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ANNEX I

Anatomy and physiology

Bone structureVoluntary muscles

Involuntary muscles

Circulatory system

Breathing system

Digestive system

Urinary system

Nervous system

Skin

ANNEXES

215

ANNEX I

Anatomy and physiologyTo provide adequate medical care on board ship there is noneed to have a detailed knowledge of anatomy (structure ofthe body) or of physiology (function of bodily systems).Nevertheless the information provided in this Annex couldbe useful when examining a patient or obtaining and actingon radio medical advice.

The principal bones of the skeleton and the main musclesof the body are illustrated in Figures I.1 and I.2. The positionof the organs in the chest and abdomen is depicted in Plates 14and 15.

The bone structureThe skeleton, which consists of bones and cartilages, providesa rigid framework. The separate bones and cartilages are heldtogether firmly at the joints by strong bands of connectivetissue (the ligaments). Each bone is enveloped in a very toughadherent sheath of fibrous tissue. Between the sheath andthe bone surface is a layer of bone-forming cells which canproduce new bone in the event of a fracture.

The shaft of a typical long bone has a thick wall of densebone which forms a hollow cylinder enclosing a central canalcontaining bone marrow. At each end the shaft is expandedto make the joint surface. These surfaces are covered by asmooth layer of cartilage to permit movements withoutcausing friction.

Voluntary musclesThese form the bulk of the fleshy parts of the body. They arefixed to the bones by blending with the sheaths of fibroustissue surrounding the bones. Some are attached directly to awide area of bone surface but others taper to form a strongcord (tendon or leader) which is attached at a specific placeon a bone. Muscles, and especially those of the limbs, arearranged in two opposing groups. Contraction of one groupin response to an impulse through the nerve supply must beaccompanied by simultaneous relaxation of the opposinggroup, or movement will not take place. These movementsare under conscious control.

Involuntary musclesThese are found in the stomach and intestines, in the heartand blood vessels, and also in other internal organs of thebody. They continue to work throughout life as part ofnatural body function outside the control of personal will.

ANNEX II

Anatomical drawings

The skeleton

Main voluntary muscles

Organs of chest andabdomen

216 THE SHIP CAPTAIN’S MEDICAL GUIDE

Circulatory systemBlood

The body contains about 5 litres of blood which consistsbasically of four constituents: plasma; red cells; whitecells; and platelet cells.

The plasma is the liquid component of the bloodwhich circulates to all the tissue cells throughout thebody. It distributes food, water, salts and heat andcollects waste products which are subsequently excreted.

The red cells predominate and give the blood itscolour. This colour is derived from a complex ironcompound (haemoglobin) which is the main oxygencarrier.

The white cells give protection against infection byattacking and killing bacteria and also by producingsubstances which are necessary for building up resistanceto further infections.

The main purpose of platelets is to assist in the bloodclotting mechanism.

The heart and blood vessels

The heart is a thick-walled muscular pump about the sizeof a clenched fist. It is divided in the mid line into two sideswhich do not communicate. Each side has an upper andlower chamber which communicate through a main heartvalve. The separate chambers are each served by a majorblood vessel that either brings blood to the chamber orcarries it away. See Plate 15.

The right side receives venous blood which, havingbeen circulated around the body, has given up its oxygenand collected carbon dioxide. This blood is pumpedthrough the lungs where it is replenished with oxygenand discards the carbon dioxide. As purified blood, itreturns to the left side to be pumped through thearteries to all parts of the body.

The blood vessels form a closed system of tubes. Thearteries, which have to take the full force of the pumpingpressure, have thick walls containing muscle fibres andelastic tissue. Each heart beat widens the bore of thearteries to accommodate the surge of blood. Betweenbeats the bore is returned to normal by the action of themuscle fibres and elastic tissue. Where an artery runsclose to the body surface, the changing pressures can befelt as a pulse.

The arteries penetrate to all parts of the body,dividing and sub-dividing until they narrow to form verythin-walled vessels (capillaries). The capillaries then joinwith the venous network which returns the blood to theheart (Figure I.2). The size of veins increases until theheart is reached.

The capillary system is vital to the life of all tissues. Thethin capillary vessel wall allows nutrients, oxygen, heatand beneficial chemical substance to enter the cells and,most important, waste products to be passed out into theblood. Figure I.2 Capillaries

Artery

Capillarynetwork

Vein

Figure I.1 The heart and the variouscirculations, diagrammatic

Legs

Arms

Lungs

Stomach

Intestines

Trunk

Legs

Liver

R L

Annex I ANATOMY AND PHYSIOLOGY 217

Breathing systemEvery time a breath is taken in, the air (20% oxygen) passes through the nose or mouth and thenpast the larynx or voice box into the windpipe (trachea) which is about 12.5 cm long. At its lowerend the windpipe divides into two main tubes called bronchi (Figure I.3).

The main air passage in each lung (the bronchus) divides into successively smaller brancheswhich carry inhaled air to all parts of the lung. Each small branch terminates by forming acluster of very tiny air sacs (the alveoli). A fine network of blood vessels covers the surface ofevery air sac thereby permitting gas exchange by diffusion. Oxygen from the inspired airpasses through the thin tissues to combine with the haemoglobin of the red blood cells.Waste gases, mainly carbon-dioxide, pass from blood into the air sacs and are expelled onbreathing out.

