First Aid Journal 1943 - 1944 by Museum of the Order of St John

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Journal Jw rljc Ambulance attd pursing ^mrioss No 589, Vol. L ]

JULY, 1943.

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By Lt.-Com. F. A. M. EDEN, R.N. 2s., by post 2s. 2d. Instructor, Ministry of Home Security School, York

CIVIL DEFENCE: •

A BASIC TRAINING M ANUAL SECOND

EDITION

•

“ It not only brings together under one cover th e information contained in five o r six handbooks, but it includes also details difficult to get at present o th er than from a visit to a Home Security School.” — British Red Cross Society, C ounty of London Bulletin.

J O R D A N & S O N S , L IM IT E D , 116 C H A N C E R Y L A N E , L O N D O N , W .C .2 .

BIOLOGICAL M B I 3 PREPARATIONS A

T I P

areSfSi

I N

O n e o r o t h e r o r all o f the three races o f g e r m s , S t r e p t o c o c c i, S t a p h y lo c o c c i a n d B. p y o c y a n e u s a re f o u n d in e v e r y s k in in fe c t io n c o m m o n to this c o u n t r y , a nd A N T I P E O L O I N T M E N T co n tain s the antibodies (an tivirus) o f these g e r m s . H e a l i n g is e x p e d it e d b y the p r o v e d in gre d ie n ts o f the o in t m e n t , and se ptic d e v e l o p m e n t is s t o p p e d o r p r e v e n t e d b y its a n t iv ir u s ste rile v a c c in e fil trates. A N T I P E O L O I N T M E N T is u nsu rp ass ed f o r B U R N S a n d S C A L D S , f o r it is m ic r o b ic id e a n d n on -a d h e siv e , and d r e s s in g s d o n o t r e q u ir e to be c h a n g e d e v e r y d a y . W O U N D S , B U R N S , etc., W I L L N O T T U R N S E P T I C i f tre at ed w i t h A N T I P E O L O I N T M E N T .

- A

I P

is a sem i-fluid o in t m e n t , m o r e c o n v e n ie n t than the o r d in a r y A n t i p e o l o in t m e n t f o r o c u la r in fe ct io n s a n d lesion s. E y e s affected b y s m o k e and d us t are s o o t h e d a lm o s t im m e d ia te ly b y the appli ca tio n o f O p h t h a l m o - A n t i p e o l , and the a n t iv iru s p r e v e n t s g e r m s f r o m d e v e lo p i n g ,

I N

- A

T I P E O

affords rapid re lie f o f C O M M O N C O L D S , I N F L U E N Z A , A N D C A T A R R H . C o n t a i n i n g the a n tib od ie s o f the g e r m s c o m m o n to infections o f the n o se and p h a r y n x (Staph ly lo co cci, S tre p to co cci, B . p y o c y a n e u s , p n e u m o c o c c i , p n e u m o b a c illi, e n t e r o c o c c i , M . cata rr h alis , B. Pfeiffer), R h i n o - A n t i p e o l is n o t just a pa llia tiv e, b u t is a r e m o v e r o f the couse o f the in fe ctio n . D u r i n g e p id e m ic s it is the ideal p r e v e n ti v e o f m i c r o b e d e v e lo p m e n t.

C lin ic a l S a m p le , o n r e q u e .t fr o m

M E D IC O - B IO L O G IC A L L A B O R A T O R IE S

L T D ., C arg ree n

Road

So u th

N o rw o o d , Lo ndon, S .E JS

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rbeAmbulance atib SRursing perukes Editor : WALTER SCOTT, J U L Y ,

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Q u i c k T r e a t m e n t for B u r n s

A U n iv e rsa l F irst A id Sp lin t

R ev iew s

B ritish R e d C r o ss S o cie ty

L e tte rs to th e E d ito r

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( C o n clu d e d from p a g e

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H o s p i t a l . — ( C o n tin u e d .)

T r a n s f u s i o n a s a m e a n s o f life s a v i n g , b o t h fr o m s h o c k a n d fro m h a e m o r r h a g e , h a s pro ved to be th e m e a n s by w h ic h m a n y a c a s u a lty w h ich o th e r w ise w o u ld h a v e been co n sid ered h o p eless h a v e been sa ved , a n d fe w th in g s a re m o r e d r a m a t i c t h a n to w a t c h th e h e a l t h y c o lo u r r e t u r n i n g to th e d e a d w h ite fa c e of th e p a tie n t a s th e n e w blood p a sse s in to th e v ein s. B y su ch m ea n s th en y o u r pa tien t w ill h a v e been b r o u g h t t h r o u g h th e p h a s e of im m e d ia te d a n g e r , a n d w ill n o w be re a d y for operation . I h a v e a l r e a d y s t r e s s e d t h e n e e d f o r s p e e d in t h e c a s e o f a b d o m i n a l i n j u r i e s a n d c e r e b r a l c o m p r e s s i o n , b u t it e x i s t s , t h o u g h t o a m u c h l e s s e x t e n t , in a l l w o u n d s . M a n y p eople h a v e th e im p re ssio n th at a w o u n d p ro d u ced b y h i g h e x p l o s i v e is e i t h e r s e w n u p a t o n c e o r , if l e f t a l o n e , w ill heal v ery rapid ly. T h e p o s i t i o n is v e r y m u c h m o r e c o m p l i c a t e d . For a l l p r a c t i c a l p u r p o s e s , e v e r y w o u n d c a u s e d in w a r i s c o n t a m i n a t e d — -t h a t is, i n f e c t e d — b y t h e p r o j e c t i l e w h i c h c a r r i e s w i t h it in to th e t is s u e s f r a g m e n t s ot c l o t h i n g , e q u ip m e n t a n d sk in . A ll these fr a g m e n ts h ave upon th em la rg e n u m bers of b acte ria , so m e of w h ic h m a y be of e x tr e m e v iru len ce. N o t o n ly a r e th e y c a rrie d d ee p into th e w o u n d , b u t th e fo rce e xe rcise d b y the b o m b fr a g m e n t d evitalises a n d k i l l s a l l t h e t i s s u e s w i t h w h i c h it c o m e s i n t o c o n t a c t . Y o u m u st pictu re, th erefo re, e v e ry in ch of th e w o u n d , w h e t h e r it b e a t h r o u g h a n d t h r o u g h o r a n o p e n l a c e r a t i o n , a s c o v e r e d w i t h d e b r i s o f a l l s o r t s a n d i m m e n s e m a s s e s of bacteria . T h e la tte r te n d to flo urish e x c e e d in g ly sin ce t h e y a r e in i d e a l c i r c u m s t a n c e s t o f a v o u r g r o w t h s u r r o u n d e d in m o i s t w a r m d e v i t a l i s e d t i s s u e s t o o d a m a g e d t o r e s i s t them . It is, h o w e v e r , n o w k n o w n t h a t a d efin ite la t e n t perio d o f t im e e la p s e s b e fo re th e h e a lt h y tissu e s s u r r o u n d in g t h e w o u n d t h e m s e l v e s b e c o m e i n v a d e d , a n d if, b y t h e c o o r d i n a t e d w o r k o f t h o s e in t h e f ie ld , t h e c a s u a l t y c a n r e a c h t h e s u r g e o n ’ s h a n d in a fit c o n d i t i o n t o b e o p e r a t e d u p o n befo re t h a t p erio d h a s p a ssed , in fin itely b etter resu lts c a n b e o b ta in e d a n d th e g r e a t e s t d a n g e r of blood p o is o n in g a vo id ed . D u r i n g th e la st w a r a v e r y l a r g e n u m b e r of m en w e r e lost a s a re s u lt of w o u n d s w h ic h b e c a m e g r o s s ly septic, a n d a lt h o u g h , t o w a r d s th e en d of the w a r, m o rta lity f r o m t h e s e c a u s e s w a s b e i n g c o n s i d e r a b l y r e d u c e d , it w a s l a r g e l y in S p a in th a t th e p r e s e n t m e th o d of w o u n d s u r g e r y w a s perfected.

R I D It w a s v ery so o n foun d th a t even the m e c h a n ic a l c le a n s in g of a w o u n d u n d e r a n a n a e s th e tic of all fr a g e m e n t s o f e x t r a n e o u s m a t e r i a l w i t h i n it w a s q u i t e i m p o s s i b l e , sin c e m a n y w e r e a c t u a lly g r o u n d in to th e tis s u e s t h e m selves. T h e m e r e r e m o v a l of th e f o r e i g n b o d ie s d id not, m o re o ve r, e n su re the d isa p p e a ra n c e of th e in fe c tin g bacteria, s in c e — c o n t r a r y to p u b lic o p in io n — th e r e is n o k n o w n a n t i se p tic y e t in v e n te d w h ic h is c a p a b le o f k i l l i n g b a c t e r ia in a w o u n d w ith o u t a t th e s a m e tim e d e s tro y in g th e tissues th em selves. T h e p roblem of th e tre a tm e n t of w a r w o u n d s w a s t h e r e f o r e a n e x t r a o r d i n a r y d i f f i c u l t o n e , a n d it w a s n o t u n t i l d isco v ery w a s m ad e of a n e n tirely n e w g r o u p of d r u g s th a t it b e c a m e in a n y w a y s i m p l i f i e d . T h e s e d r u g s , k n o w n a s th e S u lp h o n a m id e s , w e re foun d to h a v e a m o st in te r e s tin g action , not e v e n y e t fu lly u n d e r s to o d , u p o n s o m e of th e m o r e d a n g e r o u s ty p e s of b a c t e r i a f o u n d in w o u n d s . I f m i x e d w i t h t h e s e b a c t e r i a in a g l a s s test tu b e no a c tio n w h a t e v e r re su lte d , a s w o u ld h a v e b e e n t h e c a s e h a d a s t r o n g a n t i s e p t i c b e e n u s e d , in fact, th e b a c te ria a p p e a r e d ra th e r to flo u rish th e m o re . If, h o w ever, the d r u g w a s tak e n b y the m outh, or even p o w d e re d o v er the su rfa c e of a n in fected w o u n d , n ot o n ly w e re th e b a c te ria ren d ered in active, b u t th o se w h ic h h ad g a i n e d a c c e s s to th e blood s t r e a m of the p atient w e re v ery so o n killed. U p o n this d is c o v e r y th e p r es en t m e th o d s of d e a lin g w ith w o u n d s h as b een based . G i v e n t h a t th e c a s e r e a c h e s t h e s u r g e o n ’s h a n d s w it h i n a b o u t s ix h o u rs of th e re ce ip t of the w o u n d th e en tire i n j u r y is e x c i s e d c o m p l e t e , i n c l u d i n g a l l t h e b r u i s e d a n d d e v it a lis e d tis s u e s a n d t h e f o r e i g n m a t e r ia l i n g r a i n e d in to them . T h e r e s u l t i n g r a w a r e a is c o v e r e d w i t h p o w d e r e d s u l p h o n a m i d e , a n d e i t h e r p a r t l y s e w n u p o r , if t h e s p a c e b e too la r g e , p a c k e d w it h g a u z e , a n d su lp h o n a m id e s a re g iv e n b y the m o u th . If a ll g o e s w e ll, h e a lin g w ill from n o w on b e v e r y rapid . T h e r e is n o d e a d tis s u e left w h i c h n a t u r e w o u l d o t h e r w i s e h a v e l a b o r i o u s l y to g e t rid of , a n d h e a l i n g is n o l o n g e r d e l a y e d b y t h e p r e s e n c e o f b acte ria , w h ic h m u s t b e d es tro y e d a n d e lim in ate d before repair ca n occur. I h a v e g i v e n y o u this d es c rip tio n of th e m o d e r n t r e a t m e n t o f w o u n d s n o t o n l y i n t h e h o p e t h a t it m a y m a k e y o u r w o r k in t h e fie ld m o r e v i t a l a n d i n t e r e s t i n g , b u t b e c a u s e it p r o v i d e s t h e r e a s o n f o r s o m e o f t h e d e m a n d s m a d e upon you. F ir s t ly , it e x p la i n s t h e n e e d f o r s p e e d ; s e c o n d ly , fo r p ro tectio n of the w o u n d w h ic h p r ev e n ts n eed le ss co n t a m i n a t i o n ; a n d , t h i r d l y , it a n s w e r s t h e n u m e r o u s q u e s tion s w h ic h a re a lw a y s a s k e d a s to w h y a n tis e p tic s of o n e sort or a n o th e r a re n ot p o u re d into th e w o u n d s . O n e last w o rd — n e ve r r e g a r d a n y case, no m a tte r h o w s e r io u s th e in ju rie s m a y a p p e a r to be, a s h o p e le s s . There is r a t h e r a t e n d e n c y a m o n g l e s s e x p e r i e n c e d p a r t i e s t o d o t h i s a n d , p e r h a p s u n c o n s c i o u s l y , t o d e v o t e t h e i r e n e r g i e s to th e less s e r io u s l y in ju r e d t h a n to th o s e w h o a r e o b v i o u s ly d esp era tely w o u n d e d . W h a t I h a v e a lr e a d y sa id to y o u u p o n t h e s u b j e c t o f p r i o r i t y o f t r e a t m e n t m a y g u i d e y o u in t h e m a t t e r , b u t , in a d d i t i o n , r e m e m b e r t h a t t h e r e s o u r c e s o f m o d e r n 's u r g e r y a re v e ry w id e. L a r g e a rea s of sk in destroyed by bu rn s m a y be covered b y g r a f t s b r o u g h t from o th e r p a rts of th e b o d y. P o r tio n s of b o n e w h ic h h a v e b een p u lv e rise d b y h ig h e x p lo sio n m a y be re p lace d b y p ieces c u t from oth er bones. A rib m a y be m a d e to d o se rv ic e a s p a rt of a lo w e r ja w , a p ie ce of the sh in m a y s tr e n g t h e n a w e a k e n e d spine. In a ll th ese th in g s th e C iv il D e fe n c e S e r v ic e s h a v e th eir p a rt, a n d u p o n t h e s k ill w it h w h i c h t h e y p la y it d e p e n d s th e sm o o th n e s s of th e road w h ic h the A ir R a id c a s u a lty w ill tre a d u p o n h is w a y to re c o v e ry . N o w o r k is m o r e v i v i d l y i n t e r e s t i n g o r d e m a n d s m o r e selfless d ev o tio n a n d c o n s ta n t tra in in g . F in a ll y , let m e d r a w y o u r a tte n tio n to o n e of th e b est b o o k s on the su b ject upon w h ic h I h a v e been s p e a k in g

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m a y b e ca lle d u p o n to face. “ D o n o t be a s h a m e d to b e g e n t l e a n d k in d . . . E m u la te th e ten d ern ess of w o m e n . T r y to u n d e r s t a n d t h e p s y c h o l o g y w h i c h m a k e s a m a n in a g o n y c r y f o r h i s m o t h e r — n ot his f a t h e r — a n d b e p r o u d to c u lt iv a t e the fem in in e t o u c h .”

