PREFACE.
This l\Ianual is intended to give instructions to nonprofessional persons, to enable them to render first aid to those injured in the many accidents occurring in our daily life, or in cases of sudden illness. It is designed with the ,.-jew of extending the work so well begun by the late Surgeon-Major Peter Shepherd, who wrote the first handbook used by the St. John Ambulance Association, and whose untimely death at Isandula in 1879 has always been deeply regretted. MILFORD-ON-SEA, RANTS, 1893.
ROBERT BRUCE.
AT the request of the l\iem bers of the Central Ambulance Committee of the Order of 't. John of Jerusalem, I have hurriedly arranged the following Manual for the use of the M etropolitan Police and the other Ambulance Classes now organised by tIle Order of St. John in all parts of England. The careful work which I sllOuld like to have bestowed has Leen rendered impossible by the exigencies of the ervice requiring me to proceed on foreign service.
I have been aided by kind and aLle coadjutors, who have given their knowledge and experience.
I trust that this Handbook, given cheerfully and gratuitou sly- like all the work conducted for and by the Order-will be found to be in some degree "PRO UTILITATE IIOMINUM."
P. SHEPHERD.
JUNIO R USITED • ERY I CE CLl"li, LONDON, .W., 30th Odober, 1 i 8.
FIRST AID TO 'rHE IN JURED.
CUAPTER 1.
ANATO:.\IY AND PHYSIOLOGY.
F OR the purpo e of description, we may divide the body into the T runk, comprising the thorax, or che t, and the abdomen, 01' belly; the l1ead, compri ing the brain -ca e and face; the []'p e7' Limos, the arm - ; and the Lrnl'u L£mos, the leg. The framework upon which the body is built i s called th e keleton (Fig. 1), formed of oyer BONES. FIG
200 bones, which vary in ize and shape according to the work they have to perform. Be ide serving as a frame'work for the muscles, the bones form cases for the protection of various organs, and support the weight of the body.
The bones of the . kull may be divided into those of the brain-case and those of the face. 'With the exception of the lower jaw, they are all firmly joined together, forming a strong ca e for the vrotection of the brain, ear, eye, nose, and tongue. The bones forming the top of the brain-ca e are thick and curved, so a to resist the force of a blow on the top of the head.
The skull rests upon a column of bone called the Vertebral Column, or I pine, extending from the head to the haunch-bones. This column is made up of thirtythree bones, called the Vertebrre- the twenty-four upper called the true vertebrre, the nine lower the fal e. Between each of the true there i . a pad of cartilage, or gristle, which acts as a buffer, and prevent the bones jarring when they move, and gives elasticity to the whole column. The bones are kept in their places by bands of a tough strong substance called fibrous tissne, which passes in all directions around them. Although there is very little movement between allY t,yO vertebrre, the Spine is a very flexible rod, and can be bent in every direction, the greatest amount of movement being in the neck and loin portions. The , even upper bones are
called the Uervical, or neck vertebr::\:, the next twelve the Dorsal, or back vertehrre, the next five the Lumbar, or loin vertebrre. Extending from the top of the slJine nearly to the bottom a canal for the protection of the pinal cord. The fabe vertebra; unite and form a rna si ve bone, called the Racrum, or rump-bone; thi is joined all each side to one of the Haunch-bones, which join each other in front and form a strong case, called the Pel vi , to protect the bladder, &c.
The Cervical ancl Lumbar vertebrc:e are not connected to any other hones, hut the Dol' 'al vertebrrejoin the Ribs.
The Ribs are twenty -four bone, twelve on each side; they are shaped like the half of a hoop, and are joined at the back to the tw elve dorsal vertebn. The front end of the upp er oues are attached either directly oJ' by means of pieces of cartilage to the brea ·t-bone; the last two are much shorter, and their front ends are free.
The ca e formed by the junctiou of the Dol' 'al vertebrre, nib:.;, and Breast-bone is called the Thorax, or Chest, and iti to prote t the and Heart with the great blooel-vessel.' attached to it.
Thi ca 'e strengthen eel at the back by two large bones, called the 'capulre, or houleler-blude ' , which cover a grea.t portion of the upper even rib , ; many of the muscles which move the upper limb are attached to these bones.
Extending between the top of the breast-bone and-
12
13
the shoulder are two double-curved boneR, called the Clavicles, or Conar-bone .
The bones of the upper extremit.y are long thin bones, as they have to support no weight, but require to be moved about very freely. In the Arm it> one bone, called the Humerus; in the fore-arm are two, the H.adius on the thumb side and the elna on the inside, and situated
FIG. 3.
between them and the long bones of the hand is the -Wrist, which consi t of eight small bones arranged in two rows, and joined firmly together.
In the Hand, besides the wrist-bones, are nineteen bones, five in the palm, called the Metacarpal bones, the remaining fourteen, called the Phalanges, in the fingers and thumb; each finger has three bones, but the thumb has only two .
In the lower extremity the bones are "ery strong, as t h ey have to support the weight of the body. 15
On the outer ,·i<le of the haunch-bone is a deep cuplike depreH. ion, in which is inserted the head of the Femur, or thigh-bone.
In the thigb is one bone, called the Femur; in the leg ar.e two, the Tibia or ,'hin-bone on the in. ide, and the FIbula or brooch-bone on the outside. The lower ends form an arch, which rests upon one of the bones of the foot.
The front of the kn ee joint is protected by a small bone, the Patella, or knee-cap.
In the foot are several bones arranO'ed in the form of a double arch, one ex.tending theOheel to the toe " the other from one side of the foot to the other. These bones are strong anel thick, and joined firmly together, so that there is no movement between them except at the toes.
JOI::-ITS
'When byo 01' more uone' come together they form a joint; modifications of the "hall and ocket" and the " hinge " being the llJo.. t common kinds. The ends of the bones forming the joint' arc larger than their middles, or sha.fts; theyal'ecoated with alayerofgritle orcartilao-e wlllch act ' as a buffer, anel preyents pain ca.u
n the bone move upon each other; oyer thi ' cartilage IS a. kin, or membrane, 'which makes an oily fluid, to llluncate the parts and to enable them to move freely.
14
The bones ar e k ept in positi on by a number of bands of fibrou s tissu e, which complet ely surround their ends.
MUSCLES.
The b ones ar e m oved by the :JIuscles, th e masses of FIG. 4. FIG . 5.
MUSCLE AT REST. MUSCLE IN ACTION,
red fle sh which make up the bulk of the body. These are arranged and shaped according to th eir work; where they move or lift hea vy weights they are in thick masses, as in the thigh or arm, but where they h ave t o cover ill
17
ca.vities, as in the checks and alxlomen, they are thin and ilitt.
A Mu.'c le i.' made nlJ of a numher of hundles of fibres, like bundles of threaclf;, enclosed in a tough sheath . This sh eath is at each cll{11l1uch thickcned, forming a tendon by which the mu:;c:le i:s attached to the part it acts upon .
This tendon al,'() takes the place of <1, muscle in pa, sing over a joint; thus, ill the arm, the lllllsde.' acting upon the hand begin around the eUlo\\" and the upper part of the fore-arm, about the lllidLlle of the fore· ann 'se find t he temlolls taking the place of the musclc.', and passing over the 'Yl"ist to the If the continued r ight dowll to the finger..: the action of the wri -· t would be greatly impe<letl.
\ Vhen a nnt-de ads, nne end is fixed, the middle of the muscle shorten' UlHl get,:; thicker, and thus c1ra'\Ys its free ellli towards the fixe!l 011e (Fig. -! and 5).
on<; \X", OF (JITICULA'l'IOX.
The differellt part. and organs of the body are sl lpplied wi t h foo(l fol' their growth and Sllpport by a fluid called Blood. The blooll circulates round the hody through tubes called .Arteries, Capillaries, and Veins . Beside supplyiug' lloUl'ishment to all parts of the body to ena.ble them tu elo their \york properly, it takes away material \\'hich, if allowed to remain, \yould cause harm .
16
B
The blood is driven through the tubes by an organ called the Heart.
The blood is carried away from the heart by the Arteries, which spread out all over the body, like the branches of a tree, becoming gradually smaller and smaller, until they form a net\York of very. mall tubes,
CAPILLARIES
6.
called Capillaries, which enter into the d eepe.t parts of the different organ (Fig. 6).
The Capillaries re -unite and run into the smaller Veins, these gradually re-join, and form larger one., which convey the blood back to the heart. When the blood reaches the Veins it is in an impure condition, as while it is passing through the Capillaries it give up its good qualities, chiefly oxygen, and picks up any waste material, chiefly carbonic acid, which may be there.
The Heart is a hollow mu 'cular organ of a conical shape, which lies in the middle of the chc.. t, hehind the
breast-bone, chiefly on the left side. The base looks upwards and. and the point extends to just and lllsIde the left nipple, where it can be felt beatlllg.
7.
The above diagram (Fig. 7) will give a rouoh Idea of the internal of the heart. A.. Impure blood from body entenng hcart. B. Impure blood passing through Pulmonary Artery to lLmgs. c. Pure blood the lungs r eturnin g to heart through Pulmonary Vellls. J? Pure blood pa.' ing through Aorta to body.
. ba e to the apex i a partition d:v:dmg. the llltcnor lllto two portions: these are subdIVIded mto two other' by mean of flaps or "alves.
B :2
1
FIG.
19
FIG.
The upp er cavities are called the Auricles, and the 10'Yer the Ventricles,
In th e right auricle there are t\yo openll1g.', hy which the impure blood enter,' by the upper one from the veins of the head and upper extremities, and hy the lower one from those of the lower parh; of the body,
As soon as tbe right auricle is full of hlood, its walls close and force the blood through the valve into the right ventricle ' when thi, is full, it::; 'walls close and force tbe blood the Pulmonary Artery into tbe lung" The blood return s from the lun gs through the Pulmonary Veins into the left auricle; thence it passe;:; into the left ventricle, 'which force::; it into the Aorta, the large artery which begins at the back of tbe left ventride, amI through which it passei') into the smaller arteric:s, \'i'hich convey it over the system.
The left ventricle ha::; the thickest alld stronge.'t walls of any of the cavities of the heart, a, it has to drive the blood over the whole body,
The blood is prevented from r turnillg into the auricle' from the yentrides lly valves ",hicb are attached to the sides of the walls of the heart; the free edges of the valves are attrlchell to the 'walls of the ventricle hy strano' threads of fibrous ti'sue, which are ollly .in. t long enou;h to alia,,, them to moet, antI so to shut off the two cavities,
Both auricles act together, and then the ventricles,
causing the double ,'olmcl that is heard over the re!!ion of the h eart, The pul;:;ation \\ hich i:- felt in the art:ries is ca.used by the action of the ventricle, clri ving a fresh su pply of bluod against that ,,,hich is already in the Aorta: the lJul 'ation i.' only felt in the arteries, as the, blo.od loses its force while pa'sing through the caplllane' ; when it rea('hes the veins it flow;:; in a steady stream ,
The blood in the. \ l't 'rie;:; amI 011 the left ,'ide of the heart is alway' }lme, except in the Pulmonary Artery, which conveys the impure hloocl frum the heart to the lun gs whilo in tlle \' eins and on the right side of the h ea.rt it is impure, except in the Pulmonary Veins which hring the pmc lJlootl back to the heart from lungs,
OWL\.. -, OF llE:-;Pll:.\. TWX,
, One of the chief impurities taken up by the blood in lts pa-,; 'age rOllnd the hOtly i · a ga:: calbll'arbollic Acid , If be alJowed to r(>ll1aiu in the lJloocl, it will soon suffocation. To get riel of it, the bloocl pa ses through the LUIl';:-:, The IJl'(l(';CSS by which this purification is cOlllpleted is called ncsl,iration, and i::; divided into two In''l'il'atioll ilnd Expiration,
The Lungs (Fig. are twu hodies, ",hich, with the heart, fill the c.tvityof the thorax, 01' dest. They rest upon an arl'hecl muscle, l'alled the VinphraO'lll or midriff, ",11i(;11 clivid(1) the thurax from the abclolll:n. '
21
The Trachea, or wind-pipe, is a flexible tube, and runs dO-ml the front of the neck from the root of the tongue to the top of the breast-bone, where it divides
into two branches, Olle running to the right, the other to the left; these again divide and sub-divide until they form very small closed tube.. Before they terminate, the tubes bulge out (as in Fig. B), forming air-cells. The
lung is made up of these cells, covered by a network of capillaries, formed by the breaking up of the pulmonary arteries.
Inspiration i. ' the act of filling the lungs with air. It is performed by the contraction of the ml1.'cles, which raise the ribs, thus drawing them upward.. This increa 'es the depth of the thorax from the breast-bone to
the s]!ine. At the same time the Diaphragm act , and becomes straight in teac1 of curved, thus increa ing the depth of the thorax from above do"wnwarcls; the air then rushes in through the trachea and fills the air-cells.
Expiration, or emptying the lungs of air is cau ed by the muscles relaxing, and allowing the ribs by their elasticity to fall, and by the diaphragm re 'l1luing it arched position.
