 
men. In wounds of the chest and abdomen the bleeding 
can usually be controlled by direct pressure with a 
compress. 
It is frequently difficult to apply a bandage to such 
parts, but with a little patience it can be done, or the 
compress can be kept in place by adhesive plaster firmly 
applied. 
9. Bleeding from Wounds of the Genital Organs. 
Pressure directly by means of a compress will in all 
cases control such bleeding. This pressure must be con- 
tinued until surgical aid arrives. 
10. Bleeding from Wounds of Veins. In all wounds 
some of the bleeding comes from injury to the veins ; 
this is usually controlled by the direct pressure. Fre- 
quently, a varicose vein of the leg will rupture without 
having been injured; this may be quite dangerous, for 
often the bleeding is profuse. 
11. Bleeding from Wounds of Capillaries. This is 
the type of bleeding usually seen in simple abrasions of 
skin, as in pin scratches or scraping of the skin in fall- 
ing. The bleeding usually stops without radical, treat- 
ment, and the only thing necessary is simple dressing 
with a compress and light pressure with a bandage or 
adhesive plaster. 
12. Nosebleed. The emergency treatment required 
in this condition depends of course on the cause. If the 
bleeding is the result of an injury, in many cases it will 
stop without any direct treatment, except keeping the 
patient quiet and applying cold cloths. However, a 
nosebleed may be quite severe, and occur without any 
history of injury. If it is abundant, place the patient 
at rest in a reclining position, apply cold compresses to 
the face, and plug the nose with any available material, 
such as strips of a linen handkerchief, or pieces of cotton. 
The nose can be packed by using a pencil or pen holder, 
and the packing should be as firm as possible during the 
emergency. Do not be afraid of losing the material, as 
it always can be located when aid arrives. 
13. Internal Bleeding. This is hard to determine, 
unless the victim expectorates or vomits blood, or passes 
considerable blood from the bowel. 92 
POLICE HEALTH MANUAL 
The patient usually feels very weak, is pale, complains 
of blurring of vision, feels cold, and beads of perspiration 
will frequently come out on his face and forehead. 
It is always a good policy, whenever such a situation 
presents itself, to advise coihplete rest, have the patient 
lie down, protect him from the cold, and send for an 
ambulance. 
Do not give any whisky or stimulating drinks to any 
person suffering from bleeding. Water is the only thing 
permitted, and if a patient is vomiting, nothing should 
be given by mouth. 
WOUNDS 
Definition. A wound is a break of the skin and soft 
tissues of the body, caused by an injury. The kind of 
wound resulting will depend on the way the injury was 
inflicted. 
Variety of Wounds 
1. Incised Wounds. Made by a knife or razor blade. 
2. Lacerated Wounds. One that might be inflicted 
in a bad railroad wreck or automobile accident, or in a 
machine shop, the result of which is to tear the skin, soft 
tissues, and muscles. 
3. Contused Wounds. A wound caused by a blow 
of a blunt instrument-the result is a crushing injury to 
the soft tissues, accompanying a break of the skin or 
other surface membrane. 
4. Punctured Wounds. A wound of the skin and 
soft tissues caused by a nail or spike is known as a 
punctured wound. 
5. Stab Wounds. A wound of the skin and soft 
tissues produced by the thrust of a sharp pointed 
instrument is called " a stab wound." 
6. Gun=Shot Wounds. A wound inflicted by a bullet 
or piece of high explosive steel, is termed a " gun-shot 
wound," such wounds may vary greatly in severity and 
in the extent of tissue involved. 
7. Poisoned Wounds. A wound caused by the bite 
of poisoned animals or insects. WOUNDS 
93 
Treatment of Wounds 
When confronted with an emergency which necessi- 
tates the treatment of a wound, a few essential principles 
are to be observed : 
1. Always expose the wound if possible, to determine : 
a. The extent of injury. 
b. The type of wound. 
If the wound is large and disabling, always place the 
patient in as comfortable a position as possible. 
2. Stop the bleeding as far as practicable by pressure 
with a compress of clean linen, but do not destroy a clot 
by wiping. 
3. If the wound contains large pieces of glass or 
dirt, splinters of wood, or clothing, they can usually be 
removed by gently lifting from the surface of the wound 
with the fingers. 
4. Do not pour iodin into a large open wound. 
5. Dress the wound with a compress of clean linen, 
or better still, sterile gauze, if available, and bandage 
firmly. 
Treatment of Wounds of Special Parts 
(See also "Treatment of Bleeding" in the preceding 
section.) 
Wounds of the Head and Face, with or without a 
break in the skin, are frequent, and often present them- 
selves for emergency treatment. 
Wounds of the scalp bleed freely, and this usually can 
be controlled by pressure. lodin may be applied to the 
scalp surrounding the wound, but not poured into the 
cut surface. Apply a clean compress and bandage while 
waiting for medical aid. 
Wounds of the Lips or Cheeks, as a result of a blow, 
usually bleed rather freely at first, but usually in a short 
time the bleeding stops. If not, gentle pressure with 
the finger covered with a piece of linen or gauze will 
cause a clot to form. The wound may then be touched 
with iodin and let alone. Healing usually occurs with- 
out any infection. 94 
POLICE HEALTH MANUAL 
Wounds of the Neck. A gun-shot wound or stab 
wound of the neck is usually a very small affair on the 
surface, but much damage can be inflicted in this region, 
especially if the wound is located beneath the jaw bone. 
It is hard to tell the extent of the damage done, and the 
best policy is to summon surgical aid immediately. 
While waiting, insist that the patient lie down. Do 
not give any stimulants of any kind by mouth. Always 
protect the exposed wound with clean linen or gauze, 
firmly held in position by hand. 
BURNS AND SCALDS 
Burns and scalds may be considered as a special variety 
of wounds, caused by the effect of heat. 
Burns result from the direct contact or close proxim- 
ity to flames or heated solid bodies. 
Scalds result from the action of boiling water, super- 
heated steam, or other hot fluids or gases. 
Substances such as oils which boil only at a high 
temperature produce more severe results. 
Burns are usually classified according to the severity 
of the injury : 
1. A slight burn is usually seen as a diffuse red- 
ness of the skin. 
2. More severe burns produce blisters or blebs. 
3. Severe pain follows such burns where the skin 
has been injured to such an extent that the deeper 
layers and the nerve ending are exposed. 
4. A deep burn is one where the whole thickness 
of the skin has been destroyed and also some of the 
tissue beneath. 
5. When the heat has been intense, and tissue 
has been exposed to the heat for a long time, the 
skin and underlying tissue and muscles are charred 
and disorganized. 
Symptoms. Pain, of course, is the outstanding com- 
plaint. The pain is severe and continuous in even 
burns of the first degree, and increases directly as the 
extent of the burn. BURNS AND SCALDS 
95 
Frequently symptoms of shock are present, such as 
faintness, and considerable weakness, sweating, cold 
perspiration. 
