1884 Handbook Describing Aids for Cases of Injuries or Sudden Illness

JJllbn J\,mhulant£ J\,zzlldafion.

®rllcr of ,§It. lobn of 1 eruGilltm (<BnfrliGb n.anfrttag e).

H A NDBOOK

DESCRIBI NG

AIDS FOR OA SES OF INJURIE S OR SUDD EN I LLNESS.

BY

PET E R SHEPHER D)

SUllGF,ON . :llAJOR, ARMY lIIEDICAl, ASSOCIATE OF TUE ORDER OF ST . OF :KTLLED . \' '1' ..L\.)'U.\TIY "2", lfl7(l1

PE() [71LIT .. I TR J[{)J[LVr.:.lf.

P l'ice O ne Shil.ling; PO'3t free, I s. tel

COP!ll'ignr regiscs1'9d at H rlll.

1884 .

7{3th Thouiiland,

lC or'tl 'Ulrior.

HIS DROGO, DUKF, OF MANCHESTER, K.P.

18 ailiff of @ag l c.

Tbe Rigbt IIouble. WILLIAll HF.XRY, BARON LEIGH.

e:com ma n'tlcr of l'1anlcy <!Cas tl e.

Sir EOllIu:-!D A. H. LECHlIIEI.E, Bart., M.P., F.S . .!\. . ounei!.

P,·e:idf'lIt.-Gelleral Sir JOHN ST. GEORGE, K.O . B. TlIe Right HOllblo. the Earl of GL.\SI10W.

The Right. Ro\,. the Lord Bishop of St. AT.BANS (Chupla.in GeneruL).

Sir EDWARD G. IJ PEIlltOTT, Bart.

General Sir II. C' B. D.HJRENEY, (t.r.B.

Captain R. C. F. DAUAS.

Rev. HE!>RY \VUlTT', ilr.A.

@XC ( utiIJ c @ff{ c£r s ,

(Who are er . officio lIIemuus of the COltHCI!.)

Chancellor-General Sir JOHN ST. 'GEORGE, K.O.B.

Secretal'y-Sir E. A. H. LECHMF.RF., Bart., M.P., F A . Receiver-EDwIN FRESHFIELD. Esq., LL.D., V.P.S.A.

RegisL,.al' -Lieut.·Colonel GOULD HUNTER,WKSTOX, F .. A.

Almoner-General the Viscount TF.MPLETOWN, K.C.B.

As.-iMal1t A7mOllOI'-l\Tnjor J ..DIES Gtr.nF. I , Batt. Roval IVarwick. hire Regt. .

Ooncalogist-\V. AmluRiiT T. E:;q., M.P , F . A. Ubl'll.l'ia.1l--Rcv. W. K. R. BEDFORD, lIl.A . . SeCl'etal'l/-Captnill H. C PF.RIlOTT. 31'd Bllt t. Bot,,1 1\"111 I{'d ,.11110117(1 ,'P DrpHriillf'lIf-Din'l'In: )'JII"

/i",,/;,-,..,-Tlll' LONllONI:-;O \ VESf.\ll:-: T£P' HANK, 1, St. quare, R " •

FIRST AID TO THE INJURED.

ST. JOHN AMBULANCE ASSOCIATION.

Undl'l" till' Patronage of HIS GRACE THE DUKE OF i\L\ :TCIIE TEH, 1(.1'., And the ChalltcT of thf' ORDER OF ST. JOHN OF JERUSALEM LA UllAGE).

Central Committee, ConsistIng exclusively of Members and Associates of the Order. (Jhairma.n:

Sir ED:MU TD A. H. LECIIMERE, BaTt., M.P., F.S.A. (Secretary, Order of St. John).

Deputy Chairmen: Lieut.-Colonel FRA:>Clti D=CAN, R.A., M.A., n.C.L., LT,.D.

JOR' l!'URLEY, Esq.

V. BARRINGTON KJ;:NNETT, Esq., M.A., U.S.

Captain J. C. DALTON, R .A. Army MedIcal

Sir THOMAS DICK-LAUDJ;;R, Bnrt. Department).

Gencral Sir H. C. B. DAUBENEY, SANDFORD :MOORE, ESQ., M.B., F.S.S. G.C.B. (Surgeon-Major, A.M.D.).

The Rt. Hon. The EARl, OF DUDLEY. EmlU1\D OWEN, Esq., F.RC.R.

ROBERT FARQUHARSON, ESQ.,M.D. A. HARFORD PEARSON, Esq., M.A., M.P. B.C.L.

PHILIP FRANK, Esq., M.D. Captain HERRERT C. PERROTT

EDWIN FRESH FIELD, Esq., LL.D., (Assistant Secretnry, Ordcr of St. (RecelYer, Order of St. Sir Jom; ST. GEORGE, WILLlAMDAWESFRESHFIELD,Esq., K.C.B (Cbancl'llor, Order of Sc. M.A. .lohn).

Major JAMES GILDEA (Assif;tant A JULIUS POI,LOCK, Esq., M.D Almoner, Order of St. ,John). EDWARD IT Sn:vEKING, Esc[., J\I.D. 'l'b eRt.Hon.TheEARLOFULA GOW. F.B.A.

Sir BROOK K.AY, Bart. CHARLES SuunfPToN, Colonel Sir HEN IlY B. LOCH, K.O.B. S1'KWARl' RUTIlRRLAXD, .l!;Bq THOMAS LONG-MORE, Esq., C.B. (Sur- GcneTll1 Thc geon-General, Army Medical Dc- TOWN, K.C.B (Almoner, Orc\£'r of llsrtmcnt). St Jobn).

Sir WILLJAlI[ lIIACCORMAC, M.A.. LiC'ut.-Colonel GOULD HU:>TltR-WEE<F.RC.S. TON, F.B.A. (llC'gi;;tmr, Ordl'l' (If ROBERT MAOLEAN MAOLBAN, Esq St. John).

IIollo1'(lr!l Direc/f)/, of St07'es : JOHN FURLEY, E (I. (DirC'l'lor o[ AIUI>1I11111('(' DpparlJIIl'nt, Orc\£'r of Rt. ,John).

Chief Secretary: 'l'rC(/S/Irer: Captain H1HlBERT C. I'ERROTT. Captain HlJPERT C. 1<'. ])At.LA Assistant 8euctarll llwl St{)re-keeper. JOliN II. E,\STEIlBIlOOK, ESQ.

Head OJllces: ST. JOHN'S GA'fE, CLERKE""WELL, LONDO., E.C.

Bankers: LONDON WESTMINSTER BANK, L IMITED (Westminster Brancb), 1, St. James's Sqllnre, London, S.W.

CommunIcations 1118Y be addressed to the Cblrf Secreta.r y, St. John ArolJlIlnncc Associa.tlon, St. J obn's Clerkenwcll, Lontlon, E.C.

ANATomCAL AND PHYSIOLOGICAL OUTLINES.

Section 1. The keleton

II. The Muscular y tem

III. The Nervous ystem

IV. Th e Organs of pecial Sense

v. The Blood and Organs of Circulation

VI. The Orga.us of Voice and Respiration

VII The Organs of Digestion

vrn. The Organs of Secretion

IX. The Organs of Excretion

PART II.

MEDICAL A D SURGICAL OU'l'LI rES .

CHAPTER I,

INSENSIBILITY : Causes of ..

M ethod of Examination of Persons found Insensible I mporta.nt ymptollls and their Indica.tions

CHAPTER II.

IMPORTANT DISEASES AND INJURIES OF THE HEAD :

Intoxication , ,

Apoplexy" """"

Epilepsy ..

Blood Poisoning, ,

Opium Poisoning

Shock or Collapse

Concussion of Brain

Compression of Brain

CHAPTER III.

TREATMENT OF CASES OF Drowning •.

Hanging •.

Suffocation by Gases

Sunstroke, ,

General h'eatlllent of Fraci111'es of 'kull

Lower Jaw

Collal' - bOll! ' Ribs Upper A11U Fore-al'lll ,. 'Wrist and llallu. ,

V.

WOUNDS: HAPTER VI. Inci ed; Treatment of .. With Protruding Internal Organs: Treatment of Contused and Lacerated: Treatment of FOREIGN BODIES IN TlIE EYE " " " BURNS A.1'm SCALDS: Treatment of FROST BITE: Treatment of BED SORES: Treatment of EAR BITES FROM RABID ANIMALs: Treatm ent of

POISONS (contmued) :

Gases

Narcotic s ..

Alcohol

DEATH :

Cases of Suddell

Causes of .. Appearances of .. x CHAPTEH. XI.

PREFACE TO FIRST EDITION.

THIS brief Manual is simply intended for nonprof essi onal readers. The!' > is no attempt made to popularis e 1\1 dicine 01' urgery j the object is to furnish a few plain rules which may enab l e anyone to ad in of injury or sudden illues , p ending tIll' ani \',ll of }ll'oi'es ionul h elp.

30tll Uctove!', 187

PREFACE TO REVISED EDITION.

THE excellence of the Handbook compiled by the late 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 l'esul t has been the pre ent revised edition of th Handbook prepared by a sub-committee of medical gentlemen who have had special exp rience a Lecturers for the t..J obn' Am hnlance A 'sociation.

'T. JOH , 's GATE, CLERKEXWELL, E. C. Mm'ch, 1881.

INTRODucrrrON.

AT the request of the Members of the Central Amhulance Committee 01 the Order of St. John of ,J el'usa1em, I ha:ve hurriedly arranged the following :Jlanua] fot' the nse of the Ietropolitan Police and the other Ambulance Classes no:w organised by t he Order of t. John in all parts of England.

The careful \\ 01'1;;: which should like to have bestowed has br 11 r ndel'cd impo sibl by the (>xigencies of the I 'enice rCl}ull'ing 111 to proceed on foreign sc ITic '.

I have 1) 'on aided hy kiml aUlI ilule coadjutors, who h ..we giv n their know]p,lge and experience

I trust that this handbook, given cheerfully and gratuitously-like all the work conducted for and by the Order- wm be found to be in some degree " PRO UTILITATE HOMINUM."

P. SHEPHERD.

JUNIOR UNITED SERVICE OLUB, LONDON, S .W., 30th Octob e?', 1878.

ANATOMICAL AND PHYS I OLOG I CA L OUTLINE S.

THE HU IA T BODY.

I. SKELETON, 01' bOllY framework.

II. JOINTS, :MUSCLES; the orgalls of motioll.

III. NERVOUS SYSTEJU; braill, spiual murrmy. nerves of sell utioll and motioll, alld sympathetic llel'Yes.

IV. ORGA IS F SPECIAL SENSE; eye, car. tongnc, llose, Rndkin.

V. BLOOD A.ND OH.GANS OF CIRCULA· T I O ; h arL aut! blood-yc::;sels.

VI. ORGANS OF VOIUE AND RESPIRATION. larynx, windpipe, uuc11ungs.

VII. ORGANS OF DIGESTION; pharynx, gullet. otolllaeh, and inte tine .

VIII. GLANDS, SECRETING AND NON . SECRETING. B2

4

I.-THE SKELETON.

The skeleton is composed of a central column, the spine, with which are connected three bony cayities: at the upper extremity the head; at the lo\ver extremity. the pel vis; and between the two, che t or thorax.

Connected with the chest ar the two upper limh , OJ' organ of prehension; and with the pelvis the two lower limbs, or organs of progre sion.

The Spine. or back-hone. is compo ed of a Ulunbcr of twcnty-foUl' of "which are called true YCl'tehnuseVGn of ,,,hich occupy the ncck or cenical regioll. twch'c the back of the thorax, or dol' 'al region, and fin' the loins 01' lumbur region. Below the true vertebrtC aro the acrum, a large wedge-shaped bone, forming the back of the peh' i '; and the coccyx. or tail bonc, called tbe faIt-5c Yertebra!.

The spine, as a wholc. forms a bony canal for the protection of the spinal cord, and by TIrtue of its lmmerons , ('gment ::; permits of free moyement of the hunk.

The Heael con ·ist· of thc face. and of a InrO'e ca,yit \" aboyc aJld behiucl it, the Cl'Hllimn. wluch lodges t hc hraill:

The 'l'hO)'LW; i ,l hOlUH.1cd ill frout Jry tJI(' breast-bone 01' ste'mu,m., behind by the twoh ' e dorsai vertebrrn, and laterally by twelve pairs of ribs llllcl their cartilages.

This cavity i completed by the interco ial lllUode!" between the ribs, and below by the diaphragm-a large dome-shapedmu de which separates it from the helly 01' nbdom,en.

'1'he 1hol'flX COlliainc:; th(' henrt nll(l lnl'gr hlno(l-vesselc;, tho two lungs, ingcth'l' with ihe gnllt-t nJl(l some 1mpOl·taut nerves.

The Pelvis is the basin-shaped cavity which forms the lowest portion of the trunk; and contains the bladder, the internal organs of generation, part of the intestine, and several great blood-Yes 'els and nerves. It is composed of foUl' hm; C')-

2 IUllomillate or haunch-hones.

1 Sarrum or rump-hollC'.

1 Coccyx.

The AbdoliHH. hetwccll the thorax and the pelvis, is a large cavity snpported behind by the lumbar Yertebrrn, and enclosed by muscular walls. It contain -

LiYer.

Stomach and intestines, Pancreas or <>weetbread.

Spleen.

Kidneys.

Mnny large hlood- YO scI' flnd nerves.

ThC' UppP.1' Lililb consi.,t') of the shouh1er. finn, fOl'e-l1rlll, all cl hfl11(1.

T1le Shollltlel' i" formed by the "zlll:icle 01' colla)'-bonc, and SCCllJllZa or blade-bolle.

The Clavicle, or collar-bone, mark' the line dividing 11 ck al1l1 dlcsi. H1Hll'f'sts on the stcl'llum internally.

'fhe 'cC/p1lla, or bladc-bone. li('s on the back of the chc t, i of 11 trifinguhll' shap . am1 form t lIP soeker for the hmnel'ns or arm-bone.

G

The Hmne'l'1('s, or bono of npper arm, extonds from the 'houlder to the elbow; aboyo, it is jointed to tho capn]a, and below to the bones of the fore-ann.

In the are two bones extendin o' from tlle elbow to the wrIst. b

The mna is the larger and inner bone.

The is the outer bone (side of the thmnb).

The lI'1.·lSt, or carpu ,i composed of cight small bone .

The hand consists of the fiye bones and f01ll'teen phalange .. three in each fing-el' anc1 two in the thumb.

C

The Lower Limb consists of thigh, leg-, and foot.

. .The thigh-bone, or extends from hip to knee Jomt, both of which joints it helps to form.

The (k?ee-cap) is a small oyal bone which forllls the promment pomt of the knee.

In the leg are two bones extending from the knee to the ankle.

Tibicl is tho main bone of the leg, on the in ido of the hmb, and forms the shin.

. The is the small bono on the outside of the the ends of the tibia and filmln form promment proJectIons at tho sidos of the ankle.

The foot consists of the TCl1'SZlS, seyen irl'egul<1rly-shaped bones; the five bones; and fomteon Phalanges two for the great toe, and three for each of the others. '

JOINTS (ARTIOULATIONS).

Bones are united togcther at joints. Wllere bones move on each othor, the surfaccs in contact are co,ered with ... I

smooth elastic gristle, called a1"iicltZm' cartilage, and aro bound together by very strong fibrou. ti suo called ligamonts, which aro lincd hy a smooth membrane sccreting a lubricating fluid (synoyia).

n.-THE MUSOULAR SYSTE 1.

The ]Iuscles, 01' loan flesh, are formcd of bunclies of rctltli h fibre llaying thc power of contraction lmder stimulation, by which property all movcmcnt are accomplished.

Muscular ti sno is divided into two ,arieties: voluntary, acting lUlder the control of the will. alltl involuntary, acting inelcpcndcntly of tho will.