"While pa 'ing through the capillaries round the
FIG. 8.
23
FIC'. 9.
air-cells, the blood is brought into close rclation with the air in them. The air contaimi a gas called Oxygen, which is taken up by the blooll, "while the Carbonic Acid passes from the blood into the air-ccll.·, thus rendering the air in them impure. At the next expiration this impure ail' is forced out of thc lungs, and a supply of pure air is taken in at the next inspiration .
To enable respiration to be carried on properly, a good supply of pure air iR nece 'sary, and thi can only be obtained by proper yentilation.
.
The whole of the processes carried on by thc lliiferent parts of the body are regulatcll by the nervolU; sy. 'tem, which comprises the Brain and 8pinal Cord: from these t,,·o organs white, tbread-like bodies, called :rerves, pass off.
These are divided into the 'ensory, :JIotor, and Sympathetic, and thoe composed of both sensory and motor fibres. The first kind convey sensation to the brain; the second carry orders from the brain and cause the different muscles to act, The Sympathetic, "which quite beyond our control, regulate the supply of blood to the different organs, and control certain invohmtary muscles, and various functions sllch as digestion, circulation. and respiration.
IIlEl\IO(mIU(;E, or hlec(liug', i:-:; caused by thc rupture of a blood-ycsscl, and lllay be either Arterial, Venous, or Uapillary.
Capillary bleeding usually cau.'ed by a flcratch or' grazc, and "cry little blood is lost. there is merely a .Jight oozing of a. red ::;tieky fluid from the place. It i' stoppe(l l)y hlthing the part ill cold ,vater, and placing' a pad of lint, or linen rag <-lipped ill ,Yater, on the ,vOL1lld, antI keeping it there by a triangular bandage.
Yenou::; hlectling i:-; uf Illore importance than the last. It is known hy the bloot1 being of a dark red colour, and wellino- UI> from the wound. A pad of lint dipped in cold water ·houlcl l)e npplied at once to the wound, and tied on hy a hanc1agt.: ; hut if thi::i i::; not enough to stop it, a l,awhtge lllHst be appllcll rOLlllll the limb on the side of the wound awny from the heart.
The limb lllllst be raised, aud Hut allowed to hang down.
A very. ·crion::; cas of YCllOnS b1eeding occurs when a varicose yeiu ill the leg bursts, amI thi ' mu t be treated as above, the patilmt being pLtL'e(l on <L :;01a or bed, with the leg raised, amI garters, :traps, etc, round the knee loosened.
25 CIL\.PTl£lt
II. ILl.GE.
In bleeding from the nose, the patient should be placed on a chair or sofa, with the head raised, and ice or cold water applied to the forehead and nose.
In vomiting of blood, either from the lungs or stomach, keep the patient perfectly quiet, and give him pieces of ice to suck.
Arterial bleeding i' the mo t important, because, unless it i soon topped, the patient may bleed to death, as the blood always e 'capes with great force. It is of a bright red colour, and purts up from the wound with a jerky jet.
To stop it, pressure must be applied at once to the wound, by the thumb or fillger:::;, which may later be replaced by a firm pad and bandage, and if the bleeding continue, the main artery supplying blooll to the part must be cornpres:::;ed. mu ·t be done in OlUe part of it cour e where it pas es over a bone, and as near the wound as pos ·iule. The pressure shoul1 not be enough to cause the patient severe pain, but just sufficient to stop the ·tream of blood.
Pressure may be applied either by the fiugers or by a tourniquet, a very useful form of which may be made
FIG. 10. by tying a knot in the middle of a triangular bandage a in Fig. 10.
'27
The knot js placed on the artery, and the end.' are tied round the limb to keep it in its place. If a thin handkerchief or piece of cloth be used, something solid should be placed in .. ide the knot. If the pressure be not enough to stop the bleeding, pass a stick under the bandage, and twist it round until sufficiently tight. The
11.
stick mut then be secured to the limb by a second bandage or a piece of tring to prevent it slipping. By this means a patient may be left safe from further hremorrhage. An elu:-3tic handage or piece of indiarubber tubing, applied tightly round the limb, makes a useful tourniquet.
In arterial bleeding from the palm, a pad of some
26
FIG.
firm material hould be placed on the wound, and the fingers closed upon it, and a triangular bandage tied round the fist, and the fore-arm slu ng in a large arm sling.
If the wound be between the elbo\\- and the wrist, and bleeding continue after (lirect prC::i:sure has been
FIG. 12. applied, a pad lllust be placed in the fold of the elbow, and the fore-ann bent up and tied firmly to the arm. Thi· pad may be made uy taking up a fold of the sleeve of the con.t or ia.cl-et just in front of the elbo \\'.
If the wound he ahove the elhow, the Brachial artery must he cOlllpl'e.'sed. Thi· artery is ahrays tu he found ill a groove on the inside of the ann, oet-yeen the bone anc1 the lJiceps, the large muscle which lie::; on the front of the arm. Its course is \yell inclicn.teLl l)y the inner seam of the sleeve of a lllall '::; coat, if the arm be extended with the palm uppermust the scam lies almost directly over the artery. Tlle artery may be COlllpressed either by standing at the side of the patient and grasping the arm underneath (as in Fig. 11), or
hy standing in front of the patient and allowing his arm to re::it in your palm, awl pressing the artery with th e th u 111b. This artL ry III nst ahntY::i be pressed from above dO'wn to the 1)one, nn<l never he grasped from above, hecanse ill tho htter C8...,e it might be pre.'sed
FIC . 1:3.
against soft muscle a11<1 tho 1,looLlinp; might continue.
Care must he taken to place the owl joint of tho fingers on the artery; if the extreme end of fingers bo u ed, severe l'<1in ,,-ill l)e catlsecl hy the nails running into the patient':,; tlesh. This art 'ry 1118.Y be :,;topped by a tourni(luet applied as ill Fig.
If the wound be in the armpit, a firm pad must be pressed into the armpit and the arm bound down to the side; if this be in ufficient to stop the bleeding, the Subclavian artery must be compressed. The Subclavian artery is found behind the inner bend of the collar-bone, lying on the fir t rib. The hand must be placed on the patient's shoulder, and the thumb pressed firmly down
FIG. U.
into this hollow, as shown in Fig. 13. If the patient be wounded on the right Ride, the attendant must use his left hand to compress the artery, and if on the left, his right.
In arterial bleeding about the head, pressure should be applied immediately over the wound, as the artery would be compressed against the skulL
In arterial bleeding from wounds on the face, if the
wound be over a bone pres ure must be applieJ Illlmediately over it; but if it be on the cheek the forefinger should be placed in the patient's mouth, and his cheek compressed between it and the thumb.
If there be severe arterial bleeding from the lips pressure should be a)JlJlied on both sides of the wound, by means of the thumb.. and forefinger . .
In wound of the Temporal artery which runs up the side of the forehead, a com})res may be applied, a in Fig. 14. pad i 111aced upon the wound, and kept in position by means of a bandage pa 'ed round the head and tieJ over the pad; the end are then carried over the head anJ under the chin, and tied on the opposite side to the wound.
In wound of the Carotid artery the bleeding must be stopped by pntting the finger: into the wound and pressing the artery again. t the pine. are must be taken not to preR' the windpipe of the patient.
,Younds, with arterial bleeding, in the lower extremity are treated in the same way as tho}-;e in the upper.
If the foot or leg be injured, pre:sure mu.. t :fir. t be applied directly over the wound; and if the bleeding continue, a pad mu ' t be plclcecl hehind the knee, and the leg bent back and tied to the thigh.
If the bleeding be above the knee, the Femoral artery must be compressecl. Tbi art ery commences at the middle of the fold of the groin, amcl run .' dO\ymyards
30
:31
towards the inner side of the thigh. About one-third of the way down it clipi'{ uncleI' the nnmcles, and cannot be felt again till it comes behinu the knee. Pressnre is applied either by placing the thumb in the groin and pres ing the artery again. t the front of the huunch-bone
Fw. 1;).
(Fig. 13), or by a knotted triangular bandage or a tourniquet applied tightly o\'er the artery lo,,'er down the limb (Fig. 15).
The plan of trying to stop bleeding with tobacco must never be u. ed, as there is great danger of the patient becoming poisoned.
As 'oon as the strealll of llloOll ha.' been stopped, the wound must be treated as an ordinary \voun<1 hut the pres ure must not be removed till the arrival of a medical mn.n.
OIiAPTER III.
FRAOTURE,
'.
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 point, as when the collar-bone i broken by a fall upon the hand or by a fall or blow on shoulder, or the ribs broken by a patient being cru 'hed in a crowd, or between a cart and a ·wall.
The kinds of fractures mo t likely to be met with are :-
IMPLE :-.'Where the bone only i::; broken.
CO IPOU D:-\Vhere the bone is broken and a wound through the kin len.ds down to it broken ends . This woundmuy be cau ed 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, uch as placing a per:on "rith a fractured thigh in a cab or carriage before applying splints.
:-\Vhel'e the bone i broken into severn.l pieces.
COMPLICATED :-\Yhel'e the bone is broken n.nd some of the ::;ur1'ounding parts injured, as when the ribs are driven into the lungl; or liver, or \yhen all artery or vein is injured by the broken bone .
Before attempting to move a p:1tient from the place c
32
33
of accident the part mu t be secured by something firm, which will preyent the broken bone from moving.
Siuns of
1. There is diminished power in the limb or part.
2. There are pain and welling at the seat of the injury. .
3. If the injured limb be compared wIth the ound one 'Some di tortion will be noticed, it being u'lU'dly , .. shorter, or lying in 0111e unna,tural po 'ltlOn.
4. If the limb be gently pulled it will regain its natural shape, but will return to the di torted position as soon as the tra.ction ceases.
5. If the limb be gently moved it will be fonnd to move somewhere in the shaft of the oone, in tead of at the joint only; at the SlUlle time, a grating ent\ation (crepitus) may be felt.
6. If the bone be near the skin, some lrregulanty WIll be felt in pas ing the finger along it.
In examining the part, care 11111 t be taken to handle it very gently, as a great deal of harm llmy be d?lle by rough usage; if crepitus be not felt when movmg the bone gently, on no account move the fracture more roughly to get it. If in doubt, treat at:; a f.racture.
If the accident occur in the ollen mr, the clothes should be left on, a, they keep the llart warm, and 'erve as padding for the splint .
A Di 'location is the displacelmmt of the bones forming a joint.
It is known from a fracture by the following-
1. The injury always occurs at a joint;
2. The limb i firmly fixed instead of being unnaturally movable;
3. Gelltle pulling will not bring th(' limb into its na.tural po 'ition ;
4. There is no crepitus.
If the lldocation be in the upper extremity the limb :,;hould, if lJo.'sible, be supported hy a i;ling; if in the lower extremity IJlace the patient in the most comfortable position and .. end for medical aiel.
X 0 011e hut a medical man .'hould attempt to reduce or replace a dislocation, as this operation re(luires a very great amount of technical knmdedge.
FTIACT'GUE, .
FRAUTLJUE OF 'I{TLL.
SiU ns .-If the ba, e of the be fractured, there 'will be bleeding from the mouth, or ears; probably a discha.rge of a ticky bloody finiel from the ears. The patient will probably be uncon ciou ' .
In mo,t fractures of the roof of the skull the patient will probably be UllCOll. cion ' . Po,'ibly it will be a compound fracture, in which case the bone lllay be een.
T,'ttltiMnt. - Place the patient 011 a sofa or a bed, l!
.. .
35
slightly rai e the head, and keep him perfectly quie until the doct or ani ves.
FRAOTURE OF THE J A,Yo
The patient will be unable to speak properly; th mouth will remain open, a the jaw will drop.
FIG. 10.
If the finger be pas ed over the teeth and along the outside of the jaw a depre::>siol1 will be felt, and lJrobably the rough edge of the bone. The gum' may be bleeding.
T?'eatrn ent.-Gcntly raise the ja,,, to its natural po. ition, and apply a narrow triangular bandage by carrying it round the jaw and OYer the head, cro. s the ends above one ear and carry them round the head and tie Oil the opposite side.
FTIACTURE OF UOLLAn-BOXE.
The patient will probably be seen holding the elbow of the injured side with hi!" .. ound hand: hi' head will be inclined toward!> the injured side.
If the finger oe pa.s.'ed along the collar- bone, a deprc 'sion and sharp edge may be felt, as if the bone were coming through the ·kin.
The patient "",ill be unahle to raise the arm above the "houlder.
T?·e({tilunt.-Place a pad of some firm material, 'uch a a triangular bandage or handkerchief rolled tightly, in the armpit; rai 'e th ann gently, 'md blmg it with the large arm-.Jing, then tie the arm to the 'ide by a hroad oanllage, paiS mg round the ann It lid che, t out Ide the
FIG. Ii.
The bandage binding the arm to the ':iide must always be placed a.. near the el bow a':i po sil,le, a the arm is to act a. a lever to lIraw out the ou t er end of the fractured oone (Fig. 17).
37
FRACTURE OF THE ARM-BO IE.