Haemoglobin + Oxygen = Oxyhaemoglobin(purple red colour) (bright red colour of normal blood)

Whenever the blood is insufficiently oxygenated, as in pneumonia, the purple red hue of theblood shows as a blue tinge of the lips.

Each lung is covered by a lubricated lining called the pleura. The inner side of the chest wallis also covered by a similar lining. These two layers of pleura are in contact and slide smoothlyover one another during breathing.

The act of breathing is mainly due to the diaphragm moving up and down. The diaphragmis a large dome-shaped muscle which separates the chest from the abdominal cavity. Whenthe diaphragm muscle contracts, its dome becomes flattened and draws down the lungs,causing air to enter them; when it relaxes the lungs become smaller and the air in them isexpelled. The muscles of the abdomen also help in breathing. When they tighten up, theypress the abdominal contents up against the diaphragm and help in expelling air from thelungs; when they relax, they assist the diaphragm in drawing down the lungs as breathing intakes place.

The normal rate of breathing at rest is 16–18 times a minute. This rate increasesconsiderably with exertion and also with certain diseases, especially those affecting the heartand lungs.

Figure I.3 Lungs, bronchi, and alveoli

ArteryCapillarynetwork

Vein

Alveolarcanal

Artery

Elasticfibres

Vein

Alveoli

BronchioleLarynx

Left mainbronchus

Right mainbronchus

A B C

218 THE SHIP CAPTAIN’S MEDICAL GUIDE

Digestive systemThe abdomen is a cavity shut off from the chest by the diaphragm. The cavity is lined by a sheathof membrane (the peritoneum) which also enfolds some of the abdominal organs. The sheathsecretes fluid which keeps the abdominal contents moist and prevents friction.

The digestive tract

This is a passage consisting of the gullet (oesophagus), the stomach, the small intestine, thelarge intestine, the rectum and the anus.

The gullet is a straight muscular tube which joins the throat to the stomach. It passes downthrough the back of the chest cavity and goes through an opening in the diaphragm to connectwith the upper part of the stomach.

The stomach is a J shaped pouch. It enlarges when food or liquid is consumed. The lower partof the stomach is narrow where it joins with the first part (duodenum) of the small intestine.

The small intestine is a narrow-bore coiled tube, roughly 7.5 metres long, which occupiesmost of the central part of the abdominal cavity. The internal surface of the wall bears a largenumber of very small folds which project inwards to increase the surface area in contact withthe contents of the intestine. The small intestine joins with the large intestine in the right lowerquarter of the abdomen.

The large intestine is a wide-bore tube, roughly 1.5 metres long, which arches upwards andacross the abdominal cavity before descending the left side to join with the rectum.

The rectum is roughly 150 mm long and is continuous at its lower end with the very short analcanal which opens to the exterior.

The digestive process

Digestion is the physical and chemical breakdown of food into useful products which are thenabsorbed by the capillaries of the blood vessels serving the gut. The unwanted residue of foodis excreted as faeces.

The digestive tract walls contain involuntary muscle which by contractions moves thecontents through the entire length until they reach the rectum where they are stored as faecesprior to evacuation. At certain places such as the entrance and exit to the stomach and at theanus, circular bands of muscle capable of constriction (sphincters) act as valves to shut off theflow.

The physical breakdown of food is accomplished by chewing, by the churning actions of thegut and by the addition of special digestive juices to the food. This begins in the mouth whenfood is mixed with saliva which contains enzymes. In the stomach, acid gastric juice is secretedby the stomach walls and acts on the food which may be retained there for several hours beforepassing through the duodenum. Small ducts from the bile system of the liver and also from thepancreas open into the duodenum. These ducts provide juices which are partly designed toneutralise the acid from the stomach juice and thus allow the enzymes secreted by theduodenal walls to act more efficiently. The churning of the gut then ensures a thorough mixingof food and digestive juices throughout the length of the small intestine where most of thechemical breakdown takes place. The main functions of the large intestine are to re-absorbwater from the food residue and to reduce the bulk of the faeces.

The liver

The abdominal veins drain into the liver and carry to it the useful products which have beenabsorbed during the digestive process. One of the main liver functions is to act as a chemicalfactory which processes these products into substances necessary for nutrition.

Annex I ANATOMY AND PHYSIOLOGY 219

Urinary systemThe kidneys are located at the back of the upper part of the abdominal cavity, one on each sideof the spine (see Plate 14). They are embedded in fat to cushion them from injury.

The main kidney function is to remove water and certain harmful waste products from theblood and, by this filtering process, to form urine. They control total body water and theconcentration of various chemical substances in the blood. The kidneys also play an importantpart in maintaining a steady level of blood pressure.

The urine is carried downward from the kidneys to the urinary bladder by tubes of smallcalibre (the ureters); one tube for each kidney. The urinary bladder is a muscular bag situated inthe front part of the cavity formed by the pelvic bones. The bladder acts as a reservoir whereurine collects until it is expelled by voluntary muscular contractions through a tube (theurethra) which leaves from the bladder base.

The male urethra measures 18 to 20 cm from the bladder to the external opening at the endof the penis. A knowledge of this length is important when passing a catheter. The femaleurethra is much shorter, being about 4 cm in length. It runs embedded in the upper vaginal wallto the external opening just above the vaginal orifice.

