TSC Study Material PDF

1 Thal Sainik Camp Study Material  Health and Hygiene - Page No 2  Judging Distance and Field Signals - Page No 77  Map Reading - Page No 90  Obstacles - Page No 120 GCI Ann Philo Thomas...

1 Thal Sainik Camp Study Material  Health and Hygiene - Page No 2  Judging Distance and Field Signals - Page No 77  Map Reading - Page No 90  Obstacles - Page No 120 GCI Ann Philo Thomas GCI – ANN PHILO THOMAS  2 HEALTH & HYGIENE GCI – ANN PHILO THOMAS  3 CHAPTER - I STRUCTURE AND FUNCTIONING OF THE HUMAN BODY Introduction The human body is the greatest of all complex machineries. In order to carryout first aid, a first aider should have basic idea of structure and function of every part of the human body. Many lives can be saved if proper and timely first aid can be rendered. Skeletal and Muscular System Skeletal System The human skeleton is the internal framework of the body. The bones give shape and firmness to the body, as also it protects the vital organs like brain, heart, lungs and spinal cord. It is composed of around 300 bones at birth – this total decreases to around 206 bones by adulthood after some bones have fused together. The bone mass in the skeleton reaches maximum density around age 20. The human skeleton can be divided into the axial skeleton and the appendicular skeleton. The axial skeleton is formed by the vertebral column, the rib cage, the skull and other associated bones. The appendicular skeleton, which is attached to the axial skeleton, is formed by the shoulder girdle, the pelvic girdle and the bones of the upper and lower limbs. The human skeleton performs six major functions; support, movement, protection, production of blood cells, storage of minerals, and endocrine regulation. GCI – ANN PHILO THOMAS  4 Classification of Bones. Bones can be classified according to their shape as under:- (a)Long Bones. These bones are long and tubular and are confirmed to upper and lower limbs. (b)Short Bones. This bones are short and tubular and are found in the ankle/wrists (c)Flat Bones. These bones are flat like plates eg. Bones of cranium skull shoulder or hips. (d)Irregular Bones. Irregular or mixed shape eg. Vertebral column. (e)Sesamoid Bones. They develop in the tendons of the muscles around the joints e.g. Patella Long, Flat, Short and Irregular Bones Muscular System. The muscular system is an organ system consisting of skeletal, smooth and cardiac muscles. It permits movement of the body, maintains posture, and circulates blood throughout the body. The muscular system in vertebrates is controlled through the nervous system, although some muscles (such as the cardiac muscle) can be completely autonomous. Together with the skeletal system it forms the musculoskeletal system, which is responsible for movement of the human body. The muscles form about half of the total weight of the body and are responsible for body movement. The muscles form the flesh of the body. GCI – ANN PHILO THOMAS  5 Classification. The muscles of the body are classified into the following types:- (a) Voluntary/Skeletal Muscles. These muscles are attached to the surface of bones. These muscles form about 47% of the body weight. Most of the skeletal muscles pan from one bone to another across a joint and by contracting; they act upon the joints and produce movements. (b)Involuntary Muscles. These muscles are controlled by the autonomic nervous system. (c) Cardiac Muscles. These muscles are striated structurally, unstrained functionally. They form the part of heart wall. Organ Systems Circulatory System. The circulatory system consists of the Heart, Blood vessels and blood. Each time the heart contracts; blood is pumped along the blood vessels. By blood circulation, oxygen, nutrients and other substances are brought to the tissues and the waste products and carbon dioxide formed by the tissues are constantly removed. (a) Heart. The Heart is the four chambered pumping organ. It is situated in thorax between the lungs and on to the left side of the body. The size of heart is to a closed fist and the average weight of heart in a male is about 300 grams, and in a female about 250 grams. (b) Blood. The blood is also known as the transport system of the body. It consists of plasma and formed of cells such as RBC, WBC and platelets. (c) Blood Vessels. Blood vessels are tube like structures which carry blood all over the body for circulation. These are of three types: (i) Arteries. These are the blood vessels which carry blood from the heart to other parts of the body. (ii) Capillaries. These are tiny blood vessels which connect the small arteries & veins. The exchange of oxygen and nutrition with carbon dioxide by the tissue takes place in the capillaries. GCI – ANN PHILO THOMAS  6 (iii) Veins. These blood vessels carry blood to the heart. The main veins are called superior and inferior vena cava. Respiratory System. Respiration is a process by which oxygen is taken in and carbon dioxide is given out. The human respiratory system consists of a pair of lungs and a series of air passages leading to the lungs. The entire respiratory tract (passage) consists of the nose, pharynx, larynx, trachea, bronchi, and bronchioles. Air enters the nose through the nostrils. When air passes through the nose, it is warmed, moistened and filtered. The hairs present in the nose filter out particles in the incoming air. The air is moistened by the mucus present in the nose, and it is warmed by the blood flowing through the capillaries in the nose. Digestive System. Digestion is a mechanical and chemical process by which, complex food substances are converted into simple substances so that they can be easily absorbed by blood and utilized by the various tissues of the body according to their requirements. The main organs of digestive system are mouth, salivary glands, pharynx, esophagus, stomach, pancreas, liver, small intestine and the large intestine. GCI – ANN PHILO THOMAS  7 Excretory System. Excretion is a process by which waste products are removed out of the body. The excretory system is a passive biological system that removes excess, unnecessary materials from the body fluids of an organism, so as to help maintain internal chemical homeostasis and prevent damage to the body. The dual function of excretory systems is the elimination of the waste products of metabolism and to drain the body of used up and broken down components in a liquid and gaseous state. In humans and other amniotes (mammals, birds and reptiles) most of these substances leave the body as urine and to some degree exhalation, mammals also expel them through sweating. Among the organs that contribute towards the elimination of waste products are the skin, lungs, kidneys and the gastro-intestinal tract. Nervous System. Internal balance of the human body is maintained within normal limits by the nervous system and the endocrine system. The neurons are the basic units of nervous system. The nervous system may be divided into three main parts:- (a)The Central Nervous System. This consists of brain and spinal cord. GCI – ANN PHILO THOMAS  8 (b)The Peripheral Nervous System. This forms the connections between the central nervous system and the various organs and muscles. (c)The Autonomic Nervous System. It is an offshoot of the central nervous system and controls the involuntary functions of the various internal organs. Conclusion The human body is made of important organ systems which includes the circulatory, respiratory, digestive, excretory and nervous systems. They also include the immune, skeletal and muscular systems. These systems work together to maintain a functioning human body. Therefore, basic knowledge of our body systems allows us to understand the field of health and hygiene with ease. This knowledge provides us the basic framework on which subsequent knowledge and skills dealing with medical science can be gained in a progressive manner. GCI – ANN PHILO THOMAS  9 CHAPTER - II HYGIENE AND SANITATION (PERSONAL AND FOOD HYGIENE) Introduction Maintaining hygiene and sanitation is necessary for many reasons; personal, social, health, psychological or simply as a way of life. Keeping a good standard of hygiene helps to prevent the development and spread of infections, illnesses and bad odours. Personal and Food Hygiene are necessary to preserve and improve the health of the individual and of the community as a whole. Its study is aimed at making the cadets aware of the many preventable health hazards and to enable them to look after themselves and their community most efficiently. It seeks to develop in them the concepts of healthy living. Personal hygiene involves all aspects of the health of an individual. Responsibility for the maintenance of personal health therefore lies with the individual. Every person must remain in perfect physical, mental and social health, only then can he serve the community and the country well. Hygiene 6. Personal hygiene involves those practices performed by an individual to care for one's bodily health and well-being, through cleanliness. Maintenance of personal hygiene is very important in preventing disease. It deals with the practices that help in the maintenance and promotion of a person’s health. Personal hygiene habits such as washing hands and brushing teeth will keep bacteria, viruses and illness at bay. There are mental and physical benefits. Practicing good body hygiene helps you feel good about yourself. Main components of personal hygiene are:- (a) Sleep is the periodical rest of both body and mind and it is extremely essential for a healthy body. The duration of sleep one requires varies with individual age. The average requirement of sleep is about 7 to 8 hours a day. (b) Bathing, keeping the skin clean and in healthy condition is essential for good health. Wash your body regularly. Your body is constantly shedding skin. That skin needs to come off. Otherwise, It will take up and cause illnesses. (c)Brush your teeth twice a day. Brushing minimizes the accumulation of bacteria in mouth which can cause tooth decay and gum diseases. GCI – ANN PHILO THOMAS  10 (d)Keeping finger and toe nails trimmed and in good shape will prevent problems such as hang nails and infected nail beds. Feet that are clean and dry are less likely to contact Athlete’s foot. GCI – ANN PHILO THOMAS  11 Food hygiene is the condition and measures necessary to ensure the safety of food from production to consumption. Food can become contaminated at