FIRST AID TO THE INJURED.
ST. JOHN AMBULANCE ASSOCIATION.
Under the Patronage of HIS GRACE THE DUKE OF MANCHESTER, K.P., And the Chapter of the ORDER OF ST. JOHN OF JERUSALEM (ENGLISH LANGUE).
Central Execmtive Committee, cousisting exclusively of Members and Associates of the Order. Ohairman:
Sir ED}lUND A. R. LECR:lIEItE, Bart., M.P., F.S.A. (Secretary, Order of Se. John).
Deput.ll Ohainnen:
Lieut.-Colonel FRA.NCIR R.A .• }l.A., D.C.L., LL.D.
JOHN FURl.BY, Esq.
V. BA.RRUiGTON KENXETT, Esq., M.A., LL.M.
LIONEl, S. BEALE, Esq., M.D., F.RS. ROBERT lIIAcT,RAN MACLE I.N, Rsq.
Maj('ll'-Gl'neral E. S. BURNABY, M.P. Major G. E. MAf,RT.
Captain ItUPERT C. F. DALLA. W. G. N. MANLEY, Esrl-, V.C. (Deputy
Captflin J. C. DALTON, It.A. Surgeon-General, ArlllY Medlcnl
Sir TnoMAS DICK-LAUDER, Bart. De[1flrtment).
General Sir H. C. B. DAUBENEY, PEnCY :lIITFOIlD, ESQ. K.O.B. (RecelYer, Order of St. SANDFORD Moomt, Esq., M.B., F.S.R. Jobn). (Surgeon-Major, A.M. D.).
Th e Itt. Hon. The EAIlL OF DUDLEY. EmlUND OWEN, Esq., F.RC.S.
HOBERT FARQUIlARSON, Esrj., :lI.D., A. HARFORD PEARSON, Esq., M.A., M.P. B.C.L.
PHILIP FRlu."K, Esq., M.D. Captain H. C. PRRROTT (Assistant EDWIN FU.ESllFIELD, Esq., M.A., Secretary, Order of St. Jobn).
WES FRESIlFIELD, Es'l., M.A. A. JULIUS POLLOCK, Esq., 111 U.
Major JAMES GILDEA (Assistant EDWAltD H. SmVEKIXG, ESfj., M.D., Almoner, Order of St. Jobn). F.S.A. TbeRL.lIon. The EARL OF GLASGOW. CnARLES SHlUMPTON, Esq., M.D. Sir BROOK KAY, B!lrt. STEWART Jj;sq. Colonell5ir HENRY B. LOCH, K.C.B. General The VISCOUNT 'l'J (AImone!', Orller of llnrtment). Lieut.-Colonel GOULD HUN'flm-WESSir WILLIAM MACCOR)[AO, M.A., F.S.A. (H.egi stl'nl', Ord('!' of F.R.C.S. Se. Jobn).
#{HfLor;-.j( :
OILief Secretary: T?'eaSl/1'el': Cr.ptl\ln HEI:lBERT C. PERROTT. Captain RUPERT C F. DAT.LAC: Assistctnt SU?'etar/J and Store-'.et'JjJel'. J. H. EASTERBROOK. ESQ.
ST. JOHN'S GATE, LONDON, E.C. Bankers: LONDO:q' AND WESTMINSTER BANK, LIMITED (Westminster Brtmcb), ], St. James's Square, London, S.W.
PART 1.
ANATmnCAL AND PHYSIOLOGICAL OUTLINES.
Section I. The Skeleton
II. The Muscular System
III. The Nervous System
IV, The Organs of Special Sense
v. The Blood and Organs of Oirculation
VI. The Organs of 'Voice and Respi.J:atiC'u
VII. The Organs of Digestion
vrn. The Organs of Secretion
IX. The Organs of Excretion
PART II.
MEDICAL AND SURGICAL OUTLINES.
OHAPTER I.
INSENSIBILITY : Oauses of ..
Method of Examination of Persons found Insensible Important Symptoms and their Indications
OONTENTS.
PAGE 4 7 7 9 11 20 23 24 25 27 28. 29
IMPORTANT DISEASES AND INJURIES OF THE HEAD:
Intoxication
Apoplexy
Epilepsy ..
Blood Poisoning
Opium. Poisoning
Shock or Oollapse
Ooncussion of Brain
Oompression of Brain OHAPTER III.
TREATMENT OF OASES OF Drowning
Hanging
Suffocation by Gases
SlIDstroke
General
•
VI OHAPTER II.
..
..
..
..
..
OHAPTER IV. HlE:r.rORRH.A.GE OR BLEEDING:
b:eatment of .. ARTERIAL : " Treatment of VENOUS: " " Treatment of " OAPILL.A.RY: " " Treatment of " INTERN.A.L : " " Treatment of PAGE 31 31 32 33 j 33 • 33 I 34 34 35 40 40 40 41 41 41 42 42 vii SITUATION OF TIlE MAIN ARTERIES OF THE BODY, .AND TIlEIR TREATMENT WHEN WOUNDED: Hremorrhage from head and face and neck 4.3 II armpit 43 FRACTURES: Varieties of Signs of upper arm .. fore-arm palm " thigh ham back of leg front of leg and instep sole of foot OHAPTER V. General b:eatment
of Skull Lower Jaw Oollar- bone Ribs Upper Arm Fore-arm .. Wrist and Hand .. Thigh Knee-cap .. Bones of Leg Foot and Ankle 43 44 44 44 44 45 45 45 45 46 46 47 48 48 48 49 49 49 50 50 50 51
of Fractures
CHAPTER VI.
Incised; Treatment of .. With Protruding Internal Organs: Treatment of Contused and Lacerated: Treatment of F(l)REIGN BODIES IN THE EYE " " " BURNS AND SCALDS: Treatment of FROST BITE: Treatment of BED SORES: Treatment of EAR
BITES FROM R.A.l3ID ANIMALS: Treatment of
Rules for Disinfecting Unoccupied and Occupied Rooms Rules for Preventing Spread of Infectious Diseases
viii
PA<JE
WOUNDS:
APPLIAJ.'<OES FOR TIlE RELIEF OF TIlE SICK AND INJURED. 52 52 52 53 53 54 54 54 55 THE ORDER OF ST. JOHN LITTER 55 STRETCHERS, AND HOW TO USE THEM 55 Rules for carrying 56 SPLINTS 57 PADS 57 BANDAGES 57 DRESSINGS 59 59 POULTICES 59 LEECHES 59 I I ix
DISINFECTION: Definition
CHAPTER VII. MATlJ:RI.A.L AND
CHAPTER VIII.
of Disinfectants
BATHS: Cold Cool Temperate Hot Medicated Disinfectant Alkaline .. POISONS: Definition
Classes
General treatment
Emetics .. CHAJ?TER IX. OHAP'l'EH. X. Substitute for Stomach Pump .. Arsenic Antimony .. Acids Alkalies .. Phosphorus Mercury .. Nitrate of Silver .. PAGE 60 60 61 62 64 64 64 64 65 65 65 lili 66 66 67 67 68 68 68 68 68 69 69
of
of ..
of
POISONS (continued): Gases
PREFACE TO FIRSrr EDITION
THIS brief Manual IS simply intended for nonprofessional readers. There is no attempt made to popularise Medicine or Surgery; the object is to furnish a few plain rules which may enahle anyone to act in cases of injury or sudclen illness, pending the arrival of professional help . LONDON, 30th October , 1878.
Narcotics . . Alcohol DEATH: Cases
of .. Appearances of INDEX CHAPTER XI. PA\iE 69 69 69 70 71 70 . . 73
of Sudden Causes
. 01
PREFACE TO REVISED EDITION.
THE excellence of the Handbook compiled by the lato Surgeon-Major Shepherd has been proved by its almost unprecedented sale. In the short space of three years twenty-eight thousand copies have been sold. The development of Ambulance work, however, has led to many valuable suggestions from members of the medical profession. The result has been the present revised edition of the Handbook, prepared hy a sub-committee of medical gentlemen who have had special experience as Lecturers for the St. J olm's Am bulance Association.
ST. JOHN'S GATE, CLERKENWELL, E. C • March, 1881,
INTRODUCTION .
AT the request of the :Members of the Central Ambulance Committee of the Order of St. John of Jerusalem, I have hurriedly arranged the following :l\1anual for the use of the Metropolitan Police ltnd the other Ambulance Classes now Ol'ganised by the Order of St. J olm in all parts of England.
The careful work which I should like to have bestowed has been rendm'ed impossible by the exigencies of the Service requiring me to proceed on foreign service.
I have been aideu by kind and able coadjutors, who have given their knowledge and experience.
-
I trust that this handbook, given cheerfully and gratuitously-like all the work conducted for and by the Order-wm be founel to be in some degree "PRO UTILITATE HOl\UNUM."
P. SHEPHERD.
JUNIOH UNITED SERYICE CLUB, S.\V., 30th OCtObC7', 1878.
xvi
B
ANATOMICAL AND PHYSIOLOGICAL OUTLINES.
THE HUMAN BODY.
I. SKELETON, or bony framework.
II. JOINTS, MUSOLES; the organs of motion.
III. NERVOUS SYSTEM; brain, spinal marrow, nerves of sensation and motion, and sympathetic nerves.
IV. ORGANS OF SPEOIAL SENSE; eye, ear, tongue, nose, and skin.
V. BLOOD AND ORGANS OF OIROULA. TION; heart and blood-vessels.
VI. ORGANS OF VOIOE AND RESPIRATION; larynx, windpipe, and lungs.
VII. ORGANS OF DIGESTION; pharynx, gullet, ::;tomach, and intestines.
VIII. GLANDS, SEORETING AND NON - SEORETING. B2
4
I.-THE SKELETON.
.The sk.eleton is composed of a central column, the spine, wIth whlCh connected three bony 'cavities: at the extremIty, the head; at the lower extremity, the pelYls; and between the two, chest or thorax.
Connected with .the chest ?,re the two upper limbs, 01' organs of prehenslOn; and Wlth the pelvis the two lower limbs, or organs of progression.
The Spine, or back-bone, is composed of a munber of segments, twenty-four of which are called true vertebr&seven of which occupy the neck or cervical region, tweh'e the back of thorax, or dorsal r egion, and fiye the loins or lumbar reglOn. Below the true vertebr& are the sacrnm, a large wedge-shaped forming the back of the pelYis; and the coccyx, or tail bone, called the false vertebr&. spine, as. a whole, forms a canal for the protectlOn of the spmal cord, and by Vlrtue of its munerous segments permits of free movement of the trunk.
The Head of face, of a large cavity above and behind It, the cramum, WhICh lodges the brain.
The Tho?'ax is a conical ca:rity, bOlillded in fr ont by the breast-bone or behind by the twelve dorsal vertebr.&, and laterally by twelve pairs of ribs and their cartIlages.
This cavity is completed by the intercostal muscles between the ribs, and below by the diaphragm-a large dome-shaped muscle which separates it from the belly or abdo?nen. 5
The thorax contains the heart and large blood-vessels, the two lungs, together with the gullet and some important nerves.
The Pelvis is the basin-shaped cavity which forms the lowest portion of the trunk; and contains the bladder, the internal O]'galls of generation, part of the intestine, and several great blood- ve sels and nerves. It is compo ed of foul' bones-
2 Innominate or halillch-bones.
I Sacrum or rump-bone.
I Coccyx.
Tho Abdomen, between the thorax and the pelvis, is a large cavity supported behind by the lumbar vertebr&, nnd enclosed by mnscular walls. It contnins-
Liver.
Stomach and intestines.
Pancreas or sweetbread.
Splecll.
Kidneys.
Many large blood-vessels and nerves.
The Uppe?' Limb consists of the shoulder, arm, fore-arm, and hand.
The is formed by the clavicle or colla?'-bone, and scapula 01' blade-bone.
The Clavicle, or collar-bone, marks the line dividing neck and chest, and rests on the sternum internally.
Tho Scapula, 01' blade-bone, lies on the back of the chest, is of a triangular shape, and forms the socket for the humerus or arm-bone.
The H1/mel'US, or bone of upper arm, extends from the shoulder to the elbow; above, it is jointed to the scapula, and below to the bones of the fore.arm.
