FIRST AID TO THE INJU RED.
CHAPTER T.
ANATOMY AN D PHYSIO L OGY.
BONES .
FOR the purpose of description, we may divide tho body into the Trunk, compri ing the thorax., or chest, and the abdomen, or belly j the Head, comprising the brain-case, and face the U1Jpe?' Limbs, the arms j :.tnd the Lower Lim,bs, the legs.
The framework upon which the body is built is called the keleton (Fig. 1), formed of over bones, which vary in size ane! shape according to the work they have to perform. Besides being a framework for the muscles, theyiorm cases for the protection of the yarion organ, and t;Upport, the weight of the body.
The bones of the kull IDay be ilividccl into those of the brain-case, eight in number, and
1+ tho 0 of the face, fourtoen ill number. vVith tho exception of lower jaw, they aro yery firmly joinod. together. formmg a strong case for the protection of the brain, ear, eye: nose, and Th e bones forming the top of tho bralll-case are thIck, fiu.t, and curved, so that the force of any blow falling oil the head may be broken.
The skull rests upon a colulllll of bono called the vertebral colulllll, or spine, extonding from tho head to the haunch bones. This is mado up of thirty-three bones called the vertebrm-t.he twenty-four upper called tho true -vertebrm, the nine low er tho false. Betwel'll each of the. true -vertebra;) there is a pad of cartilage, or gristlo. WhICh acts as a buffer, and pre"\"e nts iho bonos jarring "hen they move, and gi-ves elasticity to tho wholo column. The bones are kept in thoir places by bands of a tough, substance called fibrous tissue, which passes in all threctlOns around them. Although there is no movement beh,eell any two vel'tebra;), the spine is a very fl exible rod, and can be bent in every directioll, the greatest amount of movement being in the neck and. loin portions. Th e seven uppor bono are called. tho cel'Yical, 01' nock Yertebrre, the next twclyo the dorsal, or back ycrtobrffi, and the remaining fiye the lumbar, or loin yertebr m. The cervical and lumbar bones are perfectly free, but tho dorsal bones are to the Ribs, bOlles shaped like half-hoops, extendmg from the spine b ehind to the breastbone ill feont, thus forming a case-the thorax-for the protection of the lungs and hea .rt.
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Runnillg from tho top to the hottom of tho spinal l'olnmn il:; a cnnal, ill which the spinal cord lies.
Tho falso yortebrw aro joined together, and forlll a massivo bone called tho Sacrum, or rump-bone: this i " io the two haunch-bonos, which join each othel' in front and form a yery strong caso called tho Pelvi s, which receiYes tho bladder, intestines, &c.
On the out ide of the haunch bone we find a deep.
FlO. 3. F IG 4.
cllp-like dcpre ion, ,,1)ich receiYes the rounded cud of tlll' F(']Jllll', or thigh-hone, the largest bOlle in the hody. The otJlI'l' '1111 of the femur reo i i:l npon the tibia, or shin-bone.
'rlH' leg ha two honcs in it: the iuner one, the Tibia, i & Yt'r), strong and ihick, mH1 CllryeS inward ; the outer, the Fibula, or broach-b olle, is a thin ono, which strengthens thc leO' without nddillO' much to its weight. In fr ont of the knce find a small rounded hono callct1 tho knee-cap. The lower ends of the tibia and fibula form an arch, which recei,es the npper part of one of the bones of tho foot.
In the ' foot thcre arc t\\enty-six tout, th ick bonCtl, juincd together yery firmly, and arranged in a doubl' ar :?h-unl:
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.arch extending from the toes to tho heel (Fig. 3),. the other from side to side (Fig. 4). This arrangement IS to o-ive elasticity and strenO'th to t,he foot, enabling us to b move freely and easily. A person in whom these arches 8.re not perfect is called flat-footed. .
All the bones in the lower limbs are strong and thIck, .as they have to support the whole weight of the body.
Extending between the top of the breast-bone and the shoulder are two flat double-curved bones called the collarbones, or clavicle, which serve to keep the shoulders .apart. Their outer en(ls, with a portion of the shoulderblades, form cups to receive the upper end of the armbone.
The Seapulre, or shoulder-blades, are large, fiat, irregular-shaped bones, whieh lie on the baek the covering the seven upper rib. They glV'e addltlOnal strength to this case, and serve for the attachment of muscles which move the upper limbs.
The in the upper limb are long, thin, and light, as they have to support no weight,. but are merely to enable us to reach a long distance, III th ' hand to cover a large space. They corre pond III numb.el' to those of the lower limb (but are arrangeu somewhat differently). .
In the arm, there is one bone-the Humerus; III thl.l :tore.arm there are two-ihs Ulna on the inside and the Radius on the outside. These join the wrist, in which
there are eight small bones joined firmly to each other, and forming a very flexible joint.
In the hand there are nineteen long bones, five being in the palm, the remaining fourteen forming the fingers.
.rOINTS .
When two or more bones come together, they form a joint, modifications of the "ball and oeket" and the ,. hinge" being the most common kinus. The ends of the bones forming the joints al'e larger than their middles or shaft ; they are coated with a layer of gristle or cartilage, whieh acts as a buffer, and prevents pain being caused when the bones move upon each oLher; over this cartilage is a skin or membrane, which makes an oily fluid, to lubricate the parts and to enable them to move freely. The hones arc kept in position by a munbcr of short bands of fibrous tissue, which completely surround their ends.
MUSCLES.
The bonos are moved by the muscle , the masses of red flesh which make up the bulk of the body; these are arranged and shaped according to their work. Where they move or lift heavy weights they arc in thick masses, as in the thigh or but when they have to cover in cmities, as in the cheeks and abdomen, they are thin and fiat.
.A muscle is made up of a munber of bundles of fibres.
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E
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like bundles of threads, enclosed in a tough sheath, which at each end is much thickened. forming the tendon by which the muscle is attached to the part it acts upon. This tendon also takes the place of a muscle in passing
o,er a joint; thus, in the arm, the muscles acting upon the hand begin around the elbow and the upper part of the fore-arm :-about the middle of the fore-arm we find the tendons taking the place of the muscle, I'mcl passing over the wrist to the fingers. If the muscle continued right down to the fingers, the action of the wrist would be greatly curtailed.
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When a muscle acts one end is fixed, the middle of the muscle shortens and gets thicker, and thus draws its free end towards the fixed one (Figs . 5 and 6).
ORGANS OF CIRCULATION.
All the organs of the body arc kept supplied with food for their growth and proper action by a fluid called the Blood, which flows in all directions through the body.
Besides canoying food to the different parts, the blood :lets as a scavenger and takes away from them matter which would be harmful if allowed to remain.
The blood is driven over the body through tubes called arteries, ,eins, and capillaries, by an organ called the heart.
The pure blood is carried away from the heart by the 3.rteries, whieh branch out all over the body, like the hranches of a tree, becoming gradually smaller and smaller, and at last form a network of yery mall tubes called capillaries, which enter into the smallest parts of the differont organs (Fig. 7).
B :3
FIG. 5. l\IUSCLE AT REST.
FIG. 6. l\IUSCLE IN ACTION.
VEIN
FIG. 7.
The capillaries re-unite and run into the veins.
While passing through the capillaries, the blood gives up its good qualities and returns in an impure state through the veins to the heart.
The Heart is a hollow, conical lllusculaI' organ, which
FIG. 8.
lies in the middle of the chest, behind the breast-bone , chiefly on the left side. The base looks upwards, and the point extends to just below the .left nipple, where it call be felt beating.
The accompanying diagram (Fig. 8) will give a rough idea of the internal arrangements of the heart.
Runrung from the base to the apex is a closed partition
dividing the interior into two portions: these are subdivided into two others by means of flaps or valves.
The upper cavities arc called th6l Am'icles, and the lower the Ventricles.
the right auricle there arc two openings, by which the Impmc blood enters-by the upper one from the veins of the 11 ead and upper extrcmi ties, and by the lower one from those of the lower parts of the body.
As soon as the auricle is full of blood, its walls close and force the blood through the valve into the ventricle. When this is full, its walls close and force the blood through the pulmonary artery into the hmgs. The blood ITom the lungs through the pulmonary veins mto the left auricle; from this it passes into the left forces it into the aorta, the large artery wl.nch begms at the hack of the left ventrical, and through this into the malleI' arteries, by which it is carried oyer the whole body.
The left ventricl e has the thickest and strongest walls of any of the cavitie:; of the heart, as it has to drive the blood over the whole body,
The blood is prevented from returning into the auricles from the ventricles by valves, which are attached to the ides of the walls of the heart; their free edges are also attached to the walls of the ventricle by str onO' threads of fibrous tissue, which ar e only just l ong to allow them to meet, and so to shut off the two cavities.
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Both auricles act together, and then the ventricles, causing the double SOlIDd that is heard over the region of the heart. The pulsH,tion which is felt in the arteries is caused by the action of the ventricle, driving a fresh supply of blood against that which is already in the aorta: the pulsation is only felt in the arteries as the blood loses its force while passing through the capillaries; when it reaches the veins it flows in a steady stream.
Th e blood in the arteries and on the left side of the heart is always pure, while on the right side and in the veins it is impme.
