FIRST All; TO TFT INJURED 
AS© 
S : A.ri'FIOK OF fll WODNDED. FIRST AID TO THE INJURED, AND TRANSPORTATION 
OF THE WOUNDED. 
A HANDBOOK FOR THE NAVY AND NAVAL MILITIA. 
Proceedings of the U. S. Naval Institute, No. 63. 
The U. S. Naval Institute will publish as a regular number 
of the Proceedings, a valuable work entitled as above, and 
profusely illustrated, consisting of six lectures, delivered to 
the Naval Cadets of the First Class, at the Naval Academy, 
by Henry G. Beyer, M. D., Ph. D., M. R. C. S., Passed Assistant 
Surgeon, U. S. Navy, Instructor in Physiology and Hygiene, 
Naval Academy, Annapolis, Md. 
The publication will be ready for issue early in September, 
1892. 8vo form. 
Price (in paper) - - - - 75 cents per copy. 
“ (in flexible cloth) - - $1.00 “ 
“ (in flexible leather) - 1.25 
The usual trade discount. As the edition will be limited, it is 
suggested that orders for copies be given in good season. 
Address, 
Secketary & Treasurer, 
U. S. Naval Institute, 
Annapolis, Md. Vol. XVIII., No. 3. 
1892. 
Whole No. 63. 
PROCEEDINGS 
OF THE 
» 
UNITED STATES 
NAVAL INSTITUTE. 
VOLUME XVIII. 
Edited by the Board of Control. 
PUBLISHED QUARTERLY BY THE INSTITUTE. 
ANNAPOLIS, MD. Copyright, 1892, by H. S. Knapp, 
Sec'y and Treas., U. S. Naval Institute. 
Press of The Friedbnwald Co. 
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CONTENTS. 
First Aid to the Injured, and Transportation of the 
Six Lectures delivered to the Naval Cadets of the First the 
Naval Academy during the Winter of 1892. By Henry G. Beyer, 
M. D., Ph. D., M. K. C. S., 343 
Advertisements. THE PROCEEDINGS 
OF THE 
United States Naval Institute. 
Vol. XVIII., No. 3. 
1892. 
Whole No. 63. 
[copyrighted.] 
U. S. NAVAL INSTITUTE, ANNAPOLIS, MD. 
FIRST AID TO THE INJURED, AND TRANSPORTATION 
OF THE WOUNDED. 
Six Lectures delivered to the NavaTCadets of the First Class at the 
Naval Academy during the Winter of 1892. 
By Henry G. Beyer, M. D., Ph. D., M. R. C. S., 
Passed Assistant Surgeon, (N S. Navy, Instructor in Physiology and Hygiene, 
Naval Academy, Annapolis, Md. 
CONTENTS. 
Lecture I. 
Introduction.—The general nature, causation and prevention of Infectious 
Diseases.—Bacteria and their relation to wounds.—Antisepsis. —Practical 
Exercises: Rendering different regions of the body aseptic. 
Lecture II. 
Anatomy and Physiology.—Bones.—Joints.—Muscles.—Nervous System.— 
Circulation.—Lungs.—Kidneys.—Skin.—Stomach and Intestine.—Bandag- 
ing.— Triangular and Quadrangular Bandages of Esmarch.—Practical Exer- 
cises : Bandaging. 344 
CONTENTS. 
Lecture III. 
Injuries of the Soft Parts.—Contusions.—Sprains.—Concussion of the 
Brain.— Shock.— Wounds. — Healing. — Dressing. — Poisoned Wounds. — 
Hemorrhage.—Manual Compression.—Instrumental Compression.—Hem- 
orrhage from ears, mouth, stomach, lungs.—Auto-transfusion.—Practical Ex- 
ercises : Arresting hemorrhage from different regions of the body. 
Lecture IV. 
Fractures, diagnosis of.—Healing of Bones.—How to set a Fracture.— 
Application of Splints.—Special Fractures.—Dislocations.— Practical Exer- 
cises : Extemporizing splints and applying them to different parts of the body. 
Burns and Scalds and their Treatment.— General Effects of Extreme Cold 
or Freezing.—Death by Freezing.—Foreign Bodies.—Drowning and Swim- 
ming.— Resuscitation.—Unconsciousness.—Sunstroke.—Apparent Death.— 
Practical Exercises on Resuscitation. 
Lecture V. 
Lecture VI. 
The Transportation of the Sick and Wounded.—Introduction.—Different 
Methods of carrying the Wounded.—The Stretcher Drill adopted by the U. 
S. Army.—Navy Stretchers.—Extemporized Means of Conveyance.—Practical 
Exercises : Stretcher Drill and Improvising Ambulance Conveyances. 
List of Books referred to in the Preparation of the Foregoing Lectures: 
Dr. Friedrich von Esmarch, Die erste Hiilfe. 
Dr. R. von Mosetig-Moorhof, Die erste Hilfe. 
Osborn, Sam., F. R. C. S., Ambulance Lectures. 
Porter, J. H., Surgeon-Major, and Godwin, C. H. Y., Brigade-Surgeon, 
The Surgeon’s Pocket-Book. 
Dr. Paul Rupprecht, Die Krankenpflege. 
Smart, Charles, Major and Surgeon, U. S. Army, Handbook for the Hos- 
pital Corps of the U. S. Army. 
Dr. Bowditch Morton, First Aid to the Injured. 
Medical and Surgical History of the War of the Rebellion, Medical Vol- 
ume, Part III, prepared by Charles Smart, Surgeon-Major, U. S. Army. LECTURE I. 
INTRODUCTION. 
The purpose of these lectures and the demonstrations which 
will follow them is to give you that knowledge and training 
which will enable you to administer to your comrades whatever 
help they may need when injured, and to do it intelligently and 
with perfect safety. 
The desire to aid an injured person and to succor a fellow- 
creature in misfortune is an attribute of every good man and 
woman. An acquaintance with the principles of “ First Aid to the 
Wounded,” therefore, ought to form part of their education, but 
it is to soldiers and sailors more especially, who are trained to 
expose themselves to the dangers of being wounded or otherwise 
injured, to whom this knowledge seems particularly desirable. 
It is, furthermore, intended in this course of instruction to im- 
press your minds with some of the leading and fundamental 
principles of hygiene, a knowledge of which will enable you to 
do much toward the prevention of infectious diseases among you, 
or, in case of an actual outbreak of an epidemic of whatever kind 
of disease, will at least form a safe guide for your conduct while 
it prevails, giving you a better chance of escape than you other- 
wise would have. 
Most all of the civilized nations, after having become convinced, 
through the accumulation of unmistakable historical statistics, 
of the enormous death-rates occurring from preventable diseases in 
an army in the field or wherever many persons are closely housed 
together, as well as of the great benefits derived from a knowl- 
edge on the part of the soldiery of “ First Aid to the Injured,” and 
the principles of hygiene, have caused such instructions to be 
made compulsory. 
In Germany, England and France instruction in First Aid is 
given to the laity; thus it is estimated that during the year 1887 
40,000 persons, men and women, received this instruction in Ger- 
many; during the same year, in England, over ioo,oco persons 346 
FIRST AID TO THE INJURED, 
passed their examinations after having received the required 
instruction under the auspices of the great St. John’s Ambulance 
Association, of which Capt. John Furley is the head. It is, no 
doubt, well known to you that the Red Cross Association is doing 
similar work in this country, and that thousands receive this in- 
struction through the benevolent efforts of this truly grand associ- 
ation, annually. 
For purposes of illustration allow me to cite a few instances 
which tend to show more clearly than this mere statement the wis- 
dom of these measures. Right at the beginning of the war of 
1870—71 between Germany and France, 30,000 men, on the Ger- 
man side, or one whole army corps, were suddenly disabled on 
account of their not having been supplied with proper shoe-gear, 
and consequently they were unable to take part in the first battles. 
Such a calamity might have been sufficient to turn victory into 
defeat. 
One such instance is quite sufficient to show you the great im- 
portance of proper attention being paid to the hygiene of clothing 
during the movements of troops from place to place. Other 
instances might be quoted illustrating the same disastrous results 
with regard to insufficient and imperfect food supplies, poor or 
insufficient water, etc. 
But the most striking figures, by far, we obtain from the records 
of the mortality from infectious diseases in the different cam- 
paigns. For instance, in the war of the Crimea the French 
troops, which were numerically the strongest, lost 20,240 men 
from arms and 70,375 from infectious diseases, a proportion of 
1 :3!; the English troops lost 1761 through arms and 16,297 from 
disease, a proportion of 1:9; and the Russians lost 30,000 through 
arms and 600,000 through disease, or 1:20. In short, whole 
armies have been conquered and destroyed by the enemy disease 
before coming into actual contact with their enemy under arms, 
and the modern general of an army corps or admiral of a fleet 
can no longer disregard the practical value, the far-reaching im- 
portance of sanitary measures properly carried out and watched 
over by competent men. In the war just spoken of, if the 
mortality rate between the English and French troops is com- 
pared during the different periods of the war, the following most 
interesting results are obtained with regard to this point. 
During the first winter the English lost 10,283 and the French AND TRANSPORTATION OF THE WOUNDED. 
347 
lost 10,934 from the same cause, although the latter were four 
times as numerous as the former. During the following winter, 
however, the English lost 551, while the French lost 21,182 men. 
Corresponding to the numerical strength of the armies, the 
French ought to have lost only four times as many as the English, 
but instead they lost forty times as many. Consequently the sani- 
tary condition of the French army must have been ten times as 
bad as that of the English army. The question, now, was asked 
and discussed all over the civilized world as to how it came that 
such a discrepancy in the mortality rate occurred in two armies 
which were exposed to the same identical climatic conditions, 
inhabiting, as they did, the same land and moving side by side, 
both being supplied with equally good physicians and surgeons ? 
The answer was easily found in the bitter complaints of French 
army surgeons of their inability to get their sanitary measures 
carried out, while the English surgeons were supported and 
supplied by their government, which spent fifteen millions of 
francs to enable them to carry out properly the measures which 
they recommended. 
During our own civil war, it is estimated that the actual mortal- 
ity in our armies from May 1861 to June 30, 1866, was 44,238 
killed in battle and 260,131 that died from disease or the wounds 
received, after the battle. The enormous pension list which at 
present burdens this nation, although willingly borne by a grate- 
ful people, will never again assume its present gigantic propor- 
tions, if our army surgeons can carry out their present magnificent 
sanitary organization in the event of another war. 
A great many appalling examples of bad hygiene and sanitary 
management might be cited from the records of our own wars, and 
are, no doubt, present in the minds of many survivors, for it is said, 
and with a good show of accuracy and truth, that since 1776, and 
although claiming to be a peaceful nation, we have lost more men 
in actual warfare than any nation of Europe. But the above few 
instances must suffice for our purpose, if otherwise we would not 
transgress the limits and scope of simply giving you some of the 
reasons for the dissemination among you of that knowledge with- 
out which no man, either educated or not, can possibly appreciate 
what sanitary suggestions mean, or have an idea of how to carry 
them into effect in the light of modern improvements. Nor does 
the necessity for giving this instruction to the officers and men in 348 
FIRST AID TO THE INJURED, 
our Navy grow less apparent on account of their number, which 
we all know is, comparatively speaking, limited. It would appear, 
on the contrary, that the smaller an army or navy, the more 
valuable is each individual life in it, and consequently the more 
economical ought we to be with the health and strength of each 
individual man. The people of the United States have all the 
more right to expect their army and navy to be a piodel of 
perfection in every respect and of their kind, as the numbers com- 
posing them are small. 
New guns and new machinery have been invented for the 
destruction of human life; new ships are rapidly taking the place 
of the old ones; new drills and tactics have had to be devised to 
meet the requirements of modern warfare. Let us not forget to 
make preparations to succor the real motive power that works 
these modern fighting machines in times of need! Quite in keep- 
ing with the spirit of the second half of this nineteenth century, 
the most remarkable advances have been made in the treatment of 
wounds and diseases in general. In order to keep abreast with 
these modern advancements and improvements, it has become 
necessary in the Navy that the simple and always useless instruc- 
tion of the men in the use of the tourniquet should be superseded 
by the introduction of a more systematic course of instruction 
in Hygiene and First Aid to the Injured. Without such knowl- 
edge on the part of the officers and men, the surgeon and sanitary 
officer is utterly unable in time of need to cope with the difficulties 
with which he is suddenly confronted, and the result of this 
condition of things can only be a repetition of all the disastrous 
occurrences, a few instances of which have been cited a little 
while ago and which time and bitter experience ought to have 
taught us how to avoid. “ In times of peace, prepare for war.” 
The surgeons of the United States Navy, from whom alone this 
sort of instruction can come, so far as our Navy is concerned, 
find that they can no longer afford to overlook this part of their 
duty without some day incurring the just criticism and righteous 
indignation on the part of their government for culpable neglect 
of the trust at all times imposed upon them. 
The surgeons attached to the different ships and shore-stations 
alone, however, would be utterly unable to do justice to their 
duties as they understand them without the commanders of 
these respective bodies of men having acquired an intelligent AND TRANSPORTATION OF THE WOUNDED. 
349 
appreciation of this part of their functions by proper instruction 
so as to aid their surgeons in carrying out their ideas. The men 
themselves will prove of the greatest assistance to the sanitary 
officer in his efforts to ward off infectious diseases among them, 
after having received the necessary instruction in these matters, 
giving them the reasons why certain things must be done. The 
work accomplished by our army medical officers is much admired 
and appreciated wherever it is known and well worthy of our 
imitation. So long as no one can tell us why the officers and men 
in the Navy should not receive the practical benefits of modern 
progress in medicine and surgery, the introduction of the system- 
atic instruction of “ First Aid to the Injured ” should be encour- 
aged and insisted upon by every officer having the welfare of the 
service at heart. 
The general nature and causation of infectious diseases should 
be a subject familiar to every officer in the service. The times 
when typhus, dysentery, cholera, wound-fever, etc., carried off 
whole armies and paralyzed whole fleets, should never again recur 
in the future. A battle of Solferino, where the dead and dying 
lay for days and nights uncared for, and the heartrending descrip- 
tion of which by Henry Dunant was the starting-point of the 
creation of the International Red Cross Association, ought to be 
sufficient argument for our cause as well. 
The General Nature, Causation and Prevention of 
Infectious Diseases. 
The fact that all infectious diseases are caused by what is called 
germs or bacteria seems so well established at the present day 
that there can be no further doubt in the matter. Bacteria pro- 
duce disease principally in two ways, namely: (i) The germs find 
their wray into the blood either directly, as through a wound, 
or indirectly, through mucous membranes, and finding all the 
conditions favorable to their growth and development they begin 
to multiply so rapidly that they soon become so numerous as to 
clog up the finer capillaries to such an extent as to render the 
circulation of the blood through them an utter impossibility. 
This form of causation is well illustrated in the eruptive fevers, as 
rose-rash, measles, scarlet fever, small pox, etc., in which the 
skin eruptions represent the small areas of interrupted capillary 
circulation. (2) The second method according to which bacteria 350 
FIRST AID TO THE INJURED, 
produce disease is that, instead of their bodily entering the circula- 
tion proper, they remain growing and multiplying at the seat of 
their primary inoculation, like a fungus on a tree, but produce 
a poison or toxine which is taken up by the blood-vessels and 
lymphatics and is thence carried to all the tissues of the body, 
causing the characteristic disease. This is the case in diphtheria, 
cholera, typhoid fever, and probably also yellow fever. The 
simple fact, so familiar to every one of us, and which is that certain 
individuals are particularly prone to catch a disease and die of it, 
while certain others do not, although exposed to its influence as 
much as those who contract the disease and die of it, proves 
beyond question that there are contained in the tissues and juices 
of our bodies substances that are able under certain conditions 
and circumstances to successfully antagonize the invasion of 
disease-producing micro-organisms. 
The experimental study and investigation of the production of 
immunity against certain disease-producing micro-organisms 
form at present the most prominent of all the problems of bio- 
logical research. A knowledge of the principles underlying these 
investigations. is of such fundamental importance from so many 
points of view, and so well calculated to give you at once a 
comprehensive idea of the whole drift of modern medicine, that 
I have been tempted to give you at least an outline of one of these 
researches. The aim and object of them all is to finally teach us 
how and in what manner artificial immunity may be conferred 
upon any or all of us against any or all of the so-called infectious 
diseases. 
The first question that arises is: What constitutes immunity 
against a disease, the cause of which, it has been proven beyond 
the question of a doubt, is a micro-organism? An animal is only, 
then, to be pronounced immune against a certain infectious disease 
when the particular disease-producing micro-organism is found to 
be incapable of undergoing multiplication in that animal’s blood 
and other tissues or fluids. 
About a year ago, the important discovery was made in Koch’s 
laboratory at Berlin, by a young Japanese physician, Kitasato 
by name, that the blood-serum of certain animals, when added to 
fluids in which bacteria were cultivated, had an influence most 
decidedly antagonistic to their normal growth and development. 
In some cases it directly impaired their growth and multiplication; 
in others it would convert the previously poisonous germs into AND TRANSPORTATION OF THE WOUNDED. 
351 
harmless ones, though not preventing their actual growth. A 
large number of experiments were at once instituted in Ger- 
many, England, France and this country with regard to this point, 
resulting in the complete confirmation of the experiments of 
Ivitasato. Thus it was found, in the course of these experiments, 
that it was more especially the blood-serum obtained from those 
of the animals which had proved themselves naturally immune 
from certain forms of infectious diseases, when injected into the 
blood of susceptible animals, would protect them against the 
disease. i 
There are substances floating in our bodies that are so ex- 
tremely fine, so astonishingly subtle as to evade discovery even by 
the most refined methods of physiological research. The cleverest 
physiological chemist is as unsuccessful with the very finest of 
his reagents in catching and separating these finer elements 
of tissue-metamorphosis as the medical student would be over his 
dissecting table were he to endeavor to find, scalpel in hand, in 
the dead body in front of him the spirit of the departed. 
It is and will ever remain the immortal merit of Dr. Robert 
Koch to have advanced and improved our modern methods of 
biological research, and all our advanced knowledge of disease 
in modern days is directly traceable to his work. In a recent 
number of Koch’s journal (Zeitschrift fuer Hyg. und Infections- 
Krankheiten, Band XII, Heft II; Brieger, Kitasato und Wasser- 
mann) a most interesting and highly important set of experiments 
appeared in regard to a substance found in the bodies of all 
mammals and other vertebrate animals, having also exhibited to 
a most remarkable degree properties which are antagonistic to 
the growth and development of disease-producing micro-organ- 
isms. This substance is the thymus gland. It had long been sus- 
pected that this gland had some important function to perform 
with regard to the destruction of some of the products of waste, 
for, in cases of disease of this gland—in other words, whenever 
from any cause its normal functional integrity was impaired, a 
disease known as acro-megaly was produced, which is charac- 
terized by an abnormal accumulation in the subcutaneous cellular 
tissue of a substance called “mucin.” This substance, a product 
of destructive tissue-metamorphosis, not being disposed of, accum- 
ulates in the system and thus produces this most characteristic 
disease. The particular bacterium to the growth of which the sub- 
stance of the thymus gland has been found to be antagonistic 352 
FIRST AID TO THE INJURED, 
is the bacillus of tetanus (see fig. i), a disease perhaps better known 
under the name of lock-jaw. 
Fig. i.—Represents the bacillus of tetanus, from a micro-photograph. 
In going over the salient points of these experiments with you, 
the subject will become clear to you and at the same time will 
place you in the possession of a key by means of which you will 
be able to comprehend all the most important problems connected 
with the entire field of bacteriology and infectious diseases, as they 
will appear to you in your future readings from time to time. 
In the first place you must know that tetanus or lock-jaw is a 
disease produced by a microbe which affects certain portions of 
the nervous system and is attended with convulsions that are 
almost invariably followed by death. The bacillus of tetanus is 
perhaps one of the best known of all the bacteria, because rather 
large and most characteristic; its morphology and physiology 
have been the object of study for many years past; the bacillus, so 
called because shaped like a rod, is often found in garden-earth 
somewhat below the surface; one of the ways of obtaining it, in- 
deed, is to take some garden-earth and bury it underneath the skin 
of a mouse, sewing up the incision over it; the next morning the 
mouse will be found either dead or suffering from the effects of the 
disease; its liver, spleen, kidneys and heart-blood will be found to 
contain almost pure cultures of these tetanus bacilli. It is now 
easy to collect them, transplant them under proper precautions 
to their favorite culture-media and raise a large crop of them. AND TRANSPORTATION OF THE WOUNDED. 
353 
They flourish best when the inoculated test-tubes are kept in a 
culture-oven at a certain temperature. At the end of the first 
24 hours’ cultivation the culture is already so poisonous that a 
single drop of it would suffice to kill any animal living within from 
20 to 24 hours. 
Now the discovery has lately been made in the Berlin laboratory 
that, when some of these tetanus cultures were mixed with an infu- 
sion made from the thymus gland, the bacilli would grow and 
multiply the same as in normal culture-fluids, but fail to produce 
spores; in other words, the addition of thymus-infusion to these 
tetanus-cultures very materially interfered with their normal 
development and hence was antagonistic to that extent. The 
spores, it must be remembered, are the most dangerous parts of 
the bacilli. When, however, these sporeless bacilli were retrans- 
planted on to more favorable soil, such as, for instance, grape- 
sugar-agar, the usual spores were again developed in the interior 
of these bacilli. Thymus-infusion, then, prevented the develop- 
ment of spores without entirely destroying their power of repro- 
ducing them. 
With a mixture of thymus-infusion and a culture of tetanus- 
bacilli, the following experiments were now made on mice: 
On October 6th, 1891: 
Mouse 1 received c.ooi ccm. subcutaneously, 
“ 2 “ 0.01 “ “ 
a CC q j i( u 
“ 4 “ 0.2 u “ 
“ 5 “ o-5 ‘‘ “ 
Six rabbits were now taken and treated similarly; each rabbit 
received on alternate days gradually increasing doses of this 
attenuated thymus-tetanus-culture until each one bore a dose of 
10 ccm. All these rabbits remained perfectly well, so did the 
mice. 
Three of the above six rabbits were now taken and given each 
a deadly dose of an original and unmixed tetanus-culture sub- 
cutaneously; three fresh and unprepared rabbits received the same 
dose at the same time. The three last rabbits died within 24 
hours; the three former ones remained perfectly well and showed 
absolutely no sign of disease. 
It was now clear that those of the rabbits which had received 
the attenuated thymus-tetanus-culture had been rendered arti- 354 
FIRST AID TO THE INJURED, 
ficially immune against the disease, because on them full virulent 
tetanus-cultures produced no effect, while on rabbits not so 
prepared they had retained their deadly power. 
Blood-serum of animals not susceptible to the disease having 
been previously shown to produce antagonistic properties when 
injected into the blood of susceptible animals, three of these pro- 
tected animals were now bled, and from their blood the serum 
was prepared in the usual way. With this blood-serum four 
mice were treated as follows: 
Mouse 1 received 0.5 ccm. 
“ 2 “ 0.3 “ 
u “ c.i “ 
“ 4 “ 0.05 “ 
these quantities being injected directly into the peritoneal cavity. 
All four of these mice were well and alive 24 hours later, when 
each of them was given a deadly dose of full virulent culture of 
tetanus-bacilli and four fresh mice received the same deadly dose. 
The four fresh mice were all dead at the end of the next 24 hours; 
the four which had received the blood-serum from the protected 
animals remained perfectly well and were well 20 days after. 
With this method Brieger, Kitasato and Wassermann were able 
to save 100 per cent of the animals; less favorable results were ob- 
tained with regard to cholera, diphtheria, typhoid and erysipelas. 
Germs and their Relation to Wounds. 
The great improvements which have taken place during the 
last fifteen years in the surgical treatment of wounds, having had 
their beginnings with the study and discovery of the life-histories 
and properties of germs or bacteria, I must use the remaining 
few minutes to make you still better acquainted with them. The 
three test-tubes which I now pass around contain cultures of three 
different kinds of bacteria on the ordinary beef-peptone-gelatine 
(see fig. 2); they were sent to me through the kindness of Dr. 
Philip S. Wales, of the Museum of Hygiene, and answer the pur- 
pose as well as any other to show you how we cultivate them in 
our laboratories. 