Signs.-The usual signs of a fracture.
Treatment.-This fracture may be put up 111 two, three, or four plints; these must be placed-
If two be u ed, one in ide the arm and the . econd @utside;
If three, one inside, one outside, and one at the back;
If four, one inside, one out ide, one in front, and one at the back. The splints must be kept in po:-;ition by triangular bandages-one tied on each side of the fracture, securing the upper bandage first.
The arm must then be slung in the small ann-sling, so that the weight of the fore-arm at the elbow may dra \Y the frugmeut into position. traw envelopes of bottle::;, or an expanding flower-pot ornament, may be u ed for this fracture, as they can be ea. ily adapted to the part.
FRACTURE OF THE FORE-AR:JI.
Signs.-If both bones be broken, the u ual signs of fracture will be pre. ent; but if only one be broken, the signs will be loss of power in the limb, a depression felt at the seat of fracture, great pain at the same point.
The treatment will be the flame in either ca. e.
Treatm ent.- Bend the fore·n,rm, keeping the thumh upwards; then apply two splints, one on the inside or
39
front of the fore-arm, the ether on the out::;ide or back. The inner one should extend from the bend of the elbow to the tips of the fingers; the outer should extend from the elbow to below the wrist. Tie the splints to the arm by a bandage on each side of the fracture, secure the upper bandage or that nearest the elbow first, then sling the fore-arm in a large sling.
FRACTURE OF FINGER, ' .
Sir;ns.- sual signs of fracture.
lJ rea tment.-I)lace a well-padded narrow splint under the finger, and keep it in position by a narrow bandage of linen, and sling the hand and arm in a large arm sling. If several finger ' be broken, place a piece of wood, well padded, under the band, and keep it in place by the handbandage, then sling the hand and arm in the large arm ling.
FIL\' TeHE OF nIB'.
Siyns.-Patient will complain of a sharp cutting pain on taking a dee]' breath or coughing; he will keep his hand firlllly pres 'ed on the injured part to prevent the Ride moving; he will breathe in a . hort, jerky manner. If the hand be placed over the seat of pain, a grating may be felt ·when the patient hreathe. ; the end of the broken bone may be felt .
3
T1·eatment.-Tie two broad triangular bandages firmly round the chest, making the lower part of one and the upper part of the other cover the seat of pain.
FRACTURE OF THE THIGH.
Signs.-Usual signs of fracture.
T?·eatment.-Place a long splint on the outside of the body, extending from the armpit to the foot. Thi
18.
must be tied firmly to the body by a bandage pa sing round the chest; another round the peh'is: one above and one below the fracture; on or two below the knees; and the legs must then be firmly tied together (Fig. 18). The upper bandage mu t be placed round the patient's chest, for if tied oyer hie:; stomach it may cause him to be sick, and it ",-m not keep the firm.
,Vhere it is su pected that this injury ha. occurred to a woman, tie both legs together, and apply a long ..plint outside the clothe, on the injured side.
For this fmcture any of the following things will serve as splints :-Broom-handle, two billiard cues, the top of one being tied to the handle of the other; any long strong trip of ,yood. A rifle makes a good splint, the butt end being placed uncler the arm and the barrel extending clown the leg; or the patient may be tied on to a shutter or a long piece of wood, either of which
must be carefully pu, hed under the two thighs ancl tied to them by bandages. If nothing suitable for a . plint be at hand, tie the t,yO legs firmly together.
A useful splint for the thigh or leg lllay be made by rolling a pole in a piece of cloth or fiannel; the free end of the cloth i. passed under the limb, and the pole is placed close up to it, and the limb then covered ,vith the cloth; bandage ' are then applied to keep the pole in position.
40
FIG.
FIG. 19.
The sleeve of a coat may be turned inside out, and filled with paper, straw, twig, or anything firm, and the coat applied in the same way as the cloth and pole (Fig. 19).
For children, walking- ticks and umbrellas are useful.
FRAOTURE OF THE LEG.
Signs.-H both bones be broken, the u ual signs of fracture will be found; if the hin-bone only be broken, the fracture will easily be detected by pa sing the hand
gently down the leg, when the rough ends of the bone will be felt.
H the brooch-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 'reatm.ent.-AppJy one 'plint on the outside of the leg, and another on the inside; tie them firmly to the limb, and then tie the leg::; together by two Landages (Fig. 20).
4.3
]HACTl:BE OF r ... TEE-CAP.
Signs.-Brokell bone may he felt under the skin . Patient will be unahle to raise the leg, which may be bent backward . .
Treatment.-Tie the leg on a splint extellding from the buttock' to the heel, and raise the limb.
FHACT"CRE OF 'PI... E.
Usually caused by fall while hunting, or by hea'Vy weight falling upon patient's back.
'i{Jlls.-The IJatiellt will probably be unable to move' if the injury be Yery severe, he will 10:-;e all power and feeling in both the lower extremities.
TTeatment.-Hemoye the patient a::; 0011 as possible to the Heare t house Leing careful nut to I';it him up, but to carry him perfectly fiat on a :-;tl'etcher.
For treating a fracture, almost any .11}1::-i<\I11'e which is strong enough to keep tbe limbs at l'e:-;t may be used for temporary ::;plint.. 'ome of the follo" ing a;·ticles can almost ahyays be obtainell, and can be ea.' ilyadapted, viz" a sword and scabbard, policeman s truncheon and cape, a stocking fillcll "with earth (Fig. 21), sand, mos,', hay, chaii', 01' paper, and tied ju. t above the ankle auu at the top; pieces of ,,"ood, hammer, rulers, rolls of paper 01' nc\\ spaper', stl'a,y ea es of wineLottle " expanding ornaments for fiower-pot , long thin books, strip ' of canlboal'u, ,mlking-stick. ,and umbrellas.
42
If any hard substance be used, care must be taken to pad it with some soft material, especially if it has to be kept on the limb for some t ime.
The splints must be securely fa. tened to the limb by
FIG. 21. bandages placed on either side of the fracture; the splints should, where possible, ext end beyond the joint on both sides of the'Jracture.
If no triangular bandages be at hanel, the splints can be secured by handkerchiefs, neckties, uoot-JaceH,tl-ing, strips of cloth or calico, straps, &c. In all ea es the
45
limb must be placed in a.' natural a position as possible before the splint. are applied .
Never attempt to carry a patient any distance until the fructu.red limb has been secured in splints, or supported III some way to prevent the bones moving.
If it be not neces ary to move the patient from the place of accident, make him as comfortable as possible with pillows, &c., until the arri val of a medical man .
In fracture complicated with arterial or venous bleeding, the blood mu:-;t fir.'t he topped and the fracture tben attended to .
•'PRAINS mu t always be treated by keeping the as quiet a po. sible. If the joint can be covered, a trIangular handage may be firmly bound round it.
If the sprain be a yery severe one, the part may be placed in a Rplint, and the patient carried at once to a doctor.
-WOUND " CL;T , &c.
Before dre sing any ""ound it hould be cleansed from any foreign matter by being washed with some clean water. The part should then be drawn together into their natural position, and kept there with strips of sticking-plaster. A pad of lint or soft linen raev dipped in clean cold 'Yater then be applied, and kept on the wound by a triangular bandage.
44
CHAPTER IY. IN 'ENSIBILITY.
A VERY common symptom of sudden illness or accident is insensibility, which is c3,used by the action the brain, heart, or lungs being interfered ·with, and which la ts for a longer or shorter period, accol'cling to the extent of the injury.
It is nece sary to try and find out the Cctuse of the insensibility before trying to re tore the pa.tient.
Th e first thing to do to an in. en ible per. 'on is to loosen the clothes round the throat and chest, llal'ticularly any belts or braces; then pa. the JJand quickly over the body, beginning at the head, to find if there be any fracture: or wound from which blood i flowing. If either of the e injuries be found, it mu t be attended to at once; but if not, the patient must be carefully carried into a hou e and placed upon a bed or sofa, Hnd kept perfectly quiet, with head rather low. It is not always easy to discover the cau e of insen, ibility; '0 in all cases of doubt the patient mu. t be kept very quiet till the arrival of the medical man.
APOPLEXY.
Sign-s.-Patient becomes suddenly insensible, lll' cathing very laboured, and accompanied by a snoring noise' the cheeks may be puffed out with each expiration.
The pupils of the eyes will probably be UnC(1ua1.
If the arms be ra1 'eel, one may gi ve some eviclence of feeling, while the other will fall helplessly to the side.
The patient ca,l1not he roused.
Treatm.ent.-Place tlJe patient on a bed or sofa, with the head slightly rai ed. Loosen clothing round neck. Apply hot bottles or flanncl' to the feet and leg.·, and cold water application to heacl.
D o not attempt to give hhn any stimulants, eme tics or' an!jthl'l1g by the mouth.
EPILEPSY, on F.\'LLL G
IKi{E-'.·'.
Signs.-The pcl.tient iti 'udLlenly 'e ized with the fit, frequently uttering a piercing scream before becoming unconscious, and fa 11:-;.
The ha.nds are tightly clenched, the leg:") and arms being jerked violently toward ' the body.
The face becume' livid, and a froth, 'o lllctil11eS streaked with blood, appear::; round the mouth.
After a fc\\' minute::; th e convul.. ion' cea 'e, and the patient either get· up and walks away or drops off into a deep sleep.
T?'etltm ell t. - If ahout to fall, catch him from behind by placing your hand.. under his ann-pits. 1£ on the ground, pu:-;h aW,lj' anything again .. t wbich he Illay hurt himself, snch as chair', <.:'C. ; or drug him away from a wa.ll, or llcnv}' piece of furniture. Put your own left arm under hi .. head, while you kneel at his head, and
46
47
4
with your right hand undo his colbe, &c. Pu, h a piece of wood, or some hard substance rolled in a handkerchief, between his teeth. Do not try to 1'e train his movements at all.
If he wish to go to sleep after the fit, do not prevent him, but do not leave him by himself for several hours.
CONC\] ION OF THE BRAIN.
Produced by blows on the head, or from falling on the feet from a great height . It is either severe or slight.
SLIGHT CONC"C ' ION.
Signs.-Patient will be very pale, breathing very elowly, lying with the eyes shut.
If spoken to, will rou e himself as if from sleep and answer properly; then will relapse into the partially insensible state.
After a few minute he will probably vomit, and then gradually recover.
T?'eatment.-Place the patient on a sofa; apply warm bottles and fiannels to hi feet and hands, and let him keep quiet for a short time.
One form of concussion frequently met with occurs in young children. -While playing, they tumble and strike the head.
of the ymptoUls men tioned above then appear.
The best thing to do ill this ca e is to keep the child
very <flliet, and allo-\\" him to go to sleep, and not to rouse him, as many pilrcllts try to do.
CAsEs.-In thcse the .. ub tance of the brain i . ' bruised, and the symptoms are like those of apoplexy, and th e case mu.. t hc treate(l as sucb. i.. due to failure of the heart's action, and is uSl.wJly caused by fright, hunger, heat, exces ive fatigne, lW:!lllOrrhage, C.
'/YJI.'.-The patient suddenly becomcs pale' if . tanding, he 't<lg rrers; if .itting dowll, he i ' rcstleHs and Ulleasy for a minute ur two; a clammy sweat breaks out over th e forche ,ul amI umler the ey es; the re. lJiration becom es hurried and shallow, anel he th e n loscs con 'ciousllei-i".
If 0<.:cnrring in a church or crovi·ded mom, the patient's h C,lll shoultl be pre 'sed down below his HIlll kcpt th ere for it fe w minute.. .\Jter this he is llsll.llly utti<:iently re<.:o\"ercli to walk out of roOln.
Th e roullli the ncck and che .. t should then be ullllul1c, al1l1 the ft1ce anll hand.. Lathed in cold water. ..\ stillluLlllt as sal-volatile, tea, coffee, or wine- may then be gi\'ell. .\nother plan iH to place the patient fiat on the fioor, with the 11e,ld on tl level with the body.
If the fainting be due to 10 :; of blood, the wound from which the Llood is coming mu t bc dressed, alld the blood stoppcd, amI somc stimulant given.
D
49
If due to hunger or excessive fatigue, care must be taken not to give too much food at once. Warm milk, beef tea, wine and water, may be given in small quantities very frequently; and as soon a. the patient able to ,it up alld eat, something ,'olid lllay be gIven.
ALCOHOLIC POI ONING
').
is helple " both sides being e(lually useless; face u ually fiu 'hed, but may he pale, pupils usually dilated, but ometimes contracted; is cold and clammy.
If the patient be questioned, he will an 'wer in an incoherent manner. There is usually a odour of alcohol about breath.
Trreatment.-If told that the patient has been c1rinking very freely within a fe,Y hour, giye all emetic of a tablespoonful of salt in a tumbler of ,yann ,Yater, or one teaspoonful of mn ·tard in the .ame lluantity of warm water. If this emetic be ineffectual it may be repeated at of ten minute. After has operated, the patIent may be allowed to go to fileep. Cn/ess 7Jerjectl.1l sure that the pallmt intoJ.:ica(ul, do not [IiI'(> the emet1·c.
