should be familiar in a general way with the following rules pertaining to gassed cases:

man.

a. Have on your mask and gloves, if possible, when you handle a gassed This precaution will probably save you from being gassed yourself. If you have no gloves, be sure and wash your hands with soap and water following the handling of such cases, or better, rub them with dry lime.

b. Don't forget that all gassed cases require-first, rest; second, warmth; third, fresh air; and, fourth, attention.

c. Don't forget that articles of clothing, blankets, equipment, etc., remain for a long time impregnated with mustard gas. A good method for removing gas, etc., from clothing, equipment, etc., is by permitting them to hang in the open in a pure atmosphere for 48 hours, or, if possible, boiling or steaming will remove the effects of gas.

d. Remove the patient's equipment, but not his mask if the air is permeated with gas.

e. If mustard gas is used, the essential treatment is, first, removal of clothing; second, neutralization of acid gas with an alkaline substance, if possible; third, avoid contact with soiled clothing; second, neutralization of acid gas with an alkaline substance, if possible; third, avoid contact with soiled clothing; fourth, treatment of the eyes or lesions of the mucous membrane, of the respiratory tract, the digestive tract, and of the skin with a mild alkaline solution or water.

f. Don't bandage the eyes. Pressure bandage over the eyes locks up the lids and retains the secretions, which after a term of hours may become purulent and pussy.

g. Don't forget that it is often difficult to tell the difference between slighly gassed cases and malingerers. Symptoms of gas poisoning generally show up within 24 hours. If possible, remove all gassed cases from woods or low ground to little knolls or hillsides, and above all, do not carry them into dugouts or cellars, for gas being four times heavier than air, seeks the lower-down parts.

20. Sunstroke and heat exhaustion.-Sunstroke or heat stroke occurs in persons exposed to high temperature, either in or out of the sun. The face is flushed, skin hot and dry, breathing labored, pulse rapid, heat of body great. The patient may be unconscious. Place him in the shade, loosen clothing, and try to lessen heat of body by cold applications to the head and surface.

The heat may also cause, especially when soldier is much fatigued, a form of exhaustion without insensibility. Rest on the back in the shade, with cold applications to the head, and a little aromatic spirits of ammonia are usually sufficient to relieve.

In rare cases this exhaustion may go on to threatened collapse, with cold skin and extremities, pale face, and very weak pulse. Here alcoholic stimulants and heat to the body become necessary.

It is well to be warned that both sunstroke and heat exhaustion are common and severe among drinkers and the intemperate.

21. Burns.-Do not pull the clothing from the burnt part, but rip or cut it off. Do not break the blisters nor prick them, even if large. Protect a burn quickly with a mixture of equal parts of linseed or olive oil and lime water, if you have them, or with the plain oil, covering the whole with lint or cotton wool. Put nothing on a burn that will be difficult to remove afterwards.

22. Electric burns and electric shock.-a. These accidents occur as the result of contact with a live wire, either electric light wires or trolley wires or some electrical machinery.

b. Persons suffering from such injuries are usually unconscious, pulse feeble and irregular, breathing slow and almost imperceptible. The parts of the body that have come in contact with the live wire are burned and blistered.

c. The most important thing for you to do is to first remove the person from contact with the wire of electrical machinery. You must remember that this is always a dangerous procedure and should never be attempted unless you have some means of insulating yourself; otherwise you may receive fully as severe a shock as the person whom you are attempting to rescue and which might result in your death. The hands should be thoroughly protected by some insulating material or nonconductor of electricity, such as rubber gloves, rubber blanket, mackintosh coat, several thicknesses of silk or dry clothing. The rescuing party should be further insulated by standing on a rubber mat or dry boards.

d. The treatment of electric shock is the same as ordinary shock following an injury or accident. The heart and respiration should be stimulated, the body kept warm by the application of heat, and, if necessary, artificial respiration should be resorted to.

e. The treatment of electric burns is the same as for ordinary burns. f. In connection with burns it may not be amiss here to remind you of a few of the things you should do in case of fire. A fire almost anywhere may be easily put out when it starts, whereas a very few moments delay will result in so big a fire that nothing can be done to subdue it until it has burned everything inflammable within reach. It is clear, therefore, that everyone should act promptly in case of fire.