Nervous system

Cerebro-spinal nervous system

This consists of the brain, spinal cord and the associated nerves. The brain is in the cavity of theskull. It is the co-ordinating centre for the nervous system, processing incoming informationfrom nerves concerned with sight, smell, taste, hearing, sensation etc. and controlling variousparts of the body, particularly muscles by way of out going (motor nerves). Higher functionsinclude intellect, memory, personality etc.

The spinal cord emerges from the base of the brain and leaves the skull into the bonyvertebral canal. It is protected by vertebrae throughout its length, and nerves emerge atregular intervals. These nerves control muscles and transmit sensation back through the spinalcolumn to the brain.

Sympathetic nervous system

This is a fine network of nerves not under direct voluntary control influencing the function ofvarious organs, especially gut, bladder, blood vessels and heart.

SkinThis protects and covers the body. It consists of two layers. The outer layer is hard and containsno blood vessels or nerves. This outer layer protects the inner layer, where there are sensitivenerve endings numerous sweat glands and the roots of the hair.

Sweat consists of water, salt and some impurities from the blood. The evaporation of thesweat cools the body, and helps to regulate its temperature.

220 THE SHIP CAPTAIN’S MEDICAL GUIDE

FRONT VIEW OF SKELETON

Cranium (skull)

Orbit (eye socket)

Mandible (lower jaw)

Clavicle (collar bone)

Head of humerusarticulating with scapula(shoulder joint)

Humerus (upper arm bone)

Ulna (inner bone offorearm)

Radius (outer bone offorearm)

Carpal bones (small handbones of wrist joint)

Metacarpal bones (longbones of the hand)

Phalanges (bones of thethumb and fingers)

Sternum (breast bone)

Ribs

Costal cartilages (non-bonyattachments of ribs to thebreast bone)

Floating ribs (not attachedto the breast bone)

Ilium (bone of the pelvis)

Ischium (bony partunderlying the buttocks)

Pubis (joining the twopelvis bones)

Head and neck of femurforming part of hip joint

Femur (thigh bone)

Patella (knee cap)

Tibia (shin bone)

Fibula

Tarsal bones (small bonesof the foot)

Metatarsal bones (longbones of the foot)

Phalanges (bones of thetoes)

Frontal

Orbital fossa

Maxilla

Mandible

Sternum

10 ribsjoined to sternumby costalcartilageplus 2 floatingribs notjoined tosternum

Ilium

Ischium

Pubis

Femur

Hipbone

Patella

Tibia

Fibula

Tarsals

PhalangesMetatarsals

Cranium

Clavicle

Humerus

Radius

Ulna

Carpals

Metacarpals

Phalanges

Figure I.1 The skeleton (front)

ANNEX II

Anatomical drawings

Annex II ANATOMICAL DRAWINGS 221

BACK VIEW OF SKELETONincluding

Parietal and occipitalbones (part of cranium)

Vertebral column (spinalcolumn)

Scapula (shoulder-blade)

Sacrum (base of the spine)

Coccyx (small bones at thebase of the spine – tailbone)

Os calcis (the heel)

Parietal bone

Occipital bone

Scapula

Vertebralcolumn

Sacrum

Os calcis

Tibia

Fibula

Femur

Coccyx

Humerus

Radius

Ulna

Figure I.2 The skeleton (rear)

222 THE SHIP CAPTAIN’S MEDICAL GUIDE

Figure II.3 Main voluntary muscles (front)

Masseter

Strenothyroid

Front oftrapezius

Biceps

Bicepstendon

Rectusabdominis

Ankle and footextensors

Tibialis and peroneal

muscles

Quadriceps

Flexors for fingers,

hand and wrist

Line of internaland external

obliqemuscles

PectoralisMajor

Deltoid

Sternocleidomastoid

Brachials

Annex II ANATOMICAL DRAWINGS 223

Deltoid

Triceps

Extensorsfor wrist,hand andfingers

Illiotibial band

Hamstrings

Gastrocnemius/Soleus

Calcaneous(achillies) tendon

Adductormagnus

Gluteus maximus

Gluteus medius

Latissimus dorsi

Trapezius

Figure II.4 Main voluntary muscles (rear)

224 THE SHIP CAPTAIN’S MEDICAL GUIDE

Plate 13 Organs of chest and abdomen (front)

Gullet

Right lung

Liver

Gall bladder

Large intestine

Caecum

Appendix

Larynx

Thyroid gland

Windpipe

Left lung

Spleen

Stomach

Smallintestine

Bladder

Heart

1

2

3

4

5

6

7

8

9

10

1

2

3

4

5

6

7

8

9

10

Annex II ANATOMICAL DRAWINGS 225

Plate 14 Organs of chest and abdomen (rear)

Largeintestine

Left lung

Spleen

Ureter

Bladder

Right lung

Liver

Right kidney

Large intestine

1

2

3

4

5

6

7

8

9

10

1

2

3

4

5

6

7

8

9

10

Left kidney

11 11

12 12

ABC status 76Abdomen

Examination 142Organs 224–5

Abdominal emergencies 142–3Abdominal pain or discomfort

Appendicitis 143–4Blast injury 40Bleeding, internal 22Chemicals, ingestion 46–7Cholera 100Colicky, causes 144–5Cyanide poisoning 48Enteric fever 102Glandular fever 103Minor abdominal conditions 137Pelvic inflammatory disease 123Peritonitis 150Severe 138–9Spasmodic 137Yellow fever 115