In the fore.arm are two bones extending from the elbow to the wrist.
The mna is the larger and inner bone.
The Radius is the outer bone (side of the thumb).
The wrist, or carpus, is composed of eight small bones.
The hand consists of the ?netacCL?}>tLS ./ five bones and fourteen phalanges, three in each finger and h,i) in the thumb.
The Lowe?' Lirnb consists of thigh, leg, and foot.
The thigh.bone, or F emtLT, extends from hip to knee joint, both of which joints it helps to form.
The Pat eZlcL (knee. cap ) is a small oval bone which forms the prominent point of the knee.
In the leg are two bones extending from the knee to the ankle.
The Tibia is the main bone of the leg, on the inside of the limb, and forms the shin.
The Fibula is the small bone on the out,side of the lim b: the lower ends of the tibia and fibula, form pro. minent projections at the sides of the ankle.
The foot consists of the TCLrsus, seven irregularly.shaped bones; the M etata?'sus, five bones ; and fourteen Phalanges, two for the great toe, and three for each of the others.
JOINTS (ARTICULATIONS).
Bones are united together at joints. Where bones move on each other, the surfaces in contact are covered with ... I
smooth elastic gristle, called a?·ticular ca?·tiZage, and are bound together by very strong fibrous tissue called. liga. ments, which are lined by a smooth membran e secretmg a lubricating fluid (synovia).
n.-THE MUSCULAR SYSTEM.
The JJlnscles, or lean flesh, are formed of ,?undles of reddish fibres having the power of contractIon lilder stimulation, by which property all movements are accom. plished.
Muscular tissne is divided into two varieties: voluntary, actinO' under the control of the will, and involuntary, act. ing of the will.
Volunta?'Y Muscles are mainly founel in the limbs, head, and neck, and walls of the cavities of the trunk. They are usually fixed at their ends to bones by fibrous tissue, or tendons.
'I:he Involuntary are found in such organs as the heart, blood- vessels, stomach, and intestines.
lH.-THE NERVOUS SYSTEM.
The nervous system is composed as follows :{ I. Brain and 9 pairs of nerves.
(a.) CEREBRO.SPINAL SYSTEM 2. Spinal cord & 31 pairs of nerves. { 3. Ganglia and (b.) SYl\1PATHETIC SYSTEM nerves,
6
CEREBRO-SPINAL SYSTEM.
The Emin is the largest and most important lllass of n ervous matter; it is subdivided into-
1. Oerebrum.
2. Oerebellum.
3. Medulla oblongata.
The Oerebnt?n, or brain proper, consists of two similar oyoid masses, divided above by a deep groove, and united below.
It is the seat of the intellect, the emotions and the will. '
The Ce1"ebelZum" or little brain, lies at the back of the head; its function is to regulate the movements of the body.
The Medulla ObZongata is the upper enlaro-ed part of the 'spinal cord , Here SOllle crossing of the fibres takes place, so that injury or disease on one side of the head produf'Cs paralysis of the muscles on the opposite side of the body.
The Oereb?'al Ne?'v es consist of nine pairs; they are motor, sensory, or compound in their fUllctions , A motor nerve conyeys an impuls e from the brain to some muscle. A sensory ner\'e receives and conveys an impression or sensation to the brain. A compound nerve contains motor and sensory fibres, and is consequently possessed of a double flmction.
The Spinal CO?'d is a cylindrical column of soft nervous tissne, occupying the ycrtebral canal; it is about eio'hteen inches in length, extending from the braili to the JOhlS; it
gives off thirty-one pairs of nelTes from its sides. 1£ the cord is cut, all parts of the body helow are paralysed.
The Spinal N erv es are thirty-one in number, on each side; they arise from the spinal cord by two roots, an anteriOl' or motor, alid a posterior or sensory. They act as conductors, to and from the spinal cord.
SYMPATHETIC SYSTEM.
The Sympathetic System of double of small nervous centres or ganglia, whIch he along the SIdes of the spinal column; their branches freely with the cerebro-spinal system. They supply the lllvoluntary muscles, and their function is to control the inyoluntary muscular tissue; they govel1l the. bloo cl-supplr, nutrition of the body, and the secretmg and excreimg organs. Paralysis of these neryes of the blood-vessels of the parts to whICh they are chstnbnted.
IV. - THE ORGANS OF SPEOIAL SENSE.
The organs of special sense are-
1. Eye.
2. Ear.
3. Nose,
4. Tongne.
5, Skin .
The SPEOIAL SENSES have been termed Th e Five Gate1vays oj Knowledge, from the fact they receiYe transmit to the brain impressions regarumg smroundmg' objects through their nerves.
8
1 II 9
These organs are of complex structure, but essentially consist of special arrangement of nerve fibres.
The EYE is an optical instrument, and consists essentially of three coatings 01' tunics, and three humours or refracting media. These transparent media are so constructed that images of objects are focussed on a delicate sheet of nervous matter at the back of tIle eye.
The EAR, the organ of hearing, is composcd of three portions: an Extm'nul, Middle, and Inte1·ncLl. The external ear consists of a funnel, canal, or tube, and a drum or membrane at its inner end. The drum divides the outer and middle portions.
The middle portion or tympanum cOIDIDunicat,es with tho throat. The internal ear is the part where the filaments of the nerves are spread out to receive the vibrations 01' sounds.
Blows on the external ear, and concussions from gunshot and other explosions, are apt to rupture the tympanum or chum.
The NOSE, or organ of smell, is a double-chambered cavity, lined with a mucous membrane, over which is spread numerous nerve filaments, branches of the olfactory nervos, for the reception of odoriferous impressions.
The TONGUE, or organ of taste, is situated in the floor of the mouth. It is mainly composed of muscular tissue and is frecly supplied with blood-vessels and nerves. Its u'pper surface is studded with papillre. The nerve filaments are spread out over the surface of the tongue and back portions of the mouth.
The SKIN, or organ of touch, is the entire covering of the body; the modified skin (mucous memb'ranes) lining
passages also possesses this property. The nerve filaments end in small loops inside the papillre. The sense of touch is most delicate about the tips of the fingers and lips.
V.-THE BLOOD & ORGANS OF OIROULATION.
The BLOOD, or " 'riveJ- of life," is the most important and abundant fluid in the body j it is contained in the arteries, veins, and capillaries-is everywhere present-provides the tissLles with nourishment, and removes their waste products. The total quantity of blood is estimated at about one-twelfth to one-eighth of the weight of the body. Its colour in the arteries is bright red; in the veins dark purple.
Great loss of blood produces death; so also does any considerable change in its composition.
Blood in the Ii \ring body consists of minute cells called cO?7JuscZes and of fiuid, the liq'LLo?' sanguinis, and when drawn separates into a clot and a watcry fluid or senon. It contains water, red and wlJite corpuscles, albumen, fibriue, fatty matter, and gases, all of which, with the exception of the corpuscles, enter into the formation of the tissues of the body.
The organs of circulation are-
Ca.) HEART. { Arteries.
(b.) BLOOD-VESSELS. Oapillaries. \Teins.
The HEART is a hollow muscular organ Cenclosed in a sac called the pe?'ical"ditL1n), situated between the two lungs, and behind the lower two-thirds of the breast-bone,
10
11
projecting on each side, but considerably more to the l eft than the r ight. Below, it is .supported by the diaphragm. It is about the size of a closed fist, five inches l ong, and t hree and a half inches broad, and is divided into two halves- a right and a left-each side 01' half having two chambers, the upper the and the lower the ventricle.
The right side receives the impure blood, and drives it to the hmgs to be purified and returned to the left.
The left side receives the pure blood, and forces it through .the arteries to every region of the body.
The openings between the chambers and the mouths of the large vessels leading into or out of the heart are guarded by valves or trap·cloors, to prevent the blood from flowing in a wrong direction .
ACTION OF THE HEART. - The heart acts by alternately contracting and dilating, at the rate of seventy to eighty times per minute. The contraction of the two a.uricles is simultaneous, and is immediately followed by that of the ventricles.
BLOOD. VESSELS.-The blood circulates through a system of closed tubes, called blood-vessels-viz., arteries, capillaries, and veins.
The arteries convey the pure blood from the hea.rt to every part of the body, continually branching and dividing. They are usually founel in protected situations; they have thick strong' walls, and are particularly elastic
The capillaries are minute tub'l.des, into which the smallest arteries break up . They are found in close networks pervacling nearly every tissue of the body. Their walls are extremely thin, and allow of the escape of fluids of the blood for the nutrition of tho part in which they are contained.
12
.
• Z 0 H H <Q H P 0 H 0 0 H H P H :E UJ ... (f) >(f) -I c:( ii UJ ... 0: c:( ::E UJ ... CJ) >(f) (f) :::l o Z UJ > ",\.\\3V
The preceding is a rough tabular view of the course of the blood.
The veins commence by the union of the capillaries, and carry the implU'e blood to the heart.
CIROULATION.-The implU'e blood returns from the body through the veins, and enters the right auricle; the right auricle contracts and forces the blood into the right ventricle; the right ventricle then contracts and forces the blood through the pulmonary artery to the lungs, where it becomes purified. It then returns to the left auricle, which contracts and drives it into the left ventricle; the left ventricle now contracts and drives the blood through the arteries to the system generally, where it is conveyed by the capillaries into the veins.
THE ARTERIES.
The arteries are the vessels which convey the blood from the heart to every part of the body.
The Pulmonary Artery arises from the right ventricle of the heart, and carries impure blood directly to the lungs, from whence it is returned by the pulmonary veins to the left alU'icle. This constitntes the lesse1' or pulmonic circulation. The Aorta arises from the left ventricle, and carries through its subdivisions arterial blood to the body generally, from whence it is returned by the venrn cavrn to the right auricle. This constitutes the gTeate1' or systemic ci'rculation. The aorta and its branches resemble a highly ramified tree. The larger trunks are usually found in the most protected situations; the arteries terminate in the capillaries; and the veins begin in them.
DIFFERENCES BETWEEN ARTERIES AND VEINS!-
1. The arteries carry pure blood away from the heart.
2. The veins carry impure blood towards the heart.
3. Arteries, except the pulmonary, carry bright red blood. Veins, except t,he pulmonary, carry dark pnrple blood.
4. The walls of the arteries are stronger and more elastic, and have no valves, except where they leave the heart.
5. The walls of the veins are .thin, and have valves on their inner wall, which prevent blood from flowing backwards.
6. Some veins are quite superficial; the arteries lie more deeply.
7. The current is remittent in the arteries, slower and continuous in the veins.
PRINCIPAL ARTERIES.
The AORTA ari es from the left ventricle of the heart· it ascends for a short di.stance behind the sternum, backwards, and descends along the left side of the spine, through the chest and abdomen, until it is opposite the fourth lumbar vertebra, where it divides into the two iliacs.
The INNOMINATE ARTERY, a short trunk arising from the arch of aorta, extends upwards for about an inch and a half, and divides into the 1'ight carotid and 1'ight subclavian.
The RIGHT COMMON CAROTID is a hranch of innominate artery; the LEFT COMMON OAROTID
14
15
16
is a branch of the aorta. These two vessels ascend the neck, one on each side of the windpipe, to about an inch below the ang-Ie of the jaw, where they divide into the external and internal carotids. The course of each vessel is indicated by a line clrailn from the joint of the collar and breast bones (ste?'no-clavic?'bla?' a?·ticulation) , to the lobule of the ear.
The INTERNAL OAROTID commences at the clinsion of the common carotid, opposite the upper border of the thyroid cartilag-e, and proceeds upwards to the base of the skull, which it enters, and supplies the brain.
The EXTERNAL OAROTID is the outer branch of the common carotid; it proceeds upwards towards the ear, in front of which it passes on to the temple. It supplies various branches to the face, temple, and back of head.
The SUBOLAVIAN, on the rig-ht side, is a branch of the innomina,te artery; on the left side it is a branch of the aorta. They leave the cavity of the chest by passingtmder the collar-bones and over the first ribs, and terminate in the armpit by becoming- the axillaries.
