Medical handbook for the use of the Revenue-cutter service online

TBEASUKY DEPARTMENT



-r T \ ~VT

U'JZLJLJ -O-A..N

SE OF

VESSELS AND STATIC






F TIE



GIFT OF




rvt-> r






TREASURY DEPARTMENT

REVENUE-CUTTER SERVICE



MEDICAL HANDBOOK



FOR THE USE OF THE



REVENUE-CUTTER SERVICE



Revised by



W. J. PETTUS, M. D.

Assistant Surgeon General, United States Public Health Service




WASHINGTON

GOVERNMENT PRINTING OFFICE
1912






J! -'
v



CONTENTS.



Page.

Medicines and articles to be supplied for medicine lockers (class A) 6

Sanitation 7

Poisons and antidotes 9

Use of clinical thermometer 9

Malarial fever 10

Measles 12

Mumps 14

Smallpox 15

Dysentery 18

Sunstroke 19

Diarrhea 20

Cholera morbus 21

Colic 22

Scurvy 23

Sore throat 24

Coughs and colds 25

Erysipelas 26

Poison ivy 27

Rheumatism 27

Fainting 30

Delirium tremens 30

Appendicitis 31

Syphilis 31

Soft chancre (chancroids) : 32

Gonorrhea 34

Stricture 35

Boils 37

Piles 37

Injuries Hemorrhage (bleeding) 37

Wounds 38

Burns or scalds 40

Effects of cold Frostbite 41

Scalp wounds 42

Injuries to the chest 42

Injuries to the back 43

Fractures 43

Dislocations 56

Sprains 63

Nosebleed 64

Drowning 65

Medicine and articles to be supplied for medicine lockers (class B)

3



254909



MEDICAL HANDBOOK FOR USE OF VESSELS AND STATIONS OF
THE REVENUE -CUTTER SERVICE.



TREASURY DEPARTMENT,

Division of Revenue- Cutter Service, 1912.

This Handbook has been prepared primarily for the use of officers
and enlisted men of the Revenue-Cutter Service serving on vessels
to which no surgeon is regularly attached. In all cases of serious
sickness or injury, however, medical assistance should be obtained
as soon as practicable. Written directions must imperfectly supply
the place of the physician and surgeon. With a medicine locker and
handbook it is not possible to provide for and explain the treatment
by persons who have not had a medical education of more than a
few of the commoner diseases.

Medicine lockers on vessels of the first and second class having
no medical officers attached will be supplied with the (A) outfit,
page 6, and those having medical officers attached with the (B) outfit,
page 71.

In the records of public property, proposals, requisitions, and
vouchers the units used will be those given in these lists, and the
items will be arranged in the order in which they appear thereon.

In requesting any of these articles on requisition they will be
noted as " allowance." If for any special reason articles other than
those on these lists are required, they shall appear on the requisi-
tion following the items of regular allowance, and the necessity for
each should be fully explained.

The dates when obtained must appear on all medicines and pack-
ages, and they must be renewed when no longer serviceable, accord-
ing to the length of time stated in the list of medicines and articles.

This Handbook is a revision for the use of the Re venue- Cutter
Service of the Handbook for the Ship's Medicine Chest, prepared by
George W. Stoner, surgeon, United States Public Health Service, by
direction of the Surgeon General of that Service.

5



6 MEDICAL HANDBOOK.

CLASS A.

Medicines and articles to be supplied for medicine lockers of vessels having no

medical officers attached.

MEDICINES.



Amounts.



100

4 ounces

100

500

200

500

16 ounces

100

600

500

100

100

200

2 ounces

500 capsules

100

1 ounce

48 papers

32 ounces

16 ounces

100

4 ounces

8 ounces

32 ounces

8 ounces

16 ounces

100

8 ounces

32 ounces

16 ounces

100

16 ounces

8 ounces

8 ounces

500

100

10 gross



Items.



Ammonii chlorid, tabs, compr., 5 gr.

Ammon., arom. spir. (1 year).

Antipyrine, tabs, compr., 5 gr.

Antiseptic tabs. (Bernay's large blue).

Aspirin, tabs, compr., 5 gr.

Bismuth subnitrate, tabs, compr., 5 gr.

Boric acid.

Bromide, potass., tabs, compr., 5 gr.

Brown Mixture, tabs, trit., 1 fl. dr.

Calomel and sod. b. c., tab. trit., A gr.

Cathart. co., veget. pills.

Chlorate, potass., tabs, compr., 5 gr.

Cholera Mixture, Sun, tabs, compr., 15 min.

Collodion flexile.