Abdominal tenderness 139, 141Abortion 140–1Abrasions 69Abscesses 172–3Aching, of body generally

Malaria 105–7Poliomyelitis 110

Acquired immuno deficiencysyndrome (AIDS) 124

Acute gastroenteritis 146Acute red eye 163–4Adhesive skin closures 71Adrenaline 181Aedes mosquitoes 101Alcohol 46

abuse 64, 179–80Allergy

Lesser reactions 181Major reaction 181

Alveoli 217Amitriptylline 46Ammonia vapour 48Amoebic dysentery 59, 147Anaemia 182Anal discomfort

fissure 143itching (pruritus) 143

Anatomy 215–19Drawings 220–5

Angina pectoris 128, 130–1Animal bites 170–1Ankle fracture 31Anorexia nervosa 193Ant sting 172Anthrax 98Antibiotic treatment

Barber’s rash (sycosis barbae) 174Boils, hand 190Burns 82Chest injuries 39Diphtheria 101Eye ointment 78–80Face/mouth wounds 82Hand infection 173Impetigo 176Internal injuries 74

Kneecap fracture 30–1Lymphangitis 186Open fracture, fingers 26Paronychia 174Rat bites 170Wounds 73

Antihistamines, side effects 181, 184

Antiseptic 91Anusol 143, 147Anxiety 159Appendicitis 138–9, 142, 173–4

Pain shifting 152Artery 216Artificial respiration

Allergic reactions 181Coronary thrombosis 129Inhaled poisons 46Lung (blast) injury 40Overdose 47Suffocation 18Survivors, after hypothermia 202Unconscious patient 15–16

Asphyxia 18Aspirin

Coronary thrombosis 129Overdose 47Urticaria 178

Astemizole 178Allergic reaction 181

Asthma 54, 133–4, 181Astringents 46Athlete’s foot 175A.V.P.U. score 76–7

BabyDeformity or death 200Not breathing after delivery 200Presentation, births 200

Bacillary dysentery 147Acute 59

Backache 94, 168–9Dengue fever 101Painful period 193Plague 109Poliomyelitis 114Yellow fever 115

Bacteria 95Bacterial vaginosis 122–3Balanitis 117Balanoposthitis 118Bandages 7–11Barber’s rash 174Bed

Baths 56Feeding patients 56Sores 57

Bee sting 172Bell’s palsy 160Benzoic acid 175–6Betamethasone 191–2Biliary colic 130–1, 138–9, 145Bites 69

Animal 170–1Snake 170–7

Black eye 79Bladder/kidney inflammation 155–6

Ind

ex

227

Blast injuries 39–40Abdomen 40Head 39Lungs 39–40

Bleaching solutions 48Bleeding

External 20–1Internal 22

Abdomen (blast injuries) 40Fractures 27High bone shaft fracture 30Pelvis fracture 36

Severe 14Wound 71

Bleeding peptic ulcers 151Blisters 83

Anthrax 98Chickenpox (varicella) 99

Blood 216Coughing up 22Transfusion 22Vomiting 22

Blood pressure, high 132Blood vessels 216Boils 172–3

Hands/fingers 190Bone structure 215Boredom 94Bovine spongiform encephalopathy

(BSE) 95Bowel

movement 58sounds 142–3

Brain 219Compression 64Concussion 64

Breathing difficulties 61Breathing systems 217Bronchi 217Bronchitis 46, 60

Acute 134–5Chronic 135Measles 107

Buboes 109, 119–20, 129Burial at sea 207Burns

Chemical 17Eye 80

Classification 82Electrical 17Fluid loss 82Heat 17Rule of nines 82–3Special 83Treatment 82–3

Calamine lotion 99, 101, 107, 177Shingles (herpes zoster) 178

Cap 195Capillaries 216Carbolic acid 48Carbon dioxide poisoning 46Carbon monoxide poisoning 46, 48Carbonic acid gas 48Carbuncles 172–3Caries 165Carrier 96

228 THE SHIP CAPTAIN’S MEDICAL GUIDE

Catering staff, personal hygiene 90Catheterisation, male 156–8Cellulitis 99, 172–3Centipedes 172Cerebro-spinal fluid, leakage 75Chalazion 163Chancre 120Chancroid 117, 119–20Chaps 175Charcoal, oral 47Chemical splashes 17Chest compression 16

Allergic reaction 181Baby not breathing after delivery 200Coronary thrombosis 129

Chest injuries 38–9Chest organs 224–5Chest pain 128, 135

Associated signs 130–1Chickenpox 99Chilblains 175Child inside womb 197Childbirth 197–200Chlamydia 117Chlamydial lymphogranuloma 117, 121Chlorhexidine gluconate 20%

(HIBISCRUB) 189Chlorinated lime 86–7Chlorine 45

Compound 86Chloroquine 106–7Chlorpromazine 158–9

Delirium tremens 180Choking 18Cholecystitis 130–1, 145–6Cholera 59, 88, 100, 146Chostochondritis 136Cimetidine 150Ciprofloxacin 102