(1) At first a fire may be smothered by a few buckets of water or by throwing blankets or woolen clothing upon it. Sand, ashes, or dirt will all quickly smother a fire. One of these should always be used instead of water on burning oil, as water will spread the oil and the fire. Anything hanging should, when possible, be pulled down before attempting to smother the fire in it. Remember that a draft will fan a fire, and therefore keep everything closed as much as possible to prevent drafts.

(2) While searching through a burning place, it will be best to tie a wet handkerchief or cloth over the nose and mouth. Remember that the air within six inches of the floor is free from smoke, so when unable to breath crawl along the floor with the head low, dragging anyone you have rescued behind you.

(3) Crawl backward in the same way as down a staircase or any slope. If your own clothing catches on fire when you are alone, do not run for help, as this will fan the flames and make them burn fiercely. Lie down on

the floor and roll up as tightly as possible in a rug, shawl, overcoat, blanket, or other woolen cloth, leaving only the head out. If nothing can be obtained in which to wrap up, lie down and roll over slowly. At the same time beat out the fire with the hands. If another person's clothing catches fire, throw him to the ground and smother the fire with a coat, blanket, rug, or the like. Section VIII

FOREIGN BODIES IN THE EYE, EAR, NOSE, AND THROAT

23. Foreign bodies in the eye.—Foreign bodies in the eye usually consist of cinders, sand, and dust, and sometimes small particles of steel.

a. Close the eye and allow the tears to accumulate. After a few minutes open it again and the foreign body may be washed out by the tears. If the foreign body is under the lower lid, pull the lid down and have the patient roll the eye up and the foreign body may be easily brushed out by a camel'shair brush, the corner of a clean handkerchief, or a small swab made by wrapping a little absorbent cotton around the end of a match.

b. If the foreign body lies under the upper lid, grasp the eyelashes of the upper lid with the index finger and thumb of the left hand; place a match or toothpick held in the right hand over about the middle of the upper lid; then turn the lid over the match and the foreign body will be readily seen and easily removed.

c. Where pieces of steel or emery have become embedded in the eyeball itself, they should never be removed by unskilled people, as it might result in injury to the eye or loss of sight. Such conditions should always be taken to a surgeon, preferably an eye specialist, as soon as possible.

d. When acid is splashed into the eye an alkaline preparation made from bicarbonate of soda (ordinary cooking soda), magnesia, chalk, or lime may be used. This will neutralize the acid. In the case of strong alkalies, such as caustic soda, potash, and quicklime, being introduced into the eye, the treatment consists in the application of acid solutions, such as dilute vinegar or lime juice, and afterwards treated like an ordinary burn.

24. Foreign bodies in the ear.-Among the foreign bodies that sometimes get into the ears are insects, beans, buttons, etc.

a. If the foreign body is a live insect or bug, hold a light near the ear and this will frequently fascinate the insect and cause it to come out toward the light, or a few drops of warm oil may be placed in the ear, holding the head to the opposite side. The oil generally kills the insect, which floats out on top of the oil.

b. If the foreign body is a vegetable substance, such as a pea or bean, be careful never to syringe out the ear with water or any fluid, for this will cause the foreign body to swell up and make it very much more difficult to

remove.

c. If the foreign body can not be removed by these simple methods, do not attempt to remove it by hairpins or other instruments, but send the patient immediately to a surgeon.

d. The ear, like the eye, is a very delicate apparatus, and if not properly treated sufficient damage might be done to cause the person to lose his hearing.

25. Foreign bodies in the nose.-a. These are usually small articles accidentally introduced into the nose, such as peas, beans, shoe buttons, etc. Such bodies interfere with breathing and set up irritation, which may produce a running of the nose.

b. The removal of such bodies is usually a simple matter. Have the patient close the opposite nostril by pressing with the finger, and then have him blow the nose hard. This will usually force the foreign body out, or induce sneezing by tickling the nostril with a feather.

c. If the foreign body is not a vegetable matter, the opposite nostril may be syringed with lukewarm water with the idea of forcing the foreign body out of the other side. Should these simple means fail, send the patient to a surgeon.

