between the teeth a cork or small bit of wood; turn the patient
on his face, a large bundle of tightly rolled clothing being placed
beneath the stomach ; press heavily on the back over it for half
a minute, or as long as fluids flow freely from the mouth.
Question. After expelling the water from the stomach and
chest, what would you next do?
Answer. I would attempt to produce breathing.
Question. What is the first step in the attempt to produce
breathing?
Answer. To clear the mouth and throat of mucus by intro-
ducing into the throat the corner of a handkerchief wrapped
closely about the forefinger; this should be done before the
patient is turned on his back.
Question. What is the second step?
Answer. To turn him on his back, placing the roll of clothing
so as to raise the pit of the stomach above the level of the rest
of the body.
Question. What is done with the tongue?
Answer. When the mouth and throat are cleared of mucus, an
assistant with a handkerchief or piece of dry cloth draws the
tip of the tongue out of one corner of the mouth and keeps it
projecting a little beyond the lips.
Question. What is the purpose of this?
Answer. To prevent the tongue falling back and choking the
entrance to the windpipe, which would prevent breathing.
Question. What should be done with the patient's arms?
Answer. An assistant should grasp them just below the
elbows and draw them steadily upward by the sides of the
patient's head to the ground, the hands nearly meeting.
Question. What is the purpose of this?
Answer. It is to enlarge the capacity of the chest and induce
inspiration.
244 INSTRUCTIONS FOR COAST GUARD STATIONS.
Question. All these things are being done as quickly as possi-
ble: is anything else being done at the same time?
Answer. Yes; a third assistant takes position astride the
patient's body, with his elbows resting upon his own knees, his
luiiKls extended ready for action.
Question. What is done next?
Answer. The assistant at the head will turn the patient's
arms down to the sides of the body, the assistant holding the
tongue changing hands if necessary to let the arms pass. Just
before the patient's hands reach the ground, the man astride
the body will grasp the body with his hands, the balls of his
thumbs resting on either side of the pit of the stomach, the
fingers falling into the grooves between the short ribs.
Question. What does the man astride the body do as th
patient's hands touch the ground?
Answer. Using his knees as a pivot, he will, at the moment
the patient's hands touch the ground, throw, not too suddenly,
all his weight forward on his hands, and at the same time
squeeze the waist between them as if he wished to force any-
thing in the chest upward out of the mouth ; he will deepen the
pressure while he slowly counts one, two, three, four, about
2 to 2 seconds, then suddenly let go with a final push, which
will spring 1 him back to his first position.
Question. What does this do?
Answer. This completes expiration.
Question. What care should be taken in placing the roll of
clothing under the patient's back?
Answer. Care should be taken that it is so placed as not to
project beyond the sides of the body and interfere with the
patient's arms touching the ground when turned down to the
sides of the body, and that it raises the pit of the stomach
above the level of the rest of the body.
Question. Where is the pit of the stomach?
Answer. It is the angle formed by the short ribs just below
the lower end of the breastbone.
Question. How should the arms be drawn upward and back-
ward ?
Answer. They should describe an arc of a circle in a plane
parallel to the body, and should be kept extended at all times so
as to enlarge the capacity of the chest as much as possible.
Question. Of what does breathing consist?
Answer. Of the inspiration and expiration of breath.
INSTRUCTIONS FOR COAST GUARD STATIONS. 245
Question. What is inspiration?
Answer. It is the drawing of air into the lungs, and is ac-
complished by the elevation of the chest walls.
Question. What is expiration?
Answer. It is the act or process of breathing out, or forcing
air from the lungs through the nose or mouth. It is the oppo-
site of inspiration.
Question. What is respiration?
Answer. It is the act of breathing, and consists of taking
air into and forcing it out from the lungs. It is the combina-
tion of inspiration and expiration.
Question. How should pressure be applied over the lower
ribs in producing expiration?
Answer. It should be applied inward and upward and riot
downward.
Question. Will it always be found necessary to change hands
in holding the tongue?
Answer. No ; after practice it will not be necessary. The
tongue must not be released in any event.
Question. How long an interval is required for inspiration
and for expiration?
Answer. Prom 2 to 2 seconds each.
Question. How often should the movements for inspiration
and expiration be repeated?