Copaiba, 5 min.

Coryza, tabs, compr. (P. D. & Co., No. 2).

Creosote.

Effervesc. co. (Seidlitz powders).

Epsom salts.

Glycerinum.

Iodide, potass., tabs, compr., 5 gr.

lodi, tra.

Laudanum (1 year).

Mustard.

Myrrh, tra.

Olive oil.

Opii and camph. pills (J gr. opii).

Paregoric (1 year).

Petrolatum.

Phenol.

Quinine sulph., tabs, compr., 3 gr.

Ricini, ol. (castor oil).

Saponis, liniment.

Soda, bicarbonate.

Sod. salicyl., tabs, compr., 5 gr.

Strychn. sulph., tabs, trit., A gr.

Venereal prophylactic tubes.



MEDICAL AND SURGICAL APPLIANCES.



25

25

2

1

1

1 pound . . .
1 envelope.

5 yards

3 spools . . .
5 yards
1 box (10).

4!!!!!!!!!!

1 spool

I...



Bandages, gauze, 2-inch.

Bandages, muslin, 2-inch.

Bandages, suspensory.

Bottle, hot-water, 2-qt.

Catheter, soft rubber, No 10 Engl. (1 year).

Cotton, absorbent.

Court plaster.

Gauze, plain, sterilized.

Plaster, adhesive, O. Z. (2 1-inch, 1 2-inch).

Plaster, belladonna (1 year).

Plaster, mustard.

Pocket case of instruments (Hamilton, with metal case).

Surgical needles, in glass-stoppered bottles.

Silk ligature, medium size.

Syringe, bulb.

Syringes, glass.

Thermometer, clinical.

Tongue depressor.

Tourniquet (Esmarch's).



These medicines will remain serviceable until used if kept in glass-
stoppered bottles, with the exception of those marked " 1 year,"
which should be renewed after that interval.

For bulky articles not over a pint of each need be kept in the
medicine chest.

All poisonous medicines must be plainly so marked on the bottles
or packages.



SANITATION. 7

SANITATION.

On vessels. The commanding officer of a vessel should observe
the following measures on board his vessel, and the same rules should
be applied at shore stations, so far as useful.

The water-closets, forecastle, bilges, and similar portions of the
vessel liable to harbor infection should be frequently cleansed.

Free ventilation and rigorous cleanliness should be maintained in
all portions of the ship during the voyage and measures taken to
destroy rats, mice, fleas, flies, roaches, mosquitoes, and other vermin.

A patient sick of a communicable disease should be isolated and
one member of the crew detailed for his care and comfort, who, if
practicable, should be immune to the disease.

Communication between the patient or his nurse and other persons
on board should be reduced to a minimum.

Used clothing, body linen, and bedding of the patient and nurse
should at once be immersed in boiling water or in a disinfecting solu-
tion of 1 to 1,000 bichloride of mercury, and should be kept so im-
mersed for 20 minutes.

The compartment from which the patient was removed should be
disinfected and thoroughly cleansed.

Any person suffering from malarial fever should be kept under
mosquito bars and the apartment in which he is confined closely
screened with mosquito netting. All mosquitoes on board should be
destroyed by burning Pyrethrum powder (Persian insect powder)
or by fumigation with sulphur, burning 4 pounds sulphur to 1,000
cubic feet air space, the room or compartment to be closed for 4 hours.
Mosquito larvas (wigglers or wiggle tails) should be destroyed in
water barrels, casks, and other collections of water about the vessel
by the use of petroleum (kerosene). Where this is not practicable,
use mosquito netting to prevent the exit of mosquitoes from such
breeding places.

Formulas for disinfecting solutions recommended for use.

Bichloride of mercury (1 : 1,000) :

Bichloride of mercury 1

Sea water 1, 000

Carbolic acid (2.5 per cent) :

Carbolic acid, pure 25

Fresh water 1, 000

Flies as carriers of disease. It is a well-known fact that flies carry
the germs of such well-known diseases as tuberculosis, typhoid fever,
and probably smallpox; hence the importance of preventing their
breeding near a dwelling or securing access to a house. They breed
in such things as stable manure, garbage, etc., in from eight to ten
days after the eggs are deposited. The fly deposits its eggs, which



8 MEDICAL HANDBOOK.

in a few days hatch into a white worm, popularly called the mag-
got, then turning into the fly. If there is a stable near the light-
house, the manure in it should be protected from the access of flies
by a screening or some similar method. All garbage not buried
or burned should be in cans, protected by tops, so that the flies can
not get in. All openings to the house should be protected by wire
netting, preferably bronze wire, 16 mesh to the inch.