St. John Ambulance Association. B r is t o l C e n t r e . — T h e a n n u a l contests at the Z o o lo g ic a l G a r d e n s , la st a r r a n g e d in J u ly 1940, w e r e s u s p e n d e d a fte r the blitzes u n til a ft e r th e w a r . T h e C o m m i t t e e felt, h o w e ver, t h a t th e i n c r e a s i n g e n t h u s i a s m of th e j u n io r s s h o u ld be e n c o u r a g e d a n d th at th e y sh o u ld h a v e a c h a n c e to co m p e te for th e J u n io r ( W e b e r ) C u p b e fo r e s o m e of t h e m w e r e p r e v e n te d b y h a v i n g r e a c h e d th e a g e lim it of s ix te e n . E i g h t t e a m s (six of g ir ls , t w o of b o y s) c o m p e te d on S a t u r d a y , J u ly 3rd, t h e te s t c o n s i s t i n g o f p r a c t i c a l w o r k a n d an oral e xa m in a tio n . T h e ju d g e s w e re D o cto r H . G. K yle, the C h a ir m a n of th e B ristol C e n tre , a n d D o c to r C. C. L a v in g ton, a v ic e -p r e s id e n t. D o c t o r K y le presided o v er th e p ro

ceed in gs. A fte r a v e ry k e e n con test, th e w in n e r s proved to be the B risto l E a s t N u r s in g C a d e t s w ith 164£ m a r k s out of a possible 200, s e c o n d c a m e B r i s t o l S o u t h A m b u l a n c e C a d e t s w i t h 1 6 1 m a r k s a n d third w e r e th e M a r k s b u r y R o a d N u r s i n g C a d e t s w it h 15 8 p oints. T h e H o n . S e c re ta r y (M r. M . R . F air) exp lain e d th a t the o b ject of the a ft e r n o o n ’s a c tiv itie s w a s n o t so m u c h th e w i n n in g of a c u p b y a p a r t ic u la r te a m , a s the e n l a r g i n g of th e e x p e r ie n c e o f all th o s e c o m p e tin g . T h e H o n . T r e a s u r e r ( M r . W . C . H a w k i n s ) in a n n o u n c in g th e re su lts s a id th a t in a d d itio n to th e C u p g i v e n b y M r. W e b e r, e a c h m e m b e r of th e w in n in g te a m w o u ld receive a d ip lo m a. H e w a s v e r y g l a d to b e a b le to a n n o u n c e t h a t a n o ff e r h a d j u s t b e e n r e c e i v e d f r o m M r . H . T . J e f f e r i e s ( a n official of t h e C e n t r e ) to p r o v id e a c u p fo r th e r u n n e r s - u p . In a dd ition , b o th w in n e r s a n d ru n n e r s -u p w o u ld r e c e iv e a coin. D o cto rs K y le a n d L a v in g to n both s p o k e of the exc elle n ce of th e w o r k don e b y th e te a m s ; the e a rn e stn e ss of th e m e m b ers g a v e a g o o d a u g u r y fo r th e fu t u r e of t h e B r i g a d e , of w h ich these ca d ets w e re th e fu tu re m em b e rs. D octor K y le h a d p l e a s u r e in a s k i n g M r s . F a i r t o p r e s e n t t h e C u p a n d d ip lo m a s to th e w i n n e r s — th e C u p fo r th e r u n n e r s - u p to fo llo w later. L a d y C o r p s S u p t . M . S a r a h s p o k e of th e k i n d n e s s o f th e d o c to r s w h o h a d d e v o te d th e ir a ft e r n o o n to th e c a r e fu l j u d g i n g of th e c o m p e titio n a n d c a lle d for a vo te o f t h a n k s fr o m the g a t h e r in g .

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T h e S t a n d in g C o n fer e n c e of N a tio n a l Ju v en ile O r g a n i s a t io n s h a s u n d e r c o n s id e r a t io n th e c a u s e s a n d in c id e n t of in d u strial fa tig u e a m o n g s t y o u n g people, b e tw e e n th e a g e s o f 1 4 a n d 20, in r e g u l a t e d a n d u n r e g u l a t e d e m p l o y m e n t . T h e g r o u p s e t u p t o i n v e s t i g a t e t h i s q u e s t i o n is d e s i r o u s o f re c e iv in g evid e n ce from the V o lu n ta r y Y o u t h O rg a n is a tio n s , fr o m p e rs o n n e l m a n a g e r s , w e lfa r e officers a n d c lu b le a d e rs, a n d p a rtic u la rly from m ed ic a l p ractitio n ers. A n y d o c t o r s w h o a r e i n t e r e s t e d in t h i s q u e s t i o n , a n d w h o a r e w i l l i n g t o fill u p a v e r y s h o r t q u e s t i o n n a i r e , a r e a s k e d t o c o m m u n i c a t e in t h e f i r s t i n s t a n c e w i t h t h e S u r g e o n - in - C h ie f at 166, H a v e r s t o c k H ill, L o n d o n , N . W . 3 . N o.

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N o. 41 ( W e s t e r n P o s t a l a n d S t . M a r y l e b o n e ) C a d e t A m b u l a n c e D i v i s i o n ; N o . 7 2 ( S t . J o h n ’s W o o d ) G i r l C a d e t N u r s in g D iv is io n .— A very p le a sin g a n d su ccessfu l m e e t in g of th e a b o v e C a d e t D iv is io n s w a s h eld a t th e T r a i n i n g H e a d q u a r t e r s , 30 , G l o u c e s t e r P l a c e , W . l , o n T h u r s d a y , J u n e 24th. A m o n g the distin gu ish ed g u e sts present w e re S ir G e o rg e a n d L a d y A b b iss, V ic e P r esid e n ts of the b oy a n d g ir l c a d et D iv is io n s resp ectiv ely, w h o w e r e receiv ed b y D iv is io n a l S u p t. W . V . M . A llen a n d L a d y D iv isio n a l S u pt. M rs. M . M . A llen a t th e e n t r a n c e h a ll, w h e r e a G u a r d of H o n o u r of b o y c a d e ts stood s m a r t ly to a tten tion . A f t e r a n in s p e c t io n of th e t r a i n i n g h e a d q u a r t e r s , t e a w a s provid ed, then fo llo w e d th e p resen ta tio n of certifica tes an d th e e n ro lm e n t c e re m o n y of n e w g ir l c a d e t e n tra n ts, a n d Sir G e o r g e A b b iss c o n g ra tu la te d the n e w m e m b e rs a n d exp la in e d to all the b o y s a n d g ir ls th e j o y a n d s a tis fa c tio n of b e in g tra in ed to re n d er p u b lic service. T h e p resen ta tio n of co m p e titio n tro p h y sh ield s w a s th en m a d e , S i r G e o r g e A b b i s s p r e s e n t i n g to t h e b o y s a s h i e l d f o r ind ivid u al com petition g iv e n by Pte. L . R a b in , a n d L a d y A b b is s p r e s e n tin g to th e g ir ls a s im ila r sh ield g iv e n by the b oy c a d e ts to th e g ir l ca d ets. D i s t r i c t O f f i c e r T . M c B r i d e , in p r o p o s i n g a v o t e o f t h a n k s to S i r G e o r g e a n d L a d y A b b is s , s a id h e r e a lis e d t h a t a s a v e r y b u s y p u b lic official, S ir G e o r g e h a d v e r y g e n e r o u s ly fo u n d t im e to a tte n d th is i m p o r t a n t p a r t o f y o u t h t r a in in g . E n t e r t a in m e n t s fo llo w e d , a n d th e r e w a s a d is p la y of h o m e cra fts b y th e g ir ls a n d a n u m b e r of m o d el a irp la n e s m ad e b y th e boys. A b o u t 120 b oy s a n d g ir ls w e re p resen t of w h ic h w e r e a n u m b e r of p r o s p e c tiv e n e w m e m b e r s . G r e a t c r e d i t is d u e t o A m b . O f f i c e r E . F . M a s o n a n d C o r p o r a l s J. C . M a y e r s a n d E. E. T r ib e , a lso o th er m e m b e rs of th e p a re n t D iv isio n s w h o g a v e v e r y v a l u a b l e a s s i s t a n c e in t h e a r r a n g e m e n t s . I t is h o p e d t o a r r a n g e a n o t h e r s u c h m e e t i n g in t h e n e a r future. N o . 93 ( F i n c h l e y ) .— T h is D i v i s i o n o f t h e S . J . A . B . h a s h ad a very active m onth. O n J u n e 5th th eir S o c ia l C o m m i t t e e p r e s e n t e d t h e H a r r i n g a y D r a m a t i c S o c i e t y in “ Q u i e t W e d d i n g , ” w h e n o v e r j£ jl5 w a s r a ise d for th e F i n c h l e y “ A id to C h i n a ” f o r t n i g h t f u n d s . T h e M ay o r of F in ch le y and D is tric t O fficer C o llin s w e re present. O n J u n e 1 9 th , S u p t . W . A . W o o d a n d N . C . O . ’s of th e D iv is io n a c te d a s j u d g e s in c o n n e c tio n w it h th e first a id s e c tio n of a n in te r-p atro l c o m p e titio n o r g a n is e d b y F in c h l e y B o y S co u t A sso ciatio n . O v e r 35 t e a m s t o o k p a rt. M em b e rs of th e D i v i s i o n a ls o a s s is t th e s c o u t o r g a n i s a t i o n as A m b u lan ce B a d g e exam iners,

4 N o.

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C h e l t e n h a m . — T he a n n u a l c h u r c h p a r a d e of th is D i v i sio n , a c c o m p a n ie d b y D e t a c h m e n t s of the B . R . C . S . , to o k p la c e on S u n d a y e v e n in g , J u n e 20ih, a t A ll S a i n t s ’ C h u r c h . A b o u t 350 m e m b e r s to o k part. T h e p a ra d e w a s u n d e r the co m m a n d of C o rp s S u p t. L . M. Starr, a n d w a s h eaded by the D o w t y E q u ip m e n t B a n d . T a k i n g a s h is s u b je c t the p e r f o r m in g of a c ts of k in d n e s s , C a n o n P . M . C . J o h n s t o n e , th e V i c a r , e x p r e s s e d g r a t i t u d e to th e A m b u l a n c e B r i g a d e for th e ir d a ily a c t s of k in d n e s s w h ic h w e r e p e rfo rm e d w it h o u t p u b licity , a n d p aid trib u te to th eir u n t i r i n g efforts. B e fo r e th e p a r a d e w a s d ism isse d , A m b u l a n c e O fficer B a r n f i e l d w a s p r e s e n t e d w i t h t h e P a r c h m e n t o f E l e c t i o n to S e r v in g B ro th e r of th e O r d e r of St. John.

S a l is b u r y . — A p a ra d e of D iv ision and the G ir ls ’ N u r s in g h e l d in S a l i s b u r y a t t h e e n d o f d e ta c h m e n t in clu d ed b oys from b erlayne.

the B o y C a d e t A m b u la n c e D iv isio n of th e S .J .A .B . w a s la st m o n th . T h e S alisb ury B arford and C o m p to n C h a m -

T h e M a y o r ( C o u n c illo r S. C la rk e ) in spected th e p a ra d e in t h e f o r e c o u r t o f t h e i n f i r m a r y . H e w a s a c c o m p a n ie d by M r. T . H e rb e rt G r e y (P resid en t of th e D iv isio n ) a n d the L a d y C o u n ty S u p t., M rs. B attye. T h e p a ra d e w a s c o m m a n d e d b y C a d e t O fficer H . H o u n som e. A f t e r t h e p a r a d e t h e c a d e t s a t t e n d e d s e r v i c e in S t . P a u l ’s C h u r c h .

S a r i s b u r y . — T h e n e w S . J . A . B . h u t in H u n t s P o n d R o a d , S a r is b u r y , w a s op en ed on J u n e 22nd by the H o n . M rs. C u b itt ( L a d y C o u n t y S u pt.). L a d y D i v . S u p t . M rs . S c a t c h a r d s p o k e of t h e p rid e felt b y S a r isb u ry D iv ision a t h a v in g a cq u ire d the h ut, esp ecially a s it w a s e n t i r e l y p a i d f o r . M rs. C u b itt m en tio n e d th e n u m b e r of C a d e t N u r s in g D iv is io n m e m b e rs , h o p in g th e r e w o u ld be m o r e re cru its. C o l. M a r s h a ll ( A s s is ta n t C o u n t y C o m m is s io n e r ) referred to th e i m p o r t a n c e of th e C a d e t S e c tio n , w h ic h fo r m e d a n in te g ra l part of the B rig a d e. A n in sp ectio n of th e D iv is io n b y M rs. C u b itt follo w ed.

A l d e r s h o t a n d F a r n b o r o u g h . — P erson n el of these tw o D iv isio n s w e re in spected re ce n tly by th e C o u n ty C o m m is s io n e r (M a jo r H . T en n yso n -S m ith , O .B .E .) . T h e r e w a s a g o o d m u ste r of the F a r n b o r o u g h D iv isio n o n t h e R . A . E . s p o r t s f ie ld , w h e n t h e D i v i s i o n p a r a d e d u n d e r th e c o m m a n d of D iv is io n a l S u p t. L . C lifford. T h e in sp e c tion w a s fo llo w e d b y a m a r c h p a s t a n d p r a c tic a l d e m o n s t r a t i o n s in f i r s t a i d . T h e in s p e c tio n a t A ld e r s h o t t o o k p la c e in th e M a n o r P a r k , a d jo in in g th e F ir s t A id Post, w h e r e the p a ra d e w a s u n d e r th e c o m m a n d of C o rp s O fficer U . O s m o n d . A fter the in sp ectio n th e perso n n e l m a rc h e d past, M a jo r T e n n y s o n S m ith t a k i n g th e salu te. In a n a d d r e s s to th e D iv is io n , th e C o u n t y C o m m is s io n e r t h a n k e d t h e m fo r t h e ir s e r v ic e s a n d e m p h a s is e d th e n e e d for a l l r a n k s t o m a i n t a i n e f f i c i e n c y d u r i n g t h e w a r a n d in p r e p a r a tio n fo r th e p o s t- w a r p erio d.

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C o v e n t r y .— T he C o v e n try C en tra l C o rp s n o w h as a s t r e n g t h o f o v e r 3 ,0 00 a n d s e v e r a l n e w D i v i s i o n s h a v e rece n tly b een form ed . A le a g u e w e e k ly “ q u iz ” co m petitio n has been started, and is c r e a t in g g r e a t in terest an d e n t h u s i a s m , w h i c h i t is h o p e d m a y e v e n t u a l l y b e c o m e a r e g u la r c o u n ty feature. A n in spection b y th e C o m m is s io n e r, M a jo r E . S. Ph illip s, D . S . O . , w ill t a k e p l a c e o n A u g u s t 7 th to i n c l u d e t h e m e n ’s

A I D D iv isio n s a n d N u r s in g a n d C a d e t section s, u n d e r the d irec tion of C o r p s S u p t. L . T . M a rc h . T h e S t a n d a r d A e r o D iv is io n held th e ir i n a u g r a l d in n e r on J u n e 2 3rd , a n d m a n y fine t r ib u t e s w e r e m a d e b y t h e m a n a g e m e n t r e g a r d in g th e w o r k perform ed by the S .J .A .B . d u r i n g th e d a n g e r o u s d a y s of N o v e m b e r , 1940. T h e a m b u la n c e s, of w h ic h th ere a re e ig h t, h a v e a g a in re m o v e d a re c o rd n u m b e r of p atients. T h i s s e r v i c e is r u n in co n ju n c tio n w ith th e H o s p ita l S a t u r d a y F u n d , to w h o s e C o m m i t t e e t h e D i v i s i o n is g r a t e f u l in m a n y w a y s . A n y n e w m e m b e r s tr a n s fe r r in g to th is p a rt of th e c o u n try w ill a lw a y s be w elcom e, a nd ca n rest a ssu re d th at t h i s D i v i s i o n is v e r y m u c h a l i v e .