ORGANS OF RESPIRATION.
One of the chief impurities taken up by the blood in its passage round the body is a gas called Carbonic Acid . 1£ this be allowed to remain in the blood, it will S0011 cause suffocation. To get rid of it, the blood passe. _ through the lungs. The process by which this pmification is completed is called respiration, and is divided int o two stages-viz., inspiration and expiration.
The Lungs are two large bodies, which, with the heart , fill the cavity of the thorax, or chest. They rest upon all arched muscle called the Diaphragm, or mid-riff, which divides the thorax from the abdomen.
The lungs are made by the division of the Trachea, 01' wind-pipe. This flexible pipe runs down the front of the neck from the root of the tongue to the top of the
breast-bone, whore it divides into two branches, one running to the right, the othor to the loft; these again divide and sub-divide until they form very SlUl1ll closed tubes.
Before they terminate, the tubes bulge out (as in Fig. 9 ). forming .air-cells. Th e lung is made up of these cell s, covered by a network of capillaries, formed by the breaking up of pulmonary arteries.
FIG. 9.
Inspiration is the act of filling the lungs with air. It is performed by all the muscles which raise the ribs contracting, and drawing them upwards, thus increasing the depth of tho thorax from the brea t-bone to the spino. At same time the diaphragm act, and becomes straight Instead of cllryed, thus increasing tho uepth of the thorax from aboye dOWllwards; the air then rushes in tlu'ouO'h the trachea and fills the air-cells. 0
Expiration, or emptying tha hmO's of ail', is caused by the muscles relaxing, and allowing the ribs by their ela-
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ticity to fall, and by the diaphragm resuming its arched position.
While passing through the capillaries round the aircells, the blood is brought into very close contact with the air in t,hem. The air contains a gas called Oxygen, which is taken up by the blood, while the carbonic acid passes from the blood into the air-cell, thus rendering the air in it impme. At the next expiration this is forced out of the lungs and a fre h supp ly taken in at the next inspiration.
To enable respiration to be carried on properly, a good supply of fresh air is necessary, and this can only l)e obtained by proper ventilation.
NERVOUS SYSTEM.
The whole of the processes carried on by the different parts of the body are regulated by the nervous system, which comprises the brain and spinal cord: from these two organs, small, white, thread-like bodies called N er-ves pass off.
These may be divided into the Sensory, Motor, and Sympathetic, and those composed of both sensory and motor fibres. The first kind convey sensation to tho brain; t,he second carry orders from the brain and cause the different muscles to act. The sympathetic, among other functi ons, regulate the supply of blood to the different organs, and control certain muscles.
25 OHAPTER II. HlEMORRHAGE.
Hrnmorrhago, or bleeding, is caused by the rupture of a blood-vessel, and may be either arterial, venous, or capillary.
Oapillary bleeding is usually caused by a scratch or graze, and vory little blood is lost. Sometimes there is merely a slight oozing of a red sticky fluid from the place. It is stopp d by bathing the part in cold water, and placing a pad of lint, or linen rag dipped in water, on the wound, and keeping it thore by a triangular bandage. Venous bleeding is of more importance than the last. It is known by the blood being of a dark purple colour, and welling up from the wound. A pad of lint dipped in cold water should be applied at once to tho wound, and tied on by a bandage; but if this is not enough to stop it, a bandage must be applied round the limb on the side of the wotmd away from the heart.
The Limb must be raised, and not allowed to hang down.
A -very serious case of venou bleeding occurs when a varicose vein in tho leg bmsts, and this must be treated as above, the patient being placed on a sofa or bed with the leg rai ed.
In bleeding from the nose, the patient should be placed
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on a chair or sofa, with the head raised, and ice or cold water applied to the forehoad and nose.
Artedal bleeding is the most important, becanse , unless it is soon stopped, the patient may bleod to death, as the blood always escapes with great force. It is of a bright red colour, and spurts up from the wOlmd with a jerky j et.
To stop it, pressure must be applied at once to the wound, and if the bleeding continue, the main artery supplying blood to the part must be compressod. This must b e done in some part of its COUI'se where it passes over a bone. The pressure should not be enough to cause the patient severe pain, but just sufficient to stop the stream of blood.
Pressure may be applied either by the fingers or by a tOUI'niquet, a very useful form of which may be made hy tying a knot in the middle of a triangular bandage, thus (Fig. 10) :-
FIG. 10.
The knot is placed on the artery, and the ends are tied round the limb to keep it in its place. If a thin handkerchief or piece of cloth be used, something olid should be placed inside the knot. An elastic bandage, or piece
of india-rubber tubing, applied tightly round the limh , makes a us eful tourniquet.
In arterial bleeding from the palm, a pad of some firm material should be placed on the wound, and the fingers closed upon it, and a triangular bandage tied round the fist.
FIG. 11.
If the wound be between the elbow and the wrist, a pad mnst be placed in the fold of the elbow,. and the forearm bent up and tied firmly to the arm. ThIS Pfidmay b e made by taking up a fold of the sleeye of the coat or jacket just in front of the elbow. .
If the wound be above the elbow, the braclllal artery lUU t be compressed. This artery is always to be fOlmd ill a groove on the inside of the arm, between the bon l'
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and the biceps muscle. Its course is well indicated by the inner seam of the arm of a man's coat. The artery may be compressed either by standing at the side of the patient and grasping the arm undern&'tth (as in Fjg. 11), or by standing in front of the patient and allowing his arm to
FIG. 12.
rest in your palm, and pressing the artery with the thumb. This artery must always be pressed from above down to the bone, and never be grasped from above, because in the latter case it would be pressed against soft muscle, and the bleeding would continue.
Fig. 12 shows a tourniquet applied to this artery.
If the wound be in the arm-pit, a firm pad may be pressed into the arm-pit and the arm bound down to the
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ide, or the subclavian artery may be compressed. The subclavian artery is fonnd behind the inner bend of the collar-bone, lying on the first rib. The hand must be placed on the patient's shoulder, and the thumb pressed firmly down into this hollow, as shown in Fjg. 13. If the
. 13.
patient be wounded in the right side, the usc his left hand to compress the artery, and vtCe ve?"sa.
In arterial bleeding about the head, pressure should be applied inllilediately over the WOlUld., as the artery would be compressed again t the skull.
Arterial wounds about the face should. be treated by placing the fore-finger in the patient's and squeezing the cheek between it and the thumb, Just below the wound.
F IG
1£ there be severe arterial bleeding from tho lips pressure should be applied on both sides of the wounel.
In wounds of the temporal artery, which runs up the side of the forehead, a compress may be applied, as in Fig . 14. A pad is placed upon tho wOlmd and kept in position by means of a bandage passed round the head and
middle of the fo l d of the groin, and runs downwards towards the inner side of the thigh. About one-third of the way down it dips lmder the muscles, and cannot be felt again till it comes behind the knee. Pressure is applied either by placing the thumb in the groin and pres ing the artery against the front of tho haunch bone (Fig. 15),
H.
tied over the pad; the ends are then carried over the head and under the chin, and tied again over the pad.
Wounds, with arterial bleeding, in tho lower extremity are treated in the same way as those in the upper.
If the foot be injm'ed, pressure must first be applied directly over the wound; and if the bleeding continue, a pad must be placed behind the knee, anel the leg bent back and tied to the thigh.
If the bleeding be above the knee, the femoral artery must be compressed. This artery commences at the
or hy a blotted triangular bandage or a tourniquet applied tio'htly over the artery lower down the limb (Fig. 16A).
o Fig.16B shows a patient stopping his own femoral artery.
The plan of trying to stop bleeding with tobacco must ncycr be used, as there is great danger of the pati.ent becoming poisoned.
As soon as the stream of blood has been stopped, the wound must be treated as an ordinary wound.
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FIG.
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FIG. Fl. FIG. 1GB. FIG. 16A.
CHAPTER III. FRACTURES.
A bone may be broken either by direct violence (by which is meant a blow falling directly on to the bone) or by indirect violence (where the bone is broken by being squeezed between two fixed points), as when the collarbone is broken by a fall upon the hand or shoulder, or the ribs broken by the patient being crushed in a crowd, or between a cart and a wall.
There are four kinds of fractures :-
SIMPLE :-Where the bone only is broken.
COMPOUND :-Where the bone is broken and a wound through the skin leads down to its broken ends. This wound may be caused either by the injury which caused the fracture, or by the broken bone being driven through the skin by improper handling of the part after the accident, such as placing a person with a fractured thigh in a cab or carriage before applying splints.
COMMINUTED :-Where the bone is broken in more than one place.
COMPLICATED :-Where the bone is broken and some of t,he surrounding parts injured, as when the ribs are driven into the lungs or liver, or the femoral artery or vein pierced by the broken thigh-bone.
Before attempting to move a patient from the place
of accident the part must be secured by something firm which will prevent the broken bone from moving.
Signs of Fmctu1·e.
1. There is loss of power in the limb or part.
2. There are pain and swelling at the seat of the injury.
3. If the injured limb be compared with the sound one, some distortion will be noticed, it beillg either longer or shorter, or lying in some ullllatural position.
4. If tho limb be gently pulled it will regain its natural shape, but will return to the distorted position as soon as the traction ceases.
