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-- and stay well in those very strange places! This posting appears here "by request". Several people who missed it the first time around wanted another opportunity to download it. So here it is: L. D. B. ____________________________________________________________________ I posted the names of four books on the Hondol list recently, that have been in my suitcase wherever I have traveled around this world during the last half-century or so. These volumes have probably saved my own life several times, and they have certainly saved the lives and eased the pain and suffering of many, many others. Medical attendance and hospital facilities, especially in the so-called Third World is at best marginal, if they exists at all. Once you get out of the cities and into the Third World "boondocks", you are very likely going to have to depend on your own resources for your survival . Unless you have some medical information or a source for it, when a medical emergency occurs, you will come to know the loneliest feeling in this world. Guaranteed. These books and the related suggestions carried inter-linea, are not going to make a doctor out of you, regardless of how diligently you study them. But in the "crunch", these books can offer priceless guidance to the management and treatment of both traumatic and systemic emergencies that may well, otherwise, prove disastrous or even fatal. Many years ago I saw a thin little volume entitled "What To Do Until the Doctor Comes." I believe that little book was in a prominent place in almost every farm house in the rural area in which I grew up. Everybody had it because it saved lives. Consider the four titles that follow to be a compendium of "What to Do Until You Get Someone to a Doctor." This because, more often than not, the doctor is not going to come to the patient. You are going to have to get the parent to the doctor, to a hospital, or to some other aid location. Your task will be to protect the patient from further trauma. Doing this means keeping the patient as comfortable as possible while moving him or her; especially protecting the patient from shock, hemorrhage, and respiratory insufficiency, for a few hours or even a few days. How well you handle your responsibility can easily determine whether the patient lives or dies. If you can handle your function, however, ideally a professional will then take over the further medical management of the case - and you can congratulate yourself for having discharged your responsibilities successfully. The books enumerated below will provide crucial guidance and support for you in doing this. In other situations, you won't even be able to hope for professional help. Accidents happen. Bones are broken. Babies are ready to be born. People get food poisoning. Bare feet step on fish-hooks. Kerosene and gasoline stoves and lanterns explode. In the face of these events, people may be slightly or gravely injured. Unless professional medical assistance is close by, you are likely to be the unwilling stand-in for a surgeon, or an orthopedist, an Ob-Gyn guy, or - God bless ‘em - the G.P’s. (General Practitioners) who seem ready to take on anything that people - or events around us - can serve up to the unfortunate victims. Sometimes I do forget my American Express Card, but as for these four books, I follow the pitch-man’s advice exactly: I "Don’t leave home without them." Neither should you. Alphabetically, they are: Cecil’s Handbook of Medicine and Surgery: This book covers everything you will expect of it - and more! It tells you how to clean, sterilize and suture (sew up) a machette slash; how to remove a fish-hook from a foot, and - heaven forfend - how to deliver a baby and even remove a "hot" appendix. And everything in between, plus an excellent listing of physical symptoms that, in the case of systemic illness, can help you tell the difference between fish poisoning, a colitis attack, and a diabetic siezure, for example. Dorlan’s Medical Dictionary: This is the best pick out of a bunch of medical dictionaries regularly available in the book stores. Some are cheaper. Others are more expensive. This one is the best, at whatever price. In addition to an excellent vocabulary, it also has lots of b/w and color charts, to visually clarify anatomical sites and key functional relationships. Gray’s Anatomy (of the human body) Gray is to human anatomy, what Rand & McNally is to road maps: Nobody else even get close. This is the most expensive book in my "must have" list, and worth every nickel of it. If you want to save a few dollars in the book store, pass up the latest issues of Playboy and Penthouse for a month or two. That should do it. A broken leg, arm, or a dislocated or badly sprained joint has to be promptly set, splinted, put in a cast, reduced, taped or whatever. You can do this if you must, (although right this minute you a totally sure you could not). You can do it, provided you can read English and follow some fairly rudimentary instructions. And further provided that not too much time has elapsed since the accident occurred, thus allowing tissue swelling and muscle spasms to complicate the manipulations required to effect repairs. Another area in which I find Gray’s Anatomy to be tremendously useful is in the placement of local anesthetics to block a particular nerve branch, or infuse a specific area in preparation for some otherwise painful cutting or sewing procedure. Example: Taking a big double-barbed marlin hook out of a foot (you will get lots of this kind of stuff in a barefoot seaside population) is a perfectly hellish task without anesthetic. With a couple of shots of any of several excellent, quick-acting local anesthetics into the "hooked" nerve/muscle package, it’s a piece of cake! P. D. R (Physicians Desk Reference) I put the P.D.R. initials first, because this is how the book is identified by people who know and use it. Of all the (medical support) books I own- or have ever seen - this is the best of the breed. And you can’t even buy it! No, this isn’t a joke. The jokes come later. The P. D. R. is a "subscription" item. Physicians and certain other health personnel subscribe to it, which insures that the latest edition arrives in the mail just as often as the materials are updated and the new edition is off the presses. The P. D. R. is updated and re-issues distributed whenever new diagnostic information, clinical management suggestions, medications, pharmaceuticals and/or prescription drugs and formulations require. This is needed o keep pace with the ever-changing state of the medical