VoZwtta7'Y JJI'l£scles nro mninly found in tho limbs, head, anel neck, and wall of tho cavities of thc trunk. They are usually fixed at their onds to bones by fibrous tissuo, or tendon.

The Involuntary arc fOlUlCl in H('ll organs a the hcart. blood-ye els, stomach, anel intestines .

llT.-THE NERVOUS SYSTEM:,

The nenou sy tem is compo eel a follow :{ l.

(a.) OEREBRO-SPINAL SYSTEM

(b.) SnTPATUEl'lC SYSTl:::\I { 3. Braiu and 911airs of nerve. Spinal cord & 31 pnir . of nelTe Ganglia and nel'Yes.

CEREBRO-SPINAL SYSTEM.

The B?'ain is the largest and most important mass of nervous matter; it is subdivided into-

1. Cerebrum.

2. Cerebellum.

3. lrfedulla oblongata.

The Oerebr'Wln, or brain proper, consists of two similar ovoid masses, divided above by a deep grooye, and united below.

It is the seat of the intellect, the emotions anel the will. '

The Ce?'ebeZlu?n, or little brain, lies at the back of Hw head; its function is to regulate the movements of the body.

The .MedlbZla Oblongata is the upper enlarged part of the spmal cord. Here some crossing of the nerve fibres takes place, so that injury or disease on one side of the head produces paralysis of the muscles on the opposite ide of the body.

The Oel'eb?'al Ne?'ves consist of nine pairs; they are motor, sensory, or compound in their fnnction. A motor nerve conveys an impulse from the brain to some muscle. A nerve and conveys an impression or sensatIOn to the braID. A compound nerve contains motor and sensory fibres, and is consequently po sessed of a double function.

The Spinal CO?'cl is a cylindrical colulllll of oft nervou tissue, occupying the vertebral canal; it i. about eio-hteen inches in length, extending from the brain to t he j if.,

p:iyes oiX thirty-one pain; of llCl'YeS from its si(lcs. 1£ the cord is cut, all parts of the hody below arc paralrccl.

The Spinal Nerves are thirty-one in number, on each side; they arise from tho spinal corel by two rootq, an antOl'ior or motor, and a posterior or sensory. They act as conductors, to and from the spinal corel.

SYM:PATIIETIC SYSTEM.

The Sympathetic I ystem consi ts of n double chain of small nervous centre or ganglia, which lie along the sides of the spinal column; their branches comnllmicate freely with the cere13ro- pillal system. They supply the im-ohmtary muscle, antl their fUllction is to ('outrol the iuyolnntary muscular tissne j they goycrn ihe. blood-supply, nutrition of the hoely, aud the secreting and excreting Ol'o-ans. Paralysis of these nerves produce enlargement of the blood-ves el of the parts to which they are eli tribnted.

TV.-THE ORGANS OF SPEOIAL SE.l.TSE.

The org-fius of sperial sense are1. Eye. Enr. No·e.

4. Tongnc.

5.

The SPECIAL SENSES have been termed The Five Gate1t:ays of Enowledye, from the fact that they reeeiYe and transmit to the hl'uiu impressions l'egawling Ul'roullding through thei.r nern)s.

These organs are of complex structure, but essent.ially consist of special arrangement of nerve fibres.

The EYE is an opticn,l instrument, and consists essentially of three coatings or tunics, and three humours or refracting media. These transparent media are so const.ructed that images of object are focussetl on a delicate sheet of nervous matter at the back of the eyo.

The EAR, the organ of hearing, i compo eel of three portions: an E x ternal, MiclcZZe, and Intern((l. The exterual ear consists of a funnel, canal, or tube, and a drum or membrane at its inner end. The chum divides tho outor and middle portions.

The middle portion or tympanum COl1Ullunicatos with t he throat. The internal ear is tho part whoro the filaments of the nerves are spread out to receivo the vibrations or sounds.

Blows on the external ear, and concussions from gunshot and other explosions, are apt to rupture tho tympanum or drum.

The NOSE, or organ of smell, is; a double-chambered cavity, lined with a mucous membrano, over which is spread numerous nerve filaments, branches of the olfactory nerves, for the reception of odoriferous irnpres ions.

The TONGUE, or organ of taste, is situated in thefioor of the mouth. It is mainly composed of muscnlar tissne, and is freely supplied with blood-vessels and nerves. Its upper surface is studded with papillre. The nerve filaments are spread out over tho surface of the tongue and back portions of the mouth.

The SKIN, or organ of touch, is tIle entire covering of the body; t.he modified slcin (mucous membmnes) lining

passages also possosses tl;is. property. . The norve filaments end in small loops ll1s1de tho paplllrn. The sense of touch is mo . t delicate abont tho tips of the fingers and lips.

V.-THE BLOOD & OF OIROULATION.

The BLOOD, 01' "river of life," is the 1110 t important and ahundant flui(l ill tho i)ody; it is contained in the arteries, YCIUS, and capillaries-i. everywhere provides i ho ti sues with Houri aud tbell' wa ·t prodnds. Th total of bloodl. estImated at. about. ono-Lwelfth to one-eIghth of the wOlght of hotly. It coloUl' ill the arteries i In'igllt reel; in the ,ellS dark pnrple.

Great los ' o£ blootl produces death; so n1so docs any con iderable chango in it composition.

Blood in the liying body con.si,ts of cells called corpu des UlHl uf fiuill, the lZfj llO)' and when (lnwm sep:wate into a. clot a watery fiuul or It <:ontnins wat cr, red and wlnte corpuscle, albumen, fatty matter, ancl gnses: all of which, .with the of the corpnscles, eut l' mto the formailoll of the tIs ues of tllC body. . .

The organs of cll'cnlatIon are(a.) { l"--ri.er ies. (b.) BLOOD-VESSEL apillaries. "'lein .

The HEART is a hollow muscular organ (enclosed in fl, sac called the periccl1'Cli1.lln) , between the two lnug , aud h hind tho lower two-tllll'lls of the breast-bone,

12

projerting' on each sido, but considerably more to the Jeft t han the right. Below, it is upported by the diaphragm. Ii is about the size of a closed fist, five inches long, and three and a half inches broad and is divided into two halves-a right and a left-each side or half baving two chambers, the upper the and the lowor the v entricle.

The right side receives the impure blood, and drives it to the lungs to be purified and returned to the left.

T he left side receives the plue blood, and forces it through the arteries to every region of the body .

The openings between the chambers and the mouths of the lar ge vessels leading into or out of the heart are guarded by valves or trap-cloors, to prevent the blood from tlowing in a wrong direction.

AOTION OF THE HEART.-The heart acts by alternately contracting and clilating , at the rate of seventy to eighty times per minute. The contraction of the two auricles is simultaneou s, and is immediately followed by that of the ventricle s .

BLOOD-VESSELS.-The blood cirrulate through a system of closed tub es , called blood-vessels - vi!,;., arterie s . capillaries, and veins.

The arteries conyey the pure blood from the heart to overy part of the body, continually branching" and dividing. They are usually found in protected situations; they ha\-e tIlir1\: strong walls, and are particularly elastic_

Tbe capillaries are minute tubules, into which the sma lie , t arterie break up. They arc found in close networks pel'vacling nearly every tissue of the body. Tb ir walls are extremely th in, and allow of the e cape of flu ids of the blood for tbe nutrition of the part in which they are rontained.

The preceding is a rough tabular view of the courso of the blood.

The veins commence by the union of the capillaries and carry the impure blood to the heart. '

CIRCULATION.-The impme blood retul'lls from the b.ody the veins, and enters the right auricle; the rIght aUrIcle contracts and forces the blood into the rio-ht ventricle; the right ventricle then contracts and force tho blood the pulmonary artery to the lungs, where it becomes pUrIfied. It thon retul'll to the left auricle, which contracts and drives it into the left vontricle· the left ventricle now contracts and ch'ives the blood the arteries to the system generally, where it is 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 youtride of the hearL, and ctuTiel:! impure blood directly to ihe hlligS, from whence it il:! rclmned by ihe pulmonary veiw; Lo the left amide. This cOllstiLnLes ihe lcssCl" or pulmonic ci1·cL£lation. The AOl·La, arises from the left ventricle. a11(l carries through its subdivisions arLerial blood to the body generally, from whence it is returned by the venm caYlE to the right amicle. rrhis constitutes the gl'eater 01' systemic Ci1'Gtblation. 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.

15

DIFFERENCES BETWEEN ARTEl-tIES AND VEINS:-

1. The arteries carry pure blood away from the heart.

2. The veins carryimpnre blood towards the heart.

3. Arteries, except the pulmonary, carry bright reel hlood. V cin', except the pulmonary, carry dark purple hlood.

4. The walb of the arteries are stronger and moro clastic, nml have no vahe , except whore they lea,e the heart.

5. The walls of the veins aro thin, and haye valve 011 their illller wall, which prevent blood from flowing hackmu·dl:!.

(). Some vein are quite superficial; the arteries lie more cleeply.

7. The current is remittent in the arteries, slower and continuous in the veins.

PRINCIPAL A.RTERIES.

The AORTA arises f1'lllll the left ventride of the bead; it aseclllll:! [or n short c1istmlco behind the sternum. arches uaekw[ll'Cli:!, und tlesceuds I1long' Lhe left side of the spine, throngh lhc chesl and ahtlolllcll, uut il iL is opposite the foudh lUUlbar Ycrtebra, where it divides into the two iliacs.

The INNO IIN 'rE ARTERY, a short trunk arisino' from the arch of a.orta, extends upwards for about an inch and a half, divide5 into the right carotid and ?'ight subclavian.

Tho RIGHT COMMON CAROTID i a branch of the innominate arlery ; the LEFT COMMON CAROTID

16

is a branch of the aorta. The e two a cCIlll. the neck, one on each ide of the windpipe, to an lllch below the ancrle of the jaw, whore they ehvldo mto th e external and internal carotids. The COl;u'.se of each is indicated by a line drawn from the JOUlt the colll1l and breast bones (sterno-clavicular articulatwn), to tllt· lobule of the car.

The INTERNAL OARO'rID eOillUlences Ht tho clivi -, -ion of tho COUlmon carotid, opposite the upper border 01 the thyroid cartilage, and proceeds to. the hase of the skull, which it enters, and supplIos the bram.

The EXTERNAL OAROTID is the outer branch of the common carotid; it proceed upward' towarc.ls the ear in front of which it passe on to the temple. upplies yariou s branche to the face, temple, and back of head. ,

Th e SUBOLA VIAN. 01 the a branch the innominate artery; on the left SIde It IS a of the aorta. Th ey leaye the cavity of the by pam? lmder the collar-bones and o,,:er the fil:St r.lbs, and telminate in the armpit by becoUllllg the axillal'les.

The AXILLARY is a continuation of the sub ; b ins at lower bonIer of first rib; and. after crossmg a:!.pit, ends in the brachial at the margi1l of the po ·tenor fold of the armpit.

The BRAOHIAL is a continuation of the axillary; iL lies well on the inside of the .upp er arm. an.d extends from the posterior fold of armpIt to abouL all lllch the front o£ the elbow, where it divides into the raclHll and ulnar. I' . ,1' 1 1 1 11 'l'OOye The course of this vesse IS lllulC<lllX Jy l IC g

17

along the inner horder of the biceps mu, cle, where it can he felt pulsa ing.

Tho RADIAL extend dOl'i'llwards along the radial or ontor side of the foro-arlll, from a little below the hond of tho elbow to the wrist; it here winds rounel to tho ba 'k of the metacarpal hono of thnmb; pase - through between the thumb alHl forcfinger to the palm; and form tho deop palmnr arch.

The ULNAR i the largcr of the two eli vi . ion of the hrnchinl. It des 'eHcil; along- tho nIn,U' or inner , ide to the wrist; and thl'll, eutt'riJlg t h.e palm, forllls the 8npcrfiri:11 palmar an'h.

The COMMON ILIAO ARTERIES aro formcd hy the hifnrcntioll of the aorta; they pas ,' downwards and outwar(l to tho hrim of the pehis, where thoy diyicle into extcl'llal and iutcl'llal iliacs.

The EXTER AL ILIAO commences at the bifmcation of the common iliac, pa e along the brim of the pehi , and make ' its exit from the abdomcn at the middle of the fold of the groin.

The INTER AL ILIAO is the iU11er diyi ion of the common ili,w; it deseend into the peh'i ',and supplies tho organs there.

The FEMORAL. the continuation of the cx.tel'llal iliac, descend along the inside of the thigh for two-thirds of its lcngth, anc.l then pa ses to the back of tho thigh to become the popliteaL The com 0 of the artery i indicated by ehawing a line from the midclie of the fold of the groin to the insielo of Imee joint.

The POPLITEAL, a conUlltUttion of tho femoral, exteucl aloJlg tho back of the lower third of the thigh to a c

ltl little below the Jmec joint; it runR c1,nm the 111idr11(' 01 the ham; i\llrl diyides illtn thc antcrior and po t('riol' tihial.

Thc ANTERIOR TIBIAL, a hrllueh of thc poplitpa1. passes to tllC frout between t hc two houes of the kg and dcscends to the wherl' it cl1yic1es i11to hrall('hes for the toes, A linc (11'awn from head of filmln i 0 a poillt mlchvay hetween the two projecting ank1t,-hmll's (m ullen/i ) will be parallel to this urt cry ,

Thc POSTERIOR TIBIAL i::; the otber brnmh of the popliteal; it l'Ull' dOWll the hack of the leg. Hll(l. pa, sing along the lx'hillcl the inller ankle-hoBl', hrauehes to the Role of the foot.

The PERONEAL uri ' l's lrom tlu' pOHterior tibi,,], pas es clown Oll the outside of the hack of t 11l' leg, H1ld (liviclps illtO hrnncllNl around the IH'c1 :11](1 ontel' ankle',

THE YEI.l. T

The yeins nrc th(' "l'1->8els whi<..:h serYl' to return the impure blood from the ('nplllnril'R throughout th(' diifel'l'nt parts of the body to tlll' 11l'al't.

The PULMONARY VEINS aro foUl' ill lI111llllt'l'; two for each lung. They eun)' pure hlood from tho lungs to the heart.

The SYSTEMIC VEINS return the (hl'k impl1l'(, bloo(l from the hody gellPl'ally to the right Hide of the heart. 1\1ost Yeins, ehidly those in the extremities. arc proyide<l with Yal'es. to preYC1l1 the reflux of hlood. Vems aTe divided into superficial and deep; tbe former can he TCflclily se(,ll nncl('l' th(' skin. tbe hlti('l' lip rlefl111y.

1 I

an<l nc('ompl1l1Y 111't(,1'i('s The C'l1l'l'Ollt in tIl ' fi towfll'ds :he 11('u1't. eXHcti y the rl'\-erse of 0': i he flrtoncs. ( . 0) :lms ill

rr: he yeins in tho cnpillarie .' lmite ao-ain and agnlll tIll they forlll two lal'O'e trunb tho b whi 'h (' 't'] 1 ,0 • vel1(e cavce, t mpl)' lClllse Yr, III the right :1lll'iclc.