Mosquitoes. Mosquitoes are known to convey such diseases as
malarial and yellow fever by biting a person sick with this disease
and afterwards inoculating other persons by biting them. The
screens mentioned above, properly applied to all the openings of the
house, will prevent their entrance into it. They breed usually in
stagnant water. The eggs are deposited on the surface of the water
and are hatched out first in the form of what is known as wiggle
tails or wigglers. At the end of about ten days these wigglers go
through certain changes and become full-fledged mosquitoes. It is
important that no water be allowed to stand in containers about the
dwelling for a period as long as eight days. If there are such con-
tainers, they should be emptied every five or six days or protected by
a netting, so that the mosquitoes can not obtain access to lay their
eggs. Ponds are the principal breeding ground of mosquitoes, and if
possible they should be drained or oiled when near a dwelling. The
malarial mosquito only bites about sundown or during the night.

Diet. In all acute diseases, especially those attended with fever,
the question of diet is a very important one, and the main reliance
may be placed on such food as eggs and milk. Thin soups may be
used, but they contain very little nutrition and can not be depended
upon to maintain the strength of the sick.

The proper mastication or chewing of the food is necessary to
good digestion and the maintenance of a healthful condition. On
this account the drinking of large quantities of fluid at mealtime is
objectionable, as it has a tendency to wash down the solids before
they are properly chewed. It is desirable to have the meals at regu-
lar hours.

Cleanliness of the person. A cold bath every morning is probably
the best plan for a person in vigorous health, but to take one with
benefit there should be a pleasant glow of exhilaration afterwards,
and it is necessary in cold weather for the average person to have a
warm room in which to take this cold bath. A great many people
do better with a bath in tepid water; but it is impossible to fix any
hard and fast rule in these matters.

The presence of bedbugs in dwellings is indicative of want of
care and cleanliness as to bed, bedclothes, etc., and means should be
taken to exterminate them when they appear. A liberal application



POISONS. 9

of kerosene oil to the places infested is probably the best means of
killing them.

Care of the mouth and teeth. The teeth should be cleansed after
each meal with a soft brush, using some mild dentifrice. Castile
soap makes an excellent cleanser in the absence of a dentifrice.

For toothache caused by a decaying tooth often the only cure is
pulling out the tooth. Relief, however, can sometimes be obtained
by cleaning out the cavity and putting in two or three drops of
creosote on a small piece of cotton. For toothache without the
presence of a decayed tooth to cause it, the application of heat to
the seat of the pain will often give relief.

COMMON POISONS AND THEIR ANTIDOTES.

Bichloride of mercury or corrosive sublimate. Give the whites
of several eggs mixed with milk or water, or flour and water, if eggs
can not be obtained. Then administer an emetic of a tablespoonful
of mustard in warm water. The importance of giving these remedies
as soon as possible .after taking of the poison should be understood.

Opium including morphine, laudanum, and paregoric. An emetic
a tablespoonful of mustard in warm water should be immedi-
ately administered, and if the patient becomes very drowsy cold
water may be dashed in his face and he may be beaten with a wet
towel and forced to walk up and down. When the respiration be-
comes slow and irregular, artificial respiration should be made, the
same as is used to restore the partially drowned.

Carbolic acid. Give grain alcohol (not wood alcohol) liberally,
as much as a half glass, followed immediately by an emetic. If the
alcohol is not obtainable, a half ounce of Epsom salts in warm water
may be administered; then give the emetic consisting of a table-
spoonful of mustard in warm water. Common table salt, two table-
spoonfuls in a glass of warm water, is an excellent emetic if nothing
else can be secured.

Arsenic, including Paris green. Administer immediately a table-
spoonful of mustard in a glass of warm water, and repeat if vomiting
is not very free, as it is all important to empty the stomach at once.
Afterwards give milk and eggs freely, or olive oil, one-fourth pint.
A tablespoonful of common washing soda in a half glass of water
will often relieve the symptoms.

USE OF CLINICAL THERMOMETER.

Place bulb of mercury in mouth under tongue for five minutes. If
it registers over 101 degrees, send for physician. Stay in bed until
he arrives. See that it registers less than 97 before using.



10 MEDICAL. HANDBOOK.

MALARIAL FEVER.

Malarial fever is an endemic infectious disease, caused by a para-
site of the blood. The disease is transmitted to man (inoculated) by
the bite of certain kinds of mosquitoes, of the genus Anopheles.

