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Section V. HYGIENE AND FIRST AID
3-33. General
In cold weather, the care of the body requires special emphasis. If men are allowed to go without washing, fail to eat properly, do not get sufficient liquids or salt, efficiency will suffer. Lowered efficiency increases the possibility of casualties, either by cold injury or enemy action.

3-34. Dehydration
a. Definition and Principle. Dehydration means to lose or be deprived of water or the elements of water. A growing plant loses (uses) water in the growing process. If this water is not replaced by either natural means (rain) or by watering, the plant will wither and eventually dry up. The same principle applies to the human body which loses water and, an additional element, salt. A certain amount of this loss is taking place constantly through the normal body processes of elimination; through the normal daily intake of food and liquids, these losses are replaced.
b. Dangers. When individuals are engaged in any strenuous exercises or activities, an excessive amount of water and salt is lost through perspiration. This excessive loss creates what is known as “imbalance of liquids” in the body and it is then that the danger of dehydration arises, unless this loss of liquids
and salt is replaced immediately and individuals are allowed sufficient rest before continuing their activities.
c. Training and Discipline. The danger of dehydration for troops operating under cold weather conditions and over ice and deep snow is a problem that does exist and cannot be overemphasized. It is equally important, however, to recognize that the problem can be overcome and will present no great obstacle to well trained, disciplined troops who have been thoroughly oriented in the causes, the symptoms, and the effects of dehydration and who have been properly instructed in preventive measures.
d. Differences. It is important, therefore, to be aware that the danger of dehydration is as prevalent in cold regions as it is in hot, dry areas. The difference is that in hot weather the individual is conscious of the fact that the body is losing liquids and salt because he can see and feel the perspiration with its saline taste and “feel” it running down the face, getting in the eyes, and on the lips and tongue, and dripping from the body. In cold weather, it is extremely difficult for an individual who is bundled up in many layers of clothing to realize that this condition does exist. Under these conditions, perspiration is rapidly absorbed by the heavy clothing or evaporated by the air and is rarely visible on the skin.
e. Cause, Symptoms, Effects, Preventive Measures, and Treatment.
(1) Dehydration results from failure to correct the body’s “imbalance of liquids” through replacing liquid and salt which has been lost.
(2) The symptoms of cold weather dehydration are similar to those encountered in heat exhaustion. The mouth, tongue, and throat become parched and dry and swallowing becomes difficult. General nausea is felt and may be accompanied by spells of faintness, extreme dizziness and vomiting. A feeling of general tiredness and weakness sets in and muscle cramps may occur, especially in the legs. It becomes difficult to keep the eyes in focus and fainting or “blacking out” may occur.
(3) The effect of dehydration on the individual is to incapacitate him for a period of from a few hours to several days. The effectiveness of the individual’s
unit is likewise reduced by the loss of his contribution to the accomplishment of the unit mission. Small patrols and detachments operating beyond range of immediate help from the parent unit must be extra cautious to avoid dehydration since they run the risk of a secondary but more dangerous effect of dehydration, that of becoming cold weather casualties while incapacitated.
(4) Dehydration can be prevented during cold weather operations by following the same general preventive measures applicable to hot, dry areas. Salt and sufficient additional liquids are consumed to offset excessive body losses of these elements. The amount will vary according to the individual and the type of work he is doing, i.e., light, heavy, very strenuous, etc. Rest is equally important as a preventive measure. Each individual must realize that any work that must be done while bundled in several layers of clothing is extremely exhausting. This is especially true of any movement by foot, regardless of how short the distance.
(5) In treating a person who has become dehydrated, the individual should be kept warm but his clothes loosened sufficiently to allow proper circulation;
liquids and salt should be fed to him gradually and, most important of all, he must have plenty of rest. When salt tablets are not available, common table salt may be used. Approximately one-half of a level mess spoon of salt mixed in one gallon of water makes a palatable solution. The individual should receive prompt attention of trained medical personnel.