VEL.'"S OF HEAD AND NECK T '

0' 1, .. £ . ,- he mterna1

OllllC(l hy 11ll1ll(,l'OU.' hranches froll th head f.llO, and Hcck pat>,' (lown from ahout the 'mo-Ie f t1 . ' jot II e' , 1 f t J J t ( /:'I 0 10 Jaw f , 111S1.( 0 0 It' (' les., and, uni.ting ,,·ith the subdaTian 1)1111 the lIIllOllUllltfC t'I'/It, '

VEL.: . OF UPPEl1, EXTREl\IITY are diyided into a ,/,pel;tlcwl <lnll a deep

r 1 Tho s,d eOlTl",poncl to alllllio along iele the arteries Ihe l->upcrn('lal set arc tho rudhl ulnar llocli 1 ili' allll ('('phalie, Thl' 111':1{'hi.:11 roee\,:os tl;o i)a , 'li an·l)t c, thc axillary. The axilln1'Y ('1'0 tlle 'll'lll{)i: OrllS th(' fmhcla,-ian :1.t tlil' l(l\wr border of first rib'. ( )ecomes

}1.H' 1!BCL..\ VIAN yein is a l'ontiunaiion of tbe hes ,helllml ('ollar-bollO. ('rossos froll outer of first :l'lb to helllud sterno-C'la;vil'nlar joint and . , the mternnl JnglLiar, to form the innominate, ' Joms

The INNOl\lJ JATE :1.re two larae trunks placcll oue on ('n('ll :-;ic1C' of the root of the lloek· tl 't togcihel' a11(l form tllc superior L'tltlL cava, ' , ley urn e

THE. UPE [{lOR VEL T CA VA formed b the II ' t Yle lrlllll t,he nppcr half of tht' ellll)tir it 10 l'Iu llt ((II/'le/ c 111

VEINS OF THE LO,\VER EX'l'REMITY " illto ;ets, slCpel:ticiaZ and deep, nrc cb\'lded

The ouperficial are the internal and extel'llal saphenons. The former begins about the instep and ascends on the iuner aspect of leg and thigh, is joined by numerous branches on its way, and joins the femoral just below the fold of the groin; the lat,tor ascends the back of leg to join the poplitoal in the ham. The popliteal pa ses up through the ham, and then through tho uhstance of the thigh to become tho femoral. The femoral lie along ide the artery in front of the thigh in its upper two-thirds.

The EXTERNAL ILIAC is the continuation of the femoral, and terminate by llliting with the internal iliRc to form the COln?1wn iliac.

The II TERNAL ILIAO collects the blood from the organs in the pelvis.

The COMMON ILIACS, form ed by the jlllction of the external and intol'llal iliacs, terminate by uniting to form the inje?'ior vena cava.

The INFERIOR VENA CAVA roturn tho hlood to the right side of tho heart (?'ight from all parts below the midriff. It is formecl by the union of the two common iliacs, and joinod by branches from the liver, lridneys , and othor viscera.

Vr.-THE

ORGANS OF VOICE & RESPIRATION.

The organs of voice and respiration areLarynx. Trachea. Bronchi. Lungs.

'1']IC L RY r is tho llppcr l>ortion of thc air-pH,ssage, amI tho organ of voi('c. It i . situated hetweell tho trachea amI hase of the Longue in tho Hpp I' awl fore part of the

neck, where it is felt ns Adam' apple; on either ide arc the large blood-yo sels of the neck. and behind is the gullet. The larynx is a cartilaginous tube; :md in ide

./.)

thi::; arc plaeed h\l) n<HT()W, tibrom, baud ' . the (Jocal cOl'ds, whieh arc attaehed lJdorc awl behind. with a chink between them for tl1e passage of the ail'. ThL vibration of these bands dUl'ing expiration produces th voice.

The, TRAOHEA, 01' windpipe i ' a cartilaginou' aUll membranous tube, extending from the lower lInrt of tlle larynx downwards into the che t to its diYl::;ioll iuto the right and left bronchus-it lies in front of the neck, antcrior to the gullet.

The BRONOHI. right and left. onc to caell lung. arc -formed by the c1i-'I'i ion of the trac1lCH.

The LUNGS arc the c cntia1 organs of respiration; they are two in mUllber, one in e,wh sille of the ehest. bet,YcC'n thcm the heart. blood-vc::;sl'ls, bl'ouehi. £lml gullet. The lnugs arc l'udosed in llnnhk saes 01' l·o \cl'iugs. termed plelll'(B, aml nro eompol'll of a lig-Ill spongy tcxture for the ramitication::; of the hrollchinl tuhes. till' pulmonary artcric:-;, and the pulmonary Yei11:-;.

The brouchial tuhCf-i. after dhidillg antI I:>lllllliyidiug'. tormiuate in milJute air-eolls. o,'cr which is "prl'acl a 11l'twork of blood-ycsseh. It is in these miuutr bI()()(l-ycsc}:.., that purincatiou of tho hIooc1 t,lkes lIlacl', .. yeuou ' " hl'iug converted into .. arterial" blo()(l. Onl'hOllll' Hel(l amI watery vapolU' patis frolll tllC hlood iuto the air-tells, aud oxygeu passes from thc air-cclls into the hlood.

MECHANISM OF RESPIRATION.-During an the che t is enlarged hy cleyating the ribs and depl'ci::isillg' the diaphragm; and d1ll'illg an expiration the the::; ( is diminished by dcpressing the ribs and elevating the diaphragm . rrhe ohject in artificial respiration is to imitate the natural action.

The aYcl'age capacity of the lungs is :2.50 euhic inches. The alllount of nil' (ticlal air) takcn in and passed out \vith each respiration is about 30 cubic imhes.

Rcspiration take::; plnco ahout 1 ") timc8 pel' millute.

The VITAL OAPACITY is the greatest 1'olu1lle of ail' tlt:tt ean he expired after the clecpest po 'sib le illpiratiou:

VII.-THE ORGAl,{S OF DIGE TION.

The orgnn of digestion tOllsi t of th .Alimentary CUL<l certain aecl' SOl')" orgalls. rI'he Ahlllt'utnr)' 'anal J., a Illllsl'nlo-ll1emhl'<l1l111lS tnbe, <thont thirty feet ill lcngth, aUll cOlllpri 'l'S thl' follo" illg part :MOllth.

PharYllx I of throat). (gnllet).

Small illtetines, Lnrgl'iute tilles.

The .:\10 'I'll, all o\'lll-"lwped (',nit)" eoutaiu tho teel h. lOllgne. palatt'. aIHl lillds of t Itl' saliy,Il'Y glaml s .

The PRARY TX lies at the hack of mouth all!l top of gnllet. he hiu!l the rllot of t he tongue and larynx.

The CESOPHAGU .01' gullet. ex.lellds from pharynx to ::;t 0 lll<lch , allli 1:-; "hunt Hiue inch" long; it lil'S behi1Hl tIlt' ',illclpip e, antI ill frout of tho 'pinc autl aorta.

rrhc rrO:;}IA H i:-; a, pouch-like enbrg'cllll'nt of tho alimentary canal; it lil" chietiyon the left sidc of body, under the c1iaphmgm. with the linl' on its right and the

spleen on its left side. The stomach is the chief organ of dige tion.

The SMALL INTESTINE is the contilllUl,i,ion of the beyoncl the stomach; is a very tortuons canal; and i JOllled below to tho lnrgo intestine.

Th e LARGE INTESTINE is a continuation of the small intestine; it ascend from a point ncar the right halmch-bone on the right side. crosses the abdomen lmder the liYer and stomach. and then descends on the left side, and opens on the surface at the anus.

VIII.-THE ORGANS OF SEORETION.

Secretion is the proccs of claborn.ting Rpecial produds from the blood, as saliva, bile, pancreatille, etc., to he fm'ther used in the economy. The Organs of Secretioll a1'e-

LiYer, Pancreas, Salivary glands.

Mucous crypt and gland " and others which need not be specified.

:rhe LIVER is a large reddish-brown organ situated the false ribs on the right side of the body; Its W?lght IS about thre e to foUl' pounds.

It IS made up of lobe, lobules, and cells; it hn. n. duct for com'eying its secretion to its reservoir-tho gall bln.dder.

The GALL BLADDER is the resel'Yoir for the bile· it lies llllder the right lobe, and empties itself iuto the intestinal canal below.

IPnnctions of the Liv(Jl'.-l. Se 'roLes bile, which aidb dig StiOH awl Clet s as a pnrgati,·e. Purifie the blood.

0. Elaborates aibulllen, fat, aud sugar.

The PANOREAS, or swcelb?'eacl, is situated behind the stomm'h, in frout of the 'pino; is mado up of a 11.umher of smalilohes; is about, even i11eheH lOJlg; and wClghs about fom ouuces. lts dud leads into the intestinal canal. The pancreatil: juice aid digestion.

The SALIV AR Y GLAND are ituated about the side of the face , ncck, and tongue, and their duct enter the ca,'it.y of the month. Their function i to ecretc wliich keeps the mouth moi. t and a ists in the proce s of swallowinO' and digestion.

Tho SPLEEN is u duet less gland which lie on the left idc uilder the fal e ribs; its function is conncd cd wHll the blood in some WHy which has not yet been detormined.

IX.-THE ORGANS OF EX RETION.

Excretion is the proces,' of elaborating' p cial produetti from the blood to be t hro,\'n out of tho sy, tom as u 'cle '5. Hch aro carhonie a('id, urea. aud uric acid. The Organs of Excretion arcLungs. kin.

Ki(lnoys.

The LUNGS hayc been alreadY de cribed; their excretory fun ·Eon is to throw off c,lrbouic acid and water)' yapour.

The SKIN is the general covering of the body; it i compo. ed of two layeroEpidermi , cuticle. or outcr layer.

Derma, 01' true skin .

The skin is porous, c0ntains sW'eat and fatty glands, and a free supply of nenes and blood"essrls.

The skin excrete the weat, and is the organ of tOllch. In health it possesses a temperatme of 9 clog.

The KIDNEYS are two in number, one sitnated in oaeh loin (slnall of back ). Externally is a fibrous layer 01' t'oyering; internaJly is a l'<t,-ity cOllnllunicating" with a <lnd (meter). The substance of the kidney conists of bundle:> of minute tnhes. The cluds 01' urc'ters desl'cJ1(l along the back wall of tllC abdomen, to terminate in the blaclcler . The bladder i::; the rl' 'cn-oir for the urillO.

The function of the kiduey is to excrete urine. aml to l'emoye certain impurities from the blood, sneh ll!:; urea and uric acid.

MEDICA

LAN D SURGICA L au TLI NES.

CHAPTER 1.

INbEr SIBILITY.

Ius ell ' ihility ih the sH . pl'nolOn of tho fHllctiou of anima, life, except thosc or rc ' pinttioll nud circulatiou.

Ohief' Catu.:es of . to braill, t:omprcs 'iou frolll fracture.

Dise:1hc of brain, apoplexy, epilcp y. &.c.

Poiouillg by uarcotic ' - opiul/L, lIlollJhia, clllol'oforill.

Blootl poisoning from kitluoy dis· ea e.

The above forllls of inseusibility arc liable to be mi1ako11 for dl'lUlkellUCo ' , and it ought to bc remcmbered that the e condition ' lllay be complicated with each other aml with the cffects of drink and that no single ign can be relied on in forming a conclu ion on the condition of t he patient.

.)-,

EXAMlNATION OP PERSON FOUND INSENSIBLE.

·When n. person is fOlUld insensihle tho follo'Ying directions aro to be most carefnlly followed :--

1. Note tho position of the body and it, urrollndings.

2. Obtain all information possible as to the cau e.

3 . Place the body on the back, ·with the head inclined to one side, the arms by the sides, and oxtend the legs.

4 . Compare the two sides of the body.

5 . In examining the head, pass the fingers gently over the surface, and search for wounds, brni 'e ' , swellings, or depres ions.

6. Open the eyes, and ascertain if the mface of the eye-balls is sensitive to the touch, if the pupils become sruall when exposed to light, and whdller the pupils are large or small, and of the same size.

7. Obserye the state of the re piration, whether en .. y or difficult; the presence or absence of snoring; and the odour of t.he breath.

8. Notice the condition of the pulse, whether strong or weak.

9. Observe the general appearance and po ition of the limbs; and mobility, crepitus, shortening or lengthening of the bones of the limbs.

10. Note the state of the ribs and collar-bolles .

IMPORTANT SYMPTOMS AND THEIR INDIOATIONS.

CONVULSIOf' occur in apoplexy, epilep y, and di 'ease'; and in d.igestiye disorders, and. teethmg 111 children.

SHIVERI G FITS usher in feyer , and indicate danger duriuO' illness.

PUL E i lI;e{(l,; in cases of fainting, shock, collapse, and 11rnmorrhage.

Irreg III {(.j' in heart disease ..

Slow and labouring in cases of and di run:-;iug pres 'nre on bralll.

PUPILS OF THE EYES are fixecl cmel dilatecl in paraly ' i aUll apoplexy. ., . .

UncCJlllllill size i.n se1'1OU . (lIsea 0 or lllJury nffcdin o' one lCle of bralll.

Contructecl in case of poi oning,. and congestion or infiurumat lOn of tho bralll.

VIOLENT FITS indicate in anity, druukenne ,hysteria, or epilep y.

HEMORRHAGE FROM EAR, OR FROM MOUTH, NOSE, or EYES indicates fractnre of base of hill.

FLUSHED FACE occurs in intoxication, apOl)lexy, and epilepsy.

GIDDINESS indicate' stomach, liYor, kidney, or bram eli order..

30

STERTOROUS BREATHING llollcl snoring) if; fOllnd in npoplexy and compl'C blon of hrain.

DIFFICULTY IN BREATHING is a ymptom of hmg diseascs, heart lli ea c" brokcn rihs, ob huciion ill air-passages, or injlli'y to the nerYou supply of these organs.

CO UGH lS a . ymptom of lung and henrt disea e -irritation of air-passages. andlH'eSSul'o on lungs or on their ncrves.

DRA 'WING OF FACE TO ONE SIDE I Arc oyiI donce of SQUINTING Par a _

FIXED OONDI'l'ION OF PUPILS (dilated) If y S , rom (18-

IRREGULARITY 1£ THE SIZE OF ,>- case or PUPILS injury of the ne1'-

TWITCHING OF THE l\-mSCLES ONJ vou sysONE SIDE OF BODY tem.

STAGGERING GAIT lnwcates di. ' ease 01' injury of thf' hrain or spinal cord; or intoxication . CHAPTER II.

IMPORTANT DISEASES AND INJURIES OF THE HEAD.

The following condition are of neh frcqucnt occnrrence that their symptoms and trcatm(,llt should be clcarly lmderstood and rcmemhcl'ecl.

:)1

TTOXICATION.-Callse: Exce s ln chilli\:.

Symptoms.

Odom of liqnor in breath.

n nn11y not cOll1plct '. T Pailent can nsually he 1'i 0 hreathillg. PupIls of cqual Slze, lltinal1y dilated large ). 0l11ea sen.-It i,' (' to toue·h. TClllperatme of body to 30 below normal. Pu} e soft and frequcnt. TO diller !lee between :lide of hocly, both helllg I?qually helple . ...

Treatment

. Emetics; l'old wator applied to head; wllrmih to surfacc of hody and ex.tl'l'lllities.

APOPLEXY.-Ccwsc : Effusi 01 I of bl()(lc1 pl'ollucing - pre ure on tho hl'ain.

S t Paticnt becomes suddenly in en ible. ym2) oms.Face Hn hed or ,ery pale.

T?'eatment . Pnbc fnll.

BreathillO' te1't01'ons.

Pt1.1'alysi .

Plare body in lying -down positi.oll, with the heac1rai ' ed. Undo clothmg around neck. Apply iced 01' cold water to head. ot to give the pntirnt anything hy month.

EP Disease or di order of brain.

SY?l1ptom . Oonvulsions.

Foaming at mouth.

Biting tonguc.

Partial insensibility.

Breathing labolU'ed, pul 0 normal.

Face livid.

Treatment . Prcvcnt patient injuring him. elf.

Rai 0 the head.

HYSTERIA OR HYS'rERICAL EPILEP Y.-Associated with other forms of hystcria.

'ymptoms . Falls tjuddenly but cal' fully.

Oonvulsions. 01' 1'athel' jerkiug of the head and body, partinl insen 'ibility, apparent but not real.

Treatment . Oold douche to faco.

SYNOOPE OR FAINTING.-Causes: Debility or mental shock.

Symptom,s . Insensibility.

Face and lips pallid.

Pulse almost impercoptible.

Oold sweat over skin.

Treatm ent . Oold douche to head and face. A littlo weak stimulant. Placo your hand bohind the patient's head, and press it down between the knees.