Having proved themselves more deadly than guns and ammuni- 
tion, the role which these germs play is of immense importance, 
and, unless I succeed right in the beginning to impress your 
minds with this fact, all the aid which you may hereafter be in a Fig. 2.—Shows how bacteria are cultivated in test-tubes. AND TRANSPORTATION OF THE WOUNDED. 
355 
position to apply to any one must, necessarily, be of questionable 
value, faulty, or prove even hurtful and dangerous. 
What, then, are these germs? Germs are the most minute 
microscopic, vegetable organisms in existence, infinitely smaller 
than the most minute particles of dust, and, unlike dust-particles, 
which are dead, they are living things, capable of almost indefinite 
multiplication in a comparatively short space of time. Multiply- 
ing as rapidly as they do, they consume a large quantity of food, 
and, on the other hand, throw out a great deal of new material. 
They lead the life of tramps, as it were; that is to say, they prefer 
to live on other creatures. The life-blood of animals seems to 
possess special attractions for them. A living animal, inoculated 
with certain kinds of these germs, may die within 24 hours. The 
germs, by their rapid multiplication, quickly consume the best 
and life’s most sustaining constituents of the body, and leave in 
their places a changed fluid which proves poisonous to the animal 
organism, and consequently death follows in their track whenever 
they find entrance into the living organism, as, for instance, 
through a wound. 
But, fortunately for us, a great many different kinds of these 
germs are perfectly harmless, some even useful; these, of course, 
having nothing to do with the causation of disease, do not interest 
us here. Nevertheless, it is well for you to know that germs are 
found most everywhere. They exist in the air we breathe, they 
are present in the water we drink, the soil we live upon and the 
food we eat; they infest our mouths, our noses, our bowels, and we 
carry them on our clothes. They are pretty well scattered all 
over the world, no portion of the globe being without them; they 
are found on mid-ocean as well as on the highest mountains. Of 
course, you will perhaps quite understand from this that most 
of them are, as was mentioned before, perfectly harmless. We 
breathe them in and out, we drink them in the water and we eat 
them with our food by the millions every day and no harm results. 
Indeed, they have been classified according to their properties into 
three great divisions: (1) those which produce contagious or 
infectious diseases, as for instance measles, scarlet fever, diph- 
theria, typhoid and typhus fevers, pneumonia, consumption, 
hydrophobia, small pox, chancroids, gonorrhoea, etc.; (2) the 
harmless ones; and (3) those which cause fermentation and decay. 
All three kinds of bacteria, however, may produce death in more 
or less all animals, including mankind, when they accidentally 356 
FIRST AID TO THE INJURED, 
find entrance into the circulation direct, that is, through a wound. 
In other words, the same germs which, when swallowed with our 
food, remain perfectly harmless, when allowed to get into an open 
wound may cause death by blood-poisoning. 
You will now, perhaps, more thoroughly realize and appreciate 
the fact than you did before, that it is owing to the invention and 
perfection of certain means and methods by which we manage to 
prevent the entrance of these germs into the wounds, that the great 
advances in modern surgical treatment have taken place, and to 
make you practically acquainted with some of these methods will 
be the object of the practical part of this first lesson. 
Before, however, proceeding to the practical part of this lesson, 
allow me to call your attention right here at the beginning to 
something that you must not do under any circumstances. Every 
surgeon of experience has often had reasons to regret that the 
knowledge of the most simple little devices used in First Aid is 
an accomplishment so rarely met with among the people at large. 
Consequently many people lose their lives, not so much from the 
serious character of the injuries which they receive as from the 
fact that First Aid has been ignorantly and unintelligently applied. 
For instance, you may meet with a severe accident at any time 
and most anywhere in one of our crowded cities, on board ship, 
or in the field. Supposing it to be a fractpre of the thigh-bone. 
You are unable to rise to your feet, you look pale, feel extremely 
weak and finally become unconscious. The people around you 
will almost instinctively try to do for you whatever in their opinion 
is the best thing to be done under the circumstances. Most 
likely they will try to stand you up on your feet and drag you to 
the nearest drug-store or down into the sick-bay, where, a few 
minutes after having been carried there, you give up the ghost 
and die. On examination, the fracture was discovered, and dur- 
ing transport the femoral artery was cut by one of the fragments 
and death was caused by loss of blood. Or, supposing the artery 
was left uninjured, one of the fragments has pierced the skin and 
amputation has become necessary when, under more favorable 
circumstances, you ought to have made a quick recovery with a 
useful limb. 
Thus, as you see, your future usefulness, your health, your very 
life may, in that short space of time, be decided by the person com- 
ing to your aid and the manner after which he applies to you the 
first aid or help. In this manner many valuable lives have been AND TRANSPORTATION OF THE WOUNDED. 
357 
lost that might have been saved; limbs have had to be amputated 
and thrown away which ought to have been and would have been 
saved under more favorable circumstances. Therefore, you must 
always keep in mind the one thing you must not do, namely, 
Harm! Do no harm! Rather do nothing, whenever in doubt, 
than add insult to injury. Unless you feel sure you can do him 
some good, keep your hands off the injured man until some one 
arrives who knows better than you do what is best to be done. 
Practical Exercises. 
The materials used here are: 
1. The ordinary operating table furnished to the ships of our 
Navy, covered with a clean white rubber-sheet and in perfect 
readiness for an aseptic operation. 
2. Several buckets of clean water, soap and brushes; also several 
towels. 
3. One tray with instruments under a solution of carbolic acid, 
strength 3 per cent. 
4. One tray with a solution of corrosive sublimate, 1: 100c, 
containing a few pieces of gauze. 
5. Needles, cat-gut ligatures, safety pins, all in antiseptic solu- 
tions; iodoform-gauze and bandages for dressings. 
6. Tray with alcohol. 
7. Irrigator. I 
We will now suppose that an operation is to be performed 
requiring absolute surgical cleanliness. The walls, the floor and 
the ceiling of the room are supposed to have been thoroughly 
scrubbed and disinfected. Any dust in the atmosphere was 
removed by sending a spray of turpentine into it; the patient is 
now brought in, having previously received a bath and been 
provided with clean clothing; assistants and surgeon the same. 
Having taken off his coat and put on a clean apron, the surgeon 
now begins to prepare his hands and forearms for the operation. 
He begins by cleaning his finger-nails, which are supposed to be 
the greatest harbingers of germs and are said to have been the 
cause of many premature deaths; the surgeon now rolls up his 
sleeves to the elbow and washes his hands and forearms with soap 
and water, using a brush in this manner, at the same time explain- 
ing as he proceeds that soap, water and the brush only remove 
ordinary dust and perspiration from the surface of the skin, but 
by no means are sufficient for the degree of cleanliness required 358 
FIRST AID TO THE INJURED, 
in an operation. Having done this, the hands must be dipped 
into alcohol for the purpose of removing the fatty particles adher- 
ing to the skin. Lastly, the solution of corrosive sublimate is 
used to kill any of the germs which still adhere or may fall on the 
arms and hands during his work. If there should happen to be 
any delay in the operation, the patient not being quite ready, the 
surgeon covers his hands with pieces of gauze soaked in the solu- 
tion until the patient is ready to be operated upon. Every nurse 
and assistant must, of course, be prepared in the same manner. 
The above described method was first devised by Fuerbringer 
and is the one in general use. Some time ago, however, Professor 
Wm. H. Welch, of the Johns Hopkins Hospital, proved very 
conclusively that this method could not be absolutely relied on. 
He made the important discovery that the skin, like the mouth 
and the intestines, besides bearing many different forms of bac- 
teria on its surface, has quite a distinct bacterial fauna of its own 
which infests its very substance. Even after scrubbing the hands 
as has been described and demonstrated to you just now, Dr. 
Welch was still able to find living bacteria of a certain kind in 
the skin. The method of cleaning the hands, as recommended 
by him, based upon his researches and adopted at the Johns 
Hopkins Hospital, is as follows: 
1. The nails are kept short and clean. 
2. The hands are washed thoroughly for several minutes with 
soap and water, the water being as warm as can be comfortably 
borne and being frequently changed. A brush sterilized (made 
germ free) by steam is used. The excess of soap is washed off 
with water. 
3. The hands are immersed from one to two minutes in a warm 
saturated solution of permanganate of potash and are rubbed 
over thoroughly with a sterilized swab. 
4. They are then placed in a warm saturated solution of oxalic 
acid, where they remain until complete decolorization of the 
permanganate occurs. 
5. They are then washed off with sterilized salt-solution or 
water. 
6. They may then be immersed for two minutes in sublimate 
solution 1:500. 
Every member of the class is now requested to practice on him- 
self either of the above methods, and the objects of the first lecture, 
that of giving you an idea of the relation of germs to disease and 
that of impressing your minds with the importance of cleanliness 
in the treatment of wounds, will, doubtless, have been attained. Fig. 4.—Shows the circulation of the blood and the large arteries and veins. Fig. 3.—The human skeleton. LECTURE II. 
ANATOMY AND PHYSIOLOGY. 
In to-day’s lesson I shall tell you all you need to know about the 
different parts and organs of the human body, and what their 
respective functions are which they must perform in order to make 
life possible and to maintain it. 
First, let me call your attention to the three pictures hanging up. 
One is a representation of a skeleton, that is, of all the solid parts 
of the body, put together just as they exist in the living subject. 
(See fig. 3.) The second represents, in a diagrammatic manner, 
the remaining parts of the human body, which I shall explain more 
in detail as we go along. The third picture is a very good dia- 
grammatic representation of the circulation. (See fig. 4; also 
fig. a.) We will begin with 
The Bones.—Without bones the human body would be a 
shapeless mass of flesh. The skeleton forms the solid basis or 
groundwork of the body and gives it shape and form. The bones, 
furthermore, protect the most important organs, such as the 
brain, spinal cord, heart, lungs and intestine, by throwing a pro- 
tecting covering or lattice-work around these organs, so that 
slight injuries, at least, cannot possibly affect them. 
The Head.—In the head we find twenty bones, most of them 
very irregular in shape, all very firmly united together with the 
exception of the lower jaw, which is attached to the base by a 
joint. The head may be divided into two parts, namely, the skull, 
which is a solid box containing and protecting the brain, and the 
face, in the solid framework of which are set up most of the 
organs of special sense, like so many precious jewels. The eyes, 
the ears, the nose and the tongue are all to be found about the 
face, lodged in very solid, protective recesses. They represent the 
terminations of the most highly specialized processes of the nerv- 
ous system, and nature, therefore, has placed them so that they 
may, with ordinary care and in the ordinary walks of life, escape 
injury. 1 360 
FIRST AID TO THE INJURED, 
The Spine consists of twenty-four small, irregular shaped and 
rather complicated looking bones, placed one on top of another, 
and which are called vertebrae. These bones, when in position, 
form a sort of column, called the vertebral column, which forms 
the main support of the head and trunk. Being firmly held to- 
gether by very strong bands, the spine can be moved and bent in 
various directions without displacing any of its component parts. 
The Chest is formed of twelve ribs on each side, seven of which 
are called true ribs and five are called false ribs. Behind, these 
ribs are connected with the spine and are movable; in front they 
are more firmly united with the breast-bone and are immovable. 
The chest cavity contains the most important organs of circula- 
tion and respiration, namely, the heart and the lungs. Below, 
this cavity is closed in by a fan-shaped muscle, the diaphragm, 
which separates the heart and lungs from the stomach and in- 
testine. (See fig. 16.) 
The Basin, as you see on the diagram (fig. 3), is a very irregular 
shaped bony ring, giving strong support to the various intestinal 
organs, and also receiving the lower limbs into two large round 
sockets, one on each side. 
The Limbs, in the human subject, are generally spoken of as 
upper and lower, or arms and legs. Each upper limb is composed 
of the collar-bone, the shoulder-plate, the upper arm-bone, the two 
bones of the forearm and the hand, which latter again is divided 
into the wrist (eight bones), the middle hand (five bones), and the 
fingers (fourteen bones). Each lower limb consists of the large 
and powerful thigh-bone, the two bones of the leg, one very much 
stronger than the other, and the foot, which is composed of 
twenty-six bones. 
The Joints. (Figs. 5, 6 and 7.)—All the bones are firmly united 
to one another by very strong bands of a white fibrous tissue which, 
in the cases of some joints, completely surround their adjoining 
ends, thus forming a perfectly air-tight cavity. If you should cut 
open one of these joints (fig. 5), say the hip-joint, which is one of 
the most complicated of them all, you would be surprised, on 
putting your finger on the inside of it, how smooth everything feels. 
You would also notice a fluid partially filling the cavity of the joint, 
which is secreted by the lining membrane of the joint and is 
intended to lubricate it, so as to facilitate motion between the two 
ends of the bones. Fig. 5.—Shows the hip-joint laid open ; the head of the femur attached to the 
acetabulum by the central ligament. 
Fig. 6.—Longitudinal sec 
tion of knee-joint. 
Fig. 7.—Finger-joints. 
Fig. a. Fig. ii.—Intended to represent the entire cerebro-spinal nervous system. Fig. 9.—Shows the biceps in different stages of contraction. 
Fig. io.—Shows the brain in its relation to the skull and face. Fig. 8.—Shows most of the skeletal muscles of the human body, with initial letters of 
their anatomical names. AND TRANSPORTATION OF THE WOUNDED. 
361 
The Muscles (figs. 8 and 9) are the red masses of flesh which are 
distinguished from other soft parts not only by their color, but 
more especially by a very remarkable property; they possess, as 
you all well know, the power of contractility, best illustrated 
in the long muscles. (Examples, biceps, figure 9.) The sinews 
in which many of the long muscles end and by means of which 
they are attached to the bones which they are intended to move, 
are, on the contrary, not contractile, but rather unyielding. Mus- 
cular contractions may be controlled by the will, and then are 
called voluntary contractions; most of the skeletal muscles are of 
this kind. They may contract independently from any manifesta- 
tions of our will power, and those contractions are called involun- 
tary contractions, the muscles themselves being called involuntary 
muscles. The muscles of most of the viscera, such as the heart, 
lungs, stomach and intestines, are of this kind. 
Ike Nervous System, (see figs. 10 and 11), of all other systems, 
is the most important, the most wonderful and the most compli- 
cated. It is divided into the brain, spinal cord and nerves. The 
brain presides over all the functions necessary for the maintenance 
of human life. It is the seat of consciousness; it directs the beating 
of the heart, the digestion of food; it is through it that we see, hear, 
smell, taste and feel. Without it, the human mechanism would be 
a most complicated machine, without a superintending engineer 
and without motion or sensation. This organ is situated in a 
very firm, bony case, and is thus protected by nature in accordance 
with its importance. Injury to the brain means unconscious- 
ness, paralysis of all the muscles of motion, of sensation and 
speech. The spinal cord is a long, cylindrical cord of nervous 
tissue contained in the spinal canal, and sending out thirty-one 
pairs of nerves through small openings in the bones composing the 
canal. These nerves go to all parts of the body, carrying the 
various impulses of motion and endowing them with general sensa- 
tion. Injuries to the spinal cord mean paralysis of motion, and 
also perhaps sensation, of all the parts below the seat of the injury. 
Both brain, spinal cord and nerves are made up of numerous 
fine fibers and an endless number of cells or pyramidal-shaped 
minute little bodies. Nerve force is generated in the cells, and 
the fine fibers which the latter send out in all directions serve the 
purpose of conductors of whatever energy may be evolved by the 
particular group of cells with which they happen to be connected. 
Thus, the spinal cord, which is in direct connection with the brain, 362 
FIRST AID TO THE INJURED, 
sends into the brain a large number of fibers, and in this way forms 
really a combination of the brain with all the other organs and 
tissues, including the skin; just as the queue of a Chinaman is 
merely the gathered up and braided mass of hair coming from and 
spreading out all over the hairy scalp, so is the spinal cord only 
the braided mass of fine nerve fibers coming from the brain and 
going through the cord into the tissues at large. 
Circulatio7i.—Before speaking of the circulation, I will first 
explain the colored diagram which you see before you (figs. 4 and 
a). In the center of the picture you see the heart; the left side is 
painted a bright scarlet red, and the right side of a blue color. 
You will also see that all those vessels connected with the left 
side of the heart are, like that side of the heart itself, of a bright red 
color, and that all the vessels connected with the right side of the 
heart also present its color, which is blue. 
The red fluid which flows in every variety of organ and tissue 
in our bodies, and which must flow to keep them alive and func- 
tional, is the blood. The blood is kept in constant circulation 
through a most wonderful piece of apparatus, the heart and a very 
complicated system of tubes, the arteries, capillaries and veins. The 
heart (see fig. 12) is a muscular sac, having a number of openings 
provided with valves. When it contracts, it forces out all its con- 
tents in a certain definite direction, owing to the disposition of these 
valves, and when it expands, it admits a new lot of blood, owing to 
the same cause. The action of a Davidson syringe (figs. 13 and 
14), which you see here, is no mean illustration of this pump action 
of the heart. But, unlike a Davidson syringe, which has but one 
cavity, the cavity of the heart is divided into four compartments, 
two for the right side and two for the left side of the heart. The 
blood, as you may see on the diagram, is then contained in a closed 
system of tubes, of which the heart forms the central propelling 
organ or motor power. We will now follow the blood from the 
left lower chamber of the heart in its course back to the same com- 
partment. It leaves this chamber by a very large blood-vessel 
which quickly breaks up into smaller and smaller ones, which 
finally terminate in such fine little tubes that they can only be seen 
with the microscope. Those tubes, or vessels, which are thus 
directly connected with the left side of the heart, leading the blood 
away from the heart, containing bright red, aerated or puri- 
fied blood, are the arteries. In these vessels you may feel Fig. 12.—Diagrammatic repre- 
sentation of the valves of the 
heart. 
Fig. 13.—Shows valves inside of 
rubber bulb of a Davidson’s 
syringe. 
Fig. 15.—Shows an artery 
breaking up into capil- 
laries on one side andthe 
beginnings of a vein on 
the other. 
Fig. 14.—Davidson’s syringe. AND TRANSPORTATION OF THE WOUNDED. 
363 
the heart’s impulse when you place your finger lightly over 
their course. The very fine, hair-like vessels which these arteries 
finally terminate in, are called capillaries (fig. 15). Every tissue 
and organ of our bodies is as completely and thoroughly per- 
meated with these capillaries as are the meshes of a sponge 
holding water. The slight amount of bleeding noticed in a 
superficial abrasion is due to the wounding of these minute, 
microscopical tubes; they reach so very near the surface of our 
skin that but a few layers of scales separate them from the outer 
world. (Ex. Pressing on our skin leaves a white mark.) It is 
here, however, where the blood comes in contact with those tissues 
which it is intended to nourish and where it performs its most 
important functions; the largest tubes are merely the channels for 
conducting the blood to this most important system of capillaries. 
It is here that the blood gives up its oxygen and receives carbon 
dioxide in its place. It is here, also, where the bright scarlet color 
of the blood is changed to a very dark red, almost black color, in 
consequence of the lost oxygen and the absorption of CO.,. 
From the venous side of the capillaries this blood, which must be 
refreshened, as it were, is collected again by a different system of 
vessels, called veins, which now carry this dark, almost black 
blood back, as you see on the diagram, to the upper chamber of 
the right heart; hence it is pushed on into the lower or larger 
chamber of the right heart, from whence it is finally pushed on in 
a very large blood-vessel into the lungs, where the vessels again 
break up into capillaries. In these capillaries which penetrate the 
lungs you will notice that the dark blood is changed again into 
bright red blood. While in one set of capillaries it lost its oxygen 
and received carbon dioxide, in the capillaries of the lung the 
very contrary takes place, namely, the blood loses its carbon 
dioxide and receives new oxygen. This purified blood is taken up 
by a few larger vessels and conducted into the upper chamber of 
the left heart, whence it is propelled on into the lower chamber of 
the left heart, whence we started in our description. One such 
turn is called a revolution; the blood makes about two such revolu- 
tions in a minute. 
From these remarks and by the help of this picture you will 
have gathered that in a wound filled with bright red blood arteries 
must have been wounded, and on the other hand, dark blood 
would indicate that veins were wounded. The former injuries 364 
FIRST AID TO THE INJURED, 
must be naturally the more serious, as arteries run much deeper 
than the veins, and more blood is lost through arteries in a given 
time than through veins, on account of the higher pressure which 
exists in the arteries. 
It was necessary for me to dwell a little more at length on the 
subject of the circulation of the blood on account of its great im- 
portance, which you will be better enabled to appreciate when we 
come to speak of the application of the tourniquet and other 
means for arresting bleeding. 
The Lu7igs (fig. 16)-are two large masses of spongy tissue con- 
tained in the chest cavity and serve the purpose of aerating the 
blood. The air is made to enter the large tube which is easily felt in 
front of the neck, also called the wind-pipe, and which branches out, 
tree fashion, into a large number of finer twigs, finally terminating 
in very small vesicles or expansions. These bladder-like vesicles are 
completely covered over with a very fine network of blood-vessels, 
the very capillaries carrying venous blood and wanting to give off 
their C02 and receive oxygen in its stead, and which I have been 
speaking to you about under the head of the circulation. Without 
this important organ life is impossible. (Example: Tying the 
trachea of a dog. Mouse under a bell-jar.) 
The Kidneys (fig. 17) are two large, bean-shaped bodies, situated 
in the abdominal cavity, in front of and to the side of the spinal 
column. They are connected with the bladder by the ureters, two 
large tubes carrying the urine which the kidneys secrete into it. 
They also are very essential to life, and their diseased condition 
gives rise to what is called Bright’s Disease. Urine, which they 
secrete, is a solution of a solid substance, urea, and which must, like 
carbon dioxide, be gotten rid of, otherwise it would poison the 
blood. 
The large sheet of skin (fig. 18) which covers our bodies does not 
only prevent the soft parts from drying up, but also throws out sub- 
stances in the perspiration which if retained would poison our blood. 
The three millions of sweat glands are actively engaged in this 
work, especially so in hot weather. Nourishment, of course, must 
supply this constant wear and tear going on within us. We are all 
familiar with the process of eating and drinking (see figs. 19 and 
20). Digestion begins in the mouth, where the food is ground up 
by the teeth and thoroughly mixed with the alkaline saliva. The 
resulting paste is passed on through a long muscular tube into the Fig. 17.—Showing kidneys, 
ureters and bladder. 
Fig. 16.—Shows all the viscera in position and their 
relation to one another. Hair. 
Epidermis. 
Pigment-cells. 
Papillae. 
Derma. 
Sweat-glands. 
Fatty tissue. 
Fig. 18.—Vertical section of skin. 
Fig. 19.— Shows stomach-tube, stomach and intestine. Fig. 2C.—Diagram showing the digestion of food and how the food is exposed alter- 
nately to the action of alkaline, acid and again alkaline fluids secreted by the 
different portions of the alimentary canal. 
Fig. 2i.—Shows results of bad bandaging. AND TRANSPORTATION OF THE WOUNDED. 
365 
stomach, where the food remains a while, undergoing further 
acid digestion. From the stomach it passes into the small intestine, 
where the bile manufactured by the liver helps to prepare it for 
final absorption and use in the economy at large. 
We will now pass on to the practical part of this lesson, which 
to-day will consist in the application of Esmarch’s triangular and 
quadrangular bandages. 
Bandaging.—As first-aid-men, allow me to urge upon you the 
prime necessity for acquiring a thorough knowledge of the art of 
bandaging. Do not permit yourselves to look upon this part of 
your work as of minor importance, simply because it has been 
relegated to what is called “minor surgery.” The subject is an 
important one, and large prizes have been awarded in the past for 
essays and treatises on bandaging. There is perhaps no one single 
thing by which one can so well and so readily distinguish a 
superior nurse from an inferior one as by watching the manner 
after which he or she puts on a bandage, and if you should ever be 
so unfortunate as to become a patient yourself, the difference 
between a good and a bad bandagist would, no doubt, be indelibly 
engraved upon your mind. 
The proper knowledge of bandaging can, very naturally, be 
acquired only by practice, and what I have to say here on this sub- 
ject will only relate to some of the more important principles 
underlying the art of good bandaging. 