5. If the limb be gently moved it will be found to move somewhere in the shaft of the bone, instead of at the joint only; at the same time, a grating sound (crepitation) lllay perhaps be felt.
6. If the bone be near the skin, some irregularity will be felt in pa sing the finger along it.
In examining the part, care must be taken to hancUe it yery gently, as a great deal of harm may be done by rough usage.
If the accident occur in the open air, the clothes should be left on, as they keep the part "Warm, and serYe as padding for the plints. .
A di location is the displacement of the bones formmg :I joint. C
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It is known from a fracture by
1. The injury always occurring at a joint;
2. The limb is firmly fixed instead of being unnaturally moveable;
3. Gentle pulling will not bring the limb into its natural position;
4 . There is no crepitus.
If no medical man be near, the limb should be supported by a splint and placed in the most comfortable position, and the patient taken to a m ed ical man.
No on(yb ut a medical man should attempt to reduce or replace a dislocation, as thi s operation r equires a very great amount of technical kn owledge .
SPEOIAL FRACTURES.
FRAOTURE OF SKULL.
Signs.-If the base of the skull be fractured, there will be bleeding from the mouth, nose, or ears; probably a discharge of a sticky, bloody fluid from the cars. The Imtient <will be quite uncon sc ious.
In fracture of the r oof of the skull tho patient will be un conscious . Probably it will be a compound fracture; so tbe broken bone will be seen.
Tl'eatrnent.-Place the patient on a sofa or a b ed, slightly raise the bead, and keep him perfectly quiet lmtil the doctor arrives.
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FRAOTURE OF THE JAW.
The l)atient will be unable to speak properly; the month will remain open, as the jaw will drop.
If the finger be pa ssed o\'er the teeth and along the outside of the jaw, a depression will be f elt, and probably the rough edge of the bone. The gums may be bleeding.
17.
T/'eatment.-Gently raise the jaw to its natural position; then apply the narrow triangular bandage round the jaw and over the head (Fig . 17).
FRAOTURE OF OOLLAR-BONE.
'rhe patif'llt "ill probably be seen holding the elbow of the injured side with his sOlmd hand; his head "ill be inclined towards the illjuretl side .
If tho finger he passed along the collar-bolle, a de-
FIG.
C
:3
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pression and sharp edge may be felt, as if the bone were coming through the skin.
The patient will be unable to raise the arm aboyo the shoulder .
FI G. 18.
T?'eatment .-Place a pad of some finn material, such as a triangular bandage or handkerchief rolled tightly, in the arm-pit; raise the arm gently, and tie it to the side with a narrow bandage; then support the arm in a small sling. The bandage binding the arm to the side mu t alway he placed as neal' the elbow as possible, as the arm is to act as a lever to draw out the outside piece of the frachU' ed bone (Fig. 18).
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FRACTURE OF THE ARM-BONE.
Signs.-The usual signs of a fracture.
TJ'eatm,ent.-This fracture may he put up in two, three, or foul' splints; these must be placedIf two be used, one inside the arm and the second outside;
If three, one in ide, one outside, and one at the back; If foUl', one inside, one out ide, one in front, and one at the back, and kept in position by two triangular bandage.
The arm must then be slung in the large arm-sling.
FRACTURE OF THE FORE-ARM.
Signs. - If both bones be broken, the usual signs of fracture will be present; but if only one be broken, tllC' 'igns will be 10 s of power in the limb, a depression felt at the seat of fracture great pain at the arne point.
The treatment i the aIDe in either ca e.
TJ'eatment. - Bend the fore-arm, keeping the thUlllh upward ; then apply two pliut, one on the inside or front of the fore-arm, the other on the outside or back. The inner oue should extend from the bend of the elbow 10 the tip of the fingers; the outer need not be so Iong-. Then sling the fore-arm in a large ling.
FRACTURE OF FINGERS.
Signs. - The usual igns of fracture.
TJ'eat-nwnt. - Place the whole hanel on a broad splint.
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well padded with some soft material; keep it in position wi th the triang ul ar hand-bandage and sling the arm in a large sling .
FRACTURE OF RIBS.
Signs.-Patient will complain of a sharp cutting pain on taking a deep breath or coughing; he will keep hj:j hand firmly pressed on the injured part to prevent tho side moving; he will breathe in a short, jerky manner. If the hand be placed over the seat of the pain, a gmtingmay be felt when the patient breathes; the ends of tho broken -bones may be felt.
T1-eat?nent .-Tie two broad triangular bandages firmly round the chest, making the lower part of one and the upper part of the other cover the scat of pain .
FRACTURE OF THE THIGH .
Signs.-Usual signs of fractme.
Treatment.-Place a long splint on the outside of the body, extending from tho arm-pit to the foot. This must
be tied firmly to the body by a bandage pas ing round tho chest; another round the hips; one above and one below
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the fractme; one or two below the 101Oes; and the legs must then be firmly tied together (Fig. 19).
For this fracture any of the following things will serve as splints :-Broom-hanclle, two billiard cues, the top of one being tied to the handle of the other; any long, strong trip of wood. A rifle makes a g;ood splint, the butt end
20.
being placed llllder the arm, and the barrel extending down the leg.
If no such splints be a"VaHable, the patient may be tied Oll to a shutter. or a long pieco of woou. lllay be carefully pushed uncleI' the two thighs and tied to them by bandage .
A u <.'fnl splint for the thigh 01' leg may be made by rolling a pole in a piece of cloth or flannel, the free end of the cloth i pas. cd lmc1er the limb, and the pole i placed close up to it, and the limb then covered with the
:FIG. Ul.
FIG.
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cloth; bandages are thon applied to keep the polE:' in position.
The sleeve of a coat may be turned inside-out and filled with paper, straw, twigs, or anything firm, and the coat applied in the same way as the cloth and pole. (Fig. 20.)
For children, walking-sticks and urn brellas are useful.
FRACTURE OF THE LEG.
Signs.-If both bones be broken, the usual signs of fracture will be found; if the shin-bone only be broken, the fractme will ea. ily be detected by passing the hand gently down the leg.
If the broach-bone only be broken, there will be inability to use the limb, and great pain and swelling. Treat either case in the same way.
T?·eat·ment.-Applyone splint on the outside of the leg, and another on the inside; tie them fu'mly to the limb, and then tie tJle legs together (Fig. 21).
In addition to the splints mentioned for the thigh, the sword and scabbard of a soldier, the tnmcheon and cape of a policeman, a square piece of wood, a soldier's knapsack, a stocking filled fu'mly with moss, sand, or twigs, may be used as splints. For setting a fracture almost anything which is at hand can be used as a temporary splint-rough pieces of wood, hammers, straw envelopes of wine bottles, rulers, rolls of paper, the expanding orna-
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ments for flower-pots, long thin books, strips of card · board, walking-sticks and umbrellas, &c.
If any hard substance be used, care must be taken to pad it with some soft material, especially if it has to b e kept on thr limb for some time.
The plint must be secUl'ely ia tened to the limb hy bandage plnced on ,jtber side of the fracture; the splints :-;hould, "here possible, enelo e the j oints on both sides of the fracture.
If it is not nece a1'Y to mo,e the patient from 1111' place of accident, make him as comfortable as possibl( with pillows, &c., until the arrival of a medical man.
In fractures complicated with arterial or venous bleeding, the blood must first be stopped and the fracture then attended to. In all cases the limb must be placNl in as natural a position as possible before the splints arc applied.
FRAOTURE OF KNEE-OAP.
Signs.-Broken bone will be felt under skin. Pati(mt will be unable to move leg-leg stiff.
Ti·eatment.-Tio leg to a straight splint extending from thigh to foot .
OHAPTER IV.
INS ENS I B I LIT Y.
A very common symptom of sudden illness or accident is insensibility, which may be produced by the action of tIle brain or heart being interfered with, either by orne injury destroying, or by a shock stopping, their action for a short time.
It is necessary to try and find out the cause of th e insensibility before trying to restore tho patient.
The first thing to do to an insensible person is to loosen the clothes round the throat and chest, particularly any b elts or braces; then pass the hand quickly over the body, beginning at the head, to find if thero be any fracture, or wound from which blood is flowing. If either of these
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injuries be found, they must he attended to at once; but if Hot, the patient must be carefully carried into a houso and placed upon a bed or sofa, and kept l)errectly quiet, with head rather low. It is not always easy to disco "Vcr the cause of insensibility; so, in all cases of doubt, the patient must be kept very quiet till the arrival of the medical lnan.
APOPLEXY.
Signs.-Patient becomes suddenly insensible, breathing very laboured, and accompanied by a snoring noise; one check is puffed out with each expiration.
If the arms be raised. one will give some evidence of feeling, 'while the other will fall helplessly to the ide.
The patient cannot bo roused.
Treahnent.-Place the patient on a bed or sofa, with the head slightly rai ed. Loosen clothing round neck. Apply hot bottles or flannel to the feet and legs, and cold water applications to head.
Do not cdtempt to giue him.. any emetics, 01· anything by the mouth.
EPILEPSY, OR FALLING SIOKNESS.
S igns. -The patient is suddenly seized with the fit, frequently uttering a piercing scream before becoming un. conscious, and falls d owll.