Treatment of Burns and Scalds 
1. Remove the clothing as gently as possible from the 
burnt region-when clothing seems to stick, cut around 
it and flood it with oil-olive-oil or carron-oil. 
(Carron-oil is a mixture of equal parts of linseed-oil 
and lime water.) 
2. In burns of the scalp, cut away the hair as freely 
as possible, and apply a compress, wet with olive-oil or 
carron-oil. 
3. When treating small burns that do not show 
blisters, all that is necessary is to protect the area by 
dusting with boric-acid powder, starch powder, or 
stearate of zinc powder and gently applying a dressing. 
4. A compress wet with a solution of baking soda 
will frequently sooth the pain. Also a compress soaked 
in olive-oil or carron-oil. 
Blisters, when present, should be punctured with a 
sterile instrument so as to allow the contained serum to 
escape-the wrinkled skin should be cut away if possible, 
and a dressing applied. 
If the patient is in a state of shock, he should be put 
to bed-and covered with warm blankets and a little 
warm stimulating fluid administered. 
In children or adults, when the burn is severe and ex- 
tensive, it may be necessary to place them in a warm 
bath and the clothes removed gently. The patient should 
be allowed to remain warm some time-until the shock 
subsides-the water to be replenished, if necessary. 
Burning Clothing. If from any cause the clothing of a 
person has been ignited-an accident that fairly frequently 
happens to women-the dangers to be avoided are chiefly 
inhalation of the flames and severe burns of the head due 
to the tendency of the flames to rise. The victim should 
be made to lie down, thrown down if necessary. The 
patient should be wrapped in a rug, coat, or similar 
object, preferably woolen (never cotton) and the fire 
smothered by pressing or patting on the outside of the 
rug. 96 
POLICE HEALTH MANUAL 
BRUISES OR CONTUSIONS 
A Bruise or Contusion is an injury to the skin and the 
tissue beneath the skin, without causing a wound. 
The Symptoms are pain, which becomes quite sharp, 
swelling, stiffness, and tenderness upon pressure. The 
Swelling increases for about the first twenty-four hours. 
If the contusion is severe, discoloration beneath the skin 
occurs in a short time. At first it is bluish, and spreads 
widely from the point of injury. Later the color changes 
to a yellowish blue. When the contusion is severe, the 
patient suffers also from shock. 
Treatment at first is by the application of cold com- 
presses to the part injured. This helps to control the 
bleeding, which is due to rupture of the minute capillaries 
in the soft tissue. After a period of twenty-four hours, 
the stiffness and soreness may be relieved by hot 
applications. 
In dealing with contusion about the joints it is well 
to have an X-ray to make sure that no bones are broken. 
When it has been definitely decided that there has not 
been an injury to the bony structures in the vicinity of 
the wound, gentle massage for ten or fifteen minutes, 
twice a day will aid nature in removing the coagulated 
blood. 
Great relief may be obtained by supporting the part 
injured by a firm bandage or by the application of ad- 
hesive plaster. 
A severe bruise or contusion may result in a large 
collection of blood beneath the skin which is known as a 
" hematoma"; this must be treated by a surgeon. 
TO SUMMON MEDICAL AID 
No time should be lost in summoning an ambulance 
at the time of an accident or medical emergency. 
This can be done by simply calling Headquarters, as 
the control of the ambulance has been placed in the 
hands of the Police Department. 
In calling Headquarters for an ambulance the patrol- 
man gives his name, rank, and shield number, also the TO SUMMON MEDICAL AID 
97 
precinct he is working in, and the number of the tele- 
phone he is speaking from. The calls should be de- 
scribed as : 
Accident case; 
Sick call; 
Insane case ; 
Contagious disease. 
In contagious cases, it is necessary to get in touch 
with the Board of Health, as they usually send a doctor 
before sending the ambulance. 
The patrolman should give the name, address, and 
floor of the house-state precisely which apartment, 
as front, rear, east or west of the house. He should 
station some one at the door of the house so that when 
the ambulance surgeon arrives he may be directed to the 
exact location of the sick or injured person. After wait- 
ing a reasonable length of time for the arrival of the 
ambulance, he should repeat the call. 
Equipment and Supplies. It is always well to have 
in mind certain supplies which might be of practical 
use in an emergency, as treated in a well equipped 
First Aid Station. For when an emergency presents 
itself and you take command of a situation, you are 
expected to know just what is needed, and to direct 
others to obtain it, or the most convenient substitute. 
Frequently the worker is required to do many things 
with improvised material-for many of the emergencies 
occur some distance from the base of supplies. 
Ordinarily the First Aid packet will contain the follow- 
ing : 
Bandages-assorted - - 3 
Sterile gauze - - - 5 yards. 
Cotton -----% pound. 
Tincture of lodin - - - 1 ounce 
Adhesive plaster (5 yards 2-in. and 5 yards 3-in.) 
2 rolls of each 
Carron-oil (for burns) - - 8 ounces 
Sodium Bicarbonate (baking soda) 2 ounces 
Vaseline .... 1 ounce 
Boric acid powder - - - 2 ounces 98 
POLICE health manual 
Used in its surgical sense, shock is a term which in- 
dicates a condition of depression of the nervous system, 
more or less profound. 
Shock follows injury, and, as a rule, the more severe 
the injury the greater the shock. However, this is not 
necessarily true. One person may suffer extensive 
injuries in a railroad or machinery accident and show no 
evidence of shock, while another person may develop 
marked shock after comparatively insignificant injuries. 
Symptoms. The symptoms develop slowly, usually 
beginning shortly after the accident, although in some 
cases they may be delayed for several hours or longer 
(secondary shock). When shock is fully developed the 
observer notices that the patient is either unconscious or 
in a stupid condition, taking no interest in his surround- 
ings. The face is pale and drawn, with the eyelids 
drooping, and the eyes dull with large pupils. The 
breathing is feeble and shallow, the pulse weak and rapid, 
the skin cold and clammy, and there is a general feeling 
of bodily and mental fatigue. 
Shock is apt to occur under the following conditions: 
1. After severe injuries. 
2. After hemorrhage. 
3. After severe mental strain. 
4. After exhaustion from bodily exertion, exposure, 
or disease. 
Severe, or long continued pain increases the shock. 
Thus, there is less danger of shock when the pain of a 
broken arm is prevented by the use of suitable splints, 
than when the patient is obliged to walk with the arm 
dangling, every step causing great pain. 
Treatment. Bearing in mind what has just been said, 
it is evident that treatment should begin with the re- 
moval of the causes which may aggravate shock. 
Hemorrhage should be stopped, the patient should be 
removed, if possible, from the immediate vicinity of the 
accident, and measures should be taken to relieve the 
pain. 
However, only temporary dressings or splints should 
be applied. We are unjustified in taking a long time to 
apply a splint when the patient is in a marked state of 
SHOCK SHOCK-FAINTIN G 
99 
collapse. In severe injuries it is often wiser to carry 
out the treatment on the spot than to attempt removal 
before there are signs of reaction. 