N o.

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R u d d in g t o n . — T h is D iv isio n of the S .J . A . B. h a s a proud re c o rd of s e r v ic e d u r i n g its sh o rt e x is te n c e o f th r e e y e a r s. I ts a m b it io n fr o m th e o u ts e t w a s to h a v e its o w n a m b u la n c e se rv ic e , a n d th is w a s re a lis e d o n S a t u r d a y , J u n e 26th, w h en a n e w a m b u la n c e w a s d ed icated a t R u d d in g to n P a rish C h u rc h b y the R e v . F. Potts. M r. j . W . N a a k e (ch a irm a n of th e R u d d in g to n S t. John A m b u la n c e C o m m itte e ) fo rm a lly h an d ed over the a m b u la n ce t o t h e C o u n t y C o m m i s s i o n e r , M r . S . J. VV. D o n a l d ( S e r v i n g B r o t h e r o f t h e O r d e r ) w h o r e c e i v e d it o n b e h a l f o f t h e R u d d in g to n D ivision . D u r in g the aftern oon the C o u n ty C o m m issio n e r in sp ec ted the R u d d in g t o n a n d v is it in g D iv isio n s a lo n g w ith the n e w l y fo r m e d local C a d e t D iv is io n .

N o.

V III

(D uke

o f C o n n a u g h t ’s )

D istrict

R a m s g a t e . — L a r g e ly b e c a u se the tim es preven t m a n y of its m e m b e r s b e i n g su p p lie d w it h u n ifo r m s , th e w o r k of th e b o y s’ C a d et C o rp s of the R a m s g a t e T o w n D iv isio n , S .J .A .B ., p a sse s m o r e o r less u n n o tice d . Y e t , b e h in d the scen es, th o se la d s a re d o in g a g r a n d job. S o m e of th e re su lts of th e b o y s ’ tu itio n w e r e seen at th e R a m s g a t e p o lice p a r a d e g r o u n d , w h e n th e a m b u l a n c e m e n of t h e f u t u r e w e r e i n s p e c t e d b y M r . J. B a k e r , C o u n t y O f f i c e r o f C adets. T h e p a r a d e w ^ s u n d e r t h e c h a r g e o f C d t . S u p t . W . W . J. N o rris , w h o a c c o m p a n ie d M r. B a k e r d u r i n g th e in sp ectio n . F o llo w in g th e in spection a p a rty of th e b oys g a v e a realistic d e m o n s t r a t i o n of first a id m e t h o d s . D u r i n g t h e a f t e r n o o n it w a s l e a r n t t h a t t h e a p p o i n t m e n t of M r. A r t h u r W i l l i a m s a s c a d e t officer h a d re c e iv ed official sa n c tio n . M r. W illia m s assisted th e R a m s g a t e D iv isio n d u r i n g t h e e v a c u a t i o n f r o m D u n k i r k , a n d w a s m e n t i o n e d in d e s p a t c h e s in c o n n e c t i o n w i t h a l a n d i n g o n t h e R e d S e a coast. S e v e r a l p r e l i m i n a r y f ir s t a i d c e r t i f i c a t e s w e r e p r e s e n t e d to m e m b e rs of th e C o rps. A d d r e s s in g a fe w w o rd s to th e boys, M r. B a k e r sa id he t h o u g h t th eir w o r k w a s w e ll ca rrie d ou t a n d he lo o k e d for w a r d to p e a ce -tim e w h e n co m p e titio n s cou ld be a rra n g e d .

N o.

D istrict

H a y l e .— T he a n n u a l m e e tin g of the H a y le A m b u la n c e D i v i s i o n w a s h e l d o n M o n d a y , J u n e 7 t h , in t h e A m b u l a n c e H all. A l t h o u g h v e r y la te in th e y e a r , th e a tt e n d a n c e w a s g o o d a n d the h all cro w d e d . M r. E . P. Lello , th e n e w ly e lected p residen t, to o k th e ch air. A m b . S u p t. J. R . B o n d w e lc o m e d M r. L e llo a s th e n e w p residen t, t h a n k i n g h im fo r a c c e p t in g the position, a n d h oped he w o u ld h a v e a p le a sa n t tim e w ith them . R eferrin g to th e past-p re sid e n t, M r. K . U r e n , L . D . S . , h e s ta te d h e h a d o n ly r e s ig n e d b e c a u s e his o th e r a c tiv itie s h a d so in c r e a s e d a s to o c c u p y to o m u c h t im e to s e r v e a ll fa irly . T h e ir relatio n s w e r e still c o rd ia l. H e th e n g a v e a r e p o r t of th e y e a r ’s w o r k in g , an d the s ta te of affairs w e re m o st s a tisfa cto ry . A ll

F I R S T

the m em b e rs w e re also m e m b e rs of the C ivil D e fe n c e C a s u a lty S ervice. T h e m o to r a m b u l a n c e h a d tra v e lle d o v e r 1,80 0 m i l e s in 1 9 4 2 , a t t e n d i n g 2 0 7 c a s e s in a l l , o f w h i c h 1 7 c a s e s h ad been road a icid en ts. H e r e fe r r e d to th e d e a t h of C o r p l. J a c k R ic h e tts a s b e in g a g r e v io u s loss to the B r ig a d e , a s he w a s o n e of th e e a r lie s t m e n to join th e D i v i s i o n , a n d o n e of its m o s t a c t i v e m e m b e r s . T h r e e o f th e old m e m b e r s w e r e p r i s o n e r s o f w a r , a n d a f u r t h e r 1 7 w e r e s e r v i n g in t h e F o r c e s . G r e e t in g a ll the n e w m e m b e rs a n d the n e w ly -fo rm e d C a d e t s ’ S ection , he e xp re sse d th e h ope th a t m o re m e m b e rs w o u ld join i n ' 194 3 . F in a lly , h e t h a n k e d a ll his officers a n d m e n for th eir w h o le - h e a r te d s u p p o r t a n d c o - o p e r a tio n t h r o u g h o u t the year. N e x t fo l l o w e d t h e t r e a s u r e r ’s r e p o r t b y A m b . O f f i c e r R . VV. W a k e f o r d , w h o s t a t e d t h e f i n a n c i a l p o s i t i o n t o b e s o u n d . It w a s th e te n th a n n u a l r e p o r t h e h a d p r e s e n te d , b u t th e fi r st t i m e h e h a d b e e n a b l e t o a n n o u n c e a c o m p l e t e c r e d i t b a l a n c e in a l l a c c o u n t s . M r . E . P . L e l l o s p o k e o f h i s p l e a e u r e in b e i n g a s k e d to b eco m e presiden t of su c h a n o rg a n isa tio n , an d re m a r k e d th at it w a s a w o r k a k i n t o C h r i s t i a n i t y , a n d w i s h e d t h e B r i g a d e co n tin u ed success. Cad et. Supt. F . W illia m s reported on the n e w C a d et section. H e w a s g l a d t o r e p o r t t h a t f u n d s w e r e c o m i n g in stead ily, a n d the y o u th s w o r th w h ile w e r e r a l l y i n g ro u n d sp len d id ly. H e h ad not anticip eted b e in g the S u p e rin te n d e n t w h e n a s k e d e a r ly on to h elp w ith the boys, b u t n o w he h a d a c q u i r e d t h e p o s i t i o n , h e w o u l d f u lf il i t t o t h e b e s t o f h i s ability. V o te s of t h a n k s w e re proposed b y S e r g t. J.

R a d c l if if e ,

R I D

Letters to the Editor. W e a r e in n o w a y r e s p o n s i b l e f o r t h e o p i n i o n s e x p r e s s e d , o r the sta tem en ts m ad e, b y C o rre sp o n d e n ts .— E d it o r . TH E

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S i r , — In the Ju n e issu e of F ir s t A i d , S e r g t . S p r e a d b u r y q u o te s fr o m a letter I w r o t e h im d e s c r ib in g a m e th o d of stra p p in g a patient on a stretch er, u s in g th ree slin gs. I sh o u ld lik e to s ta te th a t th e m e th o d w a s n ot m y “ in v e n tio n ,” b u t w a s pa rt of an in te re stin g a n d in stru c tiv e d em o n stra tio n by an A r m y F ield A m b u la n c e w h ic h w a s g iv e n to a p a rty of H .G . M e d ic a l U n its. W i t h r e g a r d to M a j o r B o w m a n E d g a r ’s a r t i c l e , m e n t i o n is m a d e o f “ r e m o v a l o f t h e b e l t m e c h a n i s m , ” w h i c h , I t h i n k , s h o u l d r e a d “ bolt m e c h a n i s m . ” I n c i d e n t a lly , th e bolt, w h e n r e m o v e d , is v e r y u s e fu l to t i g h t e n th e im p r o v is e d to u rn iq u e t, m a k i n g a n o th e r p a rt of th e e q u ip m e n t u sefu l. I a g r e e w ith the M a jo r ’s s u g g e s t io n of a p a g e d ev o te d to H o m e G u a r d . I a m su re m a n y w o u ld fo r w a rd in te re st in g n e w s a nd v iew s of the “ trou b les a nd d isa p p o in tm e n ts ” o f t h e m e d i c a l u n i t s in t h e H o m e G u a r d . — Y o u r s ,

James E. R u sh ton , C o rp l. N o . 2 B a tt ., N o tts. H . G .

Improvisations.

s e c o n d e d b y M r . A . H i g g s . ____________________ N o.

D istrict

C a m b r id g e .— S ince J a n u a r y , 1943, th e S . J . A . B . h a s re g is te r e d o v e r 550 n e w C a d e t N u r s i n g D iv is io n s , a n d for th es e D iv is io n s , h a s fo u n d s o m e t h i n g li k e 1,000 n e w c a d e t officers. L a d y D u n b a r -N a s m ith , C h ie f O fficer for th e St. John N u r s i n g C a d e t s g a v e t h e s e f i g u r e s in C a m b r i d g e o n S a t u r d a y , J u n e 1 9 t h , w h e n s h e a t t e n d e d a c a d e t d i s p l a y in t h e H o u g h to n H a ll, w h ic h fea tu red St. Joh n A m b u la n c e and N u r s i n g C a d e t s fr o m all o v e r C a m b r i d g e s h i r e a n d th e Isle of E ly. T h e c a d e t d is p la y c o n s is te d of n o less t h a n 10 ite m s , e a c h c o n trib u ted b y m e m b e r s of different C a d e t N u r s i n g and C a d et A m b u la n c e D iv ision s. In c h a r g e of the p a ra d e w a s Co rps Supt. S. S. D ick e r. C o m m e n t in g on th e d isplay, th e C h a ir m a n (D r. K . S. M a u r ic e - S m it h ) w a s full of p r a ise , a s w a s L o r d F a ir h a v e n , w h o a ls o said a fe w w o rd s. L ie u t.-C o lo n e l A rc h e r(c o u n ty treasu rer)d e liv ered a short ad d ress on th e h isto ry of th e O r d e r of S t. John. N orth ern

Ire la n d

(U lste r)

A b o u t th re e m o n th s a g o m y p la to o n w a s t u rn e d into a c y c lis t p la t o o n , a n d th e m e d ic a l o r d e r lie s h a d to a d a p t t h e m s e lv e s . T h e first t i m e o u t w e h a d t w o S c o u t p o le s a n d s a c k i n g c a r r i e d on o u r cycles, bu t n o w , ou t of th e p la to o n fu n d s, w e h a v e b o u g h t so m e w ood a n d rope and h a v e m ad e a stretch er w h ich c a n b e t a k e n to p ie c e s a n d c a r r ie d o n o u r c y c le s . T h e la st t i m e w e h a d it o u t , w e d i s m o u n t e d , a d j u s t e d g a s m a s k s , a ssem b led the stretcher, a nd w ith o u t a n y u n d u e haste, w ere r e a d y to c a r r y th e p a tie n t in s id e s ix m in u te s . B y im p ro v in g th e stretch er a n d b y m o re p ra ctice th e tim e co u ld e a s ily be h alved. T h e p o l e s a r e 7 ft . 6 in . l o n g , w i t h s h a p e d h a n d l e s , a n d t h e t r a v e r s e s 2 ft . 6 in . ( t o a l l o w a 3 i n . o v e r l a p e a c h s i d e ) a r e d o v e -ta ile d in to the poles. T h e r o p e is t h r e a d e d c r i s s - c r o s s a c ro s s th e stre tc h e r fro m o n e co rn e r to th e o p p o site one, a n d then co m es b a c k a g a in fo rm in g a n etw o rk. O n e cy c le c a rrie s th e poles, a n o th e r th e ro p e a n d tra v e rs e s , w h ile a third, th e b la n k e t a n d w a te rp r o o f, l e a v in g N o. 1 to c a rry a n y e x t r a kit. If a n y on e w o u ld lik e fu rth e r d etails, I sh all b e p lea sed to fo r w a r d s a m e . — J a m e s E . R u s h t o n ( C o r p l N o . 2 B a t t ., N otts. H .G .) .

D istrict.

T h e a n n u a l co m p e titio n s for th e S . J . A . B . N o rth e r n I re la n d D is tr ic t, w e r e h e ld in B e lfa s t re c e n tly . E ig h t team s fro m N o rth ern Ire la n d a n d fo u r fro m E ire co m p eted . The B e lfa st C h a lle n g e C u p ( A m b u la n c e D iv isio n , sen ior m en ) w a s w on by B roadstone ( G .S .R .) . O t h e r r e s u l t s w e r e :— L o r d M a y o r ’ s C u p ( n o v i c e ) , G l e n a g e a r y ; W h i t t a k e r M e m o ria l C u p ( N u r s in g D iv isio n , sen io r w o m e n ), W e s t B e lfa s t ; W h i t t a k e r C u p (n o vice w o m e n ), H ow th and S iltto n tied w it h N e w t o w n a r d s ; D istrict S u r g e o n s ’ C u p , R o y a l C a d e ts ; C ity of D u b lin C u p presented b y M r. W . S tr a th a n , B r o a d s to n e ( G . S . R . ) . W a r w ic k sh ir e C ollie r ie s A mbulance L eague. — C o v e n try C o llie ry w o n th e tw e lfth a n n u a l com p etitio n of the a b o v e a m b u la n c e le a g u e , h eld re c e n tly a t the G r iff a n d C o to n Sports G ro un d , N u n ea to n . T e n t e a m s e n t e r e d , t h e first t h r e e p l a c e s b e i n g o c c u p i e d b y : 1 , C o v e n t r y C o l l i e r y , 2 02 m a r k s ; 2, K i n g s b u r y , 1 7 5 ; 3, A r l e y , 1 7 3 . T h e total n u m b e r of m a r k s po ssib le w a s 275.