3-35. Personal Hygiene
Because of the extremes in temperatures and lack of bathing and sanitary facilities, keeping the body clean in cold weather will not be easy.
a. The entire body should be washed at least weekly. If bathing facilities are not available, the entire body can be washed with the equivalent of two canteen cups of water, using half for soap and washing, and half for rinsing. If circumstances prevent use of water, a rubdown with a dry cloth will help. Care should be taken not to abrade the skin. The feet, crotch, and armpits should be cleaned daily.
b. A temporary steam bath can be built in a large-size tent. Stones are piled up to form a furnace. The furnace is either heated inside the tent (ventilation flaps wide open) or in the open with the tent pitched over the furnace after the stones are heated. Wood is used for fuel. Seats and water buckets are taken into the tent after the stones are nearly red-hot and the fire has died down, so that they do not get sooty. The pouring and washing water is usually
heated outside the tent. The water is thrown on the hot stones in small quantities. Thus it does not drop into the ashes and the temperature does not rise too fast. A naked person spends from 15 minutes to 1 hour in this steam bath. After thoroughly perspiring, the body is washed with tepid water.
c. Beards should be shaved or clipped close. Hair should be combed daily and not allowed to grow too long. A beard or long hair adds very little in insulation value and soils clothing with the natural hair oils. In winter, a beard or a mustache is a nuisance since it serves as a base for the buildup of ice from moisture in the breath and will mask the presence of frostbite. All individuals should shave daily, when possible. Because shaving with a blade and soap removes the protective face oils, the individuals should shave, if possible several hours before exposing his face to the elements. This action will reduce the danger of frostbite. Shaving with an electric razor will not remove the protective oils. Under chemical or biological warfare conditions a beardless face and daily shaving are especially important, since an airtight seal of the protective mask is difficult to obtain with even stubble on the face.
d. Socks should be changed and the feet washed daily. If this is not possible, the boots and socks should be removed, and the feet massaged and dried. By sprinkling the feet liberally with foot powder and then rubbing the powder off, the feet can be efficiently dry-cleaned.
e. Sleeping bags should be kept clean. Subject to operational requirements, the best method is to wear the minimum clothing in the sleeping bag. Never wear damp socks or underwear in the sleeping bag. Dry underwear and socks should be put on before going to sleep and the other set hung up to dry. Perspiration will soil a sleeping bag, and cause it to become damp, therefore, the bag should be aired as frequently as possible. In the morning, the bag should be opened wide and air pumped in and out to remove the moist air within the bag.
f. Teeth should be cleaned daily. If a toothbrush is not available, a clean piece of gauze or other cloth wrapped around the finger, or end of a twig chewed into a pulp may be used in lieu of a toothbrush.
g. Underwear and shirts should be changed at least twice weekly; however, if it is not possible to wash the clothing this often the clothing should be crumpled, shaken out, and aired for about 2 hours.