In case of shock the patient should be placed in a 
horizontal position, with head slightly lowered, covered 
well with blankets to preserve the body heat, and hot- 
water bottles applied to the feet, abdomen, and to the 
sides of the chest. Glass bottles filled with hot water, 
hot bricks, or any other form of heat will serve. Heat 
may be applied internally by the use of hot drinks, 
especially coffee or beef tea. 
Stimulation may be given in addition to other treat- 
ment. Aromatic spirits of ammonia, in thirty-drop 
doses every fifteen minutes for four doses, and whisky 
or brandy, in teaspoonful doses every five or ten minutes 
for five or six doses, are suitable stimulants. Large 
doses of alcoholic drinks should not be given. Coffee, 
because of the caffein which it contains, is one of the 
best stimulants. 
If this treatment is successful, the symptoms gradually 
become less marked, the pulse is stronger, the breathing 
is easier, and the general appearance is improved. The 
period of shock may last only a few minutes or it may 
last for days. Even when early reaction occurs, it is 
better to keep the patient warm and quiet for a while to 
prevent the recurrence of shock. 
Fainting is caused by lack of blood in the brain. It 
resembles shock except that, as a rule, there is only a 
trivial injury or none at all, for in many cases it is a re- 
action to emotion. 
A person may faint after a very slight injury, such as 
a pin-prick or a comparatively slight blow ; after an 
unpleasant mental impression, such as fright, or the 
receipt of unpleasant news; after seeing something un- 
pleasant, as the sight of blood or a wound ; and when 
weak and exhausted, as after illness or severe muscular 
exertion. Fainting is more apt to occur in hot, crowded 
places, as in theaters or churches, than in the open air. 
The condition is ushered in by a sensation of weakness 
and exhaustion. The face is seen to grow pale, and it 
FAINTING 100 
POLICE HEALTH MANUAL 
is apparent that the sufferer is taking little interest in 
his surroundings. When questioned he is apt to answer 
at random or not at all. The breathing is shallow and 
the pulse is either very slow or very weak. Often it is 
impossible to detect the beating of the pulse at the wrist. 
As the condition develops, unconsciousness occurs, and 
the patient falls limp to the floor. 
Treatment. When the first sensation of faintness 
occurs, loss of consciousness can often be avoided if the 
patient is given a glass of water and allowed to stand by 
an open window. When more active measures are neces- 
sary, it is a good plan to place the patient in a chair, with 
the body bent forward, the head being held between the 
knees. 
This accomplishes two things : it places the head lower 
than the heart, and allows the blood to run into the brain, 
and it squeezes together the contents of the abdomen, 
forcing the blood from the large abdominal veins into' 
the general circulation. Try this yourself and notice how 
this position held for a minute or two will cause flushing 
of the neck and face. 
If unconsciousness has already occurred the patient 
should at once be placed flat on his back with the head 
low, preferably lower than the rest of the body. A 
fainting person should not be held upright under any 
circumstances. In ordinary cases the horizontal posi- 
tion is all that is required, recovery soon taking place. 
The position should be continued for a few minutes, 
however, so that recovery may be complete. If pale- 
ness recurs upon standing, there is danger that the 
patient may again faint and further treatment be re- 
quired. 
In addition to the above, for mild cases and to prevent 
recurrence, stimulants maybe given by mouth. Aromatic 
spirits of ammonia, whisky or brandy, ice-water, or hot 
coffee may be given. Cold sponging of the face and chest 
and smelling salts are additional aids. 
Persons subject to fainting spells, when there is no 
disease of the heart, may obtain relief and diminish the 
attacks by daily cold sponging of the chest and face, and 
by exercises to strengthen the heart and blood-vessels. 
When nervous influences, such as the sight of an opera- 
tion, cause faintness, it is possible to school one's self by FITS OR CONVULSIONS 
101 
repeatedly being present at operations, and thus over- 
coming the tendency to faint, and by taking the sitting 
position outlined above when the first faintness occurs. 
Once conquered the condition is not apt to return. 
Fainting or Loss of Consciousness is always the cause 
of considerable excitement and alarm among people in 
all classes-for frequently it is the initial sign of a 
serious illness. However, a great majority of such cases 
are not dangerous. 
In an accident, where there is evidence of severe 
injury to the head, loss of consciousness may mean 
fracture of the skull; as result of a fall without evi- 
dence of injury, it might mean concussion of the brain. 
Fainting is one of the manifestations of shock, which 
can be very slight, as the sight of blood. Loss of con- 
sciousness may be the result of drunkenness or of indul- 
gence in narcotic medicines as, opium and chloral. 
Convulsions associated with loss of consciousness would 
lead one to suspect epilepsy, or kidney disease. 
A sudden loss of consciousness in a person of advanced 
years, might make one think it was due to apoplexy or 
stroke. 
Frequently one comes across an individual in an un- 
conscious state, and at the moment it is difficult to state 
the exact cause. Under such conditions a complete 
survey of the surroundings should be made with all 
possible acuteness, and any bottles or vials in the vicin- 
ity of the victim should be noted and removed as 
evidence. 
A complete examination of the head and face might 
reveal evidence of an injury that would produce a frac- 
tured skull. If the face is drawn to one side, paralysis 
may be indicated. A bloated flushed face, with an odor 
of alcohol about would indicate drunkenness. 
Definition. A fit or convulsion is characterized by a 
jerky twitching of the muscular structure of the body- 
sometimes only a portion of the body-as the face, or 
the arm or leg; sometimes one half of the body, or the 
twitching may include the entire body. 
FITS OR CONVULSIONS 102 
POLICE HEALTH MANUAL 
The condition is beyond the control of the individual 
after it has started, and may spread to all parts of the 
muscular structure. When the entire muscular system 
is involved, the distortion of the face is remarkable, and 
the force of the convulsion is only apparent when one 
tries to restrain such a victim. 
Causes and Symptoms. In adults, the most common 
cause of fits is epilepsy. This may attack only a portion 
of the body or the entire body. The victim may become 
perfectly rigid, or utter a peculiar cry just before falling. 
He becomes immediately unconscious, is thrown into 
violent convulsions of arms, legs, face, or entire body. 
His face becomes distorted and bluish red in color; he 
froths at the mouth and grinds his teeth. Frequently 
the victim bites his tongue or lips. The convulsion usu- 
ally lasts about five minutes and then the patient passes 
into a deep sleep. 
Treatment. Nothing can be done to stop an attack 
when once it has started. The victim should be so 
placed that he can not do himself harm. Gently lay 
him down and loosen the collar, tie, and top of shirt. 
Try to restrain him, but not roughly. If possible, try 
to protect the patient from biting his tongue by inserting 
a handkerchief wrapped about a lead pencil between his 
teeth. Give him plenty of air. Do not give him any- 
thing to drink. As the spasm relaxes he will begin to 
breath regularly, and his color will improve. Allow him 
to rest as quietly as possible and protect him from the 
cold by blankets or an overcoat. 