In applying a roller bandage to any part of the body or any of 
the limbs, you must remember first of all that it should exert an 
even pressure in every turn throughout its whole length. Sec- 
ondly, after applying a rather tight dressing or bandage to any part 
of the arm or leg, a supporting bandage must be put on that part of 
the limb from the hand or foot respectively up to the place where 
that dressing or bandage is, otherwise swelling of the part below 
the dressing will ensue (see fig. 21). The reason for this is simple 
enough when you recall to your minds your lesson on the circula- 
tion of the blood. A tight bandage will compress the veins and in 
this way impede the return-flow of the blood. 
For roller bandages three kinds of material are used, namely: 
(1) Calicot. (2) Starched gauze bandages, which latter are put 
into hot water for about a minute before being used, then pressed 
out and applied. Being somewhat sticky, they are pliable and 
more apt to stay better than dry ones, and, after drying, form a 
pretty firm envelope of the part to which they were applied; they 366 
FIRST AID TO THE INJURED, 
make excellent head-bandages on account of their staying quali- 
ties. (3) Muslin bandages are found in all lengths and breadths 
and can be smoothly applied to all parts of the body. The tech- 
nique of their application will be shown in the practical exercises 
that will follow. 
Some years ago a so-called “ wound-package ” was proposed by 
Prof. v. Esmarch, intended to be carried by every soldier in the 
field. This package has done great service in the last Franco- 
German war and also in the wars of the English against the 
Boors, in Ashantee, Egypt and the Caucasus. This little package 
contains a triangular bandage, two small pieces of sublimate gauze 
to be used as compresses, and a gauze bandage four inches broad 
and six feet long. The whole is well packed and wrapped up in 
water-proof material, about four inches square and not weighing 
over three and a half ounces. 
In cases of simple gunshot wounds (see fig. 22), one of these 
gauze compresses is placed over the wounded part after removing 
the water-proof wrapper. In cases of large wounds, the gauze com- 
presses are unfolded so as to cover the entire exposed surface with 
them. The bandage (roller) is then applied over the gauze com- 
presses to keep them in place, and the triangular bandage is used 
for the further protection of the wound, for purposes of support 
of the wounded member or for tying on splints. 
The package may be worn on most any part of the lining of a 
soldier’s or sailor’s uniform. 
The triangular cloth bandage has become one of the most 
generally used bandages in first aid. The bandage ought to 
measure at its base about 60 inches, its height to the tip or point 
ought to be thirty inches. In its simplest manner it is applied 
folded together after the manner of a neckerchief. Figs. 23 and 24 
show how it is applied to the hand and foot, and fig. 22 shows 
how it is used over the dressing of a wound. In tying the 
ends together use the sailor’s knot, not the false knot, as shown in 
figs. 25 and 26. In order to cover the entire hand and foot, the 
bandage is spread out; the base of it is placed at right angles to 
the long axis of the part to be covered in, its tip is carried around 
the part, then the two remaining ends of the bandage are crossed 
in front of the point, wound around the limb and tied at the most 
convenient place. See figs. 27 and 28. 
When it is to be applied to the head (fig. 29), lay its base across Fig. 22.—Shows how to dress a simple wound. 
Fig. 24.—The triangular 
bandage applied to foot. 
Fig. 23.—The triangular bandage applied to hand. 
Fig. 25.—False knot. 
Fig. 26. — Sailor’s knot. 
Fig. 27.—Bandage applied 
to foot unfolded. 
Fig. 29.—Triangular bandage applied to head. 
Fig. 28.— Bandage applied to hand unfolded. Fig. 30.—Triangular bandage applied to chest. 
Fig. 32.—Triangular bandage applied to hand, 
elbow and shoulder, with small arm-sling. 
Fig. 33.—Shows different methods of applying 
triangular bandage. 
Fig. 31.—Triangular bandage applied to head, shoul- 
der, elbow and chest. AND TRANSPORTATION OF THE WOUNDED. 
367 
the forehead near the eyebrows, turn the cloth over the top of the 
head, its point hanging down over the back of the neck; now take 
the two corners, carry them to the back of the head above the ears, 
there cross them and bring them back, tying them together over 
the forehead; lastly, take up the tip end, pull it up over the head 
and secure it with a safety pin as shown in fig. 29. In this manner 
wounds on almost any part of the head can be covered. 
In wounds about the chest, after proper treatment by disinfec- 
tion and tying over them the gauze compresses with the roller 
bandage, the triangular bandage is placed over the chest with the 
point over one of the shoulders, whichever seems the most con- 
venient, the two ends carried around the chest and there knotted; 
the point is secured to one of the other ends as represented in 
figs. 30 and 31. 
In wounds of the shoulder, lay the center of the bandage on the 
top of the arms, with the point up the side of the neck, the lower 
border lying at right angles to and at about the middle of the arm; 
carry the two extreme ends around on the inside of the arm, cross 
them, bring them back on the outside and tie them there. Fold 
a second bandage and make a small arm-sling of it, then draw the 
point of the shoulder bandage under the sling, fold it back on itself 
and fasten with a safety pin on top of the arm. See figs. 31 and 32. 
In wounds of the upper arm, place the center of a broad-folded 
bandage on the front of the limb, carry the ends round to the 
opposite side, cross them, bring them back and tie them together. 
Next make a small arm-sling as follows: take a second broad- 
folded bandage, throw one end over the shoulder on the wounded 
side, carry it around the neck so as to make it visible on the 
opposite side, then bind the arm carefully and carry the wrist 
across the middle of the bandage hanging down in front of the 
chest; this done, take the lower end over the shoulder on the 
sound side and knot the two ends together at the nape of the neck. 
In wounds of the forearm, bandage the wound as in the preceding 
case, then make a broad arm-sling as follows: take a second 
bandage, throw one end over the shoulder of the sound side and 
carry it around the back of the neck, so as to make it appear on 
the opposite side, where it is to be held fast. Place the point of the 
bandage behind the elbow of the injured arm and draw down the 
other end in front of the patient’s chest. Next place the arm 
across the chest over the middle of the cloth, then pick up the 368 
FIRST AID TO THE INJURED, 
lower end, carry it upwards to the shoulder on the wounded side 
where it meets the upper end and the two may be tied together; 
the point may now be drawn forward around the elbow and 
pinned. Figs. 35, 36 and 37. 
The method of applying this bandage to wounds of the thigh, 
knee, leg and other parts may easily be inferred from the foregoing. 
See figs. 33, 35, 36, 37. 
A very practical and useful bandage, also, is the quadrangular 
bandage of Esmarch, which, as very well shown in figs. 38 and 39, 
may be made to be used as a protection for the head and a good 
part of the neck. In size it is about one meter square. Before 
applying it, fold it so that the broad margin of one half of the cloth 
projects about four inches from below the other half; in this way 
put it over the patient’s head so that the middle line of the bandage 
comes to lie over that of the head, the narrow lateral margins being 
allowed to fall over the sides of the neck and shoulders. Adjust it 
so that the lower border of the under layer just covers the tip end 
of the nose, and that of the upper layer is in line with the eye- 
brows (fig. 38). Of the four comers now hanging down in front of 
the neck and upper part of the chest, take the two outer ones and tie 
them fast to the chin and underneath it; the two inner corners are 
pulled out, the border covering the nose is folded up over the fore- 
head, and the two corners are carried back over the ears and tied 
behind (fig. 39). 
This bandage, like the triangular one, may also in some special 
cases be used for making a sling (fig. 34). In rough weather the 
quadrangular bandage is a most useful one. 
In general terms, the triangular and quadrangular bandages may 
be said to serve the following purposes: 
1. As a protection of the parts from dust, heat, cold and insects. 
2. To exert a certain pressure over bleeding surfaces, so as to 
aid in arresting hemorrhage. 
3. To keep the injured parts at rest and for the securing of 
splints. 
Another very convenient bandage, easily applied to the head, is 
the four-tailed bandage (fig. 40). This consists of a piece of muslin 
thirty inches long by seven wide, slit from both of its ends to within 
three inches of the center. In order to fix a dressing on the top of 
the head, lay the center of the bandage over it. Tie the two front 
ends at the nape of the neck and the two back ends under the Fig. 34.—Shows quadrangular bandage 
used as a large arm-sling. 
Fig. 35.—Shows different methods of 
applying triangular bandage. 
Fig. 36.—Shows different methods of 
applying triangular bandage. 
Fig. 37.—Shows different methods of 
applying triangular bandage. 
Fig. 38.—Shows quadrangular 
bandage folded and placed 
over the head. 
Fig. 39.—Shows quadrangu- 
lar bandage properly ap- 
plied. 
Fig. 40.—Shows how to apply 
the four-tailed bandage. AND TRANSPORTATION OF THE WOUNDED. 
369 
chin. To keep a dressing on the back of the head, tie the front 
ends under the chin and the back ends over the forehead. 
The four-tailed bandage may also be applied to the jaw, but then 
it only needs a width of three inches. Slit the ends so that four 
equally long ends are produced, leaving an unslit portion in the 
center about three inches long. In the center of this portion cut 
a hole for the chin. Place the chin into this, carry the lower two 
of the four tails upwards and tie them on top of the head, and finish 
by tying the upper two tails at the back of the neck. Fig. b 
shows bandage applied to eye. 
Practical exercises: Bandaging. 
Fig. b. LECTURE III. 
INJURIES OF THE SOFT PARTS. 
The injuries which we are liable to meet with vary much in 
nature and in gravity. A slight hurt, such as a blow from a man’s 
fist applied to most any part of the body, is hardly ever very dan- 
gerous in its consequences and, therefore, needs scarcely any med- 
ical attention. An injury inflicted by means of a sharp instru- 
ment, resulting in an open wound, though this wound is not very 
deep, is already a much more serious injury, requiring skilled 
surgical treatment. If the instrument, which may be a knife, 
spear, sword or dagger, has penetrated into the cavities of the body 
in which are contained the heart, lungs, liver, stomach, intestine 
and bladder, the most serious results may be expected. In such 
injuries still greater care and skill are required by the attendant 
than in any of the above-mentioned examples. 
The most serious of all injuries, however, are the so-called gun- 
shot injuries produced by missiles that are propelled by some 
kind of explosive material, and the treatment of which calls for the 
greatest possible degree of skill and judgment on the part of the 
surgeon. Gunshot injuries, as a rule, involve both the soft and 
hard parts of our bodies, giving rise not only to very serious 
penetrating wounds, but also to fractures and dislocations. 
Injuries, as you may see, differ in many ways: they differ in 
accordance with the particular place to which the external vio- 
lence causing the injury is applied; they differ with the kind of 
instrument producing the injury; they differ with the nature of 
the external violence, and so on. 
For our present purpose it will be found both convenient and 
advantageous if we divide all injuries into two great classes, 
namely: (i) Those of the soft parts and (2) those of the hard parts 
of our bodies. In this lecture we will confine our attention to 
the consideration of the injuries to the soft parts, and likewise 
divide them for convenience sake into two classes, namely: (1) 
Contusions and (2) Wounds. AND TRANSPORTATION OF THE WOUNDED. 
37i 
i.—Contusions. 
The large sheet of skin, covering our bodies, possesses to a high 
degree the properties of distensibility and elasticity. It is owing 
to these two properties combined that injuries of the deeper parts 
are possible without any material injury being at the same time 
done to the skin itself, and giving rise to what is known as con- 
tusions. 
Wherever we may be struck by some blunt instrument, the 
skin, owing to its elasticity, will yield to the pressure, temporarily 
exerted on it, and so escape injury. It is different with the more 
delicate tissues which lie beneath the skin, namely, the small 
arteries, veins and nerves; these are generally ruptured, the arteries 
and veins pouring their contents into the artificially formed spaces 
caused by the injury beneath the skin and their neighborhood. 
If the amount of blood which has escaped is small, then a slight 
discoloration of the skin will be the only noticeable result of the 
injury. When, however, the violence producing the injury was 
considerable and directed to a place where there is a great deal of 
loose cellular subcutaneous tissue, then the effusion of blood will 
be correspondingly large and will give rise to what is known as a 
blood-boil. We will then have a more or less distinct and poorly 
circumscribed swelling, easily yielding to pressure, covered by a 
much discolored skin, and in which fluctuation may easily be de- 
tected , owing to the fact that not all the effused blood undergoes 
coagulation, some of it remaining fluid. 
If the injury occurred to a certain part of the body which is 
richly supplied with lymph-vessels, the result would be a rupture 
of these and an effusion of lymph with comparatively little blood. 
The resulting tumor would be much cleaner looking on account 
of the lack of discoloration; it would also be much larger and 
present much greater fluctuation. 
Blood, having once left the blood-vessels, does not again return 
as such into the general circulation; it coagulates after a short 
while, the coagulum degenerates and the resulting fluid is taken 
up and absorbed by the lymph-vessels. The length of time which 
this process occupies, of course, depends on the amount of blood 
to be absorbed; absorption is, as a rule, very slow, as may be in- 
ferred from the time it takes for the discoloration to disappear. 
The discoloration of the integument, due to the absorption of the 372 
FIRST AID TO THE INJURED, 
escaped blood pigment, passes from a bluish-brown to a green and 
light yellow and then disappears without leaving a trace. 
The degree of pain felt after a contusion depends on the amount 
of injury done to the nerve-twigs of that neighborhood. 
Sprains, so called, present a similar condition of things, 
although not commonly classed under the head of contusions 
and most generally understood as injuries involving joints. 
Nevertheless we find that sprains, like contusions, are accom- 
panied by swelling and pain, owing to the effusion of blood or 
lymph and the rupture of the finer nerve-twigs at the seat of the 
injury. The ligaments about the joint may be overstretched or 
torn completely across, owing to the forcible separation of the 
bones forming the joint incident to the injury received. The 
amount of swelling accompanying such an injury to a joint is 
usually very great, the skin glistens and feels hot, the usual bony 
prominences have disappeared, and the pain is very severe and on 
the increase. To the touch, the swelling conveys the impression 
of a soft, jelly-like mass situated beneath the skin, consisting, as 
it does, of a coagulum of blood and lymph mixed together. 
On account of the local disturbance in the circulation, conse- 
quent upon the rupture of blood- and lymph-vessels, collateral 
circulation and increased transudation of blood-serum through the 
distended and partly paralysed coats of the blood-vessels must take 
place, which still further increases the affected swollen and oedem- 
atous area. Local inflammation and slight general fever will be 
found not infrequently complicating such cases. 
The treatment of the injuries described so far must differ in 
accordance with the length of time that was allowed to elapse 
from the moment the injury occurred to the time when the first 
help was administered. In case several hours have elapsed and 
the pain and swelling greatly increased, all that you can do is to 
place the limb at rest, slightly elevating it and making cold appli- 
cations with either water or ice. If, however, you should happen 
to be on the spot but a short time after the occurrence of the 
injury, then massage the part without further hesitation. The 
influence of massage on these injuries is twofold: (i) It allays the 
pain, although, perhaps, itself somewhat painful in the beginning. 
(2) It initiates and accelerates the otherwise long and tedious 
process of the absorption of the effused blood and lymph, in this 
manner shortening the duration of the healing process and thus AND TRANSPORTATION OF THE WOUNDED. 
373 
restoring the parts to their usefulness in a much shorter space of 
time than when left to themselves. Massage consists in a number 
of peculiar mechanical manipulations of the injured parts, all 
carried out by the hands and finsrers of the attendant, such as 
rubbing, pressing and beating. In fresh injuries gentle rubbing 
alone is admissible, and this must always be done in the direction 
from the periphery towards the center. In order to facilitate the 
gliding of the hand over the parts and also to prevent injuring the 
skin, the parts must first be oiled. Let us take, for example, a 
fresh sprain of the wrist-joint which is fit for massage. You 
would grasp the fingers of the injured extremity with your left 
hand and pull them slightly away from the wrist; then, with the 
right hand, after oiling the back of the hand, wrist and part of the 
forearm, you would begin by making at first very gentle and slow 
movements with the flat of your hand or the palmar surfaces of 
your fingers, and carry them up to about the middle of the fore- 
arm of your patient; there you take off your hand and go back to 
whence you started, and so on. Very soon the severe initial pain 
will cease and now you will apply a little more pressure; after a 
little while, turn over your patient’s hand and treat the other side 
in the same manner. In this way you may continue for from 20 to 
30 minutes at a time, repeating the process whenever necessary. 
Remember, however, that both in the beginning and towards the 
end of the massage the pressure to be applied must be of the 
gentlest kind. 
The object of the massage is to cause a quick return of the 
effused blood and lymph into the circulation through the lymph- 
vessels, hence also the necessity of rubbing in the direction 
of the course of these vessels, that is, from the periphery towards 
the center. After the massage the injured parts are to be covered 
with wet compresses and a bandage. Under this treatment a 
sprained wrist or ankle will get well in a few days, while under 
the delayed treatment as many weeks may pass by. 
There is still another class of injuries, occurring now and then, 
in which the skin also remains unbroken, but with much more 
serious injury done to the deeper parts than the mere rupture of 
blood-vessels and lymphatics, and which we must consider here. 
The ligaments and capsules of joints, tendons and muscles are 
frequently torn by certain kinds of direct or indirect violence with- 
out the skin being broken ; but the most serious complications of 374 
FIRST AID TO THE INJURED, 
contusions, by far, must be looked for in injuries involving the 
head, chest and abdomen. In blows upon the head that are not 
sufficient to either cut the skin or fracture the skull, the brain may 
receive such a shaking-up as to give rise to a temporary paralysis 
of the brain-centers, including the vaso-motor-centers. The face 
of the injured person suddenly becomes very pale, his limbs feel 
cold and his temperature falls below the normal. There is loss 
of consciousness and general sensation, the patient lying perfectly 
motionless on the ground; his eyes are closed, the pupils widely 
dilated and not reacting to light. Breathing is frequent, feeble 
and shallow; the pulse frequent, feeble and fluttering, sometimes 
almost imperceptible. There may be vomiting and involuntary 
evacuations taking place from the bladder and rectum. 
Symptoms of paralysis and convulsive twitchings, however, are 
not part of the symptoms of mere concussion of the brain. If you 
should find such symptoms present, about the face or any of the 
extremities, then the case ceases to be one of concussion of the 
brain and will prove to be one of more profound injury to the 
brain, for paralysis is a symptom of compression of the organ; 
the compressing agent may be either blood or a fragment of the 
fractured skull. 
In concussion of the brain the symptoms that present them- 
selves are not unlike those that occur in an ordinary fainting-fit; 
in both cases we have to deal with a condition of anaemia of the 
brain. An uncomplicated case of concussion may last from several 
minutes to so many days, but is seldom followed by death, and 
when it is the concussion will always be found, on post-mortem, to 
be associated with more serious injury, perhaps laceration of the 
brain-substance. 
First Aid in such cases consists in placing your patient in a 
horizontal position with the head low! To raise the body or 
even the head under such circumstances would mean harm, not aid; 
it would retard the return of consciousness directly. Next, you 
must take off your patient’s clothes and cover him up with warm 
blankets or, better, warm bottles; as soon as consciousness returns, 
give him some warm tea or a very small quantity of brandy; the 
head is to be covered with cold compresses, for the reason that, 
in the reaction which follows the condition of anaemia of the brain 
and which consists in congestion of the organ, cold is the only 
remedy that can be safely applied to counteract it or prevent it AND TRANSPORTATION OF THE WOUNDED. 
375 
from being too violent. In watching the patient closely and 
carefully you will observe this reaction to occur in the face, the 
extremities and the whole body; the entire surface becomes 
gradually warm and red. In case this reaction is unduly delayed 
you may be called upon to bring it about reflexly by holding some 
strong-smelling substances under his nose, such as ammonia, or 
by sprinkling cold water into his face, also giving him a cold 
enema of vinegar; if, however, on the contrary, the reaction is 
prompt, then remember that rest is what your patient most needs, 
and you should do all in your power to keep every body and every 
thing away from him that will interfere with his rest. Rest and 
fresh air will now do all that remains to be done. 
Concussion of the brain is, furthermore, frequently associated 
with concussion of the spinal cord, as is well shown by the pallor 
and decreased sensibility of the skin, as well as by its coldness. 
A case of concussion of the cord, pure and simple, passes off with- 
out leaving a trace; any symptoms of paralysis or convulsive 
movements on the return of consciousness, or any involuntary 
evacuations from the bowels or bladder, or the presence of areas 
of lost general sensibility with subjective pains in the parts or 
paralysis, would indicate injury to the substance of the cord itself 
by pressure or otherwise. The result of such an injury is always 
a sad one, and all you can do for it as first-aid-men is to secure 
for your patient as comfortable as possible a position and perhaps 
place ice over the spine. 
Shock, so called, is the result of a concussion of the sympathetic 
nervous system (fig. 41). A sudden fright, a fall, a blow on the 
stomach, injuries involving the complete loss of an entire limb, 
received suddenly, large and extensive burns, may be followed by 
shock. The patient is usually pulseless, pale, with a changed facial 
expression, deep blue rings about the eyes, covered with cold per- 
spiration, vomits frequently and complains of great thirst. In some 
of these cases the diagnosis may be difficult and even impossible. 
In the more serious cases, those that are complicated with severe 
injury to the internal organs, the best that can be expected of 
you is: 
1. That you send immediately for a physician. 
2. That you loosen all tight clothing or take them off altogether, 
according to the circumstances of the case. 
3. That you place the injured person in a comfortable position, 
allowing no one to handle it until the physician arrives. 376 
FIRST AID TO THE INJURED, 
4. That the head be placed low when face looks pale and when 
fainting; high when face looks red. 
5. That you sprinkle cold water into his face when no pulse is 
perceptible at the wrist. 
By so doing you may save the patient’s life. Do more and you 
may be the cause of his death! 
2.—Wounds. 
While in contusions the skin remains entire, in wounds it is 
divided and thus the deeper tissues of the body are exposed. A 
wound may be superficial,—in other words, the skin and superficial 
veins may be the only structures that are injured, in which case it 
may not be immediately dangerous to life. Or the wound may be 
deep and the more important deeper structures, such as arteries 
and nerves, muscles and tendons, may have suffered, in which case 
life may be endangered from loss of blood. Both deep and super- 
ficial wounds, however, equally expose thq organism to the 
danger from infection by micro-organisms, and hence the greatest 
amount of surgical cleanliness is always called for in the dressing 
of all wounds, whether they be superficial or deep, great or 
small. 
Just as in the case of a contusion, the gravity of a wound differs 
in accordance with its location and the consequent amount of 
injury done to the deeper parts, namely, arteries, nerves, lungs, 
heart, brain, stomach, intestine, liver, etc. But let us, for the 
present at least, disregard all such cases in which wounds are 
complicated by injuries to the vital organs that are contained 
in the different cavities of the body, and let us, furthermore, sup- 
pose for a moment that you are perfectly familiar with the means 
and methods of arresting hemorrhage, a subject of which you 
will hear in the last part of this lesson; the question arises: What 
is the best that you can do for this wound until the surgeon comes 
and assumes charge of it. The answer to this question that I 
should give would be that if, after hemorrhage is arrested, you 
have put on such a dressing as will prevent the invasion of the 
wound by micro-organisms, it is the very best that could be ex- 
pected from you, and that the service which you have rendered 
your patient by so doing is of the greatest possible importance 
to him. The next question then is: What does an antiseptic 
dressing consist in? Antisepsis means nothing more nor less than Fig. 42. — Healing by first intention. 
Fig. 43.—Healing by second intention. 
Fig. 41.—Shows the sympathetic system 
of nerves and their ganglia. 
Fig. 45.—Showing constricting bandage 
applied to forearm in cases of a poison 
having been introduced into the hand. 
Fig. 44.—Irrigator made from a bottle. AND TRANSPORTATION OF THE WOUNDED. 
377 
absolute cleanliness. In the first lesson you have learned some- 
thing with regard to how this is attained so far as your own 
persons are concerned; the same principles also apply to all 
wounds, only the practice differs somewhat. To a freshly made 
wound you would not apply a brush and wash with soap and water, 
but the surface of the skin around the wound should be treated 
thus. All clothing in the neighborhood of the wound should be 
removed; your own hands should be scrupulously clean, the 
wound should not be touched with anything that is not absolutely 
clean; anything adhering to the wound, such as clothing, sand, etc., 
should be carefully removed; the wound itself thoroughly cleansed 
by irrigation with some antiseptic lotion; a compress of antiseptic 
cotton and gauze put over it and a clean bandage over the whole. 
