der. To bend the arms and shove the hands in at the sides, in addition to the vertical pressure, is a waste of energy, being less beneficial than the vertical pressure alone. The operator's arms should be held straight and pressure exerted from his shoulders by bringing his body and shoulders forward. This weight is gradually increased until, at the end of three seconds of vertical pressure on the lower ribs of the patient, the force is felt to be sufficient to compress the parts; then the weight is suddenly removed; if there is danger of not returning the hands to the right position they may remain lightly in place, but it is usually better to remove the hands entirely.

With an overweight patient a light operator can utilize over 80 per cent of his weight by raising his knees from the ground and supporting his weight entirely on his toes and the heels of his hands; the latter properly placed on the ends of the floating ribs of the patient. In this manner he can work as effectively as a heavy man.

A feather or a few fibers of absorbent cotton held near the patient's nose will indicate whether or not air passes with each forced expiration and spontaneous inspiration. The rate of compression should not exceed 12 or 15 times per minute, the lungs being thoroughly emptied by 3 seconds of pressure and allowed 2 seconds to refill.

There are liable to be evidences of life within 25 minutes in patients who will recover from electric shock, but where there is doubt the patient should have the benefit of it. In drowning, recoveries after 2 hours or more of unconsciousness are on record.

Aromatic spirits of ammonia on a handkerchief may be placed continuously within 3 inches of the nose; no liquid will be given a patient while unconscious; apply warm blankets and hotwater bottles as soon as practicable.

Due caution should be observed not to bring force to bear too violently on the ribs lest fracture occur.

b. Precautions.-As a great many cases of drowning occur in connection with swimming, a few simple precautions are noted herewith for men who enter the water:

(1) Don't go in swimming alone unless you are an expert. (2) Don't swim immediately after eating; wait at least two hours.

(3) Don't swim if overheated.

(4) Don't swim if you have heart trouble.

(5) Don't continue swimming when exhausted.

(6) Don't wade into water with your arms above your head. You will not be in readiness to stroke should you step into a hole.

(7) Don't struggle if caught in a swift current or undertow. The force of the current will bring you to the surface.

(8) Don't fight or struggle to swim if you swallow water; clear your windpipe of water first.

(9) Don't cry for help in fun; you may need help some time and not get it.

(10) Don't dive without knowledge of the approximate depth of the water.

142. Suffocation from gas.-During the World War many men on the battle field were subjected to gas poisoning. It is important, therefore, that you should be familiar in a general way with the following rules pertaining to gassed cases:

a. Have on your mask and gloves, if possible, when you handle a gassed man. 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; 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 slightly 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 dug

outs or cellars, for gas being four times heavier than air, seeks the lower-down parts.

SUNSTROKE AND BURNS

143. 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.

144. 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.

For phosphorus burns, apply cotton or soft gauze wet with a 2 per cent solution of copper sulphate. Particles of phosphorus so treated become covered with a layer of copper and cease burning, and can be removed from the tissue by forceps. The copper-sulphate solution must not be applied for longer periods than three minutes. Further treatment is the same as for ordinary burns. Phosphorus will not burn under water, and if copper sulphate is not available, the affected part of the body should immediately be placed under water until further treatment may be obtained. Phosphorus melts at 112° F. so that if the part is placed in warm water, the phosphorus will melt and can be removed. (Extracted from T. R. 155–5.)

145. Electric burns and electric shock.-a. These accidents occur as the result of contact with a live wire, either electriclight 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 or 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 partly 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 6 inches of the floor is free from smoke, so when unable to breathe 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.

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

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

the

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 foreign body may be easily brushed out by a camel's-hair 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.