If the weather be very cold, care mu..t be taken to keep the patient warm, a a drunken pel' 'on i.' very susceptible to colel.
If the drinking bout has been a prolonged one, the
patient mut be kept quiet and W<1r111 till the arrival of a doctor. A cup of hot tea or coffee is the best stimulant to give the llatient.
OPIC:JI (LAUDA.LJ'C':JI) POI. 'ONTNG.
the opium ha::; taken full effect the face ma.y have a tiu::,hecl appearance; breathing very deep allll .'low; pupil.' cotilmcted; patient is very drow!')" but he can 1)e by ::Jwuting at him.
If the patient get wor:iC, hi , breathing becomes very shny and (luiet; face }Idle, anel the pupil.. contmcteJ to size of pin" head::;; wIlen in this tate he can be rou d only with the grca.test trou1)1e, 'l'i'w{lIzent.-Uive patieut an emetic, and. do not allow him to give '''ity to the great de ire f01'leep.
He shoulJ be f'uPliortcll 1)y t\\'o attendant, and kept \Y,llking UlJ nllll llo"\\'Jl.
•'tl'ong cotree should be gi "en frequently.
Hr, "l'EUI 1AL FIT.'
r sually oceur in female::; ; come on uddcn1y, in conKe luell<;e of :o;0111C excitement.
• 'ifjll,'.-Patiellt falls down (usually in some comfortable Idace); clenches her hanel' ; grind::; her teeth.
The eyelills arc partially do::;ecl, the eye being turned UI)\\'anb. Patient alternately cries and laughs,
l't'!: (I(lIu:' ilt.-Be finn with the patient and tell her })
50
51
that if the fit continue- you must drench her with cold water.
Send eyelT one out of the room except one frieml, and keep the 'patient yery quiet.
CliAPTER Y. 'VOU-,,-TD , ETC'.
BITE. ' OF ANBIAL, '.
IF the animal inflicting the wound be healthy, tll e bite should be carefully wa 'hed, and dressed with coldwater dressing.
If the animal be rabid, more seyere methods must be used. A ligature should at once be placed round th e limb bet\\-een the wound and the heart, to prevent the poison being carried all over the body. The wound shonld then be well 'washed with ,Yater, or p11 t under the tap, and where possible the patient suck thE: wound, unless he have a fresh crack 111 IllS. lIps) this it must be burnt ,..itll strong aCId, as llltne or sulphuric acid, or lunar cn.u ,tic, r,are being taken that every part of the wound is thOl oughly burned.
If the accident occur in the open, gunpowder may be placed in the wound and fired, this being onert' or hyice) or the ,",' ound may be bl.Ullt several time Ly ordinary fn. ees.
If the patient become faint, some stimulant, a brandy or wine, must be given.
ADDEIl _\ND 'I AKE BITE '.
Patient ,yill feel a sharp stahhingpain at 'eat of bite. a short time he ,rill Jeel faint and :;ick, and his face will become very pale.
The part hitten will 'well anel feel very. ·tiff.
TI'('((tIlUllt.- _\pply a drop or bvo of . trow' ammonia to the bite, and tie a ligature between the '..Olmd and heart. Ui\'e patient some brandy or ,yhi.<,ky and 'yater.
_\ snake bite would he be. t treatctl hy the instruction. given abo\'e fur hitcs of rahiel anilllnl".
, tings of in llec:-;, "'a.ps, s<.:Orpiull!':', &c. These .;;honlll be treated iu the same '\'n} a:-; ,HIdeI' hite·.
BeR."', 'CALD. ,.
.\.. hum is caused by dry heat, anel a scald by moi ·t the effect upon the body heing the same. The point of the treatmcnt i.. to exclude tbe air as CJllickly po ·ible. This may be clone by dredging the part t biddy with Hour, provided the .ki n i:; uuiJr())-en, all(l not disturbing it for some time.
.\ny yegetn.ble oil-such as :'abel, sw et or linseedmay be applied, hy'oaking a piece of rag in it and covering thc ,,,ounel.
A , ery good allplication is made by mixing equal parts of lin.;;ecll oil ancllime water, forming' carron oil."
52
54
The plan that i very popular of holding a hurn in front of a fire must never be adopted; it is imply increasing the injury'
The clothing mu. t be removed very carefully; but if it firmly adhere, oil shollld be poured over it 01' cut round it with everytbing ready to apply before removing the clothes.
When any pE'l',:,on ' dre's catcbe fire the acb-icc of Professor John ball should 1e followed, yiz. :-If the dress of a woman catch fire, be should at once lie down on the fioor, and should crawl in this po. ition either to a bell-pull or door, and call for assi tancc ; or she should roll her. elf in a ru o' or blanket. In the event of a man rendering help, hc .·bould at oncc lay the patient down, take off his coat and roll her in it, lillIe,s be can obtain a blanket or rug or roll her on the carpet; if a woman render assitance. she mu. the carcful not to aHOii' her Oil"l1 clothing to touch thc IJat ient, but to hold a rug or l)lanket in front of her 'e lf " 'hile approaching the fiamee;.
FROSTBITE.
Patient will lUl i'e been expoRed to very .. eYere cold. The p<ut affected ,,-ill be altered in colour, assuming the greyish white hue of tallow, or it may hai'e a dark purple look. The patient doe ' not complain of affected part feeling cold, a local sensation is abolished. 55
1'?·eatment.- Take care not to bring the patient into th e warmth at once, hut u ' e friction o\'er the affected parts till sensation returns.
(Jomcs on WhCll the patient has been greatly fatigued or undergoing great exertion when exposed to a high temperature. The patient lllay either fall ' uddenly or complain of throbbing in the head with fcelill'" of faintand
TI'f'(ltment. He should be rel11o\-ed to a cool place, and ice nppliell to his head or bathed freely "'ith cold w,tter. All tight clothes are to 1Je remo\'ed, and stimulall t:-; to be a voided.
l>OL BY
A per. on siyallowing caustic soda, caUL tic pota 'h, or any strong alkali, would experience a i'ery ·tronD' can tic tn.' te, with a burning feeling extending from the throat to the stomacb. The mouth will look infialllEll and of a deep red colour, with pieee uf the lining membrane hanrring (hnYll.
'l')'f'(ltll1ent.- the patient '1m h hi:-; mouth out with yinegar, lemon-juice, or tartaric acill, -well diluted with water, then gi\ e oil, white of eggs, milk, or gum wnter.
PUL 'OXIXU BY '.
A perSOll s\\a11o\\ ing a do e of ·trong acid, uch a
.16
ulplmric (Oil of Yitn'ol), (Aqua Jr'ci?'fis), or Hydrochloric (Szn:1'it of Salt), will immediately complain of an intense burning pain in the mouth and throat, and great pain in swallowing.
The mouth " ' ill look . ,vollen, and covered "ith a 'Thite kin.
T1'eatment.-ilIake the patient wash thc mouth out freely with some chalk, whiting, or magnesia,tirrecl up with water or milk.
After washing out the mouth freely, givc thc llUtient a little oil, barley-water, or milk to drink.
POT ONING BY PHO, 'PHOR
Caused frequently by children. ucking lucifer matches. The patient has a very disagreeable burning sensation in throat, inten e thirst, and sometime. vomiting.
TTeatment.-Giye the patient an emetic, and then drink of barley-water or m8gne. ia and milk, hut never give oil.
POI 'OXING BY CARBOLIC ACID.
Patient will complain of a great burning sen:-:ation in the mouth, the month will look white and :hri,' ellecl, and there will be a strong smell of tar or carbolic ncid.
Treatment.-Make patient ,,,a,'h out hi: mouth very freely with oil.
POI 'Or I G BY OXALIC _\"CID.
Patient will complain of a Yery trong aci(l ta:tc
with a burning in the throat, then in the stomach; vomitin of the content: of the stomach with a (lUantity of blood then comes on, and the patient gradually sink.,.
T1'ecltmmt.-Give patient :ome chalk or whiting mixed in 'yater.
In case' of poi 'oning by other poi. on . , ,'uch as ,'alts of Copper, Arsenic, and other mineraL, amI vegetable poi 'on, give the patient an emetic of warlll water, or a table, poonfnl of salt, or one teaslJOonful of lllu.::;tard, in a tum bIer of '''arm wuter.
If he be yery cold, apply heat to the extremities; and if the retching continue after the has been emptied, giye plain ,,,urm water or milk a,nd water to drink. , 'cnt1 at once for medical aiel in all ca 'es of poi oning.
FOREIGX nODIE.' L THE EYE.
If the foreign boely under the upper eyelid, seat the patient in a chair, and, standing bchinc1 him, place a match or bodkin over the lid: take hold of the eyela. ·he. , and turn the lid up,Yanl.. Then, hn.Ying expo ed the sulrtance, brush it off with the corner of a handkerchief or n. camel\·hair bru.. lJ. If it be under the lower eyelid, . imply depress the liel, ancl proceed as a,bo,'c with handkerchief or bru..h.
FOHEIGX BODIE'" IX THE EAn.
Do not attempt to remove the body by poking at it
57
58
with lJin , needles, or knitting-needles, but put in :1 few drops of warm oil, and take the patient to a medical man.
OHAPTER VI.
ARTIFICIAL
llE pnL-\..TION.
ARTIFICIAL HE'PIRATIOX mu·t be employed in ca 'es of accident or poisoning when the breathing has become very feeble or has cea ed; as in case. of hanging, drowning, suffocation from any cause, or opium poisouing.
The first thing to do in ca es of suffocation is to get the patient into the fresh ail', then to loo'en quickly all clothing round the throat, che t, amI ,,,aist, then to beat the patient on the che·t with a towel dipped in cold water, to try and make him ga'1\ .0 that the lung may be filled with fre hair; if he show::; no l:lign of breathing then, artificial re'lliration mu t be employed.
In ca es of drowning, get the patient on to dry land or into a boat, then 100 en the clothing round hi:-: neck, chest, and waist: clear out the mouth, in case aDY weed or foreign matter be in it; then roll him on to his chest for a minute, to allow any water to e cape from his mouth; then roll him on to his back, and draw the tongue forward, and keep it out by a band pas ing over it and under the chin. Then commence artificial 1'e piration as de cribed below.
59
DR. 'YLYESTER'S :METHOD.
Place the patient on hi back, with a small firm cushion or rolled-up artie]r of clothing under his
FI(;. B.
shoulder-llhules : kneel at the patient's head, and gra. phis arlll' just helow the elhow : draw them gently, and with a weeping motion abo\c the head, and cro ' them;
GO
keep them in this position for about two . then carry the arms down on to the side of the chest and press firm1y for two seconds (po ition B) j repeat these movement stf'.adily and slowly about fifteen times a minute till breathing commence) or till a mcdicnl mall pronounces life to be extinct. If the patient he a large per on anll the rescuer be unable to continuE' the movements, he can get an a .. si tant to take ore arm while he manipulates the other, hut in tIli.. case hoth arms must be moved simultaneously.
·Whilst the above operations are being employrc1, let a bystander dry the hands and feet) and as soon as clry clothing can be obtained strip off the wet clothing and replace it with the dry; thi. mu·t l,e clone so as not to interfere with the efforts to restore the breathing.
As soon a breathing has commenced) begin to promote the circulation by rubbing the limb urnvarcls ,,,jth firm) grasping pre' nre) 11 ing warm flannel or cloths. 0 effort mu t be made to restore the circulation till the breathing be properly carried on.
The friction must be continued uncleI' the blanket or over the dry clothing.
Promote the warmth of the body by the application of hot flannels, bottles, 01' bladder of hot water) heated bricks, &c., to the pit of the stomach) the armpits, l)etween the thigh.) and to the soles of the feet.
H the patient has been carried to a. aft er
i.. re:-;tored) be careful to let the ail' play freely a.bont the room,
On the restoration of life, a teaspoonful of '''arm water should be given; and then, if the 11O\ve1' of wallowing has returned, .. t11all (luantities of wine, warm brandyand-water) or coffee. hould be administered. The patient should he kept ill bed) and a disposition to ::dccp encouraged.
. If there he pain or difficult)' ill breathing) apvly a hot poultice o\'er the che·t.
'Watch the patient ca.refully for 'ollle time, toee that the ure,t thing' doc::> not fnil; :lny::>igll::> of failure appear) at once begin artincial
On:-1ERYATIOX.'.
The treatment .. hould be per. everetl in for some hOllr", a,.; it i:-; an erroneou.' opinion that persons are bemuse life doe' nut make it appearallc e, I'cl'"on: ha \ing been re. to red after pere\'ering fur mallY hOll!',';,
Aj))l f({)'(IIlCfS lI'lu'cli Uf'nf1'allIJ accompany Death.
al1lI the heart'::> action cease entirely; the eyehcb are gencmlly half-closed) the pupil::; dilated; the tongue 'I]l/)['oaches to the uIH.ler edge' of the lip) and thee) u:-; \\'ell a::; the nostrils) are covered. with a frotby llllH'U ' . l'oldncs::i and pallor of lll'face increase.