If he vomits turn his head to one side, so that all the 
food will run out. Do not in any way try to arouse him 
by rubbing or slapping, for often such methods may 
cause repeated attacks. 
Send for an ambulance, for the patient should rest for 
twenty-four hours after such an attack. 
Convulsions or fits may be brought about by a stroke 
of apoplexy ; in the emergency it is hard to tell the real 
cause. The care of the victim does not differ, however, 
for all who are unconsious or unable to make themselves 
understood should be treated with great consideration. 
Do not attempt to give anything by mouth, unless you 
feel sure the patient is able to swallow. HYSTERICAL UNCONSCIOUSNESS 
103 
Fits and convulsions occur quite suddenly, like a 
cloudburst from a clear sky, as the first notice of a 
serious and damaging disease of the kidneys. Here, 
again, in the emergency the cause is beyond First Aid, 
but the care of the victim is exactly the same, until 
the arrival of trained medical aid. 
Once again-the treatment is rest and quiet together 
with protection of the victim from doing himself harm 
and also from chilling the body. 
HYSTERICAL UNCONSCIOUSNESS 
Hysterical unconsciousness is the result of a functional 
disorder of the nervous system. The patient, usually a 
woman, falls to the ground, apparently unconscious, but 
the fall is not so heedless or sudden as to result in injury. 
Often there is no known cause for the attack. Some- 
times, though, it is brought on by a fright or by an 
emotional shock. 
The face appears normal, the eyes are closed ; but the 
lids are tremulous and any attempt to open the eyes 
is resisted. The eyeballs are rolled upward and the 
pupils are normal. The pulse is normal, but the re- 
spiration is greatly disturbed, possibly slow and deep, 
or very shallow and rapid. The body may be limp or 
held tight. If the hand is pinched or pain caused in any 
other manner, the part is withdrawn, but the patient can 
seldom be made to speak or cry out. In short, the entire 
appearance is that of a person who is ' ' faking ' ' for some 
unknown cause. 
When the physician arrives, patients of this type are 
surrounded by a crowd of sympathizers who are rubbing 
the wrists and dashing cold water in the face and other- 
wise causing a great commotion. In some cases there 
are convulsive movements of the arms and legs (hysterical 
convulsions.) 
Treatment. While the unconsciousness is not a true 
coma, yet it is due to a loss of nerve control, and should 
not be treated as ordinary malingering. The patient 
should be left with one unexcitable attendant, who 
should not give any treatment, but should speak quietly 
and firmly, and attempt to help the patient to gain 
control of herself. The usual result is that after a few 104 
POLICE HEALTH MANUAL 
minutes recovery is complete. In cases which persist 
for some time, the opinion of a physician should be 
secured. Even among physicians, however, cases may 
be wrongly diagnosed as hysteria > and later a more or 
less serious complaint is found which was entirely over- 
looked. 
SUNSTROKE 
When one is exposed to the rays of the sun or to ex- 
treme heat the tendency is toward an increase of the 
internal temperature of the body. Thus a temperature 
of 100° F. in very hot weather is not uncommon, and has 
no special significance. The normal loss of heat is in- 
creased through increased perspiration, and the rise of 
temperature in the body does not become excessive. 
The mechanism which causes increased perspiration is 
under the control of the nervous system. 
After prolonged exposure to the sun the nerves -which 
control this regulation become exhausted, with the result 
that the temperature of the body gradually rises, in 
severe cases rising as high as 105 to 107° F. This condi- 
tion is known as heatstroke or sunstroke. The higher 
temperatures, unless promptly counteracted, result, in a 
short time, in unconsciousness and death. 
Symptoms. The attacks may be preceded for several 
hours, or even two or three days, by certain warning 
signs, such as muscular weakness and fatigue, nausea, 
a sensation of weakness in the pit of the stomach, head- 
ache, and dimness of vision. 
As these symptoms become more marked they may 
result, slowly or rapidly, in a state of unconsciousness. 
The face is flushed, the pupils are dilated, the skin is 
hot and dry, the breathing is labored, and the pulse 
over active. The temperature (taken in the rectum or 
under the armpit, if the patient is unconscious), is 
always considerably above normal. 
Prevention. During very hot weather one's activities 
should be decreased as much as possible. The clothing 
should be cool and loose. When in the direct rays of the 
sun, the head should be shaded by a light, well venti- 
lated hat. 
The diet should contain little meat and few sweets. It 
should be light and unstimulating. Cool water should SUNSTROKE 
105 
be drunk freely and frequently. Cold sponging and 
cool baths may be frequently taken. Warm and hot 
baths, contrary to the common belief, do not make one 
cooler, and should be avoided in hot weather. 
It is hardly necessary to add that persons already 
weakened by disease or exhaustion, must take special 
precautions to avoid sunstroke. 
Treatment. If sunstroke is recognized before the 
temperature is high or unconsciousness occurs, it may 
be sufficient to allow the patient to rest in the shade, 
bathing the head, chest, and wrists in cold water, and 
giving a light stimulant, such as aromatic ammonia or 
cold coffee. 
In more severe cases, where unconsciousness has 
occurred, the patient should be removed to a hospital, 
stripped, and put to bed wrapped in a sheet wet with 
cold water, and kept wet by frequent sprinkling with 
ice water. The cold pack (or cold bath) should be 
continued until the temperature is below 103° F. 
An ice-cap to the head, cool drinks, and massage of 
the body during the cooling process, are all valuable 
additional treatment. 
The cold pack must not be too long continued, or the 
temperature may be reduced considerably below normal. 
After it is stopped, watch the patient carefully. If the 
flushing of the face returns, and the temperature rises, 
the cold pack should again be started, but if the patient 
remains pale, with a normal or subnormal temperature 
and a weak and rapid pulse, he is evidently suffering 
from the secondary effects of the injury to the nerves, 
and requires treatment to prevent secondary shock. 
During this stage it may be necessary to apply external 
heat. 
After the immediate effects of the sunstroke have passed 
off, the patient should be kept at rest for several days 
until recovery is complete, and should avoid prolonged 
exposure in the sun for several months. 
Heat Exhaustion 
Heat exhaustion occurs as a result of working in a 
heated atmosphere, especially when the physical or 
mental powers are exhausted or depressed. 106 
POLICE HEALTH MANUAL 
Symptoms. The symptoms differ from those of sun- 
stroke, and are more those of exhaustion. The face, 
instead of being greatly flushed, is pale or only slightly 
flushed, and the skin is moist and may be cool. The 
temperature is not increased, and the pulse is rapid and 
weak. Temporary unconsciousness may occur. 
Treatment. As this condition is more in the nature 
of syncope, or fainting, the application of cold is un- 
necessary. The patient should be laid horizontally in a 
cool place and given cool drinks and mild stimulation. 
Stokers who are brought to deck unconscious are usually 
able to return to work within a few hours. 