3-36. Cold Injury
a. Frostbite. Frostbite is the freezing of some part of the body by exposure to temperatures below freezing. It is a constant hazard in operations performed at freezing temperatures, especially when the wind is strong. Usually there is an uncomfortable sensation of coldness followed by numbness. There may be a tingling, stinging, or aching sensation, even a cramping pain. The skin initially turns red. Later it becomes pale gray or waxy white. For all practical purposes frostbite may be classified as superficial or deep. Treatment and management are based solely upon this classification.
(1) It is easier to prevent frostbite, or stop it in its very early stages, than to thaw and take care of badly frozen flesh. Clothing and equipment must be fitted and worn so as to avoid interference with circulation. To prevent severe frostbite-
(a) Sufficient clothing must be worn for protection against cold and wind. The face must be protected in high wind, and when exposed to aircraft prop blast.
(b) Every effort must be made to keep clothing and body as dry as possible. This includes avoidance of perspiring. For heavy work in the cold, remove outer layers as needed, and replace as soon as work is stopped. Socks should be changed as needed whenever the feet become moist, either from perspiration or other sources.
(c) Any interference with the circulation of the blood reduces the amount of heat delivered to the extremities. All clothing and equipment must be properly fitted and worn to avoid interference with the circulation. Tight fitting socks, shoes and hand wear are especially dangerous in very cold climates.
(d) Cold metal should not be touched with the bare skin in extreme-low temperatures. To do so could mean loss of skin.
(e) Adequate clothing and shelter must be provided during periods of inactivity.
(f) The face, fingers, and toes should be exercised from time to time to keep them warm and to detect, any numb or hard areas. The ears should be massaged from time to time with the hands for the same purpose.
(g) The buddy system should always be used. Men should pair off and watch each other closely for signs of frostbite and for mutual aid if frostbite occurs. Any small frozen spots should be thawed immediately, using bare hands or other sources of body heat.
(2) Some cases of frostbite may be superficial, involving the skin. But if freezing extends to a depth below the skin it constitutes a much more serious
situation, demanding radically different treatment to avoid or minimize the loss of the part (fingers, toes, hands, feet). If a part of the body becomes frostbitten it appears yellowish or whitish gray. Frequently there is no pain, so keep watching one another’s face and hands for signs. The face, hands, and feet are the parts most frequently frostbitten. The problem is to distinguish between superficial and deep frostbite. This can usually be told with respect to the face. The hands and feet are a different matter. A person may be able to judge by remembering how long the part has been without sensation.
If the time was very short the frostbite is probably superficial. Otherwise assume the injury to be deep and therefore serious.
(3) For treatment of superficial frostbite in the field—
(a) Cover the cheeks with warm hands until pain returns;
(b) Place uncovered superficially frostbitten fingers under the opposing armpits, next to the skin.
(c) Place bared, superficially frostbitten feet under the clothing against the belly of a companion.
(d) Do not rewarm by such measures as massage, exposure to open fires, cold water soaks, rubbing with snow.
(e) Be prepared for pain when thawing occurs.
(4) In treatment of deep frostbite (freezing injury) the following measures must be taken: If freezing is believed to be deep, do not attempt to treat it in the field. Get to a hospital or aid station by the fastest means possible. If transportation is available, avoid walking. Protect the frozen part from additional injury but do not attempt to thaw it out by rubbing, bending, massage. Do not rub with snow; do not place in either cold or warm water; do not expose to hot air or open fires; do not use ointments or poultices. Thawing in the field increases pain and invites infection, greater damage, and gangrene. There is less danger of walking on feet while frozen than after thawing. Thawing may occur spontaneously, however, during transportation to a medical facility. This cannot readily be avoided since the body in general must be kept warm.
b. Trenchfoot. Trenchfoot is the thermal injury sustained as a result of exposure to cold, short of freezing, in a damp or wet environment. Arbitrarily, it is said to occur in the temperature range between 32° F and 50° F. Partial causes include immobility of the limbs (legs and feet down as in sitting or standing), insufficient clothing, and constriction of parts of the body by boots, socks, and other garments. This type of cold injury is almost identical with gradual frostbite, which might be expected, since the primary causes are the same except for differences in the degree of cold. In the early stages of trenchfoot, feet and toes are pale and feel cold, numb, and stiff. Walking becomes difficult. If preventive action is not taken at this stage, the feet will swell
and become painful. In extreme cases of trenchfoot the flesh dies and amputation of the foot or of the leg may be necessary. Because the early stages are not painful, individuals must be constantly alert to prevent the development of trenchfoot. To prevent this condition—
(1) Feet should be kept dry by wearing waterproof footgear and by keeping the floor of shelters dry.
(2) Socks and boots should be cleaned and dried at every opportunity, preferably daily.
(3) The feet should be dried as soon as possible after getting them wet. They may be warmed with the hands. Foot powder should be applied and dry socks put on.
(4) If it becomes necessary to wear wet boots and socks, the feet should be exercised continually by wriggling the toes and bending the ankles. Tight boots should never be worn.
(5) In treating trenchfoot, the feet should be handled very gently. They should not be rubbed or massaged. If necessary, they may be cleansed carefully
with plain white soap and water, dried, elevated, and allowed to remain exposed. While it is desirable to warm the patient, the feet should always be kept at room temperature. The casualty should be carried and not permitted to walk on damaged feet.
c. Immersion Foot. Immersion foot is a form of injury which follows prolonged immersion of the feet in water not sufficiently cold to cause freezing or frostbite. It has been observed after exposure in subtropical waters also. Clinically and pathologically, it is indistinguishable from trenchfoot which would be expected, since its cause is essentially the same, lowering of the temperature of the part of the body involved. It is usually associated with dependency
(legs and feet down as in sitting or standing) and immobility of the lower extremities and with constriction of the limbs by clothing and shoes. Other factors which play more or less important roles are-body cooling, as the result of wind; total immersion; and inadequate clothing (protection), sickness, and starvation. The incidence and severity of immersion foot however, is more directly influenced by the other factors listed. The treatment is the same as that given for trenchfoot.
d. Total immersion. Immersion in near freezing water for but a few minutes, or exposure to severe dry cold while inadequately dressed will cause total body cooling, including a marked drop in the inner body (core) temperatures. For description and therapy see appendix F.
e. Miscellaneous. The length of time that a casualty may be exposed to the weather without danger of cold injury varies directly with the temperature and wind velocity. The lower the temperature and the stronger the wind, the sooner injury will occur. There is a great variation in individual reactions to cold. To give competent care to the injured in extreme cold, the medical personnel must have heated shelter in which to operate. Battle wounds in the cold are no different from those sustained in more temperate climates, and should be treated in the same manner. Morale is helped by the assurance that the sick and wounded can be rapidly evacuated from the battlefield to hospitals, and that for the nontransportable cases requiring prompt lifesaving surgery, hospitals with highly skilled surgical personnel are available adjacent to division clearing station level.