In the practical part of this lesson we will put on such a dressing 
and make you perfectly familiar with the method of doing so. Of 
course, the injury which you are called upon to treat may happen 
to be in a place where antiseptic solutions, are not available. 
•Under these circumstances you must let your theoretical concep- 
tions of cleanliness be your guide, use water in abundance and do 
the best you can and your duty will be done. 
Let us next consider wound-healing. How do wounds heal? 
While every wound calls for some special treatment which must 
be determined upon by the attendant surgeon, nature, broadly 
speaking, brings about healing in two ways, namely: 
1. Very quickly, through agglutination, without suppuration and 
with a fine linear cicatrix (fig. 42). It is always and should be the 
intention of the surgeon to aid nature as much as possible to bring 
about this rapid form of healing of wounds, which process, how- 
ever, can only take place under the following favorable condi- 
tions, namely: (a) the margins of the wound must be brought 
into exact contact; (b) bleeding must have been so thoroughly 
arrested that the margins will not again be separated or pressed 
apart by secondary hemorrhage; (c) the parts must be kept at 
absolute rest by properly applied apparatus; (d) the wound must be 
in a state of asepsis, that is, absolutely clean (fig. 42). 
2. The second form of wound-healing takes place slowly, with 
suppuration and under the formation of proud flesh, finally leav- 
ing a broad red scar or cicatrix. This form of healing takes 
place whenever the above-named favorable conditions are want- 
ing, namely: (1) whenever a good deal of skin was torn away, so 378 
FIRST AID TO THE INJURED, 
that the wound gapes, or when its margins have been so thoroughly- 
bruised up that they are absolutely dead; (2) when, through 
bleeding, the margins of the wound are pressed apart; (3) when- 
ever the injured parts are not kept at the requisite rest, through 
bad transport or insufficient apparatus, which is most likely to 
happen in times of war; (4) wounds never heal by first intention 
unless they were in a state of asepsis at the time the sutures were 
put in (see fig. 43). 
Every particle of dirt that was left in the wound sets up local 
inflammation, which is accompanied by that slow and tedious 
process known as suppuration. The matter accumulates, presses 
apart the margins of the wound, proud flesh grows up from the 
bottom of the wound and a broad cicatrix results. But besides 
this, the infection of wounds and their subsequent suppuration in- 
duce a far more serious condition than the production of a merely 
unsightly scar; they are accompanied by what is termed wound 
fever, threatening the very life of the patient. This, however, 
was the usual way in which wounds were allowed to heal, up to 
about 20 years ago, when surgeons began to find out the great 
importance that absolute cleanliness played in the healing process 
of wounds. In fact it is doubtful that the very significance of 
the word cleanliness was understood previous to that time, 
certainly not in its relation to the process of the healing of 
wounds. 
The object of the surgeon is to produce healing according to 
the first method, if otherwise the circumstances are favorable and 
will permit it. This process is also called “healing by first 
intention.” 
The surgeon endeavors, if possible, to bring the margins or 
edges of the wound .together, keeping them in contact throughout 
by means of properly adjusted sutures that are supplemented by 
a supporting bandage. Plasters for the purpose of bringing the 
margins of wounds together belong to the old method and find 
no place in modern surgery. All bleeding is arrested by the 
tying or ligating of all the vessels, arteries and veins with 
threads of cat-gut properly prepared and previously made aseptic. 
Cat-gut is used for this purpose because it is absorbed by the 
system during the period of healing, and hence these ligatures 
do not require removal. 
The wounded part is completely surrounded by a permanent AND TRANSPORTATION OF THE WOUNDED. 
379 
dressing, affording it not only absolute rest, but also protection 
from injury and dirt; formerly the dressing was removed daily; 
now the first dressing remains until the wound has had time to 
heal, a period varying from io to 14 days. 
But the most important factor in the quick process of wound- 
healing is and remains proper attention to surgical cleanliness, 
as has already been described. 
The processes going on in the wound while it is healing are, 
under normal circumstances, about as follows: The edges of the 
wound having been carefully adjusted, an effusion of lymph from 
the divided lymph-vessels takes place; this lymph coagulates and 
forms a sort of cement which glues the surfaces together. A new 
formation of blood capillaries and a proliferation of connective 
tissue corpuscles follows immediately and, in the end, brings 
about the more organic union of the parts. The whole process 
is completed within about one week. If, however, it should happen 
that the two wound-surfaces were not in close contact, the remain- 
ing space would be filled with coagulated lymph and blood and 
would form what is generally called a “ dead space.” Providing 
the wound was aseptic, a rapid division and proliferation of con- 
nective tissue corpuscles would take place from the walls of this 
space, new formation of capillaries would quickly follow, accom- 
panied by the immigration of white blood corpuscles which would 
quickly consume the coagulated mass, and a broad cicatrix be the 
result. In either case there is no fever nor any other disturbance 
of the bodily functions, the patient feeling perfectly well. A 
freshly formed cicatrix is always red, from the large number of 
newly formed capillaries which it contains; as these disappear in 
due time the cicatrix assumes the paler color of the surrounding 
skin and becomes less noticeable. The question is often asked 
as to whether this or that wound will leave a scar. Whenever the 
skin is divided in its entirety, a scar will surely be the result; 
but when the epidermis alone is divided without including its 
underlying connective tissue cutis, then no scar need be feared. 
The second form of wound-healing is, as has been remarked, 
accompanied with suppuration. Up to about 20 years ago sup- 
puration was believed to be a necessary accompaniment of the 
healing process. We now know for certain that the process of 
suppuration in a wound is an abnormal one, produced by the in- 
vasion of the wound by a well-defined species of micro-organism; 380 
FIRST AID TO THE INJURED, 
we can, furthermore, most positively assert that these same micro- 
organisms are the direct cause of the so-called wound-fever which 
invariably accompanies this form of healing. In this form of 
healing the same division and proliferation of connective tissue 
corpuscles and migration of white blood corpuscles take place 
as in the other form, but their fabric is interfered with by these 
micro-organisms, the building material destroyed and discharged 
and hence lost to the economy. Under proper care healing 
finally takes place by the formation of granulations from the 
bottom up and resulting in a broad cicatrix. 
Let us now assume we have before us a fresh wound which 
is covered by a cake of coagulated blood, what are you to do 
with it? Whenever the dressing to be put on is intended to be 
merely a temporary protection of the wound from infection until 
the surgeon arrives, then you may confine your work to cleaning 
the surface of the wound and the surrounding parts with some 
antiseptic lotion without interfering with the blood-clot, and cover 
it with antiseptic gauze and a bandage. 
If, on the other hand, more than 12 to 24 hours be most likely 
to elapse before surgical aid can be secured, then the coagulated 
blood-clot had better be removed by an irrigator; some iodoform 
must be dusted over the surface, 8 or 10 layers of gauze, best iodo- 
form gauze, placed over it and folded large enough to slightly 
overlap the wound; a sheet of India rubber cloth is now placed 
over the gauze and some absorbent cotton over the latter; the 
whole is covered by a bandage and the part of the body in which 
the wound has occurred kept at rest. The India rubber cloth is 
to prevent the air getting into the wound which might be in- 
fected, and also to prevent too rapid drying of the exuded lymph 
and give rise to an inconvenient scab. 
In hospitals so-called irrigators are in constant use; these are 
simply vessels of either glass or metal and provided with rubber 
tubes through which the outflow can be regulated. A fine stream 
of most any antiseptic lotion may in this way be made to flow 
over any wound for the purpose of cleaning it and disinfecting it. 
Such an irrigator may be extemporized in a simple manner from 
any bottle. A bottle is provided with a doubly perforated cork; 
into one of the holes in the cork a short piece of glass tubing is 
introduced and into the other a long piece reaching to the bottom 
of the bottle. The bottle is now filled with the lotion and the cork AND TRANSPORTATION OF THE WOUNDED. 
3«i 
with its glass tubes fitted to the bottle. On inverting the bottle 
a fine stream will flow through the short tube and may be directed 
anywhere. 
The second or air tube may be omitted, if we cut off the bottom 
of the bottle (fig. 44). This can be accomplished with a stout 
cord passed around the bottle once or twice at a point at which 
it is intended to cut, the ends of the cord to be fastened. The 
bottle is now moved to and fro very quickly until by the friction 
that point has become very hot, then cold water is poured over 
it and the bottom will crack off. 
Sponges are never used now-a-days in the treatment of wounds. 
The difficulty in the way of cleaning them thoroughly has deter- 
mined surgeons to discard them altogether. Absorbent cotton 
soaked in some antiseptic solution and then pressed out is an 
excellent substitute for the sponge and is now generally used. 
There are sometimes combinations of circumstances that re- 
quire you to watch your wounds with special care and vigilance, 
and to which it may be well to call your attention before closing 
this chapter. Whenever it happens that a wounded person has 
become unconscious either owing to loss of blood or to shock, all 
hemorrhage would naturally cease, though large blood-vessels 
may have been divided and lie gaping at the bottom of the 
wound. In such cases the hemorrhage would recommence on 
the return of consciousness, and unless it would find you prepared 
to meet this emergency your patient would most surely succumb. 
The most important disinfectants used in the dressing of wounds 
and the cleaning of the hands are the following: 
Carbolic acid 2-3 per cent. 
Boracic acid 2-3 “ 
Thymol 1 “ 
Benzoic acid . “ 
Salicylic acid ' 1 “ 
Chloride of zinc 1-3 “ 
Corros. sublimate per thousand. 
Poisoned Wounds. — Sailors, especially men - of - war’s men, 
traveling all over the world and spending a good share of 
their time in tropical countries in which snakes and other animals 
are plenty and the bites of which are more or less poisonous, 
should be somewhat familiar with the methods of treating pois- 
oned wounds. 382 
FIRST AID TO THE INJURED, 
Whatever is to be done in such cases must be done quickly. 
Any poison introduced into the system through a wound is taken 
up either by the veins or the lymph vessels, which, as you will 
remember, carry their contents, and consequently any foreign 
substance gotten into them, towards the heart 
Accordingly, your first thought must be of the prevention of 
this, and you can keep the poison from getting into the circulation 
by applying a constricting bandage above the wound, that is, 
between the wound and the heart (fig. 45). 
Wounds from poisonous snakes, poisoned arrows, insects or 
dogs must all be treated alike. After the bandage is secured, rub 
the limb in the direction from the center towards the periphery, be- 
ginning at or near the bandage, thus squeezing out any poison 
which may have entered the lymphatics; then wash out the 
wound, burn or cauterize it as much as may seem necessary. 
Internally, the administration of whisky with a small amount 
of ammonia added to it has, according to the most experienced 
travelers, proved of great service. A large quantity of drinking- 
water should also be kept ready, for thirst comes on after a time 
and is very urgent. This thirst had better be satisfied. 
Hemorrhage.—The prompt and effectual arrest of hemorrhage 
must be considered the first and foremost duty of the first-aid- 
man. 
Every wound bleeds because in every wound certain blood- 
vessels have been severed and from their divided ends blood must 
flow. The character of the hemorrhage varies, very naturally, 
with the depth and extent of the wound and the kind of vessels 
wnich were divided. Thus, for instance, in cases in which blood 
merely oozes out of the wound, not very copiously at that, we 
probably will find, on closer examination, that the divided vessels 
are of the smallest caliber, called capillaries. Whenever blood 
flows in a constant stream and is of a dark color, it most likely 
comes from a divided vein (see fig. .46). When, however, the color 
of the blood is of a bright red or scarlet, spirting out of the wound 
in an intermittent stream, then you may be sure that one of the 
arteries has been wounded (see fig. 47). 
Hemorrhage from an artery is by far the most dangerous form, 
the danger increasing in direct proportion to the diameter of the 
bleeding vessel; the hemorrhage will also be greater when the 
artery has only been partially divided than it would be had it Fig. 46.—Venous 
hemorrhage. 
Fig. 47.—Arterial 
hemorrhage. 
Fig. 48.—Method of making 
digital central compression 
over the femoral artery. 
Fig. 49 —Digital compression of the carotid. 
Fig. 50.—Digital compression of the brachial against the head of the humerus. AND TRANSPORTATION OF THE WOUNDED. 
383 
been completely cut across. Arteries that are completely cut 
across retract into the tissues and their lumina become much 
smaller than normally; the internal coat of the artery, besides, 
curls upon itself and sometimes entirely occludes the vessel. 
Arteries that are merely wounded cannot save themselves in this 
way. 
The first thing to be done, in cases of arterial hemorrhage, 
is to compress the bleeding vessel with the fingers either locally, 
in the wound itself, or at some point of its course outside of the 
wound. This is called digital or manual compression. Com- 
pression of the artery in the wound, or local compression, does 
not require as much force as compression outside the wound 
or central compression; for the former method only one hand 
suffices, its thumb or two of its fingers resting on the vessel; 
in central compression both hands are generally needed, on ac- 
count of the great resistance offered by the tissues surrounding 
the vessel. In order to find the vessel in its course outside the 
wound you must be sure of your anatomical guides, for pulsation 
is either very feeble or altogether absent in a bleeding vessel, 
especially so after considerable loss of blood has taken place. 
After having found the vessel, surround the limb with both 
hands (see fig. 48) and place both thumbs, one on top of the other, 
over the vessel, using, however, only one thumb at a time for 
compression; as soon as the one thumb gets tired, compress with 
the other without changing their former position. It is in this 
way only that digital compression can be kept up for any length of 
time, otherwise the strength would fail in both thumbs at the same 
time and any further compression of the artery become an impos- 
sibility. Instead of the thumbs, the finger-tips may also be used 
advantageously, but then, of course, the surrounding of the limb 
with the hands is not possible at the same time. 
In trying to find and compress an artery in its course it will 
be well to remember that all large vessels lie on the flexor side of 
the extremities and that it is always preferable to make compres- 
sion over the main trunk of the vessel. In hemorrhage about the 
head and face, it is the large neck-artery, the carotid, which needs 
to be compressed; in hemorrhage from the arm it is the axillary 
artery, and in the lower limb it is the large thigh-artery or femoral. 
The large arteries in the neck, or carotids, lie on either side, 
beneath and behind the two long muscular cords that reach from 384 
FIRST AID TO THE INJURED, 
the top of the sternum to a point behind the ear. For the purpose 
of compressing these, and in order to avoid compressing the wind- 
pipe and thus interfering with respiration, both hands must be 
used, and the finger-tips pushed in underneath these muscles from 
both their margins and the artery compressed against the spine, 
as shown in figure 49. 
The artery of the upper arm, the brachial, as it is called, runs 
along the inner margin of the large flexor muscle, the biceps, and 
may there be compressed against the large arm-bone, or it may be 
followed up into the axilla and compressed against the head of 
that bone (see fig. 50); in cases where the great arm artery is cut 
in the axilla, pressure must be made over the collar-bone and the 
artery compressed against the first rib, at the same time pulling 
the shoulder forcibly backwards (see fig. 51). 
The main trunk of the artery of the lower limb runs from 
about the middle of the groin towards the inner side of the knee, 
and may be compressed in the upper two-thirds of its course 
against the thigh-bone, as shown in fig. 48. 
Besides digital or ma?iual compression, we have also what is 
called instrumental compression, in which tampons and bandages 
are used to take the place of fingers and hands. Just as in digital 
compression, we may here also, according to circumstances, 
employ either local or central instrumental compression. In 
local instrumental compression the wound must be packed with 
antiseptic tampons and surrounded by a bandage (fig. 52); in the 
extremities, besides making compression over the wound, the 
parts below must be surrounded with a snugly fitting bandage, 
especially if the compression at the wound is to be kept up for 
some time. 
In central instrumental compression tourniquets were formerly 
used, but actual experience in the field as well as in hospitals has 
demonstrated their uselessness, so that they are now altogether 
obsolete. In this form of compression the simplest piece of 
apparatus that is used consists of a plain piece of cloth, handker- 
chief or neckerchief, which is wound around the limb; a short stick 
is then pushed underneath it and turned until the bleeding stops. 
In order to avoid including folds of the skin in the twist a piece 
of pasteboard or other substance is placed between it and the skin, 
as shown in fig. 53; another method of compressing the brachial 
artery may be seen in figures 54 and 55. But the safest and surest Fig. 52.—Local instrumental compression by tampon 
made of iodoform gauze. 
Fig. 51.—Digital compression of 
the subclavian against the first 
rib in cases of hemorrhage 
from the axillary artery. 
Fig. 53.—Central instrumental compression of the brachial by means of a triangular 
bandage. 
Fig. 54.—Other methods of compression 
of the brachial artery. 
Fig. 55.—Other methods of compression 
of the brachial artery. Fig. 56.—Central instrumental compression 
of the femoral. 
Fig. 57. — Same as 56, by means of a 
piece of elastic tubing. 
Fig. 58.—Shows method of applying elastic bandage 
for the purpose of compressing the femoral artery. 
Fig. 59.—The elastic suspender 
of Esmarch. 
Fig. 6o.—Auto-transfusion. AND TRANSPORTATION OF THE WOUNDED. 
385 
method of instrumental compression is that of surrounding the 
limb with an elastic cord, and it matters not whether this is an 
elastic bandage, a piece of rubber tubing, or even an elastic 
suspender (see figures 56, 57, 58 and 59). In all cases of 
hemorrhage of whatever kind, the vertical suspension or passive 
elevation of the limb will always be found to prove a great aid in 
our efforts of accomplishing its arrest. 
In this circular method of compression it is quite necessary 
that it be complete. If this is not the case,—in other words, if blood 
continues to flow through the main trunk of the vessel into the 
part of the limb beyond the point where circular compression is 
being made, it will be noticed that the hemorrhage from the 
wound suddenly increases on account of the veins above the 
wound being compressed and the return of blood prevented. The 
complete arrest of hemorrhage alone proves that your compres- 
sion is an effectual one, and this must be your aim. 
In cases of hemorrhage from the veins, local pressure at the 
wound by means of an iodoform gauze tampon is mostly always 
sufficient; in cases requiring circular compression it must, of 
course, be remembered that the compressing bandage is to be 
applied peripherally, not centrally. 
Capillary hemorrhage is most always arrested by elevation of 
the limb and constant pressure with an iodoform tampon kept up 
for five minutes. Iodoform gauze is the best material for these 
tampons because it possesses both hemostatic as well as anti- 
septic properties. 
So far we have only considered the subject of arresting hemor- 
rhage from the extremities and the neck; we must next in order 
consider cases of hemorrhage from the different cavities of the 
body and their treatment. 
Hemorrhage from the external ear is rarely, if ever, profuse, 
arising, as it does in most cases, from a ruptured ear-drum; it is 
best treated on the principles of a wound, namely, the passage 
leading to the drum must be thoroughly cleaned out and disin- 
fected and stuffed with antiseptic cotton or gauze. Absolute 
bodily rest, elevation of the head, with ice over the injured side, 
will do the remainder. 
Bleeding from the nose, when due to an injury, must be 
treated by absolute rest and the application of ice-bladders to the 
head and neck. Caution your patient against blowing through 386 
FIRST AID TO THE INJURED, 
his nose or snuffing up anything. If the hemorrhage does not 
yield to these means, the nares must be plucked up by the 
surgeon. * 
Hemorrhage from the mouth is most easily arrested with 
either cold water or pressure with the finger made on the bleeding 
point. In case of bleeding from the sockets of the teeth, which 
is sometimes very persistent and threatens to become dangerous, 
the sockets must be tamponed very tightly with bits of iodoform 
gauze. 
Hemorrhage from the lungs, due to external violence, com- 
mences with a certain amount of blood being coughed up and ex- 
pectorated. In such cases all direct methods of arresting the 
hemorrhage are, of course, out of the question. All the first-aid- 
man can be expected to do is that he place his man at rest and 
thus keep him from further harm; the head and body should be 
elevated, ice-bladders placed over his chest, head and neck, and 
iced drinks administered internally; keep a little ice in his mouth 
and also administer some salt dissolved in very cold water. Drugs 
for the purpose of causing vascular contraction, such as morphine 
and ergot, must only be given by the advice of the surgeon. 
Whenever blood is vomited up, the source of the hemorrhage is 
most probably in the stomach or stomach-tube, resulting from 
direct injury of these organs; the nature of the external injury, 
the place it was received, will, in most cases, greatly assist you in 
your diagnosis. Such an injury is most always accompanied by 
a great sense of fullness over the organ, with great sensitiveness 
on pressure, sweetish taste in the mouth and nausea. The vomited 
masses consist for the most part in partly fluid, partly coagulated 
dark masses of blood, never of a bright red color and uniformly 
mixed with the other fluids, as is the case when the blood is 
coughed up from the lungs. If the stomach contained particles of 
food, these will, of course, form part of the vomited mixture. 
Sometimes it is very difficult, indeed, to exactly locate the source 
of the hemorrhage coming from the mouth; it may come from 
the mouth itself, from the nose, the ear, the pharynx, the stomach- 
tube, the stomach, the larynx, trachea, or the lungs. In such cases 
the diagnosis can only be made by an experienced physician or 
surgeon. Fortunately for the first-aid-man, the general care and 
treatment in all such cases are so much alike that it is of no im- 
mediate practical importance whether the exact source of the AND TRANSPORTATION OF THE WOUNDED. 
387 
hemorrhage is recognized. If, however, the stomach is sus- 
pected to be the source of the blood which was vomited up, put 
your man at rest and administer iced lemonade or alum water 
internally, making at the same time warm applications to the 
extremities, cold applications over the stomach. 
Hemorrhages into the intestinal canal are not immediately 
followed by bloody stools, as might be expected, but may be 
recognized by symptoms indicative of great loss of blood some- 
where, leading even to unconsciousness in some very bad cases. 
The patient suddenly becomes very pale in the face, the lips lose 
their usual red color, the eye loses its accustomed brilliancy, the 
whole body and limbs become cold, fainting spells come on, the 
abdomen begins to swell up and shows great and increasing 
sensitiveness. Besides absolute bodily rest, the local application 
of cold and also bandaging the abdomen with elastic bandages 
may eventually save the patient. Later on, when all danger 
from death by loss of blood is over, the very characteristic 
bloody, black, tar-like stools are passed. It may happen that your 
patient has lost so large an amount of blood before the hemor- 
rhage was successfully checked, that life cannot be sustained on 
the amount that is left in his vascular system. Feeling for your 
patient’s pulse at the wrist, you may find it either very feeble or 
altogether absent. Remembering that the heart is a pump and 
that any pump ceases its work unless supplied with water, so also 
the heart will stop working unless supplied with blood under a 
certain pressure, absence of the pulse at the wrist means stopoage 
of the heart’s action, due to a lack of blood in the systemic vessels. 
One fainting-fit quickly follows upon another, on account of the 
nerve centers not receiving the necessary amount of nourishment 
to sustain them in their functions, and death seems unavoidable. 
In these cases attempts at revival must be made and kept up 
patiently and with perseverance and judgment. The first and 
foremost duty to be fulfilled is to get blood enough into the heart 
to cause it to resume its action. With this object in view, the 
blood which is contained in the legs and arms is sent into the 
blood-vessels of the trunk by their being carefully surrounded 
throughout with elastic bandages. In this manner these limbs are 
for the time being excluded from the general circulation, the blood 
which they contained is squeezed out, as it were, from their vessels 
and sent into the interior of the body, and the heart, of course, 388 
FIRST AID TO THE INJURED, 
receiving its share also, will begin to beat again. Inasmuch as 
this process of elimination of certain members of the body from 
circulation can only be kept up for a certain limited period of 
time, only two limbs are excluded at a time, one arm and one leg. 
After an hour’s time these are released and the other correspond- 
ing members are taken in hand. This process may be kept up 
for days without in any way endangering the future usefulness 
of the members involved, your patient’s life thereby saved. 
The method usually employed is to take the right arm and 
suspend vertically and eliminate, say, the right leg from the gen- 
eral circulation by means of an elastic bandage applied to it from 
the toe up to the groin; after an hour’s time, treat the left side in 
the same way, releasing the right side. In the meantime your 
patient may be fed on liquid food, such as milk and brandy, 
beef-tea with the yolk of egg, champagne and other light wines; 
patients unable or refusing to take nourishment must be fed 
through the stomach-tube. 