SUFFOCATION BY DROWNING 
Considering the fact that many lives are lost by drown- 
ing, and that the water frontage of New York City has 
considerable mileage, it is suggested that all members of 
the Police Force acquaint themselves with simple and 
effectual methods of rescue and restoration. 
The removal of the drowning person from the water is 
the first step necessary. This requires some knowledge 
of swimming, and of the various methods of rescuing a 
drowning person in the water. 
The following ideas may in some instances be practi- 
cal when confronted with the emergency of a drowning 
person : 
1. When a person is discovered to be drowning, call 
to him in a loud voice that he will be saved-this will 
help to prevent weakness from fright. 
2. Throw to him a life preserver-a plank, a chair, 
a bench, or some such object that will float, and summon 
aid. 
3. Do not jump into deep water unless you are a 
good swimmer. 
4. Undress as completely and as quickly as possible. 
5. Do not touch the drowning person while he is 
violently struggling in the water. 
6. At the first opportunity, seize him by the hair if 
possible, and turn him quickly on his back. SUFFOCATION BY DROWNING 
107 
7. Swim on your back, towing the victim after you, 
place his head on your chest-holding the head with one 
arm, so that your other arm is free. 
The steps to be taken in the resuscitation of a drowned 
person are as follows : 
1. Loosen the clothing about the neck and chest. 
2. Remove coat and vest as quickly as possible- 
loosen belt-loosen all clothing about the stomach. 
3. Pry open the mouth by the use of small bit of 
wood or pencil which may be held in the corner of the 
mouth. 
4. Wrap a handkerchief about your index finger, and 
clear the throat of seaweed or rubbish. 
5. Grasp the tongue and pull it forward, and then 
with a sweep of the covered finger the throat can be 
cleansed. 
6. Artificial Respiration. Turn the patient on his 
abdomen-place a handkerchief on the ground where 
his face will lie, turn his head on the right side and 
carry out the following rules : 
a. Press firmly with both hands over the lower part 
of the chest, as the patient lies on his stomach. 
Continue this pressure for four or five seconds. 
This is to help press out the fluid and the frothy 
material which collects in the lungs. Then sud- 
denly remove the hands to allow the entrance of 
air by the natural recoil of the ribs. 
b. Grasp the patient's left shoulder, and roll him 
on his right side. This takes but two seconds. 
c. Each time patient is rolled on his right side, 
grasp the left wrist and raise it above the head in 
line with the body. This will help to expand the 
chest, and allow more air to enter the lungs. Roll 
back on abdomen. 
Repeat operations a, b, and c at the rate of 12 to 15 
times a minute until natural breathing is established. 
Resuscitation of Drowned Person 108 
POLICE HEALTH MANUAL 
During this time all clothing should be removed in the 
ordinary way, or cut off. 
The body should be rubbed dry, and friction of the 
limbs toward the heart should be applied. The patient 
should be wrapped in warm blankets and heat applied in 
the form of hot-water bottles or bricks. 
Great care must be taken of all patients found un- 
conscious, for pneumonia frequently develops as a result 
of foreign material trickling down the windpipe during 
unconsciousness. 
FROSTBITE 
Frostbite is an injury to tlie tissues resulting from 
exposure to cold. This may not necessarily be a pro- 
longed exposure, for severe injury may result from a 
short exposure during intense cold. 
Parts of Body Affected. Usually the exposed parts 
are most frequently injured, as the tip of the nose, the 
ears, or cheeks; sometimes the fingers and toes are 
nipped, for circulation in these parts may be poor as a 
result of the exposure. 
Symptoms. Pain, which is usually present when an 
injury to the tissue occurs, is frequently absent. There 
may be a sensation of tingling in the part, but acute pain 
is not experienced in the freezing process. Onlookers 
are more likely to recognize the condition than the indi- 
vidual himself. The color at first may be reddish blue, 
but eventually the part affected becomes dull navy-blue 
or white in appearance and the skin becomes shriveled 
and hard. This appearance is very abnormal, and 
attracts the attention. 
Treatment. The frozen parts must be thawed very 
gradually. They should be gently rubbed with snow or 
cold water, and warmed by being held in the hands of 
the manipulator. It is wise to place the patient in a cold 
room, and gradually adjust the frozen parts to a higher 
temperature. The pain is intense in the frozen parts if 
suddenly placed before intense heat. 
Indians, lumbermen, etc., have found that oil of turp- 
entine is the best application at all stages. SUFFOCATION BY ILLUMINATING GAS 
109 
SUFFOCATION BY ILLUMINATING GAS 
The ordinary form of gas poisoning is by carbon 
monoxide, and is ordinarily found in cases of poisoning 
by illuminating gas. 
The onset is slow, and unconsciousness often occurs 
without warning. 
Poisoning with gas from coal fires, sewer gas, mine 
gas, and from the exhaust of an automobile in a closed 
garage, all present similiar symptoms, and require es- 
sentially the same emergency treatment. 
Symptoms. In cases which are only slightly affected, 
the symptoms are headache, dizziness, nausea or vomit- 
ing, rapid breathing and rapid heart action. 
1. Remove the patient to fresh air. 
2. Loosen the clothing about his neck. 
3. Have him walk around, if he is not too weak. 
4. Small doses of baking soda (sodium bicarbonate) 
in a half-glass of water if he is able to swallow. 
5. Teaspoonful of aromatic spirits of ammonia. 
If an alarm has been given that a victim is in a gas- 
filled room and must be rescued, certain precautions 
must be taken by the rescuer : 
1. Never take an open light into a gas-filled room. 
2. Take two or three deep breaths of air, and then 
hold the breath until a window is reached. 
3. Open the window, and take another deep breath 
at the window, and then search the room for 
the victim. 
4. Carry the victim into the open air, and return 
yourself, or send some one to continue the 
search for others. 
5. Send for a doctor. 
6. If the breathing of the victim has ceased, or is 
very shallow, start artificial respiration. See 
page 107. 
Treatment 110 
POLICE HEALTH MANUAL 
7. As the action of the gas on the circulating blood 
is to destroy its power to carry oxygen, ad- 
minister oxygen. 
8. Trained medical assistance is necessary, and pa- 
tient should be sent to a hospital. 
9. If such assistance is not available, the patient 
must be placed in bed, with plenty of warm 
blankets and plenty of fresh air, and small 
quantities of stimulating and warm fluids should 
be given, such as hot broth, tea, coffee, and 
water. 
A dose of salts in small quantities repeated three or 
four times will help to empty the bowels. 
SUFFOCATION BY CHOKING 
Choking may result from a constriction about the neck, 
or from a foreign body, as a peach pit, a large piece of 
meat, or a piece of candy, lodging in the throat. 
Symptoms. The victim is suddenly conscious of a 
sensation of pressure in the throat and also of extreme 
difficulty in breathing. The pressure and shortness of 
breath becomes quite disturbing and as a result the 
patient runs from place to place seeking relief-the face 
becomes flushed and often blue. 
Treatment. In adults a foreign body can often be 
removed from the windpipe by a sharp blow upon the 
back, which causes a sudden expulsive movement. 