Answer. The combined movements should be repeated from
12 to 15 times in every minute.
Question. How would you regulate these movements?
Answer. Either by a watch or by counting or by rny o\v?i
inspiration and expiration.
Question. When the man astride the patient's body releases
the pressure and springs back to his first position, what is next
done?
Answer. The man at the patient's head again draws the arms
steadily upward to the sides of the patient's head, as before,
the assistant holding the tongue, again changing hands to let
the arms pass if necessary, holding them there from 2 to 2*
seconds.
Question. If natural breathing be not restored after about
four minutes, what would you do?
Answer. If natural breathing be not restored after a trial of
the bellows movement for a space of about four minutes, turn
the patient a second time on the stomach, as directed in Rule
246 INSTRUCTIONS FOR COAST GUARD STATIONS.
II, rolling the body in the opposite direction from that in which
it was first turned, for the purpose of freeing the air passages
from any remaining water.
Question. How long should artificial respiration be continued ?
Answer. From one to four hours, or until the patient breathes.
Question. What would you do upon the appearance of re-
turning life?
Answer. Carefully aid the first short gasps by artificial res-
piration, timed with the patient's breathing, until deepened into
full breaths.
Question. In addition to the artificial respiration, what other
aids should be applied?
Answer. Drying and rubbing should be unceasingly practiced
from the beginning by assistants, taking care not to interfere
with the means employed to produce breathing.
Question. How should the limbs of the patient be rubbed?
Answer. Always in an upw r ard direction toward the body,
with firm grasping pressure and energy, using the bare hands,
dry flannels, or handkerchiefs, continuing the friction under
blankets or over dry clothing.
Question. How may the warmth of the body be promoted?
Answer. By the application of hot flannels to the stomach
and armpits, bottles or bladders of hot water, heated bricks,
etc., to the limbs and soles of the feet.
Question. How should a child or delicate person be handled?
Answer. More gently than a robust patient.
Question. What aftertreatment should be employed exter-
nally?
Answer. As soon as breathing is established the patient
should be stripped of all wet clothing, wrapped in blankets only,
put to bed comfortably warm, but with a free circulation of
fresh air, and left to perfect rest.
Question. What after-treatment should be given internally?
Answer. Give aromatic spirits of ammonia, or hot tea or
coffee, in doses of a teaspooriful to a tablespoonful, according
to the weight of the patient, or other stimulant at hand, every
10 or 15 minutes for the first hour, and as often thereafter as
may seem expedient.
Question. What danger is there to the patient after reaction
is established?
Answer. There is great danger of congestion of the lungs, and
if perfect rest is not maintained for at least 48 hours it sonrer
INSTRUCTIONS FOR COAST GUARD STATIONS. 247
times occurs that the patient is seized with great difficulty of
breathing, and death is liable to follow unless immediate relief
is afforded.
Question. What would you do in such cases?
Answer. Apply a large mustard plaster over the breast. If
the patient gasps for breath before the mustard takes effect,
assist the breathing by carefully repeating the artificial respi-
ration.
Question. What outside assistance would you call upon in
resuscitating the apparently drowned?
Answer. Always send for or call a physician, if one be
available.
Question. If no assistance is at hand and you have to work
alone, what is the first thing you would do in attempting to
resuscitate an apparently drowned person?
Answer. I would arouse the patient as prescribed in Rule I.
Question. What would you next do?
Answer. I would expel the water from the stomach and chest
as prescribed in Rule II.
Question. After expelling the water from the stomach and
chest what would you do before attempting artificial respiration?
Answer. I would clear the mouth and throat of mucus, as
directed in Rule III, and turn the patient on his back, the bundle
of clothing being placed so as to raise the pit of the stomach
above the level of the rest of the body. Draw the tip of the
tongue out of one corner of the mouth, as directed in Rule III.
If the lower jaw be lifted, the teeth may be made to retain the
tongue in place. It may be necessary to pass a handkerchief
under the chin and tie it over the head to keep the tongue
protruded.
Question. How would you produce artificial respiration work-
ing alone?