3-37. Shock
Shock is brought about by a reduction of the circulating blood volume within the body. This can be caused by severe injuries, loss of blood, pain, emotional disturbances, or any of many factors. The normal reaction of the body to severe cold, reduction of the volume of blood circulating to extremities, is very similar to the reaction of the circulatory system to the condition of shock. Shock will usually develop more rapidly and progress more deeply in extreme cold than in normal temperature.
a. Signs of Shock. The signs of shock are apprehension; sweating; pallor; rapid, faint pulse; cold clammy skin; and thirst. If the patient is not given good first aid treatment immediately the condition of shock may progress until the patient passes into unconsciousness and further into death.
b. First Aid for Shock.
(1) The injured person should be made as comfortable as possible.
(2) Pain may be relieved by proper positioning, good bandaging and splinting. Aspirin will also help, if it is available and if there is no known or suspected abdominal injury.
(3) The litter should be positioned so that the patient is comfortable and not apt to inhale vomitus.
(4) The patient should be kept warm with blankets and sleeping bags.
(5) When the patient is conscious he should be given warm soup, chocolate, coffee, or tea if there is no known or suspected abdominal injury.
(6) The patient should receive medical attention as soon as possible.

3-38. Sunburn
An individual may get sunburned when the temperature of the air is below freezing. On snow, ice, and water, the sun’s rays reflect from all angles; in a valley the rays come from every direction. Sunlight reflected upward from the bright surfaces attacks man where the skin is very sensitive-around the lips, nostrils, and eyelids. The exposure time which will result in a burn is reduced in the clear air of high altitudes. Sunburn cream and a chapstick
should be carried in the pocket, and applied to those parts of the face that are exposed to direct or reflected light. In mild weather protection of the neck and ears can be improvised by draping a handkerchief over the back of the head which is held in place by the cap in the manner of a desert neckcloth.
Soap or shaving lotions with a high alcoholic content should not be used because they remove natural oils that protect the skin from the sun. If blistered, report to an aid station as soon as possible, as the blistered area, especially lips, may become badly infected.

3-39. Snow Blindness
Snow blindness occurs when the sun is shining brightly on an expanse of snow, and is due to the reflection of ultraviolet rays. It is particularly likely to occur after a fall of new snow, even when the rays of the sun are partially obscured by alight mist or fog. The risk is also increased at high altitudes. In most cases, snow blindness is due to negligence or failure on the part of the soldier to use his sunglasses. Waiting for discomfort to develop before putting on glasses is folly. A deep burn of the eyes may already have occurred by the time any pain is felt. Putting on the glasses then is essential to prevent further injury but the damage has already been done. Symptoms of snow blindness area sensation of grit in the eyes with pain in and over the eyes made worse by eyeball movement, watering, redness, headache, and increased pain on exposure to light. First aid measures consist of blindfolding, which stops the painful eye movement, or covering the eyes with a damp cloth, which accomplishes the same thing. Rest is desirable. If further exposure to light is unavoidable the eyes should be protected with dark bandages or the darkest available glasses. The condition heals in a few days without permanent damage once unprotected exposure to sunlight is stopped.