Children can be picked up by the heels and held head 
downward to dislodge a small particle which has been 
drawn into the windpipe or throat. 
Sometimes if the above methods are not satisfactory, 
a foreign body in the back of the throat may be dis- 
lodged by means of a finger introduced into the mouth. 
Occasionally, in patients suffering from alcoholism or 
unconscious from poisoning or drowning, the tongue 
falls back and shuts off the windpipe; this condition is 
relieved by drawing tongue forward. 
When the throat is clear and there is no constricting 
band about the neck, breathing should be resumed im- 
mediately. If the patient does not begin to breathe, 
artificial respiration should be started. DRUGS 
111 
While the administration of drugs is not properly a 
part of First Aid it is desirable that one should be familiar 
with a few drugs that are most commonly used. 
DRUGS 
Stimulants 
1. Coffee, black, given warm, is very stimulating. 
2. Tea, given warm, is also mildly stimulating. 
3. Whisky, diluted, is stimulating, but very tempor- 
arily so. 
4. Aromatic spirits of ammonia, one-half teaspoon- 
ful doses in a little water. 
Sedatives. Aspirin in doses of 5 or 10 grains every 
four hours helps to deaden pain and quiet nervousness. 
Cathartics. Castor-oil, in doses of 2 tablespoonfuls is 
very efficient. 
Epsom salts, % to 1 ounce. 
Rochelle salts, % to 1 ounce. 
Sodium phosphate, 1 to 2 teaspoonfuls. 
Citrate of magnesia solution, 6 to 10 ounces. 
Milk of magnesia, 2 to 8 teaspoonfuls. 
All these saline cathartics work rapidly and well. 
Ointments. Boric acid ointment is very soothing and 
can be used on all parts of the body. Zinc oxide oint- 
ment is also very good for eczema. 
Disinfectants and Antiseptics. Solution of boric acid 
-one teaspoonful to a pint of water. 
Solution of sodium bicarbonate (baking soda)-one 
teaspoonful to a pint of water. 
Solution of epsom salts-one tablespoonful to a pint 
of water-as a wet dressing for a sprain or for open 
wounds. 
Tincture of lodin. Regular strength 7%% applied 
lightly and carefully on an open wound may prevent in- 
fection. Too much, however, damages the tissue. 112 
POLICE HEALTH MANUAL 
POISONS 
Poisons are defined as substances which, when taken 
into the system in amounts larger than the ordinary 
dose, may produce serious trouble and even death. 
Poisons are taken accidentally, or purposely with 
suicidal intent. 
The kinds of poisons taken with suicidal intent change 
from time to time. During one.period, carbolic acid will 
be the poison used. Then for a period bichlorid of 
mercury will be mentioned in connection with poison 
cases. Frequently tincture of iodin has been taken in 
large amounts in the belief that its action will cause 
death. 
Poisons are divided into three classes : 
1. Those which cause local destruction on the mouth, 
throat, stomach, and intestines. They cause violent pain 
and irritation wherever they touch, when introduced or 
swallowed, such as acids, croton oil, and silver nitrate 
(caustic poisons.) 
2. Those which do not cause any local irritation, but 
produce serious general symptoms, as opium, belledonna, 
chloral, strychnin, wood alcohol (narcotic poisons). 
3. Those which produce both a local irritation and 
destruction, and also severe general symptons, as car- 
bolic acid, bichlorid of mercury. 
Recently the hospitals have been receiving many 
patients who have taken an overdose of sleep produc- 
ing drugs-such as veronal, which apparently can be 
obtained without a doctor's prescription. This type of 
drug does not produce any local irritation, but its gen- 
eral effect is to produce a very deep sleep-almost coma. 
Frequently it has proven fatal. 
Symptoms. The symptoms of poisoning will vary 
according to the type of substances taken. 
Locally irritating poisons are : 
Muriatic Acid 
Nitric Acid 
Oxalic Acid 
Sulphuric Acid 
Carbolic Acid 
Ammonia 
Lye 
Pearl ash 
Caustic Potash 
Caustic Soda 
Caustic Luna 
Silver Nitrate POISONS 
113 
All these substances cause severe irritation and de- 
struction throughout the mouth, the throat, stomach, 
and intestines. They all produce severe burning pain 
in the mouth and the stomach, difficult swallowing, 
great depression, and the vomiting of material which 
may contain blood. 
In carbolic poisoning, the lining membrane of the 
mouth becomes white, hardened, and numb. It is easy 
to detect the odor of carbolic acid. 
Treatment. Call a doctor. 
If it appears that a person has taken an overdose of 
some irritating and poisonous acid or alkali, do not ad- 
minister anything that will cause vomiting. The poison 
itself has caused great destruction and harm in its passage 
from the mouth to the stomach, and any added irritation 
might be painful and do harm. 
For acid poisoning give alkali (such as baking soda, 
soda bicarbonate, saleratus, chalk), three or four tea- 
spoonfuls in a glass of water. For lye and other alkali 
poisoning give soothing solutions, that will trickle down 
and not require effort, such as raw eggs, cream, milk, 
sweet oil, or olive oil. Place the patient in bed, cover 
with plenty of blankets and protect the body as much 
as possible from chilling. 
Symptoms. Poisoning by substances which produce 
both a locally irritating effect and general poisoning, 
such as mercury, arsenic, copper and iron, all cause 
violent pain in the throat, stomach, and bowels; 
vomiting and severe diarrhea ; tenderness through the 
abdomen ; bloody stools. 
Treatment. Send for a doctor immediately or call an 
ambulance-while waiting do not give irritating sub- 
stances that will cause the patient to retch. Give raw 
eggs, milk, milk of magnesia. 
The stomach-tube is only to be used by trained medi- 
cal attendants. 
Symptoms of Sleep-producing or Narcotic Poisons. 
1. Chloral produces profound sleep; breathing slow 
and shallow; dilated pupils; rapid, feeble pulse. The 
remains of poison will be found near by. 114 
POLICE HEALTH MANUAL 
Treatment. Summon medical aid or call an ambu- 
lance. Arouse the patient, if possible-give stimulating 
drinks, such as coffee, or whisky, if patient can be 
made to swallow-keep patient well covered. 
2. Opium produces giddiness ; drowsiness or uncon- 
sciousness ; respiration very slow ; pupils contracted to 
the size of a pin point. 
Treatment. Summon medical aid or send for an 
ambulance. Try to keep the patient awake if possible, 
and give warm stimulating drinks. 
Several other poisons might be mentioned, such as 
aconite, belladonna, lead phosphorous, prussic acid, and 
strychnin-of these prussic acid is the most severe, 
and proves fatal most rapidly. Whenever the emer- 
gency presents where it is evident that any of the 
above poisons have been taken, whether accidentally 
or with suicidal intent, the first requisite is to place the 
patient into the hands of the doctor. This is best 
done by calling an ambulance. The patient must be 
kept quiet, well protected from cold, and if the patient 
is able to swallow, stimulating, warm drinks should be 
given. 