26. Foreign bodies in the throat.-a. Foreign bodies are frequently the cause of choking as result of their entering the windpipe. This usually occurs as the result of a sudden deep breath while the mouth is full of food, as during a fit of laughing, sneezing, or coughing. These foreign bodies are usually pieces of meat, bones, false teeth, etc.

b. As the result of sudden interference with the breathing, the person clutches at his throat and gasps for air.

There may be violent coughing, attempts to vomit, the face becomes blue, and the eyes stick out of their sockets.

If this condition is not treated promptly and properly the person will become suffocated and die. Frequently as the result of the violent coughing spell produced by the foreign body in the windpipe it is expelled.

First of all, send for the nearest surgeon and notify him of the nature of the accident, so that he may bring the proper instruments with him. In the meantime, attempt to dislodge the foreign body by slapping the back violently between the shoulder blades. If this is not successful, hold the patient by his feet with the head down and again slap the back between the shoulder blades.

If the above methods fail, then the surgeon upon his arrival will resort to more adequate measures of treatment.

c. When the foreign bodies have been swallowed, particularly with sharp or rough edges, such as pieces of glass, needles, etc., do not give an emețic or cathartic, for such treatment would only make matters worse. Make the patient eat freely of bread and potatoes in order that the foreign body may be surrounded by a mass of soft material, and in that way be carried safely through the bowels.

27. Epilepsy or epileptic fit.—This condition is one of convulsions due to some disease of the brain, sometimes known as "falling sickness." It may occur at any time on the street, at home, or in bed. It comes on very suddenly and unexpectedly. The patient frequently utters a peculiar cry before falling, immediately becomes unconscious, and falls into convulsions, jerking the arms, legs, and body. The face becomes deathly pale, the eyes roll and are turned upward. There may be foaming at the mouth, and frequently the tongue is bitten and the foam is then bloody. These attacks usually last from 5 to 10 minutes and are frequently followed by others. Nothing can be done to stop the fit after it has begun. The patient should be placed flat on his back, preferably on a mattress or some other soft material, so that he can not injure his head or limbs by striking them against anything hard. Place a handkerchief between the teeth in order to prevent him from biting his tongue. Do not use any force or struggle with an epileptic, as the strength of an epileptic when in a convulsion is greatly increased and he might do you more harm than you could do him good. Following the convulsion the patient is usually sleepy and drowsy and sleeps for several hours. 28. Concussion of the brain or stunning. This is a condition following the result of a severe blow on the head when the brain has been badly jarred or shaken up. There may or may not be complete loss of consciousness. This condition results from blows or falls upon the head where the blow has not been quite sufficient to produce fracture of the skull.

The patient is pale and feels weak, dizzy, and sometimes may be sick at the stomach, and sometimes faints, is more or less insensible and is sometimes wholly unconscious.

The patient should be kept absolutely quiet, head slightly raised, heat applied to the extremities and body, the same as in shock; the head should be kept cool by cold cloths or bags filled with cracked ice. Never give alcoholic stimulants.

These cases should be seen by a surgeon as soon as possible, because of the possibility of a fracture of the skull, and compression of brain may follow.

29. Compression of the brain. This is a condition of unconsciousness depending upon pressure upon the brain itself, either by a piece of broken bone, clot of blood, or some tumor. The most frequent is a severe blow on the head sufficient to produce a fracture of the skull or the rupture of a blood vessel.

The patient is profoundly unconscious and it is impossible to arouse him. The breathing is deep, snoring, and there may be more or less paralysis of one side of the body, the same as in apoplexy. The pupils of the eye are usually dilated or one may be dilated and the other remain normal. In compression resulting from fractures at the base of the skull there is bleeding from the nose and ears and there may be spots of blood in the whites of the eyes. This condition is a serious one and very often results fatally. It requires the services of a competent surgeon immediately. Send for a surgeon at once. But little can be done in such cases by the inexperienced. The patient should be placed in a horizontal position, head somewhat raised; all tight clothing should be loosened and cold applied to the head by means of cloths wrung out in cold water or ice bags. Keep the patient absolutely quiet and preferably in a dark room. Never give stimulants of any kind.