Answer. Having secured the tongue, I would take position
astride the patient; grasp the arms just below the elbows and
raise them steadily upward by the sides of the patient's head
to the ground, holding them there from 2 to 2 seconds; then
raise and lower the arms to the sides ; grasp the body with the
hands and apply pressure over the lower ribs from 2 to 2
seconds as directed in Rule III. Repeat these movements de-
liberately and perseveringly 12 to 15 times in every minute.
Question. If natural breathing is not restored after a space of
about. four minutes, what would you do?
248 INSTRUCTIONS FOR COAST GUARD STATIONS.
Answer. Turn the patient a second time on his stomach, as
directed in Rule II, for the purpose of freeing the air passages
of any remaining water.
Question. When working alone, how long should artificial
respiration be continued?
Answer. From one to four hours, or until the patient breathes.
Question. In practicing Rule II how would you keep the
patient's mouth out of the sand?
Answer. Place his face on his .Joreann so as to keep the
mouth and nose free.
Question. What precautions should be taken to insure a free
circulation of fresh air?
Answer. Prevent witnesses crowding around, especially on the
weather side of the patient.
Question. What should be taken from the station when pro-
ceeding to the place where an apparently drowned person is?
Answer. Medicine chest, roll, piece of wood with lanyard at-
tached, hot-water bottles, flannel, handkerchief, blanket, bricks.
and bucket of hot water if the place is near.
Question. Where should these articles be kept?
Answer. In a handy place, neatly stowed, where they would
be instantly accessible at all times.
Question. Give Rule I for resuscitating the apparently
drowned.
Answer. ( See directions for restoring the apparently drowned.)
Question. Give Rule II for resuscitating the apparently
drowned.
Answer. ( See directions for restoring the apparently drowned.)
Question. Give Rule III for resuscitating the apparently
drowned.
Answer. ( See directions for restoring the apparently drowned.)
Question. Give Rule IV for resuscitating the apparently
drowned.
Answer. ( See directions for restoring the apparently drowned. )
Question. Give the rules for restoring the apparently drowned
when one person must work alone.
Answer. ( See directions for restoring the apparently drowned.')
SAVING DROWNING PERSONS.
Question. What preparation should you make before jumping
in to save a drowning person?
INSTRUCTIONS FOR COAST GUARD STATIONS. 249
Answer. I should divest myself as far and as quickly as pos-
sible of all clothing, tearing it off if necessary. If there is not
time to remove all of my clothing, I would at least loosen the
feet of my drawers, if they are tied, so they will not fill with
water and drag me down.
Question. What assurance should you give a drowning person
on approaching him?
Answer. Assure him in a loud voice that he is safe.
Question. Suppose the drowning person is struggling, what
would be your first care?
Answer. Not to get close enough for him to take hold of me,
as that would be running too great a risk, but to keep off a
few seconds until he gets quiet.
Question. When he gets quiet what should you do?
Answer. Get close to him and take fast hold of the hair of
his head, turn him as quickly as possible on his back, and give
him a sudden pull which will cause him to float ; then I would
throw myself on my back and swim, holding his hair by both
hands.
Question. What would be the position, then, of the person you
are saving and of yourself?
Answer. We would both be on our backs, and his back would
be toward my stomach.
Question. Why would you adopt this method?
Answer. Because I could get him to safety by it sooner and
with less danger than by any other unaided method.
Question. What other advantages has this method?
Answer. It enables me to keep my own head up and his also,
and besides I could float in this position as long as I pleased
or until other assistance is at hand.
Question. Is there such a thing as a death grasp?
Answer. Probably not; -but yet it is dangerous to allow a
struggling person to take hold of you in the water, as both his
life and yours might be endangered thereby.
Question. What may be necessary in order to break the hold
of a drowning person?
Answer. In some cases it may be necessary to stop his breath-
ing by putting his head under, by pinching his nose and closing
his mouth with your hand, or by striking him with your knee
; in the pit of the stomach. These methods may seem brutal and
should not be resorted to except when necessary to save life.
Question. When is it a mistake to try to swim ashore with a
drowning person?
250 INSTRUCTIONS FOR COAST GUARD STATIONS.
Answer. When you have to stem a strong outgoing tide, or
when there is a point of safety which could be reached with
less effort.
Question. What is the better method in case you can not make
a point of safety?