Emetics. Sometimes it is necessary to administer 
some mild substance which will cause the patient to 
disgorge as much of the stomach contents as possible bv 
vomiting. Such substances are called " Emetics." 
1. Vomiting may be produced by placing the finger 
back in the mouth to the pharynx. Sometimes a feather 
or some other soft material to tickle the throat will cause 
vomiting. 
2. . Drinking large quantities of warm water will 
often cause vomiting. A little salt added will increase 
the effect. 
3. Chewing and swallowing tobacco juice will cause 
the stomach to rebel. 
4. Drinking mustard water, made by adding a tea- 
spoonful of powdered mustard to a tumbler of luke-warm 
water, makes an excellent emetic. CONTUSIONS, SPRAINS, AND FRACTURES 
115 
CONTUSIONS, SPRAINS, AND FRACTURES 
A contusion is a bruising or injury of a portion of the 
body without the breaking of the skin. The discolora- 
tion and swelling, which are due to small hemorrhages 
beneath the skin, are best treated in the early stages by 
cold applications, such as, an ice cap or cold wet cloths. 
At the end of thirty-six hours hot applications, such as, 
a hot-water bag, hot towels and gentle massage, will 
hasten the absorption of the blood and the return to 
normal of the part injured. 
Sprains 
A sprain is a wrenching of the joint, causing a stretch- 
ing or tearing of the ligaments and resulting in pain, 
swelling, and disability of the injured joint. Sprains 
can not be always distinguished from fractures; there- 
fore before attempting to treat sprains, surgical opinion 
or help should be had. It is absolutely wrong and dan- 
gerous to pull or twist the sprained ankle, wrist, or fin- 
gers with the idea of replacing the bones. If seen early 
after the injury and we are assured by surgical opinion 
that there is no fracture, firm, snug bandaging or strap- 
ping with adhesive tape will keep down the swelling. If 
this procedure is not possible, cold soaks or cold wet 
applications will help. As the pain and swelling begin 
to disappear, the use of the injured part is advisable, 
always under the direction of a doctor. 
Fractures 
Fractures are divided into simple and compound. A 
simple fracture is a breaking of the bone without 
wounding or injury of the skin. A compozind fracture 
is the breaking of a bone together with an opening in 
the skin leading to the fracture. Despite the common 
idea, that there is a difference between a break and a 
fracture, there is really no distinction ; a fracture is a 
break and a break is a fracture. 
It is much better for the first-aid worker to remember 
the following few principles or rules than to try to 
learn how to treat all the different fractures: 
The injured person should be made as comfortable as 
possible with some support given to the fractured bone, 
as a pillow or folded coat under the arm or leg. 
Contusions 116 
POLICE HEALTH MANUAL 
It is better if the clothing is to be removed, to cut it 
through the seams. 
Do not attempt to reduce or " set " the fracture. A 
moderately gentle pull in the normal or usual direction 
of the leg or arm, is all that is necessary. 
Do not attempt to handle or move a patient until the 
limb has been made immovable by applying splints. 
Keep the injured person as warm and as comfortable 
as possible. 
Do not attempt to distinguish between sprains, disloca- 
tions, and fractures. Treat all doubtful cases as fractures. 
In compound fractures, the first thing to do is to apply 
a sterile dressing to the wound in the skin. Emergency 
splints may be made from barrel-staves, laths, canes, 
umbrellas, cigar boxes, etc. These should be padded 
with cotton; if cotton is not obtainable, ordinary paper 
can be used. 
When splinting a broken limb, remember to make 
the joint below and above the fracture immovable. For 
example; in leg fractures the splint should include the 
ankle and knee joints, always leaving the toes and 
fingers outside the splint, so that they may be inspected 
as to blood circulation. 
A splint may be held in place by a bandage or a piece 
of any material, including cord. The splints should be 
applied snugly but must not check circulation. 
In fractures of the forearm or shoulder joint, the chest 
may be used as a splint by bandaging the arm to the 
chest, after placing the forearm in a sling. 
When moving a person with a broken bone, the entire 
attention of one person should be given to the injured 
limb. 
Where surgical attention is promptly available, as in 
large cities, by ambulance calls or by summoning a 
physician, it is better to do no more than to make the 
injured person comfortable as described above, until 
more skilful help arrives, then to watch the application 
of splint bandaging, transportation, etc. By observation 
and practise much more can be learned of the treatment 
of these injuries than by reading of them. INDEX 
A PAGE 
Alcohol, Habitual Use of - - - - 71 
Angina Pectoris - - - . . 38 
Appendicitis ------ 45-46 
Arteries, Hardening of the (Arteriosclerosis) - 36-37 
Artificial Respiration ----- 107-108, 110 
Asthma ------- 34-35 
B 
Bathing ------ - 14 
Bladder, Catarrh of the (Cystitis) - - - 51-52 
Bleeding, Internal --*--- 91-92 
Symptoms ------ 88 
Treatment of - - - - - 88 
Treatment of, from Special Regions - - 89-92 
From Wounds of: 
Arms and Hands - - - - 90 
Capillaries - - - . . 91 
Chest and Abdomen - - - - 91 
Face ------ 89 
Genital Organs - 91 
Legs and Feet ----- 90 
Neck ------ 90 
Scalp ------ 89 
Temple . . _ - _ 89 
Veins ------ 91 
Types of: 
Arterial ------ 87 
Capillary . ... . 87 
Venous ------ 87 
Blood Pressure, High ----- 36-37 
Boils ------- 16-17 
Bowel Regulation ----- 12 
Bronchitis ------ 33-34 
Bruises or Contusions ----- 96 
Symptoms ------ 96 
Treatment of - - - - - 96 
Bunions ------- 65-66 