The method of temporarily eliminating different parts of the 
body from the general circulation and infusing their blood into the 
remaining parts of it, is called auto-transfusion (see fig. 60). 
Before closing the chapter on hemorrhage I must call your 
attention to a class of cases, instances of which you will, no doubt, 
meet with much oftener than you would be inclined to expect, and 
which present all the chief characteristic signs and symptoms of 
great loss of blood. Any ordinary fainting fit, little thought of 
by some and lightly talked about by others, presents, nevertheless, 
some of these grave symptoms, although not a single blood-vessel 
is ruptured; such cases simply mean an insufficient amount of 
blood in the left side of the heart and the systemic arteries, owing 
either to tight lacing or some other direct interference with the re- 
turn circulation, or owing to vitiated air, in which case they are 
brought on reflexly, or both these combined. 
Another example illustrating almost exactly the same condi- 
tion of affairs occurs at times on board ship. Let us suppose a 
fireman working in a badly ventilated fire-room on a very hot, 
close day when there is not much air stirring; his body, especially 
his abdomen, has been exposed for several hours to the influence 
of great heat from the furnaces of the boilers; he suddenly begins 
to feel faint, is relieved from duty and struggles up on deck, where 
he breaks down and lies for a moment almost lifeless. You feel no AND TRANSPORTATION OF THE WOUNDED. 
389 
pulse at the wrist and your patient looks deathly pale; under these 
circumstances what are you to do? 
Never attempt to raise such a man from the deck, but let him 
lie undisturbed by any one; keep the head low, loosen all tight 
clothing, especially around the waist and feet; rub his legs and 
arms in a direction from the periphery towards the center of the 
body; make gentle massage movements on his abdomen or, better, 
surround it entirely with a compress and bandage; as soon as he 
can swallow give him some brandy and water. 
Now, what is the condition of things in his case? If we could 
look into his chest and abdomen we would find all the numerous 
veins of the entire intestinal canal, peritoneum and of other vis- 
cera contained in the abdominal cavity intensely injected with 
blood, their coats almost paralyzed; the arteries and the left side of 
the heart would be found empty, and consequently the heart has 
ceased to beat. The man is practically dead, and beautifully 
exemplifies the possibility of one’s bleeding to death into one’s 
own veins. No matter, then, where the blood is; as long as there 
is none in the left heart and the arteries, the man must die. There- 
fore, all indications for treatment in these cases are the prompt 
employment of all such means as are calculated getting the blood 
contained in his over-distended veins back into the heart. You 
lay him flat on his back to facilitate the flow of blood back to the 
heart, you make pressure on the abdomen and rub his legs and 
arms centripetally with the same object in view: you give him 
brandy internally in order to induce peristaltic or vermicular con- 
tractions of the intestinal canal whereby the over-distended veins 
are freed from the blood which they contain. All these means 
hav: the same object, and until this is attained our patient will 
remain dead; with the equalization of the circulation, however, 
quick recovery follows. 
Practical exercises in dressing and arresting hemorrhage from 
different parts of the body. LECTURE IV. 
FRACTURES. 
The force required to break a thoroughly sound bone is gen- 
erally quite considerable; fractures that are caused by mere 
muscular contraction, on the other hand, almost always indicate 
a diseased or abnormal condition of the bony substance. Frac- 
tures caused by direct violence are almost always associated with 
severe contusions of the soft parts; there are, however, also 
instances where the bone against which the violence was directed 
resists and causes the fracture of a neighboring bone in an indirect 
manner, and in such cases we miss, of course, the usual contused 
condition of the soft parts complicating cases of direct fractures. 
You will no doubt all remember the case which occurred here not 
long ago of a cadet breaking his collar-bone by a fall on his side 
and arm; this was a typical case of fracture caused by indirect 
violence. 
We must also remember that the bones of old people are much 
more prone to fracture than are those of young people, on account 
of the greater brittleness which exists in our bones at an advanced 
age. In children, on the other hand, bones often bend instead of 
break, that is, the fracture will be found to be incomplete, giving 
rise to what has been called a green-stick fracUire, on account of 
the greater elasticity possessed by the bones at that age. We 
classify fractures according to different principles. Thus we 
distinguish them in accordance with the line the fracture takes 
through a bone, calling them longitudinal, transverse or oblique ; 
we speak of simple fractures when the skin remains unbroken 
(see fig. 61); we speak of compound fractures when the skin is 
divided (see fig. 62); a fracture is called comminuted when the 
bone is broken into fragments, and it is complicated whenever 
there is an injury to a joint or internal viscus associated with it. 
Gunshot injuries attended by fractures of the bones are, of course, 
always compound and may, besides, be very much complicated 
with injuries to the internal organs; it happens occasionally that a Fig. 61.—Simple fracture of tibia. 
Fig. 62.—Compound fracture of tibia. 
Fig. 63.—Three different forms of healing of long bone. 
Fig. 64.—Shows method of setting fractures of arm and forearm. AND TRANSPORTATION OF THE WOUNDED. 
391 
small projectile will perforate a bone without causing it to break in 
two, or become embedded in its substance without even perforat- 
ing it completely and lie there for years. Compound fractures are 
by far the most serious ones because associated with an open 
wound, and consequently requiring the highest class of surgical 
skill. The wound may be caused in two ways, namely: (i) the, 
same force which broke the bone may also have cut the skin; (2) 
the broken ends of the bone may have perforated the skin and 
other tissues over the fracture. 
Any complete fracture of a long bone is most always attended 
by displacement of the fragments. The kind of displacement, 
however, that takes place is not always the same. In a fractured 
knee-cap, for instance, the fragments are pulled apart and a space 
is left between them. In the fractures that occur in the long 
bones, on the other hand, the fragments override one another, 
owing to muscular contraction, whereby a distinct and quite per- 
ceptible shortening of the limb is produced. Although this 
shortening is in most instances due to muscular contraction, it 
may also be caused directly by the violence that produced the 
fracture. The least amount of displacement is generally present 
in fractures of the leg and forearm as long as only one of the two 
bones is broken. 
The quick diagnosis of a fracture is in many cases easy and in 
others rather difficult, even for the surgeon. Subjective pains 
and other feelings complained of by the patient, although some- 
times of great assistance and greatly helping you in making a 
diagnosis, must not be allowed to count for more than they are 
worth. 
But even in cases of true fractures, mere pain does not count 
for much so far as diagnosis is concerned, for that is present in 
too many other injuries that are not fractures. Your sole reliance 
in a case of fracture must be placed on your own examination. 
You would, therefore, begin by inspecting or looking at the 
injured limb and by trying to discover any change in the shape 
of it; the tape-measure will tell you of any shortening that may 
exist when your measurements are compared with those of the 
corresponding limb of the other side. You may next try to 
discover any abnormal mobility about the limb and, if you dis- 
cover such a place at any point of the bone, any attempt on your 
part to move the two fragments one over the other will be 392 
FIRST AID TO THE INJURED, 
accompanied by crepitus. Crepitus is a sure sign of fracture, but 
can only be made out when the fragments are still in contact with 
one another, that is, when there is not too much displacement. 
Crepitus, then, although a sure sign of a fracture, must always be 
looked upon as being dependent on the position of the fragments, 
and its absence, therefore, would not necessarily exclude the 
possibility of the existence of a fracture. A change in the form 
and abnormal mobility of the limb are most always present and 
therefore constitute the more important signs of fractured bones. 
It is only in fractures of the skull in which this abnormal or 
preternatural mobility does not enter prominently into the 
diagnostic picture, because there the fragment is generally driven 
in towards the interior. 
Fractures of the base of the skull are attended with the escape 
of a clear, colorless fluid from the ear on the injured side, and may 
be diagnosed with certainty in the majority of cases from this 
alone. 
Fractures, then, may be recognized (i) by the abnormal form of 
the limb and the shortening of the same; (2) by the existence of 
abnormal mobility at the point; (3) by great pain; (4) by the 
peculiar grating sound produced when the two ends of the broken 
bone are moved against each other, as is done in setting the bone. 
The normal process of repair in the case of a fractured bone is 
nothing more nor less than one of cicatrization in its essential 
elements and, as such, very much like that which takes place in 
wounds of the soft parts, with the difference, of course, that the 
process in bones takes a much longer time than in the soft parts, 
and, also, the resulting cicatrix is a hard, bony one instead of one 
of connective tissue. At first, a soft cement-like substance oozes 
out at the broken ends, glueing the properly adjusted fragments 
together; then a gradual hardening of this cement substance 
takes place by the deposition in it of lime salts, the mass being now 
called callus. For the complete development of this callus nature 
requires about four or six weeks. Should it happen that the 
cement substance remains soft, e. g. that no lime-salts are depos- 
ited in it, then the union between the two fragments of bone will 
be one by connective tissue, and, consequently, preternatural 
mobility at the seat of fracture will persist. This condition is 
called a false joint. The accompanying figure 63 shows three forms 
of repair in bone, namely: (a) normal healing of a well set fracture; AND TRANSPORTATION OF THE WOUNDED. 
393 
(b) bony union of a badly set fracture, and (c) recovery with a false 
joint. 
The future usefulness of the limb must, of course, greatly 
depend upon the kind of union which results, and this again must 
naturally depend on how well the fracture was set in the first 
place. The proper healing of a fractured bone, in other words, 
will depend (i) on the health of the individual, (2) on the nature 
of the fracture, (3) on the setting of the fracture. The most 
important problems which the first-aid-man must keep in mind 
are (1) that the two surfaces of the fractured ends be brought into 
exact contact, and (2) that they remain in this position during the 
entire process of healing. 
While it must be admitted that the proper setting of difficult 
cases of fracture is the duty of the surgeon and can only be done 
properly by him, there are, nevertheless, cases that come well 
within the precinct of the first-aid-man and in which it is his duty 
to try and do the best he can. The danger of delay in these cases 
consists in this, that the sharp-pointed ends of the fragments may 
work their way through the skin or, otherwise, cause so much 
laceration of the soft parts that they eventually die. This must be 
more especially considered in fractures of the bones of the foot 
accompanied with dislocation, and also those of the leg. A 
prompt adjustment and reduction of all the bones is very necessary 
in all these cases. In fracture of bones that are uniformly sur- 
rounded with thick masses of flesh, this danger is, of course, not 
so great. 
The greatest care and judgment should be exercised in the 
transporting of these cases. Never raise a man with a broken 
bone from the ground without at the same time causing to be 
made the proper extension of the broken limb; this extension, 
furthermore, should be kept up while his clothes are being cut off. 
In order to set a fracture properly, three things are always re- 
quired, namely, extension, counter-extension, and lateral pressure. 
Before, however, the reduction is attempted, place your limb in 
such a position as to cause the relaxation of the muscles attached 
to either of the fragments, which is best accomplished by a position 
of passive semiflexion. Extension or traction is best made with 
the hands; counter-extension can be executed by means of a folded 
-cloth or bandage, the loop of which encircles the limb. Both 
extension and counter-extension should be made with firm and 394 
FIRST AID TO THE INJURED, 
steady hands, with force superior to the muscular force to be over- 
come, and in the way of the reduction. 
As soon as the two broken surfaces are brought up to the re- 
quired point, they must be pressed together, which process 
requires the use of both hands to surround the limb and should be 
done with great care. Figs. 64 and 65 show the method of setting 
a fractured arm and forearm. 
A properly set fracture must be supported by an apparatus; this 
apparatus taking, for the time being, the place of the broken 
bone, must, consequently, remain in position until the latter has 
healed and has become solid. 
It must be clear that during the whole time it takes to put on 
this apparatus, extension and counter-extension must be kept up 
uninterruptedly in order to prevent a re-displacement from taking 
place before the apparatus is put on. 
It is, furthermore, a law in surgery that every apparatus put on 
for the support of a fractured limb must pass beyond and secure 
the immobility of the two neighboring joints. An apparatus, for 
example, for a fractured tibia, must reach beyond the knee and the 
ankle, and one for the forearm must reach beyond the wrist and 
the elbow, and so on. 
Before thinking of putting up a fractured limb, we must, of 
course, first make the proper splints. This is, fortunately, not 
very difficult, and the more familiar you are with the principles of 
your work and with the ends which you have in view, the more 
readily will you find the necessary material which will answer 
your purpose, no matter where the fracture may have occurred at 
the time. Besides with splints, broken limbs are sometimes sur- 
rounded with bandages that are impregnated with certain sub- 
stances which harden on exposure to the air: plaster of Paris and 
tripolite (see fig. 66). 
But, first aid, in most of the cases at least, will have to confine 
itself to the putting on of temporary splints. If the accident 
occurs in a town or village it is, of course, easy to secure all that is 
necessary in the way of splints and soft material for pads. Rulers, 
boards, cigar-boxes, razor-strops, broomsticks, pasteboard, felt, 
walking-canes, umbrellas, parasols may be obtained most any- 
where. If the accident occurred in the field, branches from trees, 
bark, straw, hay stuffed into stockings and trousers’ legs, may be 
made to do as temporary fracture-boxes, as shown in several of Fig. 65. — Shows method of setting fractures of forearm 
Fig. 66.—I.eg and foot done up in Plaster of Paris for fracture. 
Fig. 67.—Shows various forms of extemporized splints and fracture-boxes 
Fig. 68.—Shows various forms of extemporized splints, Fig. 72.— Tin splints and leg-rest. Fig. 71.—Shows various forms of extemporized splints and fracture-boxes. Fig. 69.—Shows various forms of extemporized splints and fracture-boxes. 
Fig. 70.—Shows various forms of extemporized splints and fracture-boxes. AND TRANSPORTATION OF THE WOUNDED. 
395 
the accompanying figures. (See 67, 68, 69, 70 and 71.) Most 
anything will do to fasten the splints on to the limb, shreds of 
torn clothes, strings of all kinds, suspenders, leather girdles. 
The accompanying figs. 67—71 show a great variety of extempor- 
ized splints as well as fracture-boxes. 
Very handy things, especially for fractured legs, are the tin 
splints which have come into use not very long since, and which 
are now sold in nearly all the best drug-stores of our large cities. 
Fig. 72 shows some of these tin boots, made in different sizes 
to suit all cases and to be purchased at moderate prices. 
Whatever form of splints you may use, it will always be neces- 
sary to pack them with some soft material such as cotton-wool, in 
order to prevent pressure on bony prominences, which not only 
prove very painful after a while, but which also might give rise to 
very unpleasant sores. Instead of bolstering the splints, cotton- 
wool bandages are used to surround the limbs before putting on 
the splints. • 
The splints must be secured by bandages applied over the out- 
side, care being taken to avoid putting them over the point of 
fracture on account of the swelling and inflammation which 
usually develops at these points and the increasing tenderness of 
these parts. 
There is no necessity for that great hurry and urgency required 
in cases of hemorrhage, and you will have plenty of time to set 
the fracture well and apply a good safe supporting apparatus be- 
fore moving your patient. The point of the greatest importance 
to your patient will always be and remain that you should set the 
fracture well and, secondly, keep the fragments in position after 
setting them. The comfort of your patient, e. g. his freedom from 
pain, being, at the same time, your surest sign that all is well. 
Special Fractures.—There are three kinds of fractures to which 
splints are never applied, namely, those of the collar-bone, ribs and 
skull. 
Fractures of the skull are either caused by a fall or a blow, and 
are almost invariably complicated by unconsciousness and insensi- 
bility, on account of a certain amount of injury being done to the 
brain and its membranes, of which you will hear more in another 
lesson. 
Still more serious than fractures of the vault of the skull are 
fractures of the base of the skull, which latter are caused by a 396 
’ FIRST AID TO THE INJURED, 
man’s falling with the head upon some soft, yielding substance;, 
the weight of the body in such a case would drive in the base of 
the skull and fracture it. There is always profound stupor, 
temporary paralysis of motion and sensation, profuse bleeding 
from mouth, nose, ears, blood under the conjunctiva, and escape 
of cerebro-spinal fluid from the ear. 
In fractures of the spine you have simply paralysis of motion 
and sensation below the seat of fracture. 
In all these cases the best thing you can do is to carefully move 
the injured person on a litter to some quiet spot with the head 
slightly raised. Apply ice to the head, and if the arms and legs 
are cold, warm flannels or sandbags to them. Administer no 
stimulants! 
Fractures of the ribs require no splint, as it is impossible to 
obtain perfect immobility on account of the constant movement 
which takes place in respiration. This fracture is occasioned by 
blows or squeezing of the thorax, and is especially liable to be 
followed by secondary complications, such as inflammation of the 
lungs or of the pleural membranes, either of which may have 
been injured at the time of the accident. By placing the hand 
over the seat of the injury and asking the patient to cough, 
crepitus is easily felt. A bandage folded broad and passed around 
the chest is the only first aid that can be rendered in such cases. 
In those complicated cases in which there is perforation of the 
lung tissue by the sharp end of a broken rib, known at once by 
bleeding from the mouth, with the coughing up of blood-stained 
frothy sputa and the escape of air into the subcutaneous tissue, 
no bandage or any tight constriction must be allowed around 
the chest, as the broken end of the rib would thereby be further 
driven into the lung tissue. Braces should be loosened, stays un- 
fastened and all impediments to free breathing removed. 
Fracture of the lower jaw-bone may occur from blows or falls 
upon the chin. The mouth is found to be closed and not widely 
open as in cases of dislocation. The line of the teeth is irregular, 
as. well as the external outline of the jaw. 
This fracture requires two bandages folded very narrow and a 
splint made out of cardboard to fit the jaw so as to form a sort 
of cap for it. One bandage is placed below the chin and knotted 
at the top of the head, whilst the other, placed with its center on 
the chin, is carried to the back of the head, crossed and then AND TRANSPORTATION OF THE WOUNDED. 
397 
brought forward round on to the forehead and tied there. The 
ears are not to be covered over, but left in the center of the triangle 
formed by the bandages at the side of the head. All four ends of 
the bandages may be subsequently tied together. 
Fracture of the collar-bone or clavicle is occasioned by falls 
on the outstretched hand. The heavy shoulder with the arm 
attached rolls forward and downward, the patient instinctively 
supporting his elbow with the opposite hand. A large wedge- 
shaped pad should be extemporized and put into the arm-pit on 
the injured side with the broad end of the pad uppermost, and 
this is kept in position by a bandage passed around the body to 
prevent movements of the arm on that side. Care should be taken 
not to pass a bandage over the seat of fracture or make any 
pressure there, because being painful and liable to displace the 
fragments. The hand may be supported by a sling. 
Fracture of the upper arm"or humerus occurs from direct blows 
or falls upon the elbow. Extension should be made and then 
three splints put on. The splints should reach from the shoulder 
to the elbow and should be placed one in front, one on the outside 
and the third on the back of the arm (see fig. 73). The inner 
splint is omitted so that no undue pressure may result to the blood- 
vessels lying on that side. The splints should be fastened by two 
triangular folded bandages and the forearm Hexed and supported 
by a sling, which must be small and not reach up to the elbow. 
Be careful to put on the arm-sling with the elbow at right angles, 
and never allow the hand to drop lower than the elbow. 
An extended trellis flower pot cover forms an excellent splint 
for this fracture (see fig. 67) as well as for fractures of the limbs in 
general; care, however, should be taken that it is well padded 
so as not to arrest the circulation in the limb. 
In case the fracture happens to be at the lower end of the 
humerus, close to the elbow-joint and perhaps combined with 
some injury to the bones of the forearm, a rectangular splint 
should be applied to the inner side of the elbow-joint with the arm 
in a semiflexed position. Two pieces of wood can be lashed 
together by a bandage wound around them where the pieces of 
wood cross one another, and thus a rectangular splint easily con- 
structed. Outside splints must be applied as well. 
Fracture of the forearm or radius and ulna occurs usually 
from falls, but may also happen from direct blows. The arm 398 
FIRST AID TO THE INJURED, 
should be placed in a semiflexed position and two splints put on. 
The splint on the inner side should extend from the elbow to the 
tips of the fingers, and the outer one from the elbow to the wrist 
joint. Two bandages folded narrow keep the splints in position, 
and the arm is subsequently supported with a large arm-sling. 
Fractures of the fingers or phalanges are almost always caused 
by direct violence. They require a long, narrow splint, which should 
extend from a little above the wrist to the tip of the injured finger, 
applied to its palmar surface. A long paper-knife answers the 
purpose admirably. The hand should be subsequently supported 
by a large or small arm-sling. Another very comfortable plan of 
treating this injury is to flex the fingers over a cricket-ball and 
bind them there. 
Fractures of the thigh bone or femur occur from falls, and in the 
aged from very trifling causes. It requires two splints: the one on 
the outer side should be a very long one and extend from the 
arm-pit to the sole of the foot (see fig. 71), whilst the shorter one 
should be placed on the inner side of the thigh and should reach 
from the fork to a little below the knee-joint. Four bandages 
folded broadly are required. One is applied in the figure of 8 
form around the sole of the foot and ankle-joint, taking in at the 
same time the lower end of the splint, the bandage crossing itself 
on the instep. A second bandage should be placed below the 
seat of fracture and just above the knee-joint, and a third above the 
seat of fracture as close to the hip-joint as possible. The fourth 
bandage is applied round the abdomen to keep the upper end of 
the splint in close proximity to the body. Finally bind both legs 
together, as greater support is thereby given to the injured limb. 
A rifle may be used as the outside splint in this injury. The 
butt end is placed in the arm-pit and the stock down the leg, with 
the barrel towards the ground on which the man is lying. 
Keep in mind that the joints above and below the fracture 
must be rendered immovable or as much so as that can be done. 
Fracture of the knee-cap or patella occurs usually from muscu- 
lar action and occasionally by direct blows. Two bandages, 
folded narrow, are required; the first is placed with its center 
below the knee-cap, carried to the back of the joint, crossed be- 
hind the splint, and brought above the knee-cap and tied in a 
knot. (A broad splint should be applied to the back of the knee- 
joint extending some eight inches above and below it.) The Fig. 73.—Showing position of splints in case of fracture of arm. 
Fig. 74.—Shows dislocation of head of humerus 
into axilla (left side). 
Fig. 75.—Dislocation 
of lower jaw. AND TRANSPORTATION OF THE WOUNDED. 
second bandage is put on in a similar figure of 8 manner, but is 
placed first above the knee-cap, then crossed behind the splint and 
knotted below the knee-cap. The broken fragments, generally 
very widely separated, are by this means, assisted by elevation of 
the limbs, brought close together. The front of the joint is left 
uncovered, so that cold applications or an ice-bag can be applied 
to the swelling, which is always considerable. 
Fractures of the leg bo?ies or tibia and fibula are occasioned 
usually by direct violence, but sometimes by a sudden twist of 
the ankle. Two splints are required of the same length, to ex- 
tend from just above the knee-joint to the sole or the foot. One 
is placed on the inner and the other on the outer side of the 
limb and kept in position by two bandages. One is passed in a 
figure of 8 form around the sole of the foot and ankle-joint; 
taking in at the same time the two splints, the bandage crosses 
itself on the instep. The other bandage is applied just below the 
knee-joint; thus all movement from above and below is prevented. 
A scabbard may be used for the outside splint in this injury, 
or a couple of bayonets, the point of each bayonet fitting into the 
lock of the other (see figs. 70 and 71). 
When the fibula alone is broken, the tibia forms a splint for it 
and people are able to walk with this fracture. Splints must be 
applied to this fracture in the same manner as if both bones were 
broken. 
Fractures about the foot are always caused by direct violence. 
They require a special form of splint, made rectangular, into which 
the heel fits; the sole of the foot resting against one support and 
the calf of the leg against the other. The first aid consists in 
elevating the foot and applying cold water. 
The important matter of safely transporting the injured persons 
will be treated of in a special chapter. 
Dislocatio?i. See figs. 74 and 75.—Whenever a bone is thrown out 
of the position it naturally occupies in the body, it is said to be dis- 
located. A dislocation is always complicated with more or less 
severe injury to one or more joints; its ligaments may be torn and 
the joint surfaces injured in various ways. As regards the reduction 
of a dislocation there is little to be said to the first-aid-man; the 
sooner you obtain medical assistance the better; for the sooner a 
dislocated bone is put back into place, the easier that process can 
be accomplished. The longer a time is allowed to elapse, the 
* 400 
FIRST AID TO THE INJURED, 
more difficult will be the reduction of the dislocated member, it 
may even become entirely impossible, and consequently deformity 
and loss of power will remain for the rest of life. The reason 
why I should not advise a first-aid-man to attempt the reduction 
of a dislocation is the great danger with which careless and 
ignorant procedures of this kind have been attended. Blood- 
vessels and nerves have been torn across, and the entire limb even 
has been known to have been dragged off. 