It is a disease of warm and temperate regions; very prevalent
and of severe type in hot countries, especially along the seacoast
and basins of rivers, but gradually declining in extent and virulence
in proportion to the distance on either side from the Equator. In
the Tropics the disease is constantly prevalent. In the cooler, or
temperate regions, as, for example, along the coast of the Central
Atlantic States, it is active only during summer and autumn. It is
seldom developed at a lower temperature than 60 F. (15.5 C.),
and even in the hot climates malaria is probably never contracted
far away from land. The disease is said to be most frequently con-
tracted during the night, just after sunset and just before sunrise
being the most dangerous periods. It is, therefore, very important
in infected localities not to permit the men to go ashore nor to allow
them to sleep on deck if the vessel is lying near the land ; or, if they
must sleep on deck or other exposed places, to provide suitable pro-
tection by means of blankets and properly constructed mosquito bars.

There are different varieties and types of malarial intermittent
fever: (1) Quotidian, when the paroxysm occurs every day; (2)
tertian, when it occurs every other day; and (3) quartan, when it
occurs every fourth day. The disease is popularly known as " fever
and ague," " chills and fever," " the shakes," etc. It is characterized
by recurring paroxysms, consisting as a rule of three distinct
stages: The cold, the hot, and the sweating stage. The attack may
be sudden or it may be preceded by a feeling of uneasiness, a desire
to stretch the limbs and yawn, headache, loss of appetite, and some-
times by vomiting. The chill may be of any degree of severity.
Patients sometimes complain only of chilliness or of a creeping sen-
sation of coldness over the back. More frequently the chill is well
marked; the feeling of cold spreads all over the body, the teeth
chatter, the patient shivers, and his whole body shakes. This cold
stage may last from a few minutes to an hour, or longer.

The hot stage gradually comes on as the cold stage subsides, and
soon there is a feeling of intense heat. The face becomes flushed,
the pulse full or bounding, the headache continues, and the patient
is in high fever. This stage may last from half an hour to four or
five hours, when perspiration appears, first on the forehead and
gradually over the entire body, and the sweating stage is fully estab-
lished. With the appearance of perspiration the fever declines, the
distressing symptoms gradually cease, the patient experiences a feel-
ing of great relief, and soon falls into a refreshing sleep. The dura-



DISEASES. 11

tion of the sweating stage varies from one to three hours. It may
be very profuse or very slight. At the end of the sweating stage
the patient may be greatly prostrated or may feel quite well, and
able to be up and about until the beginning of the cold stage of the
next fit, twenty-four, forty-eight, or seventy-two hours from the
beginning of the first.

There are three varieties of malarial fever intermittent, remit-
tent, and a very severe type known as pernicious malarial fever.

In the intermittent the paroxysms may recur at irregular intervals,
the cold stage may be absent, the fever may come on gradually and
decline to normal in the same manner.

When the attacks are prolonged, and when instead of declining to
normal there may be only a slight fall in the temperature and slight
sweating, the fever is called remittent fever.

Pernicious malarial fever, as the name indicates, is a very fatal
disease. It occurs chiefly in hot climates, but is occasionally met with
in temperate regions. It may be preceded by an apparently mild at-
tack of intermittent fever or the patient may be taken suddenly with
intense headache, high fever, wild or perhaps muttering delirium,
rapidly passing into unconsciousness, and death may occur within
a few hours from the beginning of the attack.

In another form of the disease the attack begins with extreme cold-
ness of the surface of the body, with vomiting, or with severe diar-
rhea or dysentery, and the patient may die from collapse.

There is also a hemorrhagic form in which bleeding may occur
from the nose, mouth,*or gums. The urine may be bloody or quite
dark in color, in some cases almost black. In tropical Africa and
other hot countries where the disease prevails it is known as " black-
water fever."

Hemorrhages, however, may occur in any severe or prolonged form
of malarial infection, and bloody urine (malarial hematuria) is not
infrequently met with.

Treatment. Quinine is the remedy, and quinine also acts as a pre-
ventive. In going to a malarial region, treatment should be com-
menced several days before arriving at port. To each man on board
should be given at least 10 grains (0.6 gm.) of quinine daily for a
period of one week. The allowance may then be reduced to 5 grains
(0.3 gm.) or even to 3 grains (0.2 gm.) a day. The bowels should
be kept freely open.

If a chill occur, the patient should at once be wrapped in blankets
and given hot drinks. During the hot stage, cold drinks, lemonade,
etc., may be given. As soon as the sweating stage begins, 10 or 15
grains (0.6 gm. to 1 gm.) of quinine should be given, and thereafter 5
grains (0.3 gm.) every six hours, for two or three days, and then con-



12 MEDICAL, HANDBOOK.

tinued in smaller doses, say 3 grains (0.2 gm.) three times daily, for
the next two weeks.