The AXILLARY is a continuation of the subclavian; beg-ins at lower border of first rib; and, after crossing the armpit, ends in the brachial at the margin of the posterior fold of the armpit.
The BRAOHIAL is a continuation of the axillary; it lies well on the inside of the upper arm, and extends from the posterior fold of armpit to about an inch below the front of the elbow, where it divides into the radial and ulnar.
, The course of this vessel is indicated by the g-roove
along the inner bordor of the biceps muscle, where it can be felt pulsating-.
The RADIAL extends downwards along- the radial or outer side of the fore-arm, from a little below the bend of the elbow to the wrist; it hore winds rOlUHl to the hack of tho metacarpal bono of thumb; passes through between tho thumb and forefinger to the palm; and forms the deep palmar arch.
The ULNAR is the larg-er of tho two divisions of the brachial. It descends along- the ulnar or inner side to the wrist; and then, entering the palm, forlUs the superficial palmar arch.
The OOMMON ILIAO ARTERIES are formed by the bifurcation of the aorta; they pass dOWllwards and out. wards to the brim of the pelvis, where they divide into external and intol1lal iliacs.
Tho EXTERNAL ILIAO commences at the biflU'ca· tion of tho cornmon iliac, passes along the brim of the pelvis, and makes its exit from the abdomen at the middle of the fold of the g-roin.
The INTERNAL ILIAO is the inner clivision of the COlUmon iliac; it descends into the pelvis, and supplies the organs there.
. The FEMORAL, the continuation of the external iliac, descends along the inside of the thigh for two-thirds of its length, and then passes to the ba,ck of the thigh to become the popliteal. The course of the artery is indicated by drawing- a line from the middle of the fold of the groin to the inside of knee joint.
The POPLITEAL, a continuation of the fL'llloJ'ul] extends along the ba,ck of the lower third of the thigh to a c
17
18
little below the bee joint; it rtms down the midclie of the ham; and divides into the anterior and posterior tibial.
The TIBIAL, a branch of the popliteal, passes to tbe front between the two bones of the leg and descends to the instep, where it divides into brancbes for the toes. A line drawn from head of fibula to a point midway between the two projecting ankle-bones (malleoli) will be parallel to this artery.
The POSTERIOR TIBIAL is the other branch of the popliteal; it runs down the back of the leg, and, passing along the depression behind the inner ankle-bone, supplies branches to the sole of the foot.
The PERONEAL arises from the posterior tibial, passes down on the outside of the back of the leg, and divides into branches around the heel and outer ankle.
THE VEINS.
The veins are the vessels which serve to return the impure blood from the capillaries throughout the different parts of the body to the heart.
The PULMONARY VEINS are four in number; two for each lung. They carry pure blood from the lungs to the heart.
The SYSTEMIO VEINS return tho dark impure blood from the body generally to the right side of the heart.
Most veins, cbiefly tbose in the extremities, are provided with valves, to prevent the reflux of blood.
Veins are divided into superficial and deep; the former can be readily seen under the skin, the latter lie deeply.
and accompany arteries. The current iu the veins flows towards the heart, exactly the reverse of what ohtains in the arteries.
The veins stal'iing in the capillaries unite again and again till they form two large trtmks, the vence cavce, which empty themselves in the right auricle.
VEINS OF HEAD AND NEOK.-The internal jugulars, formed by numerous branches from the head, face, and neck, pass down from about the angle of the jaw to the inside of the chest.. and, uniting with the subclavian, form the innominate vein.
VEINS OF UPPER EXTREMITY are divided into a supmjiciaZ and a deep set.
The deep set correspond to and lie alongside the ,arteries. Tbe superficial set are the radial, ulnar, median, ba5ilic, and cephalic. The brachial receives the basilic, and forms the axillary. The axillary crosses the armpit, and becomes the subclavian at the lower border of first rib.
The SUBOLAVIAN vein is a continuation of the axillary, lies bebind the collar-bone, crosses from outer edge of first rib to behind sterno-clavicular j oint, and joins the internal jugular, to form the innominate.
Tbe INNOMINATE VEINS are two large trunks placed one on each side of the root of the neck; they unite together and form the supe'rior vena cava.
THE SUPERIOR VENA CAVA, formed by the main vessels from the upper half of the body, empties itself in the rig ht auricle.
VEINS OF THE LOWER EXTREMITY are divided into two sets, supe1jicial and Mep.
c 2
19
The superficial are the and exte1'llal saphenous. !he former begins about the instep and ascends on the lllner aspect of leg and thigh, is joined by numerous branches on its :vay, and joins the femoral just below the of the .the latter ascends the baek of leg to Jom the popliteal III the ham. The popliteal passes up the ham, and then through the substance of the thIgh to be.come the femoral lies alongside the artery m front of the thIgh III Its upper two-thirds.
The EXTERNAL ILIAC is the continul1tion of the femoral, and terminates by uniting with the internal iliac to form the CO?1MnOn iliac.
The INTERNAL ILIAO collects the blood from the organs in the pelvis.
The ILIACS, formed by the juuction of the exte1'llal and mte1'llal iliacs, terminate by uniting to f orm the inje?'iol' vena caVCt.
The INFERIOR VENA CAVA returns the blood to tho right ?f the (?'ight aU?'icle) from all parts below the. l!udnff. formed by the union of the two common lhacs, and Jomed by branches from the liver Jridneys, and other viscera,. '
VI.-THE ORGANS OF VOICE & RESPIRATION.
The organs of voice and respiration arcLarynx. Trachea. Bronchi. Lungs. 21
The LARYNX is the upper portion of the air-passage, and the organ of voice. It is situated between the trachea and base of the tongue in the upper find fore part of the
neck, where it is felt as Adam's apple; on either side are the large blood-vessels of the neck, and behind is the gullet. The larynx. is a cartilaginous tube; and inside
20
this tube are placed two narrow, fibrous bands, the vocal cords, which are attached before and behind, with a chink between them for the passage of the air. The vibration of these bands during expiration produces the voice.
The TRACHEA, or wind-pipe, is a cartilaginous and membranous tube, extending from the lower part of the larynx downwards into the chest to its division into the right and left bronchus-it lies in front of the neck, anterior to the gullet.
The BRONCHI, right and left, one to each lung, are f ormed by the division of the trachea.
The LUNGS are the essential organs of respiration; they are two in number, one in each side of the chest, having between them the heart, blood-vessels, bronchi, and gnUet. The lungs are enclosed in double sacs or coverings, termed pleurce, and are composed of a light spongy texture for the ramifications of the bronchial tubes, the pulmonary arteries, and the pulmonary veins.
The bronchial tubes, after dividing and subdividing, terminate in minute air-cells, over which is spread a network of blood-vessels. It is in these minute blood-vessels that purification of the blood takes place, " venous" being converted into "arterial" blood. Carbonic acid and watery vapour pass from the blood into the air-cells, and oxygen passes from the air-cells into the blood.
MECHANISM OF RESPIRATION.-During an inspiration the chest is enlarged by elevating the ribs and depressing the diaphragm; and during an expiration the chest is diminished by depressing the ribs and elevating the diaphragm. The object in artificial respiration is to imitate the natural action.
23
The average capacity of the lungs is 250 cubic inches. The amOlmt of air (tidal air) taken in and passed out with each respiration is about 30 cubic inches.
Respiration takes place about 18 times per minute.
The VITAL CAPACITY is the greatest volume of au' that can be expired after the deepest possible inspiration.
YII.-THE ORGANS OF DIGESTION.
The organs of digestion consist of the .Alimentary and certain accessory organs. The AlIm entary Canal IS a musculo-mem branous tube, about thll,ty feet in length, and comprises the following payts:-
Mouth.
Pharynx (back of throat) . (Esophagus (gullet).
Stomach.
Small intestines.
Large intestines.
The MOUTH, an oval-shaped cavity, contains the teeth, tongue, palate, and ducts of the salivary glands .
The PHARYNX lies at the back of mouth and top of gullet, behind the root of the t.ongue and laJ:ynx.
The (ESOPHAGUS, or gullet, extends from pharynx to stomach, and is about nine inches long; it lies behind the windpipe, and in front of the spine and aorta.
The STOMACH is a pouch-like enlargement of the alimentary canal j it lies ehiefly on the left side of body, under the diaphragm, with the liver on it::; right and the
22
spleen on its left side. The stomach is the chief organ of digestion.
The SMALL INTESTINE is the continuation of the beyond the stomach; is a very tortuous canal; and is JOllled below to the large intestine.
The LARGE INTESTINE is a continuation of the slllall intestine; it, asccnds from a point near the rig-ht haunch-bone on the right side, crosses the abdomen lIDder the liver and stomach, and then descends on the left side and opens on the surface at the anus. '
VIII.-THE ORGANS OF SECRETION .
Secretion is the process of elaborating special products from the blood, as saliva, bile, pancreatine, etc., to be further used in the economy. The Organs of Secretion Rl'e-
Liver, Pancreas, Salivary glands,
. Mucous crypts and glands, and others which need not be specified.
!he LIVER is a large reddish-brown organ situated tbe false ribs on the right side of the body; Its IS about three to four pOlIDds.
It IS made up of lobes, lobules, and cells· it has a duct for conveying its secretion to its reser'voir-the gall bladder.
The GALL BLADDER is the reservoir for tIle bile ' it lies lIDder the right, lobe, and empties itself into intestinal canal below,
Ftmctions of the Live1· .-1. Secretes bile, which aids digestion and acts as a purgatiye. 2. Purifies the blood.
3. Elaborates albumen, fat, and sugar.
The PANCREAS, or sweetb1'eacl, is situated behind the stomach, in front of the spine; is made up of a n,umher of small lobes ; is about seven inches long; and weIghs ahout foul' ounces. Its duct leads into the intestinal canal. The pancreatic juice aids digestion.
The SALIVARY GLANDS are situated about the sides of the face, neck, and tongue, and their ducts enter the cavity of the mouth. Theil' flIDction is to secrete saliva, wliich keeps the mouth moist, and assists in the process of swallowing and digestion.
The SPLEEN is a ductless gland which lies on the left side lIDc1er the false ribs; its function is connected with the hlood in somo way which has not yet boen determined.
IX.-THE ORGANS OF EXCRETION,
Excretion is the process of elaborating special products from t,he blood to he thrown out of the syf5tem as useless. Such are carbonic acid, urea, and uric acid. The Organs of Excrotion uro-
Lungs.
Skin.
Kidneys.
The LUNGS haye been already doscribed; their ex. cretory function is to throw off carbonic acid and watery yapour,
24
25
The SKIN is the general covering of the body; it is composed of two layers-
Epidermis, cuticle, or outer layer.
Derma, or true skin.
The skin is porous, contains sweat and fatty glands, and a free supply of nerves and blood-vessels.
The skin excretes the sweat, and is the organ of touch. In health it possesses a temperature of 98 deg.
The KIDNEYS are two in number, one situated in each loin (small of back). Externally is a fibrous layer or covering; internally is a cavity communicating with a duct (ureter). The substance of the kidney consists of bundles of minute tubes. The ducts or ureters aescend along the back wall of the abdomen, to terminate in the bladder. The bladder is the reservoir for the urine.
The function of the kidneys is to excrete urine, and to remove certain impurities from the blood, such as urea and uric acid.
MEDICAL AND SURGICAL OUTLINES..
CHAPTER 1.
INSENSIBILITY.
Insensibility is the suspension of of animal life, except those of respiration and ClrculatIOn.
Ohief Oauses of Insensibility- .
Injuries to brain, compreSSIOn from fracture.
Diseases of brain, apoplexy, epilepsy, &c. . . Poisoning by narcotIcsmorphia, chloroform. . . Blood poisoning from kIdney dISease.
The above forms of insensibility are liable to be mistaken for drunkenness, and it ought to b.e remembered that these conditions may be complicated wI.th other and with the effeds of drink, and that no smgle s.I&"n call be relied on in forming a conclusion on the condItIOn of the patient.
26
EXAMINATION OF A PERSON FOUND INSENSIBLE.