any point during slaughtering or harvesting, processing, storage, distribution, transportation and preparation. Lack of adequate food hygiene can lead to food borne diseases and death of consumer. The five keys to safer food are listed below:- (a) Keep clean. (b) Separate raw and cooked items. (c) Cook thoroughly. (d) Keep food at safe temperatures. (e) Use safe water and raw materials. Important Components of Food Hygiene Food is a potential source of infection and is liable to contamination by micro organisms at any point during its journey from the producer to the consumer. Prevention of contamination of food has to be observed from production to handling, distribution and serving. The following are the important components of food hygiene. (a) Milk Hygiene. Milk is an efficient vehicle for many disease organisms Contamination of milk may be through infected animal, human handler or environmental factors. Following aspects should be ensured to obtain clean and safe milk:- (i) The animal and its surroundings should be healthy and clean. The animal should be properly washed before milking. (ii) Milk handler should be free from any communicable disease. GCI – ANN PHILO THOMAS  12 (iii) Milk vessels should be cleaned, sanitized and kept covered. (iv) Water supply must be safe. (v) Pasteurization. It is the heating of milk to such temperature and for such periods of time, as are required to destroy any pathogens without destruction of nutritive value. It does not alter taste. (Temperature 130 C and time 1 to 2 seconds.) Hands, contact surfaces and milking equipment must be kept clean at all times. (b) Meat Hygiene. (c) Fish Hygiene. Fish for human consumption should be fresh. In fresh fish, the gills are bright red and the eyes are clear and prominent. Consumption of contaminated fish may give rise to fish poisoning. (d) Egg Hygiene. Though the majority of freshly laid eggs are sterile inside, the egg shell may become contaminated by fecal matter from the hen. The egg must be properly washed before cooking. (e) Fruits and Vegetables Hygiene. Fruits and vegetables are an important source for the spread of pathogenic organisms, protozoan GCI – ANN PHILO THOMAS  13 and helminthes. Fruits and vegetables consumed raw must be washed well before eating. Fruits and Vegetables should be washed before eating (f) Hygiene of Eating Places. (i) Eating places should not be located near filthy places, open drains, animal, sheds, manure/soakage pits and other such places. (ii) Floors should be easy to clean, and should be preferably tiled. (iii) Room for storage of food should be well ventilated, insect and rat proof and should have adequate lighting. (iv) Perishable and non-perishable items should be kept separately. (v) Furniture should be strong and easy to clean. (vi) Refuse should be collected in covered bins and removed regularly. (vii) Water supply should be independent, adequate and safe. (viii) Proper place for cleaning of utensils should be provided. (g) Hygiene of Food Handlers. (i) Complete medical examination of food handlers must be done at the time of employment. (ii) Regular health checkups should be done. (iii) Food handlers should be regularly educated on health and hygiene aspects. (iv) They should be constantly reminded about hand washing, trimming of nails, covering of hair, wearing of overalls and covering mouth while coughing and sneezing during cooking. GCI – ANN PHILO THOMAS  14 Cleanliness and Hygiene in Restaurants Sanitation Definition. Sanitation means keeping the living area and its surroundings neat and clean. This involves removal of waste products and refuse. Waste Products / Refuse Types. Some types of the waste products are:- (a) Human excreta - faeces & urine. (b) Stable litter - horses & cow dung. (c) Dry refuse & garbage - household, municipality, industrial & agricultural. (d) Liquid wastes: household sullage, municipal & industrial effluent. (e) Offensive trade wastes. (f) Dead animals, carcasses & offal of slaughtered animals. Sources of Refuse. (a) Street Refuse. Refuse that is collected by street cleansing service or scavenging is called street refuse e.g. leaves straw paper etc. GCI – ANN PHILO THOMAS  15 (b)Market Refuse. Refuse that is collected from markets is called market refuse. e.g. spoiled vegetable and animals matter. (c) Stable Litter. It contains mainly animal dropping and left over animal feeds. (d) Industrial Refuse. Industrial refuse comprises of a wide variety of waste ranging from toxic and chemical wastes like chemical solvents, paints, sand papers, industrial bye-products, metals and radioactive wastes. (e) Domestic Refuse. The domestic refuse consist of ash, rubbish and garbage. Disposal of Waste Products / Refuse. Collection and Removal of Refuse. (a) House Hold Refuse. Covered galvanized irons bins are placed on brick / cement platforms at convenient distances from the house. These should be used for dumping house hold refuse. This refuse is then collected in covered wheel barrows or municipal vans to prevent blowing out by air. (b) Special Refuse. This is from stables and cowsheds. It is collected in carts and taken to disposal grand at frequent intervals. (c) Street Refuse. Covered dustbins should be placed at suitable intervals along the street and all the sweeping should be dumped in it. It is then collected early morning in covered vans. Disposal of Refuse. Various methods for disposal of refuse are:- (a) Filling. In this method the refuse is generally utilized in filling up pits, unsanitary tanks or in reclaiming low land. The area selected should be at least 100-150 feet away from any habitation. No refuse should be left uncovered for more than 72 hrs. (b) Controlled Tipping. Controlled tipping or sanitary landfill is the most satisfactory method of refuse disposal where suitable land is available. Chemical, bacteriological and physical charges occur in buried refuse. (c) Incineration. Hospital refuse, which is particularly dangerous, is best disposed off by incineration. (d) Composting. It is a method of combined disposal of refuse and night soil or sludge. (e) Manure Pits. The garbage, cattle dung, straw and leaves should be dumped into the manure pits and covered with earth, after each days dumping. (f) Burial. This method is suitable for small camps. A trench 1-5m wide and 2m deep is excavated. When the level in the trench is 40 cm from ground level, the trench is filled with earth and comported. (g) Sorting. This method consists of storing refuses in three separate parts for easy disposal:- GCI – ANN PHILO THOMAS  16 (i) Breeze. Cinders and pieces of coal are used for making bricks. (ii) Soft Core. Animal and vegetable organic matter, which is used as manure. (iii) Hard Core. Broken bottles and crockery is used for metaling of roads. Disposal of Human Waste. Proper disposal of human night soil / excreta are very essential for prevention of various communicable diseases and also to prevent pollution / contamination of soil, water or food (through flies). Various methods are available for disposal of human waste / excreta as per the type of area ie, area with a proper sewage system (sewered areas) and areas without proper sewage system (unsewered areas). (a) Sewered Areas. The latrines used in such areas are mainly the Flush Latrines. It implies that ample supply of water is available to flush the night soil away. It is simple and hygienic. (b) Unsewered Areas. There are of various types latrines for such areas:- (i) Domestic Latrines. These are those latrines which are used in houses in areas not having a sewage system. These are of following types:- (aa) Bore Hole Latrine. The latrine consists of a circular hole 30-40 cm in diameter dug vertically in the ground to a depth of 4 to 8 mtr. In loose sandy soil the hole is lined with bamboo matting or earthenware lining. (ab) Dug Well Latrine. A circular pit about 75 cm in diameter and 3 to 3.5 m deep is dug into the ground for the reception of the night soil. In sandy soil the depth of the pit may be reduced to 1.5 to 2 mtr. (ac) Water Seal Latrine. The water seal performs two important functions e.g. it prevents access to flies and it prevents escape of foul odour. Out of many designs of water seal latrines, the RCA type is widely adopted. (ii) Camp Latrines. These are of following types:- (aa) Deep Trench Latrines. A pit three feet wide, at least eight feet deep and of a length suitable to the requirement is constructed and wooden seats placed over it with proper partitions and curtains. Soil may necessitate reverting of sides with sand bags, bamboos or wire netting. On vacation of camp, these are filled up with soil to assist in disintegration and prevent breeding of flies. GCI – ANN PHILO THOMAS  17 (ab) Shallow Trench Latrines. For camps of less than a week’s duration, dig a row of trenches in parallel, each trench being 3 feet long, 1 foot wide and 2 feet deep. Each trench should be 2 feet apart. The ratio is 5 trenches for the first hundred users and three for each subsequent hundred. After defecation, the excreta is covered with loose earth with a shovel or a scoop. These trenches are filled up after 24 hours and new trenches are dug up. (ac) Urinals. The most common urinal used for camps is the Funnel Urinals which are constructed over a simple soakage pit. (c) Soakage Pits. These are essential for the disposal of liquid refuse like greasy water from kitchen and waste water from bathrooms. Dig a pit 4 feet by 4 feet and 5 feet to 6 feet deep. Fill with small stones and broken bricks. Cover the top with oiled sacking and put earth or sand 6 inches above. In the centre keep a perforated empty tin of kerosene oil. Fill this tin with layers of gravel or sand and gravel. In this fit remove the strainer daily and replace with fresh one. (d) Disposal of Garbage. Disposal of solid refuse like kitchen garbage, bones etc, be done by burial or burning. The household refuse should be deposited in a covered bin placed outside. Improvised kerosene/oil tins are not advisable. Further disposal should be done under municipal arrangements. Disposal of Sewage. Proper disposal and treatment of sewage has assumed great importance today. The disposal of sewage involves treatment and disposal as under :- (a) Treatment of Sewage. Treatment of sewage is brought about by the action of anaerobic and aerobic bacteria. The different steps involved in this process are:- (i) Screening. (ii) Chambering. (iii) Primary Sedimentation. (iv) Trickling