61
G:2
UAUTIOX:::i.
Prevent unnece '::;a1'Y cro\yc1in;; of pel':o;ons round the body, especially if in an apartlllc:nt.
Avoid rough and do not allow the patient to remain on the baek unless the tongue is pulled out. -c nder no circumstance - hold the patient U1) hy the feet.
On no account place the patient ill a \\'ann bath, unless under medical directiull.
STRANGULATION.
Accidental strangulation lllay occur from tightening of neck-ties, &c., round chi1(11'en'8 necks, or in intoxicated persons from various Tteaim en t.-At once cut the compressing band round the throat, and commence if necessary, not forgetting to pull out the tongue a1ld ,enue it. If in a confined space, open ·,,"indo\\'. 1n 'ist on bystanders allowing free of nir.
CHOKING.
May take place from a piece of meat being accidentally drawn into the windpipe in:tcal1 of the gullet; or from hanl subtallces, .'uch as coin>;, &c., ",hieh had been placed in the mouth bl'in,!; accidentally :swalluwed. The patient start up, attempts tu 1mt his to the back of his mouth, st ruggle for breath, the complexion
G3
becoming If the . ub -tance be not at once removed, he falls in -ensible, an.d respiration cen.es.
Treatm en t- Boldly hut firmly carry the thumb and forefinger to the back of the mouth, and try to hook the obstruction for\Ya,rd. 'houlcl this fail, the patient may be were he to yomit and this may be brought about III the follu\\'ing way: Lay him on his back, and putting your knee 011 the pit of his stomach lean on it and with your open h<1m1 ::-trike him firmly the cheek: This 'will cau e him to try and take a Jeep breath, and he will vomit. If he still remain insensible after the ob -truction has been removed, at once COllllllence artificialrespiration.
HAl. GI..,rG.
Do not ,va 'te time 1>y going for a i tance, but cut the rope at once, nnd if the patient elo not breathe freely commence artificial respiration immediately.
POrOL IXG BY U..:l. 'E. '.
. Thi may be caused by the escape of onlin<ll'Y ga mto a room; hy a coke or charcoal fire in a badlyventilated room; by the accnmulation of carbonic acid gas in sewers or \\ ells; by chloroform; or by chokedamp in mines after eXll]O ,ion " &c.
Do not take a light into a room where gas is e ·caping. Open or break winLlows before trying to elm.,; the paticut out if he be far from the door.
Signs.-Patient is in ensible; face pale; lip livid; the tOllo'ue livid swollen and perhaps protruding bet'ween the teeth. The' hands u ually clenched, and the nails bluish.
T?· ea tment.- The patient must be at once removed into the fresh ail'; the clothe must be loo::;ened round the neck and che ·t, the face and chest bathed with cold water,
If the e means fail to produce respiratiun, artificial respiration must be used.
C HA.PTER VIr. BANDAGING.
TIUAKGULAR BA JDAGE (Fig. 2-1) may be applied to any part of the body. It is made PO INT
FIG. 2-!. by cutting a piece of lin en or calico forty inl;hes (iuare
into two pieces crossways. The bandage may be used either as a broad or narrow bandage.
The br'OCul is made by spreading the bandage out, then bringing the point clown tu the lower border, and then folding into two.
The narrow if) made by drawing the point down to th e lower border, antI then folding into three.
Tke uanda;;e should always be fastened either by a pin or by being tied with a reef-knot (Fig. 23). It is applied. to the body as follows :-
FIG. 2.i .
To tiLe scalp (Fig. 2G).-Fold a hem about 1 inches deep along the lower border, place the bandage on the head. so that the hem lies on the forehead and. the point ha.ng , down at the back; then carry the two ends round the head above the ear1:i, cross them at the back, and E
64:
65
66
bring them forward and tie on the forehead; then draw the point downwards, and turn it up and pin it on to the top of the head .
In applying this bandage, care must be taken to put the hem close down to the eyebrows, to carry the ends
67
side of the neck; carry the ends round the middle of the arm and tie them; take a second bandage, fold it into a broad bandage, place one end over the point of the first
FIG. VIEw . FIG. 27. BA.CK VIEw. auove, not oVel', the ears, anll to tie them clo. e (lown to the eyebrmys, and not high up on the forehead.
For the jO?'ehead, side ()j head, ('yr', cllf(,k', jf)?' rmy part oj the body 'lUMch is To'und (as ann or thi?h, &c.) the nanow bandage must be u. ed, Its centre bemg on the wound, and the enels being carried round the limb and tied over the wound.
For iho'l.dder (Fig. 28).-Place the centre of a bandage on the injured shoulder, "ith the point running up the
FIG. handage, sling the arm by carrying the other end of the hnnllnge o"\'er the Round shoulder, and tying at the Ride of the neek; bring the point of the handage uncleI' th:1t part of the fding resting on the injured shoultler, draw it tight, turn it down, and pin it.
FO?' hip (Fig. 2D).-Tie a l1illTO\V bandage round tbe hody above the tyillg the knot on tbe f:iallle side as the injury; take another bandage, turn up a hem according to the size of the patient, place it centre on the wound, carry the ends round the thigh, and E2
Fro. 29. tie them; then carry the point up under the waistband, turn it down over the knot, and pin it.
Fo?' the hand (Fig, 30).-Bprcall out a hnncbgc, place
30. FI(.l. 31,
the wrist on the horder with the fingers towards the point; then bring the point over the 'wrist, pass the two ends over the wrist, cross, and tie them.
Fo?' the foot (Fig. 31).-f 'pread out a bandage, place
FIG. 3:!.
the foot on its centre with the toe toward the point; draw up the point over the instep, bring the two end forward, eros, , and tie them either on the sole (if to keep 11 splint on) or round the ankle.
Larg e ann-sling (Fig. 32).- pread out a bandage, put
68
69
FIG.
70
one end over the sound shoulder, let the other hang down in front of the che t; carry the point behind the elbow
FIG. 33.
of the injured arm, and bend the arm forward over the middle of the bandage; then carry the second end over the shoulder of the injured side, and tie to the other end; bring the point forward, and pin to the front of the bandage.
Small a?·m-sling.-Fold the bandage into the broad bandage; then place one end over the shoulder on the sound side; cross the arm over the middle of the
71
bandage hanging down the clle t; then bring the other end over the injured shoulder and tie at the side of the neck.
For chest (Figs. 33 and 34) . ' - Pln.ce the middle of the bandage on the injured 8ille, with the point over the slwulc1er; carry the two ends ronnd the wai.. t and tie them; then dmw the point over the shoulder and tie to one of the ends.
PO?' the bClCk.-The bandage is applied as above, but beginning by placing the bandage on the back.
CHAI'TIm VHI.
C.\HHYISG
I accidents " 'here the patient ha ' been rendered unallie to \ntlk alolle, he may he cill'ricll l>y the bystamlel'::l 11lakillg either of the following 'cat· :-
(1.) The four-handed is made by two per ' Ol1S cIa ping their left \vri ts 'ivith their right hands, then clasping each other'. right wrist with their left hands (as Fig. 35).
After the hands are clasped together, the bearers stoolJ down behind the patient, who 'it · on the hands, and at the '<11ue time places one arm round the neck of each bearer.
This seat is used where the patient is sufficiently conscious to give some assistance to the bearers and is able to use his arms, but is unable to walk.
FIG. 35.
(2.) The two-handed seat is made by two bearen, cla 'ping their hands as in Fig. 36, and placing their free hands on each other's shoulder.
In case of the patient being a short person the bearers should place their hauds on each other's hips instead of on the shoulders.
This seat is used when the patient is unable to give any assistance, as when the arms have been injured or the patient feels faint. The second kind of seat lllay be used to lift a helpless patient from a chair to the bed.
A bearer stands on each side of the patient, and lJasses one arm under his knees and clasps the hand of the other bearer. The bearers then pass their arms ronnd the back of the patient and grasp each other's shoulder.
72
73
FIG. 3G.
71
One bearer may carry a patient by the ordinary "pick-a-back" method, or a' followtl :-
The bearer stoops down in front of the pationt and passes hitl right arm between the patient's leg::;; patient then falls across the bearer'::; back, so tlw.t Illtl right a.rm comes in front of the bearer's left arm. The patient is kept from falling by the bearer holding his right leg and right arm .
The plan of canying the patient by the anns and le(ls, with the face downwa?'cls, cornmonly called the "f),o(l's ?lw?'Ch," neve?' be used, as death ?rwy ensue from this t1'wtment .
'Where a proper stretcher cannot be obtained, a temporary one may be ma.de in either of the following ways :-
(1.) The sleeves of a coa.t ma.y be turned in .. iLle; two stout poles arc then pa'sed through them, and the coat buttoned. This makes a. good seat. (Fig. ;37.)
The patient sits on it, and re::;ts agaimit the back of the first bearer.
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If a longer stretcher be rerluired, two coat::; must be treated 111 the same way. (Fig. 38,)
FIG, 3'),
en Two sacks ma.y be taken; a hole i made in each corner of the bottolll, a.ncl two poles passed through the sack and out of the holes. (Fig. 39,)
FIG. 38.
(:3.) A large piece of cLnpet, :-;acking, tarpaulin, or a Llanket may be spread out, and two stout poles rolled up in the .. ide.
T"o bearer. then . tand all each side. They gra p the middle of the pole with one hand, and near the end with the other. To carry the patient, they must walk sideways.
(4:.) A hurdle, broad piece of \ycod, or shutter may be
76
employed as a stretcher; but if either of them be used, some straw, hay, or clothing should be placed on it, and then a piece of stout cloth or sacking; the sacking is useful in taking the patient off the stretcher when he arrives at the bed-side, Always test a temporary stretcher before placing the patient on it.
Temporary stretchers must be carried, and the patient placed on them as laid down in the Stretcher Exercises."
N ever allow stretchers to be carried on the bearers' shoulders.
Always carry patient feet foremost, except when going up a hill. In cases of fractured thigh or frachued leg, if the patient bas to be carried down hill, carry the stretcher head first.
In carrying a patient on a stretcher care should be taken to avoid lifting the stretcher over walls, hedge', or ditches, but whel'e these cannot be avoided the stretcher must be carried in the following ways :-
To OROSS A DITCH.
The foot of the stretcher must be carried to about one pace from the edge of the ditch and lowered. NOR. 2 and 3 bearers must then jump into the ditch. and each take hold of one of the handles, No. 1 remaining at the head of the stretcher. When all are ready the stretcher is carried forward, and the foot carried to the other side
77
of the ditch, and the stretcher again lowered ; No 2 then iumps out of the ditch and J o. 1 jumps into it. Nos. 1 and 3 then take huld of the head of tbe stretcher and No.2 the foot, and the stretcher is slowly curried till the head is placed on the other side of the ditch. :ros. 1 and 3 then jump out of the ditch and take their ordinary places. If the ditch be a very broad one the stretcher must to the ..ide and lu\yered. l' 0::;. 2 and 3 j llll}.P mto the dItch and take hold of the handles and lift the it!'; heau reflt::; on the edge. ..... o. 1 thenjumps mto the dItch, o. 3 then gives the foot to 0, 2, and goes to the head with No.1, the .. tretcher is then carried furward and gradually lowered to the bottom of the ditch; to lift the stretcher out of the ditch proceed as if crossing a wall.
To ORO,'S A 'W·_UL.
The stretcher i::; lowered about one pace from the walL No::;.:2 and 3 bearer::; then take bold of the foot of the stretcher and TO. 1 the head; the stretcher is rai 'cd till the lower end is pla<.:ed on the \yall. No. 2 then jumps over the \yall and takes hold of the foot of the stretcher while os. 1 alld 3 support the head' tbe stretcher is then carrieu forward till the head rests on the wall, :ro. 2 supporting the foot. Nos. 1 and 3 then jump over the wall, and take hold of the head of the stretcher, which is then slowly lifted off the wall on to the ground, and the bearers take their u.:ual places.
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To LOAD A WAGGON.
The stretcher is carried to within one pace of the end of the waggon and lowered. Nos. 2 and 3 take hold of the foot of the stretcher, No.1 the head. The stretcher is then raised and carried forward till the fr?nt wh.ee1::> rest on the floor of the waggon. No.2 then Jump llltO the waggon, while No.3 goes to the head of the stretcher and helps No. 1. '1'he stretcher is then pushed slowly into the waggon. If the tail-board cannot shut, the stretcher must be lao hed firmly to the .lcles of the waggon.
To UNLOAD WAGGON.
Nos. 1 and 3 take hold of the head of the str?tcher, while No.2 gets into the waggon ; the stretcher IS then O'radually dra\vn out till the foot-wheels rest on the edge the waggon. No.2 jumps out of the waggon and \\'ith .r o. 3 takes hold of the foot of the stretcher, No. 1 supporting the head. The stretcher is then gently away one pace from the waggon and lowered. The bearers then fall in in their usual places. .
·When four bearers are attending to the patlent, Nos. 1 and 3 would lift the head of the stretcher, while Nos. 2 and 4 lift the foot.