When a person is found insensible the following directions are to be most carefully followed :--
1. Note the position of the body and its smrolmdings.
2. Obtain an information possible as to the cause.
3. Place the body on the back, with the head inclined to one side, the arms by the sides, and extend the legs.
4. Oompare the two sides of the body.
5. In examining the head, pass the fingers gently over the surface, and search for wounds, bruises, swelling's, or depressions.
6. Open the eyes, and ascertain if the surface of the eye-balls is sensitive to the touch, if the pupils; become small when exposed to light, and whether the pupils are large or small, and of the same size.
7. Obserye the state of the respiration, whether easy or difficult the presence or absence of snoring; and the odour of the breath.
8. Notice the condition of the pulse, whether strong or weak
9. Obsel've the general appearance and position of the limbs; and. mobility, crepitus, shortening 01' lengthening of the bones of the limbs.
10. Note the state of the ribs and collar-bones.
IMPORTANT SYMPTOMS AND THEIR INDIOATIONS.
OONVULSIONS occur in apoplexy, epilepsy, and diseases; and in digestive disorders, and teethmg III chilclren.
SHIVERING FITS usher in feyers, and danger during illness.
PULSE is wea7.: in cases of fainting, shock, collapse, and hffimorrhagc.
Ir 'regular in heart diseases.
Slow ancl labou1'ing in cases of and (useases causing pressure on bram.
PUPILS OF THE EYES aro fi xe cl ancl clilatecl in paralysis and apoplexy. .' . in size i.n serious. chsease or mJury affectino' one SIde of bram.
Oont?'actecl in cases of Opil:11l poisoning,. and congostion or inflammatIon of the bram.
VIOLENT FITS indicate insanity, drunkenness, hysteria, or epilepsy.
H1EMORRHAGE FROM EAR, OR FROM MOUTH, NOSE, 01' EYES indicates fractme of base of skull.
FLUSHED F AOE occurs in intoxication, apoplexy, and epilepsy.
GIDDINESS indicate stomach, liver, kidney, ot' brain disorders.
28
STE.RTOROUS BREATHING (loud snoring) is found ill apoplexy and comprcssion of brain.
DIFF.ICULTY IN BREATHING is a symptom of lunO' diseases, heart diseases, broken ribs, obstruction air-passages, or injury to the nervous supply of these organs.
is a.symptom of lung and heart diseases-irritatIOn of air-passages, and pressure on lungs or on their nerves.
DRAWING OF FACE TO ONE SIDE 1Are eviSQUINTING
dence of Par a-
FIXED CONDITION OF PUPILS (dilated) I y s i , dis-
IRREGULARITY IN THE SIZE OF /,ease or PUPILS injury of
the ner-
INTOXICATION.-Oause: Excess in ill·ink.
Symptoms Odour of liquor in breath. Insensibility . usually not complete. Patient can usually be N 0 breathing. Pupils of equal SlZe, usually dilated (large). Cornea senSItive to touch. Temperature of body 2° to 3° below normal. Pulse soft and frequent. No difference between sides of body, both being equally helpless.
Treatment . Emetics; cold water applied to head; to surface of body and extrcmities.
JTWITCHING OF THE MUSCLES ON vous sysONE SIDE OF BODY tem.
GAIT indicates disease or injury of the bram or spmal cord; or intoxication. CHAPTER II.
IMPORTANT DISEASES AND INJURIES OF THE HEAD.
The following conditions are of such frequent occurrence that their symptoms and should be clearly understood and remembered. 31
APOPLEXY.-Oause: Effusion of blood producing pressure on the brain.
Symptoms . Patient becomes suddenly insensible. Face flushed or very pale. Pulse full.
Breathing stertorous. Convulsions. Paralysis.
Treatment . Place body in lyin g-down positi.on, with the head raised. Undo clothing around neck. Apply iced or cold water to head. Not to give the patient anything by mouth.
30
Disease or disorder of braID.
Sympt01ns . Convulsions.
Foaming at llJouth.
Biting tongue.
Partial insensibility.
Breathing labolU'ed, pulse normal.
Face livid.
Treatntent . Prevent patient injuring himself. Raise the head.
HYSTERIA OR HYSTERIOAL EPILEPSY.-Atiso. ciated with other forms of hysteria.
Symptoms . Falls suddenly but cardully.
Oonvulsions, 01' 1'athe?' jerking of the head and body, partial insensibility, apparent but not real.
Treatrnerui . Cold douche to face.
SYNOOPE OR F AINTING.-Ocmses: Debility or mental shock.
Syl1vptOl1tS . Insensibility.
Face and lips pallid.
Pulse almost imperceptible.
Cold sweat over skin.
Treatnwnt . Oold douche to head and face. A little weak stimulant. Placc your hand behind the patient's hend, ancl press it clown between the knees. 33
BLOOD POISONING from kidney disease.
Symptol1tS .
Treatment . ConvLllsions-insensibility.
Twitching of muscles.
Delirium.
Breath has a urinous odour.
Signs of dropsy.
Hot air or yapolli' bath.
Actiye plU'gatiYes. Icc to head.
OPIDM OR MORPHIA POISONING.
Symptoms.
T1'ecdment . Stupor; pupils contractcd to a pin's point; progressive insensibility, which is seldom complete till con. yulsions or death OCClli'S.
Emetics - cold douche to head and chest - walking cxerci e - strong coffee-artificial rcspiration-shock from gnh-anic hattery.
SHOCK OR COLLAPSE.
OatGse Injmies to nervous system by blows, opemt,ions, fright, grief, lightning. Death may be instantaneous; recovery may be slow 01' rapid.
SY111,ptuJnS . Face pale and pinched, eyes dull.
Pulse almost imperceptibl.e.
Breathing very feeble; the functions of respiration and circulation are reduced to a minimum.
D
32
T1'eatment . Place patient in horizontal position, restore circulation and respiration, remove tight-fitting clothing from neck, apply warmth to surface of body and extremities; stimulants may be given cautiously in small quantities.
CONOUSSION OF BRAIN.-Oauses: Blows or falls on head.
Symptoms . External bruises, &c.
In Sl7'ght cases, patient lies motionless and insensible.
If roused, answers hastily and then relapses.
After a time becomes restless, and vomits, and recovers .
In severe cases, pati ent is profoundly insensible; surface pale and cold; pulse feeble; breathing slow and sighing.
T"eatment . Place patient on his back, with head slightly raised, in a dark, quiet room -apply warmth to surface of body and extremities.
COMPRESSION OF BRAlN.
Oauses Pieces of bone or hremorrhage pressing on substance of the brain.
Symptoms Those of apoplexy, following some injury to head, such as fracture of the skuU .
Treatment . The same as in apoplexy.
35 OHAPTER III.
TREATMENT OF OASES OF DROWNING, HANGING, SUFFOOATION BY GASES, SUNSTROKE.*
I.-DROWNING.-Send immediately for medical assistance, blankets, and dry clothing, but proceed treat the patient INSTANTLY, securing as much fresh au' as possible. . . .
'fhe points to be aimed at are-first, and the RESTORATION OF BREATHING; and secomUy, after breathllig is restored, the PROMOTION OF W ARJUTH AND CIRCULATION. . .
The efforts to restore life must be persevered 1ll until the arrival of medical assistHnce, or until the pulse and breathing haye ceased for at least an hour.
TREATMENT TO RESTORE NATURAL BREATHING.
Rule I.-To ?naintain a Free Entrance of Ai)' into the Winclpipe.-Oleanse the and nostrils; open the mouth· draw forward the patJent's tongue, <tnd keep it for;ard; an clastic band over thc tongue and under the chin will answcr this purpose. R emove all tight clothing from about the neck aml chest.
Rule 2.-To adjust the Pati ent's thc patient on his back on a flat surface, lllchned a lIttle
" The above directions are chiefly Dr. H. R. SILVESlTER'S method of restoriug the Appareutly Dead or aud have beeu approved by the Royal Medical and Ullll"Lu'glcnl 1::!0ClCty.
D
34
from the feet upwards; raise and support the head and shoulders on a small firm cushion 01' folded article of dress placed under the shoulder-blades.
Rule 3.-To imitate th e of B1·eathing.-
Grasp the patient's arm just above the elbow, and draw the arms gently and steadily upwards, until they meet above the head (this is for the purpose of drawing ail' into the lungs); and keep the arms in that position for two seconds. Then turn dflWll the patient's arms, and prcss them gently and firmly ior two seconds against the sides of the chest (this is with the object of pressing air out of the lungs. Pressure on the breast-bone will aid this).
Repeat these meaSUl'es alternately, deliberately, and perseveringly, fifteen times in a minute, lilitil a spontaneous effort to respire is perceived, immediately upon which cease to imitate the movements of breathing, and proceed to INDUCE CIRCULATION AND WARl\ITH.
Should a warm bath be procurable, the body may be placed in it up to the neck, continuing to imitate the movements of breathing. Raise the body for twenty seconds in a si tting position, dash cold water against the chest and face, and pass ammonia lilider the nose . The patient should not be kept in the warm bath longer than five or six minutes.
Rule 4 .- To excite Inspi?·ation.-During the employment of the aboye method excite the nostrils with snuff or smelling salts, or tickle the till'oat with a feather . Rub the chest and face briskly, and dash cold and hot water alternately on them.
36
TREATMENT AFTER NATURAL BREATHING HAS BEEN RESTORED .
Rule 5.-To incltwe ancl Wal'mth.- Wrap the patient in dry blankets and commence rubbing the limbs upwards, firmly and energetically. The friction must be continued under the blankets 01' over the dry clothing.
Promote the warmth of the body by the application of hot flannels, bottles or bladders of hot water, heated bricks, &c., to the pit of the stomach, the armpits, betwecn ihe thighs, and to the soles of the fect. Warm clothing may gcneTaily be obtained from bystanders.
On the restoration of life, when the power of s,'rallowing has returned, a. teaspoonful of warm water, smail quantities of wine, wnrm brandy-and-water, or coffee should be given. The pntient should be kept in bed. and a disposition to sleep encouraged. During readion large mustard plasters to the chest and belo,'v the shoulders will great.ly relieve the distressed breathing.
DIREcrrIONS FOR RESTORING THE APPARENTLY DROWNED.
The leading principles of the following Directions for the Restoration of the .A pparently Dead from Drowuing are foumlecl on those of the late DR. MARSHALL HALL, and are the result of extensive inquiries which were made by the Royal .r ntional Lifebont Institution in 1863-4 amongst Medical Mon, Meclical Bodies, and
37
38 qoroners throughout the United Kingdom. These DirectIons have been extensively circulated by the INSTITCTION the l!nitedKing-dom and in the Oolonies. They are muse 111 Her MaJesty's Fleet, in the Ooastguard SerVlce, and at all the Stations of the British Army at home and abroad.
I.
Send i:nmecliately for medical assistance, blankets, and dl'y clothing, but proceed to treat the patient instantly on the spot, in the open air, with the face downward, whether shore or afloat; exposing the face, neck, and chest to the wmd; except in severe weather, and removing all tight clothmg f,rom the and chest, especially the braces. The pomts to be aImed at are-first and the RESTORATION OF BREATHING' and secondly afte;' breathing is restored, the OF W AND OIRCULATION.
o The. efforts to 'restaTe Breathing must be commenced lI)1mediatelyand energetically, and persevered in for one 0,1' ho?-rs, or a medical man has pronounced that life IS extmct. Efforts to promote WaTmth anCi. Oi?'culation, beyond removing the wet clothes and drying the skin must J?-ot be the first appearance of natural breathmg; for If CIrculation of the blood be induced before breathing- has recommenced, the restoration to life will be endangered.
II.-To RESTORE BREATHING.
To OLEAR THROAT.-Place the patient on the floor or ground WIth the face downwards, and one of the arms under the forehead, in which position all fluids will
39
more readily escape by the month, and.the vlrill fall forward, leaving the entrance lUto the wmdpIpe free. Assist this operation by wiping and cleansing the month.