arts. This means that my physician (and yours) has an obsolete P. D. R. just as often as a new edition emerges. I have a deal with my fearless healer by which he gives me his outdated P. D. R. whenever a new version arrives. Don’t be put off by the idea that the book involved (that you should get free) is "outdated". The current edition doesn’t self-destruct when the new edition arrives to supplant it, and at least 99% of the information and data between the covers is the same - word for word - in both editions. If you can’t wangle a deal with your family physician to get a free copy of the P. D. R., from him, maybe you should consider changing doctors. (This is a medical-type joke.) But however you get it, get it! I’m sure that in seven or eight instances out of ten, when somebody needs help, the P. D. R. (Physicians Desk Reference) will be the book you will reach for; both to orient your thinking apropos the problem, and help you settle on a procedure to handle it. Anybody’s Pharmacopeia: I don’t give you a Publisher’s Index or List title reference in this connection, because there are so many good ones in circulation that choosing between them would be obvious affectation. Provided the book you get was edited and published in the United States, its contents vis-a-vis both proprietary (over the counter) and ethical (prescription) items are all subject to the extremely stringent rules of the F. D. A. (Food and Drug Administration), and deviations from those standards are not allowed - until and unless approved by the F. D. A. beforehand. Virtually all of the major pharmaceutical manufacturers have a pharmacopoeia under their own logo. They scatter copies of these volumes throughout the land, to every drug store, dispensary and street-corner pharmacy that stocks any of their products. Since drugs, and the prescription protocols under which they are legally dispensed, are constantly undergoing changes, so are the books that define and explain those drugs - and their uses. New editions supplant older editions at relatively short intervals. A modest amount of sweet-talk should result in your friendly neighborhood pharmacist giving you one of his superfluous copies. Like the old edition of your telephone book, it’s "out-of-date", but - like Ivory soap - it’s still 99-44/100% pure. And you should be able to get your copy free. Or (another medical joke) you need a different drug store. I consider these books imperative for anyone who is living outside reasonable travel radius from reliable medical attention and/or a formal medical facility. Beyond just buying or otherwise acquiring these books, I urge you to familiarize yourself with their contents before you need to use them. If somebody arrives on your "boonie" doorstep on a dark night, with a severed tibial artery squirting blood, you will not have time to get Cecil’s Handbook off the shelf and read up on suturing an artery and putting a trustworthy compression bandage on it. Trust me on this one. Yet this is precisely how these midnight dramas play themselves out. Most of the accidents in this world take place during the darkness hours. Except involving cats. Cats see great in the dark. But people, no. Somebody goes out to chop a few pieces of firewood, in the dark, and he (or she) instead, chops an artery. They come looking to you for help, because it’s twenty - or two hundred - miles to the nearest "real" doctor. That’s much too far to walk with arterial bleeding. Get the picture? So, Good Luck! Tools of the trade: Beyond the books. You are going to need some stuff to work with. Not much, but some.Here is what I routinely take with me when I head for the wild and wooly precincts scattered around my "beat." Alcohol, Merthiolate, germicidal ointment, petroleum jelly, and boric acid powder, topical analgesic salve, calomine lotion. Sterile gauze in both rolls and in swab squares, Q-tips, tongue depressors, adhesive tape in several widths, supportive cervical "horse-collars, in two or three sizes, two or three gauges of urinary catheters. (One size does not fit all.) Heavy, medium and fine gauge sutures with needles attached. (You can sew flesh and skin with regular needle and thread, but neither you nor the patient will enjoy it at all.) Two or three handles and an assortment of detachable scalpels, or (cheaper) a couple of hobbyist-type Exact-o knife sets. (Metal. They must be boilable for purposes of sterilization.) Injectable (local) anesthetic (I prefer Xylocaine) because it works well in a deep cut, where it can be applied via a well-saturated strip of gauze for preliminary desensitizing, followed by infusion (injection) to whatever degree required to control the scream factor. Any of several "cuff" arrangements principally used for measuring blood pressure in the brachial artery (upper arm). This quite simple device can be used for lots of things, depending on your own acquired skill with it. Basically, it measures changes in blood pressure between the diastolic and systolic circulatory modes. (When there are no discernible changes between the high and low readings, you may have installed the cuff too loosely, or perhaps your patient is dead.) (This is another medical-type joke.) Stethoscope. This familiar device allows you to hear things you can’t hear with the naked ear. ( This is a medical-type joke, also. Generally speaking, medical jokes aren’t very funny. Like this, more or less.) Specialized flashlights to look up noses, into ears and down throats.(Or vice-versa, and not necessarily in any particular order of precedence.) Scissors, tweezers, rubber (plastic is better) gloves. Small rubber hammer. (This device has no very important role to play in either tropical or traumatic medicine, but it does provide amusement for small children.) Anything else that you think might be useful. The name of the game in bush medicine is improvisation. You can make splints out of tree limbs; crutches out of half-inch water pipe. A couple of sawed off and strung-together water-skis make a quite serviceable carrying litter, if you don’t happen to have a stretcher. Innovate. Make do. Improvise. There's no other way in the "bush." IMPORTANT NOTE: Do not, by any means, consider this list complete. You will be expanding it and refining it to meet your own needs and skills, for as long as you continue to inhabit those "faraway places with the strange-sounding names." Or until somebody builds a hospital - with an Emergency Room - right in your immediate area, whichever comes first. In the meantime, however, Good Luck. You’ll be needing it! L. D. B.
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