If the chill is severe, or if the surface of the body is very cold, hot-
water bottles or heated bricks or stones wrapped in cloth or in a
separate piece of blanket should be placed to the feet. Mustard
plasters may also be applied to the extremities and over the region
of the heart, and hot stimulating drinks should be given.

If vomiting occur, a mustard plaster may also be placed over the
region of the stomach, above the navel, and cracked ice may be given
by the mouth. Headache may be relieved by cold applications.

If the hot stage is severe, a tepid bath may be given in a tub or by
means of a sponge. If the temperature is very high, 105 or 106 F.
(40.5 or 41.1 C.), a cold bath should be given.

In remittent and other severe types of malarial fever the treatment
should be more active. No time should be lost in giving the quinine ;
10 or 15 or 20 grains (0.6 gm. to 1.3 gm.) should be given imme-
diately, and along with this, if the bowels are not freely open, a calo-
mel tablet, one-tenth grain each, should be given every half hour until
10 have been taken. After the bowels move, the quinine should be
continued in 5-grain (0.3 gm.) doses every four or five hours.

The symptoms and signs of typical malarial intermittent fever are
so striking that they can hardly be mistaken for anything else. It
must not be forgotten, however, that there are typical and irregular
forms of malarial fever, and that they may be mistaken for other
diseases, such as tubercle (consumption) of the lungs, abscess of the
lungs or of the liver or any part of the bocfy, or the result of the
passing of a catheter, all of which produce chills or chilliness and
fever.

Some forms of remittent or continued remittent malarial fever
may be difficult to distinguish from typhoid fever. The remittent
type may be mistaken for yellow fever.

Quinine is the remedy for any form of malarial fever. If the
fever does not yield to full doses of quinine, it is probably not mala-
rial. At any rate this is the most practical method for determining
the question as to whether the fever is malarial or not. In the hos-
pital or laboratory the diagnosis is made by microscopical examina-
tion of the blood.

The diet in any form of acute fever should be light, liquid, and
nourishing; and if there is much prostration, stimulants will be re-
quired. Solid food should not be allowed.

MEASLES.

Measles is an acute infectious disease, which most commonly at-
tacks children but may occur in adults. It usually spreads from per-
son to person by exposure to a patient with the disease, as going into



DISEASES. 13

the room where he is sick, riding in the same street car, or being in
the same schoolroom. It generally makes its appearance from twelve
to fourteen days after exposure. One attack is usually a protection
against a second one.

It usually begins with the symptoms of an ordinary cold. There
may be an initial chill; the patient's face looks flushed and some-
times slightly swollen about the nose and eyes, and the eyes are red-
dened. There may be a tendency to sneeze, and an examination of
the throat will disclose a reddening of the mucous membrane. The
rash often appears first in the throat. Some cough may be present
at the onset, with more or less headache. Fever is generally present
with the onset of these symptoms. The eruption on the skin devel-
ops on the third or fourth day of the fever. It may be most marked
on the forehead or about the ears, looking like fleabites, and gradu-
ally spreads over the entire body. The patient has considerable
cough with expectoration. In children there is some liability to a
form of pneumonia called broncho-pneumonia, which renders the
disease much more dangerous. It may also have the complication of
diarrhea and vomiting, due to implication of the bowels and stomach.

As soon as a case is discovered it should be put in bed and isolated
in a room, from which children should be excluded and only those
adults admitted who are directly concerned in the care of the case.

It is necessary to protect the patient from becoming chilled, and
he should not be exposed to drafts, but fresh air should be admitted
to the room. If the weather is cold, he should be provided with
plenty of covering.

The treatment of an ordinary case of measles is practically nil, as
little or no medication is required. If there is much irritation of the
eyes, it is well to have the room darkened and to wash out the eyes
with a saturated solution of boric acid in warm water. Take a glass
of warm water and put into it all the boric acid it will dissolve and
use it as a wash for the eyes, keeping it covered to prevent dust or
other impurities getting into the solution. Everything applied to
the eyes should be scrupulously clean.

If the skin is dusky and the eruption is not well marked, the pa-
tient may be enveloped in sheets or blankets wrung from hot water,
but care must be exercised that he does not become too rapidly chilled
afterwards. Only sufficient covering should be used to render the
patient comfortable.

If the cough is very troublesome, a tablet of brown mixture may be
given three or four times a day.

After the eruption has disappeared and the peeling of the skin has
begun, the patient should bathe daily in order that the skin may be