If satisfactory breathing commences, u e the treatment described below to l)rOnlOte Warmth. If there be ouly slight breathing-or no breathing-or if the breathing fail, thcn-
To EXCITE BREATHING-Turn the patient well and instantly on the side, supporting the and the nostrils with snuff, hartshorn, ltnd smellmg salts, or tIckle the throat with a feather, &c., if they are at hand. Rub the chest and face warm. and dash cold water, or cold and hot water alternately, on them. If there be no success, lose not a moment, but instantly-
To IMITATE BREATHING-Replace the patient on the face, raising and supporting the chest welt on a folded coat or other article of dress. Turn the body very gently on the side and a lit.tle beyond, and then briskly on the face, back again, repeating these measures cautiou Jy, efficiently, and perseveringly, about fifteen tim.es in the minute, or once every four or five seconds, occasionally varying the side. (By placing the patient on the chest, the ?f the body fO?'ces the ai?' out; when tu?'ned on the stde, thts p?'essure is removed, and ai? ' enters the chest.)
On each occasion that the body is replaceCi. on the face, make uniform but efficient pre sure with brisk movement, on the back between antI below the shoulder-blades or bones on each side, removing the ploessure immecliately before turni.ng the body on the side, During the whole of the operations let one person attend solely to the move· ments of the head and of the arm placed under it.
40
(The fi"st the second cornmences tnsp11·cdwn.) '1'lle Result is or Natu1·.aZ B1·eathing,. and if not too late, Life .
Whilst the ahove operations are being proceeded with dry the hands and fect, and as soon as dry clothing 0;' hl,ankets can he pr.ocured, the hody, and cover or gIadually re-clothe It, but taking care not to interfere with the efforts to restore hreathing.
II.-HANGING.-Remove all constrictions from neck and and employ artificial respiration as for drownmg. '
III.-S.UEF.OOATION . BY GASES. -Remoye the 111:0 all', and employ al hficial resplratlOn, as III drownlll O i use galvanic hattery. b should he applied to tllC head , whIch should he kept well raised. Tight clothing should he removed from the neck and chest. StilllUla'lt.. should he avoided.
CHAPTER IV .
H.i£MORRHAGE.
HffilllOl'l'hage, or hleeding, is the result of the opening of a hlood-:vessel hy a wound or otherwise. It may he external or m ternal .
into-I, A1'i81'iaZ, where the hlood flows III Jcts III great force, and is of a hright red colour. 2, Venous, where it flows slowly-wells
41
out-and is of a dark, purple hue. 3, Capillary, where there is a general oozing of red blood from the surface.
GENERAL TREATMENT OF HlEMORRHAGE.-Pl'eSsure is the most powerful means of arrest.ing extel'llal hremol'rhage i and to use it effectively, it is important that the pressure should he directed against some hone as a point of resistance.
In all portions of t.he hody where special treatment, is not specified, direct pressure to the wounded part \TIlI be sufficient to arrest hffilllOl'l'hage t.ill fudher assistance can he procured.
ARTERIAL HlEMORRHAGE is the mo st importaut and the most dangerous form of bleeding, and not a moment ought to bc lost in giving help .
T1·eatIlLent.-1. Exposc and examine wOlmd. 2. Wash with cold water. 3. Elevate the bleeding part, but place body in the lying-dowll position.
.t, Apply prCSSlU'e with the fingers directly over the mouths of the bleeding vessels till you can get fmther help.
5. Apply pressure to the main artery on the heart side, with the fingers or with a pad and bandage (tomniquet).
6. Apply a pad and handage oyer wound as an additional safeguard.
VENOUS H1EMORRHAGE may occur along with arterial, or by itsclf. A superficial wOlmd is more
42
likely to divide veins than arteries. Dangerous venous bleeding often takes place where the patient has varicose veins and ulcers on the lower limbs.
(The direction of the flow of blood-towards the heart-just the reverse of what obtains in the arteries is a fact which bears on the treatment.) ,
Treatment.-l. Expose and examine wound. 2. Wash well in cold water. 3. Elevate limb, keeping body in lying-down position. 4. Apply a pad and bandage on both sides of wound. 5. Remove any pressure or r estriction to the circulation on the heart side, such as tight clQthing (this cannot be done where arterial bleeding has also to be treated).
CAPILLARY H1EMORRHAGE is easily controlled.
Treatment.-I. Direct pressme to the bleeding surface. 2. Application of ice or of styptics, such as alum, steel drops, cl1ustics, &c., &c.
INTERNAL H1EMORRHAGE is seldom so rapicl, except in cases of bursting of an aneurism, as not to give time for skilled aid.
Treatment.-I. Place patient in an easy recumbent position. 2. Apply ice to, or as near as possible to, the part affected.
3. Sucking ice is useful in bleeding about mouth, throat, or air-passages.
43
SITUATION OF THE MAIN ARTERIES IN THE DIFFERENT REGIONS OF THE BODY, AND THEIR TREATMENT WHEN WOUNDED.*
REGIONS.
HEAD. NECK.
SITUATION OF VESSELS. TREATMENT.
Temporal, in front of ear. Compress over P. Att1'icular, back of ear. the wound, anci
Occipital, back of head. bandage.
Carotid Aderies ascend Digital compresin a line from inner sion in line of ends of collar-bones to vessels above angles of jaw. and below the wound, or directly into wound on the mouths of the bleeding vessels.
ARMPIT.
UPPERl
ARM.
AxiLZa?'y A?,tery lies across Compress subhollow space of armpit. clavian artery behind middle of coIl ar- bone, or digital pressme into the wound.
B?'achial A?"te?'y lies on Compress artery inner side of arm, in by a tourniquet a line with seam on above wound. coat sleeve-from inner fol<1 of armpit to mi<1dle of bend of elbow.
... Wounded veins sbonld be treated according to rules laid down under" Venous Hremorrhage."
REGION.
FORE -ARM
PALM OF HAND.
THIGH.
HAM.
44
SITUATION OF VESSELS.
Radial ancl UlnCL1' A1,teri es begin a little below the midcUe of bend of elbow, and des cend one on each side of the front of the arm to the wrist.
TREATMENT . Compress brachial artery in the uppor arm by a tOUl'niCluet, 01' place a pad in hollow of elbow, and bend fore-arm against arm .
Raclial ancl Ulna?' A.1't eri es Apply two small give a number of firm pads to branches , which spread a l' t e l' i e sat out aud supply the wrist, or forcipalm. bly close and fix hand over a piece of stick or hard subs tan c e, a n cl bandage.
Feln01'al A1·t el'Y , from Pressure at midmiddle of fold of groin dle of fold of runs down the inside of groin, with t,he thigh in its upper two- fingers or by thirds. t 0 urn i que t above wound.
Poplit eal A1·t e1'y lies along Compress poplimidcUe of ham. tea 1 art e l' y above wound, or compress femoral art,ery in front of thigh by tOUTniquet.
REGION. BACK OF LEG.
FRONT OF LEG AND INSTEP. SOLE OF FOOT, 45
SITUATION OF VESSELS.
Post. Tibial and Pm'oneal A 'rte1'ies descend the hack and outside of leg from below ham, passing behind ankle-bones.
TREATMENT. Compress at ham or in front of thigh, or double leo' on thigh with a pad in th e ham,
Ant e)'. Tibial Arte1'Y de- Compress artery sce11(ls alon 0' middle of above wound. front of leg b and instep.
Post. Tibial and Pm'on eal Oompress bl a descend behind ankle- pad b e h I n d bones; the former sup- inner plies branches, which bone; if thIS spread out on sole of place pads foot. behind outer
OHAPTER V.
FRAOTURES. aukle-bone, and on middle of front of ankle ,
Fractures, or broken bones, IDay be divided into four classes :-
1. Simple Fracture; a simple break,
2. Oompound Fractme; a :flesh wound communi. eating with the broken ends of the bone.
3. Oomplicated injul'i.es to soft, parts, blood-vessels, nerves, 01' Jomts, or mternal olgans.
4. Comminuted Fracture; smashing of bone into pieces.
A fractme may take place transversely obliquely, or longitUdinally. '
Fractures are caused by violence.
SYMPTOMS OF FRACTURE.
The symptoms of fracture are-
1. Inability to use the limb.
2. Alteration in shape and o-eneral appearance.
3. Unusual mobility at seat of fractur e .
4. Crepitus or crackling on placing one hand over the broken part, and creating motion with the other.
S. Shortening of limb.
6. Some inequality felt on mnnIDo' the fino-ers along the surface of the injured b
Fractures are di stingui s h ed d is locations as follows ;-
FRACTURES.
Crepitus.
Unnaturally movable.
Easily replaced.
Lim b often shortened.
Seat of injury in the shaft or body of the bone.
DISLO CATIONS.
No crepit us.
More or Jess fix ed.
R eplaced with difficulty.
Limb may be shortened. or lengthen ed.
S eat of injury at a joint.
TREATMENT OF FRACTURES.
1. Reduce the fractured ends or portions to their natural position.
2. Retain them immovably in their proper places till nature has effected a permanent cure.
There is no urgency about treating a broken lim? :pr?vided no attempt is made to move the person, but if It IS imperative that the patient be in the absence of a suro-eon, it is an absolute necessIty to secure the safety of theP">limb by putting it in splints before removal.
A stretcher is the only safe means of com-eyanco for cases of fracture.
Unskilful handJino- may cause either serious mischief or even loss of life; dangers are pressing the sharp ends through the skin, and thus making the fracture con;pound, or through blood·vesEels, nerves, or into some mternal organ, such as the lungs.
SPECIAL FRACTURES.
FRACTURE OF THE SKULL.
Causes.
Treatment. Blows or falls.
External signs not always present. In fracture of the base there may be halmorrhage from ear, mouth, or nose; r ed patches of blood under conjunctiVal of eyes; and oozing of watery fluid from the ears.
Accompanying these there may be symptoms of concussion, or symptoms of compression.
Place pati ent in a dark and quiet room on his back, with head slightly raised.
ApJ:>ly cold to h ead as soon as reaction sets in and patient g ets hot and feverish.
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FRACTURE OF LOWER JAW.
Causes. Direct blows; falls on chin.
Symptoms. IrreguJal'ity in the line of the teeth and the outline of the lower margin of bone; inability to move jaw.
Treatment. Fix lower jaw to upper jaw by a band. age.
FRACTURE OF COLLAR.BONE .
Causes. Blows on shoulder; falls on elbow or hand.
Symptonts. Shoulder chops.
Arm is helpless.
Irregularity on drawing finger along . surface of bone.
Patient inclines head to the injured side, nnd supports the elbow with the sound hand.
Treatment. Place a pad in armpit, bind arm to side just abo-ve elbow, and sling fore.arm.
OF RIBS.
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FRACTURE OF THE HUMERUS.
Gauses. Direct blows, falls on elbow.
Symptoms. Mobility at seat of fracture. Crepitus.
Shortening, usually present when frac. hue is oblique.
'Jlreatmerd. Apply a roller bandage from hand to elbow, a.bduct arm and apply three or four sj)liuts from houlcler to elbo,,·.
Support arm in a sling.
FRACTURE OF THE FORE·ARM.
Causes. Direct violeut blows, falls.
Symptoms . Crepitus.
Mobility.
Alteration in shape of arm.
'lJ/·eatment. Semiflex fore-arm with thumb pointing upwards. Apply two splints, one in. side from bend of elbow to the tips of the fingers, and one outside from elbow to m'ist.
Causes.
SY1nptoms. T1'eatntent. Blows, falls, weight passing over chest or back.
The splints should be well padded. Place arm in sling.
FRACTURES ABOUT WRIST .AND HAND.
Catching pain and difficulty in breath. ing, which is jerky and shallow, and crepitus when patient coughs.
Apply a broad roller bandage firmly round chest, so as to prevent all movement; or strap the injured side with adhesive plaster.
Ca'u,ses. Blows or other injuries.
Symptoms. Pain, swelling.
Irrcgularity in the outlinc of the bones. Crepitus.
Treatment. Bnndage to n fiat boanl 01' splint, and support by sling.
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FRAOTURE OF FEMUR OR THIGH-BONE.
Oauses. Blows, falls.
Symptorns. Pain and loss of power.
Orepitus.
Shortening. Broken ends may be felt.
Foot turned out.
Treatment. Extend the limb, apply a long splint on outside alOlJg the whole side, from the armpit to the outside of the heel, and another on the insido of the thigh, from top of the inside of the thigh to the knee.