Quick Treatment for Burns. R . A . F . c r e w s w ill so o n c a r r y a s m a ll firep ro o f a n d w a t e r pro o f first a id p a c k c o n t a i n i n g m a t e r ia l fo r th e m o s t m o d e r n te a tm e n t for b u rn s. B y t h e a d a p t a t i o n o f t h e S t a n n a r d a n t i - b u r n g l o v e first aid tre a tm e n t for b u rn s on th e h a n d s w ill be a v a ila b le w ith in a few seconds. T h e a d a p t a t io n o f th e g l o v e to first a id ap p lica tio n fo llo w s the su cce ss of tre a tm e n t w o r k e d out b y the R . A . F . m ed ica l a u th orities. T h e g l o v e is m a d e o f o iled silk w h ic h e x c lu d e s the a ir a n d co n ta in s a n tisep tic a nd cu rative pow ders. M r . W i l l i a m S t a n n a r d , a s i l k m e r c h a n t a n d a p ilo t of the la st w a r , h a s co -o p era ted w ith th e R . A . F . m ed ica l a u t h o r i t i e s in p e r f e c t i n g t h e g l o v e a n d t h e p a c k c o v e r , w h i c h co n tain s the g lo v es, m o rp h ia, w o u n d -d r e ssin g , a nd a tube of a n ti-b u rn jelly.

F I R S T

A Universal First Aid Splint. D r . F . O ’S u l l iv a n ( H a r r o w ) se n d s u s p a r t ic u la r s of a n e w t y p e of first a id s p lin t w h i c h h e d e s i g n e d re c e n t ly , a n d w h i c h m a y , h e t h in k s , h e lp to fa c ilita te th e t r e a t m e n t of c e rta in types of fractu res of the lo w e r a nd u pper lim b s ; also a copy o f a l e t t e r h e w r o t e t o t h e B r itis h M e d ic a l J o u r n a l a n d w a s p u b l i s h e d in t h e i s s u e o f t h a t J o u r n a l o f A p r i l 1 0 t h l a s t . T h e sp lin t c a n b e e m p lo y e d fo r first a id t r e a t m e n t of f r a c t u r e s o f th e f e m u r (u p p er, m id d le a n d lo w e r thirds), th e n e c k o f th e f e m u r — a c t i n g a s a m o d ified l o n g L i s t o n — the p a tella, fib u la a n d tibia, a n d th e ta r s u s a n d m e ta ta r s u s . It is p o s s i b l e t o d i s a r t i c u l a t e t h e s e c t i o n s f o r t r e a t m e n t o f fr a c tu re s of th e h u m e ru s, th e ra d iu s a n d u ln a, a n d the carpu s and m etacarpus. T h e s p l i n t m a y b e e m p l o y e d a l s o in c e r t a i n c a s e s a s a tou rn iq u et ; w ith su itab le p a d d in g , no b a n d a g e s a re needed fo r its a p p lic a t io n , v a l u a b l e t im e t h u s b e i n g s a v e d . Its use d o e s n o t in te r fe r e w i t h X - r a y s , so t h a t d i a g n o s i s c a n be v erified w it h o u t r e m o v a l. A n o th e r a d v a n t a g e of th is typ e of

A I D

g i v e firm a d ju s t a b le su p p o rt, la t e r a ll y a n d a n te rio r ly . The a r t i c u la t i n g e n d s o f th e sp lin t h a v e c la m p s c r e w s a n d pins f o r t h e a d j u s t m e n t o f a n g l e s . T h e s p l i n t is q u i c k a n d s i m p l e i n a p p l i c a t i o n , a n d i t s t e c h n i q u e c a n e a s i l y ’ b e l e a r n e d b y f ir s t aid stu den ts. H is g r a t e fu l t h a n k s a re d u e to M r. K e a r s e y , ch ief e n g in e e r to H . M . S ta tio n e r y O ffice, w h o k in d ly c o n stru c te d th e first m o d e l fo r h im , a ls o th e d r a w i n g d e ta ils of th e sp lin t itself. T h e im p ro v e d m o d e l h as b een m a d e b y M essrs. D o w n B ro s. L td , w h o h a v e k in d ly su p p lied the illu stration s.

Reviews. N u rses'

P h a r m a c o p e ia . By H. L. H eim an n , M .D ., M .R .C .P ., and D o r a W ilso n , S .R .N . London : B ailliere, T in d a ll & C o x . P r i c e ys. 6d. net.

T h i s u se fu l little b o o k , w h i c h c a n b e c a r r ie d c o n v e n i e n t l y in t h e a p r o n p o c k e t , h a s b e e n c o m p i l e d t o h e l p s t u d e n t n u r s e s in t h e i r s t u d i e s a n d f o r u s e in t h e w a r d s a n d in t h e i r p r a c t i c e o f n u r s i n g a f t e r t h e y l e a v e h o s p i t a l . It w a s first p u b lis h e d in 1 9 3 3 ; a n d th is, its fo u r t h e d itio n , h as been revised a n d b r o u g h t u p -to -d ate by the a d d itio n s of n e w sectio n s w h ic h w e re s u g g e s t e d by readers. I n its n e w form the b o o k sh o u ld ob tain a w id e r circu latio n .

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2s. n e t ; by p o st 2s. 2d. T h i s b o o k ( w h i c h a l s o c o n t a i n s SO Q u e s t i o n s A n s w e r e d for F ire G u a r d s ) w ill be u sefu l to N . F . S . p erson n el and m e m b e r s of W o r k s F ir e B r ig a d e s a n d a lso to F ire G u a r d s a n d W a r d e n s w h o a re t a k i n g c o u rses on use of trailer p u m p s. I t w i l l s u r e l y p r o v e i t s u s e f u l n e s s in t h e a d v a n c e m e n t o f k n o w l e d g e b e c a u s e it is b a s e d o n a m e t h o d w h i c h is w e l l re co gn ised . W e f o r e s e e a s u c c e s s f u l c a r e e r f o r it.

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s p l i n t is t h a t it c a n b e f o l d e d w h e n n o t in u s e . T h e splin t m a y be ap p lied o u tsid e th e cloth es, a n d h a s b een proved effective fo r m o s t s ta n d a r d sizes. T h e a p p lia n c e is c o n s tr u c te d of li g h t w o o d , c o n s is t in g of r ig id b a c k p ieces w ith t a n g ib le h in g e s , w h ic h ca n a ls o be lo c k e d . T h e sid e s a r e fo r m e d of strip s of s t r o n g , r o u n d ed la th , a tt a c h e d to firm s tr ip s of c a n v a s , r e s e m b l i n g c r i c k e t e r s ’ le g - p a d s , w h ic h c a n be rolled, a n d at th e s a m e tim e

C e n t r a l H a c k n e y D e t a c h m e n t (L /S 0 3 M ).— T h e in a u g u r a t io n c e re m o n y a n d d istrib u tio n of a w a r d s g a in e d by m e m b e r s of th is d e ta c h m e n t w a s h eld r e c e n tly a t the H a c k n e y A s s . C l u b s , M a r t e l l o - s t r e e t , H a c k n e y , E . 8. T h e r e w e r e p resen t a b o u t 160 people, in c lu d in g the . A ss. C o u n ty D irecto r, M rs. M c V ie ; the D iv . C o m m a n d a n t, M r. H . T . N a s h ; a n d the M a y o r of H a c k n e y , C o u n c illo r A. C u ll in g t o n , J. P. T h e C o u n t y D i r e c t o r a n d M a y o r in s p e c t e d t h e g u a r d of h o n o u r u n d e r the c o m m a n d of M iss S. P in n e r, a n d c o n g r a t u la te d th e m on th eir s m a r t n e s s a n d efficiency. T h e C h a ir m a n (M r. R o la n d ) open ed th e p r o c e e d in g , and sp e e c h e s fo llo w e d , d u r in g w h ic h the points m e n tio n e d w e re : S in c e t h e fo r m a tio n of th e D e t a c h m e n t in O c to b e r , 194 2, w ith a s t r e n g t h o f 1 4 officers a n d m e m b e r s , it h a s n o w i n c r e a s e d t o 30 o f f i c e r s a n d m e m b e r s a n d 2 2 p r o b a t i o n e r s . It h a s c o lle c te d o v e r ;£ 1 0 0 fo r th e P r is o n e r s o f W a r F u n d ; i t s m e m b e r s h a v e g a i n e d o v e r 100 c e r t i f i c a t e s , 6 m e d a l l i o n s a n d 2 b a r s, a n d h a v e g i v e n o v e r 3,400 h o u r s to R e d C r o s s w o rk , b esid es fu lly e q u ip p in g a F ir s t A id P o s t a t the “ E l m s ” S p o r ts g ro u n d , W a lth a m s t o w , o u t of th eir o w n funds. T h e y h a v e 6 m e m b e r s in t h e F o r c e s ; a l l m e m b e r s , w i t h t h e e x c e p t i o n o f t h e C o m m a n d a n t , a r e u n d e r 20 y e a r s o f a g e , a n d t h e y a r e t h e f i r s t m i x e d d e t a c h m e n t in E n g l a n d ,

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M r. H . A d a m s C la r k e (C h ief S ta ff a nd E sta b lish m en t O fficer) h a s b een p r o m o te d b y the V e n e r a b le O r d e r of St. J o h n o f J e r u s a l e m f r o m t h e G r a d e o f S e r v i n g B r o t h e r in t h e O r d e r to t h a t of O fficer. M r . A d a m s C l a r k e is C h a i r m a n o f t h e C e n t r a l C o m m ittee of th e G . W . R . C e n tre of th e S .J .A .A . a n d C h a ir m a n of the G. W . R . D iv ision a l A m b u la n c e S ecreta ries’ Conference.

R e a d e r s w ill p e rh a p s fo r g iv e m e for w r i t i n g on a su b ject, w h i c h t h o u g h n o t s t r i c t l y c o m i n g u n d e r t h e h e a d i n g o f fi r st a id , is, a te r a ll, e sse n tial k n o w l e d g e for th e M ed ica l O rd erly. In th e e ve n t of a g e n e r a l ca ll-o ut, iso la te d a n d co u n try u n i t s m a y fin d s o m e d i f f i c u l t y i n c a t e r i n g f o r a l a r g e n u m b e r o f m e n , a n d e v e n in t o w n a r e a s , e n e m y a c t i o n m a y r e n d e r th e u s u a l s o u r c e of s u p p ly useless, a n d th e u n it c o n ce rn e d , m a y , a t le a s t t e m p o r a r ily , be fo rced to o b ta in s u p p lie s fro m a less reliab le sou rce. T h e d a n g e r s of in fection t h r o u g h pollu tio n a re m a n y , y e t t h e r e m e d i e s a r e r e a l l y s o s i m p l e if t h o r o u g h l y u n d e r sto o d , th a t th ese d a n g e r s c a n e a s ily be a v o id e d . 1 trust th e r e f o r e , t h a t fo r th o s e u n a b l e a s y e t, to o b ta in e x p e r t t u it io n o n t h e s u b je c t, a f e w g e n e r a l h in ts m a y p r o v e of in terest. N a tu r a lly , o n e ca n o n ly h o p e to to u ch the o u te r f r i n g e o f th e s u b je c t in t h e s e notes. F ir s t th en , let us lo o k a t th e v a r io u s s o u r c e s of su p p ly. T h e s e c a n b e r o u g h l y p l a c e d in t h e f o l l o w i n g o r d e r o f p u r i t y , t h o u g h n o n e c a n be c o n sid e re d e n tire ly free fr o m possible c o n t a m i n a t i o n :— ( 1 ) A r t e s i a n w e l l s ; (2) D e e p w e l l s ; (3) S p r i n g s ; (4) R a i n w a t e r ; (5) L a r g e la k e s (cen tre) ; (6) R iv e r s ( m id s t r e a m ) ; ( 7) S m a l l s t r e a m s ; ( 8 ) L a r g e l a k e s ( n e a r b a n k s ) ; ( 9) S h a l l o w w e l l s ; ( 1 0 ) R i v e r s ( n e a r b a n k s ) ; a n d ( 1 1 ) p o n d s and ca na ls. In a d d itio n , m e n tio n sh o u ld be m a d e of the w a t e r in s h e l l a n d b o m b h o l e s , w h i c h is d a n g e r o u s l y c o n ta m in a te d , a r s e n ic often b e in g p resen t. I m p u r i t i e s p r e s e n t i n w a t e r s u p p l y , a r e f o u n d e i t h e r in s u s p e n s io n (as d e c a y e d v e g e t a t io n , a n d l iv in g o r g a n i s m s s u c h a s d i s e a s e g e r m s ) o r in s o l u t i o n . T h e latter a re c o m p o sed of m in e r a l salts, su c h a s th e c a r b o n a te s a n d the su lp h a tes of calciu m and m a g n e siu m . T h e s e a re often h a r m fu l to d igestio n . T h e d e t e c tio n of p o llu tio n a n d th e p u r ific a tio n of s u p p ly , I w ill d eal w ith n e xt m on th . M ea n w h ile , the M ed ica l S e c t i o n ’ s f i r s t d u t y w o u l d b e t o p r o t e c t t h e s u p p l y , b y p o l i c i n g it , a n d t o r e n d e r it p h y s i c a l l y i m p o s s i b l e f o r t h e m e n t o g e t a t u n u sab le w ater.

S p r e a d b u r y (S erg t.), S ch o o l H o u s e , N o e l-ro ad , W .3 .

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T o u rn iq u e t (T im e and d an ger). T ic k e ts (n am es a n d addresses).

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Publishers N o te.—W ill re a d e r s p le a s e n o te t h a t all b ack n u m b e r s o f " F irs t A id ” a r e now o u t o f p r i n t a n d c a n n o t b e s u p p lie d . W ill S o u th A fric an a n d o th e r C o lo n ial re a d e r s p le a s e a d d t o t h e i r r e m itta n c e s , “ o r E nglish e q u iv a le n t.”

C a r d i f f a n d L l a n d a f f . — -A l a r g e n u m b e r o f r a i l w a y m e n a n d th eir fa m ilies, t o g e t h e r w ith w e ll- k n o w n lo ca l resid en ts g a th e r e d at W h itc h u r c h , C ard iff, for th e p r es en ta tion of a w a r d s g a i n e d b y m e m b e r s of th e C a r d i f f Q u e e n S tr e e t L a d ie s a nd L la n d a ff A m b u la n c e classes. M r . H . J . P e a c o c k , A s s t . S u p t . o f t h e L i n e , w h o is P r e s id e n t of th e W h itc h u r c h D iv isio n of th e S . J . A . B . , pre sid ed, a n d the a w a r d s w e r e d istrib u ted b y M r. H . H . P h illip s, D iv is io n a l T r a ff ic S u p t . for th e C a r d i f f D iv is io n . M r. B . B o a rd , D iv isio n a l A m b u la n c e S e c re ta ry , and M iss F. M oore, S e c re ta r y of th e C a rd iff L a d ie s class, w e re a ls o present. I t i s i n t e r e s t i n g t o n o t e t h a t M i s s M o o r e is t h e fir st l a d y i n t h e C a r d i f f D i v i s i o n t o q u a l i f y f o r t h e G . W . R . IS y e a r e fficien cy m ed a l.

