FREEZING AND FROSTBITE.

The part frozen, which looks white or bluish white, and is cold, should be very slowly raised in temperature by brisk but careful rubbing in a cool place, and never near a fire. Stimulants are to be given cautiously when the patient can swallow, and followed by small amounts of warm liquid nourishment. The object is to restore the circulation of the blood and the natural warmth gradually and not violently. Care and patience are necessary to do this.

RESUSCITATION OF THE APPARENTLY DROWNED.

In the instruction of the Army in First Aid the method of resuscitation of the apparently drowned, as described by "Schaefer,"

will be taught instead of the "Sylvester Method," heretofore used. The Schaefer method of artificial respiration is also applicable in cases of electric shock, asphyxiation by gas, and of the failure of respiration following concussion of the brain.

Being under water for four or five minutes is generally fatal, but an effort to revive the apparently drowned should always be made, unless it is known that the body has been under water for a very long time.

The attempt to revive the patient should not be delayed for the purpose of removing his clothes or placing him in the ambulance. Begin the procedure as soon as he is out of the water, on the sh.o.r.e or in the boat. The first and most important thing is to start artificial respiration without delay.

The Schaefer method is preferred because it can be carried out by one person without a.s.sistance, and because its procedure is not exhausting to the operator, thus permitting him, if required, to continue it for one or two hours. When it is known that a person has been under water for but a few minutes continue the artificial respiration for at least one and a half to two hours before considering the case hopeless. Once the patient has begun to breathe watch carefully to see that he does not stop again. Should the breathing be very faint, or should he stop breathing, a.s.sist him again with artificial respiration. After he starts breathing do not lift him nor permit him to stand until the breathing has become full and regular.

SCHAEFER METHOD.

As soon as the patient is removed from the water, turn him face to the ground, clasp your hands under his waist, and raise the body so any water may drain out of the air pa.s.sages while the head remains low.

(Figure 9.)

[Ill.u.s.tration: FIG. 9.--Schaefer method of artificial respiration.

Inspiration.]

The patient is laid on his stomach, arms extended from his body beyond his head, face turned to one side so that the mouth and nose do not touch the ground. This position causes the tongue to fall forward of its own weight and so prevents its falling back into the air pa.s.sages.

Turning the head to one side prevents the face coming into contact with mud or water during the operation. This position also facilitates the removal from the mouth of foreign bodies, such as tobacco, chewing gum, false teeth, etc., and favors the expulsion of mucus, blood, vomitus, serum, or any liquid that may be in the air pa.s.sages.

[Ill.u.s.tration: FIG. 10--Schaefer method of artificial respiration.

Expiration.]

The operator kneels, straddles one or both of the patient's thighs, and faces his head. Locating the lowest rib, the operator, with his thumbs nearly parallel to his fingers, places his hands so that the little finger curls over the twelfth rib. If the hands are on the pelvic bones, the object of the work is defeated; hence the bones of the pelvis are first located in order to avoid them. The hands must be free from the pelvis and resting on the lowest rib. By operating on the bare back it is easier to locate the lower ribs and avoid the pelvis. The nearer the ends of the ribs the hands are placed without sliding off the better. The hands are thus removed from the spine, the fingers being nearly out of sight.

The fingers help some, but the chief pressure is exerted by the heels (thenar and hypothenar eminences) of the hands, with the weight coming straight from the shoulders. It is a waste of energy to bend the arms at the elbows and shove in from the sides, because the muscles of the back are stronger than the muscles of the arms.

The operator's arms are held straight, and his weight is brought from his shoulders by bringing his body and shoulders forward. This weight is gradually increased until at the end of the three seconds of vertical pressure upon the lower ribs of the patient the force is felt to be heavy enough to compress the parts; then the weight is suddenly removed. If there is danger of not returning the hands to the right position again, they can remain lightly in place; but it is usually better to remove the hands entirely. If the operator is light and the patient an overweight adult, he can utilize over 80 per cent of his weight by raising his knees from the ground and supporting himself 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 light feather or a piece of absorbent cotton drawn out thin and held near the nose by some one will indicate by its movements whether or not there is a current of air going and coming with each forced expiration and spontaneous inspiration.

The natural rate of breathing is 12 to 15 times per minute. The rate of operation should not exceed this. The lungs must be thoroughly emptied by three seconds of pressure, then refilling takes care of itself. Pressure and release of pressure--one complete respiration--occupies about five seconds. If the operator is alone, he can be guided in each act by his own deep, regular respiration or by counting or by his watch lying by his side. If comrades are present, he can be advised by them.

The duration of the efforts as artificial respiration should ordinarily exceed an hour; indefinitely longer if there are any evidences of returning animation, by way of breathing, speaking, or movements. 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 be given the benefit of the doubt. In drowning, especially, recoveries are on record after two hours or more of unconsciousness; hence, the Schaefer method, being easy of operation, is more likely to be persisted in.

Aromatic spirits of ammonia may be poured on a handkerchief and held continuously within 3 inches of the face and nose. If other ammonia preparations are used, they should be diluted or held farther away.

Try it on your own nose first.

When the operator is a heavy man it is necessary to caution him not to bring force too violently upon the ribs, as one of them might be broken.

Do not attempt to give liquids of any kind to the patient while unconscious. Apply warm blankets and hot-water bottles as soon as they can be obtained.

CHAPTER XIV.

LAWS AND REGULATIONS.

=Section 1. General provisions.=

The Army of the United States is governed by certain laws called "The Articles of War" and certain regulations called "Army Regulations."

The following list includes the offenses most often committed by soldiers, generally through ignorance or carelessness rather than viciousness. Violations of any rule or regulation should be carefully guarded against, since they not only subject the offender to punishment, but also bring discredit on his comrades, his organization, and on the military profession:

1. Selling, p.a.w.ning, or, through neglect, losing or spoiling any Government property, such as uniforms, blankets, equipment, ammunition, etc.

2. Disobedience of the orders of any officer or noncommissioned officer.

3. Disrespect to an officer or noncommissioned officer.

4. Absence from camp without leave.

5. Absence from any drill, formation, or other duty without authority.

6. Drunkenness on duty or off duty, whether in camp or when absent either with or without leave.

7. Bringing liquor into camp.

8. Noisy or disorderly conduct in camp or when absent either with or without leave.

9. Entering on private property, generally for the purpose of stealing fruit, etc.

10. Negligence or carelessness at drill or on other duty, particularly while on guard or as a sentinel over prisoners.

11. Wearing an unauthorized uniform or wearing the uniform in an improper manner.

12. Urinating in or around camp.

13. Failing to salute properly.

14. Disrespect or affront to a sentinel.

15. Abuse or neglect of his horse.

"The basic principles of the combat tactics of the different arms are set forth in the Drill Regulations of those arms for units as high as brigades." (_Preface, Field Service Regulations._)

"The Drill Regulations are furnished as a guide. They provide the principles for training and for increasing the probability of success in battle. In the interpretation of the regulations the spirit must be sought. Quibbling over the minutiae of form is indicative of failure to grasp the spirit." (_Paragraph 4, Infantry Drill Regulations._)

Field Service Regulations govern all arms of the Army of the United States.