Filter. (v) Activated Sludge Process. (vi) Sludge Digestion. (vii) Disposal of Effluent. GCI – ANN PHILO THOMAS  18 (b) Disposal of Sewage. The sewage is collected by the water carriage system and where no treatment facility is available can be disposed of by:- (i) Sea out fall. The sewage is drained into the sea. This is applicable mostly for coastal cities / towns. (ii) River out fall. The sewage is drained into the river. This is applicable mostly for cities / towns situated along the rivers or connected by drains. (iii) Land Treatment. Here the sewage is allowed to drain out on the earmarked land / pits. This is mostly applicable to small villages. (iv) Oxidation Pond. Conclusion Adequate sanitation, together with good hygiene and safe water, are fundamental to good health and to social and economic development. Many sanitation programs are planned and executed by government bodies, and few are successful due to the failure to convince and educate the people of the importance of sanitation and the need for an active cooperation. Education factors play a very important role because it is only through the basic understanding of the need for sanitation can the people be mobilized for its implementation. It is only when they understand the consequences of the unsanitary conditions they have that they will be willing to change their habits. GCI – ANN PHILO THOMAS  19 CHAPTER - III PHYSICAL AND MENTAL HEALTH Introduction Health is the level of functional and metabolic efficiency. In humans it is the ability of individuals or communities to adapt and self-manage when facing physical, mental, psychological and social changes. The World Health Organization (WHO) defined health in its broader sense in its 1948 constitution as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. Physical Health Physical health is the absence of disease and infirmity and it is assessed by taking health state measurements of the body. Poor physical health can lead to an increased risk of developing mental health problems. Similarly, poor mental health can have negative impact on physical health, leading to an increased risk. Traditional definitions of physical health prior to the onset of modern medicine would have considered someone physically healthy if he or she was not stricken with a serious illness. With modern medical innovations came longer life spans, which changed the way we define physical health. Today's definition can consider everything ranging from the absence of disease to fitness level. Physical health is critical for overall well-being and is the most visible of the various dimensions of health, which also include social, intellectual, emotional, spiritual and environmental health. Some of the most obvious and serious signs that we are unhealthy appear physically. Addressing this dimension is crucial for anyone attempting to sustain overall health and wellness. GCI – ANN PHILO THOMAS  20 Elements of Good Health. Good health is an essential condition for a purposeful existence. The main elements of good health are:- (a) Absence of disease. (b) Ability to work hard with efficiency and enthusiasm. (c) Ability to endure stress and strain. (d) Cheerfulness. (e) Courage. (f) Freedom from anxiety. (g) Self control and self-confidence. (h) Sense of well being. (j) Wholesome mental attitude. Components of Health. (a) Physical Activity. Most healthy children and adults should be active on a daily basis. This should be a mix of both leisurely physical activity and structured exercise. Examples of leisurely physical activity include hiking, biking, and walking. Examples of more structured forms of exercise include strength training, running, and sports. (b) Nutrition and Diet. A well-balanced diet should contain carbohydrates, proteins, fats, vitamins, and minerals. Restricting specific nutrients should only be done under the supervision of a licensed health professional. Fluid, ideally in the form of clean water, should be regularly consumed. Meals and snacks should be consumed throughout the day, and portion sizes should be sensible. (c) Alcohol and Drugs. Substances that alter mood or other bodily processes should be limited or avoided. Those with addictive tendencies or other health risks should consider complete abstinence from these substances. GCI – ANN PHILO THOMAS  21 (d) Medical Self-Care. Basic items, such as bandages, lozenges, and over-the-counter pain-relieving medications, should be easily accessible from home. Long-term coughing, fevers, or other ailments should be addressed through primary care. Emergency treatment should be sought when signs and symptoms are significant or life-threatening. (e) Rest and Sleep. While regular activity is essential for physical health, allowing the body to rest is just as important. Spending time relaxing or taking short naps can help rejuvenate the body. Sleep should take place in a quiet, dark environment and should last approximately 7- 9 hours. Consistent sleep that is much shorter or longer than this duration, or is low quality, may need to be addressed by a health professional. Mental Health Importance of Mental Health. Mental health refers to the successful performance of mental functions, resulting in productive activities, fulfilling relationship with other people, ability to adopt to change and cope up with adversities. Parents and teachers play a major role in providing an environment in which children develop healthy mental attitude. Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act. It also helps determine how we handle stress, relate to others, and make choices. Mental health is important at every stage of life, from childhood and adolescence through adulthood. Characteristics of a Healthy Mind. These are normal appetite, cheerful outlook, socially acceptable habits and positive outlook and attitude. Mental Disorders. Following are some of the indicators of mental disorders:- (a) Embarrassment in presence of others. (b) Lack of courage. (c) Low intelligence. (d) Depressed and pessimistic outlook. (e) Undue anxiety and Moodiness. (f) Bad Temper. Measures To Improve Mental Health. Following measures will help in improving mental health:- (a) Favorable and stress free home and school environment. (b) Regular medical examination. (c) Provision of educational and vocational guidance/ counseling. (d) Provision of co-curricular activities. GCI – ANN PHILO THOMAS  22 Life style Factors. The life style factors can influence the state of both your physical and mental health. Physical activity in any form is a great way to keep you physically healthy as well as improving your mental wellbeing. Even a short burst of 10 minutes brisk walking increases our mental alertness, energy and positive mood. Physical and Mental Health Results in Happy Human Beings Conclusion Health is very important aspect for all living beings. Humans have a tendency to get into bad life styles due to facilities available to them which results in their poor health. The subject of health must be understood by all of us to remain in good health. GCI – ANN PHILO THOMAS  23 CHAPTER - IV INFECTIOUS AND CONTAGIOUS DISEASES AND THEIR PREVENTION Introduction A disease is a particular abnormal condition, a disorder of a structure or function that affects part or entire body. The study of disease is called pathology which includes the study of cause. Disease is often construed as a medical condition associated with specific symptoms and signs. It may be caused by external factors such as pathogens, In humans, disease is often used more broadly to refer to any condition that causes pain, dysfunction, distress, social problems, or death to the person afflicted, or similar problems for those in contact with the person. In this broader sense, it sometimes includes injuries, disabilities, disorders, syndromes, infections, isolated symptoms, deviant behaviors, and a typical variations of structure and function, while in other contexts and for other purposes these may be considered distinguishable categories. Diseases can affect people not only physically, but also emotionally, as contracting and living with a disease can alter the affected person's perspective on life. Classification of Contagious Diseases Contagious diseases (communicable diseases) can be classified as follows:- (a) Excremental Diseases. These are those diseases which are communicated through human excreta (urine and faeces). The excreta can contaminate food, water or hands of cooks and thus pass on the infection. Typhus fever, dysentery, diarrhea, jaundice and intestinal worms are some of the important diseases belonging to this group. GCI – ANN PHILO THOMAS  24 (b) Droplet Infection. These are those diseases which are communicated or transferred through germs which are sprayed out from the nose, throat or lungs in the air, in small droplets of saliva during coughing, sneezing or even while talking. Common cold, influenza, diphtheria, meningitis, (inflammation of the brain) and tuberculosis are the common diseases in this group. (c) Contact Diseases. These are those diseases which are communicated or transferred when the germs pass from a sick person to a healthy person by actual body contact. Venereal diseases i.e. syphilis, gonorrhea and skin infection are some common examples. (d) Insect Borne Diseases. These are those diseases which are communicated or transferred when the germs move from a sick person to a healthy person through blood sucking insects known as ‘carriers’. These insects first bite a sick person and then bite a healthy person, transferring the germs of the diseases in the blood of the healthy person. These germs then multiply in the blood of the healthy person during the period of incubation, and at the end of which he starts showing symptoms of the disease carried by the insect. Some of the carrier insects and their disease are:- (i) Mosquito - Malaria, Dengue and Filariasis. (ii) Sand fly - Sand fly fever, Kala Azar, Oriental Sore. (iii) Lice - Typhus, Relapsing Fever. (iv) Flies - Diarrhea, Dysentery, Cholera, Typhoid. (v) Fleas - Plague, Typhus. (vi) Ticks - Relapsing Fever, Typhus. GCI – ANN PHILO THOMAS  25 (e) Water Borne Diseases. Certain diseases spread due to infection carried through water. These are cholera, dysentery, diarrhea, jaundice etc. These spread as water gets contaminated through vomits or faces passing into it. Epidemics are likely to spread if immediate steps are not taken to disinfect water and to