M is s M . P . J e n k in s , c a r r i a g e cle a n e r, C a rd iff, w a s this y e a r ’s w i n n e r o f th e “ A n n B e n c e ” C h a l l e n g e C u p c o m p e t e d fo r b y m a le a n d fe m a le m e m b e r s of the C a r d if f G e n e r a l G . W . R . A m b u l a n c e cla ss. T h e C h a lle n g e Cup, to geth er w ith th e r e p lic a w h i c h s h e w ill r e ta in , w a s p r e s e n te d to M is s J e n k i n s b y D r . C l i f f o r d B e n c e , w h o is l e c t u r e r t o t h e c l a s s a n d fa th e r of th e donor.

O R S A L E . — C o r p s O f f i c e r ’ s U n i f o r m , 42 in . c h e s t , 33 in . i n s i d e l e g ; s u i t m a n 6 ft . 2 in . ; c o m p l e t e l y n e w , n e v e r w orn. A ls o M e s s J a c k e t a n d V e s t , s a m e size. B argain, 10 g u in e a s . N o coupons. B o x 2 8 3 , “ F i r s t A i d , ” 46, Cannon-street, Lo nd on , E .C .4 .

A N T E D . — S .J .A .B . N u r s in g U n ifo rm s, W a n d W X fittin gs. A ls o O ffic e rs ’ U n ifo r m s for n e w D iv isio n b e in g fo rm ed . M rs. T u d o r Jones, H ead ley Rectory, B ordon, H an ts.

E W D iv is io n w is h e s to p u rc h a s e St. Joh n A m b u la n c e U n i f o r m s (m a le ), m u s t b e in g o o d c o n d itio n . Par ticu lars, D iv . S u p t. F . C a rr, 14, W e m b le y A v e n u e , T h o rn to n , B radford, Y o rk sh ire.

R G E N T L Y req u ired, “ S o rb o ” bed fo r tra iler a m b u la n ce. P le a s e c o m m u n i c a t e , g i v i n g p r ic e r e q u ir e d , to C . B en nett, B eccles D iv isio n , St. Joh n A m b u la n c e , IS, D a r b y R o a d , B eccles.

0 fl C o n c e r t T i c k e t s 5/6. M em o s, R u b b e r S ta m p s, R oll Z v U T ick e ts, S am p les— “ A ” T ices, 11, O ak la n d s Grove, London, W .12 .

I R S T A I D C O M P E T I T I O N S are w on by good coach in g . A n y F ir s t A id e r (either s e x ) m a y c o a c h a n y a m b itio u s t e a m — m ale , fe m a le , o r m ix e d — to e a r ly su cce ss. C o m p etition exp erien ce not n ecessary w ith n e w G u id e ( a d a p t a b le to a n y t e x t - b o o k ) . F o r particu lars, send sta m p ed e n v e l o p e t o :— R . J e f f e r y , S, A v e n u e G a r d e n s , L o n d o n W . 3 .

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Queries and Answers to Correspondents Q u e r i e s w i l l b e d e a l t w i t h u n d e r t h e f o l l o w i n g r u l e s :— L — L e t t e r s c o n t a i n i n g Q u e r ie s m u s t b e m a r k e d on th e top le f t - h a n d c o r n e r o f t h e e n v e lo p e “ Q u e r y , ’’ a n d a d d r e s s e d to F ir s t A i d , 46, C a n n o n - s t r e e t , L o n d o n , E . C . 4 .

h e h a d l a i d d o w n In t h e w a t e r , h e s m e l t g a s a n d q u i c k l y b e g a n t o fe e l q u e e r . B e c o m in g d ro w sy, and sen sin g d a n g e r he p u lled the p lu g o u t of th e b a th w ith h is to es a n d fo r th w ith lo st c o n s c io u s n e s s . T h e la st sen ten ce su p p lies th e n a m e of th e so ld ier ( W e r n h e r K u n s t ) an d not th at of the o rig in a to r o f a n e w m e t h o d o f a r t i f i c i a l r e s p i r a t i o n ; a n d it t e l l s u s t h a t fiv e h o u r s l a t e r h e r e c o v e r e d c o n s c i o u s n e s s a n d f o u n d h i m s e l f l y i n g in t h e e m p t y b a t h . — N . C . F .

2 .— A ll Q u e r ie s m u s t b e w r it t e n o n o n e sid e o f p a p e r on ly. 3.— A ll Q u e r ie s m u s t b e a c c o m p a n ie d b y a “ Q u e r y C o u p o n ” c u t f r o m th e c u r r e n t is s u e of t h e J o u r n a l, or, in c a s e of Q u e r ie s fr o m a b r o a d , fr o m a r e c e n t issu e. 4 .— T h e T e x t b o o k to w h i c h r e fe re n c e m a y b e m a d e in this c o l u m n is t h e 3 9 t h ( 1 9 3 7 ) E d i t i o n o f t h e S . J . A . A . M a n u a l of F ir s t A id to th e In ju re d .

A s p h y x ia w ith B le e d in g . E .G . ( R u n c o r n ).— R e c e n tly at B r ig a d e P ractice there arose a d iscu ssion co n c e rn in g w h ich 1 sh ou ld a p p recia te yo u r kin d assistance. T h e q u e s t i o n a s k e d w a s w h a t w e w o u l d d o if a p a t i e n t , w h o is b l e e d i n g p rofu sely, sh o u ld b e c o m e a s p h y x ia te d from s o m e o th er cau se. I said th at I w o u ld t r e a t t h e h a e m o r r h a g e first a c c o r d i n g to th e p r in c i p le s l a i d d o w n in t h e T e x t b o o k a n d t h e n p r o c e e d t o d o artificial resp iration . I w a s told th a t th is w a s th e w r o n g p r o c e d u r e b e c a u s e , w h i l e a s p h y x i a is p r e s e n t, t h e r e w o u ld be no d a n g e r from h a e m o r r h a g e . I t h a n k y o u v ery m u c h fo r all the h elp w h ic h I h a v e re c e iv ed fro m y o u r q u ery colu m n .

A p o p le x y a n d B le e d in g P a lm . G . W . (R is c a , M o n .) .— A s a m e m b e r of a n e w ly registe red N u r s i n g D i v i s i o n o f t h e B r i g a d e I w a s i n t e r e s t e d in t h e t e a m t e s t , d e t a i l s o f w h i c h w e r e p u b l i s h e d o n p. 1 2 5 o f th e M a y issu e of F ir s t A id . I n t h e t e s t t h e p a t i e n t is sta te d to h a v e fa lle n o n to h is fa c e a s th e r e s u lt o f a n a p o p l e c t i c s t r o k e . T h e m a r k i n g s h e e t , h o w e v e r , is s i l e n t a s to w h e n p a t ie n t w a s tu r n e d o n h is b a c k — a s h e o b v i o u s l y w a s ; a n d I s h a l l b e g r a t e f u l if y o u w i l l t e l l m e w h e n this c h a n g e of p osition s h o u ld be effected. I w o n d e r if t h i s w a s d o n e i m m e d i a t e l y a f t e r a r r e s t i n g b le e d in g fro m th e p a lm of the h a n d . I t is n o t p o s s i b l e f o r m e t o k n o w w h a t w a s in t h e m i n d of the j u d g e w h o p rep ared th e test a n d to s a y w h e n he w a n te d th e p atien t tu rn e d on h is b a c k . L ik e you, how ever, I take it t h a t th e im m e d i a t e r e q u ir e m e n t s of th e test w o u l d be to co n tro l th e b le e d in g p a lm b y d ig it a l p r es su r e on the ra dial a n d u ln a r a rterie s, a n d th en , w ith a ll d u e p r e c a u tio n s a g a i n s t a g g r a v a t io n of fr a ctu re s w h ic h m ig h t b e presen t, to tu rn the p a tie n t o n his b a c k b e fo re p r o c e e d in g w it h f u r th e r tre a tm e n t. — N .C .F .

I d e a l A n tis e p tic . I t is t r u e t h a t w i t h t h e o n s e t o f a s p h y x i a , h a e m o r r h a g e d oes b e c o m e re d u ced o w i n g to the w e a k e n e d a c tio n of the h e a r t w h i c h is u n a b l e t o p u m p b l o o d t h r o u g h t h e s y s t e m . Y o u r a n sw e r, h o w ev e r, w a s not qu ite correct b ecau se y o u o u g h t n o t to d e l a y s t a r t i n g a r t i f i c i a l r e s p i r a t i o n u n t i l t h e b l e e d i n g w o u n d h a s b e e n t r e a t e d a s l a i d d o w n in t h e T e x t book. Y o u sh o u ld ra th e r t a k e p rev en tive a c tio n o n ly by p l a c i n g a t o u r n i q u e t in p o s i t i o n if s u c h s t e p is i n d i c a t e d a n d b y c o v e r in g th e w o u n d w ith a te m p o ra r y d r e s s in g so that, w h e n p a t i e n t b e g i n s t o b r e a t h e a n d b l e e d i n g is l i k e l y t o r e start, y o u c a n im m e d ia te ly tig h te n to u rn iq u et. T h is done, y o u s h o u ld a t o n c e re s o r t to a r tific ia l r e s p ira tio n , r e m e m b e r i n g t h a t th is o p e r a tio n , to b e effe c tiv e , m u s t be c o m m e n c e d a t t h e fir s t p o s s i b l e m o m e n t . T h e n w h e n b r e a t h i n g h a s b e e n r e - e s t a b l i s h e d y o u w o u l d d r e s s t h e w o u n d a s l a i d d o w n in th e T e x t b o o k . — N . C o r b e t F i.e t c h e r .

E x a m in a tio n H o w ler. M .R . (C a n n o n S t.). — In a recen t e x a m in a tio n I a s k e d a c a n d id a te w h a t h e w o u ld call a jo in t of w h ic h , a s th e re su lt of an a ccid e n t, on e or m o re b o n es h a d been d is p laced. I c o u ld not resist a sm ile w h e n he r e p lie d — “ S u c h j o i n t w o u ld be d e sic c a te d ! ” T hen, w hen I com m e n t e d — “ W h a t , d r ie d u p ? " h e r e p l i e d — “ O h n o ! I m ean d esecra ted ! ” Good!

N ext, p le a se !

!— N . C . F .

W . L . ( M a u l d e n ) . — O n p. 1 0 6 o f t h e T e x t b o o k it is s t a t e d t h a t a n tis e p tic s w h ic h do n ot stain , b u rn or irritate a n d w h i c h a r e n o t p o i s o n o u s s h o u l d b e u s e d in f i r s t a i d w o r k . C a n y o u p le a s e g i v e m e a list of a n t is e p ti c s w h ic h c o n fo r m to t h e s e r e q u ir e m e n t s ? T h e r e a r e v a rio u s p r e p a r a tio n s w h ic h c o n fo r m to th e d e f i n i t i o n o f t h e i d e a l a n t i s e p t i c g i v e n in t h e T e x t b o o k , t h o u g h it d o e s n o t n a m e a n y o n e of t h e m . T h is apparent om issio n w a s m a d e d elib erately b e c a u s e the s u rg e o n -le c tu r e r ca n e x p la in fu lly th e u se s of w h a t e v e r a n tise p tic he/she recom m ends. F o r a l i k e r e a s o n I g i v e n o lis t . I m ay, h ow e v e r , r e m i n d y o u t h a t , w h e n in 1 9 3 7 , t h e B r i g a d e w a s f a c e d - w i t h t h e s a m e d e c i s i o n , it a d o p t e d s u r g i c a l s p i r i t w h i c h c o n fo r m s to the definition of th e T e x t b o o k a n d w a s r e c o m m e n d e d by a Conference of B rig ad e S u rg e o n s .— N .C .F .

H o m o n r in F ir s t A id . J . S . ( T a v i s t o c k ) . — N o t l o n g a g o in a n e x a m i n a t i o n I a s k e d a c a n d id a t e w h a t w o u ld be his t r e a t m e n t of a p a tien t su fferin g from sh o c k a s th e re su lt of se v ere arterial b leed in g. I w a s a m u s e d w h e n h e r e p l i e d :— " I w o u ld

rem ove h im from a p o sitio n o f d a n g e r : but sin ce the w o u n d is b lee d in g freely I w o u ld ap p ly p ressu re to the artery w h ich is s u p p ly in g the w h o le n eigh b ourh ood w ith b lo o d ! " S o m e w o r k for one a rte ry 1 ! Good!

N e x t , p l e a s e ! !— N . C . F .

E s c a p e fr o m D r o w n in g .

S c h a fe r a n d N ie ls e n .

W . H . ( M id d le s b r o u g h ).— I en clo se a c u t t in g fro m a G e r m a n n e w s p a p e r a n d d ire ct y o u r atte n tio n to th e la st se n te n ce w h ic h c o m m e n c e s w ith th e w o r d s — “ W e r n h e r K u n s t . . .” I s h a l l b e g r e a t l y o b l i g e d if y o u w ill, t e l l m e w h e t h e r o r n o t h i s n a m e r e f e r s t o a n e w m e t h o d of artificial resp iration . M e a n w h ile p lea se a c c ep t m y th a n k s for y o u r a n sw e r.

M . R . ( Y o r k ). — I w is h to d r a w y o u r a tte n tio n to a n a d d itio n al m e t h o d o f a r t i f i c i a l r e s p i r a t i o n u s e d in c o n j u n c t i o n w i t h th e S c h a fe r m eth od . I a m c o n v i n c e d t h a t it c e r t a i n l y is a n i m p r o v e m e n t a n d t h a t it w i l l g r e a t l y h e l p t o r e s t o r e life. O p e r a to r N o . 1 k n e e ls at sid e of the patient, h a n d s in p o s i t i o n . O p e r a to r N o . 2 in s tru c te d b y N o . 1, k n e e ls b y h e a d o f t h e p a t i e n t ( p a t i e n t ’s . p a l m o f h a n d s d o w n w ards). O p e r a t o r N o . 2 th e n lifts p a t i e n t ’s a r m s u p w a r d s a s fa r a s p ossible. T h e n O p e ra to r N o. 1 presses

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F I R S T d o w n a n d w h en he co m es back, O p era to r No. 2 b rin g s t h e a r m s to t h e flo or. T h e t h e o r y is t h a t th e p a tie n t b e in g lifeless c a n n o t of c o u rs e u s e th e c h e st m u scle s, but w i t h t h e a r m m o v e m e n t t h i s w o u l d s u c k a i r in t h e l u n g s w h ile d riv in g ou t th e w a t e r or oth er o b stru ctio n . T h is w a s tried o u t b y o u r d o c to r a n d w a s p roved to b e s u c c e s s ful. Y o u r c o m m e n ts w ill be a p p reciated . T h e m e t h o d d e s c r i b e d is in e f f e c t a c o m b i n a t i o n o f t h e m e th o d s of S c h a fe r a n d N ielsen . C a p t a in A l w y n B is c o e of t h e R o y a l L i f e S a v i n g S o c i e t y t e l l s m e t h a t it i s s e t o u t in d e t a i l u n d e r t h e n a m e s o f D r i n k e r a n d S h a w in a b o o k e n t i t l e d B r e a t h in g M a c h in e s a n d T h e ir U ses in T rea tm en t p u b lish ed b y th e M e d ic a l R e se a rc h C o u n cil. A s y o u s u g g e s t , t h e p a t i e n t is p l a c e d f a c e d o w n w a r d s , a n d on e o p era to r a p p lie s th e u s u a l p rone p ressu re m ethod. T h e o t h e r o p e ra to r, k n e e l i n g a t th e p a t ie n t ’s h e a d e x t e n d s a n d r a is e s th e a r m s a t t h e m o m e n t w h e n th e first o p e ra to r r e le a s e s t h e p r e s s u r e on t h e l o w e r p a r t of t h e t h o r a x . A ssist a n c e is t h u s g i v e n b o t h t o i n s p i r a t i o n a n d e x p i r a t i o n , a n d it is p o s sib le th a t th is m e th o d p r o d u c e s a s lig h t ly g r e a t e r v e n tila t io n t h a n t h a t of S c h a f e r ; b u t, D r i n k e r s t a te s , “ e x p e r ie n c e h a s n o t s h o w n th e a d v a n t a g e s to b e g r e a t e n o u g h to w a r r a n t d i s c a r d i n g all th e e d u c a t io n a l p u b lic ity w h i c h h a s been d ev e lo p e d for th e p ron e p ressu re m eth o d , a n d re - tr a in in g the l a r g e n u m b e r s o f p e r s o n s n o w s k i l l e d in i t s u s e . ” — N . C . F .