FRAO'l'URE OF PATELLA OR KNEE-OAP.
Oauses. Blows, or excessive muscular action.
Symptoms. Inability to stand npon leg.
Fragments can be felt.
Treatment. Raise bmb on a splint to a position oblique with the body, and apply a figure-oi-eight bandage around the knee, including the fragments.
FRACTURE OF BONES OF THE LEG.
Oat£ses. Blows, falls, crushing weight, such as wheels passing over the limb.
Symptoms. Pain and loss of power.
Alteration in shape.
Crepitus.
Broken ends may be felt.
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Treatment. Apply two splints, one inside and one ou tside the limb.
Elevate limb.
FRACTURES ABOUT FOOT AND ANKLE.
Oauses. Blows or other injuries.
Symptoms. Pain, swelling.
Alteration in outline of bones. Crepitus.
Treatment. Elevate foot; apply cold water.
Before applying any splint, be careful to pad it well with some soft material, as tow, wadding, cotton-wool, &c.
N.B.-It must be remembered that the treatment for fractures here given is only temporary, to enable the patient to be moved without further injuries, which might result in the loss of the limb or even life, till a surgeon can be sent for.
The treatment for dislocations is pnrposely omitted, as being dangerous, except in the hands of a surgeon.
SPRAIN.
A sprain or strain is a twist or over-extension of It muscle or tendon or ligament about a joint, usually with rupture of some of its fibres and of small blood-vessels . In rheumatic people it is often followed by persistent pain.
T?·eairnerd.-If thore be great pain, a hot bath and fomentations with complete rest; later on, embrocations, friction, cold and warm douches, and passive movements are requisite, according to the severity of the accident.
E
OHAPTER VI. WOUNDS,
INOISED WOUNDS.
T1'eatment , 1. Wash the part carefnllywith water.
2. Arrest the hremorrhage.
3. Adjust the edges and fix in a natural position.
4. Place patient in an easy position, so as to ayoid straining the parts. In WOlllids of throat, salllLbags good supports for fixing head andlleck.
5. .Apply cold water dressing, or strips of adhesive plaster.
INOISED WOUNDS, WITH PROTRUSION OF INTERN.AL ORGANS.
T1' ecliment . Wash the parts carefully with warm wa l er, and }'ehlrn, unless they are mnch injmed, and place patient in a thorough state of rest.
In inoisd wounds about the face it is yery important to replace the wounded portions with as little delay as pO:3sible.
OONTUSED AND LAOERATED WOUNDS are more dangerous and Lrouhlesome to heal, besides being liable 10 erysipelas, gangrene, &c.
Treatment . "\.Vash . Arrest lu:emorrhage.
Replace parts in th eir nat ueal position. Apply cold water dressillg' s, and HOWl' flllow Lhem to get dry, .
FOREIGN BODIES IN THE EYE.-I£ the foreign body is nncler the upper eyelid, seat the patient in a chair, and standing hehind, placo a pencil oyer the lid j lay hold of the eyelashes, and (wert the lid. Then, having exposed tho suhstance, brush it off with the comer of a, handkerchief 01' a camel's hair 1lrush. 1£ it i uucler the lower eyelicl, simply depress it. and proceed as a13o,o with hanclkercruef or hrnsh.
FOREIGN BODIES IN THE EAR.-The eanalleacling to the inside of the ear is about an inch and a qnarter in lengtJl, and at the inner end of this clUwl is placed the drum of the ear-a very thin, delicate memhrane, resembling a picco of tissne pilpel'.
A blow on the cal' with the opell hanc1. 01' the concussion fr om the disC'hargo of firearms, is quite sufficient to l'llpturo aud destroy tbi::; mcmbrane. No interference, therefore, "'itll the ear, beyond using a syringc, should be attempted, except by a surgeon . Snch substances as of wax, pieces of slatc-pencil, insects, &c., may be remove 1 by syringing with tepid water. It will be well, however, to remember that peas and porou!; snbstan00s, which absorb moisture, wonld be rendered more difficult of removal after the usc of the Hyringe .
BURNS . AND
SOALDS.-A
burn is caused by concentrated heat, fire elirectly applied to surface, or chemical agents, destroying the skin and the tissues unelel'lleath.
A scald is proeluced by hot or boiling liquids touching the skin; tho cuticle is raised and the true skin reddened and i nflam etl.
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54
Besides their local action, hums and scalds are apt to produce dangerous effects by congestion of internal organs.
Treatment of -!1Lt?·rls .-Apply a mixture of oil and lime-water, olive oil, castor oil; and wrap up the part in cotton wool, wool, or flannel.
Treatment of Scalds.-Apply a stronO!"ly alkaline solution made with the of soda, . lime, or magnesia; and enclose the or part, in cotton wool, excludmg aIr as far as possible.
scars, causing deformity, burns; It IS therefore important to make the patIent lie m . a natural position, and avoid twisting the neck or doubling up the limbs.
is the result of exposure to severe cold.. The VItality of the pari is reduced to a. very low pornt, the part loses its natural colour and becomes blue or purple. '
Treatm,ent _ . about reaction gradUc'111y by fr!-ction . Place the patient in a room Wlthout a fire, and avoid heat. Rub the part with snow or other cold application, and administer brandyand-water carefully in small quantities.
BED are the result of pressure from lying in one They may be p?·evented by hardening the skin ?y it with brandy, salt.and.water. &c., adheSIVe plaster spread on leather, or the use of all- or water cushions .
BITES OF RABID ANIMALS.
Treatment . If possible, immediately apply a ligature on the side nearest the heart; bathe the wound with warm water, so as to encourage bleeding; scarify around it to the depth of a quarter of an inch; usc can tics, such as nitrate of silver or carholic acid.
The internal use of brandy and ammonia is necessary.
CHAPTER VII.
MATERIAL
.AND APPLIANCES FOR THE RELIEF OF THE SICK AND INJURED.
THE ORDER OF ST. JOHN LITTER is a combined stretcher and wheeled ambulance. It obtained the medal of the Sanitary Institute of Great Britain, as well as the prize medal at the Brussels Exhibition. It is the best of its kind, and is a most useful conveyance for sick anel wotmded in the field, for colliery districts, railways, or for street accidents . Metropolitan Police have recently adopted this as their regula,tion ambulance, and have placed It at their stations for the use of the public.
STRETGHERS.-A stretcher is simply a light portable bed for carrying the sick; it is composed of a framework of poles, with a piece of CttllVas stretched between them as a mattress.
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An improved folding stretcher is now issued by the St. J oln .Ambulance Association.
A variety of things will answer as substitutes for a stretcher-such as cloors, wiudow-shutters, ladders, 01' hurcllcs.
TO PLACE A MAN ON A STRETCHER WITH THREE BEARERS.
1. The three men fall in facing the feet of the injlU'ed man, and are numbered off from the right. Put .the foot of the st,retcher at the mun's hend. in a line continuous with his body.
3. Nos . 1 and 2, one at either side, locking hands tle. shoulders and hips, raise the patlCnt; cany 111m forward oyer the stretcher' and then lower him on to it. '
4 . No.3 takes charg? of . injlU'ed portion ( li-lnb or h ea d), ancl steadies It WIth a hand on either sicle of the wOllnd .
5. Nos. 1 ancl 2 then take their placcs at head and foot of stretcher, lift and cany off, while No . 3 walks at sicle of the stretcher as a safeguard to the patIent, and as a relief to No. 1 01' 2 if necessary.
RULES
FOR CARRYING A STRETCHER.
1. Oarry stretcher in hands, or suspencl it by straps over the bearers' shoulders .
2. Never allow the stretcher to be placed on the shoulclers. 57
S. Bearers to march in broken step, anclnot in time,
4 . Avoid all jolting, crossing fences, ditches, &c.
5. Pace to be about 20 inches .
6, In ascending, pat,icllt's head to be in front, and ill descending behind.
SPLINTS.-Splints are applia.nces used. in trc?'ting fractures, for snpporting the bones 111 theu' natural position till a ('mc is effected. . .
Tho materials chiefly used for making splillts arc wood, iron, pasteboard, leather; felt, 'wire tin and hark. Extemponsed splints may be umbrellas, walking-sticks, cigar -boxcs, folded newspapers, policemen's truncheons, anel soldiers' weapons, such as rifles, swords, or bayo?ets.
P ADS.- Splints should be .well padded with wool, eoti:on wool, tow, flannel, or lint.
BANDAGES arc usually made from unbleached caUco, flannel, linen, webbing, &c.
Bandages are used-
1. As supports to the different parts of the boely.
2. .As means of applying' pressure.
3. For fixing splints, dressings, &c.
4 . To allay muscular action.
The chief kinds of bandages are the roller bandage and the triangular bandage. .
A combination of s:plint bandage IS by saturating orclinary bandages mth plaster Pans, glue, starch, starch and gum, chaTh: and gum, or silicates of soac"\' and potash (glass .
These balldage-spl rnts, bcrng p ut on moist, and allowed
to dry, whilst they are kept in position, have the advantage of being very immovable, and well adapted to the surface of the parts to which they are applied.
ROLLER BANDAGES have certain convenient sizes, according to the part of the body for which they are required, as follows :-
For the fingers, -! inch wide and 1 yard long.
arm, 2! inches wide and 3 to 6 yards long.
l eg, 3 inches wide and 6 to R yards long.
chest, 4 to 5 inches wide and 8 to 12 yards long. head, 2t inches wide and 4 to 6 yards long.
In applying a ?'oZle?' bandage: 1. B egin from below and work upwards. 2. Insure that the pressure is uniformly and evenly applied. 3. Avoid wrinkles. 4. Bandage from within out,wards by the front. 5. Reverse on the fleshy side of the limb, and not over' the sharp edges of a bone. 6. Where the limb is of uniform thickness use the simple spin'al; where the limb thickens use the reverse spi1'al; and at joints use the figure-oj-eight.
The application of baudages is best learnt by a practical lesson.
ESMARCH'S TRIANGULAR BANDAGE is a triangular piece of unbleached calico; the lower border measures 4 feet, and the two side borders 2 foet 10 inches each.*
It can be applied in thirty-two different ways; it answers every purpose for temporary dressings or field work; and
* A triangular bandage, with figures illnstrating its use, can be obtained from the Order of St. J ohn.
the means ot mu,king one are alwu,Ys at hand, namely, a pocket,handkerchief cut diagonally III two. eli 0" Its application is so easy, that a look abram will enable anyone to use it in the manner mclicated.
MATERIALS USED IN DRESSING .are adhesive plasters, oiled silk, gutta-percha tIssue, lint, charpie, oakum, tow, cotton wool, &c. f
Adhesive plaste1's are used for the. of wounds in position, anu for fixing dressmgs m leu 0 bandaO'es. . d' ther
Oa:d silk and g'l.dta-percha tu;sue are use over 0 dressino's to retain moisture, to prevent the escape of liquid and to protect the part from any external impUl'ities.
STIMULANTS.
Th e stimulants in Ol'dinu,ry use are: tea, b.ee!tea brand and coffeo. Exte'rnally, Inchon, salts to mustard to extremities, cold affUSIOn, and slapping the face with a wet towel.
POULTICES.
The u se oI poultices is to apply and heat and moisture' they clean Ioul woumls, allay pam, dl:aw the . ul t" f the blood towards the surface from mtel'llal cnc a IOn 0 ". or ans and encouru,go suppm'atlOn m abscessot;. may be maclo from breac.l, linseed, or other meals; charcoal, mustard, carrots, &c., &c.
LEECHES.
In applying leochos, observe tho following rules :1. Thoroughly clean the part.
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2. Use an inverted wine-glass; 01', if to the inside of the mouth, use the leech-glass made for that purpose.
3. If it is necessary, bleeding may be further encouraged by usiug a poultice afterwards.
4. Take care that bleeding docs not become too an . event which may happen with c41ldrcn. If It docs, the hremorrhage may be arrested by exposing the part to the ail', and applying cold 01' prCSSlU'e.
CHAPTER VIII.
DISINFECTION.
The terms infecti01.LS and contagious (catching) applied to a disease signjfy that it is communicable from the sick to the healthy.