After delivery 199Bacillary dysentery 147Bronchitis 135Cholecystitis 146Genital ulcers 119Otitis media 162Urethritis 118

Circulatory collapse 19–20Circulatory system 216Cleanliness 69

On board ships 90Clove oil 165–6Codeine phosphate

Backache 168Boil in the ear 162Coronary thrombosis 129Gout 168–9Head injury 77Meningitis 108Twisted testicle 154Urticaria 178

Coil 195Cold in the chest 134Colds 95Collapsed lung 137Collar bone fracture 28Common cold 182

Virus 85

Communicability period 96Communicable diseases 95–115

Infectious agents 95Management, general rules 97Symptoms and signs 96Terms used 96Transmission modes 95–6

Composite temperature 94Compression of brain 75Compression test, pelvis fracture 36Concussion 77Condom 126, 195Conjunctivitis 160, 163–4Consciousness level 74Constipation 204Contact 96Contraception 195Contraceptive pill 195Convulsions 19, 48

Head injury 76Corneal abrasion 79Coronary arteries 128Coronary thrombosis 128–31Crepitus 191Cresol 48Creutzfeld Jacob disease 95Crush injuries 25

Hand 30Crutch bandage 10Curly weed rash 192Cyanide 48Cystitis 140–1, 155–6

Dapsone 106Death

Cause of 206Disposal of the body 207Mistaken 205Procedure after 206–7Signs 205

Dehydration 61–2Alcoholic 179–80Cholera 100Survivors 204

Delirium tremens 180Deltoid muscle, intramuscular

injection 66Dengue fever 101Dental abscess 160Dental injuries 81–2Dental pain 165Deodorant 91Depression 158–9Dermatitis 175, 181Dhobie itch 175–6Diabetes mellitus 118, 173

Treatment 182–3Diabetic coma 64, 182–3Diaphragm 126, 217Diarrhoea 61, 138, 140, 142, 146

Acute gastroenteritis 146Anthrax 98Cholera 100

Diazepam 19, 46Angina pectoris 128Anxiety without depression 159Burns 82

Hernia rupture 148High blood pressure 132Paroxysmal tachycardia 129Prickly heat 177Rectal 76Snake bites 170

Diet, balanced see also Food 89Diclofenac 133, 191

Rheumatic fever 169Digestion 218Digestive system 218Diphtheria 101Diseases

Causes and prevention 85Communicable 95–115

Disinfectant poisoning 48Disinfection at the end of illness 91–2Disinfestation 91Dislocations 37, 84Doctor(s)

Communication 214Ship-to-ship transfer 213

Dogger Bank itch 192Doxycycline 100, 110, 114

Chancroid 120Chlamydial lymphogranuloma 121Genital ulcers 119Granuloma inguinale 122Pelvic inflammatory disease 123Sinusitis 165Syphilis 121Twisted testicle 154Urethritis 118Vaginal discharge 123

Dressings 7Drug abuse 183–4Drunkenness 179Duodenal ulcer 150–1

Perforated 144Duodenum 218Dying, care of 205Dysentery 90

Ear(s)Boil 162Examination 161Foreign bodies 81Infection

Middle 162–3Outer 161–2

Internal 81Parts 161Wax 161

Ectopic pregnancy 123, 140–1, 145,194

Eczema 181Elbow fractures 28Electrocution 17Enteric fever 95, 102, 146Epilepsy 64

Fits 19Ergometrine 194, 198–9Erysipelas 99Erythromycin 114

After delivery 199Appendicitis 144Bronchitis 195

INDEX 229

Chlamydial lymphogranuloma 121Otitis media 162Sinusitis 165Syphilis 121

Exercise 94Eye 163

Anatomy 78Bandage 11Chemical contact 47Deep inflammation 164Diagram 78Examination 78–9Fire extinguisher powder, damage 17Injuries 78–81

Arc eyes (Welder’s flash) 80Chemical burns 80Corneal abrasions 79Eyeball wounds 80Eyelid wounds 80Foreign bodies 79

Facial paralysis 100Faeces

Examination 58–9Abnormalities 58–9Certain diseases’ effects 59

Testing 195Fainting 64Fansidar 106–7Female sexual organs 193Femidom 195Fenol oils 48Fever 53

Anthrax 98Chickenpox (varicella) 99Malaria 106Meningitis 107Scarlet fever 112

Fibrositis 169–70Filariasis 95Finger

Dislocation 84Fractures 29Infections 189–90

First aidGeneral assessment 6General principles 5Kit 14Priorities 5

Fish hook, removal 192Fish poisoning (erysipeloid) skin

disease 192Fishermen’s conjunctivitis 191Fishermen’s tenosynovitis 191Fits, head injury 76

see also ConvulsionsFlies 85Fluconazole 118, 123Fluid balance 61–2Fluid retention 187Fluids by rectum 22, 62, 150Fluorescein 80Food

Bacteria 89–90Canned 89Contamination 89Fruit 89

Poisoning 146Vegetables 89

FootBandage 10Fractures 32

Forearm fractures 29Fractures 26–36

Circulation 27Closed 26Immobilisation 27Open 26Stress 26Treatment

General 27Principles 26–7

Freon 49Frostbite 94, 203Frusemide

Coronary thrombosis 129Heart disease, oedema 187

Fungi 95

Gallstone 138–9Colic 145

Gastric ulcer 150Genital

herpes 117, 120itching 195ulcers 119warts 117, 123

Germaliods 147German measles 103Gingivitis 160, 165Glandular fever 103, 167, 180Glasgow Coma Scale 74Glyceryl trinitrate 128Gonorrhoea 85, 95, 117, 122