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CHAPTER IX.
C,1HHYI G •'TllETCHETI•.
BY JUR. JOllN FURL1W.
HITHERTO the gi,'en to the Classes of the •'to John Ambulance As::;ociation, on the removal of Sick and Injured persons by stretchers or improvised methods of transport, has been founded on Hule' laid down in Profes 'o r Longmore's" Treati e on the Tran<;port of • ick and 'Vounded."
But it ha. he en amply proved that rules necessary for drilled and eli. cipiinetl bodies of men, such as the Army Hospital Corp.', are not apIJlicable to tho. 'e 'iyho undergo a brief training to enable them to give iir:-;t aid in the accidents of civil life. In the majority of ca 'es in which a certificated pupil is called upon to act, he ha.' to look for assistance from men who haye had no such instruction as he posses es, wherea.. eycry lllemher uf a military bearer company is drilled to work \\ ith other., an(l when three or foUl' of su ·h men hn,ye been nmllbered oIl', each know ' what is expectc(l of him.
The regular drill rCljuired for a bearer company in the army is therefore 1I0t the be::;t for a class of pupils of this As 'ociation, except in the ea e of a corps which may be callecl on to act with a 111 ilitary body.
On a parade ground or in a military ho.. pital there is generally plenty of space, and one system of lifting
80 and carrying invalids can be adopted, but the accidents which happen in civil life make it necessary that much should be left to the intelligence and experience 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 ll1Cl,chinery, or in the tortuous passages of a mine, it would be quite impossible to follow the directions given in the" Manual of Exerci e for Stretcher Bearers and Bearer Companie. ," but the stretcher must be put at the side of the patient or in any other position possible, and the bearers mu t act accordingly, under the direction of one of their party.
On this subject Professor Longmore has sai.d: "The military rules were framed for service in the open air, where there is, of course, plenty of space, but all such rules must be modified according to circumstances. It is well, I think, to teach the system which is thought to be best, and at the same time to prepare persons for doing that which is next best, when what may be best under other conditions ceases to be applicable."
For purposes of drill, numbering the bem'ers will be found useful, whenever three or four 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; but it must be repeated that in nearly all ordinary accidents, an efficient bearer will have to select his assistants without previous notice, and give
them his as briefly and clearly as he can. T.he most. Important. point is to understand the 2Jl ' inclples "\ hlch hCl,ve dlctated the rules laid dO'wn in the Exercises.
is not pretended that the following. 'tretchel' Excrclses 'wIll be found e<lual to every circumstance that may arise. For in .'tance, the placing of a stretcher in a road -cart ?r railway carriage must d epend on the shapc of the vehlclc, and pcrhaps on the ,\yidth of a door. It ",.ould. occupy too much space, and then, perhap.·, the chrectlOns would be found inad equate, were attempt made. to suggest plans for all cases. From personal ?xpet:lence-and '\"e arc duily assisting in the removCl,1 of lllvahds by road and rail - we are sati 'fied that tho e who take the trouble to attend the lecture and <lualify themsclyes for the certificate are fully able to meet diiliculties u they ari. e. In. 'tructor anll pupIls may, howeycr, be reminded that whenever necessary the .stl'ct.cilcl' iss ned by the As. ·ociation lllay be lesscnctl 111 wlclth without illconvcniem:e to a patient upon it.
STRETCHER EXERCISE. No. I.
For three Bearers. To be used when space will allow.
1. TilE In tt'uctor selects the Bearers and numbers them-I, 2, 3, at his eli cretion. hould one man be taller and stronger than the others, he should be tyled F
81
NO.1, as he will have to bear the heavier part of the burden.
AU orders will be given by IO. :3.*
2. "PLACE THE STRETCHER."
No.1 taking the head of the. tretcher, and No.2 lhe foot, place it in a linc with the Patient's body, the foot of the stretch er being close to his head.
o. 3 attends to the patient, assi. ted by IOS. 1 and 2 when necessary.
3. "FALL IN." At this order,
o. 1 places himself at the Patient's right side.
No. 2 at his left side, and both Bearers face each other.
No.3 takes po. ition on the injured side, in ;1, line with the Patient's knees.
-,-Yote.- The duty of No.3 will'be entirely to look after the injured part of the Patient's body or lim hs, to see that no bandages or splints become displaced, and also that No. 2 Bearer, in lifting or carrying, do es not in any way touch the Patient's feet.
,Vhen everything has been arranged for the removal of the Patient, the order will be given -
* Bearers should be taught to take any of the p08itions named in the following Exel'ci es, whether that of 1, 2, 3, or 4 Bearer. 3
4. " READY."
os. 1 and 2 now each sink clown on one knee and grasp eiteh other's lu"tnds uncler the .·houlden; and thighs of the Patient, whilst 0.:3 places his hands underneath the lower limb:4, always taking C<1re, in Clt,'e of a fmctlll'e to 1mve one haud on each side of the seat of injury. '
5. " LIFT."
j..ll three Dearers rise together to their feet, keeping the Patient in a horizontal po ition.
6. " MARCH."
jJl take hort side-pace,' until the Patiellt's head H::I over the pillow of the stretcher.
7. " HALT."
All three Dearers remain steady, and \\ ait for tLe next order.
8. " LOWER."
The Patient is placet1 gently on the stretcher alld the nearers then stand up. '
9. "FALL IN.'' On thi.,· order bein u giyen
o. 1 places himself at the head of tlw I'itrctc1ier with hi.. face to"wards the Patient, TO. 2 at the foot \\ ith his back to the Patien t, ant1 IIO . :3 places himself at the side of the Patient.
10. "READY."
Nos. 1 and :2 stoop clown and grasp the handles of the stretcher, havillg previou. ly adju 'ted their ..:houlderstrap in ca e they are u. ed.
F .2
82
No.3, as soon as he sees all is right gives the word11. "LIFT."
T he stretcher is now raised to position rendy for moving off, care being taken to keep the Patient's heac1 ftbove the level of bis feet .
12 . " MAROH. " On this wurd being given, No.1 steps off wilh the left foot, and TO. 2 ·with the right.
'rhe step should be a short one of twenty inches, nnd taken with bent knees j u t from the hips.
13. " HALT. "
The place of d esti nation being reached, on the word I( Halt" being given, the Bearers remain steady in position .
14. ' " LOWER. "
At this order the Hearers place the stretcher 011 the ground, and then stand up; care being taken to let the l\ltient's feet reach the ground hefore his head.
1 5 . " UNLOAD STRETO H ER- READY."
The Bearers prepare to take the Patient oft· the stretch er.
16. " LIFT. "
The Bearers raise Ui> the Patient as before instructell.
17. " LOWER. "
T he P atient is carefully lowered on to the vehicle, hed, or other place to which it bas been de!::igned to carry him.
STRETCHER EXERCISE , No. II.
For four Bearers. To be u sed when there is not Bufficient space for car rying out Exer cise No. 1.
1. T he Instructor the Rearers-], 2, 3,4.
1\,,11 orders will be given by o. 4.
2. " FALL IN. ''
At the ,,"orus "Fall in," X os. 1, 2, and 3 take po. ition on one side of the Patien t. No.1 places him. elf at the Patient's shou]ller, No.2 ncar the middle of the body, Xo. 3 ncar the Patient's feet. At the same time No. ,1 l)Llcc,' the ,'tretchcl' on the ground by the other ide of the Patient, about one pace alyay from him, and remains sLam1ing ncar its centre', facing the other Bearers.
3 . " READY. "
os. 1, 2, and 3 stoop dowll, and kneel on the left knee if they are on the left. ide of the P,ltient, on the right knee if they are on the right. ide of the P'Jtient. They then proceed to take hold of the Patient :-i\ o. 1 pas:-;ing one of his arms heneath the Patient s neek and the other under his. houlder-blade.' ; i\ o. 2 passing bot h nncler the middle of his hody, one abo \'e, tbe other below the buttocks; a1ll1 o. 3 p<ls!,)lng boLh anm; under the luwer extremities, e_'cepting in case of fracture, when he must place one band on each ..ide of the broken bone, o as to steady it. No. 4, when the word" Ready" is gi ven, should place hi111se]£ opposite No.2, stoop down.
85
6 and lock h.is hands with No.2 under the Patient's body. If t he PatIent be able to help, he should clasp his hands round the neck of No. 1.
4. "LIFT. "
On the wo rd" Lift" the Bearers rai e the Patient gently and rest him on their knee j as soon as he is securely rested, No. 4 runs round by the head of the stretcher it under the Patient, being careful that the pIllow IS Immediately under the Patient'/) heall j he then stoops do·wn and locks his hands with those of No. 2.
5. "LOWER. "
At word" Lower," Nos. 1, 2, and 3 carefully lower the PatIent down to the stretcher, while J o. c1 at illC same time assists in supporting and placing him Oll it.
6. "STAND TO STRETCHER. "
On this order being given, each Bearer stand- up:No .1 goes to the head of the stretcher, with his face towards . the Patient j No 2 to t he foot, with his back to the PatIent; while Nos. 3 and 4 relllain in position on each side of the stretcher.
7. " READY. "
Nos. 1 and 2 grasp the handles of the stretcher hnvin o. previously adjusted their shoulder-straps, in the; arc using them, -
8. " LIFT. "
At this word, Nos. 1 and 2 Dearer;:; raise the stretcher steadily together and stand up.
9 . " MAROH. "
All being ascertainell to be in order, on the worcl " " being given, No;:;. 1 and 2 Bearers move off:No.1 stepping off with his left foot and No. :2 with his ri"'ht foot. :x os. :3 and 4 march on each side of the tl arriving at the place of destination, the following orders arc successively given :-
10. " HAL T ."
11. "LOWER. "
12 . " UNLOAD STRET OHER- READ Y."
13 . " LI F T. "
14. " LOWE R ."
N.B.-The:,;e orders, viz., Nos. 10 to 14 inclusiye, are to be carried out in a .. imilar manner to os. 1:3 to 17 in Exercise No. 1.
STRET CHER EX ERCISE, No. III.
When only three Bearer:; rne available, and the space is limited as hcfore, the following alterations III n"it he made in the foregoing (r o. 2) Exercise.
1. The Instructor numbers the Benrers-l, 2, 3. All orders will be given by No.3 .
87
2. "PLACE STRETCHER."
N o. 1 Bearer places the stretch er on th e ground by t he side of the Patient, and as close to him as practicable
3. "FALL IN."
The t hree Bearers take t he same positions on one side of the Patient as laid down in Exercise No. 2.
4. " READY. "
Nos. 1, 2, and 3 kneel down, placing themselves as close to the Patient as they conveniently can, and then take hold of him as directed in Exercise No . 2.
5. " LIFT. "
Nos. 1, 2, and 3 raise the Patient as directed 111 Exercise No. 2.
6. " LOWER. "
At the word" Lower," No . 1, 2, and 3 lean forwar(l so as to carry the Patient over the stretcher, and then carefully lower him down upon i t .
7. " STAND TO STRETCHER. "
At this direction No . 1 goes to the head of the stretcher, No. 2 to the foot, and No . 3 remains ill position at the side of the stretcher.
The remainder of this Exercise will be precisely the same as is given in Exercise o. 2, from orders 7 to l-!, both included-the instruction for No . 4 Bearer to walk by the side of the stretcher being alone omitted,.
STRETCHER EXERCISE , No. IV.
For use in Mines and narrow Cu ttings, where two men only . can be engaged.
Necessary 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 sb'etcher being, if possible, * close to hi..; head.
No. 1 'will give the word" Ready," when both get into position a' follows :-
No.1 places his feet one on each ide of the Patient hetween hi, bo 1y and arms, the toe of each foot as near the armpits as possible, standing over the man. He then RtoOp. down and passes his hand between the .'ides of tho che t and the arm underneath the shoulders, and locks the fingers.
If the Patient'.. arms be uninjured he may put them round the neck of No.1, and by thi" means greatly a si t him in lifting.
1\'0. 2 at the same time places his right foot between the calves of the injured mall'S legs, as close to the knees as po'sib1e, and his left foot at the injured man" right side, clo!:le to the Cl'e..;t of the hip; t he tben kneels clown and passes his arms round the outside of the Patient's
* It if; l1(1t arlYisable t(l he too particular ns to tho head 01' foot (If a stretcher in a mine, as it would probably be qnite to reverse it, amI it is always computent for tho to 10wcI: the pillow.
t Whcn thc Paticnt's legs nrc in spltnts fintl tied together, the feet I'll .TO. 2 must necessarily be placed outside.
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89
90 thighs at the lowest part, and locks his fingers behind just at the bend of the knees.
'When both are ready, No. 1 will give the order, "Lift and move forward." The Patient ii) then to be lowly lifted ju't sufficient to allow his body to clear the. tretcher. Both Bearers will slowly and grauually move forward, No. 1 by very short step., and No. 2 by bending his body forward over his left thigh, by which meaw he exercise, a pushing movement which very greatly assi ts No. 1. No. 2, when he has bent his bo(ly fonml'd as much a. he can without moving his feet, advances his right foot to his left, then again ad Yances his left foot, and bend his body forward. This movement is to be repeated until the Patient is laid on the stretcher.