A c tio n o f C o ffe e . A . E . ( R h o n d d a ) . — P le a s e tell m e w h a t e ffe ct or a c ti o n s t r o n g b l a c k coffee h a s w h e n a d m in is te r e d to a p a tie n t w h o h a s b een b itten b y a ra b id a n im a l. A ls o p lea se a c c ep t m y t h a n k s fo r th e g r e a t h e lp w h ic h I h a v e re c e iv ed from y o u r a n s w e r s t o m y q u e r i e s in t h e p a s t . C o f f e e c o n t a i n s a n a c t i v e p r i n c i p l e w h i c h is c a l l e d c a f f e i n e a n d w’ h i c h a c t s a s a s t i m u l a n t . T h e T e x t b o o k in this i n s t a n c e ( R u l e 2, p. 1 3 4 ) s u g g e s t s a d m i n i s t r a t i o n o f c o f f e e a s a n a lt e r n a t iv e to th e u s e of b r a n d y o r w h i s k y . F u r t h e r , to g e t t h e m a x i m u m e f f e c t it t e l l s u s t o g i v e t h e c o f f e e h o t a n d a ls o b l a c k , th a t is s t r o n g . — N . C . F .

E p ile p t ic F it a n d F r a c t u r e d L e g . A . C . ( S t r e a t h a m ) . — W e s h a l l b e g l a d if y o u w i l l g i v e u s t h e b e n e fit of y o u r o p in io n a s to th e b e s t first a id t r e a t m e n t i n t h e f o l l o w i n g c i r c u m s t a n c e s :— “ A f i r s t a i d e r is a l o n e w i t h a m a n w h o f a l l s a n d fr a c tu r e s h is l e g a n d b e fo re h e h a s tim e to co n tro l the f r a c t u r e in a n y w a y t h e p a t i e n t h a s a n e p i l e p t i c f i t . ” S o m e of o u r c la ss d ec id e d to su p p o rt th e fra ctu re d l e g u n til th e co n v u ls io n s ce ased , to p rev e n t a n y a g g r a v a tion of th a t k n o w n in ju ry, a n d to r is k the c h a n c e of p a tie n t b it in g h is t o n g u e o r k n o c k i n g h is h ead . O ther m e m b e r s d ec id e d to su p p o rt th e h ead a n d p rev e n t b itin g o f t o n g u e a n d to le a v e th e fr a c tu r e u n c o n tr o lle d u n til the co n vu lsio n s ceased . M ea n w h ile our thanks. I n a n e p i l e p t i c fit t h e c o n v u l s i o n s m u s t r u n t h e i r c o u r s e . C o n s e q u e n t l y , 1 a m a f r a i d t h a t t h e r e is n o t h i n g w h i c h y o u c a n d o to p r ev e n t a g g r a v a t i o n of fr a c tu r e d le g . So m etim es, h o w e v e r , a t t h e o n s e t o f t h e fit t h e r e i s a s h o r t p e r i o d d u r i n g w h ic h all th e v o lu n t a r y m u s c le s b e c o m e tau t. If th is h a p p e n s , y o u h a v e th is b rief s p a c e of tim e d u r in g w h ic h y o u c a n t a k e w h a t p r e v e n t i v e a c t o n is p o s s i b l e . — N . C . F .

A I D t e ll m e o n w h i c h s i d e t h e r i b b o n s h o u l d b e w o r n o n H o m e G u a r d un ifo rm . T h e ty p e of u n ifo rm d oes n ot affect y o u r q u estion , b e c a u s e th e R a i l w a y rib b o n c a n n o t be w o r n o n th e left b reast. Y o u sh o u ld h o w e v e r, ob tain th e a p p ro v a l of y o u r P la to o n C o m m a n d e r befo re p la c in g the rib b o n on H o m e G u a r d u n ifo rm .— E d it o r .

T r e a tm e n t o f F r a c tu r e d R ib s . B . R . (Ip sw ic h ).-— R e c e n t l y a t a F . A . P o s t I h a d to a tt e n d a p a t i e n t f o r a s i m p l e f r a c t u r e o f t h e r i b s ( le f t s i d e ) . I let p a tie n t r e m a in se a te d , ap p lie d t w o b ro a d b a n d a g e s , l a r g e a r m s l i n g , t h e n in m y t r e a t m e n t f o r s h o c k I d id n o t k n o w w h e r e to p la c e th e h o t w a t e r bottle. S o I p l a c e d it o n t h e r i g h t ( u n i n j u r e d ) s i d e t h i n k i n g t h a t if I p l a c e d i t o n t h e i n j u r e d s i d e it m i g h t c a u s e c o n g e s t i o n ; b u t I a m s t i l l w o n d e r i n g w h i c h is correct. I s h a l l be p le a s e d to r e c e iv e y o u r r e p ly for w h ich I th a n k you. I f y o u r p a t i e n t w a s a b l e t o r e m a i n in a s e a t e d p o s i t i o n , it w o u l d s e e m ( 1 ) t h a t h e w a s n o t s u f f e r i n g s e v e r e l y f r o m s h o c k a n d (2) t h a t h is c o n d it io n d id n o t in d ic a t e t h e a p p l i c a tion of e x t e r n a l h eat. I n r e p ly to y o u r sp ecific q u e s tio n a h o t - w a te r b ottle p l a c e d o v e r f r a c t u r e d r i b s is n o t l i k e l y t o c a u s e c o n g e s t i o n a n d m i g h t a f f o r d r e l i e f t o t h e a s s o c i a t e d p a i n if t h i s s h o u l d be severe. I n t h i s c o n n e c t i o n I r e f e r y o u t o p. 4.S o f t h e T e x t b o o k w h e r e u n d e r t h e t r e a t m e n t o f s h o c k i t t e l l s y o u to a p p l y h o t w a t e r b o ttle s to th e sid e s o f th e b o d y , b e t w e e n the le g s a n d to th e fe e t.— N . C . F .

F r a c t u r e s o f P e l v is a n d F e m u r . M . S . ( C a m b r i d g e ) . — A t a r e c e n t c o m p e t i t i o n h e l d in C a m b r i d g e t h e f o l l o w i n g c a s e w a s s e t :— A m a n w a s foun d on the g r o u n d u n co n scio u s h a v in g fallen from a la d d e r w h ic h w a s n e a r b y a n d s u fferin g fr o m fr a c tu r e s of p elvis a n d fe m u r (m id d le of sh a ft) w a s treated . A ll th e c o m p e tito rs u sed a splin t for g r e a t e r s e c u rity fro m th e h ip d o w n w a r d s , b u t th e e x a m in in g o fficer ru led th at a s p lin t s h o u ld n ot b e used. W o u ld y o u k in d ly g i v e y o u r v ie w s on th is case, a s a t a recent D iv isio n a l P ractice th ere w a s con sid erab le d ifferen ce of op in ion ? W i t h t h i s c o m b i n a t i o n o f i n j u r i e s t h e f r a c t u r e d f e m u r is m o re lia b le to a g g r a v a t i o n a n d s h o u ld c o n s e q u e n t ly re c e iv e p referential tre atm e n t. In oth er w o rd s, I a g r e e w ith the m e m b e r s o f y o u r c l a s s a n d if I h a d t o d e a l w i t h t h i s c o m b i n a t i o n I w o u l d t r e a t t h e f r a c t u r e d t h i g h a s l a i d d o w n in th e T e x t b o o k a n d k n o w th a t th e fr a c tu r e d p elvis w o u ld be p rop erly co n tro lled .— N .C .F .

C o m p r e s s io n o f B r a in a n d A p o p le x y . P . M . ( C o v e n t r y ) . — P l e a s e t e l l m e w h a t is t h e e s s e n t i a l d i f f e r e n c e b e tw e e n C o m p re s sio n of b rain a n d A p o p le x y. B o t h c o n d i t i o n s r e s u l t f r o m b u r s t i n g o f a b l o o d v e s s e l in th e b r a in a n d c o n s e q u e n t rise o f p r e s s u r e w ith in th e s k u ll. B o th p ro d u ce th e sa m e s ig n s a n d sy m p to m s a n d b o th call for th e s a m e t r e a tm e n t. In C o m p ressio n , h o w e v e r, a cciden t, in A p o p le x y , d is e a s e is th e c a u s e of th e r u p tu r e d v essel. In short, doctors d ia g n o s e A p o p le x y by the sig n s a n d sym p to m s o f C o m p r e s s i o n , c o m b i n e d w i t h t h e f a c t t h a t t h e r e is n o h isto ry o r e vid e n ce of h e ad in ju rie s.— N . C . F .

H o m e G u a rd U n ifo rm . W . M . ( R u a b o n ) .— I h a v e b een a m e m b e r of the St. Joh n A m b u la n c e A ssociation (G rea t W e s te rn R a ilw a y Centre) fo r t h e p a s t t w e n t y - e i g h t y e a r s ; a n d I h o ld th e fifteen a n d tw enty-fiv e y e a r g o ld m ed als. A s a m e m b e r of the B r i g a d e I w a s su p plied w ith a rib b o n for th ese m ed a ls w h ic h sh ou ld be w o rn on the r ig h t breast. A s a first a id t r a i n e r i n t h e H o m e G u a r d I s h a l l b e o b l i g e d if y o u w i l l

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- A

I P

is a semi-fluid o in t m e n t , m o r e c o n v e n ie n t th an the o r d in a r y A n t i p e o l o in t m e n t f o r o c u l a r in fection s a n d lesions. E y e s affected b y s m o k e and d us t are s o o t h e d a lm o s t im m e d ia t e ly b y the a p p li ca tio n o f O p h t h a l m o - A n t i p e o l , a nd the a ntiv ir u s p r e v e n t s g e r m s f r o m d e v e lo p i n g .

I N

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T I P E O

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E n te r e d a t 1 {.S ta tio n e rs H a it i

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R E A D E R S.

E D IT O R IA L .

F U ^5 T A ID is p u b lis h e d o n th e 20t h o f e a c h A n n u a l S u b s c rip tio n is 4 S . p o s t fre e ; s in g le c o p ie s 3 d .

m o n th *

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used lin e .”

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CO N TEN TS

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...

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T h e H o m e G u ard and F irst A id

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th e a rriv a l o f th e d o c to r w h o , a s so o fte n

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at le a st b e a b le

a n d to s a y w h a t th e y

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form .

The Future of the St. John Ambulance Brigade. B

CO RBET

F L E T C H E R , M .A ., S u rgeo n -in -C h ief.

M .B .,

M .R .C .S .,

R e c e n t l y s o m e o n e ra ise d a q u estio n a s to the fu tu re of the B r i g a d e a n d a s k e d w h a t in m y o p i n i o n w i l l b e i t s l i k e l y position a t th e te r m in a tio n of th e p resen t h ostilities. W h i l s t it is d i f f i c u l t t o f o r e c a s t t h e e x a c t l i n e o f d e v e l o p m en t, so m e g u id a n c e m a y b e o b tain ed b y lo o k in g b a c k w a r d s to th e W a r of 1 9 1 4 - 1 8 a n d b y c o n s id e r in g h o w fa r th e e x p e r i e n c e of t h a t t im e w ill a p p ly to th e fu tu re . D u r i n g th e la s t W a r m a n y n e w D iv is io n s c a m e into b e in g , a n d the estab lished D iv isio n s received m a n y n e w m em bers. T h e r e w a s a n a t u r a l d e s i r e t o h e l p in t h e w a r effort a n d r e c r u it s w e r e e n c o u r a g e d to t a k e u p w o r k fo r th is purpose. T h i s w a s a c o m m e n d a b le idea. A s, h o w e v e r, the m e n a n d w o m e n h ad jo in ed fo r w a r service, th e y w e r e p e r h a p s j u s t i f i e d in t h i n k i n g t h a t w i t h t h e e n d o f t h e W a r t h e i r w o r k also ended. C o n s e q u e n tly th ere w a s a c on sid erab le f a l l i n g o f f i n t h e n u m b e r o f D i v i s i o n s a n d in t h e m e m b e r s h i p of th e D iv isio n s w h ic h rem ain ed . I n d e e d , it w a s n o t u n t i l 192 2 th a t th e B r i g a d e R o ll w a s stabilised. T h i s s ta te of a f f a i r s is n o t d e s i r a b l e ; a n d it m u s t b e t h e a i m o f e a c h o n e o f u s to m a in t a in o u r s t r e n g t h , no less t h a n o u r efficien cy, a t th e en d of th is w a r . A t th e o u t b r e a k of th e p resen t h o stilities th e C h ie f C o m m issio n e r w is e ly d ec id ed th at th e p ersonn el of th e B r ig a d e s h o u ld offer th e ir serv ices, a s in d iv id u a ls , to th e lo ca l a u t h o r i ties w h o h a d b een g iv e n th e re sp o n s ib ility of o r g a n i s i n g the c a s u a l t y s e r v i c e in C i v i l D e f e n c e . T o m a n y th is se em ed a w a y of lo s in g o u r id e n tity a s a n o rg a n is a tio n ; a n d to so m e e x te n t th is w a s tru e, t h o u g h , a s th e o n u s w a s on th e local a u th o r itie s to fo r m the n e w units, th e step co u ld not be avo id ed. O u r p r o b le m , h o w e v e r , is to c o n s id e r w h a t c a n b e d o n e t o r e g a i n , w h e n f i g h t i n g e n d s t h e s t a n d i n g w h i c h w e h a d in 1 9 3 9 , a n d t h e n t o t r y t o e s t i m a t e t h e d e v e l o p m e n t ’s w h i c h m a y t a k e p lace. F ir s t a n d f o r e m o s t I w o u ld u r g e th e n e c e s s it y for m a i n tain in g h ap p y and p r o s p e r o u s D i v i s i o n s , in w h i c h t h e D iv isio n a l S u r g e o n s p la y a m ost im p o rta n t part. A good S u r g e o n w ill c o n tr ib u te m u c h t o w a r d s th e m a in t e n a n c e of a g o o d D iv is io n b y s t i m u l a t i n g th e in te re s t of m e m b e r s a n d so h e lp in g to a ttr a c t re cru its ; a n d w it h o u t a g o o d S u r g e o n no D iv is io n c a n r e a lly flourish. T h e m a jo r it y of S u r g e o n s a r e e a g e r to h e lp a n d to g i v e o f t h e i r s p e c i a l k n o w l e d g e ; b u t a t t i m e s t h e y fin d t h a t t h e y g e t little a s s is t a n c e fr o m th e L a y O ffic e r s of th e ir D iv is io n . I n s h o r t , in t o o m a n y i n s t a n c e s t h e S u r g e o n s a r e t r e a t e d a s m e r e fig u r e -h e a d s , a r e g iv e n no real in s ig h t into D iv is io n a l a ctivitie s, a n d a r e left to t h in k o u t th eir o w n m e th o d s for t r a i n i n g t h e m e m b e r s a n d t o d i s c o v e r w h a t is h a p p e n i n g in th eir u n its. I t m u s t b e r e m e m b e r e d th a t th e S u r g e o n , w h o is the t e c h n ic a l h e a d , d o e s n o t k n o w th e w o r k o f th e B r i g a d e to th e s a m e e x t e n t a s d o e s t h e S u p e r i n t e n d e n t w h o is t h e e x e c u t i v e