33

BLOOD POISONING from kidncy disease.

Symptoms . Oonvulsions-insensibility.

Twitching of muscles.

Delirium.

Breath hal:> a minon odour.

Signs of drop. y.

TreatnLent . Hot air or yupom hath. ActiYe pnrgatiyes.

1('0 to head.

opr 1\1 OR l\IORPHIA POISONING.

SVmplOlllS . Stupor; pupib to point; progrl'bsi,'o m wllich is seldom completc tIll conyulsiolls or death 0('('111'8.

Emcti('s-colc1 douchc to hcad and chest - walking cxorcibc - ·trong coffec-artifi ial 1'C piration-shock from gah-anic battery.

SHOOK OR OOLLAPSE.

Cause Inj1ll'i es to ncrYOllS sy l?y opcrations, fright, lightnmg. Dcath may bo ; recoycry may bo slow or rapId.

SY1npioms . Face palo and pinched, eyes dull.

Pul e almost imperceptible. . Breathing very feeble; . the of respiration and Cll'CulatIOn are reduc ed to a minimum.

D

TJ'eatm,ent . Place patient in .hori zontal re tore circulatIon and re'lHraholl, remove tight-fitting (·lathing from neck, apply warmth to snrface of body and extremities; stimulants may be gi,e n cautiously ill small quantitic .

CONOUSSION OF BRAIN .- Causes: Blo,,'s or fall::; on head.

SY1r/,pto?ns .

Extemal s.c .

In cases. paticnt licl'i lllotionlel:>s Hnd in en ible.

If roused, answer:, hastily mal thCll rclapses.

After a time becomcs restlcss. awl '{omits and recovers.

III I'cvel'e paticllt is pl'Oflllllltlly inscllsible; suriaec pale aud culd; pulse feeble; hl'cathing slow and sighing .

T"eatment .

Place patient on his baC'1\:, ,yith head slio'htlyrai ed. in a clark. qniC't room warmth to surface of body a11(l extremities.

COMPRE SION OF BRAIN.

Causes Pieces or hone or l1aJmol'l'hage pressing on substancc of the hrain.

SY11l1Jtom s Th ose of apoplexy, following S0111(' iuj1ll'Y io head, :mdl a:,; frndul'e (If thc skull , T1 'catment , Th e same as in

CHAPTER III.

OF OASES OF DRO"\VNING, HAl'G.

lNG, SUFFOOATION BY GASES,

I.-DROWXIX<J.-!:;cllc1 immedi.ately for mcdical a:,;:,istnllC'l', blaukets, all(l dry cluthillg'. "b ut procced to treat the patient I ' "l'AX'I'LY, ::-e<:uriug' as lUUl'h freh ail' a' possible.

'fhe ll()illh t() hl' aill1ctl at al'c-first, HUU imlllediately. the RE ·TOH.ATIOX OF \THI:\U; aud after hrcathing' i.., rC':itoJ'ec1 , till' !'nOitIOTLOX OF WAR:\ITH AND 'I1WUL1\ TION.

'rllc effort s t () rl':,t orc lifl' 1lUlst bL' l'el'l-)l'\ erell i U llll ti 1 til, al'l'iYal of lUl'llical a.,si:,tauCl" or llutil th' pube aml breathing' Ita YC for at h a.,t au hOlll'.

'I' '1'0 TORE NATUIUL BREATHING.

Rule 1.-1'0 IIwillt(lin (l PJ'ce Elltl'u/u'(; at' Ail' into the Windpipe. -Oleall,e the mouth aud nostril . opeu the month; drcnr fOl'ward the patieut's tougue, aud keep it forward ; au l'lastie baud over the tono-ne and uud er the chin will auswer thi purpose. Rcmoyc all tight clothiug from about the Hcck and chest.

Rule 2.-To acZjust the Pati ent's PO'ition.-Place the patieut 011 his back on a Hatur£acc, iuclineu a littlc

• The allo\'o llil'edit)lls nl'(' ('hieHI Dr. 11. [t • 'IL\ method oj the Appal'elltl,\ Ilr1ri Ill' l)'l'owncd, nlHt halc heen 1I1'1'I'o\'cd hy lite l{oyal )I cdical ll11d Cit ll'lll'gil'a i ·ociety.

n

from the feet upwards; raise and support tho head and shoulders on a small fin11 cushion or folded articlo of dress placcd undor thc houlcler-blades.

Rule 3.-To imitate the oj B?·eathing.-

Grasp t,he patient's arm ju t above the elbow, and draw the arlUS gently and steaclily upwards, lUltil thcy meet aboyc the head (thi is for the purpose of druwing ail' into the lungs ) ; and keep the arms in that positi on for by o sceom1 · . Then t Ul'll down the patient's arms. and pres them gently alld firmly for two secollds again st tho side of the che t (this is "rjlh tho object. of In'essing' ail' out of the hwgti. Pressure on tho hroatit-bono ,TIll aid this ) .

Rcpeat these measures altm'natcly, delibcralely, and l:lerse,eringly, fifteen times in a minute, until :), spontaneons effort to respirc is perceived, imlllediately upon which cease to imitate the lllOYelllents of breathing, and proceed to INDUCE CIRCULA.TION AND WARMTH.

Should a warm bath bo procurable, the body may he pb,ced in it up to tho neck, continuing' to imitato the movelllents of breathing. Ruiso tho bolly for twenty seconds in a sitting position, dash cold water again t the chest and faco, and pass ammonia undor tho nose. The patient should not be kept in the warlll bath longer than five 01' six lllinutes.

Rule 4.-To excite Inspimtion.-During the employment of tho abovo method excito tho nostrils with snuff or smelling salts, 01' tickle the throat with a feather. Rub the chest amI face briskly, and dash cold and hot water alternately on thorn.

TREATMENT AFTER NATUR L BREATHING HA BEEN RE TORED.

Rule 5.-To incZllce Circulation ancZ Warmth.-Wrap the Inltient in dry blankets and ('ommence rubbing the limbs upward, firmly and energetically. The friction mu t be ('ontinued under thc hlnnkets or o,er the dry clothing.

Promote the wal'lnth of the body hy the application of hot ilnnnels, bottle' or bladders of hot water, heated bricks, &c .. to the pit of the stomach. the armpit., hchyecn the thigh, and to the sole' of the feet. Warm clothing mny generally be obtained from bystander .

On the restoration of life, when the power of swallowing ha returned, a teaspoonful of warm water, mall quantities of wine, warm hrandy-and-water, or coffee shonlcl be giyen. The })atient houlll bo kept in bcd, amI a disposition to lecp encouraged. During reaction large nm tard plast er to tho chest and bolow the honlders will greatly relioye tho eli hes od breathing.

DIREOTIONS FOR RESTORING THE APPARENTLY DROWNED.

Tho leading principles of tho following Directions for the Re ·toration of the ..A pparontly Dead from Drowning nre found d on those of the late DR. :MARSHALL HALL, and nro tho result of exton i,e inquirie which were made by the Royal N ationul Lifeboat In titntioll in 1863-4 mnongst Medical Mon, Medical Bodies, amI

,) . uc

<,,:01'One1'8 throughout the United Kingdoll1, These Dircchons have been extensh-ely circulated by the INSTITl.'"TION the and in the Colouirs, They are III usc 111 Her MaJesty's Fleet, in the Ooastguarcl Sernce, and at all the Station of the Briti,11 Army at home and abroac1.

1.

Send immediately for medical nnd dry clothing, but proceed to treat the patient instantly on the spot, in the open air, with the face downwanl, whether shore or afi?at; expoRing the face, neck, and ch('st to th(' 'Tmd, except III • eY('1'O wenthpr, and rel1l(WillO' all tio'ht (·lothing from the ncck and chest, e. pccinlly

The points to he aimeel nt are-first mid illllJlec7iately, the OF BREATHING; and. ('coudly, ,dter breathlllg IS rcstol'rcl, th(' PROIVWTIOX OF WARMTH AND CIRCULATION,

The effort to ?'estore Breathil1g must he eommenced immediately and energetically, and pers('veretl ill fol' OlH' 0,1' t,:o or a metlical man has pl'OllOnllCed t 11n t hfe IS extmct, Effort' to promote Wa'rmth awl Ci?'Clilation, beyond removiug the wet clothes and ChylUo' thc skill mnst not be made uubl th(' fir t appenraUl'e llaturai hrenthing; for if circulation of the blood he iuduced breathing' has recommcnced, the restoration to life Wlll be enclangerecl ,

n,-To

RESTORE BREATHING,

To CLEAR THE THROAT,-Place thc patient on the fioor or ground with the face downwards, and one of the arm8 nnder the forehead, in which position all flnids will

lIl()l'\' l'l'adily ('S('HPO by thc month, anc1,nl(, tOl1gn: wil1 f<lll fOl'w<1rd, h':l\ illg nil' elltl'illlC'C mto ihl' mnupIpc frl't', A this opernti.oll hy wiping- and ('lean ing the month,

If snhsfactol'Y hrcnihillg COli IU1('llC l'S, nsc thc treatment (Ie crihed below to promote \Vnl'lllOI. If there he only "Jig'ht lll't'Hlhiug-or no hl'l'atltilW-(ll' if the 1m'Hth ing fuil, t hl'll-

To EXCITE BREATHING-Turn the paticnt well and iu-;tnntly on the 1'51(1(" l:mpporting the henl1. nIld excite the 'with uHff, hartshorn, and lllclling salt, 01' tickle 1l1l' throat " 'iih a fl'nthcl', l\.('" if they are at hemel. Rnh the dlC.t. nntl f1H'l' wm'm, aud dn ·It ('oItl wedel', or cold and hot wntpl' nltl'l'Hntcly, on tht'lll, If thc1'(' 1w no sneep,s, lo:->e llot a lIloment, l;nt ilJstantly -

To InUTATE BHEATHING-Rcplnee the patil'ni Oil tht' facl', rai"illg and .. uppudiug the dlCl't well 011 n folded coat Ill' 01 her art iell' of Turn the hody ycry grlltly ou Il)(' tilde nIHl 11 little heyoUlt and thcn hl'isldy 011 the fact', hack again, repen tiug the,",e mens,me::; efficiently, lmd pCl'f'ieYel'illgl)', ahont fiftct'n h,mos m the or oYt'ry fonr (\1' tiyC sccowls, Ynrylllg the SIde, (By plllCill[J the lullicllt on the thC1L:cight the body lorce8 tlte ail' Ollt,. ll'hen tlll'nelZ on the sule, tIns lJreSS1We 'i ,-.; l'el/lOvcel, aneZ air elltal) the chest,)

On eaeh occasion that the body is rcplaced on the face, make ll11ilor111 but cfficient prcssurc with bri. k movement, ou the unek betwcen and below the houldcl'-blades 01' hOllc on eaeh idc, l't'JUOVillg the pre sm'e immediately hefore turning the bo(ly Oll the ide, During the whole of the operations let 011C pen;on attend olely to, the movements of the head nnel (\f the firm placed \UHler It,

40

(The fi?'st .inc?'eases the expi?'ation-the second cO?nmences 1'he Result is Respiration or },Tabu'al B?·eathing,. and if not too late, Life.

'Whilst the abol'"e operations are being proceeded WitIl, dry hands and feet, and oon as dry clothing or blankets can be l)l'ocured, ,tnp the body, and ('ol'"er or gradually re-clothe it. but taking care not to interfere 'with the efforts to re tore breathing.

II.-HANGING.-Remove all constrictions from neck and and employ artificial re'1liration, as for droWllrng.

III.-SUFFOOATION BY GASES.-Remol'"e the into air, clothing, and employ artlDclal respu'atlOn, as rn clrowning; usc galvn.nic battery.

should be applied to {,he head, which should be kept well raised. Tight clothinO' should be remol'"ed from the neck and chest, lants should be al'"oided.

CHAPTER IV. H1EMORRHAGE.

Hoomorrhage, 01' bleeding, is the result of the opening of a blood- yessel by a wotmd or otherwise. It may be external or internal.

divided into-I, A?,te?'ial, where the blood flows III Jets in great force, and is of a bright red colour. where it flows slowly-wells 41

out-and is of a dark, pUl'}1lc hne. 3, Oapillary, where there is a general ooz-iug of red hlood from the surface.

GENERAL TREAT.lY[E T OF HJFjl\TORRHAGE.-Pre, sure is the mo t powerful meall of arrestillg external hmtnol'rluto'e; and to u e it effectively, it j , i.mportant that the honld be directed again ,' t SOUle hOlle as a point of resistance.

In a.ll portions of 1he hody where special treatment is not pecified, direct pre nre to th wounded part will be 'uffi 'ient to arre, t hmmolThage till further a ' i, tance can be procured.

ARTERIAL H1E1\10RRHAGE i the 1110 t important and the lllost dangerous form of bleecling, and not a momellt onght to he lost ill giving help.

Treatment.-I. Expo e and examine wound. 2. 'Wash with cold water. 3. Eleyate the hlcetlillg part, but place body in the lying-clown po ition.

4. Apply pre mc with the fingers (lirectly oyer the lUouths of the bleeding ves ' cIs till you can get. further help.

5. Apply pressure to the lUain artery 011 the heart side, with the fingers or with a pad and bandage (tourniquet),

G. Apply a pad aml bandage ol'"er woullcl a an atlclitional safeguard.

VENOUS H1EMORRHAGE may occur along with artcrinl, 01' by itself. A suporficial wound is more

J:2

likely to divide vcim; thnn artcl'll's. Dtlllg'C'l'on yenous bleeding often take placc wherc thc pai il'lI t has varicose veins and ulcers on the lowcr limh .

(The dircction of tho flow of blood-toward. the heart-just the rcyerse of wlw.t obtaills in the artcrie , is a fact which bears on the treatmcnt.)

T}·eatment.-l. Expo e and ('xtnnille WOlnlCl. 2. vVash well in colel ,yater. 3. Elevate limb, keepiug hody in lying-down position. ±. Apply a pad and bandage on hoth sides of wound. 5. Remoyo any pre sure or restriction to the eil'l'ulation on the heart id, such as tight clothing (this cannot be done where art('rinl ble('c1illg has al. 0 to he treated ).

OAPILLARY H1EMORRHAGE is easily cOlltrollecl.

'l'reatment.-l. Direct prcs me to the hl!'cdillg' H11l'fncc. Application of iC'(' or of styptic , uch as alum, f:itcel chop . . caustics. &c. &c.

INTERNAL H1EJYIORRHA GE is soldom so rapid, except in cases of hnrsting of an aneurism, as not to give time for skilled aiel.

T1·eatment.-l. PInco patient in an eu y rcc1ll11bent po. itioll. 2. Apply ice to, or as near as possible to, ihe purL affeCted . 3. Sucking ice is useful in blceding about mouth throat, 01' air-passages. ,., ld

SITUATION OF THE ]IAIN ARTERIES IN THE DIFFERE...YT REGIO S OF THE BODY, A...YD THEIR TREAT:JIEXT TITHEN TVOUNDED.*

HEAD.

NECK.

SITUATION OF VE SELS. TREATMENT. Temporal, in front of ear. OOJl1pl'e oyer P. Auricular, back of e<11·. the wOlmd, and OccipituZ, hack of head. bandage.

C(lroticl A rterie.o:; a celHl Digital compl'e in a line from iUller SiOIl in line of enrl. of collar-hon(":; to Ycs ' l'l abo,c anglc of jaw. :mcl below tl1C "'onnd, 01' dirertly into wound' on tll' moutlls of ihe blcc(lillg YC"f'cls.

ARMPIT.

UPPER

ARM .

A,l'ill((rij Artery lie . acro. , Cmupl'c nbhollow spa('c of armpit. clayian artery behind middle of collal'- bone, or digital premc into the wonnel.

BI'Clchial AdeJ'y lies OIl Oomprc s artery iuner side of ann, in by a tourniquet a liuD with seam on above wound. coat sleoyo-from inner fold of armpit to midtlie of beud of elbow.