Complication 153Gout 168–9Gouty arthritis 168–9Grand mal 19Granuloma inguinale 117, 122Grazes 69Guardia 95Guedel airway 63, 65, 83Gullet 218, 224Gum(s) ulcers 166

Haddock rash 191Haematoma 22Haemiplegia 160Haemoglobin 216

Oxygen carrying capacity 217Haemorrhoids see also Piles 58, 143,

147–8Bleeding 148

HandCuts 191Infections 173, 189–90Tendons 189

Hand bones, fractures 29Hangover 180Hay fever 184Head injuries 37

Assessment of the patient 74–5Communication 76–7Minor 77

Pain relief 77Serious 75–6Signs 75–6

Head and scalp bandage 11Headache

Cellulitis 173Hangover 180Head injuries 76Sea sickness 188Tension 164

Heart 216, 224Pain 128

Heartburn 130–1, 150Heat illness, prevention 93–4Heel bone fracture 31Heimlich sign (choking) 18Helicopters 211–13Hematoma scalp 77Hepatitis 97, 104

B 117Hernia

Inguinal 148Rupture 148Strangulation 148–9, 155

Herpes zoster see Shingles 178High-test calcium hypochlorite 87Hip bandage 10Hookworm 95Hornet sting 172Human immunodeficiency virus (HIV)

117, 124–5Hydrocoela 154Hydrocortisone (1%) ointment 175, 192Hydrogen 46Hyoscine hydrobromide 188Hyperbaric oxygen therapy 48Hyperpyrexia 52, 184–5Hypertension 132Hypothermia 17, 53, 94, 201–2

Causes 201Diagnosis 201–2Treatment 202

Ibuprofen 191Immersion foot 203Immunisation 98

Enteric fever-typhoid 102Poliomyelitis 110Tetanus 112

Impetigo 176Incontinence 58Incubation period 96Indigestion 137

Acute 138–9Infectious mononucleosis

see Communicable diseases 103Influenza 95, 104Inguinal hernia 118Inhaled poisons 45–6Injections

Filling a syringe 66–7Intramuscular 66Subcutaneous 66

Insecticides 91Insulin 183

coma 182–3Internal injuries 74

230 THE SHIP CAPTAIN’S MEDICAL GUIDE

Intestinal colic 138–9, 149Intestinal obstruction 140–1,

149Intestine 218, 224–5Intra-uterine (coil) device 123Involuntary muscles 215Isolation 92

Period 46

Jarisch-Herxheimer reaction 119, 121

Jaundice 149Gallstone colic 145Glandular fever 103Hepatitis 104Yellow fever 115

Jaw fracture 32, 81–2Muscle spasm 92

Jellyfish 171Jumbo wrist 191

Kidney(s) 219, 225Stones 138–9

KneecapBandage 10Fracture 30–1

Kuru 95

LabourAfter delivery 199Birth 198–9Onset 194, 198Preparations 198Problems during 200Stages 197Subsequent management 179

Lacerations 69Laerdal Pocket Mask 46Laryngitis 167Laxative, after delivery 199Legionnaires’ disease 85Legs, fractures 32Lice

Head 177Pubic 177

Lignocaine hydrochloride 71Fish hook removal 192Gel 147Injection, pattern 171Pulp space infection 190Sea urchins 172

Lindane (1%) cream 124, 177Liver 218, 224Local anaesthetic 71Lumbago 94Lungs 217Lymph node

Location 186Swelling 122

Lymphadenitis 186–7Lymphangitis 185–6

Septic finger 190Lymphatic inflammation 185–6Lymphoid fever 90

Madness 158Magnesium trisilicate compound

137, 146, 150

Malaria 85, 95, 146Areas 105Guidelines 106Mosquito bites, avoidance 105Prevention 105–6Treatment 106–7

Malnutrition 204Maloprim 106Mastoid cells, infection 163Mattress suture 72–3Measles 95, 107, 134Med Alert Bracelet 181Medivac service by helicopter 211–13Mefloquine 106–7Melaena 58Meningitis 107–8

Headache 163Knee straightening test 108Neck bending test 108

Meningococcal sepsis 97Menstrual cycle 193Mental illness 158–9

Serious 62–3Metacarpal bones 29Metazoa 95Methyl chloride 48–9Metronidazole

Amoebic dysentery 147Appendicitis 144Gingivitis 166Pelvic inflammatory infection 123Peritonitis 150Vaginal discharge 123, 195

Miconazole cream 176Microbes (germs) 85Migraine 164Miscarriage 140–1

Inevitable 194Threatened 194

Morning-after pill 195Morning sickness 193Morphine 20, 22

Anxiety relief 205Backache 168Biliary colic 145Bleeding peptic ulcers 151Contraindications