properly dispose off the excreta through efficient conservancy arrangements. All sources of the diseases ought to be eliminated. (f) Animal Borne Diseases. The germs are transmitted through the agency of animals by drinking milk or through the agency of insects. Rabies, plague, anthrax and tuberculosis are some of the common diseases. Preventive Measures Specific measures to prevent diseases are as under:- (a) Prevention of Excremental & Water Borne Disease. (i) Control of water route is easy by disinfecting water or providing safe water in place. (ii) Control of the milk route is easy by subjecting the milk to boiling or pasteurization. (iii) Food born infection may be controlled by standards of food hygiene, exclusion of sick persons from food handlings. (iv) Safe disposal of excreta will block the transmission of disease by the faecal matter. (b) Prevention of Droplet Infection. This can be achieved by use of mask, proper spacing of bed, screening, dust control, avoiding of over- crowding, proper ventilation, avoiding of spiting in public places, proper sunlight and proper disinfection of air. (c) Prevention of Contact Disease. This can be achieved by:- (i) Complete segregation of patient. (ii) No direct personal contact between patient and the relatives/staff. (iii) Early diagnosis will help in preventing the spread in the patient. (iv) Proper disposal of all the excreta and disinfection of all articles of the patient. GCI – ANN PHILO THOMAS  26 (d) Prevention of Insect Borne Disease. Filling, leveling and drainage of breeding places and water management will help in eliminating larvae. Adequate collection, removal and disposal of sewage and waste water are important in preventing culex. (i) Use kerosene oil, fuel oil, or special oil to prevent larvae. (ii) Use of residual sprays like Malathion. (iii) Use of mosquito nets, screening of doors and windows, mosquito repellant and sun down sleeves down. (iv) Control the presence of rodents and fleas in and around the home. (v) Avoid contact with any species of wild rodents, especially sick or dead rodents. (vi) Not to handle sick or dead animals or animal waste. The following preventive measures are necessary to ward off these diseases:- (a) Segregation of the Patient. Important points are as under:- (i) Preferably shift patient to an isolated room. (ii) Ensure room confirms to hygiene and sanitation standards i.e, adequate ventilation, sunlight and cleanliness. (iii) Nominate one healthy person to undertake nursing and care of the patient. (iv) Nominated person to take preventive measures like use of mask, gown, and gloves and avoid direct contact and hand washing before and after every visit. (iv) Clothing and utensils used by patient to be cleaned / washed separately. (vi) Safe disposal of patients excreta – Urine, Stool, Sputum, Refuse e.g., discarded dressings, garbage etc. by burning. (b) Destroy Agents (Germs) Causing Infection in the Surrounding Area or Premises. Immediately on detection of a communicable disease, the source of agents /germs causing infection should be destroyed by following actions :- (i) Removal / destruction of garbage. (ii) Cleaning the drains & keeping them covered. (iii) Remove/ dry out waste water. (iv) Spray Malathion mixed in water (ratio: Malathion - 1 ml, water 1000 ml) in and around the premises. (Caution - Malathion GCI – ANN PHILO THOMAS  27 is highly poisonous. Direct breathing / touching should be avoided). Wash hands after use. (v) Keep premises free of rodents (rats), stray dogs. (vi) Use mosquito nets, long sleeves, screening of doors and windows. (c) Disinfection. All articles in contact with the patient should be disinfected by following means:- (i) Natural. Sunlight and air can be used to disinfect articles like blanket, mattresses, pillows and also the rooms. The microorganisms thrive in darkness and need moisture for their survival, on being exposed to sunlight and air they die. (ii) Physical. Physical agents like heat, cold radiation etc. can also be used for disinfection and sterilization. (aa) Heat. Heat can be used in two ways for sterilizing. Moist Heat in the form of ‘boiling’ kills germs very rapidly. In addition, ‘autoclaving or Steam under Pressure’ is the most effective method used to disinfect all hospital equipment which can be boiled like linen, bandage, dressing material, gloves and instruments. Dry heat like flaming or use of hot air oven. Sterilization by steam under pressure (autoclaving) is the commonest method for sterilization which is being used in the Army. (ab) Cold. Freezing or freeze-drying can inactivate bacteria. Some of them can however survive even at 0° C. (ac) Radiation. It includes ionizing radiations like X rays, gamma beta and ultraviolet radiation. These are expensive methods and are not suitable for small-scale procedures. (ad) Other Methods. Disinfection and sterilization can also be done by using other methods like of infrared rays, filtration etc. (iii) Chemical Agents. Chemical agents like phenol, savlon, potassium permanganate, hydrogen peroxide etc are commonly used for disinfection and sterilization. The strength of agent depends up used concentration being used. (iv) Control of Food & Drink. Salient points to be observed while feeding the patient:- (aa) Clean water preferably boiled must be served to the patient. Water container must be kept covered. GCI – ANN PHILO THOMAS  28 (ab) Balanced diet, well cooked, hygienically prepared food using less oil and condiments, should be served hot. Stale, cold and food exposed to flies & insects should not be served. (ac) Food items sourced from restaurants /dhabas must not be served. (iv) Inoculation and Vaccinations. Inoculations and vaccinations are provided free of cost under various government programmes. These are administered at Primary Health Centers/Hospitals. If not available the same should be administered/ taken from market. Important inoculations and vaccination are as under:- Disease Name of Vaccine Prevented Injection Rabipur Rabies Injection TAB Typhoid Injection Hepatitis ‘B’ Hepatitis ‘B’ Injection T T Tetanus Oral Polio Polio Conclusion The identification and confirmation of infectious causes of chronic diseases is complicated by several problems, including frequent multifactor causation for many of these diseases and differences in the environmental background and genetic composition of different populations. Recently developed molecular and immunological techniques offer new approaches to address the technical barriers. Although the task is daunting, taking the practical and pragmatic pathways described above could clarify many of the uncertain relationships between infectious agents and chronic diseases. It is advisable to always follow the prevention measures to save precious human and animal lives, national resources and effort. GCI – ANN PHILO THOMAS  29 CHAPTER - V FIRST AID IN COMMON MEDICAL EMERGENCIES Introduction First aid is the assistance given to any person suffering a sudden illness or injury, with care provided to preserve life, prevent the condition from worsening, and/or promote recovery. At its most basic, first aid is the initial assistance given to a victim of injury or illness. Comprised of relatively simple techniques that can be performed with rudimentary equipment, first aid is usually carried out by a layperson until professional medical assistance arrives. There will be number of occasions on which we may be faced with a situation where, we may be required to provide First Aid to the injured, because of an accident or due to any calamity. Therefore it is very important for all cadets to have knowledge of providing basic First Aid in common medical emergencies. Part-I : Injuries To Internal Organs Internal injuries cannot be seen but can only be suspected, where bleeding instead of coming to the surface occurs into the cavity of chest or abdomen wherein important organs like heart, lungs, liver or spleen might get ruptured. The following symptoms are observed in case of internal injuries:- (a) Cold clammy skin. (b) Weak or rapid pulse. (c) Shallow sighing and breathing. (d) Face pinched and pale. (e) Eyes deeply sunken with dark rings around them. (f) Patient usually restless and anxious and may lose consciousness. GCI – ANN PHILO THOMAS  30 Injuries to the chest and abdomen can be difficult to recognize and treat, and many injuries can go unnoticed until they become very serious. The muscle and bones that serve to protect vital organs can also mask their injuries - or at worst contribute to them. It is important for the rescuer to consider injuries that lie beneath the skin. In addition, the different organs react in different ways when subjected to trauma. Hollow organs (such as the bladder) tend to rupture, releasing their contents into the surrounding space. Solid organs (such as the liver) tend to tear instead, often bleeding at a slow enough rate to be overlooked. Closed Chest Injuries. Closed Chest injuries can be inherently serious, as this area of the body houses many critical organs, such as the heart, lungs, and many blood vessels. Most chest trauma injuries should receive professional medical attention. Always call for an ambulance for any potentially serious chest injury. Rib Injuries. A common result of trauma to the chest is damage to the victim's rib cage. The curved shape of the rib cage helps to deflect the force of some injuries, but damage to cartilage or the ribs themselves can still result. While a single broken rib can be very painful for the patient, a number of broken ribs can lead to other complications. A victim with broken ribs may take very shallow breaths without even noticing it, as their body tries to prevent the pain with taking a full breath. 