Answer. To get on your back and float until assistance comes.
Question. How may the position of the body of a person which
has sunk to the bottom be located?
Answer. By the air bubbles wnich rise occasionally to the
surface.
Question. What allowance must sometimes be made in locat-
ing a body by this means?
Answer. An allowance for the bubbles, in coming to the sur-
face, being carried out of a perpendicular course by the motion
of the water in a tideway or stream.
Question. How may a body be recovered from the bottom?
Answer. By diving for it in the direction indicated by the
bubbles.
Question. How would you raise a body from the bottom to
the surface?
Answer. I would seize the hair of the head with one hand
only and use my other hand and my feet in bringing the body
and myself to the surface.
TREATMENT OF FEOSTBITE.
Question. Into how many degrees are the local effects of cold
known as frostbite divided?
Answer. They are usually divided, according to their severity,
into three degrees.
Question. How are these degrees distinguished from one
another?
Answer. In the first degree the affected part is painful and the
skin is of a dark-red hue. In the second degree the skin is
of a bright red or livid hue and blisters form on the surface.
In the third degree the affected part is pale, stiff, and brittle.
Question. What is frostbite of the first degree commonly
called and among whom does it chiefly occur?
Answer. The first degree or condition is known as chilblain.
It occurs* chiefly among children or poorly nourished persons
who are exposed to cold.
INSTRUCTIONS FOE COAST GUARD STATIONS. 251
Question. What is the effect of severe cold on the blood ves-
sels and tissues of the body?
Answer. Severe cold causes constriction of the blood vessels,
and if continued long so that the blood is completely cut off
from the part for a considerable time the tissues die.
Question. Describe the effects the application of heat has on
each of these cases?
Answer. If heat be applied to a part that has been slightly
affected (frostbite, first degree), a sensation of itching and
tingling is experienced ; if applied to frostbites of the second
degree, it causes pain and swelling and the skin may peel off
and leave a raw surface. In frostbites of the third degree no
reaction takes place upon the application of heat if the part
is dead. The dead portion turns black arid a line of demarca-
tion appears between it and the living tissue.
Question. What is the danger of applying heat suddenly to a
badly frozen part of the body?
Answer. The liability of gangrene (death of the tissue) is
increased on account of the intense reaction that takes place in
the tissue that is still alive.
Question. What results when the whole body is exposed to
severe cold?
Answer. The individual becomes benumbed, exertion is diffi-
cult, and drowsiness which can not be resisted overtakes him :
.the eyesight fails ; he totters as he walks, and then falls and
becomes unconscious.
Question. What precautions should be taken to protect the
body when exposed to severe cold?
Answer. The body should be warmly clad and all parts of it
kept as dry as possible, as dampness increases the tendency to
frostbite. The ears and face, except the eyes, nose, and mouth
should be well covered, especially if snow is falling or a brisk
wind is blowing. The hands should also be protected ; fur-
lined gloves are the best protection, as they are warmer than
woolen ones.
Question. What special care should be taken of the feet?
Answer. The shoes should be large. In extreme weather, in
case of exposure, it is well to wear two pairs of stockings, a
woolen pair over a cotton pair. The feet should be washed
each day and a small quantity of oil rubbed into them. A
large quantity of oil is harmful, and only such quantity should
252 INSTRUCTIONS FOE COAST GUARD STATIONS.
be used as can be rubbed in well, leaving a dry surface when
the rubbing is completed. Clean stockings should be put on
each day. Wet stockings should be changed to dry ones when-
ever practicable. The feet are less liable to become frost-
bitten if the person keeps moving. If he has to stand in one
place, the shoe strings should be loosened.
Question. What is the general rule for the treatment of frost-
bites if a physician is present?
Answer. To follow his instructions.
Question. In case no physician is present, what treatment
should be given in the case of frostbite of the first degree?
Answer. The part should be rubbed gently and cloths wrung
out of cold, fresh water applied. Snow may be rubbed on the
affected part, but it is not as efficient as cold cloths. The rub-
bing and the applications should alternate, rubbing a few min-
utes and then applying cloths for a few minutes. The tempera-
ture of the water in which the cloths are soaked should be
raised gradually until it is lukewarm.