• Wounded veins shollld he tl' e n.ted [lccol'uing to rnles laid down nnder "Venom; HtUlUOl'l'ltull'c."

REG I ON.

F O R E -ARM

SI TUAT I ON OF VESSELS.

Radial and mna?' A?'im'ies begin a little below the middle of bend of elbow, and descend one on each side of the front of the arm to the mist .

TREATMENT . Oompress brachial artery in the upper arm by a tourniquet, o?· place a pad in hollow of elbow, and bend fore-arm against arm.

PALM OF HAN D.

HAM.

Radial and Ulna?' A?·te?·ies Apply two small give a number of firm pads to branches, which spread art e l' i e sat out and supply the wrist, or fo1'cipalm . bly close and fix hand over a piece of stick or hard substanc e, and bandage.

F enw,'al A?·tm·y, from Pre sme at midmiddle of f old of groin clle of fold of runs down the inside of groin, with the thigh in i ts upper two - fingers or by thirds. tau l' n i que t above wound.

Popliteal A 'rtm'y lies along Oompress popli. middle of h am. tea 1 a.r t e r y above wound, or compress femoral artery in front of thigh b y tour . niquet.

REGION. BAOK OF LEG .

FRONT OF LEG AND I TEP.

OLE OF FOOT.

45

SITUATION OF VESSELS.

Post. Tibial and Pe?'oneal A?·tel'ies descend the back and out ide of leg from below ham, passing behind ankle-bones.

TREATMENT. Oompress at ham or in front of thigh, or double leg on thigh with a pad in the ham.

Aliter. Tibial Art ery de- Oomprc . artery sccmls along middle of aboye ,,"ouml. front of leg and in ' tep.

Jio .' t. Tibial (lnd Peron ea l de scend behind anklehoue:,,; tho former supplie ' bran<:hes, which spread out on solo of foot.

Oompref> by a p a (1 b chi 1111 i nn era n k 1ehOlle; if this fails, place pads behind outer ankle-bolle, and on middle of front of ankle .

OHAPTER V. FRAOTURES.

Fractures, or broken boues, may be divided into fom classes :-

1. Simplo Fracturo; a simple break.

2. Oompound Fracture; a fie h wound communicating with the broken end of the bone.

3. Oomplicated Fracture; iujurie to soft parts, blood-vossels, nerves, or joint, or internal organs .

THIGH.

4. Comminuted Fractme; smashing of bone into pieces.

A fractnre may take place transversely obliquely, or longitudinally. '

Fractures are caused by yiolence.

SYMPTOMS OF FRACTURE.

The symptoms of fracture arc-

1. Inability to u e the limb.

Alteration in hape and general appearilll<.:e.

3. Unu ualmobility at of fracture.

4. Crepitus or crH,ekling on plating one IlHnd 0\ er tIle broken part, and creating motioll ,dth the other.

5. Shortening of limh .

0. Some inequality felt. on runnino' the fillgcl's alollg" the surface of the injured

}j1ractures are j1'0?n clislocation8 a follows :-

FRACTURES.

Crepitus.

Unnaturally moyabk.

Easily replaced .

Limb often shortoned.

Seat of injury in the shaft body of the bOllO.

DI 'LOCATIO N

No crepitus.

More or Ie fixed.

Replaced \\Tith difficulty.

Limb may be sllOrtelled or lengt.hened.

Seat of injury at a joint.

TREATMENT OF FRACTURES.

1. Reduce the fractured ends 01' POrijOllS to their natural po:-;ition .

.) Retain thcm immovably in their propel' plaee/; till llahn'C lHIS "ffC'de<l 11 PCl"l11UlIC'llt (·lll"t'. 4-,

There it:> no urgeney about treating a broken limb pro,ided no attempt is made to moye the per::;on, but if it it:> imperatiye that the patient be moyed in the absence of 11 urgeon, it is an abbolute neccs 'ity to secure the afety of the limb by pnttillg it in splint before remoyaL

A stl'etl:hcr is thL' only bafe llleallS of l:omeyanL'C for cases of fract lll'e.

Um;lcilful hnlHlliug" lllay canse eithcr :-;cl'ion ' mischief or Hen lo::;s of liJ:\'; the <lallg erH nrc pres:;illg" the harp emls thro1!o'h thc skin, and thu:, ll1aking the fl'adurc compound, 01' neneb. or iuto somc internal organ, ::,ul:11 as tho lung-.

SP EUIAL FRACTU ltBS.

ERL\CTURE OF THE SKULL.

Oauses.

J::J!flnpt01l1s.

BloWb 01' falls.

External sigu. uot alway::, precut. III fmdnre of Uw 1>a 'o there lllHy be lu.clllorrhage frum ear, mouth, or nose'; red patthe of blood Huckr coujlUlctinE of eyeli; and oozing of watery fluid from the car .

Aeeompanyiug thesc therc may be symptoms of COlleus ion, or symptoms of compression.

T/'eatment.

Place patient in a dark and quiet 1'00111 ou hi::; back, with head slightly raised. Apply tolll tu h ead a:o boon as reactiull :oet::; in and patiL'llt get · hol and 10\'o 1'i...,1I.

-±

FRAO T URE OF LOWER JAW.

Oauses. Direct blows; falls on chin.

SymptO?ns . Irregularity in the line of the teeth and the outline of the lowcr margin of bone: inability to move jaw.

T1·eaMnent . Fix lower jaw to upper jaw by a bundage .

FRAOTURE OF OOLLAR-BONE.

Oct'uses. Blows on shoulder; fulh; on elhow or hand.

SYIlLploll1,s. Shoulder drops . Arm is helpless.

Irregularity on drawing fingcr along surface of hono.

Patient inclines hoad to tho injur tl side, and supports the elbow with the sound hand.

Trcatmcnt. Place a pad in armpit, bind arlll tu side just above elbow, and sling fore.arm.

FR A OTURE OF RIBS.

Blows, falls, weight passing over chest or back.

Sympto?1t8. Oatching pain and clifficnlty in breath. ing, which is jerky and shallow, and crepitus when patient coughs.

Preatment. Apply a hroad roller bandage firmly round chest, so as to prevcnt all movement; or strap the injured side with adhesive plaster.

49

FRAOTURE OF THE HUMERUS.

Oauses. Direct blows, f alls on elbow . Symptoms. Mobility at seat of fractme. Orepitns.

Shodelliug, usually pre ent when fl'actUl'C is oblique.

Treahnent. Apply a rollcr bandage from hand to elbow, abduct arm and apply three or four plints from shoulder to elbow. Support arm in a ling.

FRAOTURE OF THE FORE·ARM.

Direct violent blows, falls.

Sym,ptoJns. Orepitus. Mohilit.y.

AlteratIon in shape of arm.

'l'J'eatJnent. Semifiex fore. arm with thumb pointing upwards. Apply two plint·, one iuside from bend of elbow to the tips of tho fillO'er, and one out ido from clbow to wri t.

The splint should be well padded. Place arm in sling.

FRAOTURES ABOUT WRIST AND HAND.

Oa Blows or other llijurios.

Sy))/,ptolns. Pain, .welling.

Il'l'cgnlarity in the outline of the bones. Orepitus.

Treatment. Bandage to a flat board 01' splint, and upport by Illig.

50

FRACTURE OF FEMUR OR THIGH-BONE.

Ccwses. Blo,,, , fall:-;.

Symptom '. Pain of power.

Crepitus.

Shortoning.

Brokcn ends may be felt.

Foot tumed out.

Treatlllwt. ExtellCl tht' limb. apply a loug Splillt 011 oui:-;ic1o along; tho whole :-;ide. frOID the armpit to the ont ide of tlle llcel. nnc! nll()thcr on the illSitlo (If the thigh. from top of the im,illc of the thigh to the kuce.

FRAO'l'URE OF PATELLA OR K 'EE-UAP.

Causes. Blows. or extcbbiyc lIluscular udion.

Sympto?n8. Inabiliiy to stand upou leg.

Fr8 o 'lllcnt:-; can he fell.

7'reatllleui. Rai c lillllJ ou a SpliUl to CI po i liUl1 oblique with the body, aull apply a figmo- of· ei gIlt ban dago H l'! lUll tl the knee. inclucliug the fragmollts.

FRAOTURE OF BONES OF THE LEG.

Blows, falls, crushillg weight, I;;uth al;; "heeb oyer the limb.

S?/?nlJtO?H8. Pain loss of :power.

Alteration in I;;hapc.

Crepitus.

Brokell eud lIlay 11(.' felt.

Treatmellt. Apply two one iu:;ille auc1 one olltsidc the limb

Elcnlto limb.

FRACTURE.' ABOUT FOOT A TD A.l KLE.

Causes.

Symptom;;.

Blp"'ii or other injuries.

P<1il1. s'YI'llitlg.

Alteration in ontlillc of hOHl'

Crcpitu:-..

Treatmellt.

Elcynte foot; rold water.

Before applying' auy splillt. lIe ('arPinl to pad it "ell \\ itl! somo soft matl' rial. a.., tow, "atltliug, ('oUoll-woo1, &c.

T.B.-lt mll'>t ))1; rell1l'lIl1)e'l'CU tlwt the tl'catmeut for f'l'lIrbll'cs here giYl'1l i.., ouly tl'mporal'y. to cItable the jllItit'ut to hI' lIlf)Y!'tl \\'ilitout ful'tiJcr illjllri('s. ,,-hil'lI llIight rc..,ult ill the 10 '> of tll!' lillJl) 01' c\,PJllifl', till a ..,m·g COll l'illl he :->Cll t fol'. '

'1']11' t I'cnillH'ld for tli..,]o(·alilJlh i:-i }llll'po:-'I'l,\" ollliliell, as beillg llallgCl'Uu::;, l'xtcpL ill the lJamb of a

A .'1pl'ain or strniJI is a hyist or oyer-exten -ion of a mu, elc 01' telldou or ligal1l('ut ahout n joint. usually with 1'uptme of ,>ome of it s fibres alld of slllall hloou- vc '" els. III rheumatic people it is oftcll followed by persistent pain.

Trcatmellt.-If there be grea.t pain. a hot hnth am] fOlllclltations "'itll complete rest; latol' 011, embrocations, friction. cold ancl 'nU'lll donchel->. aml pn SlYO lllO' elllcut::; al'(, l'Nlui..,ite, accordiJ)g' In the be,-crity of the aeri<1I ' llt.

C HAPTER VI.

WO UN D S .

IN CI S ED WO UND S.

T? 'eatment . 1. Wash the part carefully wit h water.

2 , Al'l:est the h:mnorrhage .

3. AdJust tllO and fix in a nn turnl po itioll.

4 . Place pa.tient in an ea y po ition, so a' to aYolCltrnilling the part. I II wounds of throat, sand-bag arc O'ood supports for fixing head and

5 , App ly c.old water dressing, or strips of aellie lye plaster.

INCISE D W OUNDS, WIT H PRO TRUSION OF INT ERNAL ORGANS.

T? 'eatment , Wash the part carefully with warm water, . return. 11111e s they are much lllJured, and place patient in

. . a thorough tate of 1'C t.

In lllclsecl wouuds about the face it. is ycry important to the wounded portions with a little delay as p o sIble .

CONTUSE D AND LACERATED WOUNDS arc more trouble ome to llCal, LC8i<les be ing hahlc to ery ·lpela8. gangrene, &e . TreaiJnent . Wa h.

Anest hffimorrhage . Replace parts in their llat ura l po iti on. Apply col d water cll'essin g's , and ne y er allow them to get d ry.

FOREI G N BODIE S IN THE EYE. -I£ the f orei gn hody i undel' tho npper eyelid, scat the patient in a chair, and sbmc1ing behind, place a pencil oyer the lid; lay hold of the eyelashes, and eyert the lid. Then, haying' expo ed the substance, hrush it off with the corner of a ltnmlkerchief 01' a camel's hair brush . 1£ it is uwler the lower eyelid, imply depress it, and proceed a aboye with handkerchief or bl'u h.

FOREIGN BODIES IN T HE EAR.-The cal1alleading to the in . ido of i he caris about an in -h and a quarter in length, (uul at tho inner end of this canal is placed t he chum of the ear-a yery thin, delicate memb r ane, re embling H, picce of ti ne paper .

A blow on the cal' with the open hand. or the concussion f r om the di::;chal'go of firearm, is quite ufficient to rnptmo and destroy this membrane. No interfercnce, therefore, with the cal', heyond n 'ing a YTillge, hould be att mpt (1, cxccpt hy a nrgeon. Snch nb ·tance as accumulation of wnx, picce of slaie- pellcil, in ect , &. ., mny be remoy II by yt'illging with tepid water . It will bc well, howeycr, to rcmemher that pea' and porou ' snhst:mecs, which ah orh moisture, would be rendered more difficult of rellloyal after the usc of the yringe .

BURl.: SAND SCALDS

.-A bw'n, is cau cd hy concentratetl heat, firo directly applied to mfnce, or chemical agent', dcstroying tho skin ancl tho tissue umlerneath.

A scald is produced by hot or boiling liquids touching the kin; the cuticle is rni . cd and the true s1..in reddened amI infiamccl.

B e. ides theil' l(wal Ildi()1l.1mrlls awl sCH](l are apt to p r oduce clcmgeron hy l' ()llgl'stioll of intt'l'llal Ol'galls.

T reatment of BI( I'lls .-Apply a mixtim of oil and lillle-wnter, oliy(' oiL castor oil· and wTap up the part ill ('ottOJl wool. wool. or thlllll C1.

T Teatment of 8CIl7ds.- pply n strongly alknlillP made ,,-Hit tIll l'Hl'houail' of :ada, lim!', or mag-lIcsin: ancl cl](:l()sc the limh, 01' part, in l'OttOll wool, cxclnding all' a far a" pos;;ihl('.

N .B .-Tl'onhle<;()1llC ('ollfrndillg (l('fol'lllity, oftcn foliow 1)111'11S; it is ihl'l'dor' illl11()l'talli to make th(' patient lie ill a l\;ltll1'nl }>o",itiOl\, n1l(1 a,oi,l til!' nerk or donhJi1\g' np tll(, lin11),;.

FROST-BITE.-Fl'ost -hitl' i:-; the ]'('SlIlt of expos1U'(, to . e,en' cold. 'rhc YitHlit.Y of the pH1'1 is 1'('(111('('(1 til :t ycry low point, tho pHl't losl'''; ih llatlll'al ('O]Olll'. a]1(l hceome. hlnc or pnl'pk.

Tl'entll1Cllt . Bl'ing abont 1'l,.wtiOll ,!.!.'l',](lnally hv fl'idioll . Place the patil'lIt ill n withont a fire. amI :1yoicl 1H'at. Ru1, the llart with SlJOW 01' other coM application. mal acllllillisi l'r Immelyand-water eHrefully in smnll (111<1i1tities.

BE D SORES arB the result of prc snl'L' from lyillg ill ow' position. Thcy mny he pre'vented hy harclcning' the skin by rubhing it ,rith brandy. LT(' applying adhcsin plaster , pl'ea(l 011 ]f'uilJPl'. Ol' jIll' liSt.' uf air or watpl' rnshiolls. ·).)

B iTE OF RABID IMAL

TI'Cattl1ellt . If possiblc, immediately apply a ligatnre 011 the siele ncal' ·t the heart; hathe the ""llUlHl with warm water, so as to eueourage bleeding; ;;eal'ify nrOlUld it to the clcpth of n qnarter of an iuch; use eansties, snch as nill'nte ()f silYer or carholic acid.

The intl'l'l1al n e of lmmc1y and ammonia i::; neces al'y.

'HAPTER VII ,

MATERIAL D APPLIANCE FOR T HE En1()Y AL A D RELIEF OF TUE AND 1 JlTRED .

THE ORDER OF T. J HN LrrTER.