10. When many adjoining ribs are broken in different places, a portion of the rib cage can move in the opposite direction the chest should. This is known as a "flail" segment, and can make breathing very painful and less effective GCI – ANN PHILO THOMAS  31 Recognition. (a) Trouble breathing (b) Shallow breathing (c) Tenderness at site of injury (d) Deformity & bruising of chest (e) Pain upon movement/deep breathing/coughing (f) Dusky or blue lips or nail beds (g) May cough up blood (h) Crackling feeling upon touching victim's skin Treatment (a) Call for an ambulance (b) Assist the victim into a position of comfort (typically seated upright, to avoid fighting gravity) (c) Conduct a secondary survey (d) Monitor patient's condition carefully (e) Be vigilant, keep alert for any changes. (f) If a flail segment is suspected, tightly secure a bulky dressing (such as a tightly folded hand towel) to help stabilize the injury. GCI – ANN PHILO THOMAS  32 Open Chest Wounds. An open pneumothorax or sucking chest wound - the chest wall has been penetrated (by knife, bullet, falling onto a sharp object...) Recognition. (a) An open chest wound – escaping air (b) Entrance and possible exit wound (exit wounds are more severe) (c) Trouble breathing (d) Sucking sound as air passes through opening in chest wall (e) Blood or blood-stained bubbles may be expelled with each exhalation (f) Coughing up blood Treatment. (a) Assess ABCs and intervene as necessary (b) Do not remove any embedded objects (c) Call for an ambulance (d) Lateral positioning: victim's injured side down (e) Treat for shock (f) Conduct a secondary survey (g) Monitor vitals carefully GCI – ANN PHILO THOMAS  33 Abdominal Injuries. (a) Protruding Organs. (i) If a trauma injury has caused the victim's internal organs to protrude outside the abdominal wall, do not push them back in. Doing so will only cause greater complications - remember that preventing further injury is one of the aims of first aid. (ii) Instead, have the person lie flat with their knees bent and cover the organs with a moist, sterile dressing composed of material that will not stick to the affected organs. Normally a special GCI – ANN PHILO THOMAS  34 dressing, ABD Pad (Army Battle Dressing) or trauma dressing is used, though large Telfa dressing will work well. (iii) Gauze can stick if it is dry - be careful to keep normal gauze moist if you do use it. Paper products like paper towel or toilet paper must never be used, as they will turn to pulp, causing major complications. (iv) Do not allow the victim to eat or drink, though they may complain of extreme hunger or thirst. (v) Call an ambulance, treat for shock, and monitor ABCs until the emergency medical team arrives. (b) Internal Bleeding. If the abdominal injury does not cause an open wound, have the person lie flat with their knees bent and treat for shock until EMS arrives. GCI – ANN PHILO THOMAS  35 Burns and Scalds Burns may be caused by heat either, dry by contact with fire or flame, or wet, as caused by moist heat such as hot water, hot fluids and steam, which is called scalding. Chemical burns may be caused by strong acids or alkalis. First aid Treatment. (a) If the burn is chemical, let water from a pipe or hose flow freely on the burn so that the chemical flows off. (b) Protect the burnt area by applying bandage or cover exposed part with clean towel or cloth. (c) Give complete rest and plenty of fluids to the patient. (d) Re-assure the patient. (e) Evacuate patient to the nearest hospital or dispensary. Snake, Scorpion And Dog Bite GCI – ANN PHILO THOMAS  36 Snake Bite In Snake bite, the poison is injected by the snake through a pair of hollow and deeply grooved biting fangs. The majority of bites occur on parts of limbs which are exposed like hands, feet and lower legs. First Aid Treatment. All cases of snake bite should be treated as being bitten by poisonous snakes. The First Aid treatment will be as follows:- (a) Make the victim lie down comfortably. (b) Give convincing reassurance against fear of death. (c) Apply a light constricting tourniquet with hand kerchief, bandage or shoe lace above the knee for a bite on the leg and above elbow for a bite on the arm. So that the poison does not flows to all parts of the body. (d) Wash with soap and water. Use water freely. (e) Evacuate the patient quickly to the nearest dispensary or hospital. (f) If breathing fails, start artificial respiration. GCI – ANN PHILO THOMAS  37 Snake Bites: Do’s and Don’ts. (a) Do’s. (i) Stay calm, make the victim lie down comfortably. (ii) Give convincing reassurance against fear of death. (iii) Call ambulance. (iv) Take off anything constricting the area, such as a ring or watch. (v) Position the affected area at or above heart level on the basis on the affected site. (vi) If breathing fails, start artificial respiration. (b) Don’ts. (i) Don’t apply ice as it can cause local tissue damage. (ii) Don’t cut the affected area and don’t attempt to suck venom out. (iii) Don’t use a commercially available extraction device. (iv) Don’t use electrical therapy. (v) Don’t apply any type of lotion or ointments. Scorpion Bite Bite by scorpions should be treated like snake bite. GCI – ANN PHILO THOMAS  38 23. First Aid Treatment. If blood has been drawn, the wound should be cleaned well with antiseptic lotion. GCI – ANN PHILO THOMAS  39 Rabid Dog Bite Rabies is a very dangerous disease transmitted by a rabid dog. The disease is preventable by giving anti-rabies vaccine. First Aid Treatment. (a) Immediately wash the bite area with lots of water and soap. (b) Wound should be cleaned with available antiseptic. (c) Patient should be sent to hospital for an anti-rabies injection course (d) Dog and the patient should be kept under observation for at least 10 days. Foreign Bodies in Eye, Ear and Nose Foreign Body in Eye Particles of coal or dust may lodge on the eye-ball or inside the eye lid causing discomfort and damage to the tender structure. First Aid Treatment. (a) Ask the patient not to rub the eyes. (b) Wash the eye with water repeatedly for a minute or two. (c) Search for the foreign body by lifting the upper eyelid and parting the lower eyelid down. The patient should face the light. If the foreign body is seen, it can be wiped off with the moistened corner of hand kerchief, cloth or cotton swab. (c) If foreign body is fixed to the eye-ball, patient should be sent to the hospital with a light eye bandage. GCI – ANN PHILO THOMAS  40 Foreign Body in Ear This is common with children. They often put beads, peas, nuts and other objects into the ear or an insect may get into the ear. First Aid Treatment. Do not try to remove the foreign body with the help of a pin or forceps as this may push the foreign body further in, causing damage to the ear. The patient should be sent to the hospital. Foreign Body in Nose This is a common occurrence among children. They might put peas, beads in the nostril. First Aid Treatment. (a) Blowing the nose and sneezing may expel the foreign body. (b) Make the casualty breathe through the mouth. (c) Do not try to remove the foreign body. (d) Send the patient to the nearest hospital. Asphyxia The tissue and organs of the body are supplied with oxygen through respiration, essential for the functioning of body. Respiration consists of inspiration, expiration and a pause. During inspiration air is drawn inside causing the lungs to expand. During expiration the lungs contract and air is pushed out. The respiratory system consists of the air passage known as respiratory tract and lungs. The actions of muscles concerned with respiration are controlled and regulated by the respiratory centre of the brain. Asphyxia Causes. Anything which interferes with respiration producing irregularities in breathing, produces a condition known as Asphyxia. The main causes of Asphyxia are:- (a) Drowning – due to water entering the air passage. (b) Hanging and Strangulation – due to obstruction to entry of air. (c) Suffocation. (ii) Due to obstruction to entry of air through the air passage. (iii) Foreign body obstruction in air passage. (iv) Inhalation of poisonous gases e.g. carbon monoxide. GCI – ANN PHILO THOMAS  41 (d) Over dosage of drugs such as sleeping pills, morphine, pethidine. (e) Electric Shock. (f) Diseases e.g. tetanus, epilepsy, rabies. Signs and Symptoms of Asphyxia. (a) Dizziness and weakness. (b) Shortness of breath rate or breathing increase. (c) Rapid pulse. (d) Partial loss of consciousness. (e) Swelling of the veins of the neck. (f) Face, lips, nails, fingers and toes turn blue. General Rules for Treatment of Asphyxia. (a) Remove the cause if possible or the casualty from the cause. (b) Ensure that there is a free passage for air. (c) Lay the individual on his back. Press the head back-wards supporting the neck on your palm. Lift the tongue clear of the airway. Give mouth to mouth breathing. First Aid for Special Cases - Drowning. (a) Wet clothes should be loosened. (b) Mouth, throat and nostril should be cleaned of mucus and any foreign body. (c) Patient should be made to lie down over his belly, face down, head turned to one side, arms stretched beyond the head, tongue pulled out. (d) Artificial respiration should be given till he starts breathing. (e) Cover the patient with a blanket. GCI – ANN PHILO THOMAS  42 First Aid in Case of Strangulation or Hanging. (a) Cut the constriction. (b) Clear the air passage. (c) Start artificial respiration. (d) Give inhalations if possible. (e) Make the patient warm and comfortable. GCI – ANN PHILO THOMAS  43 First Aid in Case of Choking. Bend the casualty‘s head and shoulders forward, to dislodge the obstructions. In case of small child hold him upside down and thump his back hard between the shoulder blades or encourage vomiting by passing two fingers to the back of the throat. First Aid in Case of Suffocation by Poisonous Gas. Protect yourself and remove the casualty from the gas as early as possible. GCI – ANN PHILO THOMAS  44 First Aid in Case of Electric Shocks. (a) Switch off or break the current, if possible. (b) Remove the casualty from contact with the current, if possible. Stand on some insulating material such as rubber soled shoes or boots or piles of news papers. (c) Give artificial respiration. (d) Treat for shock and burns. Insensibility Or Unconsciousness Insensibility or unconsciousness is caused due to interruption of the action of the brain, through some interference with the functions of the central nervous system. Stages of Unconsciousness. Delirium – When the restlessness of body and (a) 1st Stage mind are present. Patient responds to loud commands, gives (b) 2nd Stage maximum response to minimum stimulus. GCI – ANN PHILO THOMAS  45 (c) 3rd Stage Semi- Coma- Patient responds to painful stimuli only(minimum response to maximum stimulus). When the patient makes no response to any (d) 4th Stage Stimulus. Causes of Unconsciousness or Coma. (a) Head injury and brain Hemorrhage. (b) Hypoglycemia. (c) Heart failure. (d) Physical agents such as heat strokes, electric shocks. (e) Epilepsy. General Rules of First Aid in Casualties of Unconsciousness. (a) Make the patient lie down with head turned to one side. Pull