Question. In the case of frostbite of the second degree?
Answer. Rubbing should not be resorted to, as there is danger
of increasing the ill effects. Cold cloths should be applied,
but the cold treatment must not be kept up too long, as cold
prolongs the cause of the injury. The temperature of the
water should be raised gradually a degree or . two every few
minutes, using fresh cloths each time the temperature of the
water is changed.
Question. What should be the temperature of the place where
treatment is given?
Answer. It should be remembered, that reaction takes place
naturally as soon as the person is taken indoors out of the cold,
even if he be treated in a cold room, and the object of treat-
ment is to prevent this reaction from taking place too rapidly
and at the same time not to retard unduly the restoration of
vitality.
Question. What do you understand by the term " reaction "
in cases of frostbite?
Answer. The return of blood to the part, restoring circulation,
sensation, and function.
Question. How can you tell when reaction has set in ?
Answer. The affected area begins to tingle and burn; the
blood vessels to dilate, possibly causing swelling of the part;
INSTRUCTIONS FOR COAST GUARD STATIONS. 253
normal color returns; more than likely there will be intense
pain.
Question. What treatment is prescribed for frostbite of the
third degree?
Answer. The same method should be followed in order to
brincr about a reaction as in frostbite of the second degree; reac-
tion, however, will not happen in a part that is dead, but the
adjacent living tissue will react, and a red line will form be-
tween it and the dead portion.
Question. In what cases is the above treatment unnecessary?
Answer. In cases where reaction has already taken place
when the person is first seen.
Question. What treatment should be followed after reaction
has taken place?
Answer. After reaction has occurred the patient should be
moved into a warm room and an ointment, composed of vaseline
1 ounce, camphor 6 grains, should be applied. The part should
then be surrounded with absorbent cotton or wrapped in flannel
cloths.
Question. In this treatment what may be used in place of
vaseline and camphor?
Answer. Boracic acid ointment.
Question. What should be done in case blisters have formed?
Answer. They should be pricked with a needle and the water
allowed to flow out, but the covering of the blisters should not
be removed.
Question. What should be done in case gangrene has set in?
Answer. If gangrene occurs, cloths wet with alcohol placed
over the part will prevent infection and hasten the separation
of the dead part from the living tissue.
Question. What is gangrene and how can you tell when it
has set in?
Answer. Gangren6 is mortification of a part of the body,
caused by interference with the local nutrition. It begins with
sharp pains and tenderness of the part, the pain partaking of a
severe burning character. At first there is a vivid red dis-
coloration, later turning to purple and black, with green
splotches. Swelling soon develops. Disappearance of pain and
heat shows that the part is dead, and a fetid odor is soon
noticed.
254 INSTRUCTIONS FOR COAST GUARD STATIONS.
Question. What treatment should be given a person suffering
from exposure to a low temperature or from immersion in cold
water ?
Answer. He should be placed in a cold room and artificial
respiration practiced as in the case of an apparently drowned
person. The extremities should be rubbed with a solution com-
posed of equal parts of alcohol and water.
Question. How would you proceed when he begins to react?
Answer. When the patient begins to react the temperature of
Ihe room should be raised slowly and the patient given hot
drinks, such as coffee, tea, or chocolate. If the patient is unable
to swallow, a pint of hot coffee or tea should be injected into the
rectum.
Question. How long should eiforts to restore animation be
continued?
Answer. For a long period, as instances are on record of re-
covery after several hours of suspended animation.
BOAT SALUTES AND BOAT ETIQUETTE.
Question. You are in charge of a pulling boat. How do you
salute a flag officer of the Navy in another boat with his Hag
flying?
Answer. Toss oars ; stand up and salute with hand ; remain
at salute until it is returned or the flag officer has passed.
Question. Who is a flag officer of the Navy?
Answer. Any officer of the line of the Navy above the rank
of captain.
Question. Suppose the officer to be saluted is a general officer
of the Army, with his flag flying, how do you salute?
Answer. The same as for a flag officer of the Navy?
Question. Suppose you are in charge of a laden or of a tow-
ing bont, how would you salute a flag officer?
Answer. Make the hand salute only; do not stand up.
Question. If you are in charge of a boat under sail, how do