Chest injury 24, 38, 40Head injury 24, 77

Coronary thrombosis 129Crush Injuries, hand 30Eye, chemical contact 47Fractures 27Gallstone colic 145Internal bleeding 22Internal injuries 74Pelvis fracture 36Perforated ulcer 152Renal colic 155Retention of urine 156Shoulder dislocation 84Strangulated hernia 148Thigh bone shaft fracture 30Vaginal bleeding 194

Mouth Care 36Injuries 81–2Ulcers 160

Mumps 109, 118Complications 153

Muscular rheumatism 130–1, 136,168

Nail bed inflammation 174Nail fold infections 190Neck injuries 35Neil Robertson stretcher 33, 42–4Neomycin 191–2Nerves 159Nervous system 219Nettle rash 178, 181Neuralgia 159Nitrazepam 46Non-freezing cold injury 203Nose bleeding 132Nose injuries

Foreign bodies 81Inside 81

Nurses 51Nursing

Care of the injured 52General 51–2

OedemaCaused by heart disease 187Generalised 187Localised 187

Oesophagus 218Oil, contamination with 204Onchcerciasis (river blindness) 95Orchitis 109Osteo-arthritis 170Otitis media 161–3Overdoses 46–7Oxygen

Coronary thrombosis 129Haemoglobin carrying capacity 217Pleural effusion 136Pneumothorax 137Requirements, head injury 37Suffocation 18

Oxyhaemoglobin 217

Palmar space infection 190Panda eyes 75Paracetamol

Abscesses 173Anal fissure 143Boils 162, 173Bronchitis 135Carbuncles 173Cellulitis 99Chostochondritis 136Common cold 182Dengue fever 101Fibrositis 169–70Glandular fever 103Hangover 180Head injuries 77Influenza 104Measles 107Minor abdominal conditions 137Mumps 181Overdose 47Painful periods 193Pleurodynia 136

INDEX 231

Paradoxical chest movements 39Paraffin gauze dressing 24, 83, 174Paralysis

Aids for 57Effects on limbs 57Patient supported in bed 57Signs 75

Paraphimosis 153Paraplegia 160Paronychia 174Paroxysmal tachycardia 129Pediculosis 177Pelvic inflammatory disease 123, 124Pelvis fracture(s) 36Penetrating wound, chest 220Penicillin 76

Abscesses 173Allergy 181Anthrax 98Appendicitis 144Boils 173Carbuncles 173Cellulitis 99, 173Genital ulcers 119Lymphadenitis 186Meningitis 108Otitis media 162Perforated ulcer 152Peritonitis 150Pulp infection 174Quinsy 168Sinusitis 165Skull fractures 76Sore throat 167Syphilis 121Urethritis 118Urticaria 178

Penile swelling 153Peptic ulcer 130–1, 137, 150–1Perforated ulcer 140–2, 151–2Peridontal disease 166Period problems 193Peritoneum 218Peritonitis 138–9, 142, 150Peritonsinal abscess 167–8Permethrin cream 177Perspiration see also Sweat 93

Unseen perspiration 61Pertusis 114Petit mal 19Petroleum products 48Phenol 48Phlebitis 133Photophobia 108Physiology 215–19Pigeons (salt water boils) 186Piles see also Haemarrhoids 58, 132,

143, 147–8Pinworms 152–3Pips (salt water boils) 191Placenta 197

Delivery 199Plague 85, 109, 109–10Plasma 216

Loss 82Platelet cells 216Pleura 217

Pleural effusion 136Pleurisy 130–1, 135Pleurodynia 130–1, 136Pneumonia 135

Anthrax 98Bacteria caused 95Influenza 104Inhaled poisons 46Lobar 136–7Measles 107Pulse rate: respiration rate 54Sputum examination 60

Pneumothorax 130–1, 137Poisonous fish 171Poliomyelitis 110, 114Port health clearance 93Post-herpetic neuralgia 160Post-mortem examination 207Posthitis 117–18Potable water 85–9Potassium permanganate 175–6Pre-menstrual tension 193Pregnancy 193–4

Bleeding 194Pressure sores 57Prickly heat 177Prions 95Prochlorperasine 188Proctitis 125Proguanil 106Promethazine 188Prostate gland enlargement 156Protozoa 95Pruritus vulvae 195Prussic acid 48Pubic lice 117, 123–4Pulmonary oedema 46, 60Pulp infection 173–4, 190Pulse rate

Chart 55Normal 54

Pupil response 75Pyelitis 155–6Pyorrhoea 166Pyrimethamine 106

Quadriplegia 160Quarantine period 96Quinine 107Quinsy 167–8

Rabies 95, 111, 170Radio medical advice 209

Information to have ready 210–11Rashes 97Recovery position 181Rectum 218Red cells 216Refrigerated gases, poisoning 49Renal colic 138–9, 155Respiration rate 54, 217

Chart 55Normal 54

Respiratory burns 83Restlessness 74Rewarming 202

Frostbite 203

Rheumatic fever 169Rheumatism

Acute 169Chronic 170Muscular 169–70

Rib fractures 38, 130–1, 136Rice water motion 59Ring pad 11Ringworm 85, 95, 176Roundworms 153Rubella 103

Salbutamol inhaler 134Salpingitis 123, 140–1, 145Salt water boils 191Scabies 117, 124, 178Scalds see also burns 17Scalp lacerations 77Scarlet fever 97, 112Sciatica 94, 160, 168Scorpions 172Scrotum swelling 118, 154–5Sea sickness 188Sea urchins 172Sensation, absence 33Septicaemia 107–8Sexually transmitted disease 117–26