out his tongue. (b) Loosen the clothing, ensure fresh air. (c) If breathing has stopped or is irregular, start artificial respiration. (d) Keep the air passage clear. (e) Nothing should be given by mouth. Remove false teeth, if any. Artificial Respiration. If there is any irregularity in breathing or a cardiac arrest, artificial respiration is given. If it is given correctly and in time, the patient‘s life can be saved. There are three methods for providing artificial respiration, but we will tell you only about the most common one. GCI – ANN PHILO THOMAS  46 Mouth to Mouth Respiration. This is the most common and simple method and is given immediately. If given timely, it can save many lives. This can be given by following way:- (a) Casualty should be in supine position. (b) Clean the mouth and throat to maintain clear air passage. (c) Extend the neck to straighten the air passage. (d) Cover the patient‘s mouth with clean gauze and blow directly and slowly into it. (10 – 12 times per minutes). GCI – ANN PHILO THOMAS  47 First Aid For Different Type Of Fractures First Aid In Case of Simple Fracture. The first aid to be rendered is:- (a) Reassure the patient and make him comfortable. (b) Apply splints with any common article like stick or ply board or card board to immobilize the fracture. (c) Relieve him of discomfort and pain and keep the patient warm. In Case of Compound Fracture. The first aid to be rendered is:- (a) Bleeding should be stopped immediately. (b) Remove foreign objects, if any, but do not meddle too much. (c) Cover the wound with a clean pad with light bandage. (d) Apply appropriate splints. (e) Transfer the patient to the nearest hospital immediately. A traction splint most commonly refers to a splinting device that uses straps attaching over the pelvis or hip as an anchor, a metal rod(s) to mimic normal bone stability and limb length, and a mechanical device to apply traction (used in an attempt to reduce pain, realign the limb, and minimize vascular and neurological complication) to the limb. A traction splint is commonly used to treat complete long bone fractures of the thigh, femur and not for tibia and fibula area. Their use is common in pre-hospital care. Evidence to support their usage however is poor. GCI – ANN PHILO THOMAS  48 Treatment of Fractures Fracture of the Jaw Bone. (a) Apply Barrel Bandage. (b) Warn the patient not to speak. (c) Instruct the patient to sit. (d) In lying cases, place patient on his chest, his head projecting outside the stretcher canvas, properly supported with bandages secured on stretcher handle. Fracture of the Clavicle. In fracture of the clavicle we need to:- (a) Support the arm of injured side by passing a narrow folded bandage under the arm pit and tying it on the back of the shoulder. (b) Put a pad in arm pit, apply greater arm sling and fix the arm with a narrow fold bandage tied across the elbow to lower chest. 52. Fracture of the Ribs. When ribs are fractured following action is taken:- (a) Uncomplicated. Restrict the movement of chest on fracture side, with broad-fold bandage, one above and one below the fracture side, half overlapping each other. Support the arm of injured side with greater arm sling. (b) Complicated. Put the patient on the affected side and support the position by long fold blankets. Send the patient immediately to the nearest hospital. GCI – ANN PHILO THOMAS  49 Fracture of the Shoulder Blade and the Upper Limb. Fix the elbow to the affected side and put the finger in a position touching the opposite shoulder. Secure the hand in position by cuff sling. Secure the limb firmly to the chest by two broad bandages one on shoulder and the other at the elbow level and knot on opposite side. Fracture of the Lower Limb. (a) Fix the injured limb to the sound limb with four narrow folds. (b) Apply long wooden splint from axilla to just beyond the foot on each side. Secure them by seven broad folds bandages tied at chest, pelvis, ankles, both thighs below the fracture, both legs, and knees. (c) In case of fracture of the pelvis, apply Thomas splint if available, otherwise the methods described in (a) and (b) should be used for immobilization of lower limb before evacuation of injured person to the nearest hospital. Fracture of the Spine. Fractures of spine are to be very carefully handled. We have to:- (a) Treat any case of back injury as a fracture of the spine. There will be severe pain and shock in all cases. (b) Make the patient still. Do not allow the patient to move about. (c) If unconscious see that the tongue does not fall back and choke the patient. (d) Get medical aid at the earliest. (e) Apply broad bandages for thigh and knees. (f) Carry the patient face downwards on a board placed lengthwise on the stretcher. Fracture of the Skull. It may injure the brain, nervous system or the arteries and cause concussion and compression. It may be caused by direct or indirect blow. (a) If Breathing is Normal. Lay the casualty on back with shoulders and head raised with cushions. Turn the head to one side. (b) If Breathing is Abnormal. Lay the casualty in a three quarter prone position. Apply pads under the chest and draw up the upper knee. GCI – ANN PHILO THOMAS  50 (i) Do not give anything to drink. (ii) Do not disturb the patient. (iii) Keep air passage clear. (iv) Treat for shock. Conclusion First aid is a very simple and effective method which if known to an NCC cadet can save precious lives under various life threatening situations. The crucial aspects are promptness and correctness in administering first aid. A NCC cadet who reaches the victim must first quickly investigate the cause and type of injury before attempting to administer first aid. GCI – ANN PHILO THOMAS  51 CHAPTER - VI TREATMENT AND CARE OF WOUNDS Introduction In our daily life, we do suffer from various types of wounds. Proper treatment and care of wounds is extremely important for a healthy life, especially in children because, if some wounds are not treated properly, they may cause serious diseases like gangrene or tetanus. A wound is a type of injury which happens relatively quickly in which skin is torn, cut, or punctured (an open wound), or where blunt force trauma causes a contusion (a closed wound). In pathology, it specifically refers to a sharp injury which damages the dermis of the skin. Classification Of Wounds Definition. Wounds can be defined as a break in continuity of the skin or muscles membrane. It is caused by violence. Classification. According to level of contamination, a wound can be classified as under:- (a) Inside Wound. It is wound caused by a sharp instrument like knife, razor and soon. Its edges are clean. (b) Lacerated Wound. It is caused by blunt instrument. The edges are torn or uneven. (c) Open Wound/ Punctured Wound. It is a deep narrow wound caused by a pointed instrument like knife, bayonet. The wound is small on the surface but may be very deep causing injuries to internal organs. (d) Closed Wound/ Contusion. A contusion is an injury or a bruise in which some of the tissues or a part is irregularly torn or ruptured but, the skin may not be broken. It is caused by a blow or blunt instrument. Open Wound. Open wounds can be classified according to the object that caused the wound:- (a) Incisions or Incised Wounds. Caused by a clean, sharp-edged object such as a knife, razor, or glass splinter. (b) Lacerations. Irregular tear-like wounds caused by some blunt trauma. Lacerations and incisions may appear linear (regular) or stellate (irregular). The term laceration is commonly misused in reference to incisions. GCI – ANN PHILO THOMAS  52 (c) Abrasions (Grazes). Superficial wounds in which the topmost layer of the skin (the epidermis) is scraped off. Abrasions are often caused by a sliding fall onto a rough surface. (d) Avulsions. Injuries in which a body structure is forcibly detached from its normal point of insertion. A type of amputation where the extremity is pulled off rather than cut off. (e) Puncture Wounds. Caused by an object puncturing the skin, such as a splinter, nail or needle. (f) Penetration Wounds. Caused by an object such as a knife entering and coming out from the skin. (g) Gunshot Wounds. Caused by a bullet or similar projectile driving into or through the body. There may be two wounds, one at the site of entry and one at the site of exit, generally referred to as a "through- and-through." GCI – ANN PHILO THOMAS  53 Closed Wound. Closed wounds have fewer categories, but are just as dangerous as open wounds: (a) Hematomas (or blood tumor). Caused by damage to a blood vessel that in turn causes blood to collect under the skin. (i) Hematomas that originate from internal blood vessel pathology are petechiae, purpura, and ecchymosis. The different classifications are based on size. (ii) Hematomas that originate from an external source of trauma are contusions, also commonly called bruises. (b) Crush Injury. Caused by a great or extreme amount of force applied over a long period of time. First Aid For Wounds The method for giving first aid for different types of wounds are:- (a) Place the patient in a comfortable position. (b) Stop the bleeding, if any. (c) Remove any foreign body, if it is easily visible and can be easily removed. (d) Prevent the entry of germs by applying sterilized dressing like first field or shell dressing. (e) Give rest to the injured part by sling. (f) Immobilize the part, if wound is large or complicated by fracture. (g) Treat the patient for shock. GCI – ANN PHILO THOMAS  54 (h) Send the patient to nearest hospital. Dressing Of Wounds A wound is to be cleaned with antiseptic lotion and covered with cotton or gauze piece with medication, before applying the bandage. Aim. The aim of dressing a wound is as under:- (a) To protect the wound from infection. (b) To reduce swelling and early healing. (c) To support the effected part. (d) To enable the individual to carry out his day to day routine. (e) To stop the bleeding. Articles Required for Dressing of Wounds. (a) Anti septic (A/S) lotion. (b) Cotton / Gauze piece (c) Scissors. (d) Bandages of different size and band aid. (e) A/S ointment or powder. Procedure for Dressing of Wounds.The following procedure is to be adopted while dressing of wounds:- (a) Reassure the patient and place him in comfortable position. GCI – ANN PHILO THOMAS  55 (b) Stop the bleeding, remove foreign body and clean the wound with A/S lotion and cotton. (c) Apply A/S ointment or powder