The hand are tightly clenched, the legs and arms heing jerked violently toward the body.
42
44
The face becomes livid, and a froth, sometimes streaked with blood, appears round the mouth.
Mter a few minutes the convulsions cease, and the patient either gets up and walks away, or drops off int o a deep sleep.
Treatment.- Place a piece of wood between the patient ,", teeth to prevent his biting his tongue.
If a pillow or hassock cannot be obtained, roll up ;' coat or shawl and place it under his head.
N ever attempt to hold the patient firmly to the ground. hut use just sufficient force to prevent his injuring himself.
If he wish to go to sleep after the fit, do not pre-ven1 him.
CONCUS SION OF THE BRAIN.
Produc ed by blows on the head, or from falling on tb(, feet from a great height. It is either se-vere or slight .
SLIGHT CONCUSSION.
Signs.-Paticnt will be -very pale, breathing very slowly, lying with the eyes shut.
If spoken to, will rouse himself as if from sleep and answer })roperly; then he will relapse into the partially insensible state.
Mter a few minutes he will probably vomit, and then gradually recover.
Treatl1tent.-Place the patieut on a sofa; apply warm
45
bottles and £annels to his fe et and hands. As soon as he able to drink, give him a cup of warm tea or coffee.
One form of concussion freqnently met with occurs in young children. While playing about, they tumble and trike the head.
Most of the symptoms mentioned aboye then appear.
The best thing to do in this case is to keep the child very quiet, and allow him to go to sleep, and not to rouse him lUany parents try to do.
SEVERE CASES.-In these the substance of the brain is tom, and the yrnptoms are like those of apo})lexy, and the case must be treated as such.
FAINTING is due to the failure of the heart's action, and is usually caused by fright, hunger, heat, excessive fatigue, hcemorrhage, &c.
Signs.-The patient suddenly becomes pale; if tanding. he taggers; if sitting down, he is re tless and uncasy for a minute or two; a clammy sweat breaks out over the forehead and under the eyes; the re 'piration becomes hUlTied and shallow, and he then 10 e consciousness .
Treatment.-If occurring in a church or crowded room, the patient's head hould be pre sed down below his lllees and kept thel'e for a few millUtes. Aftel' this he is usually sufficiently recovered to walk out of the room.
The clothes l'ound the neck and chest should then be undone, and the face and hands bathed in cold water. A stimulant-as sal-volatile, tea, coffee, or wine-may then
bo given. Another plan is to place tho patient flat on the tioor with the head on a leyel wit,h the body.
If the fainting is due to the loss of blood, the wound from which the blood is coming must be drossed, and the blood stopped, and some stimulant given.
If due to hunger or excessive fatigue, care must be taken not to give too much food at once. Some warm milk, beef tea, wine and water, may be given in small quantities very frequently; and as soon as the patient feels able to sit up and eat, something solid may be given.
ALCOHOLIC POISONING (DRUNKENNESS).
Signs.-Patient is helpless, both sides being equally useless; face usually flushed; pupils usually dilnted, but sometimes contracted.
If the patient be questioned, he will answer in an incoherent manner. There is usually a sLrong odour of alcohol about breath.
T1·eatlnent.-If told that the patient has been drillling very freely within a few hOUTS, give an emetic of a tablespoonfu l of salt in a tumbler of warm water, or one tablespoonful of mustard in the same quantity of warm water. Unless pe1fectly SU1'e that the patient is hlioxicatecl, clo not give the C1netic . After this ha operated, tho patient may be allowed to go to sleep.
If the weather be very cold, care must be taken to
47
keep the patient wa-rID, as a drunken person is very susceptible to cold.
If the drinJring bout has been a prolonged one, the patient must be kept quiet and warm till the arrival of a doctor. A cup of hot tea or coffeo is the best stimulant to give the patient.
OPIUM (LA.UDANUM) POISONING.
Signs.-Before the opium has taken full effect the face may have a flushed appearance; breathing very deep and slow; contracted; but he can be roused by shouting at him.
If the patient get worse, his breathing becomes very slow and quiet; face pale; and the pupils contracted to size of pins' heads; when he can be roused only "nth the greatest trouble.
Treatm,ent.-The patient must be roused np, and not allowed to giyc "my to tho great desiro for sleep.
Hc should be supported by two attendant, and kept walking up and down a long room or corridor.
Strong coffee should be given frequently.
POISONING BY GASES.
This may he caused by the escape of ordinary gas into a room; by a coke or charcoal fire in a badly-ventilated room' by the accumulation of carbonic acid gas in sewers or wells; by chloroform; or by choke damp in mines after explosions, &c.
48
Signs.-Patient is insensible; face pale; lips livid; the tongue livid, swollen, and perhaps protrudiug betweeu the teeth. The hands are usually clenched, and the nail bluish.
T'reatment.-The patient must be at once removed into the fresh air; the clothes must be 10osC'ned rOlmd the neck and chest, the face and chest bathed with cold water.
If a galvanic battery or an electric machine be obtaina,ble, it should be applied to the patient.
If these means fail to produce respiration, artificial respiration must be used.
HYSTERICAL FITS.
Uusually occur in females; come on suddenly, in consequence of some excitement.
Signs.-Patient falls down (usually in some comfortable place ) ; clenches her hands; grinds her teeth.
The eyelids are partially closed, the eyelids being turned upwards. Pati ent alternately cries and laughs.
Treat?nent.-Be firm with the patient, and tell her that if the fit continue, you must drench her with cold water. Send everyone out of the room except one friend aud keep the patient very quiet.
4-9
CHAPTER V. WOUNDS, ETC.
BITES OF ANIMALS.
If the animal inflicting the wound be healthy, the hitt" ooould be carefully washed, and dressed with cold-wate]· (hes ing.
If the animal he mad, more severe methods mu t bv n cd. A ligature should at once be placed round the liml) between the wOlmd and the heart, to prevent the poi 011 heing carried all over the body. The wouud should theu he well washed with warm water; after this it must be burnt with some strong acid, as nitric or sulphuric acid, or lunar caustie, care being taken that e,ery part of the wound is thorOlwhly blU"ned.
1£ 110 acid cau be obtained, the part should be burned \'i·ith a pieco of red-hot iron.
If the accident OCClli" in the open, gnnpo"der may be placed in the wound and fired, this being done three Ill' four times; or the wonud may be burut seyeral times by ordinary fn ee .
Somo tilllulaul, a brandy or wine, must be given to the patient, in large qU<lnlitiei5.
BURNS AND SCA.LDS.
A burn i caui5ed hy dry heat, and a scald by moitit. the erred upon tho body being the same. The p0int of the D
50
t r eatment is to exclude tho air as quickly as possible. This ma y be dono by dredging tho part well with flour . It should be spread thickly over the wound, and not disturbed for some time.
Any oil-such as salad, sweet, 01' linseed-may be applied by soaking a piece of rag in it and CO"vering the wound.
A very good application is made by mixing equal parts of linseed oil and lime water, forming" carron oil ."
The plan that is very popular of holcling a bul'll in front of a fire must never be adopted; it is simply increasing the injury .
The clothing must be removed very carciully; but if it firmly adhere, oil should bo poured over it.
Blisters should never be broken, but the (hes ing put oye r them.
SPRAINS must always be treat ed by keeping the part a quiet as posRible. If tho joint can be covered, a triangular bandage may bo firmly bound round it.
If the sprain be a very severe one, tbe part may be' placed in a splint, and the patient carried at once to a doctor.
POISONING BY ALKALIES ( nch as caustic soda, caustic potasb, and lime ) shoul(l be treated with vinegar, orange or lemon juice, tartaric acid in water.
POISONING BY AcIDS.-If a patient bas taken a do so of strong acid, he should at once have two tea-
spoonfuls of magnesia, whiting, 01' chalk, mixed up in a tumbler of milk or water to ch-ink.
In eithor ca e, if thero ho great pain, tho patient should flriuk oil, barl ey water, or milk; these will be found to give great relief.
In cases Ot by any other poison, an emetic hould bo at once giyen to tho patient ( uch as warm water or two teaspoonfuls of salt, or ono of mustard, in a tumbl el: of warm water).
If he bo very cold, apply heat to the extremities' and the ret,ch ing continue after the. tomach bas b een gIve plain warm water or milk and wator to chink. Send at onco for merEeal aid.
. WOUNDS, CUTS, &c.-Beforo dre sing any wound It should be cleaned from any forei!D.l matter by beinowa hed with 0111e tepid water. The parts should tben dntwn together into their natural position, and kept therp with . hips of sticking-plaster. A pledget of lint or oft linen rag dipped in colu ,Yater shoulU th \n be applied, and kept on th o WOlUlCl hy a triangular bandage.
FOREIGN BODIES IN THE EYE.-If
tbe foreign body is uuder tho upper eyelid .. eat the patient ill a chair, and, standing behiml. placo a pencil o,er the lid; take hold of the eyelashes. and turn the lid upwards. Then, having expo od the su bstance, brush it off with the corner of a handkerchie£ 01' a camel's hair brush. If it is undJr D 2
51
the l ower eyelid, . imply depress it, and proceed as aboyc with handkerchi.ef or brush.