'rUE .. A HFORD" LITTER.

TRETCHER '-\Yith all(l without tdc-,;copie hmHlles,

Rules f or pl ac ing a man on a str etc her will be found in the Appendix - " S tr et cher Exercise."

RULE FOR CARRYI:TG A STRETCHER,

1. Carry . ' tretchcr in hantls. 01' • n ' peml it by trap_ oycr the bearcr ' shouldcl", Ncyer allow tho , tl'otchel' to h plncCll on the shonl(ll'l's.

3. Bearers to march in broken step, and not in time.

4. Avoid all jolting, crossing fence, ditche &c.

5. Pace to be about 20 inches.

6. In ascending, patient's head to be in front, and in descending behind.

SPLINTS.-Splints are appliances u ed in treating fractures, for supporting the bones in their natural position till a cure is effected.

The material chiefly u ed for making. plints are wood, iron, pasteboard, leather, gutta-percha, felt, wire, tin, and bark. Extempori ed splint may bc formed with umbrellas, walking- ticks, igar-boxes, folded newspapers, policemen's truncheons, and soldiers' weapons, such as rifles, swords, or bayonets.

P ADS.- Splints should be well padded with wool, cotton wool, tow, flmmel, or lint.

BANDAGES are usually made from unbleached calico, flannel, linen, webbing, &c.

Bandages are used-

1. As supports to the different parts of the body.

2. As means of applying pressure.

3. For fixing splints, dTessings, &C.

4 . To allay muscular action.

The chief kinds of bandages are the roller bandage and the triangular bandage.

A combination of splint and bandage is made by saturating ordinary bandages with plaster of Pari, glue, starch, starch and gum, chalk and gum, or silicates of oda and potash (glass splint).

These bandage-splints, being put on moi t, and allowed

to dry, whilst they are kept in position, have the advantage of beillg very immovable, and well adapted to the surface of the parts to which they are applied.

ROLLER BANDAGES have certain convenient si:F.es, according to the part of the body for which they are required, a follows:-

For the :flliger ,linch wide and 1 yard long.

" arm, iuche wide mld 3 to 6 yard long. leo', 3 illChc wide and 6 to yard. long. chest, 4 to 5 illche wide and to 12 yard long. head, ill che . wide and 4 to 6 long.

In aplJZying a ?'olZe1' bandage: 1. Begin from below awl work upwards. 2. In . nre that the pres lU' \ i uniformly and cycnly applied. 3. Avoid wrinkles. 4. Bandago from within outwards by the frunt. 5. Rever e on the fle hy side of the limh. and not over the . harp edge of a bone. o. "Where the limb i of uniform use the simple spil'Cll; where the limb thickens u e the ?'everse spi?'al; and at joints u e the jiyul'e-of-eight.

The applic.'1tion of baudages is be t learnt by a practical Ie on.

ESMAROH'S TRIANGULAR BANDAGE i a triangular piece of unbleached calico j the lower border measure 4 feet, nnLl tho two side bordor 2 feet 10 illche cach.*

It can he al)plictl ill thirty-two differont way j it an weI'S eyery pnrpo e for temporary dre ing or field work; and

* A triangular bandage, with flgures illustrating its u,e, can be obtnined from the Orll er of St. John.

the mcallS ot makillg 0110 .ne always a.t hnllcl, namely, a ent dingoually iu two . .Its appltcatlOu I 0 that a look the diagrmll WIll ellable anyone to use lt III the manner lJH1icatecl.

MATERIAL' USED IN DRESSING WOU TDS arp pIa tel's, oiled silk, gntta-perella tissue, liuL aharpH>, oakum. cotton wool, &e. &r. are used for ke 'ping i ho edges of wounds m posItIOn, and for fixing dressing', in lieu of bandage , '

Oiled silk ((l1cZ glltt((-pcrrlz(( tis.';)(e are n . N1 oY('r oth0r dressings to retain moi tllrC', to pI' Y(,11t thC' (' cape of liquid applicatiOJ1s. and to proted tho part from any 0xt0l'llal impnri tics.

STI.MULANTS.

The stimulant , ill orllinar), u e are: illtenw71y. tea, heeftea , brandy, and coffee. E.rtenw71y. fridion, f:lllellilwsalts to nostrils. mustard to extremities, col(1 affn ion slapping the fare with a wet towel. .

POULTICES.

usc of poultices i. to apply and retain heat and n;t0l. they clean foul wounds, allay paiu, (haw tho cnculatIOn of the blood towards the urfaee from inLernal organs, and enronrago suppuration in abscesses.

They may be made from bread, lin eed, or other meal:-; ; charcoal. mustard, carrots, &e., &c .

LEEOHES.

In applying leeches, observe the following I'nlps :_

1. Thoroughly (·lean the pari.

1.: sC' all 1m"cr! u w-ine-gIns ; 01'. i£ to the in idc uf ihe mouth, lll:ie the leech-gIn .. s macle fnr that pnrpose.

3, 1£ it is necessary. bleeclillg may hI' further encouraged 11y ul:iing poultiee afterwards.

4-. Take ('nr that blercling cloes not bccom :1 huuclallt, an eY<'nt whic'h may happ<'n ,nth children. If it· docfi. the IUBmorl'hag(' may he nnC'sh'u 11)' exposing' the part to the ail', Rml applying cold or prc sme.

OR [l'TER YIlT .

Dr. 'LTFE

The term.., nllcl cOIl/uyiol/s (('utchiIlY ton t1i 'ease c,igll ify that. it i.. eOllllnullieable from the "'H'k It) the healthy.

'rhe following' firc tho principal iu£cctiou tlibeasl's:

Ernptiye fCYCl's-Ulea -Ie , and fever. Oontinued £evers-typhu, ro1a1 Illg yellow fevCl' '. Diphtheria, erYSIpelas, whoopmgrong-h, and cholcl'n.

DISINFEOTA rrs are material used for the purpose of purifying' tho nil'. d' .. by remo'iing or rCllclerillg iuert cerium noxlOU sub ia11('e".

Thl' most ('ommon patl nt tIi infedal.1h are '-

60

Condy's fluid.

Burnett's fluid .

Ledoyen's fluid.

Dougall' powders.

Sircl's .compounds.

RULES FOR DISI FECTING AN UNOCCUPIED ROOM .

1. .Close do,or and window, and top up every opemng or creVIce WIth old rags or tow.

2 . Fumigate by any of the following methods :-

(1.) By CHLORINE.-Place a few saucer in differe n t parts of the room, containing a mixture of one part of common salt, one part of hlack oxide of manganese, and two parts of oil of vitriol.

(2 .) By IODINE.-Place two drachm of iocline in a cup or vessel, and place a lamp or burnmg candle underneath it till it evaporates.

(3.) B y SULPHUROUS ACID.-Burn ulphur in sancers.

(4.) B y NITROUS ACID FUMES.-Placo everal cup into saucer or basins containmO' hot water and inside the cups put two olmges of of potash and one ounce of sulphuric acid.

(5 .) B y CARBOLIC ACID . -Place some pure carbolic acid in shallow ves els arolmd tho room.

3. Furniture and floors to be well washed or crubbed a of chloride of lime; the latter may be sprmkled WIth the powdered chloride of lime or Douo'all's powder . n

4 . Papers to be stripped from the walls and the walls and ceilings to be w hite- washed . '

5. All clothing to be disinfected by wa hillg', boiling, baking in an oven, or exposure to the un or before a fire, if a di -illiectin?; establi hment is not available.

6. Ourtains and carpets arc best di infected by exposure to a heat of from 200 deg. to 400 deg.

7. In extreme 'ases, destroy by fire all clothing, bedding, carpet, &<:.

RULE :FOR DISINl!'ECTING AN OCCUPIED ROO1)f.

1. Maintain a proper tate of veutilatiou by do or:>, window , and outer Ol)enings.

2. Keep up a good fire in the room.

3. U::;e oudy's fluid, Burnett's fiui(l, or solution of chlorid.e of lime for utensils in room, closets , &c.

4. Disinfect all clothing, linen, &c., beforo it leayes the room, a laid down in Rule ,for preventing spread of di ea e .

5. Fumigate room cautiou ly with either chlorinated. lime 01' carbolic acid, p1aced in aucers in differeut part::; of the room.

Be careful not to u e gases or vapours too freely, as they arc liable to cau e inconvenience to the patient, by irritation of hi lungs or air-passages.

RULES FOR THE PREYE TION OF THE SPREA.D 0]' INFECTIOUS DISEA E

.

1. Decide a to emling the patient to a ho pital or treating the cn e in the hou e. If a ca e for the hospital, 'apply to the Vestry for

a . pecial conyeyance, and do Hot uudel" tiny nrcullstanees elllploy a public ("aninge. .

3. After the . of tho infedecl pel'i::>un, fUUligute and rOOlllS occupicd ( viele instruction for chbmfectmg unoccupied rOOllil-i ).

·1. If n case for treatment at hOllie, ('leal' the huul:)e far as pos of all inmate except thc attendants on the i::>lCk. and ecurc the of a trained nUl':>!'.

5. Remoye carpets, curtainlS, and all ,' upc}'fiuuu;-, f1ll'nitlll'c . .

o. If small-pox, YHcclnatc eyer)' one in any way exposecl to infection.

I. as much fresh HiI' as pOlSsible WitlWllt lllg drangl,tlS, allll kcep a O'ouc1 fire hnrnilw elil\" and night ill the room. t" •

;:;. Use di:':iinfectallt Hol.ntiom; in all utcllsils ancl bIol'Pall.. Placoollerl dothcH 1111(1 lilll'lI ill a <1 i ...iuicctanL SOllltiOJl hefore they arc takell 1'1"1)111 the room. .

U Opell dou}'c Ol' wiml()wH are to be tlll'taiu e ll witlt sheets kcpt mobt with carbolic acid aud ,,-atl'!'.

10. Drains, sinks, and closets to l)e finshc(l at once a clay with disinfectantI'>.

11 . Eyery room that has been occnpiec1 hy all illfectcel ;person he tJlOroughly pmifiecl before it IS re-occuplCd.

12. During pati cllb should ha., e tcpid ?1' warm hath . ll1edleateel with some suitable dis, uch as Conely's fluid or carbolic acid T Jns 1. \-ery useflll ill ca. c!:; of fl'H'l'

63 lHAPTER IX . BATH.

The following arc the principal kinds of baths :-

B'lth. Wal c r Ya pour. \'ir. D cb ret' s.

The Oold ... 33 to 65 0001 . . .) to 75

Temperate -r:: to 5 It)

Tepill K to 80 to 100 9(j to lOti

Warlll to ll ' 100 to 115 JOG to 120

Hot ... lO 11:2 115 to 14:0 J:20 to 10

'1'1Il' COLD B .i\'rH ('hill the lll'face, ('ouhacb thfl hluml-, eb .. eb. forcl' tlll' l'il'l'llialiull from the to tho internal l'l'p;iuus, tlllll check ' pcrspiration; ,,,hell llot too prolong-ell. auel the illlli,illual ib in l'ohn t henltll. thc..,e cffect ' arc follOW-ell hy a reaction. UlHl a ploa ant feclillg' of 'YHnnth.

lb gCllcml ('lfed ou thc is hl'ctciug aUlI touie. The dangcr.., nre congestions of intcrllal organb.

HOvVER B TH i similar to the cold hath in it effects; probably ::;omowhat more bracillg.

GOLD AFFU ION i' the apl)lication of a stream of l'old water fl'om a height; it ])1'0(lnco a sudden aud yioleut timulating effect. and ib n eful for ]'on . ing )l 1'son ' from statcs of insen ihility, uffocation, dl'llllkenncs , 11)' teria, and poisoning. It iR OlliCtimes n, fn1 for producing sleep ill delirium ire men or l;l'lI11kt'll Illa ·:in.

'THE WET OOMPRESS acts as a local bath, and giYes a combination of effect j it first acts as a cold bath, and secondarily as a prolongod warm bath: its effects are very soothing.

IOE AND IOED WATER applied locally produco contraction of the blood-vessels, and drive the blood away from the part. They are useful for reducing swelling and inflammation, and arresting hromorrhage.

THE TEPID, WARM, AND HOT BATHS act as stimulants; they incroa e the circulation in the surface of the body, relieve congested internal organs, and promote secretion and excretion. The repeated 01' 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 bath " and act in a similar way j they are useful for relieving pain.

AOID BATHS are u efuI in liver and malarious disease.

Add three ounces of nitro-hydrochloric acid to thirty gallons of water, u ing a wooden tub.

DISINFEOTANT BATHS should always be used during convalescence from infectious diseases, and for several days before the inyalicl is allowed to join hiti family.

Add eight ounces of Oonely's fluid to 16 to 30 gallons of water (tepid or warm).

A. L KA.L I NE BATHS are useful in cases of gout and r heumatism. Add a pound of carbonate of soda to 30 gallons of water.

(j.)

N.B.-Persolls in delicate health who cannot bear a l'old bath lllay manclge to do so hy getting into warm or tel)id water, and then gradually lowering the temperature; by this plan a sudden chillillg of the mface i avoided, n11(1 tho benefits of a, combiued hot. anel cold bnih arc ubtaille(] with safoty.

GHAPTER X POI ONS.

Poison are snhsianres capable of de . troying life. They aro dhided int 0 cla . es, according to their action 011 the hody.

1. hl'itcmts de troy tho ti nes. and produce nervous shock.

:) X(ll'cotics produce in . en . ibility hy their action on the hrain.

:1. Nal'cotico-il'l'itclllt comhine the action of ll<lr<.'oties and il'l'itants.

Symptoms-Are tho sudden attack of Yomiting, pmging, nHl1lps. pail! in the ·tomaell, delirium, or unc!lllsl'iouSllCSS SOOl! after partaki1lg of food 01' cll'iuk.

Tl'eafmcnt.-The point to he kept in yiew in poi onllig

F arc:-

1. To get riel of the poison hy encouraging ....omiting.

I)li

.) To couutemd the effL'l"b, of t Ite by antidote'. which will lueelialli('ally Ol' ('ltemically routler tho poi ou ha1'1111 ss.

3. To rOlUedy tho offects ,md tllC tendcncy to death by ::,ti1111llauts, arbfil'ial l'c,..;pirntioll. nm1 cxciting' the c'{tl'etory Ill'g·<ll\:-;.

EMETICS.-Emctirs nrc l'l'1l1L'llil''> n"';L'll fot till' }lllrpO'll' of causing' .oll1iting. Til(' snf(':-;t <111(1 l'L',Hlic:-;t al'L'irrHatinl?:'i1c1ck of throat \,ith t11e fulg'Cl' or a fpathL'l': large of h'llltl ,,"'atcr witll a tahlepoonfnl of aU or mustard; one 01' two tnbk",;po(.lIlfrus of ipecat'uanha winc in w<ltcr; ;lll(1 t\\'euty of sulphate of zinc in WeLter.

ACIDS AND ALKALIES fOl'lll antidotes to oach other.

The aeicls suitable for the purpo e arc yillogal'. lime juice, and orange juice. mixed with water.

The alkalics arC' soda. pota. h. lim(" and muO'ne .' ia diluted "ith water.

ALBUMEN AND OILS will protect thl gullet UlHl walls of the tomadt ill poi oning by irritants. \Vhit.e of egg, milk, fiuur-flml.watcl'. salncl oil, ;\1\(1 ('as1<)1' Oll may be llHed.

The STOMACH PU IP eaullot hc ns('c1 l'x(,pl>L lJy a surgeon, but a \ ery good e. cmt be foull.a ill. a piece of gutta-perella tubmg, pl'onded the patIcnt, 1 , Hot in an insl'llsihle cOllditiou. Take threo yards of elastic O'utta - pcrella tubiuO', abuut half au iuch in make the patient swallow abu.nt. 20 to inches of it· raise the free end aho':e U1 head, nuu

07

pour down a pint of water, 01' a much as the st.oma?h will receiyo. Then lowl'l' the free ond, aud It Will Olllpty itsclf; ropeat the filling and ellptying as often as yon t hink Thi ' remcuy is perfectly safo awl effcdnal; it hat! heen n cd hy Gorman physiciuus for disol'dl'!" of the stolllach witl] con::;ider. able SLlcee ' . 'The i:;\\alluwiug of the tube cau he (lOll(' ,,-illl UJO gr!'a( est facilit.y. ,,-ithout a . sit,;! am'p. awl without dangPl'.