R I D h e a d of th e D iv isio n ; a n d th a t a D iv isio n w ill o n ly be h app y a n d pro sp ero u s w h e n th ese tw o O fficers w o r k han d -in -han d. A c a s e c a n be cited of a g e n e r a l p r a c titio n e r w h o a t th e outset of h is c a re e r w a s a s k e d to a ssist a D iv isio n . H e w a s told t h a t h e w a s f a r too b u s y a m a n to a t t e n d w e e k l y l i k e the o t h e r m e m b e r s a n d t h a t if h e c o u l d a t t e n d o n c e e a c h m o n t h h e w o u ld a fford h elp w h ic h w o u ld be g r a t e fu lly a ccep ted . T h e o u tc o m e of th is w a s th at the e n th u s ia s m of th is S u r g e o n w a s e x c ite d ; th a t for m a n y y e a r s th e S u p e r in te n d e n t a n d he u s e d t o v i e w i t h e a c h o t h e r f o r t o p p l a c e in t h e a n n u a l r e c o r d of a tt e n d a n c e s a t D iv is io n a l p r a c tic e s ; a n d t h a t th is unit b eca m e h ap p y and prosperous. M y se co n d a n d e q u a lly im p o r ta n t p oin t is th a t a ll m e m b e r s m u s t g i v e o f t h e i r b e s t in w h a t s o e v e r a m b u l a n c e d u t i e s th ey a re e n g a g e d w ith in a n d w ith o u t th eir D iv ision s. By so d o i n g th e y w ill c r e a t e a n a tm o s p h e r e fa v o u r a b le to the B r i g a d e w h i c h m a y b e s u b m e r g e d f o r a t i m e in t h e C i v i l D e f e n c e O r g a n i s a t i o n e v e n if a t t h e o u t b r e a k o f w a r in 1 9 3 9 m a n y of its u n its fo r m e d th e n u c le u s o f t h is S e r v ic e . N ever th eless, th e k n o w le d g e th at th ey a re B r ig a d e m em b e rs and a r e g i v i n g re a l h elp w ill a l w a y s be r e c o g n ise d . T h e r e h a v e c o m e t o m y n o t i c e i n s t a n c e s in w h i c h t h o s e in c h a r g e of lo c a l C i v il D e f e n c e u n its h a v e e x p r e s s e d th eir sa tisfa ctio n w ith certain in d ivid u als an d h a v e been g ra te fu l t o t h e B r i g a d e f o r t h e w o r k d o n e in m a k i n g t h e m s o e f f i c i e n t . A g a in , the o fficer-in -ch arge of a certa in B lo o d D o n o r O r g a n isa tio n told m e th a t w h e n s o m e of o u r A m b u l a n c e S iste rs a tte n d e d fo r d u ty , s h e h a d n o c a u s e to w o r r y b e c a u s e th o se m e m b e r s k n e w th eir w o r k ; a n d s h e a ls o w a s g r a t e f u l to the B r i g a d e . A g a i n in t h e v o l u n t a r y a s s i s t a n c e g i v e n t o h o s p i t a l s B r ig a d e p ersonn el freq u e n tly sta n d ou t as in d ivid u als w h o a r e h i g h l y efficien t a n d d e m o n s t r a t e th e r e s u lt s o f g o o d t r a i n i n g in t h e B r i g a d e b e f o r e t h e y t o o k u p h o s p i t a l d u t i e s . T h e effect of th e g o o d im p r e s s io n s t h u s m a d e w ill be t h a t in t h e f u t u r e a s in t h e p a s t t h e r e w i l l a l w a y s r e m a i n a h i g h r e g a r d fo r th e B r i g a d e a n d its p e rs o n n e l w h e n th e need f o r t h e i r h e l p in C i v i l D e f e n c e h a s p a s s e d . M o r e o v e r , the m e m b e r s t h e m se lv e s w ill c e a s e th eir w a r a c tiv itie s w ith the k n o w l e d g e t h a t it w a s t h e B r i g a d e w h i c h e n a b l e d t h e m to r e n d e r e ffic ien t s e r v ic e a n d t h e y w ill re ta i n a n a ffe c tio n for th e o rg a n is a tio n w h ic h w ill g o a lo n g w a y t o w a r d s c a u s in g t h e m to r e m a i n m e m b e r s o f th e B r i g a d e . W h i l s t it i s u s e f u l a t p r e s e n t t o e n r o l m e m b e r s w h o a r e k e e n t o h e l p in t h e w a r e f f o r t , it is u n d e s i r a b l e t o s e e k s u c h in d iv id u a ls b e c a u se w e k n o w th a t m a n y w ill d ese rt w h e n the w a r is en d ed . B u ild in g u p th e m e m b e rsh ip of o u r D iv isio n s s h o u ld b e d o n e w it h a n e y e to th e fu tu r e a n d its n e ed s. F u r t h e r , it is e s s e n t i a l t o t a k e s t e p s t o k e e p in t o u c h w i t h t h o s e o f o u r p r e s e n t m e m b e r s w h o a r e s e r v i n g in H . M . F o r c e s o r for o th er re a so n s a re te m p o ra r ily a w a y fro m h o m e . If t h e s e feel t h a t t h e y a r e f o r g o t t e n n o w a n d t h a t b e i n g o u t of s i g h t is b e i n g o u t o f m i n d , t h e y w i l l c o n s i d e r t h a t t h e y a r e n o t r e a l l y w a n t e d , a n d t h e y w i l l n o t r e t u r n t o t h e B r i g a d e fo r th e p e a ce-tim e w o r k w h ic h w ill s u re ly com e. N e w l y e n ro lle d m e m b e r s s h o u ld b e m a d e to r e a lis e th a t t h e B r i g a d e is p r i m a r i l y a c i v i l i a n o r g a n i s a t i o n f o r d e a l i n g w i t h c i v i l i a n e m e r g e n c i e s ; t h a t it s e r v e s i t s m o s t u s e f u l p u r p o s e in d a y s o f p e a c e ; a n d t h a t it w i l l h a v e n e e d f o r t h e i r s e r v i c e s w h e n t h e w a r is o v e r . F u r t h e r , t h e y s h o u ld b e told s o m e t h i n g a b o u t t h e w o n d e r f u l h i s t o r y o f t h e O r d e r w h i c h is t h e g o v e r n i n g b o d y a n d e s p e c i a l l y t h e w a y s in w h i c h f o r m a n y c e n t u r ie s its m e m b e r s h a v e e v e r s o u g h t to g i v e h e lp to th e s ic k a n d injured. M y t h i r d a n d f in a l p o i n t i s t h a t e v e r y t h i n g p o s s i b l e s h o u l d b e d o n e t o e n c o u r a g e o u r A m b u l a n c e a n d N u r s i n g C a d e t s on w h o m the fu tu re of the B r ig a d e d ep end s. A l t h o u g h it i s 20 y e a r s s i n c e t h e C a d e t s w e r e f i r s t a d m i t t e d t o t h e B r i g a d e , it i s o n l y in t h e l a s t t w o y e a r s t h a t a n o t e w o r t h y i n c r e a s e in th eir n u m b e rs h a s b een ob tain ed . T o -d a y , a s part of the Y o u t h M o v e m e n t , b o y s a n d g ir ls a r e b e i n g u r g e d to u n d e r t a k e so m e form of pre-service t r a i n i n g ; an d m a n y h a v e jo in ed o u r r a n k s , t h e r e b y o b t a i n i n g i n s t r u c t i o n in m a t t e r s w h i c h w i l l b e o f g r e a t a s s i s t a n c e t o t h e m t h r o u g h o u t t h e i r l iv e s ,

F u r t h e r , t h e k e e n n e s s o f o u r C a d e t s is p r o v e r b i a l ; a n d e r e th is s o m e h a v e d o n e o u t s t a n d in g w o r k . A s to th e fu t u r e I se e n o g r o u n d s fo r t h i n k i n g t h a t th e m ain s tru ctu re of the B r ig a d e w ill be a ltere d , e sp e c ia lly the p r o u d f a c t t h a t i t is a v o l u n t a r y o r g a n i s a t i o n o f w h i c h a l l it s m e m b e r s , fr o m th e C h ie f C o m m i s s i o n e r d o w n to its m o s t ju n io r C a d et, g iv e th eir services w ith o u t a n y p a y m e n t or other financial r e w a r d . T h e r e m a y b e a t e n d e n c y for th e v o lu n t a r y o r g a n i s a t i o n s i n t e r e s t e d in f i r s t a i d t o w o r k in c l o s e r c o n t a c t and e ven to m e r g e . N e v e r t h e l e s s , in p r o p o r t i o n a s o u r m e m b ers w o r k e ffic ien tly n o w a n d d o th e ir u t m o s t to u p h o ld the g o o d n a m e an d tradition s of th e B rig a d e , even so w ill the s t a n d i n g o f t h e B r i g a d e b e r a i s e d a n d i t s p o w e r in a n y s u c h m e r g in g b e increased. It h a s b e e n s a id t h a t C i v il D e f e n c e h a s c o m e to s ta y . T h i s m e a n s t h a t a ft e r t h e w a r t h e r e w ill still r e m a in s o m e k in d of o r g a n is a t io n , p o s s ib ly u n d e r th e lo c a l a u t h o r it ie s , to k e e p t h e s y s t e m in f o r c e a n d r e a d y f o r a n y n e w e m e r g e n c y . P e r s o n a l l y I d o u b t v e r y m u c h if t h i s w i l l b e o n a p a i d b a s i s ( e x c e p t p e r h a p s w i t h a f e w i n d i v i d u a l s ) ; a n d I f a n c y t h a t it w ill be e s ta b lis h e d on th e v o lu n t a r y s y s te m . In su ch post w a r o r g a n i s a t i o n t h e B r i g a d e w i l l t a k e i t s f u l l s h a r e , if o n l y w e m a i n t a i n o u r e f f i c i e n c y t o t h e fu ll a n d if w e — e a c h a n d a l l — re m ain tru e to th e g lo r io u s tra d itio n s of T h e O r d e r a n d the B rig a d e .

St. John Ambulance Association. B a l h a m . — T h e A u t u m n p r o g r a m m e o f t h i s B r a n c h is a n a tt r a c t iv e o n e a n d h a s b e en a r r a n g e d to m e e t r e q u e s ts from a ll q u a r t e r s . T h e u se of R a v e n s to n e S tre e t S ch o o l w as o b tain ed d u r in g the s u m m e r , a s a n e w m e e t in g p lace, a n d it s f a c i l i t i e s h a v e b e e n v e r y m u c h a p p r e c i a t e d . T h e r e s u l t s o f t h e f i r s t e x a m i n a t i o n s h e l d in t h e S c h o o l in J u l y , s h o w e d t h a t a l l t h e e n t r a n t s o b t a i n e d c e r t i f i c a t e s , a n d it is h o p e d t h a t t h i s i s a g o o d o m e n f o r t h e f u t u r e . T h e n e w sessio n c o m m e n c e s w ith tw o e n r o lm e n t m e e t i n g s , f r o m 7 . 3 0 p . m . t o 9 . 3 0 p . m . , o n M o n d a y , A u g u s t 3 0 th , f o r t h o s e i n t e r e s t e d in F i r s t A i d , a n d o n T h u r s d a y , S e p t e m b er 2nd, for H o m e N u r s i n g . T h e C l a s s S e c r e t a r y w i l l b e in a tt e n d a n c e on b o th e v e n i n g s to g i v e a n y in f o r m a tio n . Any l a d y o r g e n t l e m a n i n t e r e s t e d in t h e f i r s t a i d m o v e m e n t w i l l be w elcom ed .

British Red Cross Society. B r is t o l .— T h e B ristol B ra n c h of th e B ritish R e d C ro ss S o c i e t y h e ld t h e ir a n n u a l first a id c o m p e t i t i o n a t C o t h a m S e c o n d a ry S ch o o l on S a tu rd a y , J u ly 31st. O w i n g to S e r v ic e d e m a n d s th e w o m e n ’s d e t a c h m e n t s d id n o t c o m p e t e fo r the “ L a d y W i l l s ’ ” C u p , b u t s i x t e a m s w e r e e n t e r e d b y th e m e n ’s d e ta ch m e n ts to c o m p e te for th e “ S ir P e te r W i l l s ’ ” C u p . D r. L . E . C la re m o n t, A ss ista n t C o u n ty D ire c to r, w a s re sp o n s ib le for th e e fficien t o r g a n is a t io n of th e c o m p e titio n , an d D r. C. C. L a v in g to n , V ic e -P re s id e n t of th e B ristol S .J .A .A ., w a s the ju dg e. T h e w i n n i n g t e a m r e p r e s e n t i n g D e t a c h m e n t 1 1 w a s :— L e a d e r , W . G . N . W i lli a m s , C o m m a n d a n t ; N o . 1, W . E . G . P r i t c h a r d , S e c t i o n L e a d e r ; N o . 2, A . H . P r e s s , N o . 3, R . P . D y e r , N o . 4, S . G . Y o r k e , M e m b e r s .

L a d y W ills, w h ose presen ce w a s m u ch ap p recia ted by th e a s s e m b ly , m a d e o n e of h e r first p u b lic a p p e a r a n c e s a ft e r a se v er e illn ess, to p r es en t th e C u p . D r . L a v in g to n then add ressed th e co m p e tito rs a n d m a d e v a rio u s h elp fu l s u g g e s tion s for th eir fu tu r e g u id a n c e . V o t e s o f t h a n k s to L a d y W i ll s a n d D r . L a v i n g t o n received g e n e r a l a c c la m a t io n a n d c o n c lu d e d a p le a s a n t a n d in stru ctive e ve n in g .