Comparisons between Fractures and Dislocations. — In both 
cases there is deformity and pain; but, while in fractures you will 
find increased and unnatural movement in any part of the limb, 
in dislocations you have a decrease if not entire loss of movement 
in connection with the implicated joint. 
In a dislocation there may be shortening or lengthening of the 
limb, according to the position assumed by the displaced bone, 
but in a fracture there is nearly always a shortening, from the frag- 
ments overlapping one another. The more important distinguish- 
ing sign is the presence of a grating noise, or crepitus, in the line 
of the shaft of the bone in cases of fracture, while in dislocations 
there is an absence of crepitus and the seat of the injury is always 
a joint. i 
The distinguishing features of the two classes of injuries are 
best shown in the following table: 
Fractures. 
Deformity and pain. 
Crepitus. 
Unnatural mobility. 
Easily replaced. 
Limb shortened. 
Seat of injury anywhere in the bone. 
Dislocations. 
Deformity and pain. 
No crepitus. 
Movement limited. 
Replaced with difficulty. 
Limb shortened or lengthened. 
Seat of injury at a joint. 
Another and final piece of advice to you is, that, no matter 
what the injury may be that you are dealing with at the time, 
always compare the injured limb with the sound one on the oppo- 
site side of the body. You will quickly perceive by comparison 
what you might overlook without it, namely, any irregularity in 
the shape or deficiency of movement, as well as any change in the 
respective length of the limb. 
Practical Exercises.—The practical work done after this lecture 
consists in the making and applying of splints from all sorts of 
material to supposed fractures. LECTURE V. 
BURNS AND SCALDS. 
There are substances which produce injuries by virtue of their 
chemical composition and by the chemical changes which they 
arouse in living tissues whenever brought in contact with them. 
The so-called alkalies and acids are the principal substances of 
this class, and caustic ammonia, soda and potash constitute the 
chief ones of the alkalies, while muriatic, nitric and sulphuric acids 
are the most dangerous representatives of the acid class. 
Their effects upon living tissues, however, are so similar to 
those produced by burns and scalds, injuries caused by fire or 
steam, etc., that they may well be spoken of under one head. 
The eschar which these substances produce arouses local in- 
flammation, followed by suppuration and a slow and very gradual 
process of repair of the injury by cicatrization through the forma- 
tion of granulation tissue. 
Both acids and alkalies may come in contact either with the 
skin or with the mucous lining of the mouth, throat and stomach. 
Whenever alkalies are brought in contact with mucous mem- 
branes the eschar which is formed will be of a dirty white color, 
while acids will produce a brown discoloration in them. 
These substances are sometimes swallowed with suicidal inten- 
tions, are very dangerous in their consequences, and, when not 
followed by immediate death, are at least always succeeded by 
very burdensome strictures of the oesophagus, obliging the poor 
unfortunate victims to remain permanently under medical care 
for the remainder of their natural lives. 
First aid, in these cases, consists principally in neutralizing these 
substances, chemically speaking; thus, in case lye was swallowed, 
you would have to administer vinegar or lemon-juice, and if it 
was an acid that was swallowed, solutions of alkalies in water or 
milk must be given, the best of which are magnesia and bicarbon- 
ate of soda. Injuries to the skin by these substances must, of 
course, be treated on the same principles. 402 
FIRST AID TO THE INJURED, 
In case any one should happen to fall into a lime-kiln, it would 
be a dangerous proceeding to try and wash off the lime adhering 
to any part of the body with water unless a very large quantity of 
it was on hand and complete immersion possible; if this is not the 
case, oil should be the thing made use of. 
Bjitjis may be produced by molten metal, overheated liquids or 
gases. Three degrees of burns are generally distinguished in ac- 
cordance with the extent of the damage done to the parts affected. 
Whenever the skin is merely reddened, it is called a burn of the 
first degree; if the injury leads to the formation of blisters it is 
called one of the second degree, and if the parts are completely 
charred the injury is called a burn of the third degree, whether 
this is superficial or whether this includes the muscles and bones 
(see fig. 76). 
The first two degrees of burns are often found together, some- 
times all three degrees are found associated. Burns are dangerous 
injuries, being often followed by death. Fires in theaters, explo- 
sions of gas or powder, benzine or petroleum occur but rarely 
without some one’s clothing catching afire. The victims of such 
accidents should be promptly warned not to run, which they most 
generally are inclined to do; the flames are most quickly extin- 
guished bv the person being thrown on the ground and rolled 
about; covering it up with clothing, blankets, rugs or anything 
that may be at hand which will quickly put out the flames, such as 
water. 
The flames having been extinguished, water in great abundance 
should be used, the person removed to a warm room and warm 
stimulating drinks administered. The clothes should be taken off 
with the greatest possible care; in places where they stick to 
the skin, the scissors must be used to cut around the adhering 
portion so as to leave them in place, because, the skin being the 
best protection, it must under all circumstances be left in place. 
Blisters may be pricked with a clean needle and the fluid gently 
pressed out. 
All these injuries soon become exceedingly painful, especially 
when deprived of the skin and exposed to the air, the effects of 
which we must endeavor to counteract by the application of oil. 
The complete immersion of the parts under water, or the ex- 
ternal application of flour or raw potatoes is also very soothing. 
When, however, you are treating burns of the second degree, AND TRANSPORTATION OF THE WOUNDED. 
403 
then you must remember that you are treating wounds, and as 
such all the precautions necessary in the modern treatment of 
wounds and of which you have heard in the third lecture of this 
course must be observed. 
After preparing everything for an antiseptic dressing, the 
blisters must be opened with an absolutely clean pair of scissors, 
the fluid pressed out and the dead epidermis removed. The best 
antiseptic substance that can be used in the dressing of burns 
is, without doubt, the iodoform, which may be applied either in 
the form of the powder or in that of the liniment made as follows: 
Take equal parts of oil and lime-water and mix the two well 
together by shaking, then add to this mixture about one per cent 
of thymol, two per cent of creolin and ten per cent of iodoform. 
After completely covering the surface of the wound with the 
iodoform or the liniment, put several layers of iodoform gauze 
over the same and a layer of rubber-cloth over the gauze; cover 
the latter now with a thick layer of cotton-wool and secure the 
dressing by a bandage. Iodoform acts like magic in these burns; 
but a short time after its application the excruciating pain that 
usually accompanies these injuries ceases altogether and the 
patient may then be transported without any suffering or material 
inconvenience. 
In case the materials necessary for an antiseptic dressing are 
not at hand you must be content with simply pricking the blisters 
and squeezing out their contents, leaving on the dead skin as a 
temporary protection for the wound. 
Effects of Extreme Cold or Freezing. 
Just as in burns and scalds, we distinguish here also three 
different degrees, namely, the simple reddening of the surface, 
the formation of blisters, and the complete death of the parts. 
The color of the reddened skin in cases of freezing is somewhat 
different from that produced by a burn. While, in a burn, the 
color of the skin is of a bright red, indicative of a disturbance in 
the arterial territories of the circulation, a sign of active inflam- 
matory congestion, in frozen surfaces we find that the skin has 
a bluish-red color, which is indicative of a disturbance in the 
venous circulation and a sign of passive congestion and retarded 
return-circulation. Consequently the parts lack the local heat 404 
FIRST AID TO THE INJURED, 
and pain which we find in burns, and are, on the contrary, cold 
and devoid of all sensation. There is no sign of inflammation 
to be found anywhere about a frozen area, but instead we find 
oedema due to the existing passive venous congestion. 
The second degree, or that of the formation of blisters, is 
developed slowly and not suddenly as in burns; the blisters are not 
so dense and so prominent as in burns, but rather flat and filled 
with a dirty white exudate consisting of serum and blood. 
The third degree also is slowly developed; the parts dry up, 
turn dark brown and put on a mummy-like appearance. 
Death by freezing occurs not only in the coldest regions of 
our earth but also in the moderate zones. When men have be- 
come very much exhausted by thirst hunger and long marches, 
or are benumbed from having too freely indulged in alcoholic 
drinks, the prolonged influence of intense cold may go so far as 
to give rise to the formation of ice in the interior of our bodies, 
causing the fluids of them to turn solid. The tissues are thereby 
rendered stiff and brittle, losing at the same time their sensibility; 
such persons are overcome by an irresistible desire for sleep, 
which is quickly followed by death unless assistance is very near 
and prompt. 
In drunkards, very much under the influence of liquor at the 
time, a cold wind, blowing on them for a long time, has been 
known to produce unconsciousness. In such persons you would 
find the entire surface pale and cold; the nose, mouth, hands 
and feet are of a bluish-red color; the pulse cannot be felt and 
breathing has almost or entirely ceased; the limbs are stiff and 
cold and devoid of all sensation. 
The greatest possible caution is required in all attempts to bring 
such persons back to life; they must, first of all, be treated with 
cold, for sudden thawing would mean sudden death of the affected 
parts, hence avoid carrying them into a warm room immediately. 
If you carry the person or persons into any room at all, let it be 
cold by all means; their clothes should be cut off, not pulled off, 
and they should be rubbed with snow or very cold water; give 
them a cold general bath, if possible, and continue the rubbing 
in it. At last they may be lifted into a cold bed and covered up 
with some light things. The whole process should be slow and 
gradual and the external application of heat altogether avoided. 
Internally the administration of cold brandy and, towards the 
end, of lukewarm tea is admissible. AND TRANSPORTATION OF THE WOUNDED. 
405 
If at any time during the course of treatment pursued by you 
it should happen that an unusual redness of the face and heat 
of the skin supervene, that headache comes on, with spots appear- 
ing in front of your patient’s eyes, you must at once return to 
treatment with ice or very cold water. 
If after a certain time no reaction occurs in the frozen parts, 
no normal warmth returns, no sensation reappears, the chance 
for a final return of life in them is very small. 
The parts of the body most exposed to and most frequently 
attacked by frostbites are the nose, ears, fingers and toes. 
Foreign Bodies. 
Foreign bodies, so called, may become lodged in the different 
parts of our bodies in many various ways; they may enter through 
natural passages or get in through the skin in a more direct way, 
as through wounds. But most often they pass in through the 
nasal passages, through the external ear, the eyelids and the 
mouth. 
Foreign substances having penetrated into the intestinal canal 
or bladder can, of course, be removed only by the surgeon. 
The nasal passages consist of three rather complicated tubular 
cavities arranged on either side of a medium, straight partition 
or septum, one above the other. Things may get into them 
in front or from behind; these accidents happen most frequently 
to children who, without thinking of the consequences, will in- 
troduce peas, beans, cherry-stones, etc., while playing; more 
rarely it happens that certain contents from the stomach get in 
from behind during the act of vomiting. Whenever the object 
has been pushed in from in front and not very far beyond the 
external openings, it may be seen by a tilting up of the point of 
the nose under a good direct light; if it is deeper, a nasal specu- 
lum may be required to bring it into view. If it is far enough for- 
ward so it can be seen, simple bilateral compression of the nose is 
sometimes sufficient to expel the intruder, or a sneezing attack 
brought on by tickling will do it; if, however, the object is deeper, 
a more effectual remedy will be a rubber tube about a foot or two 
long; this tube is introduced into the free nasal passage and there 
secured as nearly as possible air-tight by outside pressure with the 
fingers. A sudden powerful blow from the other end of the tube 406 
FIRST AID TO THE INJURED, 
in your mouth will generally bring forth the offender. When 
not too far in, fruit seeds and other smaller things have also been 
successfully removed by hair-pins slightly bent to suit the case. 
In all these cases the head must be held steady by an assistant. 
In the ear passages all sorts of small objects are sometimes 
found, but most frequently insects. The passage is about one inch 
in length, partly bony, partly cartilaginous. Both portions being 
joined together at an obtuse angle, this must be overcome, the 
passage straightened out so as to render inspection easier; this 
is easily done by pulling the ear outwards and backwards. 
Here you must avoid all manipulating with hair-pins, tooth- 
picks and other sharp instruments which might prove very dang- 
erous. The best method for you to adopt is that you make an 
attempt to dislodge the foreign body by means of a good stream 
of water. For this purpose, pull the ear outwards, introduce the 
nozzle of your syringe on the floor of the passage so as to direct 
the water underneath the foreign body and cause it to accumulate 
behind it, then make a forcible injection and the object will fly 
out. If success should not crown your first efforts, you must not 
be discouraged but repeat the maneuver. 
Hardened ear-wax must first be softened up by oil before it 
can be washed out by irrigation. 
Insects in the ear are best dealt with after the following man- 
ner: Lay your patient’s head on the table, the sound ear, of course, 
touching the table; then introduce a sufficient quantity of oil 
into the other ear, so as to completely fill it, and the insects must 
rise to the surface because unable to breathe in oil. 
We all have experienced the unpleasant sensations caused by 
the presence of small insects, particles of dust, etc., in our eyes; 
fortunately, they rarely get any further than the conjunctival sac, 
and most of them may be gotten rid of by rubbing the closed eye 
in the direction towards the inner or nasal corner of the eye, where 
they are swept by the aid of the naturally increased flow of tears. 
If, however, this little maneuver does not succeed, then the eye- 
lids must be turned out, first the lower, then the upper, and the 
object removed by means of a soft handkerchief or a moistened 
camel’s hair pencil. In case of lime having gotten into the eye, 
keep all water out of it, but drop some oil into the eye. 
It happens not infrequently in machine shops that very small 
pieces of iron get into the eye, and very often, too, they will be AND TRANSPORTATION OF THE WOUNDED. 
407 
found seated somewhere on the transparent cornea, giving rise to 
the most unpleasant sensations. When on hand immediately after 
the accident, a good magnet is the surest means of getting them 
out, but later on it will require more skill than a first-aid-man 
would care to engage in. 
All kinds of foreign substances have been known to become 
lodged in the throat and stomach tube. In these cases, the first- 
aid-man can do two things, namely, either induce vomiting by 
tickling the throat with a feather or finger, or cause the object 
to pass on into the stomach by making your patient swallow a 
big bolus of something like bread or boiled potato. Even if 
the foreign body were already in the stomach, boiled potato 
would be a good thing to eat, because well intended to round off 
sharp edges and corners, which will materially aid its passage 
onward through the intestinal canal and prevent wounding it. 
In case leeches were swallowed, which sometimes happens 
when water is drank hurriedly and perhaps in the dark, strong 
solutions of kitchen salt must be at once administered. 
Splinters under the skin and finger-nails must be removed by 
means of a fine pair of pincers, and should be withdrawn in a direc- 
tion opposite to that in which they entered. Very fine splinters 
sometimes get under the nails and then break off beneath the nail 
and no pair of pincers are fine enough to get hold of them; these 
may be easily removed with the point of a needle. 
Punctured wounds caused by rusty nails must be treated like 
poisoned wounds and under strictly antiseptic precautions, other- 
wise suppuration, if not lock-jaw, might follow the accident. 
In cases of stings from bees and hornets, the external applica- 
tion of ammonia to the parts is indicated to neutralize the irritant 
fluid substances introduced by the insect; if inflammation should 
follow, cooling lotions must be applied, of which the ordinary 
lead and opium wash is the best. 
You may some day be called upon to remove a ring from a 
finger that is very much swollen up. To avoid complications of 
this sort, it would be, of course, very much better if every one 
would remember in case of injury to his finger, that all rings on 
that particular finger should be removed immediately, before any 
swelling has set in. Swelling having set in, however, the ring 
must be promptly removed, since death of the entire finger by 
strangulation might result if left on. 408 
FIRST AID TO THE INJURED, 
The ring might perhaps be cut, but that requires instruments 
of a certain kind that are not always on hand and certain men 
who may not be found right off. In such a dilemma you must 
begin by trying to reduce the size of the finger first. With this 
end in view, take an elastic band and firmly apply it to the swollen 
finger, beginning at the tip and carrying it to where the ring is. 
This may be repeated several times if it should not work well the 
first time. The finger being now considerably reduced in circum- 
ference, a little oil is put on and the ring removed with the greatest 
of ease. 
This process, however, would be admissible only when no sup- 
puration complicates the case, because otherwise septic matter 
would surely be forced into the lymph vessels and blood poisoning 
result. 
Drowning. 
When a man falls into the water knowing he cannot swim, he 
generally gets so bewildered that all the efforts which he makes, 
frantic as they are, to save himself are directed to no purpose 
whatsoever and the energy which he expends is consequently 
wasted. 
In a good swimmer, on the contrary, the very consciousness 
of his ability to swim keeps him perfectly cool and self-composed, 
and enables him to save himself and others from drowning without 
unduly wasting a particle of his much needed energy. 
While all of you perhaps know how to swim and swim well, 
too, it may happen some day that the odds are very much com- 
bined against you and you become exhausted before reaching 
your goal and before more substantial assistance can reach you. 
Under such conditions and circumstances, remember these few 
and simple rules, which, nevertheless, may keep you from drown- 
ing: (i) Lie on your back, with the head well backwards; let the 
mouth and nose be the only parts of the body that are above the 
surface of the water. (2) Keep your lungs full of air by taking 
deep inspirations and short, quick expirations. (3) Leave the 
arms under water, as shown in fig. 77. 
The fact that the human body will float when in this position 
depends on its being very slightly lighter than the volume of 
water which it displaces. When, therefore, the arms are held 
above the surface of the water, the head must sink, owing to the 
loss of displacement (see fig. 78). Fig. 76.—Arm showing different degrees of burns. 
Fig. 77.—Showing how to keep horizontal position when floating in water. 
Fig. 78.—Shows how head sinks below 
surface of water when hands are kept 
above the surface. 
Fig. 79.—Shows position which the body 
assumes under water when hands are 
kept alongside of it. AND TRANSPORTATION OF THE WOUNDED. 
409 
The practice of this little maneuver should always form the first 
lesson in the art of swimming. The two best positions to be taken 
while floating in the water are represented in figures 77 and 79. 
When the arms are kept above the head, the position will become 
a horizontal one; when, on the other hand, these are kept along- 
side of the body, the position of the body in the water will incline 
towards the vertical (see fig. 79). 
This is easily explained and understood by a glance at these 
pictures. The white oval space is made to represent the air 
contained in our lungs and which, therefore, answers the purpose 
of a swim-bladder; this space is very nearly in the center of the 
body whenever the arms are held above the head, and hence the 
horizontal position in the water; with the arms alongside of the 
body the greatest weight falls below this space, hence the posi- 
tion inclining more towards the vertical. In the vertical position 
the head must be bent further backwards than in the horizontal 
position in order that the mouth shall come to lie out of the 
water. 
Whenever a man falls out of a boat into the water, an oar, boat- 
hook or rope may be passed him; a good little device also is 
your coat which you may take off, passing the man in the water 
one sleeve while you hold on to the other yourself. 
According to Hans Mueller, a very celebrated teacher of swim- 
ming in Hamburg, Germany, and quoted by von Esmarch as 
having saved over 200 people from death by drowning, conse- 
quently well qualified to speak on the subject, the best method 
of saving life on the water is as follows: Before taking hold of the 
drowning man call out to him loudly that he is saved, in order to 
reassure him; approach the man from behind, passing your left 
arm between his left arm and body and seizing his right wrist 
and, in this manner, swim ashore on your back, striking out with 
your right free arm. The man is thus prevented from paralyzing 
your efforts by taking hold of you, which might be the cause of 
both drowning together. In case, however, the drowning man 
has seized the swimmer, the best thing the latter can do is to dive 
under until the former begins to lose consciousness and thus 
loosens his grip. 
Whenever the tide is against you it will be best to float on 
your back with the tide and not exhaust your energies by trying to 
swim against it* and quietly wait for assistance to arrive. 410 
FIRST AID TO THE INJURED, 
Whenever any one breaks through thin ice, as is frequently the 
case during the skating season, and he is unable to extricate 
himself, the best help will be a long ladder or board intended to 
distribute the weight over a larger surface of the ice and upon 
which the boy may crawl out. Another very good means is said 
to be a wooden ball, such as is used in bowling, made fast to a 
rope and rolled out to him until it drops into the water; to this he 
can cling until further assistance arrives (fig. 80). 
In approaching a man broken through weak ice, you must 
take the precaution either of crawling up to him on your stomach 
or at least arm yourselves with a long pole or boat-hook, which 
you must hold to your back with your elbows, as shown in fig. 81. 
Death under water may be produced in two ways: 
1. By suffocation, through water getting into the lungs. 
2. By fainting. 
Whenever death is brought about by suffocation, the face of 
the drowned person will present a puffed-up, swollen appearance, 
the skin of his face will be of a dark bluish color, particularly 
noticeable about the lips and eyes; there will, furthermore, also be 
a good deal of water found in the stomach and the lungs. 
In cases of death by fainting, the face will look pale and there 
will be no water in the lungs, the spasmodic closure of the glottis 
over the wind-pipe having prevented its entrance there. It is 
much easier to revive one of the latter class than one of the former. 
However, every drowned person ought to be looked upon as 
only seemingly dead, because it has happened that persons were 
brought back to life even after remaining under water for hours. 
Attempts at resuscitation should be undertaken and conducted 
with confidence and perseverance and continued for several hours. 
The following rules are borrowed from Prof. v. Esmarch’s 
“ Erste Huelfe,” their observation is recommended to all whose 
duty it may become to save a drowning person, the rules them- 
selves having been adopted by the German Samaritan Associa- 
tion. They are: 
1. As soon as the drowning person arrives on shore send for a 
physician, for woolen blankets and dry clothes; take off all the wet 
ones. 
2. At once begin with your efforts at resuscitation, if possible 
in the open air, weather, of course, permitting. 
3. Always remember your first duty to be the re-establishment 
of his breathing. Fig. 80.—Trying to save a person broken through the ice by means of a wooden 
ball attached to a rope. 
Fig. 81.—Manner of approaching a person broken through weak ice. 
Fig. 82—First step in the resuscitation of a drowned person. B 
Fig. 84.— Showing Howard’s method. 
Fig. 85. — How to push the lower jaw forwards. Fig. 83.—Illustrating the different steps in Sylvester’s method of resuscitation. AND TRANSPORTATION OF THE WOUNDED. 
411 
4. Efforts at resuscitation must be kept up for hours before hope 
is given up. 
5. Never stand the drowned man on his head; place him over 
your left knee with his stomach downward, pressing on his back 
so as to give the water a chance to run out of his lungs and 
stomach (see fig. 82). 
6. Clean out his mouth with a small swab and also his nose so 
as to allow air to enter; if the tongue falls backward, pull it out, 
taking hold of it with a handkerchief. 
7. Tickle the nose with a feather, try the effects of smelling- 
salts or ammonia water; rub his face and chest alternately with hot 
and cold water. 
8. If no success follows these means, commence at once to make 
artificial respiratory movements. 
9. The object of these movements is to expand and compress 
the chest alternately so as to force fresh air into the lungs. 
10. The method recommended most is Sylvester’s. 
11. Put your man flat on his back, a folded blanket or coat 
supporting his shoulders. 
12. Take your place behind him, seize both his arms near the 
elbows, raise them over his head, holding them in this position 
for a couple of seconds, as shown in -fig. 83 a, thereby expanding 
the chest and forcing air into the lungs. 
13. Thereupon return the arms to the side of the chest, press 
the elbows against the chest gently but firmly for two seconds, 
thereby pressing air out of the chest (fig. 83 b). 
14. When two people are present, each may take one arm and 
the two work together (fig. 83 c). 
13. These movements should be repeated at the rate of 15 
times per minute and kept up until voluntary respiratory move- 
ments occur, generally announced by the red color returning to 
the man’s face. 
Another method recommended is that of Howard and illus- 
trated in fig. 84. 
16. The drowned person is placed on the back, the arms crossed 
behind, and a folded coat supporting the small of the back. 
17. An assistant pulls out the tongue or pushes the lower jaw 
forward, as shown in figure 85. 
18. The hands are laid flat on the lower part of the chest, and 
firm and steady pressure is made and kept up for two seconds. 