3-40. Constipation
a. When operating under cold weather conditions there is a general tendency for individuals to allow themselves to become constipated. This condition is brought about by the desire to avoid the inconvenience and discomfort of relieving themselves under adverse conditions. This condition is also caused by changes in eating habits and failure to drink a sufficient amount of liquids.
b. Constipation can usually be prevented by adjusting the normal eating and drinking habits to fit the activities in which engaged, and by not “putting off” the normal, natural, processes of relieving the body of waste matter. Medical personnel should be consulted if constipation persists. Each individual must be educated concerning the consequences of neglecting personal hygiene habits.

3-41. Carbon Monoxide Poisoning
a. Whenever a stove, fire, gasoline heater, or internal combustion engine is used indoors there is danger of carbon monoxide poisoning. A steady supply of fresh air in living and working quarters is vital. Carbon monoxide is a deadly gas, even in low concentration, and is particularly dangerous because it is odorless.
b. Units should appoint a qualified carbon monoxide safety officer. AR 386-55 and TB Med 269 should be used as references by these safety officers.
c. Generally there are no symptoms. With mild poisoning, however, these signs may be present-headache, dizziness, yawning, weariness, nausea, and ringing in the ears. Later on, the heart begins to flutter or throb. But the gas may hit without any warning whatsoever. A soldier may not know anything is wrong until his knees buckle. When this happens, he may not be able to walk or crawl. Unconsciousness follows; then death. Men may be fatally poisoned
as they sleep.
d. In a case of carbon monoxide poisoning, the victim must be moved into the fresh air at once, but must be kept warm. In the winter, fresh air means merely circulating air that is free from gases. Exposure to outdoor cold might cause collapse. If the only fresh air is outdoors, the patient should be put into a sleeping bag for warmth. A carbon monoxide victim should never be exercised, because this will further increase his requirements for oxygen.
If a gassed person stops breathing or breathes only in gasps, mouth-to-mouth resuscitation should be started immediately. In the latter case, the operator’s movements must be carefully synchronized with the victim’s gasps. Breathing pure oxygen removes carbon monoxide from the blood faster than does breathing air and greatly hastens recovery. Carbon monoxide is serious and a victim who survives it must be kept absolutely quiet and warm for at least a day. Hot water bottles and hot pads are helpful in maintaining body temperatures.

3-42. Care of Casualties
If any member of a group is injured, the most important course of action is to get him to competent medical aid as soon as possible. The casualty should be given first aid treatment, protected from the cold and shock effects, and evacuated to an aid station with a minimum of delay. He should be placed in a
casualty bag, sleeping bag, or the best available substitute. He should have warm drinking water or other hot drinks, except in the case of abdominal injury.
Warning: Once a tourniquet has been applied, the wounded man should be examined by a medical officer as soon as possible. If possible, the tourniquet should not be loosened by anyone except a medical officer who is prepared to stop the hemorrhage or bleeding by other means and to administer other treatment as necessary. Repeated loosening of the tourniquet by inexperienced personnel is extremely dangerous, can result in considerable loss of blood, and endanger the life of the patient. Halting of circulation to the extremities is an invitation to frostbite. If morphine is to be administered, caution must be exercised to avoid overdosage.

3-43. Emergency Evacuation
Personnel who have been wounded should be evacuated to the nearest medical facility by the fastest means of transport available. Sleds can be used if oversnow vehicles or air evacuation facilities cannot be obtained. It may be necessary to use man-hauled sleds to move the wounded a safe distance behind the frontlines before they can be transferred to faster means of transport (fig. 3-19). Speed in evacuation is essential because of the combined effects of severe cold and shock on the wounded.
Figure 3-19

3-44. Body Parasites
a. General. Body parasites are very common in the more populated cold regions because of the crowded living conditions and shortage of bathing and cleaning facilities. When in the midst of a native population, or when occupying shelters which have been used before, individuals must inspect clothing and body each night for parasites.
b. Means of Control. If clothing has become infested with lice, the following methods of removing them are recommended:
(1) While extreme cold does not kill lice, it paralyzes them. The garments should be hung in the cold; then beaten and brushed. This will help rid the garments of lice, but not of louse eggs.
(2) An appropriate insecticide powder can be used to free the body and clothing of body parasites.

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