CHAP'l'ER
VI.
ARTIFICIAL RESPIRATION.
ARTIFICIAL RESPIRATION must be employed whene.er the breathing is ye1'y feeble, or has stopped, as in cases of hanging, d1'o·wuing, suffocation by gas, chloroform, carbonic acid, c c.
DIRECTIONS FOR RESTORING THE APPARENTLY DHOW TED.
Th e following rule arc taken from those laad dOWll hy the Roval National Lifeboat In titution:-
Th; points to bo aimed at are-first antl immediately. the RESTORATION OF BREA.THI G; and sccondly, aftcr breathing is restored, the PROMOTION OF W ARMTII AND CIR€ULATION.
The efforts to 1'est01"e Breathing mu t be commenced immediately and energetically, and persevered in for 011e '->1' two hour, or until a medical mall has pronounced that 1.ife is extinct . Efforts to promote Warmth and Circulation, heyoml removing the wet clothes and drying the skin, must not
be made until tho first appearance of natural breathing; for if circulation of the blood be induced before breathing has recommenced, the restoration to life will be endangered. Send immediately for medical assistance, blankets, anel dry clothing, hut proceed to treat thc patient instantlyby remo\ring all tight clothing from the neck and chest, especially braces, belts, or btays .
To RESTORE BREATHING.
To CLEAR THE THRO AT.-Place the patient on the fioor or ground with the face downward , folel one of the arms so that the forehead may rest upon the forearm, in which po ition all fiuids will morc reaclily escape by the mouth, and the tongue itself will fall forward, le lwing the entrance into the "rindpi.pe free. As ist this operation by wiping and clean. ing the mouth.
If satisfactory breathing commence, u e the treatment described below to promote warmth. If there be only slight breathing-or no breathing-or if the breathing fail, then-
To EXCITE BREATHING.- Turn the patient well ancl instantly on the side, supporting hi8 head on his forearm, and-
Excite the nostrils with snuff, hartshorn, and smelling salts, or tickle the throat with a fea.ther, &c., if they are at hand. Rub the chest and face warm, and dash cold water, or cold and hot water alternately, on them.
52
53
Fl G 22 I'O .· TTTON 1
FI G 23. - POSITION 2
56
1£ there be no success, lose not a moment" but instantly-
To IMITATE BREATHING.-Draw the tongue out and keep it out by means of an elastic band pa sing over it and round the chin. Replace the patient on his face, raising and supporting his chest well on a folded coat or other article of dress. (Position 1. Fig. 22.)
Turn the body very gently on the side and a little b eyond, and then briskly, back again on to the face, repeating these measures cautiously, efficiently, and perseveringly, about fifteen times in the minute, or onco every fOlli' or frye seconds, occa ionally varying the side. (Position 2, Fig. 23, )
On each occasion that the body is replaced on the face, make lmiform but efficient pressme with brisk movement, on the back between and below the shoulder-blade or bone on each side, removing the pressme immediately befor(' turning the body on the side.
(By placing the patient on the chest, the weight of the body jo 'rces the ai?' when tu?'ned on the side, thi r; 13reSS1./,1'e is renwvecl, and air ente?'s the chest.)
During the whole of the operations let one perSOll attend solely to the movements of the head and of thc arm placed lmder it.
Whilst the above operations are being proceeded. with, dry the hands and feet, and as soon as dry clothing or hlankets can be procured, strip the body, and cov-er or
gradually re-clot]lO it, hut taking care not to intcrfere witb the cfforts to rest oro brcathing.
DR. SYLVESTER'S METHOD.
Dr. Sylve tel's meth od may be u se d if no assistance he at hand :-
Place the patient on his back on a flat surface, inclined a little up'lards from the feet; rai and support the head and sboulders on a small firm cushion or folded article of dress placed under the shoulder-blades.
Draw forward the l)atient's tongne, and keep it projecting beyond the lips by an elastic band or piece of tape or string oyer the tongue and under the chin. Remo,re all tight clothing from about the neck and chest, e pecially the brace, &c.
To hIITATE THE MOVEMENTS OF BREATHING.-
Stand at the paticnt's head, gra p the arm ju t helow the elbo'l8, and draw the arms gently and teadily upwards aboye the head, and keep th en"" sb'etched upwards for two secondR (Po ition A. Fig. {By this means ai1' is drawn into the lungs.) Then turn dOlDl the patient's arms, and pre s them gently and firmly for two ,econds against the ides of the che t. (B!J tlL i.' ?neCOlS ail'is 1JreSReCZ 011t of the 11l11gs.) (Position n. Fig. 2.). )
Repeat the e mea nre alternately, deliberately, and pers e yeringly, about fifteen times in a minute, until a
57
58
spo ntaneous effort to respire is perceived, npon which cease to imitate the moyements of breathmg, and proceed to INDUCE OIRCULA.TION AND W ARl\1TH.
FIG. 24.-POSlTION A.
TR EATMENT AFTER NATURAL BREATHING HAS BEEN RESTORED.
To PROMOTE WARMTH AND OIRCULATION.-Oommence rubbing the limbs upwards, with firm grasping pressure and energy, using handkerchiefs, flannel', &Q.
(By this ?neaSU1'e the blood is propelled along the vein8 towa? 'ds the hea?·t.)
59
The friction must be continued under the blanket or <rver the dry clothing.
Promote the warmth of the body by the application uf
FIG. :n.-POSITION B.
hot flmlllcl , bottles, or bladders of hot water, heated bricks &'c., to the pit of the stomach the arm-pit " between the thighs, and to the soles of the feet. .
1£ tho patient has been carried to a houso re.spmllion has been resiored, be careful to let the aIr play freely ahout the room.
On the restoration of life, a teaspoonful of n-arm water
60
tShoul d be given; and then, if the powet.' of s"\Y:111owing has returned, small quantities of wine, warm bral1clyand-water, or coffee, should he administored. The paiieni should be kept in bed, and a disposition to sleep OllcOUl·aged.
If there be pain or difficulty in breathing, apply a hot linseed poultice over the che. t.
Watch the patient carefully for some time to see that the breathing does not fail: should any signs of failure appear, at once begin artificial respiration.
GENIi:RAL OBSERVATIONS.
The above treatment should be pel'seYered in for ome hours, as it is an erroneous opinion that persons are irrecoverable because life does not soon make i.ts appearance, persons having been restored after per evering for many hours.
Appearances 'Which generally accompany Death.
Breathing and the heart's a,ction cea, e entirely; thc cyelids are generally half-closed; the pupils clilated; the tongue approaches to the under edges of the lip , and these, as well as t.he nostrils, are covered with a, frothy mucus. Coldness and pallor of surface increase.
CAUTIONS
Prevent unnecessary crowding of persons ronnd the hody, especially if in an apartment.
Avoid rough usage, and do not allow the body to remaill nn the back ullless the tongue is pulled out.
UncleI' no circumstances hold the body up by the feet.
On no aCcoullt place the hody in a warm bath, unletSs IInder medical direction.
C HAPTER VII. BANDAGING.
ESMARCH'S TRIANGULAR BANDAGE (Fig :2G ) may be applied to uuy part of the body. It is mad e
by cutting a pieec of linen or calico forty inches sql"k'lre into two pice s crossways. 'rb e bandage may b e used either a a broad or narrow bandage.
The bro [uZ i made by spreading th e handage out, tJlcn hrillging ihe eml down to the lower border, and th t'll i olc1ing into two.
61
£NDA ... l.UW£R a ONO i. R F IG.
62
, The nan'ow is made by drawrug the end down to the hOI del', and then folding into three.
27.
FIG. 28.-FRONT VIEw. FIG. 28.- BAeK VIEW.
. The always be fastened either by a pm,. or by bemg tIed with a reef knot (Fig. 27). It is applIed to the body as follows:-
To the scalp (Fig. 28).-Fold a hem about H inches deep along the lower border, place the bandage- on the
63
11011t1 bO that the hem lies 011 the forehead and the point hangs down at the back; then carry the two ends ronnd the head above the cars, cross them at the hack, and bring tJlem forward and tie on the fOl'eheac1; then thaw the point downwards, and turn it up and pin it on to the top of the head.
FIG. 29.
In applying this bandage, care must be taken to put the hem close down to the eyebrows, to carry the .ends ((bot'C, not OVCl' the cars, am1 to tie them close down to 111e eyebrows, and not high up on the forehead.
For the fa l'eJzead, side of head, jaw lFig. 29), eye. cheek, fa?' any part of the body which l'ouncl (as the arm or thigh, &c.). the narrow bandage must be used, its centre being placed on the ,\'ouuc1, llllC1 the ends being carried round the limb and tied over the \lound.
FIG.
64
Fo?' shoulder (Fig. 30) .-Place the centre of a on the injmed shoulder, wit.h the point running up the sIdn of the nock; carry the ends round the middle of the arm and them i take a second bandage and make a small
FIG. 30.
FIG. 31.
i bring the point of the first bandage 1Jlldor part of the sling resting on the injmed shouldor, draw It tight, tmn it down, and pin it .