19. Then the hands are raised, the chest expands. 412 
FIRST AID TO THE INJURED, 
20. As soon as voluntary inspirations commence, help the circu- 
lation along by hot blankets. 
21. Rub the legs and arms from the periphery towards the 
center, as in massage. 
22. As soon as both respiration and circulation have become 
re-established, put your man into a warm bed, surrounding him 
with hot bottles. 
23. Finally, administer hot drinks, such as coffee, tea, etc. 
These same methods of resuscitation can, of course, be applied 
also in cases of suffocation caused by the inhalation of poisonous 
gases. 
Unconsciousness 
Is a condition characterized by the loss of consciousness, of 
general sensation and voluntary movements. It may be due to 
a number of causes, namely: i. Injuries to the brain. 2. Diseases 
of the brain (epilepsy, apoplexy). 3. Temporary anemia of 
that organ from loss of blood either internally or externally. 
4. Difficult respiration. 5. Sunstroke. 6. Poisoning by alcohol 
and other narcotics. i 
In the treatment of the condition of unconsciousness two car- 
dinal rules with regard to the position of your patient must be 
kept in mind. (1) Whenever your patient’s face looks pale, the 
position which you must place him in is the horizontal one. (2) 
When, however, his face looks red, as will be the case in apoplexy, 
then you must raise his head and trunk and place him in a half 
sitting position. 
In the one case you are dealing with a case of anemia of the 
brain, and the horizontal position is the best in this case because it 
facilitates the re-establishment of the circulation through the 
organ. In the other you have either congestion of or hemorrhage 
into the brain, and the horizontal position would aggravate these 
conditions, hence you must elevate the head and trunk. 
Smelling bottles, ammonia and ether, etc., much used in fainting 
fits, are directly contra-indicated in cases of congestion of or 
hemorrhage into the brain, in other words, in cases of apoplexy. 
Moreover, when finding a person struck down in the streets, 
never forget to take a few mental notes of the position the person 
was in when found by you, for this may prove of considerable 
importance from a medico-legal point of view. AND TRANSPORTATION OF THE WOUNDED. 
413 
If the man begins to vomit, turn him over on his side with the 
face downward, so as to prevent any of the contents of his 
stomach from being sucked down into the wind-pipe and the 
lungs, which is a frequent cause of pneumonia. The vomiting 
over, swab out his mouth. 
An epileptic may be allowed to lie on the ground until the fit 
is passed; he only requires watching so as to keep him from 
injuring himself. Consciousness soon returns, accompanied by 
great fatigue; these patients never have the slightest recollection 
of what happened during the attack. 
Sun-Stroke or Heat-Stroke. 
The prolonged influence of solar heat on the more exposed 
portions of the surface of the skin is followed by inflammation 
and, may be also, the formation of blisters. 
Sunstroke is a form of unconsciousness caused by hard work 
in an atmosphere which is overheated and oversaturated with 
moisture, aided by a scarcity of drinking water. Soldiers com- 
pelled to march in closed ranks for a long time often fall victims to 
sunstroke. 
Sunstroke may be caused not only by the direct rays of the sun 
but also by radiated heat. 
We distinguish two forms of sunstroke or heat-stroke, namely, 
(i) The grave form, which is characterized by paralysis or the 
suspension of all the cerebral functions, including respiration, and 
which is invariably followed by death. (2) The mild form, which 
frequently occurs in places where water is scarce, and is due as 
much to loss of water through perspiration and the consequent 
thickening of the blood as to the influence of the heat. 
It is a good rule to take large quantities of water while at work 
in hot weather. 
The mild form of heat-stroke commences with extreme drowsi- 
ness, stupefaction, cramps, severe headache and back-ache, difficult 
breathing, dark red color in the face, dry tongue, dry skin and 
feeble pulse. 
Any person showing such symptoms had better at once be 
taken to a cool spot, his clothes taken off, ice applied to the head 
and lukewarm drinks administered; if convenient, give him a 
lukewarm bath to encourage perspiration; afterward put him in 
a wet pack. 414 
FIRST AID TO THE INJURED, 
Lightning either produces enormous burns, in some cases 
completely charring the parts struck, or it causes paralysis of the 
nervous system through the electricity which it sends into it, and 
the effects of which are most difficult to treat. 
Apparent Death. 
The condition of apparent death from real death may be dis- 
tinguished as follows: i. By electrical currents passed through 
the different regions of the body; the electrical excitability ceases 
but a very short time after death has taken place. 2. By taking 
the temperature in the rectum; anything below 8o° F. indicates 
sure death. 3. By winding a string around one of the fingers; 
as long as the peripheral portion of the finger swells up and 
assumes a bluish color under this treatment, and the white place, 
after removing the string, turns red again, death is not real but 
only apparent. 4. Irritants applied to the skin, in apparent death, 
are not followed by blisters with a red basis, but only by eleva- 
tions of the cuticle having a white ground. 
The treatment of apparent death must, of course, depend on 
circumstances. LECTURE VI. 
THE TRANSPORTATION OF THE WOUNDED. 
The best method of transporting- the wounded from one part of 
a modern man-of-war to the other must be considered still as an 
open, unsettled question. Perhaps there is no one best method at 
all, and every new ship requires a new method and new means 
to this end, owing to its own peculiar construction, just as every 
injury may require its own peculiar handling and form of appa- 
ratus. 
However this may be, the problem must have appealed to the 
good sense of many an able medical mind as being an im- 
portant one, if the number of cots that have been designed for the 
transport of the injured on board ship form any criterion to 
judge by. 
Most every man-of-war has on board at least one or two of 
these relics of past ingenuity, which are, however, far from 
answering the purposes for which they were originally intended; 
they all prove that the necessity for something of the kind was 
nevertheless felt sufficiently strong to arouse even the most phleg- 
matic minds into a state of productive activity. 
But granting even that every one of these different cots is 
very good and useful, the question might still be asked, what is 
the use of even the best of cots without trained bearers to 
handle it? 
The best gun in the world would be perfectly useless without 
the men trained to work that gun, while an inferior one might be 
made to do good work under the pressure of circumstances with 
properly trained hands and minds behind it. Just so with the 
handling of the wounded and the cot. 
The first and most important step, therefore, that must be taken 
to bring about some much needed reform in this much abused 
and neglected department aboard ship, is to train men. 
We hold that it is not the most useless and the most stupid 
landsman that can be found among a crew whom you would 416 
FIRST AID TO THE INJURED, 
select as the proper person to aid you when wounded or in danger 
of life or in sickness. Why, then, thrust him onto others? 
The surgeon on board ship and his patients need, on the 
contrary, intelligent assistants; hands, minds and hearts that are 
trained in the gentle duties required from such persons holding 
similar positions on shore. 
But it requires some knowledge and experience in matters 
medical, as well as in life on board ship and its possibilities, to 
fully see and realize how imperfect a modern fighting machine 
like some of the present men-of-war appear in the eyes of a naval 
surgeon who is mindful of the duties and responsibilities of his 
position, without much better arrangements being made for the 
care of the sick and the transportation of the crippled and 
wounded. 
And, by arrangements, we refer not to space alone, which may 
be ample and yet wasted. 
In some of the more modern ships the constructor seems to 
have entirely forgotten that it is within the range of bare possi- 
bility for accidents and sickness to occur among the crew during 
the natural life of his ship. 
A man-of-war without any provision for the sick and wounded 
may indeed go out and fight his battles, so might a man without 
his left arm or in the last stages of consumption; neither the ship 
nor the man will, however, in the long run, be able to compete 
with his more perfectly equipped adversary and must be con- 
sidered crippled to that extent. 
It is not the expenditure of necessary life which we mean to 
save; it is the waste and unnecessary expenditure of lives which 
it is our aim to prevent. 
The matters of fact are indeed simple and clear and scarcely 
need any argument, as you will readily concede. 
No matter, then, where a man may have been injured, whether 
on land or sea, the fact remains that, after dressing his wounds, 
it becomes the duty of the first-aid-man to employ or improvise 
means for his safe transportation to a place where he may receive 
further treatment. 
The different methods of lifting and carrying the sick or in- 
jured must vary according to the nature of the case and the num- 
ber of persons available for the purpose. 
(i) There are cases of injuries which do not disable any one AND TRANSPORTATION OF THE WOUNDED. 
417 
from walking, and such persons need, therefore, no transportation 
at all. 
(2) When the injury has occurred to the foot or the parts below 
the knee, the patient may, if of light weight, be conveyed pick- 
a-back, putting his arm around the neck of the bearer; but this 
would, very naturally, be impossible if the injury were in the 
upper part of the leg, on account of the pain it would necessarily 
entail. 
(3) If the patient is suffering from some injury to the upper part 
of the leg, is unable to walk and yet perfectly sensible, he may be 
greatly assisted by the bearer placing his hip against the patient’s 
hip on the uninjured side and taking the arm of the same side, 
placing it around his own neck and holding it there with one hand 
whilst his other hand and arm encircle the patient’s waist. Then, 
by a series of light hops, the patient can be quickly moved along 
and the injured limb kept well off the ground (see fig. 86). 
But circumstances may be such as to require you to move un- 
aided an insensible person. 
The method that is most frequently used in such cases is the 
following: The insensible person is put fiat on the face, with the 
arms extended in a line with the body, and then brought into a 
kneeling position. The bearer places his right shoulder against 
the center of the body while placing his right arm between his 
legs and around the right thigh; at the same time he seizes the 
left wrist with his left hand, taking it around his own neck and 
under his left arm, passes it to the right hand which grasps it by 
the wrist. This may be done in the reverse way and the right 
arm left disengaged. 
(5) A slight modification is sometimes adopted as follows: The 
patient, lying as before, extended and flat on his face, is raised to 
the kneeling position by the bearer, who stands in front, putting 
one arm in each arm-pit. He then slips his hands and arms 
around the patient’s waist and brings him into the erect posture 
with his head hanging over the bearer’s shoulder. Then, grasp- 
ing either wrist and passing it over the head to the opposite 
shoulder, he slips under the body and swings it over his shoulders, 
grasping the legs with the opposite hand. 
(6) Another method is to place the patient in a sitting position 
and to pass a soldier’s belt or any broad continuous strap behind 
the thighs and under the arms. The bearer then seats himself 418 
FIRST AID TO THE INJURED, 
dos-a-dos and, passing the strap over his own forehead, raises 
himself. The weight will then fall upon the shoulders and upper 
part of the back. The strap under the arm will prevent the pa- 
tient falling out, as he will be somewhat wedge-shaped, the broader 
portion above and the apex formed by the buttocks below. Both 
arms of the bearer are then disengaged and, therefore, this method 
is a good one in cases that occur on board ship while in motion. 
When two bearers are available things are much easier. 
(1) The ordinary dandy or sedan-chair, as made by children 
clasping their wrists as shown in fig. 87, is, of course, well known 
to you. This is only adapted when the injured person is sensible, 
as he must support himself by placing his arms around the necks 
of the bearers on either side of him. 
(2) Another four-handed seat is sometimes made by the bearers 
crossing their arms and then taking each other’s hands (fig. 88); 
but this is a bad one and not to be countenanced, because, if the 
patient is at all heavy, it soon becomes most painful to the bearers 
at the point where their arms cross, and they will have to put the 
patient down to relieve themselves. 
(3) Also the bearers may lock only one pair of hands under the 
thighs of the patient and place their other arms around his loins, 
while he supports himself by placing his arms around their necks. 
This, again, is not so good as the first described. 
(4) - If the patient is not in sufficiently good condition to be 
trusted to supporting himself, the three-handed seat should be 
used, as represented in fig. 89, and then the bearer whose hand is 
left free places it upon the shoulder of the bearer whose two hands 
are engaged and thus a back is formed to the seat. 
(5) A seat, but not as good a one as that just described, with 
a back to it, may be made by the bearers locking opposite hands 
under the thighs and placing their other two hands on each 
other’s shoulder, as shown in fig. 88. 
(6) Two bearers may convey an insensible person by one (the 
stronger) of them lifting the upper half of the body by placing 
his arms under the arm-pits and locking his hands in front of the 
chest, while the other bearer goes between the patient’s legs and, 
turning his back to the first bearer, lifts one leg of the patient 
under either arm, as shown in fig. 90; a third person supports the 
lower limb, should that be the part injured. 
(7) If circumstances should make it desirable that the patient Fig. 86.— Howto aid an in- 
jured person single-handed. 
Fig. 87.—The ordinary dandy or sedan-chair 
Fig. 88.—Another four-handed 
chair not so good as the se- 
dan chair. 
Fig. 90.—How two bearers may carry an 
insensible person. 
Fig. 89.—Still another chair. 
Fig. 91.—Manner after which an injured person is put 
on a stretcher. AND TRANSPORTATION OF THE WOUNDED. 
419 
be carried in a more extended position, the two bearers kneel 
down on their left knee only, and, passing their hands underneath 
the patient, lock them together. One pair of locked hands is 
placed below the shoulder-blades and the other pair below the 
buttocks. The bearers then rise gradually to their feet and move 
the patient by sideway steps, while his head is supported by a 
third person and the legs by a fourth. If only one other person 
is available, then priority should be given to the head if the patient 
is insensible, or to the leg if that is the part of the body which is 
injured. This is also the manner after which an injured person is 
put on a stretcher (fig. 91). 
Then, as to the manner the bearers should lock their hands: 
this is usually done wrongly. The bearer on one side should 
notice which way the other is going to pass his hands under 
the patient, so that the bearer at the opposite side may pass his 
hands with the palms uppermost, while the other, passing his 
with the palms downwards, must keep close to the body of the pa- 
tient, so that the bearer at the opposite side may pass his hands 
beneath the other one’s. Their hands will then be clasped as shown 
in fig. 92, palm to palm, and held by the thumbs on one side of the 
wrist and the fingers on the other. This is the only right and 
proper way of joining the hands. 
Whenever patients are to be carried some little distance, a 
stretcher should always be made use of. 
The lifting of patients on to a stretcher and carrying them there- 
on by word of command is known by the name of stretcher drill. 
Every military organization the world over has its stretcher drill. 
Captain John Furley, the director of the St. John’s Ambulance 
Association of London, has drawn up a system of stretcher 
exercises that are purchasable at St. John’s Gate, Clerkenwell. 
In connection with the stretcher drill, I must quote the words 
of Dr. Charles Smart, Surgeon and Major, U. S. A., and author 
of the Handbook for the Hospital Corps of the U. S. Army and 
State Military Forces, who says: “Drills by word of command 
are needful to perfect men in all movements that require concerted 
and co-operative action. It is a mistaken notion to suppose that 
because a drill is authorized and provided for, the various details 
of that drill must be rigidly observed on every occasion. The idea 
of seizing a man whose thigh-bone or spine is broken, or who has 
received some injury that must remain undiscovered until a care- 420 
FIRST AID TO THE INJURED, 
fill examination is subsequently made, and lifting him to or from 
a stretcher by word of command, is simply absurd. The drill is 
merely a means to an end. A well-manned battery keeps up a 
rapid fire on the enemy because every man at every gun knows the 
duty devolving upon him and does it without command at the 
precise moment when it should be done; but this perfection of 
co-operative work can be attained only by repeated and careful 
drills in the consecutive movements, each executed at the word of 
command. An analogous drill with the stretcher and a represen- 
tative of the disabled human body familiarizes men with the 
management of these objects and prepares them to act intelligently, 
one with the other and irrespective of commands, when the neces- 
sities of the occasion require such action.” 
These words, in our opinion, express the raison d'Hre of the 
stretcher drill beautifully and forcibly. 
The Drill Manual issued from the office of the Surgeon-General 
of the Army provides for the falling in of the men for inspection, 
drill, or active service, and prescribes the duties of each member 
of the squad in connection with litters, ambulances and other 
means or modes of transportation. 
The detachment for inspection or drill is formed in single rank, 
privates of the hospital corps on the right, company bearers, with- 
out arms, in the center, and musicians on the left. The senior 
hospital steward is on the right of the line; the other hospital 
stewards and acting hospital stewards are posted as file-closers, 
two yards in rear of the line and in order of seniority from right 
to left. The formation, opening and closing of the ranks, ma- 
neuvering, inspection and muster of the detachment are effected 
by the commands and in the manner prescribed for infantry 
troops, modified in certain special details as follows: 
i. After fours are counted in forming the detachment, if the 
knapsack or medicine-case men are not already in that place, they 
are assigned as' No. 4 of each set. The sets of four or squads are 
numbered from right to left, and these numbers are not changed 
during the exercises. The left squad, if incomplete, may remain 
in line on the left and its men be afterwards utilized as dummy- 
wounded, or ordered to practice in transferring patients to litters 
or to beds or in improvised means for transportation; or they may 
be assigned as supernumeraries and posted on the line of file- 
closers behind the squads to which they are attached. Super- AND TRANSPORTATION OF THE WOUNDED. 
421 
numeraries are attached to squads when the duty to be performed 
promises to be so fatiguing as to require more than the usual 
reliefs. 
(2) When one or more squads or the whole detachment is to be 
mounted, the detachment having been formed dismounted, the 
senior hospital steward gives the necessary directions, under the 
instructions he has received, for the squad or squads, or the whole 
detachment, to be marched to the picket line or stables for their 
horses and horse equipments. The mounted squads are formed 
in line in single rank, the lowest number squad on the right. A 
mounted hospital steward, specially assigned to this duty, or, in 
his absence, No. 1 of the right squad, superintends the formation 
of the mounted squads at the place designated. If the whole 
detachment is mounted, the senior hospital steward superintends 
the formation. The position of the stewards and acting stewards 
with detachments mounted are the same as with detachments un- 
mounted, except that the file-closers are one yard in rear of the 
rank, the distance being measured from the croups of the horses 
in the line to the heads of the horses of the file-closers. If only 
part of the detachment is to be mounted, the instructor receives 
the report of the senior hospital steward at the formation dis- 
mounted ; if the whole detachment is to be mounted he will receive 
the report of the steward mounted. 
(3) At the command, draw—swords, of inspection those armed 
with knives draw them and hold them in the position of carry 
swords. Inspection of the knife is similar to that of the sword 
or saber. First motion: Raise the right hand as high as the 
neck and six inches in front of it, edge of the blade to the left. 
Second motion: Turn the wrist outward to show the other side 
of the blade, the edge to the right; make a slight pause and then 
turn the wrist back. Third motion: Drop the right hand to the 
side and hold the knife as prescribed after drawing from the 
sheath. At the command,return swords, the knives are sheathed. 
(4) Knapsacks, medicine cases and dressing boxes are unslung, 
opened, repacked and slung by the commands, and as nearly as 
practicable in the manner prescribed for the inspection of knap- 
sacks or blanket bags of an infantry command. The company 
bearers take their dressing packets in the right hand and, as the 
inspector passes, they advance the hands so as to display the 
packets. 422 
FIRST AID TO THE INJURED, 
Bearer Drill.—In bearer drill the inspector designates by their 
numbers the squads which he wishes to operate with the hand- 
litters, ambulances, etc., and assigns the hospital stewards and 
acting hospital stewards to the superintendence of drills that are 
not supervised by officers. No. i of each set is the ranking 
member and gives the commands needful for the proper maneu- 
vering of the squads. 
No. i of a squad designated to practice with a hand-litter pro- 
cures the litter and prepares it for use, placing it lengthwise on 
the ground, its near end opposite and two yards in front of the 
center of the squad; he then resumes his place on the right of the 
squad and commands: 
i. To your posts; 2. March. At the second command Nos. 2 
and 3 take position between the handles—No. 2 in front, passing 
by< the right, No. 3 in rear; No. 4 takes position on the left of 
the litter opposite its center and one yard from it; and when No. 
1 has seen that the other numbers are in their proper places, he 
takes his own on the right of the litter opposite its center and 
one yard from it, all facing to the front. 
Or, the folded litter being in position in front of the squad, 
at the command, To your posts, March, the members take post, 
No. 2 on the right of the front handles, No. 3 on the left of the rear 
handles, and Nos. 1 and 4, respectively, on the right and left of the 
litter at its mid-length, all facing to ihe front. Then, at the com- 
mand, Open Litter, 1st, all face inward to the litter; 2d, Nos. 1 
and 4 bend on the knee, grasp litter with hands under poles and 
rise erect, holding litter horizontal; 3d, Nos. 2 and 3 unbuckle 
and fix straps, adjust legs and straighten transverse irons, etc. 
Then, at the command, Lower Litter, Nos. 1 and 4 lower litter 
to the ground, and all resume position as mentioned above, after 
the command To your posts, March. 
No. 1 now commands: 1. Prepare to lift litter; 2. Lift Litter. 
The first command is executed by Nos. 2 and 3, adjusting the 
braces about their shoulders; the second by the same members, 
raising the litter in position to be carried, Nos. 1 and 4 standing 
fast. If, owing to a difference in height of the carriers, the litter 
is not horizontal, No. 1 directs a change in the length of the 
braces to correct the inequality. 
He then commands: 1. Forward; 2. March, when, at the 
second command, the carriers break step, that is step off with AND TRANSPORTATION OF THE WOUNDED. 
423 
different feet, No. 2 with the right, No. 3 with the left foot, march- 
ing with the litter as nearly as possible horizontal and taking 
short sliding steps to avoid jolting and to secure a smooth, uni- 
form movement of the litter; Nos. 1 and 4 march on their respect- 
ive sides of the litter. 
The litter is carried to the point previously designated by the 
proper officer by means of the command: 1. Litter right {or left)-, 
or Litter half-right {or left); or Incline to the right {or left); 
March. 
To halt the litter and rest the squad, No. 1 commands: 1. Litter; 
2. Halt; 3. Lower litter; 4. Rest. At the third command, the litter 
is slowly and steadily lowered to the ground and the carriers 
release themselves from the braces; and at the fourth command, 
the men stand at ease in the vicinity of their posts. 
To resume the attention the commands are: 1. Squad; 2. At- 
tention. 
The transfer of a patient to a litter requires practice and the 
united action of two, three or all the bearers of a squad, accord- 
ing to the gravity of a wound or the helplessness of the patient. 
Every movement should be made without haste and as gently as 
possible, and the wounded part should be carefully protected from 
all injurious contact. 
Having reached the sick or wounded man, No. 1 halts and 
lowers the litter so as to place it in front of the head or feet of 
the patient in the direction in which he is lying. As soon as the 
bearers are released from the braces, Nos. 2 and 3, passing by 
their right and left respectively, take position facing each other 
on opposite sides of the patient, near his hip-bones, and, if a limb 
be injured, No. 4 places himself by its side. Everything in readi- 
ness, No. 1 commands: 1. Prepare to lift patient; when Nos. 2 and 
3 stoop down and get each one hand under the back of the 
patient near the shoulder-blades, and lock them by grasping 
firmly each other by the wrists; the other hands are passed under 
the upper part of the thighs and clasped; No. 4 attends only to the 
injured limb. No. 1 now commands: 2. Lift Patient; when the 
bearers rise slowly and, when upright, as shown in fig. 91, at the 
command, 3. Forward, 4. March, they move by short steps until 
the head of the patient is over the pillow on which it is to rest. 
No. 1 then commands: 1. Squad; 2. Halt; Lower Patient; when 
the bearers slowly lower the patient on the litter. 424 
FIRST AID TO THE INJURED, 
Or the commands for marching- and halting may be omitted, 
the bearers standing fast while No. i slips the litter under the 
patient. 
Nos. i and 4 now see that the patient is in a comfortable posi- 
tion and perfectly secure, the head properly supported and the 
wounded part so placed that it can be easily attended to on the 
march. 
The movements on the loaded litter are executed in accordance 
with the commands of the hand-litter drill as stated above. 
It will be observed that, in raising the patient to the litter by 
this method, the head and upper part of the body are considerably 
elevated. An individual who is intensely prostrated may not be 
subjected to this treatment without risk of syncope. In such 
cases the following method is recommended by Smart: 
When the litter has been halted near the head or foot of the 
patient, and in line with his body, No. 1 commands: 1. Stand to 
wounded; 2. Right (or left); 3. March. If right has been 
ordered, Nos. 2, 1 and 3 proceed by the right of the litter and range 
themselves along the corresponding side of the patient, facing 
him—No. 2 by his right knee or left shoulder, according as the 
head or feet of the wounded man point to the litter, No. 1 at his 
hip and No. 3 at his right shoulder or left knee, while No. 4 takes 
position opposite and facing No. 1. If left has been ordered, Nos. 