The following are the principal iniectious diseases :_ Eruptive fevers-measles, small-pox, and scarlet fever. Continued fevers-typhus, typhoid, relapsing and yellow fevers. Diphtheria, erysipelas, whoopingcough, and cholera.
DISINFECTANTS are materials used for the purpose of plll'ifying the ail', water, soil, &c., by removing 01' rendering inert certain noxious substances.
The most common patent disinfectants are :_
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Condy's fluid. Blll'nett's fluid.
Ledoycn's fluid.
Dougall's powders. Sirol'8 compouuds.
RULES FOR DISINFECTING AN UNOCCUPIED ROOM.
l. Closo every door and window, aud stop up every opetlinO' 01' cre\'iee with 01<1 rags or tow.
2. by any of the following :-.
(l.) By CHLORINE.- Place a 111 chfferent parts of the room, conta1ll111g a one part of common salt, one part ?f .0xHle of manO'unese, and two parts of 011 of vltnol.
(2.) By two drachms of in. It metal cup or yesscl, an.d a lamp 01 bumrug candle undel'llcath It tIll It oyaporatos. .
(3. ) By SULPHUROUS ACID.-Burn sulphur m sancers.
(4.) By NITROUS ACID sel"etral ctup.s into saucers 01' bas111s ' contarnmg 10 and inside the cups put two ounces of. mtrate of potash and one ounce of sulphnric aCId. .
(5.) By CARBOLIC ACID. -Place pure ca.rbohc acid in shn110w vessels arouU( 10 room.
3. Furniture a.nd floors to be well wn.shed or scrubbed with a solution of chloride of limo; latter may sprinkled with the powdered chloride of lIme or Dongall s powder.
4. Pap ers to 1)(' f1',)1n 010 walls, and the walls find ceilings to be \lhIte-washed.
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5: clothing to be disinfected by washing, boiling, .m an .oven, or e.xposure to the sun or before a fire, if a dismfectmg' establishment is not available.
6. Curtains and carpets are best disinfected by exposure to a h eat of from 200 deg. to 400 deg.
7. In extreme cases, destroy by fire all clothing, bedding carpets, &c. '
RULES FOR DISINFECTING AN OCCUPIED ROOM.
1. Maintain a proper state of ventilation by doors, windows, and outer openings.
2. Keep up a good fire in the room.
3. Use Burnett's fluid, or solutions of chlol'lde of lIme for utensils in room, closets &c. '
4. Disinfect all clothing, lillen, &c., before it leaves the room, laid down in rule 8, for preventing spread of dIseases.
5. room eautiously with either chlorinated lime or carbolic acid, placed in saucers in different parts of the room.
Be not to use gases or vapours too freely as to cause inconvenience to the patient,' by lrl'ltatlOn of hIS lungs or air-passages.
RULES FOR THE PREVENTION OF THE SPREAD OF INFECTIOUS DISEASES.
1. Decide to sending. the patient to a hospital or treatmg the cases m the house.
2. If a case for the hospital, apply to the Vestry for
a special conveyance, and do not under any circumstances employ a public carriage.
3. Mter the removal of the infected person, fumigate and disinfect rooms occupied (vide instructions for disinfecting unoccupied rooms).
4. If a case for treatment at home, clear the house as far as possible of all inmates except the attendants on the sick, and secure the services of a trained nursf'.
5. Remove carpets, curtains and all superfluous furniture.
6. If small-pox, vaccinate everyone in any way exposed to infection.
7. Allow as much fresh air as possible without Cl'eating draughts, and keep a good fire burning day and llight in the room.
8. Use disinfectant solutions in aU utensils and sloppails. Place soiled clothes and linen in a disinfectant solution before they are taken from the room. .
9. Open doors or windows are to be curtained with sheets kept moist with carbolic acid and water.
10. Drains sinks and closets to be flushed at least a day with disinfectants.
11. Every room that has been occupied by an infected person should be thoroughly purified before it is re-occupied.
DurinO' convalescence patients should have tepid or baths, medicated with SOIDe snitable cusinfectant, such as Condy's fluid or carbolic acid. '1'his is very useful in cases of scarlet fe,er.
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CHAPTER IX. BATHS.
The following are the principal kinds of baths :Bath. Water. Vapour. Ail'.
The Cold ... Cool... Temperate Tepid Warm Hot ... Derrrees Dt'gl'ecs. Degret'R.
33 to 65
65 to 75
75 to 85
85 to 92
92 to 98
98 to 112 90 to 100 100 to 115 115 to 140 96 to 106 106 to 120 120 to 180
'fhe COLD BATH chills the surface, contracts the blooel-vessels, forces the circulation from tho surface to . the internal regions, and checks perspiration; when not too prolongeel, and the indiviclnal is in robust hcalLh,. these effects are followecl by a reaction, and a pleasant feeling of warmth.
Its general effect on the system is bracing and tonic. The dangers are congestions of internal organs.
SHOWER BATH is similar to the colcl bath in its effects; probably somewhat more braciug.
COLD AFFUSION is the application of a stream of cold water from a height; it procluces a suclden and violent stimulating effect, and is useful for ing persons from states of drunkenness, hysteria, and pOlsomng. It IS sometimes useful for producing sleep in clelirium tremens or drunken mania.
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THE WET COMPRESS acts as a local bath, ancl gives a combination of effect; it first acts as a cold bath, and secondarily as a prolonged warm bath: its effects are vory soothing .
IOE AND ICED WATER applied loc.'llly procluce contraction of the bloocl-vessels, and drive the blood away from the part. They are useful for reducing swelling and inflammation, ancl arresting hremorrhage.
THE TEPID, WARM, AND HOT BATHS act as stimulants; they increase the circulation in the slU'face of tho body, relieve congested internal organs, and promote secretion and excretion. The repeatecl or prolonged use of hot baths has a very weakening effect on the body; they relax the tissues and weaken the nervous system .
HOT FOMENTATIONS are simply loral hot baths, and act in a similar way; they are useful for relieving pain.
ACID BATHS are useful in liver and malarious diseases.
Add three ounces of mtro-hydrochloric acid to thirty gallons of water, using a woodell tub.
DISINFECTANT BATHS should always be used during convalescence from infectious diseases, and for seyeral days before the invalid is allowed to join his family.
Add eight ounces of Condy's fluid to 16 to 30 gallons of water (tepid or warm).
ALKALINE BATHS are useful in cases of gout and rheumatism. Add a pound of carbonate of soda to 30 gallons of water. F
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N.B.-Persons in delicate health who cannot bear a cold bath may manage to do so by s-etting into warm or tepid water, and then lowermg the by this plan a sudden chllhng of the surface IS avoIded, and the benefits of a combined hot and cold bath are obtained with safety.
CHAPTER X. POISONS.
Poisons are substances capable of destroyjng life. They are divided into classes, according to their action on the body.
1. Ir't-itants destroy the tissues, and produce nervous shock.
2. Narcotics produce insensibility by their action on the bruin.
3. Narcotico-irritants c'ombine the action of narcotics and irritants.
Symptoms-Are the attack of vomiting '. cramps, pam m the stomach, or unconsciousness soon after partaking of food or drink.
Treatment.-The points to be kept in view in poisoning are:-
1. To get rid of the poison by encouraging vomiting.
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2. To counteract the effects of the poisons by antidotes, which will mechanically 01' chemically render the poison harmless.
3. To remedy the effects produced, and obviate the tendency to death by stimulants, artificial respiration, and exciting the excretory organs.
EMETIOS.-Emetics are remedies used for the purpose of causing vomiting. The safest and readiest areirritating back of throat with the finger or a feather; large draughts of tepid water combined with , a table. spoonful of salt or mustard; one or two tablespoonfuls of ipecacuanha wine in water; and twenty grains of sulphate of zinc in water.
AOIDS AND ALKALIES form antidotes to each other. The acids suitable for the purpose are vinegar, lime juice, and orange juice, mixed with water.
The alkalies are soda, potash, lime, and magnesia diluted with water.
ALBUMEN AND OILS will protect the gullet and walls of the stomach in poisoning by irritants. White of egg, milk, flour-and-water, salad oil, and castor oil may be used.
The STOMAOH PUMP cannot be used except by a surgeon, but a very good substitute can be found in a piece of gutta-percha tubing, pJ'ovided the patient is not in an insensible condition. Take t,hree yards of elastic gutta - percha tubing, about half an inch in diameter, make the patient swallow about 20 to 25 inches of it; raise the free end above bis head, and F 2
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pour down a pint of water, or as much as the stomach will receive. Then lower the free end, and it will empty itself; repeat the filling and emptying as often as you think necessary. This remedy is perfectly safe and effectual; it has been used by German physicians for disorders of the stomach with considerable success. The swallowing of the tube can be . done with the greatest facility, without assistance and without danger.
POISONS.
ARSENIC ANTIMONY (Butte'/' oj Antinwny and Ta?'ta?' entetic).
MINERAL ACIDS (Oil oj Vit 'riol, Aqv,a jo?'tis, Spirit oj Salt).
OXALIC ACID.
CARBOLIC ACID.
ALKALIES (Oaustic Potash, Soda or Li?ne).
PHOSPHORUS - (Rat Poison).
ANTIDOTES.
Emetics; milk; peroxide of iron; raw eggs; castor oil; salacl oil.
Encomage vomiting. Milk; tea; tanllic acid.
Encourage vomiting. Alkalies-solutions of soda; potash; lime; magnesia; whiting; wall plaster.
Olive oil.
Acids-vinegar and water; lime juice; orange juice in water; emetics; salad oils.
Encourage vomiting by large draughts of water. Large doses of magnesia in water. Avoid oils.
POISONS.
MERCURY SALTS (OO?'SUbli?nate, Oalomel).
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ANTIDOTES.
Encourage vomiting; white of eggs; flour and water; milk.
SALTS OF LEAD (Suga;;· Emetics and Epsom salts. oj lead, paint).
NITRATE OF SILVE&- Common salt and water. CAUSTIC.
IRRITANT GASES
(Ohlo'/'ojo?'1Y/, ).
PRUSSIC ACID .
STRYCHNIA .
NARCOTICS
MO?']Jhia). See page 33.
ALCOHOL
Fresh air; loosen dress; artificial respiration; dash cold water about face and neck.
Cold douche; smelling salts to nostrils; artificial respiration; brandy and ammonia.
Emetics; cold affusion' artificial respiration; brandy and ammonia.
Emotics; strong ooffee; cold affu sion: forced wa.lkingabout; galvanism.
Emetics; cold affusion; warmth to surface of body; a dessert-spoonful of vinegar in water.
OHAPTER XI..
MODES OF DEATH.
Death may occur in three different ways, according as it begins in the heart, lungs, or head.
1. syncope, as in hcenw f rrhage.
2. Lungs and air-passages-by asphyxia, as in d?·owning.
3. Head-by CO?1W, as in apopZexy. SIGNS OF DEATH.
The most obvious signs of death 3re-
Oessation of breathing-no movement of chest-no moist breath to dim a looking-glass placed before mouth.
Oessation of heart's action-no impulse against side or pulse beating in arteries.
Eyelids half closed, eyes dim and glassy, pupils dilated.
Jaws clenched.
Tongue appearing between teeth.
Frothy mucus about nose and mouth.
Fingers half-closed, and after a time, body rigid and surface cold. 71
OAUSES OF SUDDEN DEATH.
The chief causes of sudden death areApoplexy. Aneurism.
Hearl disease. Suffocation.
Injuries to the nervous system. Sunstroke.
Struck by lightning. Poisoning.