The Bearers will then act in the ordinary m.Lllllel', as far a the nature of the lo cality will permit.
CHAPTER X.
By E. :1fACDowEL COSGRAVE, M.D., F.RC.P r.
PREP FOR RECEPTION OF ACCIDENT CA E, .
VVIIEN news of an accident comes, preparatiollFl should R.t once be made so as to have everything renay before the injured person is brought in. Of course the preparations needful will vary according to the nature and extent of the injury, but the following are the chief things which may have to be done. 91
CHOICE PREP AR.\"TIO OF ROUM.
:.\. room mu t be choRen. In a bad case this should he one easily reached, as it is difficult to carry an injured per,'on through narrow pas,·age. and up stairs. nle s there i,' some such reason again<;t it, the injured person's own room i ' he. ·t .
The way to the room mu. t be cleared, projecting furniture and loose mats in the hall or in lobhies should he removed. If the injured per 'on is carried on a door or shutter, or even on a ,tretcher, a couple of strong kitchen chairs shoul(l be lllaced ready to support it, "\, hel'ever the bearers would be likely to require rest. 1. !'lele"s furniture should he remoyed from the hedroom. The bed .. hould ue drawn out from the \\-all so that 110th sitles can be approached and the clotbes t lll'J1ccl back to one sille to their full length. ..(\ hot hnttle should he got ready. If there is much collapse several hot bottle and hot blanket may be required j ('over the hot bottle with flannel.
If the injury i· very severe, if mud-stained clothes have to be remo,Tcd, or if exten. ive dressings Lase to be applicl1, it may be nece.. sary to have another heel, a couch , 01' a table placed near the bed to lay the sufrerer on in the iir:)t Thi:-l r-;houhl he so arranged that. oiling may do no harm; old sheets, "\Yaterproof material thin oildoths, or even nmvspaper, may he used QS a protection.
9:2
LIFTING A:t-.'TI CARRYI G.
If present at the pln.ce where the accident occurred, it will be nece sary to see that the patient is carefully lifted after propel' " Fir t Aid" has been rendered.
The following rules should be remembered :-Sclect the proper number of per ons to assist, and do not let them lift the patient until they thoroughly understand how they n,re to do it.
For ordinary case, where the injured per on has to be lifted a very short distance, three helpers are sufiicien t. Two (who hould be as far as possible of equn,l height) are to bear the weight, the third is to support and tn,ke charge of the injured part. This is be::;t clone hy a person who has been through a " First Aicl " cour 'e.
lf the injured person is insensible, another helper should support his head.
The lifters, one at each side, should kneel on one knee, and pass their hands under the patient'. back at the lower part of the shoulder-blades, and under the hips, clasping each his right hand in the other's left. The injured patient should, if practica1Jle, place his arms round the necks of the bearers.
The third helper should attend to the seat of injury j if this is a fractured limb, he . houlcl support it hy placing the palms of his hancls under the limb, one above and one below the seat of the injury, grasping it firmly but avoiding unnecessary pressure.
93
The helpers should remain thus until the order " Lift" is given, and then they should all lift slowly and 'teaclily, avoiding jars, attempts to change position of hnmIs, &c.
If the injured per::lon is to be placed on a stretcher or shutter. this. 'hould be previously placed" ith the bottom end at his heall; the bearers should then move, one at each side of it, until the l)atient is over it. The word , Lower" should then be giYen, and the injured per.. on should then be slowly lowered. A pillow or folded-up coat should be ready, and as the sufferer is lowered, this should be lllaced under his head. *
MEAN.' OF CAIlRYIXG.
a streteher, and substitute. sueh a' a gate, a shutter, or a door, other means of carrying C,ln be illl}lrovi. ed.
In . light injul'ie:;, where the injured person i;:, una1le to walk, t,,·o bearer:; can carry him by forming a foUl'IHl.lltle(l, three-h'1l1!lml, or two-hal1Llel1 ::;C,lt.
A four-ham1et1 seat i::; thus f01'1ncl1: To the helpers they are lle::;ignatecl A anel B. Eaeh helper grtlsp::i 'with his left lw.l1l1 the 'wrif't of his right hancl j A the]) gra::ll1 ' with his right hand the left wrist of 13, ,,,!Jil.t D with hi. right han 1 gra. ps the left wri,t of A. Thus a . quare seat i macle. (li'ig. 33.) The helper stoop
*' Fullllirections fire given in Ohaptel LT.
94 down, the injured person sits on the banch;, ancl places his arms on the shoulders or round the necks of the helpers, wbo then rise. The he111ers mn. t advance sillewards, very slowly and keeping in step.
A three-handed scat is thus made :-A grasps his right wri. t with his left hand, \yith his right hanel he grasps B's right wrist, and B's right hand grasps .A's left wrist. B then places hi· left hand on the right shonlller of A, and a seat with a back to support tbe injured person is made.
A single helper can lift by supporting with one arm the two knees, and with the other the back. The arms must be passed wel] under before commencing to lift.
A single helper can give support by putting his right arm round the wai t, gra ping the right hips alldlllacing the injured person's left arm round his own neck, holding the left hand with his own left hand.
A capital stretcher can be improvised out of a strong sheet and two broom handles or other short pole,'. Each side of the sheet is wound up on a broom handle until there is just room for a person to lie between. This requires four bearers, two at each side, to prevent the sheet slipping.
CARRYIr G UP TAIRS.
In carrying a· stretcher up ·tairs the head -houlll go first, and an extra helper should assi.. t at the lower end
so as to raise it and keep the stretcher nearly horizontal.
The two, three, or four-handed scat may lJe used for carrying up stairs; or a strong chair, the patient being c!lrricd up backwards. In the latter casc olle heillcr shoulll ,,,alk after the chair and help to support it, and to preyent the injured per<;on slipping out.
LIFTlxn I:XTO nED.
If the hed i:-; narrow fI nd there i.. roOUl the .trctcher Hlwuld be placed on tbe floor with tbe head ('10:-;e lo the foot of the heel. The injured person should then he lifted over the foot and placed on the bed. If the bed is too wiele to admit of this, the .. tretcher ..hould be 111nced it, and two helpers should stand at the far side of the F;trctcher. One helper 1>a ses one ann beneath the shoulders and one beneath the middle of the bark, tbe other helper placing his uncler the lower part of the hack flud under the knee _ The injured per::;Oll is til n lifted, another helper }lulls away the stretcher, and after a single step forward the burden is placed on the beel.
PREP AIL\, TION OF BED.
A finn maltre:-;.·, not a feather hed, -hould be selected. If there i much injury, or if dressing.· have to be applied, a draw- heet ought to be placed on the bed. It -bould be of four or more tbickne", e , extend aero the bed,
95
96 and reach from the middle of the patient's back to the knees. A piece of waterproof sheeting or of thin oilcloth should be placed under the draw-sheet. As the draw-sheet becomes soiled, the soiled portion should be rolled up and a clean part drawn smoothly lUuler the patient.
Jn fracture of the leg or thigh, sprained ankle, and some other cases, a "cradle" hould be improvised. The use of a "cradle" is to sUP110rt the bed-clothe and keep them from pressing on the limb. Bandboxos, threelegged stools, and similar articles may be u eel. A corkscrew passed through the bed-clothes with it.' point guarded by a cork, and tied by string to the bed or a nail in the wall, will relieve the pres. ure of the bed· clothes effectually.
REMOVING TIlE CLOTHE..
In taking clothes off an injured person a few rules should be borne in mind.
In serious cases it is much better to SHeri lieu tbe clothes than to run any risk of increasing the injury.
In removing a coat, &c., in a case of fractured arlll, the uninjured arm should be drawn out first.
In putting on anything the injured arm should be put in first.
In burns and scalds nothing should ever be dragged off. A shaltp pair of scissors should be use<;l, and every·
thing nO.t adhering should be cut awny. If anything adheres It should be left until medical aid can be obtained. clothing adhering may, with advanLn ...;e, be ".1[h oil. To remove the trousers from a se\'el'ely ll1Jured lanb, the outsielf' seam should be ripped up.
TIONS FOR S
As soon as the injured person has been attel1lL:cl to preparation should be made for the surgeon's yisit.
The preparations needful willllellel1l1 upon the nature of the case. The follmying hints lllay he of 11. 'e :-
A fire in the room will generally l)e of serviee even in SUllllll cr. There be plent.y of ,Yater, 10th llOt nnd collI, 0.1'0 several basins, plenty of clean towoL, and cioap. T'uere shoultl be something to empty "ate!' illto . a foot-bath docs well The ba 'in ' should be placed on table, with a cl ean white cloth; a large towel makes a s1lltable cloth; the to\yels, fuldell up, should be placed on the same table, anJ the hot a11tl eo1(1 \\',lter should be within eil:") rench. The foot -balh ::;houlJ 10 ullder the table or close at hand.
In the case of a lJurn, cutton wuddin" soft cloths olll linen, oil, ilour, bread, and of (baking soda), should be ready, auJ material:; .11OUkl be tOl'll up for If a chemi::;t's shop is within roaeh, carron 011 and plenty of cotton wool sholllJ \)1' sent for.
G
97
In the case of hremorrhage, sponges, plenty of water, and at least two basins should be ready.
In the case of a person rescued from drowning the sheets should be taken off the bed, plenty of blankets should be heated before the fire, and several hot bottles should be ready.
If poultices are likely to be required, boiling water, lin seed-meal, mustard, a loaf of stale bread, a small basin, a large spoon, sweet oil, and tow, flannel or handkerchiefs may be required.
For fomentation, have boiling water, flannel, a kitchen roUer, and two sticks, or a large toweL
'Yhen summoning a medical man to an accident always let him know what kind of case he is required to treat, so that he may bring whatever is needful. J1y this llleans vnluable time may be saved.
INDEX.
11
.Acicls, P?iSl1uing hy, .').)
.\.(ldcr bItes, ,}3
...\lcoII.ol, poisolling hy, .-,0 " ".-).')
Ammals, bite of, .}2 . \poplcxy 1G Arche in foot, 1.} Arm ' , 14
\'rm -sling, mall, 70
)) " large, 6n .fracture of, 38
. \.rtene , 1
Artery, brachial, 2 " face of, 30 femoral, 31 ll('atl of, 30 lips of, :n sllb-eltniall. :30
., telTlporal.;31
., pulHatioll ill .)0)
. \r ierial lJlcel1illg, " .J'. treatmcllt of, _b
respiratioll, ;}R
.A uncles, 20
,'Ol'JO:T 13
]jcarers, for stretcher, 8!J " 3" 81 , " ..4 '! " 83 Led, hftlllg l1lto, !);) ", ],Ites of <l.11111lals, .,)2 nlecding from arm , " armlnt,30 foot, 31 " fore -arm, heau, 31 ., leg, J1 no 'e , :?(j " l'nlm, '27 " "thilTh 3» Bloot1, II of, 17 0
IIJll'lI1'1', :?l
" }lUl'C, I J
DUlle, I mlOcl! , 1.')
" cullar, 1-1
" shill, 1·3
" thigh, 1.3 DOllll, hroken, 33 "
Rraclual artery, 28
98
Brain, compressicn of, 48 " of,
r r<!atbing, stertorous,
Burn., !'I3
CAPILURIUI, 18
Capillary bleeding, " "treatment, 25
Cal bolic aeill poiEOning, 56
Carl onic acid, 21
Carryiug ratients, 71
Cal tiJage, 15
CelYieal vertebuB, 13
Chest, 13
Uhoking,62
Circulation, organs of, 17
Clavicle, 14
Clotbes, removing, 96
Coat stretcher, 74
Collar-bone, 14
Comminuted fracture, 3:)
Complicated " 33
Compound " 33
Com pre sion of brain, 48
Concussion" 48
(Jonl, spinal, 13
Crepitation, 34
Cuts, 43
DLIGUAM 01<' HEART, 10
Diaphragm, 21 _
Dislocation, signs of, 30 " treatment, 35
Distortion in fractures, 34
Dorsal \'crtehn', 1:3
Dress on fire, what to (10, ;34
Drowning, 58
Drunkennesll, 50
E.\H, FOREIGN nOllY IX, ':)7
Ela tic Bamlagc Tourni(l1.lCt, 27
Epilep. y, -17
Esmarch' ban(lagc, G-1
Expiration, 28
Eye, forcign bally in, ;,7
FAINTING, 4n
Falling , 47
Femoral artery, :n
Femur, 1;-)
Fibula. 13
Finger, hones in, 1-1
Foot, 15
Foreign body in eye, :'17
}'our-hantlc<l Hcat, 71
}'racturcs, :3:3
}'racture of arm, 38 collar-hollc, :)7 " forcarm, " fingers, " " j:\W,,)u knee -cap, -1:3 " leg, 43 " rihH, 3D ., skull, 33 ., spine, 4H ., "thigh, 40
Fractulc. signs of, 3 1
Fm'}Lul'c, commillute.l, complicatc(l, :}:3
cOll\poullll. 3:{ simple. 3:3 ,. (liRtUl'tio:l ill, :H
Fl'o'lthite, 54
Por OXING BY, 03
25 " H:wging, arterial, 2G capillary, 2;)
] laullchbollC, 13 lIea(l, 12
" injurics to, 4
Heart, l' (liitgram of, III .'ouml,; of, " yal '-cOl of, III
Hinge-joint. l.i
1I umerus, " fracture of, 3
Hy terical fits, 51
brpURE BLoon, 21
Insensibility, Cal.lHC of, 4fj
» examina.tiun ill, 1'j
Inspiration, 23
Intoxication, ,')u
.TAW, 12 fracturr of. 30
]UI
.Joint, ].)