POI:'OK. '.

AR 'El: Ie

Al: TIMO ry l Butter of Alit i mOil Y (( lid 'l'£lJ'tu I' cm eli (. I

ill! TERA L ACID Oil ot' Vitriol. A'll"/ fodis. 81U"if n/ Salt . ACID.

IARBOLI ' ACID . ALKALIES ({.. /(lIudi{ · Pn{ash. CY oclr£ OJ' j ,ililc

AX'l'lDOTE. ' .

Ellletie"'l i milk; pel'oxllle of iroli; raw egg':-;; pa:-;tol' oil Sl1 la(l oil.

Ell courage YOllliting. 1\1i Lk; tea; tauuie acid.

Enl'omuO'c yomiting. Alkalies -solutioll ' of , ucla. potash; lime; magne. ia : whitillg- ; WillI plaster.

01i\ e (lil.

ACHls-villegcu' amI water; lime juice; orallge juice ill watol'; emeties n.lafl "ill'.

PHOSPHORPS- ' Rul j>oi'un )

Eneomage YomitiuO' by lnrgo ul'anght , of ",at 1'.

Large doses of lllagnc::;i:l ill water.

A\uiLl uil ' .

POISONS.

MEROURY SALTS (OO?'?'osive Sublimate, Oalomel).

SALTS OF LEAD (S1lgCtl' of lead, paint).

NITRATE OF SILVEROAUSTIC.

IRRITANT GA ES (07Ilo?'().fo nn ).

PRUSSIC AOID .

STRYOHNIA . N ARCOTIOS (Opi'l,tJn, MO?'J.Jhia). See page 33.

ALOOHOL

A TIDOTES.

Encourage vomiting; white of eggs; fiom and wator j milk.

Emetics and Epsom salt .

Oommon salt and water.

Fresh air; loosen (lros8; artificial respiration; da. h rold water ahont face neck.

Oold douche; smelling salts to nostril ; artifirial respiration; brandy and a.mmonia.

Emetics; cold affusion; artificial respiration; brandy and ammonia.

Emetics; Bhong coffee j cold a1iu::;ion: forced walking about; galvHnism.

Emetics; cold aUn 'ion ; warmth to llrface of body; a des ert-, poonfnl of vinegar in water.

OHAPTER XI.

MODES OF DEATH.

Death lllay ocenr in throe difforeut 'ways, according a ' it boO'iu::; in 'the heart, lunO's, or head.

L Heart-by syncop e, in hannol'l'hage.

o Lungs .and air- pa ages-by asphyxia, as in cll'ownwg.

3. Head-by COIIW, a in apoplexy.

IG r • OF DEATH.

rrhe mo , t obyions igns of d 'ath aro-

Oe ation of brcathillg-uo movement of clle t-uo moi t breath to dim a lookillg-O'la s placed bo£or mouth.

e 'ation of heart's adiOll-no impulso agniu ·t ide or pul 0 heating ill arteries.

Eyolids half do ed, eyes dim and glas y, pnpil ' dilah·d.

Jaw ' clenched.

Tongne appearing hetw'oun teeth.

Frothy lUUCU about uo 'e and month.

FinO'ers half-clo 'ed, and after a tilUe. body rigid o and nl'face cold.

UAUSES OF SUDDEN DEATH.

Tho chief cause::; of smlc1cll death al'eApoplexy.

Allcuri lll. Heart ditiease.

Suffocatiou.

Iujul'ieti to the llen-ous tiy::;il'lll. SUllstroke.

Struck by lighblillg.

Poi::;oning.

INDEX.

.\.ClD liA'llIS, lil c<lrl,olie, auli(lutl':-' to, Oi oxalir, [lnti(lotes to, (ji 111'11"'';IC, nutillotcs to, (is .\t.itls. milloral, ttl.

. \.cids awl alkalios, (jlj

.\'tUle"iYl: plaster'. :h'

.\.H·n"ll1ll. cllltl, tj:; _\'il'. \\atLr. "uil, .\:l' .. lIInll'riab [01' plll'ifyiug, .in

_'dIJUlllell amloib. Uti

.\.It.;ohoL autitiote- to. li

.\.lUllOUtul'Y canal, Alku (lutillotC8 to, 67

Alkalies aud acids, 66

Alkaline baths, G1

Auatomical aud

OUUiUC8, 3

Auimals, uites of rabid, .j;j

Ankle aud foot, fra.cture" [Luout, ;')1

Antidotes to poisons, 67 "\ antirlotes to, 67

Apoplexy, :Jl

ArJU (fore), fract ure of, ·lD Al'senir, antillotes to, lii' .\.rtcriul hcclllorrhagc, 1 .\.dories, 1i. itnatiou of, amI treatmeut wheu wouuded, 43 .\.l'tcl'ies and diffel'ellLl: uctweell, 1.)

li.0.'DA.U.t: aud PLIX'l', eulll hililt tiOll of ..)LJ

Baudage8, .jli

" sizes of, 57

Baths, acill, 6·!

a.lkaliue, 6J cold,63

III iufectuut, tH shower, 63

tepid warm, and hot, 6-1 temperature of, 63

7:2

Bearers, how to place a man on a stretcher with three, 56

Bed sores, 54

Bites of rabid animals, 55

Blood, composition of, 11

Blood and organs of circulation, 11

Blood poisoning from kidney disease, 33

Body, the human, 3

Bones, broken, 45

Bones of leg, fractUl'e of, 50

Brain, 8 compression of, 31

" concussion of, 3 1

l>eathing, difficulty in; a symptom of, 30

Breathing, stertorous, 30

Broken bones, 45

Bmns and scald , 53 alimentary, 23

Capacity, vital, 23

Capillary hffimolThage, J2

Carbulic acid, antidotcs to, 67

Caustic, antidotes to, 68

Chill, how to avoid in use of bath, 6.:;

Chloroform, antidotes to, 6

Circulation, organs of, 11 tabulnr view of, 13

Cold affu ion, 68

" bath, 63

Collap e, 33

Colla1'- bOlle, fracture of, 48

Comminuted fractlU'e, 16

Complicated fracture, 4.:;

Compound fracture, 45

Compre s, wet, 6J

Compre ion of brain, 31

Concussion of brain, 3{

Congestion of internal organ ' apt to follow burns and scalels, 5J

Contused ancllaccratcd wounds, 52

Conveyance, stretcher ouly t;afe means in cases of fractlU'e,47

Convulsions, 29

Cough, a symptom of, 30

DEATII, cases of s udden, 69 causes o f sudden, 70 sigus of, 69

Difficulty in breathing, a symptom of, 30

Digestion, organs of, 2:3

Di eases, infectiou , iS9

" "rules fur preventing preaLI of, 61

Diseases and injuries of the head, 30

73

Disillfectaut blt1.11s, 61

Disinfectn.nts, GO

Disinfecting lln occupied room, rules for, 61

Disinfecting an Ulloccupicd room, rules for, 60

Di!;infectiou, 5!)

Di locatious distinguished from fracttu'es, 46

Di,locations, treatmeutof, dangeron except in hauds of surgeon, 4.7

Dres::lings for wound::;, .38

Drowning, 3.')

Drunkenness,iuseusibility liaLle to be mi taken for, '27

E.lR, dangor of iutelicrellco ,vith, ;):3 foreign bOllies in, ,")3

Emetics, GG :t2

l'Jrysipelas, contused wouUtls, liable to,

Esmnrch's triangular bandage. ;j7

E.\.cretion, orgau of, :2.)

Eye, foreign bodies in . .')3

Eyes, pupils of: iutlica tiou from, 29

FACE, flushed, 20

Femur, fructul'l' of, ,jU

Fits, shivering, 29 " violent, 29

Flushed face, :29

Fomenbtions, hot, 61

Foot and ankle, fractmc:; about, 51

Fore-arm, frachu'e of, 49 .

Foreign boclies in the ear ,):3

" " "cye, 53

Frachu'e, comllliuutetI, 46 complicated, 1.5 compoUlld, 45 simple, {,)

" stretcher only safe means of conyeyance in cascs of, 47

FmctlU'c, ymptoms of, 46 of co11a1'- bone, 4 of boncs of leg, .50 of feUllll' , or thighbone, 50

Frachu'e of fore-arm, -19 of humerus, -19 of lower ja w, 1 of pa tella or h'llee-cap, .30

" of rib, 4

Fracturc of skull, 4. 7

FractLn'es, 45

Fracturet; about foot and a ukl e, 51 about w r ist an d hand, 49

F ractures distinguished from ilisl ocations, ±6

F ractures, heahnent of, 16

F r ost - bite, .54

GASES , ir r itant, autidot't; to, (j , suffocat i ou by, 10

Gidcliness, a of,

Gu tl a - percha tissue, .")n

ILI..:\D .L,\D WRb 'l'. fradlll'(' alJout, HJ

Hallllling, llll kilful; danger uf, in ca e of fractnre, 47 Hanging, 40

H remorrhage, arterial, ·11 ccLpillary, 1 from ear, mouth, nose, or eye : indications of, 29

H remolThage, gcneral treatment of, 41

H re m orrhage, internal " venou ,41

H ead , di seases and iujw-ies of, 30

Heart, 11

Hot bath, 04

" fomenta tiOllS, li-t

Hwnll11 hotly, ;3

H umerus, fracture of, Hl

I CE and ICED 'VATEH, (lj

I ncised with prutl'll-

siou of internal organs, Infedinlls llisensl' . , .-)9 rilles ful'

IH'Cyelltiug spread of, (i 1

Injuries aUll tliSl'HSeS of tlll' head,30

1asen ibility, '2/ call,;e,; of. ('xmrunatioll lit perou fllllnd insensible . Inseusibility: important ymptoms and their indicatiolls, 29

Insensibility liablc to be mistaken for clrunkenncss, '27

I uterual ht-emorrhage, )) organs, dingmm of,

I ntoxication , 31

I nit<'lnt antidote to, a8 .f AW, lu wer: fnu·tlll'l' "f, is

KI DNE Y hluod poit;oning frum, 3:3

Kidneys, 26

Knee - cap, fractlU'C of, ;')0

LAClllRATED aud cuntllcll ,,"ouuds,

Lead, salts of, autidotes to, 6S

Leeches, .j fracture of bone of, :")0

Litter, Order of t. John, .i:> . , AsltflJnl, " ;)., Li, er, fuuction of, 21

Lungs, 22, 2.)

ailli a fur thc l'llJJ1uyal aud relief of the and injured, ;j.j

MUllical aud .'ul'git'al Ou!liul':<, 27

salt", antidotes to, Ij, :;\Iiueral acid:;, tlnti<1otcs tn, 6/ antidotes to, 68 or opium poi 'ouiug, 3:3

Muscula.r system, 7

X ARCOTICS, antidotes to 6 K ervous system, 7 X itrnte of I' il wr. nlltidote to,138

OILED :::iILK, 5

Oils, 66

Opium, a.ntidotes to, 68 )) or mOl'phiapoisoning,:);)

Order of t. J olm littcr, ;j;j

Or gans, iuterual, iliagram of, of circula.tion, 11 of digestion, 2:3 of excretion, 2.5 of sccretion, 24 of special sen 'e, D of ,"oice and re:<pint tiuu,

Uxalic acid, autidotes to, 6i

PAD,. , ;')0

Paruly::;is, indication uf,;)O

Patella, fractme of, 50

Phosphorus, antidotes to, 67

Plasters, adhesi,c, 5'

Poi::;oning, blood, from kidney 33

Puisoning, opiwn or morphia, 33 " treatment of, 68

Poit;ons, classifications of, 65 )) and uutidotes, 67

Poultices, 68

Prussic acid, antidotes to, 68

Pulse, indications of, 29

P ump, tomach, ubstitute for, 66

Pupils of eyes, inclications from, 29

P mifying ail', water, soil, &c., materials for, 59

RABID L'ITMALS, bites of, 55

Rat poison (phosphorus), antidotes to, 6/

Respiration, organs of,

Ribs, fracture of, 4:

Roller bandages, 56, 57

Room, rules for disinfecting un occupied, 61

Room, rules for disinfecting an unoccupied, 60

SALTS OF LEAD, antidotes to, 6tl

Scalds and burns, 53

Scars, causing deformity, often follow bUllls, 5{ 'ecretion, organs of, 2J

Sense, organs of special, 9

Shivering fits, 29

Shock or collapse, 33

. hower Lath,

Silk, oiled, 5R

nitrate of : antid o t e' to, 68

Simple fractUl'e, 4;)

keleton, description of, { it)

Skeleton, tliagram of, 2

Skin, the, 26

Skull, fracture of, {7

Sores, bed, 51

Special sense, organ of, 9

Splint and bandage, comLintlti on of, 56 plints, 5G

" extemporised, 56 prain, 51

taggering gait, indications from, 30

" tertorous breathiug, 30

Stimulants, 5

Stomach, 23 to mach pump , substitlltll for, 66

tretc11er, how to place a mall on with three Learert; App endix '

tretcher only safe means of conveyance in cas es of fra ctur e , 17

tretch'er, rul es for carrying , oj.)

Stretchers, 5 ;j

:-;trychnia, autidotes to, 61{

Sudden death, cases of, un

" "causes of, 70

Suffocation by gase . 40

Sunstroke, 40 the muscular, / the nervous, 7

T EPID BATHS, 61

Thigh - bone, fractme of, 50

Triangular bandage, 57, .j ,

UNSKILFUL II.tL"'\'DLING, clanger of, in cases of fractUl'e, 47

VEI::-;'S, 15, 18

Yeins and arteries, difference between, L"i

Yenous IIremorrhagc, 11

Vital capacity, 2:3

Voico and respiration, organs of, 20

'W ARM BATTIS, 64

Water, iced, 61

'Vet compress, 64 \VoUlHls ii2

" contused and lacerated,52

Wounds, incised, 52 " with protrusion of internal organs, 52

Wounds, materials used in dressing, 56

Wrist ancl hanel, fractnres about, 49

STRETCHER EXERCISES.

IIITIIERTO the instruction giYl' 1l to the Classes of the, t. John Amhulance .Associatioll, 011 the remoyal of :-iick an!1 Injured perSOllS, hy stretdH'ni or illll'l"Oyis('(l lllctholb of transport, has hCl'll founded Oil Uules lail1 <1o,\,n ill Longmore'., " T1'l'a tisc 011 the Transport of and \YOlllHlcl1."

Bnt it ha.s hecn amply proyel1 that rules 1l('c!'sSHlT for drilled n1111 tlisciplinetllJOdies of IllPH, snell as tIle Army Hospital Corps, arc not applicahle to those who und e rgo a In'ief trailling" to Pllal,lc them to giye first aill in the accillelltsof ciyil lifl'. III the majority of cases, ill which a eertifieatell P1l1,il is call eel upon to act, he has to look for n. ,'istauce from lllPll ,,,llo haye hallno illstrnctioll as he ]lo;;Re. SI'S, whereas en'ry llll'ml'l'r I)f a military hearer company is drillcel to work "'jtlt others, allcl when three or four of Imclt men h<lye 11cell nHlllhl'l'ml off, each KUows what is expected of him.

The regulnr elrill rel11lirell for a hearer COmp<lIly in the Anny is therefore not the hl'st fol' a elass of pupils of this tiOIl.