and cover it with gauze. Select suitable bandage, Start bandaging clock wise from outer aspect to inner aspect by covering 1/3 of previous lining. (d) Put the knot away from the wound. (e) Bandaging should not be either too tight or loose. Conclusion Wounds are a common feature among humans who are outdoor oriented. If cared properly during early stage the wounds heal quickly. Resultantly the wounded person suffers less and is available to the society as a healthy and fit person to resume work. NCC cadets by virtue of their routine are prone to injuries and hence must possess this basic knowledge to help fellow cadets or friends in school or at home. GCI – ANN PHILO THOMAS  56 CHAPTER - VII INTRODUCTION TO YOGA AND EXERCISES Introduction Yoga is a commonly known activity for physical, mental, and spiritual disciplines which originated in ancient India. One of the most detailed and thorough expositions on the subject are the Yog Sutras of Patanjali. Various traditions of yoga are found in Hinduism, Buddhism, Jainism and Sikhism. UNO has declared 21 June as the International Day of yoga. NCC is practising, propagating and celebrating this in a big way every year. Definition And Purpose Of Yoga Definition The concepts and practices of Yoga originated in India about several thousand years ago. Its founders were great Saints and Sages. The great Yogis presented rational interpretation of their experiences of Yoga and brought about a practical and scientifically sound method within everyone’s reach. Yoga today is no longer restricted to hermits, saints and sages; it has entered into our everyday lives and has aroused a worldwide awakening and acceptance in the last few decades. The science of Yoga and its techniques have been reoriented to suit modern sociological needs and lifestyles. Experts of various branches of medicine including modern medical sciences are realizing the role of these techniques in the prevention and mitigation of diseases and promotion of health. GCI – ANN PHILO THOMAS  57 Yoga is one of the six systems of Vedic philosophy. Maharishi Patanjali, rightly called “The father of Yoga compiled and refined various aspects of Yoga systematically in his “Yoga Sutras. He advocated the eight folds path of Yoga, popularly known as “Ashtanga Yoga” for all round development of human beings. They are – Yama, Niyama, Asana, Pranayama, Pratyahara, Dharana, Dhyana and Samadhi. These components advocate certain restraints and observances, physical discipline, breath regulations, restraining the sense organs, contemplation, meditation and Samadhi. These steps are believed to have a potential for improvement of physical health by enhancing circulation of oxygenated blood in the body, retraining the sense organs, thereby, inducing tranquility and serenity of mind. The practice of Yoga prevents disorders and improves an individual’s resistance and ability to endure stressful situations. Yoga is a very individual and organic practice. There is no right way to do it, as in cardiovascular and strength training. The whole essence of yoga is to be aware of your body’s strengths and capabilities and slowly accept it while pushing yourself a little further, only as much as comfortable. So no one expects you to twist and turn into a pretzel without breaking a sweat, in the first go. Just do whatever feels good for you. It’s not a team activity. Purpose Yoga is a disciplined method utilized for attaining a goal. In the sense the physical postures of yoga are to alleviate health problems, reduce stress and make the spine supple. Yoga is also used as a complete exercise program and physical therapy routine. The characteristics of Yoga are given below:- (a) The Yogic system of health involves the exercise of skeletal as well as the deep seated smooth muscles of the body. (b) The intra-thoracic and intra-abdominal pressure may be mentioned as special characteristics of the yoga system of health. (c) Little expenditure of energy and money is involved in the Yoga practices. (d) The rich as well as poor, and men and women of all ages can practice Yogic practices. (e) Every school of Yoga emphasized specific practices, but their aim always remained the same; but the highest level of integration through the control of the modification of mind. (f) The nature of Yogic practices is psycho-neurophysical. (g) All yogic practices are complementary. GCI – ANN PHILO THOMAS  58 Potential Benefits Of Yoga For Adults Yoga as Exercise or Alternative Medicine. (a) Many yoga practitioners have reported musculoskeletal and mental health improvements, as well as reduced symptoms of asthma in asthmatics. Regular yoga practice increases brain Gamma-Aminobutyric Acid (GABA) levels and has been shown to improve mood and anxiety more than some other metabolically matched exercises, such as walking. (b) The three main focuses of yoga (exercise, breathing, and meditation) make it beneficial to those suffering from heart disease. Overall, studies of the effects of yoga on heart disease suggest that yoga may reduce high blood pressure, improve symptoms of heart failure, enhance cardiac rehabilitation, and lower cardiovascular risk factors. (c) For chronic low back pain, specialist Yoga for Healthy Lower Backs has been found 30% more beneficial. (d) Mindfulness Based Stress Reduction (MBSR).This program includes yoga as amind-body technique to reduce stress. A study found that after seven weeks the group treated with yoga reported significantly less mood disturbance and reduced stress compared to the control group. Another study found that MBSR had showed positive effects on sleep anxiety, quality of life, and spiritual growth. (e) Yoga has also been studied as a treatment for schizophrenia. Yoga is found to improve cognitive functions and reduce stress in schizophrenia, a condition associated with cognitive deficits and stress- related relapse. (f) The practice of yoga in Indian tradition also has psychological benefits, allowing one to develop control over one's mind and body. Rather than adapting the sick or mentally ill mind (which is also the primary focus of modern psychology), traditional Indian psychology focuses on enhancing the normal and healthy mind through the practice of meditative techniques such as yoga. Physical Benefits. The physical benefits of the ancient practice are too many to count; each body part gains something from every asana and every breath. Better posture, strength, balance, endurance, coordination, flexibility, steadiness and increased lung capacity are the basic gems one finds when beginning to engage with yoga. It is also a well-known fact that those who incorporate yoga into their daily lives are more likely to maintain a healthy weight than those who don’t. They are much more aware of their body and this translates into their everyday care for themselves including diet and rest. Even though yoga is more than just a workout, it still serves as a great workout. There GCI – ANN PHILO THOMAS  59 are intensive forms of yoga which consist of quick transition between aasanas and mudras to increase the metabolic rate and heart beat; there are also restorative forms of yoga which focus on breathing, stretching and calming the mind. The suryanamaskara, a series of 12 poses is said to be one of the best ways to lose weight. Yoga lowers levels of adrenalin, cortisol, blood pressure, pulse rate and cholesterol. Additionally, total body awareness attained from yoga is essential to preventing bodily injuries. Mental and Emotional Benefits. Simply becoming very aware of your breath and body brings an immediate calming to the mind. Stress, anxiety and depression levels decrease as respiration rate decreases and the amino acid, gamma- aminobutyric acid (GABA) increases which facilitates calmness and relaxation in our bodies. Continuous practice of yoga enables a person to have greater mind control or control over his/her emotions. It increases concentration and focus and fosters a healthier body-image. Research shows that yoga helps in reducing symptoms of certain neuro-psychiatric disorders like schizophrenia; also but not limited to Post-Traumatic Stress Disorder (PTSD) and Obsessive Compulsive Disorder (OCD). Regular practitioners of yoga are happier and more peaceful due to the release of Endorphin or the happiness hormone. It helps in getting better sleep and better digestive health and improves intuitive ability. Spiritual Benefits. Yoga leads to an overall sense of fulfillment and a deeper sense of gratitude in general. It inculcates a greater sense of appreciation and fosters the ability to truly live the positive experiences of daily life. Yoga allows spending time with ourselves leading to introspection about our limitations: physically, mentally and emotionally. It can lead to the one thing we’re constantly looking for: discovery of one’s sense of purpose and meaning in life. The list of benefits from yoga is endless. Start slow, start somewhere. Take your time. The whole process becomes redundant if you set out to prove a point. Stretch till it feels good. Learn to be curious about who you are and know your body. Inhale peace. Exhale chaos. You will see many, if not all these benefits soon. Yoga teaches you to honor your body, let go of things that no longer serve you, be present, achieve more than you think and breathe. Just breathe. As the Bhagvad Gita says, yoga is the journey of the self, through the self, to the self. Potential Problems Certain health problems associated with yoga have been brought to the attention of the general public. Yoga has been criticised for being potentially dangerous and being a cause for a range of serious medical conditions including thoracic outlet syndrome, degenerative arthritis of the cervical spine, spinal injuries, retinal tears, damage to the common fibular nerve, knee injuries, and headaches are common ailments which may result from yoga practice. Some yoga practitioners do not recommend certain yoga exercises for women during menstruation, for pregnant women, or for nursing mothers. However, meditation and breathing exercises are encouraged. GCI – ANN PHILO THOMAS  60 Children and Yoga. Research in the countries which have advanced medical research and development facilities do not recommend, Yoga exercises for children under 16 because their body’s nervous and glandular systems are still growing, and the effect of Yoga exercises on these systems may interfere with natural growth. However, meditation