Fo?' hip (Fig . 31).-Tie 3, narrow bandago round tIle above the haunch bones, take another tu:'n up a hem according to tho size of the putwnt, It. centre on the wound, carry the ends round the thIgh, and
65
tie thmu i then carr)" the poiut np nuder the waistband, tmn it down. lllld pin it.
Fo?' the ha I1cl (Fig . 32).-Sprcad ont a handage, placo tho wri ·t 011 the horder ,,-it11 tho fillgers towards the
FIn.
FIG. 34.
point i tlWll hring- tIll' poiut ovor tho mi t. pas the two cuds oy('r tho ('1'0.' ,and tic them.
For the foot (Fig. 33).-Spreacl out a bandage, platl' the foot ou it. ("('ntre ,,,itll the toe toward, the point, draw up the VOil1t oyer the in h'p, hring the bvo cud ... forw'arcl, cross, anel tic thelll either on the 010 (if to keep a . plint on) or round i11e aukle.
Larg e arm-sli17f/ (Fig . 34: ).-Sprcac1 ont a bandage, put E
one end o,er the soul1l1 shoulder, lot the other h ang down in front or the chest. Carry the point behind. the elbow of the inj Lued arm j belld the ann forward oYC'r the middle of t ,he bandage j then carry the second end OYf'l' the should r
FIG. 35 . FIG. 36.
or the injured . ide, and tie to the front eud; hring the POillt forward alld pin to the frollt of the bandage.
Small C(rm,-sZing (Fig. 30 ).--Fold the bandage into the broad bandage j then place one end over the shouldC'r on the injured side cro s the arm oyer the middle of the baudage hangiug dOWll the chest thOll brillg the other
elld oyer tho souud shoulder aud tie at the baek of the lleck.
Fol' chest (Figs. 35 aud 36 ).-Place the midille of the hanclage 011 tho illjureel side, with the poillt over the shoulder j carry tho two ud.' rouud tho waist aud tie them; theu elmw the poiut 0\'01' the bhollitlol' and tie to Olle uf the ellds.
!f0/: the back.-The bandage is applied as aboye, hut begmnlllg by placillg tho bandage 011 tho back.
CHAPTER VIII.
CARRYING PATIENT
In llceidt'uts ,,-hcr' the patieut has bl'ell rendel'etl to 'walk alolle, he ltlay be cal'l'icll hy the by::,tander::, waklllg allY of the followillg beats:-
( 1. ) The fOllr-!litncl:d is made by t\\·o per .' olls cll1spiug' each other s "Tl t, cl iu Fig. 37.
Tllis Sl'at i ' lU-icd ill cases where the pa,tieut i:::. lluahle to w<llk, hut ahle to giye SOUle assistance.
After the hands 11re ela peel together, the hearer ' toop llowll hehilld the paticnt, who sit ou the lLalld ' , alld at the arne time place one arm rouucl tIt 11 ('k of 1'11('11 bearer.
}j :6
66
07
----- ------
68
(2.) Tho two-handed scat is mado hy two bearer clasping their hands a . iu Fig. 3 and placing one hand on each ot hcr 's ]leek.
This scat i::; used when thc paticnt is unnble to give any a tance. n whcll the arms ]Inye bceu injured, 01' the pationt fcrIs faint.
FIG. 37.
(3.) The three-handctl beat iti a modifitalioll of the abo\-e, and is used fur n sllOrt perl>oll or child.
It is made hy Olle bearor holtlillp,' up one ar11l (say his left ) ; t]le R('conel l)ear('r p;rnsps just aboye the wrist with his right. hand j he then gTUSpS hi own arm jn t abo\'e the wrist with his left hand, the fir t bearer thcn grasp. the left ann of tlle second j nst ahove t11C ,n'ist with hi' left hand, ancl plac('s his right arm on tho other' shoulder (Fig. 39).
69
The ecouel kind of 'at may he used to lifL a helpless patient from fL chair to the hecl.
A hen.rer stauch; ou carh fiiele of the patient, n.lld olle anlt uuder l1is aud the hand of the other hearcr. The hearers thell l)(lHS their In'IllS round the hack of the paticnt and grasp each othor's shoulder.
Que bearer lllay (,llny a patient hy the ordinary t, pick. " llletliotl, or n" follows :-
TIle bearer stoop' (101Dl in front of the patient and llasses hiH right arm hctwecu the patient's legs j the patient then ;)('ross the hearer\; hack, so that hi' right arlll l'omcs in front of thc l)cal'er 'H left ann. The patient is kept from fnlling l)y the hearer ho1c1i.Jlp: ]Iis right leg and right arIll.
'l'he plan of carryillg tlle patient by the Clllcllegs, with the lace commonly calleel the ,. jl'og's HUl/'eh," lnHst never ue (t •.; death muy ensllejl'om thi , irccifment.
'\Vhel'e a propel' stretcher t'allllOt hc ohtained, tcmporar." OIl(,S lIlay he llHHll' ill allY of the following ways:-
(1. ) The of 11 ('oat lUay h turned inside' two stont poles nrc thcn throuO'h them the b , coat bnttollC(1. makes a good eat. (Fig. 40. )
The pati!'ul sit" 011 it, and against the haek of the fir ... t hearer.
1£ a l:11'O'er stretcher he reqnireel, t,,·o coats must lJl' treate(l ill t]1(' same way. (Fig'. 41.)
'1',\"0 sad::s lllay be taken; a hole is made in cach comer of the bottom, and h\-o poles IIHssed through the sack and out of the holes. (Fig. 42.)
FIG 40.
(3.) A large piece of carpet, saeking, tl1rpanling, 01' a blanket, lllay he Rpread out and two stout poles rolled np in the sides.
(-/..) A hnrcUe, bron.d piece of wooel, Ot· shuttel', may be Plllployecl as a stretcher; hut if either of them he llsed, some stl'C1,W, llay, 01' clothing, shonlel be placed Oll it, and then a piece of stout cloth or sacking';
FIG. 41.
Two hearer then tand 011 eath bide. They g'l'a:-p the middle of the pole ,,-jtlt one hand, and ncar the end with the other. To l'any the patient. they lllust walk sideway.
Fw. 42.
the sal'kiug is nseful in taking the patient off the stretl'11l'1' when he arriYes at the beel-siue.
Temporary stretchers rou t he catTiea, anel the patient placec1 on 111t'll1 as laid down in the' c Strctl'her Excl'eif>es."
I ( 73
INDEX.
ABDOllE:\, 13
Acids, poi oiling by, !i0
Alkalies, " GO
Alcohol, " ,,4l1
Air cells, 23
Anatomy, 13
Animals, bites of, 49
Apoplexy, 43
Arches in foot, Hi
Arms, 16
Arm-sling, small, G5 " " large, Go
Arm, fracture of, 37
Arteries, 19
Artery brachia,}, '27 face of, '2D femoral,30 head of, 29 lips of, 30 sub-chtyjan, 20 temporal, 30 " pulsation in, 22
Arterial bleeding, 26 treatm€l1t of, 27'
Artificiall'e piration, f>2
Auricle, 21
BALL AND SOCKET Jor 'T, Ii
Bandage ,61
Belly, 13
Bearers, 2 for Rtrctchcr, G'
3 " GH
" 4" " (ii
Bites of aninulh;, 4!l
Bleeding from arm, 27 armpit, '2 ,' car, 34 foot, 30 fore-arm, 2'j head, 2!1 leg, 30 nO'c,2;) palm, '2i
" "thigh, 30
Blood, use of, 19 impure', Hl
" pure, 20
Bones, 13
Bone, broach, 1.; collar, 1(; haunch, 1.)
rump, 15 shin, 1.1 thigh, Hi
BOllc, ul'oken, 33 " dislocated, Brachial artery, 27
Brain, compression of, 44 " concussion of, 4!)
Breathing, stertorous, DU111S, 4!J
CAPILL. \RIES, 19
Capillary bleeding, 2.1
25 treatment,
Carbonic acill, 23
C'a,l'l'ying patients, G'j
Cartilage, 14
Cervical vertebrm, 17
Chest, 13
poisoning by, 47
CrrculatIOn, organs of, IV 'lavicle, III
'oat tretcher, 7:3
Collar bone, IG
Comminuted fr:tctul'e, 3'2 ()0l11plicatc<1 " 32
Compound " 32 'om pression of umin, 44
Concu.sioll " " 4.)
Cord, spinal, 1 ;)
Crepitation, 3;)
Cut::;, 51
OF HEART, 20
Diaphragm, 23
Dislocation, signs of, 34 tl'eatmcn t. 34
75
Distortiull ill frnctlll'C'. , :13
D orsal Yertebrce, 14
Drowning, 52
Dl'un kennes!'l, 4(;
ELASTIC J 3ANDAGF.
QC'E1',2!.i
Epilepsy, 43
El:unarch's ban<lage, G1
Expi.ration, 23
Eye, foreign bo(ly in, ;;1 pupil of, 4U
FAIXTIS(;, 4;)
Falling 43
Femoral Artery, 30
Femur, 13
Fibrous tis ue, 17
Fibula, 1.)