2, 4 and 3 proceed by the left of the litter and range themselves 
along the corresponding side of the patient, while No. 1 takes posi- 
tion opposite to and facing No. 4. The accompanying diagram 
shows the positions of the bearers when the order is right (fig. 93). 
At the command, Load—using the numbers for the movement, 
one, the bearers kneel on the right knee if on the right, and on 
the left knee if on the left of the patient; two, No. 2 or 3, who is 
stationed at the patient’s knee, passes both arms about the patient’s 
legs, carefully supporting the fracture, if there be one, Nos. 1 and 4 
pass their arms under his hips and loins, No. 2 or 3 passes one arm 
under his neck to the farther axilla, with the other supporting the 
nearer shoulder; if possible the patient clasps his arms about the 
neck of this bearer; three, all lift together, slowly, supporting the 
weight upon their knees, and as soon as the patient is firmly sup- 
ported, No. 1 or 4, whichever is on the free side, withdraws his 
arm and passes by the shortest line to the litter, which he takes 
up near the middle, one pole in each hand, and returning to his AND TRANSPORTATION OF THE WOUNDED. 
425 
position, places it under the patient and close against the bearers, 
being careful to see that its legs are properly arranged, and then 
assists, as before, in supporting the patient; Jour, all the bearers 
gently lower the patient on the litter; five, the bearers rise and re- 
sume their position, 2 and 3 as carriers, and 1 and 4 on the right 
and left of the litter, respectively. 
It will frequently occur that, being wounded in the leg or foot 
too severely to walk, the injured man can, nevertheless, with 
proper attendance, seat himself upon the prepared litter placed by 
his side and then lie comfortably upon it. 
To change bearers on the march, No. 1 commands: 1. Litter; 
2. Halt; 3. Lower Litter; followed by 1. Change Posts; 2. 
March ; when Nos. 1 and 2, and 3 and 4 exchange posts and duties, 
except that No. 1 retains command of the stretcher. 
The transfer from litter to litter, or to bed, is effected in the 
same way as from the ground to the litter, the bearers always 
observing, as far as practicable, that the litter or bed to which the 
patient is to be transferred shall be at the head of the patient, its 
length in the direction in which he is lying. 
As a general rule in hand-litter operations, the feet of the 
patient should point in the direction in which the litter is carried. 
But in going up hill or upstairs, the patient’s head should be in 
front, unless he has a broken leg or thigh, in which case the order 
is reversed to prevent the weight of the body from pressing down 
on the injured part; and on the going down hill, the patient’s head 
should be behind, except for the reason given in cases of fracture 
of the lower extremities. It is important that the bearers should 
keep the litter level, notwithstanding an unevenness of the ground. 
In making ascents, the stronger of the two bearers should be in 
rear, as he has to bear a greater weight in raising his end of the 
litter to the proper level, and in making descents he should, for 
the same reason, be in front. A breach should be made in a fence 
or wall for the passage of the stretcher, if there be no gate or other 
opening, rather than risk the passage of the injured man over it; 
but should it be necessary to surmount the obstacle, Nos. 1 and 
2 place the front handles securely on top, while 3 and 4 elevate 
the rear handles; the two first-mentioned then cross the wall and 
advance the litter until its rear handles rest upon it, when 3 and 4 
cross, resume the handles, and all lower the litter, after which the 
march is continued as before the obstacle was reached. 426 
FIRST AID TO THE INJURED, 
In crossing a ditch or deep cut, the litter is laid on the ground 
with the front handles near the edge; Nos. i and 2 descend and ad- 
vance the litter, -keeping it level, until the rear handles rest upon 
the edge, when Nos. 3 and 4, who have assisted in this movement, 
descend and resume the support of their respective handles; the 
ascent is made on the other side by Nos. 1 and 2 resting their 
handles on the edge, ascending and advancing the litter until its 
rear handles rest upon the edge, when Nos. 3 and 4 ascend and the 
march is resumed. The position of a patient on the litter depends 
on the site and nature of his injury. The head should be, as a rule, 
low, particularly when the patient is faint; but difficulty of breath- 
ing in penetrations of the chest often requires that the head and 
shoulders be elevated. In wounds of the abdomen the best posi- 
tion is on the injured side, or on the back if the front of the 
abdomen is wounded; the legs in either case being drawn up and 
a pillow or other suitable object placed behind or beneath the 
knees to keep them bent. In an injury of the upper extremity, 
calling for litter transportation, the best position is on the back 
or on the uninjured side, while in injuries of the lower extremity 
the patient should be on his back or inclining towards the 
wounded side. 
To change the direction of the litter in order to ascend an 
elevation, when the patient’s lower limbs are not fractured, or to 
descend an elevation when such a fracture is present, No. 1 com- 
mands: 1. Squad; 2. Halt; 3. Lower litter; 4. About Face; 5. 
Raise litter; 6. On No. 2 (or 3) right (or left) Wheel. 
To fold the litter when the patient has been disposed of and the 
necessity for the open litter is at an end, the squad being at their 
posts, No. 1 commands Fold Litter ; when 1st, No. 2 steps to the 
outside of his right handle, No. 3 to the outside of his left handle, 
and all face the litter; 2d, Nos. 1 and 4 advance to mid-length of 
the litter, bend on the knee, grasp the litter with hands under 
poles and rise erect, holding the litter horizontal; 3d, Nos. 2 and 3 
remove slings from handles and lay them across litter near its 
ends, close handles, legs and transverse irons, fold canvas length- 
wise on top of poles, placing slings lengthwise on canvas, buckles 
out, and securing all by straps at ends. The litter is then lowered. 
At the command Lower Litter, Nos. i and 4 lower the litter on 
the ground, handles on the right of Nos. 2 and 3, and recover the 
erect posture. The command To your posts, March, brings the AND TRANSPORTATION OF THE WOUNDED. 
427 
squad to the position occupied before the litter was unfolded, after 
which, at the command Front into line, March, i, 3 and 4 advance 
to the line of No. 2 in their regular formation, 1, 2, 3 and 4 from 
right to left. The squad may then be rested or marched off in 
any direction without the litter or with it. 
The foregoing description of the stretcher drill, adopted by 
our army, taken from Dr. Smart’s “ Handbook for the Hospital 
Corps,” shows the drill to be simple, to the purpose and devoid 
of all unnecessary frills. 
The adaption of the bearer drill of our army by the Navy would 
seem desirable from many points of view, but more especially 
so in the not impossible event of future co-operation of both 
branches of the service. 
The stretcher is, fundamentally, the most important piece of 
apparatus used in the transportation of the wounded, whether on 
board ship or on shore. All other means of conveyance must be 
considered merely as modifications of the regular stretcher, and 
any one expected to improvise and extemporize means of con- 
veyances for the sick and wounded in time of scarcity and need, 
must first have been made familiar with the principles underly- 
ing the practical management and construction of the stretcher, 
no matter what its form or description. 
For use on shore and in hospitals the plain, ordinary stretcher, 
provided with legs, will always be found to be the best and most 
convenient as well as the safest means of conveying the sick and 
wounded. Such a stretcher can be carried by two men either 
by hand or by means of shoulder straps, the ends of which are 
slipped on to the handles. A change of bearers is easily effected 
and without having to lower the patient flat on the ground, 
which may be rough, uneven or wet. During all naval opera- 
tions on shore, therefore, such stretchers, provided with legs to 
stand on, should, if possible, be used, and other means of con- 
veyance extemporized when a sufficient number of regular 
stretchers are not at hand. 
For purposes of handling and transporting the sick and 
wounded on shipboard several very ingenious cots have been 
designed. 
Fig. A represents the ambulance cot invented by Dr. A. L. 
Gihon, U. S. N., with patient in position and ready to be lowered 
either into a boat or through a hatchway. As seen in the figure, 428 
FIRST AID TO THE INJURED, 
the cot consists of a wooden frame with a sheet of canvas 
stretched across, and with a number of canvas bands of different 
widths sewed on so as to secure the patient in position and prevent 
his slipping out in case of accident while being lowered through 
a hatch or down a ladder. 
In cases in which the injury would be such as to necessitate 
the patient’s being passed down a ladder head foremost, the 
shoulder straps can be easily and effectually so arranged as to 
prevent the patient from slipping in this direction also. Gihon’s 
cot, therefore, seems to me a perfectly safe one and well adapted 
for use on board ship. 
Fig. B shows the cot designed by Dr. A. C. Gorgas, U. S. N., 
in position and ready to be lowered. 
As seen in the diagram, the thighs and legs of the patient are 
resting upon a leather-covered, double inclined plane which can 
be moved and adapted to suit the requirements demanded by 
special cases, while a narrow leather band is made to hold the 
upper part of the body in position and prevents it from slipping 
in a downward direction. 
The so-called “ Rapid Transit Ambulance Cot,” made by the 
Walton Manufacturing Co., of New York, and invented and 
patented by Dr. H. M. Wells, U. S. N., is another very good cot 
for purposes of moving patients on board ship. This cot is con- 
structed of stout canvas with thin hickory slats stitched in 
across the bottom, which give it sufficient stiffness laterally and 
permit it to adapt itself longitudinally to the form of the patient. 
There are ten stout canvas handles on the sides for lifting, 
and the cot may either be carried straight or at an angle, as may 
be required by the particular disability of the case. It is also 
narrow enough to be passed down any ladder or along any gang- 
way, and has no lateral projections; it can also be slung by the 
handles and raised or lowered by pulleys through any hatch. 
Fig. 94, A, represents the cot rolled up, weight io lbs.; B shows 
how a patient may be carried at an angle; C, cot without poles; 
D, cot with poles. 
The cot suggested by Lieut. T. B. M. Mason, U. S. N., belongs 
to the class of extemporized cots and simply consists of an ordi- 
nary ship’s hammock stretched across and secured to a wooden 
frame. There are, indeed, times when no one single ready-made 
conveyance will answer the purpose and when a special one must 
be improvised. Fig. 92.—Showing correct 
manner of clasping hands. 
Fig. 93.—Standing to wounded 
by right. 
Fig. A.—Gihon’s cot for ship’s use ; patient ready 
to be lowered through a hatch or into a boat. 
Fig. B.—The Gorgas cot. Fig. 94.—The Walton-Wells cot. 
Fig. 95.—Extemporized cots. Fig. 96.—Extemporized cots. 
Fig. 97.—(Notes in text.) AND TRANSPORTATION OF THE WOUNDED. 
429 
Hammocks and cots are always plenty on board every ship, 
and these may easily be converted into ambulance cots by being 
suspended from single poles, as shown in figs. 95 and 96, or they 
also may be changed so as to be carried between two poles. 
The former plan was adopted during the late expedition of 
British troops in Western Africa, and Staff Surgeon H. Fegan, 
R. N., mentions that each hammock was fitted with a pillow made 
of another spare hammock, which in the event of an emergency 
could be easily slung from tree to tree and thus often proved very 
useful. 
Any blanket, bed cover, traveling-rug may be converted into a 
hammock, as shown in figure. 
For purposes of embarking or disembarking the sick and 
wounded where stretcher conveyance is not available or inappli- 
cable, Dr. J. D. Macdonald, F. R. S., R. N., has designed an 
“ ambulance lift ” for ship or shore, seen in the accompanying 
figure. 
Fig. 97.—Ambulance Lift for Ship or Shore.— References 
to the Figure. 
1. Hook or eye-bolt fixed to the beam over the hatchway. 
2. A “ double whip ” or a purchase with a double block above 
and a single one below, a and b; c, the hauling part. 
3. A span with an eye in the middle for the lower hook of the 
purchase. 
4. A pole, 4-| feet long, with which the span is connected. 
5. An ordinary hammock attached by the head and foot clews 
to the extremities of the pole and further sustained by lanyards, 
a, fixed to a hand piece, b, besides the leg. In cases such as these 
the cacolet bed has rendered excellent service. In order to pre- 
vent the shaking as much as possible it is desirable to make the 
patient sit or lie on pliant cushions, and for this purpose India 
rubber ones are recommended, which have frequently been made 
use of. 
Two rifles and one or two coats, the sleeves turned in, make a 
very good temporary stretcher. The present working suits of 
our sailors used in the same way with two boat-hooks, would 
make a very solid stretcher, as will also several knapsacks or 
sword-belts. Figs. 98 and 99. 430 
FIRST AID TO THE INJURED. 
The means that are employed in making extemporaneous cots 
and stretchers must, of course, at all times depend upon where 
the accident will find you. The more thoroughly you are familiar 
with the principles of your work, with the aim and object you have 
in view, the more readily will you find such means as will answer 
your purpose. 
Practical Exercises: Stretcher drill and extemporizing ambulance 
cots. Fig. 98.—Extemporized stretcher. 
Fig. 99.—Extemporized stretcher. 
Fig. ioo.—Modified Indian travois for transporting the sick or injured over 
rough and mountainous roads. SPECIAL NOTICE. 
NAVAL INSTITUTE PRIZE ESSAY, 1893. 
A prize of one hundred dollars, with a gold medal, is offered by the Naval 
Institute for the best essay presented on any subject pertaining to the naval 
profession, subject to the following rules : 
1. The award for the Prize shall be made by the Board of Control, voting by 
ballot and without knowledge of the names of the competitors. 
2. Each competitor to send his essay in a sealed envelope to the Secretary 
and Treasurer on or before January i, 1893. The name of the writer shall 
not be given in this envelope, but instead thereof a motto. Accompanying the 
essay a separate sealed envelope will be sent to the Secretary and Treasurer, 
with the motto on the outside and writer’s name and motto inside. This 
envelope is not to be opened until after the decision of the Board. 
3. The successful essay to be published in the Proceedings of the Institute; 
and the essays of other competitors, receiving honorable mention, to be pub- 
lished also, at the discretion of the Board of Control ; and no change shall be 
made in the text of any competitive essay, published in the Proceedings of 
the Institute, after it leaves the hands of the Board. 
4. Any essay not having received honorable mention, may be published 
also, at the discretion of the Board of Control, but only with the consent of 
the author. 
5. The essay is limited to fifty (50) printed pages of the Proceedings 
of the Institute. 
6. All essays submitted must be either type-written or copied in a clear and 
legible hand. 
7. The successful competitor will be made a Life Member of the Institute. 
8. In the event of the Prize being awarded to the winner of a previous year, 
a gold clasp, suitably engraved, will be given in lieu of a gold medal. 
By direction of Board of Control. 
H. S. Knapp, 
Lieut., U. S. M., Secretary and Treasurer. 
Annapolis, Md., March 15, 1892. Thos. F. Rowland, Pres. 
Thos. F. Rowland, Jr., Treas. 
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Gallatin, 
Hamilton, 
Seward, 
Colfax, 
Bache, 
Oliver P. Wolcott, 
Walter Forward, 
Geo. S. Boutwell, 
Com. Perry, 
Dallas, 
Ewing, 
Fessenden, 
Manhattan, 
Richard Rush, 
Dolphin, Despatch Boat. 
Vesuvius, Dynamite Boat. 
U. S. Navy. 
Miantonomoh, 
Puritan, 
South Carolina, 
Massachusetts, 
Young Rover, 
Cambridge, 
Vicksburg, 
Adams, 
Alliance, 
Essex, 
Thetis, 
Bear, 
Crawford. 
U. S. Fish Commission. 
Albatross. Fish Hawk. 
Coatzacoalcos, Transport. QUINTARD IRON WORKS, 
N. F. PALMER, Jr. & CO. 
MANUFACTURERS AND BUILDERS OF 
ENGINES, BOILERS AND MACHINERY 
OF EVERY DESCRIPTION, 
Ave. D, 11 th aijd 12th and Dry Dock Streets, East River, 
NEW YORK. 
Repairs Done at Short Notice and with Dispatch. 
OFFICE, 742 EAST 12th STREET. 
HORACE SEE, 
No. ONE BROADWAY, NEW YORK. 
Plans and Specifications of Hulls and Machinery 
Prepared and Work Superintended. 
IMPROVED QUADRUPLE EXPANSION ENGINES. 
THE YARROW WATER TUBE BOILER, 
THE HYDRO-PNEUMATIC ASH EJECTOR, 
THE FEEDWATER SCOURER, ETC., ETC. 
KATZENSTEIN’S SELF-ACTING METAL PACKING 
For PISTON RODS, VALVE STEMS, etc., of every description, 
for Steam Engines, Pumps, etc., etc. 
Adopted and in use by the principal Iron Works and Steamship 
Companies, within the last twelve years, in this and foreign countries. 
Also FLEXIBLE TUBULAR METALLIC PACKING, 
for Slip joints on Steam Pipes, and for Hydraulic Pressure. 
Also, Metallic Gaskets for all kinds and shapes of flanges. 
For full particulars and reference, address 
L. KATZENSTEIN & CO., MACHINISTS, 
357 WEST STREET, NEW YORK. 
Also Agents for the McCou Comming Patent “ Liquid Rudder Brake” and Cumming 
“Double-Acting, Water-Tight Bulkhead Door.” SHIRTS 
SOLD EVERYWHERE 
WITH INCREASING POPULARITY. 
SOLD BY THE NAVAL ACADEMY STORI 
CLUETT, COON & CO.’S 
80LLARS and GUFFS 
FOR GENTLEMEN. 
SLUETT, SOON & SO., Manufact’rs. F. J. HEIBERGER, 
ARMY 
AND 
Merchant Tailor, 
NAVY' 
535 FIFTEENTH STREET, 
OPPOSITE U. S. TREASURY, 
WASHINGTON, D. C. 
A Silver Medal Awarded our Work at Paris Exposition of 1889. 
The Friedenwald Company, 
PRINTING, LITHOGRAPHING, ENGRAVING, BOOKBINDING 
AND FOLDING-BOX MAKING, 
Baltimore, Eutaw and German Sts. 
(Telephone 1233.) BALTIMORE, MD. 
QUR Business, which occupies eight large floors and has a force of nearly three hundred em- 
ployes, consists of the following Eight Departments, each conducted on an extensive scale, 
and first-class in facilities and appointments, viz.: 
BOOK PRINTING DEP’T, 
JOB PRINTING DEP'T, 
WOOD ENGRAVING DEP’T, 
PHOTO-ENGRAVING DEP’T, 
LITHOGRAPHIC DEP'T, 
PHOTO-LITHOGRAPHIC DEP’T, 
BOOKBINDING DEP’T, 
FOLDING-BOX DEP’T. 
THE Completeness of our establishment, and the wide range and excellence of our work, com- 
* bined with moderate prices, have rapidly extended our business to all sections of the United 
States, as well as to a number of foreign countries. 
QUR Constant Aim is to keep fully abreast of the times by promptly introducing improvements 
and new processes that contribute to superior and more economical production, and while we 
are prepared to execute orders of every description, we make a specialty of work of a difficult and 
trying character, in dealing with which we have always been singularly successful. 
CORRESPONDENCE INVITED. Wheeler Cogdegser & Engineering Co. 
92 & 94 IiibeFty Street, JSteou Yoi?k, 
Proprietors and Manufacturers of 
WHEELER’S 
imPROVED 
Patent Surface 
Condensers, 
ALSO THE 
Wheeler Admiralty Condenser, 
with Patent Screw Glands. 
• The Wheeler Surface Condenser is used as a test condenser for the instruction of students 
in testing steam engines, in the Mechanical Engineering Departments of the following colleges : 
1 *7ew *nstlfute’ Massachusetts Institute of Technology, Sibley College, Iowa Agricultural Col- 
ege, orcester 1 olytechnicInstitute, Lawrence School of Technology (Harvard), University of 
Pennsylvania, University of Michigan, Pennsylvania State College, Purdue (Indiana) University, 
Toronto School of Practical Science, Agricultural College of Michigan, University of Illinois, 
and Rose Polytechnic Institute (Indiana). 
™8E0.FJLAKEMT'E 80. 
BUILDERS OF EVERY VARIETY OF 
95 & 97 Liberty Street, 
4 |Stecn York. 
‘'Ufaiinc Sfcow %uapof Sociij 
Independent Air Pumps and 
Combined Air and Circulating Pumps a Specialty. 
*** Contractors for the outfit of Steam Pumps for the U. S. Cruisers New York, Detroit, 
No. 9, No. to, No. it, No. 12 and No. 13; also for Battleships Maine, Massachusetts, and Indiana ; 
also for Gunboats Petrel, No. 5, and No. 6; also Dynamite Cruiser Vesuvius ; also Harbor Defense 
Ram No. 1, Comparative Tests. 
Royal Baking Powder 
Purest and Strongest. 
Dr. PETER COLLIER, late Chemist-in* Chief of 
the Department of Agriculture, Washington, 
D. C., having analyzed the chief brands of 
baking powder, 
Reports the Royal Baking Powder 
the greatest in leavening strength, 
Yielding over 27 per cent, more gas than 
the average of the others tested. Dr. Collier 
adds: “I have made many analyses of various 
brands of baking powders and 
“I have always found the Royal 
composed of pure and wholesome 
ingredients. 
“Peter Collier, M. D., Ph. D.” 
“April 2, 1892.” NOTICE. 
The U. S. Naval Institute was established in 1873, having for its object the 
advancement of professional and scientific knowledge in the Navy. It now 
enters upon its twentieth year of existence, trusting as heretofore for its 
support to the officers and friends of the Navy. The members of the Board of 
Control cordially invite the co-operation and aid of their brother officers and 
of others interested in the Navy, in furtherance of the aims of the Institute, by 
the contribution of papers and communications upon subjects of interest to the 
naval profession, as well as by personal support and influence. 
On the subject of membership the Constitution reads as follows : 
Sec. 1. The Institute shall consist of regular, life, honorary, and associate 
members. 
Sec. 2. Officers of the Navy, Marine Corps, and all civil officers attached to 
the Naval Service, shall be entitled to become regular or life members, without 
ballot, on payment of dues or fee to the Secretary and Treasurer, or to the 
Corresponding Secretary of a Branch. Members who resign from the Navy 
subsequent to joining the Institute will be regarded as belonging to the class 
described in this Section. 
Sec. 3. The Prize Essayist of each year shall be a life member without 
payment of fee. 
Sec. 4. Honorary members shall be selected from distinguished Naval and 
Military Officers, and from eminent men of learning in civil life. The Secretary 
of the Navy shall be, ex officio, an honorary member. Their number shall not 
exceed thirty (30). Nominations for honorary members must be favorably 
reported by the Board of Control, and a vote equal to one-half the number of 
regular and life members, given by proxy or presence, shall be cast, a majority 
electing. 
Sec. 5. Associate members shall be elected from officers of the Army, 
Revenue Marine, foreign officers of the Naval and Military professions, and 
from persons in civil life who may be interested in the purposes of the 
Institute. 
Sec. 6. Those entitled to become associate members may be elected life 
members, provided that the number not officially connected with the Navy and 
Marine Corps shall not at any time exceed one hundred (100). 
Sec. 7. Associate members and life members, other than those entitled to 
regular membership, shall be elected as follows : Nominations shall be made 
in writing to the Secretary and Treasurer, with the name of the member making 
them, and such nominations shall be submitted to the Board of Control, and, 
if their report be favorable, the Secretary and Treasurer shall make known the 
result at the next meeting of the Institute, and a vote shall then be taken, a 
majority of votes cast by members present electing. 
ARTICLE VII. 
The Proceedings are published quarterly, and may be obtained by non-mem- 
bers upon application to the Secretary and Treasurer at Annapolis, Md. 
Inventors of articles connected with the naval profession will be afforded an 
opportunity of exhibiting and explaining their inventions. A description of 
such inventions as may be deemed, by the Board of Control, of use to the 
service, will be published in the Proceedings. 
Single copies of the Proceedings, $1.00. Back numbers and complete sets 
can be obtained by applying to the Secretary and Treasurer, Annapolis, Md. 
Annual subscription for non-members, $3.50. Annual dues for members and 
associate-members, $3.00. Life membership fee, $30.00. 
All letters should be addressed to Secretary and Treasurer, U. S. Naval 
Institute, Annapolis, Md., and all checks, drafts and money orders should be 
made payable to his order, without using the name of that officer.