and simple breathing exercises (without breath-holding) are safe and can help children to manage stress, impulsiveness, and emotional situations. Asanas There are innumerable asanas. Some of the asanas useful for curing ailments and maintain good healths are as follows:- (a) Padmasana. Sit on the asan. Spread the leg forward, place your left foot on the join of your right thigh, and right foot on the joint of left thigh in such a way that both heels tough each other below your navel in the middle of abdomen. Place your hands on your knees. Keep the head and spinal column erect. Keep your eyes close or open. Stay in the final position for 1-2 minutes in the initial stage. Later increase the time gradually. This asan is useful for Jaap, Dhyana and Samadhi. This asan also helps in curing diseases like asthama, hysteria and insomnia. (b) Baddha Padmasana. Sit in Padmasana. Try to project the feet as far as possible. Take the hand behind your back. Catch the right toes with your right hand and left toe with your left hand. Keep the back bone straight and fix your eyes on the tip of the nose. This asana improves nervous system and the abdomen. It also cures drowsiness, sleepiness, laziness and night discharge. GCI – ANN PHILO THOMAS  61 (c) Siddhasana. The main function of this asana is to awaken the power of Kundalini. Sit on the carpet. Place the heel of left foot under the testis on the prostrate gland in such a way, that the sole of your foot should be placed at root of genitals. Place the hand on the knees so that palm face upward. This asana helps the mind to be firm, attentive and alert. (d) Gyan Mudra. Sit in Padmasana or siddhasana. Put your Hands on your knees with palm facing upwards. Bend your index finger and place them at the root of your thumbs. Spread the remaining three fingers forward, all joined together. This asana is most suitable for pranayam and dhyana. (e) Trikonasana. Stand erect keeping the distance between the feet 60 – 75 cm. Raise your right hand towards the sky and look towards its palm. Then bend the truck to the left side and try to touch left toe with the left hand without bending your legs. Repeat this process with your left hand up and right hand down. This asana is useful to the eyes, spinal cord, neck and mental power. Timings 3 – 6 sec. 4 – 6 times. GCI – ANN PHILO THOMAS  62 (f) Ardha Chandrasana. Stand erect. Raise your both hands and join them above your head. Bend towards left from the waist. After some time bring they body back in straight position. Repeat this by bending the body towards right. This asana improves the functioning of heart, liver, intestine, stomach, lungs and make the body flexible. Timing 4 -6 sec and 4-5 times. (g) Suryanamaskara. Suryanamaskara is a combined sequence of 12 positions. By this sequence of 12 positions, the whole body is well exercised. While practicing Suryanamaskara recite the different names of Sun god at each position. Stage 1:- Stand in attention. Foldyour hands in the centre of your chest. Now recite the first of the twelve mantras. Stage 2:- Stretch your hands up and take the body backwards from the waist as far as possible. The hands must remain straight and touch your ears. Stage 3:- Now bend down without bending the knees. Try to put the palms on the ground and touch the nosewith knees without bending knees. Stage 4:- Take left leg back. Bend your right knee, the knee will remain between thetwo arms, with the hands sticking to the ground, Now bend the neck backward as for as possible. Look forward and hold the breath. State 5:- Take right leg back. Put both the toes and the knees together and pull yourbody up in such a way that it looks like inverted ‘V‘. Look backward through your legs keeping the head, the waist and the arms in a straight line. GCI – ANN PHILO THOMAS  63 State 6:- Bend down your body in such a way that your forehead, chest and knees should tough the ground except your hips which should be slightly raised from the ground. State 7:- Stretch the arms, Inhale, put the chest forward and move back your neck asmuch as you can. Look up and hold the breath. State 8:- Maintain same position as in Stage 5. Stage 9:- Maintain same position as in Stage 4. Stage 10:- Maintain same position as in Stage 3. Stage 11:- Maintain same position as in stage 2. Stage 12:- Maintain same position as in Stage 1 and then take your hand down. Make the rest posture. (g) Shavasana. The main aim of this asana is releasing the mind from the body. By this asana we can achieve relaxation in the shortest possible time. This asana provides relief in disease like blood pressure, weakness of nerves and other ailments. Lie on your back and let your body be relaxed completely. Your feet should be 30-45 cm apart, arms in sides with palmupwards, eyes gently closed with attention on breathing. Keep body in a straight position. For proper blood circulation in the body, the legs, hand and neck should have no curves orbend. Take a long and deep breath then concentrate on each and every partof your body, putting it in a relaxed state Timing 5-10 minutes. (h) Gomukhasana. Sit on the seat comfortably. Place your left foot heel under your left hip. Now take the right leg over the left buttock in such a manner that the heel of your right foot is placed near your left hip. Take right arm behind back from above and left arm from below, so that fingers of the both hands are interlocked behind the back. Stay in this position for some time. Then repeat this with opposite side. Timings 20-30 seconds, 4-6 times. GCI – ANN PHILO THOMAS  64 (j) Vijrasana. Bend the legs and sit on knees. Place the heels at the sides of the anus in such a way that thighs rest on the legs and the buttock rest on the heels. Stretch the arms and place the hands on the knees. Keep the knees close by. Sit erect. This asana can be done immediately after eating food. This helps digestion and eliminates gas troubles. Timing 1-3 minutes. (k) Dhanurasana. Lie down on the chest, legs shouldbe folded at the knees and the feet should be grasped with both the hands near the ankles. The thighs and the chest should be raised, making the body appear like a bow. This asana provides good exercise to the abdominal muscles, lower back and thighs, Timing 10-30 seconds, 4-5 times. (l) Bhujangasana. Lie down on the chest. The hands should be below the shoulders with the fingers pointing forward. The legs are kept straight with the feet touching each other and the soles facing up. Raise the head, giving a backward bend to the spine. Try to keep the spine bent backward as much as GCI – ANN PHILO THOMAS  65 possible without raising the navel. This asana is good for the spine, the chest, the neck and the head. Timing 20-30 sec. 4-6 times. (m) Chakrasana. Lie down on the back. Bend the legs at the knees. Heels are close to the hips and sole touching the ground. Bend the arms at the elbows and place them on the ground on either side of the head. Place them in such a way that palms should rest on the ground and the direction of the fingers should be towards your feet. First raise your hips and waist, keeping the legs straight. Raise the back as far as possible. This asana helps in making the spine supple. Timing ½ -1 min, 1-2 times. (n) Sarvangasana. Lie down flat on the back. Raise legs from the hips, push the trunk up until legs are in vertical position. The chin should press against the chest. The hands are giving support to lower ribs. Hold this position upto 2-10 minutes. Come back as slowly as possible. Do not give any jerks to the body. This asana improves circulatory, respiratory and alimentary systems of the body. Timings: ½ -1 minute. GCI – ANN PHILO THOMAS  66 (o) Halasana. Lie down flat on the back. Place the arms by sides along the hips, palm facing the ground. The legs are raised up in a single motion and put down behind the head keeping knees unbent. The chin should touch the chest. In this exercise, the legs will remain straight and breathing should be normal. Hold this position for 30-50 seconds. This asana stimulates blood circulation and makes the spine flexible and elastic. The Ministry of AYUSH was formed on 9th November 2014 to ensure the optimal development and propagation of AYUSH systems of health care. Earlier it was known as the Department of Indian System of Medicine and Homeopathy which was created in March 1995 and renamed as Department of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy (AYUSH) IN November 2003, with focused attention for development of Education and Research in Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy. International Yoga Day GCI – ANN PHILO THOMAS  67 National Cadet Corps (NCC) was presented the certificate by Limca Book of Records for the 'Largest Yoga performance simultaneously by a single uniformed youth organisation' at multiple venues on International Day of Yoga (June 21). The certificate has been presented by Mr Vijaya Ghose, Editor Limca Book of Records to Lt Gen A Chakravarty in the presence of Defence Minister Manohar Parrikar. International Day of Yoga Conclusion Yoga is a subject which can be looked at intellectually and some useful and beneficial ideas imbibed. Yoga can be imbibed by adopting certain attitudes which alter the nature of the samskaras. Yoga can be imbibed by living in an ashram environment and trying to be aware of the physical, mental and spiritual dimensions at the same time. Yoga can be learnt in a classroom environment as science, as psychology, as an applied subject, with the aim of providing new understanding and insight into the life process, into areas where karmas are performed, into areas which shape the inner being in terms of awareness, inner development, the experience of harmony or balance, eventually culminating in the experience of samadhi and the fullness of wisdom, prajna. GCI – ANN PHILO THOMAS  68 SUMMARY  The human skeleton is the internal framework of the body. The bones give shape and firmness to the body, as also it protects the vital organs like brain, heart, lungs and spinal cord. It is composed of around 300 bones at birth – this total decreases to around 206 bones by adulthood after some bones have fused together..  The human skeleton performs six major functions; support, movement, protection, production of blood cells, storage of minerals and endocrine regulation.  Classification of Bones:-  Long Bones, Short Bones, Flat Bones.  Irregular Bones, Sesamoid Bones.  The muscular system is an organ s