Finger, bones in, 17
Foot, "" Lj
Foreign bOlly in eye, .)1 ]<'olU'-balHlc<l seat, G 32
Fracture of arm, 3'j " coHilr bonc. 0.' " fore-arm, 31" " fingers, 37 " hand,3i " jaw, 33 " knee cap, " 4.0 , " nbs,;)K " • k1:l11, 3} , " tlugh, i)
Fracture, signs of, 3:3 comminuted, complicated, compound, 32 imple, 32
" eli tortion in, 33
Frog's march, 6Q
GA " POIHOXIXG BY, 47
25 arterial, 26 capilla,l'Y, 25
" vcnous,25
Halld, fracture of, 37
Hanging, 52
HalIDch-bone, 15
Head,14
" injuries to, 44
Heart, 20 c1iagram of, 20 ouuds of, 22
" valves of, 21
Hinge joint, 17
Humerus,lu
" fractm'e of, 37
Hysterical fits, 48
bIPUHE BLOOD, 22
Insensibility, cause of, 42
" examination in, 42
Inspiration, 23
Intoxication, 4G
JAW, 14
fractur e of, :3')
76
Joint, 17
cartilage in, 17
lubriclttion of, 17 kinds of, ] 7
POJ.'ONTXG,47
Leg, 15
" fracttuc of, 40
Lumbar 1
Lungs,
MID-RIn', 22
Mmcles, 17 at rest, 18 in action, 1 kinds of, 1 structure of, 17 tendons of, 1
XERVES, MOTOR, 24 sensory, 24 " sympathetic, 24
N ervou. system, 24
Nose bleeding, 2;")
POI:-;OXING, 47
Organs of circulation, 14 " rcspiration, Oxygen, U
PAIX IX FRAC1TRE, 3:-1
Palm, bones in, 17
Pelvis, 1.1
Pick-a.-back carrying, (j'
Poisoning by acills, 1)0
" alcohol, 41)
" alkalies, 50
" chloroform, -17
" gas, 47
" " opium,-17
Power, loss of,
Pulsation ill arteries, 2:3
Pupil. of eye,. , 40
Pure blood,
Rabid animab, Lites of, 4!1
Radius, Hi , ' fractme of, 37
Respiration, 2:3. . _')
artIficIal, ;.>:0.,
Ribs:'H orgalls of, 22
" fracture of, 3 '
Rump bone, 1.1
'ACR1.:)r,l.i
:::lack stretchcr, 73
Scalds, olD
Scapula,IG
Seat, 2- hanl1e(l, (iR 3-handell, fjH
" 4-hamled, 67
Shin-bone, 15
Shoulder blallc, Hl
Signs of dislocation, 34
" fracture, 33
" insensibility, 42
Simple fracture, 32 ,'keleton, 13
77 , kull, 1:, ling for arm, Gi oUllll of heart,
Special fn1.ctures, 3-4
Splint , temporary, 3D
Spinal cod, 1:)
,'pin'l,14
prain .' , 50
tertorOll:S breathing', 4-4 'timulants, 4:3 (j!)
" tempOl:ary, Ij ! )
,'ub-clayian artery, Sutfoca tiOll , 47 'welling in fnwtures, 33
TlmpOH.\HY :-;PI.TXTS, 39 'l'endon, tu;e of, Thigh bone, 1;1
" fractllrc of, 3s Thorax, 13
Three-hau(lctl seat, G' Tibia,l.i
" fracture of, 40
Tobacco, usc of, (l,tngerons in bleeding, 31
Tourni(luet, temporary, 2G
Trachen, 3:3
Triangular bftlltl<lcie, 61 " broad, 61 " narrow, 62 " for back, 67 cheek, u3 chest, 67
" cye, 63 " foot, 63 forehead,
78
Triangular bandag e for hallll, 65 I " l.lip, I " Jaw, (j3 " scalp, li3 " shoulder, (i4
Trunk: 13
Two-handed seat, li ' 16
U e of blood, 19
Yn,lves of h eart, 21
Varicose veins, 23
Veins, 19
Ventilation, 24
Ventricle.., 21
Venous bleeding, 2f>
Vertebral column, 14
Vertebr al cervical, 14 dorsal, 14 lumbar, 14
\'{em-PIPE, 22
\Younds,49 Wri t, 16
STRETOHER EXE.ROISES.
HITHERTO the inshudion given to the Classes of the St. John Ambulance Association, on the remo,al of Sick anu Injured persons, by stretchers or improvised methods of trnnsport, has been founuecl on Rules laid down in Longmore's " Treatise on the Transport of ick amI \V'oUHued."
But it has been mnply proyed that rules for drilled and disciplined bo(lies of men, such as the Army Hospital Corps, are not applicable to tho. e who undergo a brief traiuing to enable them to give ilrtit aid in the acciuents of civil life. In the majority <>f cases, in which a certiticateu pupil is called upon to act. he has to look for assistance from men who have had no such in huction as he possesses, whereas every member of a military bearer company is drilled to work "ith others, and when three or four <>f such men have been uumbered off, each knows what is expected of him.
The regular drill l'eqnired for a hearer company in the Anny is therefore not the best for a class of pupils of Association.
On a parade grOlmd, 01' in a militaryhospitaJ, there is gm1erally plenty of space, aUtl one s)'titem of lifting and inyalids {!an be allopted, lJllt the accidents which happen in ciyil life, make it necessary thnt llluch sllOuld be left to the intelligence and eXIJerienee of those who have to render first aid. For instance, when a patient has to be placed on a stretcher in a cottage, in a factory crowded with machinery, or in the tortuous pa;;:-agcs of a miue, it would lIe quite impossible to follow the (lirections given iu the "Manual of Exerci:-;e for Stretcher Bearers, and Bearer Companies," but the stretcher must be put at the side of the patient or in any other position possible, and the bcarers must .act ull(lrr the (lirection of one of their party.
On this subject Professor Longmore has sajtl: "The military
CASSELL & C O M P ANY, LIMITED, LA BELLE SAUVA G F, L O NDON, E C.
r ules were framcd for service in the open air where there is, of COUTse, plenty of space, but all such rul es must be modified according to circuDlstances. It is well. I think, to teach the system which is thought to be best, nnd at the same time to prepare persons for doing that which is next bcst, whcn what may be best under othcr conditions ceases to be applicablc. "
The following rules have been drawn up to supply a want which has been felt, and frequently expressed, by gentlemen of the medical profession, who have kindly devoted much time and attention in the ginng of First Aid Lectures. It may also be added that dUTing the last two ycars they have been practically adopted in more than one active Centre of the Association.
For purposes of drill, numbering the bearers will be found useful whenever three or foUT men, thus instructed, find themselves in a position to work together; they will act 'with less hesitation, less liability to accident, and with more speed; bnt it must be repeated that in nearly all ordinary accidents, an efficient bearer will have to sclcct his assistants without previous notice, and give them his directions as briefly and clcarly as he can . The most important point is to understand the principles 'which have dictated the rules laid down in the Exercises.
T.B.-It is not pretcnded that the following Stretchcr Exerci,;es. 'will be found equal to every circnmstance that may arise. For instance, the placing of a stTetcher in a road-cart or railway carriDgc must depend on the shapc of the vehiclc, and perhaps on the width of a door . It would occupy too much space, and thcu, perhaps, the directions would be fouml inadequatc, were attempt made to suggest plans for all cases . From personal experienceand we are daily assisting in the removal of invalids by road and rail-we are satisfied that those ,yho take the trouble to attend the l ectures and qualify themselves for the certificate are fully able to · meet exceptional difficulties as they arise. Instructors and pupils may, however, be reminded that whenever necessary the stretchcri ssuetl by the Association may be lessened in width without in convenience t o 0. p atient upon it .
STRETCHER EXERCISE, No. I.
For t hree Bearers. To be use d whe n space will allow.
1 . TrrE Instructor selects the Rem'ers and numbers thcm-1, 2, 3. at hi !! dIscretion. Should one man be taller and stronger than tile others, he shonld be styled No.1, as he will have to bear the heavier part of the bUldpn.
All orders will. 1e gin:n by No.3 *
2 , " PL ACE THE STRETCHER."
No.1, taldng the hl',\!l of the stretC'her, and No .2 the foot, places it in 11 liue with the Putit:nt':; budy, the foot of the :stretcher being clo 'e to ills head.
No.3 attends to the Paticnt, by Nos. 1 and 2 when neCeStiiU'Y.
3. " FALL IN." At this order,
No.1 place" him,pH nt the Patient's right side, 1\ o. 2 at his left sirlr', and both Bearers face each other. No.3 takes positIOn un the injured ::;ide in a line with the knees.
No/e.-The duty of TO, 3 will be entirely to look after the iniurerl part of the Patient'::; bOlly or limhs, to e Unt no b:1Jlllage' or splints Il'cum,· displaced, and also that Xo. '2 Bearer, ill ur lln" ... 11"[. in any way touch thc PatienVs feet.
'When everything has been llrrung-cd for the rcmond of tlte l'utie!lt, the order will be giH'll-
4 " R EADY."
Nos. 1 and 2 now each sink down on one knee and each others' hands under the shoulders and thighs of the Putient, whilst No.3 placcs his hands underneath the lower limbs, ulways taking enre, in case of a fracture, to have one hnnd on each side of the seat of injury.
5 "L I F T."
All three R eru'ers rise together to theu' feet, keeping the Patient in a horizontal position.