cartilagc in, 1:5 lubrication of, I.') kiwls of, 1,)
K:->EE-CAP,15
POrKOi\L\,G,1 I Leg, 13
, fracturll of, 42
Lumbar 13
Lung ,22
1\(IIlRH'F,21
Muscles, IG at rest, 17 ill actioll, 17 structurc of, 17 of. 17
.I. ERIF.S, :lIOTOR, " sensory, :3
" sympathetic, 24 Xo e bleeding, 26
OPIUM POI:-lONI 'G, 51
Oxalic acid ,Poisoning, 5G
Organs of cU'cula,tion, 17
" respiration, 21
Oxygen, 2-1
P.A.TN IN FR.WTURE, 34 Palm, bones ill, 14
100
rick-a-back carrying, 74
l'oisoning by acids, 55
" alcohol, 50
" alkalies, 5."5
" carbolic acid, !iG
" gas, 63
" opium, 51
" " oxalic acid, 56
Phosphorus, 56
Preparation for surgeon, H7
Pulsation in arteries, 22
Pure blood, 21
RABID ANIMALS, BITES 01<', f>2
Radius, 14
" fracture of, 38
Respiration, 21 artificial, 5
nibs, 'i3 organs of, 21
" fracture of, 39
Room, choice of, m
SACK-ST HETCHEH, 7f)
Scalds, 53 13
Seat, 2-handt:d, 72
" 4-handed, 71
Shin-bone, If)
Shoulder-blade, 13
I'igns of dislocation, fracture, 34
" insensibility, 46
i::limple fracture, 33
Skeleton, 11 12
102
Sling for arm, 70
Snake bites, 53
Sound of heart, 21
pecial fractures, 3f)
Spinal cord, 13
, pine, 12
.'plints, temporary, 43
•'prains, 45
•'tretchers, 79
" temporary, 75
·'nb-clavian artcry, 30
• ufi'ocation, 63
• unstrokc, 55
TRilIPORA.RY SPLINTH, 4i{
'l'el1l10n, use of, 17
rrhigh-bone, 15
" fracture of, 40
Thorax, 13
Tibia, 15
" fracture of, 42
Tobacco, use of, dangerous ill bleeding, 32
TOlU'niquet, temporary, 2G
Trachea, 22
Triangular hall(1agc, G-t broad, [j;-)
" llarrow, G::i
" for back, 71
" " cheek, Gli
., " chest, 71
" " eye, GG foot, liD forehead, Gfi
" " hal1(1,68
" " hip,(i7
" " RcaIL), (j;)
Triangular bandage for shoulder, 66
TnUlk,11
Two-handCl1 Reat, '/2
1 LX \, 1-1
r<;c of hloo(1, 1'1
\T ALyE,' Db' HE,\nT, 1!1
\Taricose veill. , 2:)
Yein .1, '
Yl'IlOUS bleeding,
Ventilation, 24
Ventricles, 2U
Vertebral column, 1:2
Vertelmc, cervical, 18 (101'sal, l:l Illmh;n, 1:{
TO LO\J), I '
" unload,
IYhat to 110 Wlt\'ll
c,ltclies fire. :-,i
I\-in(l -pipe, \\Taun!1 "
I\Trist, 1 i
J\.tnhulanct J\.zzoriafintt
<S T O R ES D EFA RT MENT>_
General Price List.
As hford Litters. -Consi. ting of a foluing stretcher coyer on a two-wheeleu un(1er carriage, fitte(l wIth ellJptlcal springs. Any impro\'etl Furley sUl.'plietl h) the .\ ssociatioll can be use!l wIth the same uncler canwgt'. PI
Lowmoor J a cke t.-For securing fL patient on a , trctcher, £ s. d. which can then be placed in all upright 1:; (J
Horse Amb ulance Carriag es.- Full particu lars, estimates (which vary from £;')0 to £HiO), antI list of placet! supplie!l, can be obtaincd on application.
Ambula nce Hamper s. "W ith \\Taterproof 'overs an!1 ,'traps. ,'mall, c\llltnining one .'ct of splints; ol1e tuurllJqud; tlll"er t:JllljlOllS; two packet.' of patent lint: fOlll' roller balldages (wille all11 nalTo\\,); fonr triangnlar ballllnges; cotton wool. Ill.trine lint. patl!nt pbi. tel', in till cases: knifl', sci. SOl'S, thn'ad. lIeedle,s, pins, &c., &c., A:c. , ' -eight-, cOll1plete.
1 ft. (j in.; depth, .i in .. wi!Hh, I in. Suitnhlc for usc in factories, collieries, mincs, ra ilway statiolls, :;hipbuil!lil1g y:tnls, and for yoltmteer corps, c c., a' well as for domestic usc
Cover with Hegulatioll Pulice. tl'etcber :lnt1
Cover
Coyer alone alone . with Ordinary Stretcher amI Coyer with Military " " with Telescopic-hanuled Stretcher ant1
hoo(l antl apron , ' Ta terl'l'oof sheet.
I ndia-rubber tyres to wbeels, extra Stretchers (Furley improyed pattern) :-
Ordinary, fitted with self-raising pillow
Ditto fitteu with telescopic hanules, by means of which thd l ength can be reduced from 8 feet to G fpet . lJIilitm 'Y, exact size of army regulation path'rll, recommended for use of the ambula.nce brigaLle .
P ulice , very strong, and provided with straps
Cover for Stret cher
Spar e Bed for do.
Army Rug, to covel' patient 011 :;tretcher Superi or Rug, fitte!l with air-cushion, for me on stretcher or when tra yelling
Large, with a much more complete outfit
Loring's Patent Ambulance Kit
Bandages.-Plain triangular . per
Holler (:31 in. <1 yds. long and 3 in. (j ytls. long) "
Il1ustrated triangular (after Esmarch), 1-1 applications of the triangular bandage, with printe,l
0 instructions, en.ch (id. per doz. 0
Hawlage rolling l!lachine, imaluahle to Xur ing 0
Tourniquets.-Esmarch 's Ela
'l'oul'Ili1luet Braces, for use as ordinary braces, or a all clastic bml'lli(luct.
Splints, wooth'n cane
Co t ton wo ol Lint . l'l!l' get 0
Plai ·tel', all tiseptic (he sing", amI all kind .. of ,lge . prices 011 aPlllica tion .
t R. d.
ic(s.
I) ii Ii 11 0 0 11 !i 0 11 ] 0 0 ] 0 O};; 0 10 0 o 10 fj 1 10 0 2 10 0 2 .) 0 0 o 1.i II U 10 (j o :-, (i :; II
1 11 G Ii (j 0 1 16 0
dUl. o '* (j
o
tic 0 Field 0
o
o
o
pel' lb. 0
6 Ii 6 0 G U (j 1 !) :3 0 h:uHI-
Books. -" :First Aill to the Injmel1." By thc late. 'urgeon-Major Petcr Shcpherd; Hevised by Rohert Brucc, 1\I.RC.S. The au thorisell tox t-book for thc First Aid Course. Is.; by po t, 1" 1<1.
Ditto, ,\Tel'h Ellition, sallle priee.
"Hints and Helps for llomc :NUl' ing ;llJcI Hygiene. " ny E. MacDowcl Cosgr:lYC, 1\[, D. The authorised text-book for the Nlll'sing Course. 1s. ; by post, Is . 2tl .
"Questions amI Answcr upon Ambulance 1\"ork." By John , Yo 1\I;lrtin, M . D., of Sh Hielll, amI John Martin, F.R '.1 ' . E,l., of HUthlersfieltl. Is . ; hy post, 1. . ILl.
"Questions allt!.Answers upon Nursing." By John IY. III:u,tiJl, M.D . 1. lid.; by po. t, Is. 8tl.
"First Aid to the Injurcd (Fiye Ambulance Lecture!')." By Prof. Frcrlerich ESlDarch. Tran lated hOlD the Genna!1 by H.RH. 1'rince s Christian. 2s.; hy post, 2s. 2<1.
"Elemelltury Banllaging ant! Surgical Dressing." 13y " "alter 1'yc, F . H. C. ' . 2s.; hy post 2s. It!.
8pecimcn Examination Papers, First Aitl aJHl COlln,e, 3t1.; by post, -111.
Diagra ms.-Large (for lecturers' usc), the H liman .'ke1etoll, the Arterial nnd Yellous ystem, the Heart allfl Circulatiou of the Blood, Fractm'es ( imple and Compound), and Dislocations Printed in colours. Per set of SL\, 151:'.
Smail, showing the main arteries ana points where preSSlU'e should be applied to arret bleeding. 2t1.; by post" 3d.
Aide Mem oire.-On canlboanl, in linen-linell em'elope, for the pocket. By the late Surgeon·l\l:1jor P. :-:hephel'l1. Containing useful hints for First Ait! to the InjlU't·ll. by post, c[ll.
Nursing Cha rts , rlesignetl hy :;\ [iHS 11l,lelll ick, :llld 'l\:l11j1l'ratnre l'ltnrbl, in sets containing seven of eaell. I'eI' Ud . ; hy post, 71l . ,£ '. d.
Registers. -Class Attendance and Certificate (two to set) 0 Ii 0
Case Report . 0 1 0
Ice-Ball (Rudel's), with line complete, for usc ill icc accidents . II 10 (j
Arm Badges, with the rl c \'ice, ullIIcr thc authority of the Ccntral };',ccnt;ve COll1mittee, havil.g ]'e(,l1 first approve,l hy H.1UL the (il,IIlIl 1'rior ns tlle snic ollieial all<l 1"eco"lIiscll ll;tclg-e of tlIc j\. "l'oei:n ion awl J:rignd('. 0 '0. 1. for the of illdi\'idua l C(;l tificate(l pupils- .£ s. d. lll(;erlllan:-';ilver. . . . " 0 0 n
In Electro] 'late 0
JIl Cloth :lll,1 :-.;ilk .
In Cloth alld •'iln'l' . . . . . .
Xo. for of tilt' St..Tol·n Amlmlancc llrigac1(" haling the l1:une of tIle eor!,s HllIlexL'd on a laIJl·l; ollly issuell ill fjuantltlCS -
In Uelln:lll Sih'cr, first ,loz.. £1 ; .11hse([ucn t dozs.,
Tn Electro J'Lttl', tir:<t duz., ,tt subseljuent Ilozs., t14s.
In Cloth <In,l :-;ilk, pcr ,luz., I:?
In (,luth nne! :-;ih'el', per flo7.., -1::110 . :-';p,'cial (luOt:J.tio11S for large quantities.
Electrotypes of aho\'c (l(>\'icc- £ s. d. !'llllnll, for :-;tltilJllel'r al\(l Circulars 0 1 0
Large, for Pus tel's . 0 1 ()
Flags bearillg the abovc feet hI' Ii feet
ii feet h) feet
Bo.·es of Stationery for the use of :-;lcrd:uit,. :111,1 otllers
COIlIlI'ct, 1 with tht' .\sslIciatiol1. t\I't·he shee'hi of lli;h-da",.. papl.'l', f:llifal>ly hencll"1, a 1111 , b\eh'e CJ1\'elupcs ,h:'a.l"lllg the of A....ol;iatioll. l'liec lid.; by pust, !h1. I wlce nut IIllal1tlty, pncc 1;:.; by llo.'t, Is.
n-Iedallions, in accol'llance with 51'ccial for which st'll lcallet ;\0. to be ha,l fill al'P1icatioll.
Bronze, . 'iller, IS. (jd.; Golel £2 lOs.' inchlllil1g' en;ra\'i11g namc anll register lluinber 011 iJ;tck. 1\lo1'oCCO ,e1 "ct-lillct! case. . 2s.
All o/'d(}'i! fO/' :;{Ol'CIJ should 1,( (lirc!! to the Local "- ('I'l'clm'p, 0/' the • {rll'CS DCI/urt/llcnt, St. .Johll Ambulance Ass ociatlOll, "- t. .1 oil 1I'1i aait, Cit l'/.:ulIl"cll, E. C.
Small Pocket Certificates, fo1(lill0' in two aJHl bound in lIlorocco price (jd. paeh (lly post /11.), be obtaincll by C'cl"titicatc,l J'upils from the. 'l'cl'etary on application throl1"h the Local 'pcretarie' of l'entrcs or Deta hl'llCl:'\. Sl'S. 0
2 0
0 0
n
0 2
()
1 7 (j
0 U
(j