InstructionsMedical attendants 125Patients 125–6

Prevention 126Treatment centre at ports 125Vaginal discharge 194–5

Shakes, alcohol withdrawal 180Shingles 130–1, 136, 178Ship-to-ship transfer 213Shock

Abdominal wounds 24Causes 19Signs 19Symptoms 19Treatment 20

ShoulderBlade fracture 28Dislocation 84Fractures 28

Sick quarters 51Sinusitis 165

Frontal 165Maxillary 165

Skeleton 220–1Skin 219

chemical contact 47Skull fractures 75–6Sleeping tablets, overdose 46Slings 12–13, 28Slipped disk 94Snake bites 170–1Sodium bicarbonate, stings 172Sodium chloride

Acute gastroenteritis 146Bacillary dysentery 146

Sodium hypochlorite solution 48, 87Solvents 48Sore throat 167Spencer Wells forceps 70–2Spiders 172

232 THE SHIP CAPTAIN’S MEDICAL GUIDE

Spinal cord 219Injury 160

Spine fractures 33–5Splints 13–14

Inflatable 14Sprains 84Sputum, examination 60Stab wounds 25–6

Abdomen 26Chest 25Limbs 26

Sterilisation 69, 91Steristrips 70–1Stings 171–2Stomach ulcer 150–1Stove-in chest injury 38–9Stretcher see Neil Robertson stretcherStrains 84Strangulated hernia 140–1Strangulation 18Stroke 64, 132, 160

Headache 164Styes 163Suffocation 18, 134

Carbon dioxide 48Suicide, potential 159Sunburn 83, 94Surgeon’s knot 72–3Survivors 201–4Sutures 72Swallowed poisons 46–7Sweat see also Perspiration 219Swollen legs 204Sycosis barbae 174Sympathetic nervous system 219Syphilis 85, 117, 120–1

Tapeworm 95Temazepam 46Temperature

Chart 55During cold water emersion 201High

Delirium tremens 180Malaria 106Treatment 185Typhoid 102Typhus fever 114Yellow fever 115

Normal 53Rectal 53Taking 53

Tendon injuries 191Tepid sponging 185Testicle(s)

Injury 154Pain 153–4Torsion 118, 153–4

Tetanus 73Lockjaw 112Protection 180

Tetracycline ointment (1%) 118Thigh bone shaft fractures 30Threadworms 152–3Thrush 195Tic Douloureux 159

Tinea 176Tinea pedis (athlete’s foot) 95Tingling 33Tit juice conjunctivitis 191Tonsillitis 167Toothache 165–6Toxic hazards 45Transient ischaemic attack (TIA) 160Transport of casualties 40–4Triangular sling 12–13, 28Trichlorethylene (trilene, trike) 49Trichomoniasis 122–3Trigeminal neuralgia 159Trike see Trichlorethylene 49Trilene 49Trimethoprim

Bronchitis 135Cystitis 156Pyelitis 156

Tubal infection 145Tubal pregnancy see also Ectopic

pregnancy 145Tuberculosis 95, 113Typhoic fever 85Typhoid 59, 102Typhus fever 114

Ulcers 150–2Umbilical cord, tie and cut 199Unconscious patient

Chest injuries 39Choking 18General management 65Head injury, care of 75Moving 443 MUSTS 63Treatment 15–16

Unconsciousness, diagnosis 64Upper arm fractures 28Upper eyelid eversion 79Urethra 219Urethral discharge 117–18Urethritis 117–18

Complications 153Urinary infection 144Urinary system 219, 224–5Urination difficulty 204Urine 219

Blood-stained 36Examination 143Retention 156–8Testing 59–60

Glucose 173, 195Protein 132, 187

Urticaria 178, 181

Vaginal bleeding 196Vaginal candidiasis 122Vaginal discharge 122–3, 123, 194–5Valium 46Varicella 95, 97, 99Varicose ulcer 133Varicose veins 132Vein 216Venom, sucking 171Ventilation 93

Viruses 95Visual disturbances 132

Migraine 164Voluntary muscles 215

Front 222Rear 223

Vomited matter, examination of 60Vomiting

Cholecystitis 145–6Cholera 100Coronary thrombosis 128–9Dehydration 61Drunkenness 179Head injury 76Inhalation 179Lifeboat, in 204Meningitis 107–8Migraine 164Peritonitis 150Pregnancy induced 193Sea sickness 188Severe abdominal pain 138–41Snake bites 171

Wasp sting 172Water, fresh

Distribution system by super-chlorination 86

Hoses 87–8Taking water on board 88Treatment by chlorine 88–9

Storage tanks 85–6Disinfection 86

Water retention see also Oedema132

Welder’s flash 80White cells 216Whitlows 172, 174Whooping cough 114Wind 137Worms 59, 152–3Wound(s)

Abdominal 24Bullet 23Chest 24Classification 69Face and jaw 25Head 24Healing 70Infection 73Metal fragments 23Palm 25Stitches, removal of 73Treatment 70–3

Wrist fractures 28

Yellow fever 85, 115

Zinc oxideOintment 143, 175Powder 166

Index by Dr Olivera Potparic