On a panlell' g-rollU!1, or in a militnryhuspita1, thl're is gl'lll'rally plenty of 8p([('e, :\llIl nile of lifting' ilJ1l1e:lrryillg innllirls can he <llloptell, hut the al'Cillellts whil'h hal'pen iu ciyil life, make it necessary tlla! Ulllch :,;houhl he left to the iutclligcucl' aDd experience of those who han' to remlel' first aid. For iu,.;talll:e, ,,,hell a patient has to he placed on a 'trcil'her in a in a factory cruwdcIl with llHwhillery, or in the tortuOllH passages of It miue, it woulll be (luite impo :;ible to follow the tlll:ectiuns given

2 in the "Manual of Exercise for tl'etcher Bearers, and Bearer Companies," but the stretcher must be put II t the side of the patient or in any other position possible, and the bearers must act accordingly, lmder the direction of one of their party.

On this subject Professor Longmore has saill: "The nulitary rul es were framed for service in the open air where lhore is, of course, plenty of space, hut all such rules must he modified according to circumstances . It is well, I think, to teach the system 'which is thought to be best, amI at the samo timo to prepare persons for doing that which is next best, when what may be best under other conditions ceases to be applicahle."

The following rules have been drawu up to supply a want which has been felt, and frequently expi'essell, by gentlemen of the medical profession, who have kimlly devoted mueh time and attention in the giving of First Aid Lecture . It may also be added that during the last two years they have beon practically adopted in more than one active Centre of tho lbsociatiou.

For purposes of ch'ill, nlUnbering the boarer will be found useful whenever three or four men, thus instructed, fill<I themselves in a position to work together; they will act with l ess hesitation, less liability to accident, and with more speed; but it must be repeated that in nearly all ordinary accidents, an efficient bearer will have to select his assistants without preyiou notice, and give them his directions as briefly amI clearly as h e can . The most important point is to understand the prillciples which have dictated the rules laid dO\V11 in the Exercises.

STRETOHER EXERCISE, No. I.

For three Bearers, To be used when space will allow.

1. THE Instl1LClor sl'1C'cts the Bearers nnd numbers them-1, 2, 3, at his dis(')"('tion. f\houlcl one man !J(' taller and the others, he i"hnuld be styled No.1, as he mil have to bear the hcavlCr part of the bm-den. .

All ordcrs will be given by Xo 3

2 "PLACE THE STRETCHER."

No.1, taking' the head of the stretcher, and Xo. 2 the fo?t, places It in a line mth tIll' I'aticnt'O! hotly, the foot of the Ftrcteher bemg close to his attends to the Patient, a;;;;istecl by :Xos. 1 and 2 when necessary.

3. "FALL IN," At this ortIer,

No.1 place,:; himl'df nt til<' Patient's li!tht side, ;\0. :! at his lcft si<il', !lnd both B('rH'Cl"R f!lc'e c!lch other. Xu. 3 ldkcs position on the injul'e:u 'ido in a line \lith the Pn.tlCnt's knees.

Xlil c. The duty of "·0.3 will he entirely tn look after the part of lhe l'aticnfs blldy or limbs, to sce that no handages or splints I eeome disIlhu·cd, that Xo. 2 Heurer, in Iiftlllg or docs not in /lny way touch tile Patient',,; feet.

has be.'n al'mnged for the removal of the Patient, the order will be gin::n-

4 . "READY."

Nos. 1 anti 2 now carh sink down on one knec and gra p each others' hantis under lhe shoulders al\(l thighs of thc Patie!lt, whih;t 3 places his hands underneath the lower limbs, always tulung Cilre, 10 case of a fracture, to have one hand on each side of the scat of injury.

5. "LIFT."

All three Rl'urers rise together to their feet, keeping the Patient in a horizontul position.

6. " MA RCH,"

All take short side-paces until the PatlCnt's head is over the pillow of the stretcher .

Bl'llrl'rS should he tlltll;\,bt to tuke any of the llositioons named in the fol· lowing Exercises, whecber Wilt of No .1, 2, 3, or.j Benre r.

4

7. "HALT."

.All three Bearers remain steady, and wait for the next order

8. "LOWER."

The Patient is placed gently on the Stretcher, and the Bearers then stan d up.

9. "F A L LI N." On tlus order being g-i,cn, Xo. 1 placcs himsclf at the head of the strl'tclll'l' \I ith his face tU\\'!uds the Patient, Xo. 2 at the foot with his back to the l'ntiellt and No.3 places himself at thc side of the Patient . '

10. "READ Y."

2 stoop d.own ancl g'l'a;;p the handles of the stretcher, luning p reVIOusly adjusted then' shoultlu-strilps in ca;;e they are used. Xo. 3, as soon as he sees all i' right, giYes thc w()rd-

11. "LIFr :'

The stretcher is now raised to position ready for moving off.

12. "MARCH " On this word being given, No. 1 steps offmth the left foot, and No.2 with the right.

The step, hould be a short one of twenty inchc,"" lind tlllcCll with hent knees just from the hips, .

13. "HALT. "

The place of destination being reached, on the word" IIalt" being given , the Bearers remain steady in position.

14. "LOWER."

At this order the Bearel'S place the stretcher on the ground, und then stand up.

15 . "UNLOAD STR E TCHER- READY."

The Bearers prepare to take the Patient off the stretcher.

16. "LIFT. "

The Bearers rui;;e up the Patient as before in. trudell.

17. "LOWER. "

is carefully lowered upon the vehicle, bed, 01' other place n which It has been designed to curry him.

STRETCHER EXERCISE , No. II.

For four Bearers. To be u s ed when there is not sufficient spa ce f or car r ying out Exe rci s e No . 1.

1. The lnstl'udor 1lll1nlu'l's tll' lknl'ers 1,:!, :1, l.

All urders \yill Ul: gi\'l'Jl b) Xo. 1.

2. " FAL L IN.''

At lhe won],; 'Pall in," Xo,.,. 1, :!, Hnll take po"ition on one SIde of the Patient. Xo 1 plar'L's himself at the r,ltient',.; 'houltlcl', Xo, 2 the midllle of the bOIlY, "",u, nenr the- Patient's fl'pt. .\t the same tlllle Xo oJ. phlCf'S the "tl'etcher on tlte g-roun<l by the other side of the Patient, llllli rClllains near its ceutre ftll'ing the other Bearers.

3 " B E A D Y."

Xos l,:!. Hull ;J stoop rlown, and knp..] on the h'ft Impp if they al'e on lilt left "ill!' of the ['atit ,u t. on thl' ri::rht Imt'c if till')' are on the rig-ht side of the I'atit'nt '!'llt'y tJ.t'1l 11l·Ot:"l'll to bke hul.l of the Patient :-Xo. ing' one of his :t1'1Il" 1'l'lIeath thl' ratienL's 11" (']': and LlH' othf'1' under lU8 shoultlcl'-hl:ulcs; Xo. :! passing' 110th m'ms U1H.lf'r the middle of his llOdy, onL' the other helow the lmttol;ks; anll Xo. 3 passing- both uIlIlel' thc 10\\'('1' ('xtrcmitie", l'\:.cepting- in ease of frnctul'e, when hc must plal'e one hawl on e:leh the broken hOlle, sO as to:teady it. Xo . .J, when the word" H ..ady • J" g'1\'en. g-ra"ps the ne'll' pole of the stretcher '\'\'lth hi>; left hant!. and the ('pposite pole with his right hand, neftI' the centre.

4 . "LI F T. "

Onthpwonll'Lift" bcingginm. nnd3 misethc Pl1tient uJl I'lu·h Ilt lIll' SaHl(' tillle llhwing- OIl the knee whil'h is not tOHchinf!' t he his elllnwof the sam e ' ''''hill' 1, 2, and ;'3. are thus raising- tilt' rlltipnf, No. -! moyes the stretcher mto propel' posItion under him nrlll kneels down on one knee by it.o; side.

5 . "LOWE R."

At the word ., Lower," Nos. 1, '2, ancl3 eHrefully lower the Patient down to the while No. -! at tlre same time us'ists in su p p orting an d p l acing him on it.

6. "S'I!AND TO STRETCHER. "

On this order being given, ench Bearer stands up :-No. 1 goes to the }l('ad uf the stl'etchenvit]l his face towards the Patient; No.2 to the foot, with his back to the Patient; while Nos. 3 and 4 remain in position on eae h si de of the stretcher.

7. "READY ."

Nos . 1 and 2 gro p the handles of the Rtretrhel'. having preYiously adjusted their shoulder-straps in case they are using them.

8. "LIFT."

At this word, Nos. 1 and 2 Bearers raise the stretcher stcadily together a n d stan d up.

9. "MARCH "

Al l bcing ascertained to be in order. on the ""01'(1 "J\1ar('h" being given , Nos. 1 and 2 Bear('rs moye off :-No. 1 off with his lcft f oot, and NO.2 with hil' foot. NC'!' .'l and J mnr('h on ('o('h side of the , tretchel'. On aniying- at the plllce of dcstin <t tiun, the following ord ers are successively given -

10. "HALT ."

11. "LOWER ."

12. "UNLOAD STRETCHER- READY. "

13. "LIFT ."

14. "LOWER."

N.B .-These ordcrs, viz ., Nos . 10 to H inclusive. arc to be carried out in a similar m anner to orders Nos. 13 to 17 in Exercise No. 1.

7 STRETOHER EXERCISE, No. /11.

' Vhell on ly three Bearers are available, and the space is limited as before, the following alterations must be made in the foregoing (:::fo. 2) Exorcise.

1. The Instructor numhers the BearCls-I, 2, 3. Al] Ol'der will be given by No.3.

2. " PLAC E ST RETCH ER. "

No.1 Bearer places the stretcher on the ground by the side of the Patient Llnd us clo"e tu him us practicable.

3 . " FALL IN .''

The three Bearers take the same positions on one siele of the Patien t as laiel down in Exercise No. '2 .

4. " READ Y."

Nos. 1. 2. LlntI 3 kneel down. placing themselYes as close to the Patient as tJu,y conveniently can, anel theu take 1.wld uf him as directed in Exerci e No.2

5. "LIFT ."

NOR. 1, aud 3 mise the Patient as (lirected in Exercise No.2.

6. "LOWER."

At the wort1" Lower," XOR. 1.2, and 3 l ean forward so as to carry t h e Patient over the stretcher, and then carefully lower him down upon it .

7. "STAND TO STRET C HER"

At this direction No.1 goeR to the head of the stretcher, No.2 to t he foot, anel No.3 remains in position ut the side of the stretcher.

'rhe remainder of this Exercise will be prerisely the same as is giye n in Exerci:;e No.2, from orders 7 to 14, both indueleel-the instruction for No . 4 Rearer to walk by the side of the stretcher bcing alone omitted .

"Pro utilitate homimem."

STRETOHER EXERCISE, No. IV.

For use in Mines and narrow Cuttings where two men only can be engaged.

Necessary Fir t Aiu luwiug' been g-iven, Nos. 1 and 2 will carefully plnce the stretcher in a line with the injureu mlm'" body, the foot of the tretcher being, if po.'sible, clo e to Iiis head.

NO.1 will give the word" Ready," when both get into a. foll ows :-

NO.1 places hIs feet one on earh "ide of the I'ati!'nt betwem his hody !lnd Arms, the toe of each foot as near the armpit as st:Ulding" over the man. ne then stoop down ,rnd passes his hands bet\\'('en thl' sides of the chest and thc arms ulluerne:tth the shoulder,;;, anLl locks thC' fin gers.

If the Patient's arm be wunjured he may put thcm rounu the neck of No 1, a.nd by tlus means greatly n, si t him in lifting. No.2 at the same time plares hi" rig-ht foot Lctween the ('alves of thC' injuTed man's legs, a. (:lose to the lowes as possible, and his IC'ft foot Ilt th e injured man's right sidC', elo:-;C' to the rrest of the hip; T llr tlJ(>u down and pa ses lu arm round the ouh,iue of the I'aticnt's thiq-h.· nt the low est part, andlo('ks fingers hehind just at, the hC'nd of the lowes

When both are ready, Ko, 1 will g-iye the order" Lift Ilnd move f<?rwI\rd ." The Patient i' then to he slowly lifted just suf:l:i<:ient to allow his body to clear the stretcher. Roth Bearers will slowly and g-l1lcl1lttlly move forward, Ko. 1 by Ycry ",hort stC'ps, and :No.2 by hClllling- his hody forw ard over hi. left thigh, 1Iy wlti('h meuns he exen:isp a pushing IlIOY<.'ment which yery greatly assist. No. 1. o. 2, when he has Ul'llt IJis forward as much a he can \\ithout mo\ing his feet, adnlllt'C's his right foot to his left, then ag'ain advanccs left fnot and hPlll1s his hoth forward. This movement is to be repcated until the Putient laid on the sti·etcher.

The Bearers will then act in the ordinary mnnner as fill' the natlll'c of the locality will pelmit,

(Signed ) JOHN FURLEY, Deputy Chairman , S.J.A,A.

'" It is not til hC' too ]mrtirulnr to lllp h('",1 or foot o[ a "I 1'1'1 rlll'l' in a mine, as it would IJI'ohnhly b" qllitl' to ]'P\'l'I'B( il, unci it alwrJ)'s competC'nt for the lo lower th(' pillo\\'. t Wh en the Patient's legs arc in splints nnu lieu together , the feet of 2 must necessarily lJe placed outoide.

JJobn J\.nthulance J\.zzodation.

AMBULANCE CORPS,

For the Tl'anspO}·t of Sick and Injured Patients, infectious cases excepted.

S5ub=<!enmmittct.

Captain Rupert C. F. Dallas, Chairman..

Major James G11dea, TreQ.S'",rer. Owen, Esq., F.R.C.S.. &c. &c., Hon.. COlf,S1Llt£ng

John Furley, Esq., Hon.. SzcretaMJ and Manager, to whom all communica.tions must be a.ddressed.

OFFICE-

ST. JOHN'S GATE, CLERKENWELL, LONDON, E.C.

( Witl.in ;five milmte.s' walk oj FarriJl$dM Street Station.)

Horse Ambulance Carria,ges and Litters for the conveyance of Sick and Injured persons may be had on application on the following conditions :-

A Horse Ambulance Can'iage-

Cost all charges) one guinea for a removal within the four-mile radius of Uhul'ing Cross.

A Two-wllepled Ambulance Litter-

Cost (including all charges) half-a-guinea within the fourmile radius of Charing Cross.

In each case 011e .ykillcd Attendant only is sent. Extra Attendants Is. per hour eacA.

Special terms for the removal of Pati(llt"l C[ n b" nrrang-('d for C'ither of the above conveyances outsIde this radius and for 'country journeys.

[In Cel·tain exceptional cases a reduction on tke above terms may be made. ]

Payments to be made at the tim!' of rpm oval in exchange for a printed receipt. Gratuities to atten ]ants stlictly pIOhibited.

Removals are made without responsibility, and in ('ach ('ase on thE:' undtln;tandllig that the Patient is free trom infectious dibea:;e.

Office Hours from 10.30 :t.m. until 5.30 p.m., !Wd on Saturday!! from 10.30 a..m. until 1.30 p.m.

FOR JYURSl i VG ('LASSES REIiPS

NUl{SING AND IIYGIENE.

A HANDBOOK FOR ALL WHO HAVE TO DO WITH SICKNESS . .\.1'l'o.n o Pll ;t('('ol'Lling tu tlll' '-'yllalJtl-o uf the Spconu (ur XUl'.inguf L(·t'tul'l'''. 11)' E. :\f .. "E, l:L-\.., :\L D., ('lI. II L. IU'.'-'. r.. L,( tm!:'!' :11111 to t11' . sSlll'iatil 1J j',';,./ is.; h!/ flu.\I, 1s.2d. .1ppli('((It(J/( (01' tv lit· "tldt t \.\n{ lit tIlt liolltl/'((I'!J lJil't'r/u/' ' of ::Stu)'t, , J A._1.., t. Joh,l'" Gllit', f ,'ltI'kl'llICd l, E.U.