Burning Clothing . ... . 95 
Burns and Scalds ----- 94-95 
Symptoms ------ 94-95 
Treatment of - - - - - 95 118 
INDEX 
C PAGE 
Cancer - - • - - - - - 30-31 
of Bladder 52 
of Mouth 33 
of Skin 20 
of Stomach ------ 44-45 
Carbuncle ------ 17 
Chickenpox 82 
Chilblain and Frost-bite - - - . 21 
Clothing ------ 12-13 
Colds ------- 75 
Constipation 46-47 
Contents ------ 7_8 
Contusions - - - # - - - 115 
Corns and Callouses ----- 66-67 
• 
D 
Diabetes ------ 54 
Diarrhoea 42-43 
Diphtheria gl 
Diseases, Common and Methods of Prevention - 15-21 
Drowned Person, Resuscitation of - - - 107 
Drugs: Ill 
Cathartics - - - - - - 111 
Disinfectants and Antiseptics ... Hl 
Iodine, Tincture of - - - - 111 
Ointments ------ Hl 
Sedatives ------ Hl 
Stimulants ------ Hl 
Dwellings ------ 13 
E 
Earache 25-26 
Ear, Diseases of the ----- 24-26 
Boils in . 26 
Chronic Discharging - - - . 26 
Deafness ------ 26 
Wax Accumulation - 24-25 
Eczema - - - - - - . 17-19 
Emergencies, Medical and Surgical - . . 84-87 
Epilepsy - - - - . . 71-72 
Erysipelas 19-20, 82 
Exercise ------ 13 
Eye, Diseases of the ----- 21-24 
Cold in the ----- 22-23 
Foreign Body in the - - - . 23-24 
Styes 24 INDEX 
119 
F PAGE 
Fainting ------- 99-101 
Treatment ------ 100-101 
or Loss of Consciousness - - - - 101 
Feet:- 56-67 
Chafing and Blistering of - - - - 67 
Fissures of ----- - 67 
Sweating of - - - - - - 67 
Fissures of Anus and Eczema - - - - 48 
Fistula (Fistula in ano) - . - . 48 
Fits or Convulsions - - - . 101-103 
Causes and Symptoms - - - - 102 
Definition ------ 101-102 
Treatment ------ 102-103 
Flat-foot ------ 64-65 
Foods - - - - - - - 9-10 
Foot-baths - -- -- - 61 
Foot Gymnastics - - - - - 62 
Strain, Acute and Chronic - 61 
Fractures ------ 115-116 
Frostbite ----- 108 
Parts of Body Affected , - - - 108 
Symptoms ------ 108 
Treatment ------ 108 
G 
Gall-stones ------ 43 
Gastritis - -- -- - 42 
Gout53-54 
H 
Hay Fever ------ 27 
Headache ------ 67-68 
Heart and Blood Vessels, Diseases of the - - 36-40 
Alcoholic ------ 39 
Disease, Valvular ----- 38-39 
Influenza ------ 40 
Muscle, Nervous Affections of the - - 39-40 
Obesity ------ 39 
Tobacco ------ 39 
Heat Exhaustion ----- 105-106 
Symptoms - - - - - 106 
Treatment ----- 106 
Prostration ------ 73 
Hemorrhage or Bleeding - 87-92 
Hydrophobia (Rabies) ----- 81-82 
Hygiene and Sanitation, Personal - - - 9-15 
Hysterical Unconsciousness - 103-104 
Treatment ------ 103-104 120 
INDEX 
I PAGE 
Index117-122 
Indigestion, Acute - ... 40-42 
Infectious Diseases ----- 74-82 
Influenza • ... . 76 
Insanity ------- 70 
Introduction ------ 5-6 
Itch, The (Scabies) ----- 19 
J 
Joints, Diseases of the ----- 74 
Acute Inflammation of - - 74 
Chronic " " - - - 74 
K 
Kidney and Bladder, Diseases of the - - 49-52, 103 
Bright's Disease ----- 50 
Stone in the - - - - 51 
L 
Leg Ulcer, Chronic ----- 55-56 
Varicose Veins, of the - - 55 
Legs and Feet, Disorders of - - 55-67 
Lockjaw (Tetanus) .... 81 
Locomotor Ataxia - - - - 69-70 
Louse Infestation ... 19 
Lungs, Diseases of the ----- 33-36 
M 
Malaria 78 
Measles ----- 82 
Medical Aid, To Summon - - - 96-97 
Equipment and Supplies - - - - 97 
Packet, First Aid, Contents - - - 97 
Metatarsalgia (Painful Affection of the Foot) - 65 
Mouth, Diseases of the ----- 31-33 
Infection, Chronic ----- 32-33 
N 
Nervous Exhaustion (Neurasthenia) - - - 72 
System, Diseases of the - - - 67-73 
Neuritis ------- 68-69 
Nosebleed ------ 26-27, 91 
Nose, Chronic Nasal Catarrh of the - - - 28-29 
" " Obstruction - - - 27 
Cleansing of the ----- 28-29 
Diseases of the - - - - 26-29 
Nostrils, Pimples in - - - 29 
Nutrition, Diseases of - - - - - 52-54 INDEX 
121 
° PAGE 
Obesity ------- 52-53 
P 
Paralysis ...... 69 
Paresis ------- 70-71 
Patrolmen, Position of, Physical Requirements - 11 
Piles (Hemorrhoids) ----- 47 
Pimples ------- 16 
Pleurisy . - ----- 35-36, 77 
Pneumonia 76-77 
Poisons: ------ 112-114 
Emetics - -- -- - 114 
Locally Irritating, List of ... 112 
Narcotic, Sleep-Producing, Symptoms of - 113-114 
Symptoms ------ 112-113 
Treatment ------ 113-114 
Pyorrhea ------ 31 
R 
Respiration, Artificial, Method of - - - 83-84 
Schaeffer Method ----- 84 
Rheumatism ; Rheumatic Fever - - - 78 
Rupture (Hernia) ----- 48-49 
S 
Sanitary Rules ------ 14-15 
Scarlet Fever ------ 82 
Sex Problems - -- -- - 71 
Shock - - - - - - . - 98-99 
Symptoms ------ 98 
Treatment of ----- 98-99 
Shoes ------- 59-60 
Special ------ 63-64 
Skin, Diseases of the ----- 15-21 
Sleep ------- 13 
Smallpox ------ 82 
Sprains - - - - - - - 115 
Standing at Rest ----- 62-63 
Stomach and Intestines, Diseases of the - - 40-49 
Ulcer 44 
Suffocation ...... 83 
By Choking - - - - - 110 
Symptoms - - - - - 110 
Treatment - - - - - 110 
By Drowning ----- 106-108 122 
INDEX 
Suffocation-Continued : pagh 
By Illuminating Gas .... 109-110 
Symptoms ----- 109 
Treatment . ... . 109-110 
By Smoke ------ 83 
Sunburn 20-21 
Sunstroke - - - - - - 73, 104-106 
Prevention . ... . 104-105 
Symptoms ------ 104 
Treatment ------ 105 
Syphilis ------- 69-71,78-80 
T 
Teeth, Decayed ----- 31-32 
Throat, Diseases of the - - - - 29 
Septic, Sore .... - 75 
Toe: 
Hammer ------ 66 
Nail, Ingrowing ----- 66 
Tonsils, Enlarged . ... . 29 
Tourniquet ------ 88-89 
Tuberculosis - - - - - - . 77-78 
Typhoid ------- 80 
Vaccine 80-81 
Typhus Fever ------ 82 
U 
Undernutrition (Malnutrition) . . . 53 
V 
Vision, Defective, Diminished or Impaired - - 21-22 
W 
Walking Exercises - - - - - 61-62 
Water - -- -- -- 12 
Wounds: - - - - - - 92-94 
Definition ------ 92 
Treatment of - - - - - 93 
" " Special Parts: ■ - - - 93-94 
Head and Face - - - 93 
Lips or Cheeks - - - 93 
Neck ... - 94 
Variety of: - - - - 92-94 
Contused - 92 
Gun-shot ----- 92 
Incised ------ 92 
Lacerated ----- 92 
Poisoned ----- 92 
Punctured ----- 92 
Stab 92