" M ARCH."
All take short side-paces until the Patlent's head is over the pillow of the stretcher.
• BNtrers should be tnu/':ht to take any of the positions n:ullcd in thc folExerciscs, whether thnt of No. I, 2, 3, or 4 Bearer .
2
3
4
7... HALT ......
All three Bearers remain steady, and wait for the next orde't".
8. "LOWER."
The Patient is placed gently on the Stretcher, and the Bearers then stand up.
9. " F ALL IN." On this order being gi,en,
No.1 places himself at the head of the stretcber with fnce towards the Pntient, No.2 at the foot wiU} his back to the l'aLient, and No.3 places himself at the side of the Patient.
10. "READY."
Nos.! and 2 stoop down and grao;p the handleR of the stretcher, having previously adjusted their shoulder-straps in case they are used. No.3, as soon as he sees all is right, gives the word-
11. "LIFT."
'l'ne streteheris now raised to position ready for moving off.
12. "MARCH ." On this word being given, No.1 steps off with the left foot, and No.2 with the right.
The step should be a short one of twenty inches, and taken with bent knees just from tlJe hips.
13..• HALT."
The place of destination being renchoo., on the word" IIalt ., Leing given, the Bearers remain steady in position .
14. "LOWER. "
At this order the Bearers place the streteher on the ground, and thE'n stand up.
15. "UNLOAD STR E TCHER- READY."
The Bearers prepare to take the Patient off the stretcher.
16. "LIFT."
The Bearers raise up the Patient as before instructed.
17. "LOWER."
The Patient is carefully lowered upon the vehicle, bed, or other place to which It has been designed to carry him.
5 STRETCHER EXERCISE, No. II.
For four Bearers . To be used when there is not sufHcient space for carrying out Exercise No. I.
1. The Instructor numbers the Bearers-I, 2, 3, 4. All orders will be giyen by No.4.
2. "FALL IN.''
At the words" Fall in," No!'. I, 2, ani! 3 take position on one side of the Patient. No.1 phces him>lf'lf at the Patient's shoulder, No.:2 near the rnir1t1le of the borly, No.3 near the Pa.tient's feet. At the <;ame time No. -1 plarrs the ;;t.retcher on the g-round by the other side of the Patient, and remains staUlling neal' its centre facing the other Bearers.
3. "READY."
Nos. 1,2. flnd:3 st-nop clown. and kneel on the left knee if they are on the left side of the PmlPnt, on the knee if they fire on the right lilde of thc Patient. They then proreetl to Lake hold of the Patient :-No. 1 passing one of his arms 1lll1 eath the Patient's neck and the other uncl er his No.2 pnssing hoth arms umlpr the middle of his body, one above, the other Lelow the buttocks; '''Hl No. 3 passing both arms under the lower exln:milies, in case of fracture, when he must place one hand on each side of the broken bone. so as to steady it. No 4. when the word" Heady" is given, grasps the near pole of the stretcher with his left hanll. and the opposite pole with his rigllt hand, near the centre.
4. "LIFT. "
On the word" Lift" being- g-h·en. No'l. 1, 2, and 3 the Patient up, each at the time placing on the knee which is not touching the gronod his elhowof the same sille. \Vhile TOS. 1, 2, anll 3 are thus raising the Pati e nt •• TO. 4 mo,es the into proper position under him and kneels down on one knee by its sille.
lI.
"LOWER."
At the word" Lower," Nos. 1, 2, and 3 carefully lower the Patient d own to the stretch!'!', while No.4 at the same tinJe assists in supportingand placiog him on It.
6
"STAND TO STRETCHER."
On tIns order being g ven, each Bea.rer tands up :-N'o. 1 goC's to the h ead uf the stretcher witl! his face towards the Patient j 1\0. 2 to the foot w ith his back to the Patient j while Nos. 3 anll 4 remain in position e3.eh side of the stretcher .
7. "READY ."
Nos . 1 and 2 grasp the bandIes of the stretcher . haYing previousl y adj usted their shoulder-straps in case they are using thew.
8. "LIFT."
At this word, Nos. 1 and 2 Bearers raise tbe stretcher :steallily togetLe r and stand up .
·'MARCH."
All being asrert'l.ineil. to be in order. on the word" l'IInrch .. being Nos. 1 and 2 Beal'C'l's lIIo\'e off :-No. 1 step1Jing off with his jpft foot, nnd No.2 with his l'ight fuot. 1\'05. 3 and 4 march on each side of the stretcher. On arriving at the place of lle:stination , the followillg orders are sueeessi, ely given :-
10. "HALT ! '
1.1. "LOWER."
12. "UNLOAD STRETCHER- READY."
13. "LIFT ."
14. "LOWER."
N .D.-TbeRc O1'dl'rs, viz ., Nos . 10 to 14 inc l us i ve, are to be carried ou t in a siruilar manner to orders Nos . 13 to 17 in Exercise No. 1.
STRETOHER EXERCISE, No. '".
"l Ien only three Bearers are avaihble, and the space is limitetl as before, the following alterations must be made in t heforegoing (No.2) Exercise
1. The Instructor numbers the Bearers-1, 2, 3. AIl orders will be given by No.3.
2. .. PLAC E STRE TC H E R."
No.1 Bearer places the tretrher on the groUDll by the side of theratient and as close to him as praetieable.
3. "FALL IN ."
The three Benrers ta.kr the same positions on one side of the Patient as laid dowll in 1\0. 2.
4, " READY ."
Nos. 1, 2. nnll 3 kneel down. placing as to the Pntient as tllf')' eouyeniently can, and then take holll of him as directed ill Exercise Xo. 2.
5. "LIFT ."
TOS. 1, nnd 3 raise the Patient as directed in Exercise No.2.
6. "LOWER ."
At the word" Lower," Nos. 1,2, and 3 l ean forward so as to carry thePulient oyer the stretcher, and then carefully l ower him down upon it.
7. " STA N D TO STRETCH ER."
At this direction No.1 goes to the head of the stretcher, No.2 to thefoot, auu No.3 remains in position at the side of the stretcher.
The remainder of this Exercise will be precisely the same as is given i n Exercise No . ' 2, from orders 7 to 14, both instr.uction flll' N o.4 Hearer to walk by the side of the stretcher beIDl:' alone oIDltted .
7
STRETOHER EXERCISE, No. IV.
For use in Mines and narrow Cuttings where two men only can be engaged.
N ecessary First Aid having been given, Nos. 1 and 2 will carefully place the stretcher in a line with the injured man's body, the foot of the stretcher being, if po iblc,* cln e to his head . No.1 will give the word" Ready," when both get into position as f ollows :-
No.1 places Jus feet one on each side of the Plltient between his body and arms, the toe of each foot as the armpits possible, standing over the man. He then stoops down nnd passes hi,:; hands betw (> C'n the sides of the chest and the arms underneath the shoulders, and locks the fingers.
If the Patient's arms be uninjured he may put them rOlmd the neck of No.1, and by this means grelLtly [ls ' ist him in lifting.
No.2 at the same time places his right foot betwecn the calves of the injw'ed mnn's legs, as close to the knees as possible, and his left foot lit the injured man's right side, close to the crest of the hip; t he then kneE'ls down and passes his arms round the outside of the Patient's thighs at the low est part, nnd locks his finger uehind just at the bend of the knees.
When both are ready, No.1 WIll give the onler .. Lift and move forwflrd." The Patient is then to be slowly lifted ju t sufficient to allow his body to clear the stretcher. Both Bearers will slowly nnd g'l'lulually move forward, No.1 by very short steps, and No.2 by bending his body forward over his left thigh, by which means he exercises a pushing movement which very greatly assists No. 1. 1\0. 2, when he has bent his body forward as much as he can without moving his feet, advances his right foot to his left, then again advances his left foot and bends his body forward. This movement is to be repeated untIl the Patient is laid 011 the stretcher.
The Bearers will then act in the ordinary ma=er as far as the nature of the locality will permit.
(Signed) JOHN FURLEY,
Deputy Chairman, S.J.A.A.
* It is not advisable to be too particular as to tbe bead or foot of a Rtrctrbcr in a minc, as it would prohably b e quite imllos5ible to reverse it, aL 1 it is always competent for tbe B earers to lower tbe pillow.
t When tbe Patient's legs nre in splints Ilnd tied togctber , the feet of NO.2 must necessarily be placed outside
FOf the Transport of Sic," ancl Inj'lO'ecl Patients, infectious cases e;t:ccpted. .
Captain Rupert C. F. Dallas, Chairnl<m.
Major James Gildea, '/ ,ra .mT.
Edmund Owen, Esq .. ' F.R.C.S .. &c. &c .• 1l01l. ('0 ISH/tin!J Surgeon.
John Furley, Esq., lIon. Secreta/Ii amI ,\fullager, to whom all communicfLtioIlS must be ad(lresiic,l. OFFICE-
ST.
JOHN'S
GATE,
CLERKENWELL, LONDON, E.C.
(Within fire 11111/Ued '/I'lllk of F((l'I'illgdoll Street Station.)
[CJvlm
8
II Pro IItilitate homil!!rJn." ASsodafion. AMBULANCE CORPS,