70
ACID BATHS, 65
" carbolic, antidotes to, 68
" oxalic, antidotes to, 68
" prussic, antidotes to, 69
Acids, mineral, antidotes to, 68
Acids and alkalies, 67
Adhesive plasters, 59
Affusion, cold, 64
Air, water, soil, &c., materials for pUl"ifying, 60
Albumen and oils, 67
Alcohol, antidotes to, 69
Alimentary canal, 23
Alkalies, antidotes to, 68
Alkalies and acids, 67
Alkaline baths, 65
Anatomical and physiological outlines, 3
Animals, bites of rabid, 55
Ankle and foot, fractures about, 51
Antidotes to poisons, 68
Antimony, antidotes to, 68
Apoplexy, 31
Arm (fore), fractUl"e of, 49
Anenic, antidotes to, 68
Arterial hrnIDorrhage, 41
Arteries, 14
Arteries, situation of, and treatment when wounded, 43
Arteries and veins, difference between, lij
BANDAGE and SPI,INT, comhination of, 57
Bandages, 57 " sizes of, 58
Baths, acid. 65 " alkaline, 65 cold, 64
" disinfectant, 65 " shower, 64
" tepid, warm, and hot, 65 " temperatUl"es of, 64
Bearers, how to place a mall on a stretcher with three, 56
Bed sores, 54
Bites of rabid auirnals, 55
Blood, composition of, 11
Blood and organs of circulation' 11
Blood poisoning from kidney disease, 33
Body, the human, 3
Bones, broken, 45
INDEX.
Bones of leg, fracture of, 50
Brain, 8 compression of, 34
" concussion of, 34 difficulty in i a symptom of, 30
Breathing, stertorous, 30
Broken bones, 45
Burns and scalds, 53
CANAL, alimentary, 23
Capacity, vital, 23
Capillary hremorrhage, 42
Carbolic acid, antidotes to, 68
Caustic, antidotes to, 69
Chill, how to avoid in use of bath, 66
Chloroform, antidotes to, 69
Circulation, organs of, 11
" . tabular view of, 13
Cold affusIOn, 64
" bath, 64
Collapse, 33
Collar -bone, fracture of, 48
Comminuted fracture, 46
Complicated fracture, 45
Compound fracture, 45
Compress, wet, 65
Compression of brain, 34
Concussion of brain, 34
Congestion of internal organs apt to follow burns and scalds, 5±
Contused and lacerated wounds, 52
Oonveyance, stretcher only safe means in cases of fracture, 47
Convulsions, 29
Cough, a symptom of, 30
DEATH, cases of sudden, 70
" causes of sudden, 71
" signs of, 70
Difficulty in breathing, a symptom of, 30
Digestion,. orgaJ?s of, 23
Diseases, infectious, 60
" "rules for preventing spreaJ. of, 62
Diseases and injuries of the head, 30
Disinfectant baths, 65
Disinfectants, 61
Disinfecting an occupied room, rules for, 62 .
Disinfecting an unoccuPIed room, rules for, 61
Disinfection, 60
Dislocations distinguished from fractures, 46
Dislocations, treatment of, dangerous except in hands of surgeon, 47
Dressings for wounds, 59
Drowning, 35 . . . .
Drunkenness,insenslbllity liable to be mistaken for, 27
EAR, of interference with, 03
" foreign bodies in, 53
Emetics, 67
Epilepsy, 32
Erysipelas, contused wounds, liable to, 52
Esmarch's triangular bandage, 58
Excretion, organs of, 25
Eye, foreign bodies in, 53
Eyes, pupils of: indications from, 29
FACE, flushed, 29
Femur, fracture of, 50
Fits, shivering, 29
" violent, 29
Flushed face, 29
Fomentations, hot, 65
Foot and ankle, fractures about, 51
Fore-arm, fracture of, 49
Foreign bodies in the ear, 53
" " "eye, 53
Fracture, comminuted, 46 complicated, 45 compound, 45 simple, 45
" stretcher only safe means of conveyance in cases of, 47
Fracture, symptoms of, 46
" of collar- bone, 48 of bones of leg, 50
" of femur, or thigh- bone, 50
Fracture of fore-arm, 49 of humerus, 49 of lower jaw, 48 of patella or knee-cap, 50 of ribs, 48
75
Fracture of skull, 47
Fractures, 45 about foot and ankle, 51 " about wrist and hand, 49
Fractures distinguished from dislocations, 46
Fractures, treatment of, 46
Frost- bite, 54
GASES, irritant, antidotes to, 69 " suffocation by, 40
Giddiness, a symptom of, 29
Gutta-percha tissue, 59
HAND AND WRIST, fractures about, 49
Handling, unskilful; danger of, in cases of fracture, 47
Hanging, 40
Hremorrhage, arterial, 41 capillary, 42 " from ear, mouth, nose, or eyes: indications of, 29
Hremorrhage, general treatment of, 41
Hremorrhage, internal, 42 " venous, 41
Head, diseases and injuries of, 30
Heart, 11
Hot bath, 65 " fomentations, 65
Huma,n body, 3
Humerus, fracture of, 49
74
ICE and ICED WATER, 65
Incised wounds, 52 , " with protru, sion of internal organs, 52
Infectious diseases, 60
" "rules . for preventing of, 62
Injmies and dlseases of the head, 30
Insensibility, 27 " causes of, 27 examination of a found insensible, 28
Insensibility: important symptoms and their indications, 29
Insensibility liable to be mistaken for drunkenness, 27
Internal h remorrhage, 42 " organs, diagram of, 21
Intoxication, 31
Irritant gasef:1, fIJltidotes to, 69
JAW, lower: fractme of, 48
KImrEY DISEASE, blood poisoning from, 33
Kidneys, 26
Knee-cap, fractme of, 50
LACERATED and contused wounds, 52
Lead, salts of, antidotes to, 69
Leeches, 59
Leg, fractme of bones of, 50
Litter, Order of St. J ohil, 55 76
Liver, functions of, 24
Lungs, 22, 25
MATERIAL and appliances for the relief of the sick and injured, 55. .
Medical and SmgIcal Outlines, 27
Mercmy salts, antidotes to, 69
Mineral acids, antidotes to, 68
Morphia, antidotes to, 69 " or opium poisoning, 33
Muscular system, 7
NARCOTICS, antidotes to, 69
Nervous system, 7
Nitrate of silver, antidotes to, 69
OILED SILK, 59
Oils, 67
Opium, antidotes to, 69 " or morphia poisoning, 33
Order of St. John litter, 55
Organs, internal, diagram of, 21 " of circulation, 11 of digestion, 23 of excretion, 25 of secretion, 24 of special sense, .9 . [20 " of voice andresprratlOn,
Oxalic acid, anticlotes to, 68
PADS, 57
Paralysis, indications of, 30
Patella, :n:actme of, 50
Phosphorus, antidotes to, 68
Plasters, adhesive, 59
77
Poisoning, blood, from kidney disease, 33
Poisoning, opium or morphia, 33 " treatment of, 69
Poisons, classifications of, 66 " and antidotes, 68
Poultices, 59
Prussic acid, antidotes to, 69
Pulse, indications of, 29
Pump, stomach, substitute for, 67
Pupils of eyes, indications from, 29
Pmifying air, water, soil, &c., materials for, 60
RABID .ANIMALS, bites of, 55
Rat poison (phosphorus), antidotes to, 68
Respiration, organs of, 20
Ribs, fracture of, 48
Roller bandages, 57, 58
Room, rules for disinfecting an occupied, 61
Room, rules for disinfecting an unoccupied, 62
SALTS OF LEAD, antidotes to, 69
Scalds and bmns, 53
Scars, causing deformity, often follow burns, 54
Secretion, organs of, 24
Sense, organs of special, 9
Shivering fits, 29
Shock or collapse, 33
Shower bath, 6'1
Silk, oiled, 59
Silver, nitrate of: antidotes to, 69
Simple rractme, 45
Skeleton, description of, 4 " diagram of, 2
Skin, the, 26
Skull, fractUTe of, 47
Sores, bed, 54
Special sense, organs of, 9
Splint and bandage, combination of, 57
Splints, 57 " extemporised, 57
Sprain, 51
Staggering gait, indications from, 30
Stertorous breathing, 30
Stimulants, 59
Stomach, 23
Stomach pump, substitute for, 67
Stretcher, how to place a man on with three bearers, 56
Stretcher only safe means of conveyance in cases of fractme, 47
Stretcher, rules for carrying, 51}
StJ:etchers, 55
Strychilia, antidotes to, 69
Sudden death, cases of, 70 " "causes of, 71
Suffocation by gases, 40
Sunstroke, 40
System, the muscular, 7 the nervous, 7
TEPID BATHS, 65
Thigh- bone, fructme of, 50
Triangular bandage, 58, 59
UNSKILFUL HANDLING, danger of, in cases of fractuTe, <.t7
VEINS, 15, 18
Veins and arteries, difference between, 15
Venous Hremorrhage, 41
Vital capacity, 23
Voice and respiTation, organs of, 20
78
WARM BATRS, 65
Water, iced, 65
Wet compress, 65
Wounds, 52
" contused and lacerated, 52
Wounds, 52
" "with protru- sion of internal organs, 52
Wounds, materials used in messing, 55
W rut and hand, fractures about, 49
STRETOHER DRILL
WITH A DETACHMENT OF THREE MEN.
The stretcher is placed at the head of the Patient, and. the detachmeut stand in line at his feet, facing him.
" NUMBER."
This is done-" 1" "2" "3" f1'om right to left.
"FALL IN.''
No.1 goes on left side of Patient, and No.2 on right, opposite thighs.
No. 3 attends to wounde(l limb (assisted by the others if necessary).
[No.2, with a trained detachment, gives all wo'rds of command.]
The limb "!Jeing attended to, the next word is"READY."
Nos. 1 ancl 2 kneel down on one knee, and interlace hands underneath shoulders and hips of Patient, while No.3 holds on to injured part.
" LIFT."
Nos. 1 and 2 rise on their feet, bringing Patient into horizontal position.
" MARCH."
Side pace, placing Patient over Stretcher.
2
'"HALT."
" LOWER."
Place Patient on Stretcher, No.3 looking aO'ain to the bandages, &c. 0
" FALL IN."
No.2 places himself at head of Stretcher, between the halldles, and No.1 at feet. Patient is ca,r'i'ied feet tint.
"READY."
Nos. 1 and 2 stoop, and grasp handles.
" LIFT."
[No. 2 raises head a little before giving word.]
" MARCH."
No. 1 steps off with left foot. No.2 with the ?'ight foot.
"HALT."
" LOWER."
N.B.-1£ the bearers were to keep st.ep, the Stretcher would roll each side at every step, or 90 in all.
1£ bearing straps are usod, they mu t be shortened, 01' lengthened, according to height of bearers. On slope, the btretcher can be kept horizontal by similar adjustment.
(Signed) F. DUNCAN, MA.JOR, R.A., Deputy- Chctirm,an, St.J.A.A.
NOTE.
Whilst the Handbook was in the Press a new LITTER was brought out and patented by Mr. John Furley, the Honorary Direct or of Stores.
This consists of a folding Stretcher with automatic pillow and removable cover, resting without any fastenings on four small ir on crutches. with an under Carriage of two wheels on elliptical springs.
One great advantage of this vehicle is that the bearers can pass with the stretcher between the wheels and over a crank axle, and thus t he lifting over the wheels is avoided.
WEIGHT COMPLETE, 111 lbs.
Stretcher alone £2 2 0 with Litter complete 70 70 0 FOR PARTICULARS APPLY TO -
THE HONORARY DIRECTOR OF STORES, ST. JOHN AMBULANCE ASSOCIATION, St. John's Gate, Clerkenwell, E. C.
TEXT-BOOKS published by special permission of the Committee for the use of the Classes.
·I.-For Preliminary Classes (First Course).
HANDBOOK
DESCRIBING AIDS FOR CASES OF INJURIES OR SUDDEN ILLNESS.
By
PETER SHEPHERD, M.R, Surgeon-Major, Army . Medical Department.
RZVISED EDl'l.'loN, 1881. P"ice Is.; by post, Is. Id.
2.-For Nursing Classes (Second Course.)
HINTS AND HELPS FOR 110MB NURSING AND HYGIENE.
A HANDBOOK FOR ALL WHO HAVE TO DO WITH SICKNESS.
AlTanged according to the Syllabus of the Second (or Nursing) Comse of L ectures, by E. 1'I1AcDOWEL COSGRAVE, B.A., M.D., CH.B., L.R.O.S.!., Lecturer and Examiner to the Association.
P"ice Is.; by post, 1s.2d.
Application f01' copies to be add"essed to the HOn01'a1'Y IJirect01' of Stores, S.J.A.A., St. John's Gate, Cle1'kenwell, E.C.