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N o . U S ( E d g w a r e a n d M ill H il l ) D ivisio n .— M e m b ers of th is D iv is io n s e r v i n g w ith H . M . F o r c e s w ill le a rn w ith r e g r e t of th e p a s s in g su d d e n ly, on J u ly 22nd, a t R e d h ill C o u n t y H o s p i ta l, of C o rp l. E . C h i d w i c k . Co rp l. C h i d w i c k w a s a l w a y s a n u n ti r in g a n d z e a lo u s w o r k e r in h i s D i v i s i o n a n d in C i v i l D e f e n c e i n t h e c a u s e o f first a id . H i s d e a t h is a g r e a t l o s s t o t h e D i v i s i o n . T h e B r ig a d e a r r a n g e m e n ts for th e in te rm e n t w e r e a d m i r a b l y c a r r i e d o u t b y S e r g t . J. A . W e b b , t h e r e p r e s e n t a t i v e s n u m b e r in g 16, in c lu d in g L a d y D iv . S u p t. M rs. E . M c C a b e of the 101 ( E d g w a r e a n d M ill H ill) N u r s in g D iv is io n a n d P t e . H . S a r g e a n t ( b r o t h e r - i n - l a w ) of t h e 28 ( H a r r o w a n d W e a ld s to n e ) D ivisio n . F lo ra l trib u tes w e re se n t on b e h a lf of the tw o E d g w a r e D iv is io n s . T h e c a s k e t w a s b o rn e a n d g u a r d e d b y S e r g t. S. N e w , C o r p l. A l d r i d g e a n d P te . B u t l e r (of th e 1 1 Sth), w i t h P te. H S a r g e a n t ( o f t h e 2 8 t h ) , w h i l s t in t h e f i n a l s t a g e D i v . S u p t . W . H . L a n e , w h o h a d c o m m a n d e d th e p a rty, rep la ced Pte. B u tle r— a g e s tu r e m u c h a p p re c ia ted by th e relatives. T h e in term en t to o k p la ce at H e n d o n P a r k C e m e te r y on W e d n e s d a y , J u l y 28th.

N o . 150 ( B o r o u g h o f R o m f o r d ) D ivisio n . — I n ce le b r a ti o n of t h e first a n n i v e r s a r y o f t h e f o r m a t i o n of th e R o m ford C a d e t D iv is io n s , the C a d e ts a n d th e ir p a re n ts m et at D iv isio n a l H e a d q u a r t e r s on S a t u r d a y , J u ly 24th, for a B irth d ay Party. T h e re w e re present M iss P a rro tt ( L a d y D is tric t O fficer G irl C a d ets), C o u n c illo r M rs. W h ite , D iv. S u p t. D . B. H o w a r d a n d L a d y A m b . O ffic e r G . B ritto n (of the 10 8N D iv isio n ). A n a p o l o g y fo r in a b ility to a tte n d w a s r e c e iv e d fr o m D iv . S u p t . E . H o w a r d (ISO A m b u l a n c e D i v i sion ) w it h b est w is h e s for th e s u c c e s s o f th e p a rty . T h e p r o g r a m m e w a s a v e r y full one, i n c lu d in g d e m o n sta tio n s b y the C a d ets, s o n g s b y th e C a d e t C h o ir, a n d in d i v id u a l ite m s. T h e b o y s g a v e d e m o n s t r a t i o n s of first a id a n d ph y sica l tr a in in g ; th e g ir ls of b e d - m a k in g a n d ph ysica l t r a i n i n g ; a n d b o y s a n d g i r l s c o m b i n e d in t h e p r e s e n t a t i o n o f c o u n try d a n c e s — a n in te g ra l part of th eir p h y sic a l t ra in in g . T h e r e w a s a selection of H a n d w o r k by th e C a d e t s on v ie w , i n c lu d i n g a r tic le s m a d e in w o o d a n d m e ta l, w e a v i n g a n d strin g w o rk , b o o k crafts and toy m a k in g , e m b ro id e ry and a r t ; in a d d i t i o n a s m a l l c o n t r i b u t i o n f r o m t h e C a d e t A l l o t m en t. A s m a ll tab le, th e w o r k of o n e of th e b o y s, w a s g iv e n to th e S e n io r N u r s i n g D iv isio n . D u r i n g th e a ft e r n o o n a c u p — to b e k n o w n a s th e “ S y d n e y U p to n ” C u p — w a s p resen te d to e a c h of th e C a d e t D i v i s i o n s b y L . D / O M i s s P a r r o t t f o r c o m p e t i t i o n in I n d i v id u a l F ir s t A id . T h e d on or w a s L .A / O Jo yce U p to n , a fo rm er G ra n d P rio r C adet. A book, g iv e n by C o u n cillo r M rs. W h ite , w a s a lso p resen te d to the C a d e t N u r s in g D iv i s i o n in a p p r e c i a t i o n o f t h e w o r k d o n e b y t h e g i r l s in t h e lo ca l h o sp ita l. Im m e d ia te ly before th e tea in te rva l, s ix g ir ls w e re e n rolled b y L . D / O M iss P a r r o tt. T h e s e th en to o k th eir a l l o t t e d p l a c e s in t h e f o r m a t i o n o f t h e S t . J o h n C r o s s . A t th e en d of th e e v e n in g prize s w e re p res en te d to th e w in n e r s of th e c o m p e titio n s, a n d C a d e t F r a n k S m ith p re sen ted M iss P a rro tt w ith a b o u q u e t of roses on b e h a lf of the Cadets.

N o . 69 ( B o r o u g h o f L e w i s h a m ) N u r s i n g D i v is io n .— O n S a t u r d a y , J u ly 10th, a la r g e g a t h e r i n g of p eople e n jo y e d a D is p la y , D a n c e and S o cia l a t St. M a r k s C h u r c h H a ll,

F I R S T P e c k h a m , w h e r e th e n e w P e c k h a m S e c t io n h old th e ir c la s s e s e v e ry T h u r s d a y even in g. T h e officers a n d m e m b e r s of th e L e w i s h a m N u r s in g D iv is io n a n d H it h e r G r e e n S e c tio n m e m b e rs assisted th e n e w P e c k h a m S e c t i o n in p r o d u c i n g a d i s p l a y o f g e n e r a l s m a r t n e s s a n d e ffic ie n c y in first a id , e tc ., a n d to a d v e r t is e t h e S e c t i o n o f N u r s e s n o w in P e c k h a m . T h e D is p la y o p e n e d w ith a n In s p e c tio n of O fficers, m e m b e r s a n d C a d e t s ( n u m b e r i n g o v e r SO) b y t h e M a y o r a n d M a y o re ss of C a m b e r w e ll (M r. a n d M rs. E v a n -C o o k ). M i s s P e a r c e e x p l a i n e d t h a t a s t h e r e w a s n o t a D i v i s i o n in t h e B o r o u g h of C a m b e r w e ll on b e in g a s k e d to sta rt one, sh e c o m m e n c e d b y h a v i n g it a s a S e c t i o n o f L e w i s h a m , a n d f o r th e p u rp o se of h e r id e a sh e h a d g a in e d the su ppo rt of h er t w o s e n io r officers, M is s R e a d a n d M is s G u e s t . T h e tw o officers w e r e th en in tro d u c e d to th e M a y o r a n d M a y o re s s , w h o w e l c o m e d th e m to th e B o r o u g h , a n d th e M a y o r s a id h e w o u l d b e v e r y p l e a s e d t o h a v e t h e m if a D i v i s i o n w a s f o r m e d a s t h e y w o u l d b e in c h a r g e . A f t e r t h e i n s p e c t i o n , t h e d i s p l a y f o l l o w e d , a n d a v e r y fin e s h o w of effic ien c y a n d g e n e r a l s m a r t n e s s w a s d is p la y e d , all officers a n d m e m b e r s t a k i n g part. T h e M a y o r , in h is s p e e c h , s ta te d h o w th rille d h e h a d b e en a t a ll h e h a d see n , a n d th at h e w e lc o m e d th e In v a d e r s fr o m L e w i s h a m in to P e c k h a m , s in c e t h e y w e r e in v a d e r s of “ real w o r k e r s .” H e h op ed th at a D iv ision w o u ld soon be in t h e B o r o u g h if t h i s w a s a n e x a m p l e o f t h e i r “ g o o d w o r k , ” w h ic h w a s not o n ly for w a r tim e b u t for peacetim e.

N o.

EL D i s t r i c t

S ou th B u c k s .— O n S a tu r d a y , J u ly 17th , C a d e ts of the S o u th e rn a re a , B u c k s , a n d from M a r lo w , W o o b u r n G ree n a n d d istrict, w e r e in sp ected b y L a d y D u n b a r N a s m ith , D e p u t y L a d y S u p t.-in -C h ief, a cco m p a n ied by the C o u n ty C o m m is sio n er, M a jo r F . G . D a r v il- S m it h , C . B . E . T h e in sp ection w a s a r r a n g e d b y th e A sst. C o m issio n e r, M r. F . H . S c h o o lin g , a n d the p a ra d e w a s co m m a n d e d by C orps Supt. D ruce. T h e in sp ectio n to o k p la ce at th e B o y s ’ G r a m m a r Sch o o l, S lo u g h , a n d a b an d w a s p rovid ed b y th e B o y s ’ B rig a d e , S lo u g h area. E v e r y d ivision w a s represen ted a n d n early 400 C a d e t s w e r e on p a r a d e . A fte r th e in s p e c tio n th e r e w a s a d is p la y of drill, p r a c t i c a l first a id , e t c ., u n d e r t h e d ir e c t io n of C o u n t y S u r g e o n W e a v e r A d a m s , M . B . , w h o en tertain e d th e sp e cta to rs w ith a ru n n in g com m entary. T e a w a s a ft e r w a r d s p ro vid ed fo r all C a d ets .

A I D th is g o o d e x a m p l e w ill be f o llo w e d b y o th e r D iv is io n s in th e R i d i n g , ” a n d c o n g r a t u la t e d t h e H u m b e r s id e C o rp s on the p r o g r e s s m a d e , re fe rr in g fe licito u sly to the e n th u sia stic w o r k done by C o rp s S u r g e o n T h o m p s o n and C o rp s Supt. R a n k in e . T h e C o r p s , of w h i c h t h e first A m b u l a n c e D i v i s i o n w a s r e g i s tered in 1 9 4 1 , n o w c o n ta in s 3 A m b u l a n c e a n d 3 N u r s i n g D iv i s io n s , m a i n l y t h r o u g h t h e e ffo rts of t h e s e t w o officers.

N o.

V I

D istrict

H u m b e r sid e . — In con n ection w ith the a m b u la n c e a p p eal l a u n c h e d in t h i s a r e a , a G a r d e n F e t e w a s h e l d o n J u l y 1 0 t h in t h e g r o u n d s of M r . A r n o l d R e c k i t t ’s h o u s e a t B r a n t i n g h a m t h o r p e , k i n d ly offered b y h im fo r th is o c c a sisn . A large n u m b e r of peop le a tten d ed , in c lu d in g th e C o u n ty C o m m is sio n e r a n d all th e C o u n t y O fficers. C o l. W . H . C a r v e r , M .P ., a c te d a s c h a ir m a n for the fo r m a l p r o c e d u re a n d in tro d u ced L a d y W ilb e r fo r c e B ell, w h o o p en ed the F ete. In p res en tin g th e n e w b la ck and w h ite a m b u la n c e to th e H u m b e r s id e C o r p s on b e h a lf of all the s u b s c r i b e r s , - M rs . A r n o l d R e c k i t t p a i d h i g h t r i b u t e t o a l l w h o h a d w o r k e d so h a rd a n d co n trib u te d so n o b ly to m a k e the A m b u l a n c e S e r v ic e s u c h a n e s ta b lis h e d fact. D r. G eoffrey T h o m p s o n , C o rp s S u rg e o n , w h o, w ith M rs. T h o m p so n , had s a c r ific e d m u c h t im e a n d effort to th e s u c c e s s of th e a p p e a l, receiv ed th e A m b u la n c e on b e h a lf of th e C o rp s. The am bu l a n c e w a s d e d i c a t e d f o r s e r v i c e b y t h e R e v . I. W . T w e l v e trees. In p r o p o s in g a vote of t h a n k s to a ll w h o h ad a c c o m p lished so m u ch , D r. N o rm a n J e n n in g s, C o u n ty C o m m is s i o n e r , s a i d : “ Y o u a r e t h e f i r s t D i v i s i o n in t h e E a s t R i d i n g to s ta r t a n A m b u l a n c e S e r v ic e o u ts id e H u ll, a n d I h o p e th a t

(D uke

o f C o n n a u g h t ’s)

D istrict

K in g s t o n B uci C o r p s . — T h e first A n n u a l D i s p l a y b y th e S o u t h w ic k A m b u la n c e a n d N u r s in g C a d e ts D iv isio n s, K i n g s t o n B u c i C o r p s , w a s h e l d o n F r i d a y , J u l y 3 0 th , a t t h e S e n io r G irls S ch o o l. C o u n ty C a d e t O fficer P ile a n d C o u n ty C a d e t O ffice r M rs. B ro d ie c a rrie d o u t the in sp ectio n . They th e n p r e s e n te d to M r. H . E . B a r b e r a n d M rs. E S m i th e r s , t h e ir V i c e - P r e s i d e n t s w a r r a n t s to th e C a d e t s D iv is io n . C a d e t S u p t. H . G o o rd an d C a d e t O fficer H . N e w m a n w e re h an d ed th eir w a r r a n t s as O fficers of th e A m b u la n c e C a d ets . G. P a y n e w a s g iv e n his C a d e t S e r g e a n t c h e v r o n s a n d H . S tilw ell h is C a d e t C o rp o ra l ch e vro n s. N u r s in g C a d e ts w e r e th en en rolled . T h e n fo llow ed se v era l in te re stin g d isp la y s b y both g ir ls a n d boys, after w h ic h F irst A id , C h ild W e lf a r e a n d R e - e x a m in a tio n C ertifi ca te s w e re presented. C o u n t y C a d e t O fficer P ile said th at h e w o u ld lik e to see the b oys en ter for the C h ild W e lfa re , a n d stated th a t h e had v i s i t e d s e v e r a l D i v i s i o n s in S u s s e x a n d t h e w o r k h e h a d s e e n th a t n ig h t w a s s o m e of th e best. T h e even in g w as ended by a ca m p fire s in g s o n g . A lso present w e re C o rp s Su pt. W . G . Sh elton, C orps O f f i c e r J. W . G . B r o w n , D i v . S u p t . E . - W . S m i t h e r s , L a d y A m b u la n c e O fficer M iss P h illip s a n d the C o rp s C h a p la in , R ev. T arran t.

N o. N o.

V III

F o l k e s t o n e .— A n e x a m i n a t io n for L a y I n s t r u c to r s h a s b een re c e n tly held at th e R o y a l V ic t o r ia H o s p ita l, D o v e r , co n d u c te d b y D r . H in ch liff. T h e fo llo w in g m e m b e rs of the F o lk e s to n e D iv isio n w e r e s u c c e s s f u l in p a s s i n g f o r t h e L a y I n s t r u c t o r ’ s c e r t i f i ca te , a n d a r e th er efo re q u alified to g i v e le c tu re s fo r the s h o r t F ir s t A id C o u r s e in s tr u c tio n to C iv il D e f e n c e w o r k e r s , a ls o to th e g e n e r a l p u b lic , D iv is io n a l S u p t. J. H u n tle y , A m b u la n c e O fficer G . H u n tle y a n d P r iv a te R . L e p p a rd . L a d y D i v i s i o n a l S u p t . M i s s M . D a v i s is a l s o a u t h o r i s e d to g i v e s im ila r le c tu re s u n d e r th e a b o v e a r r a n g e m e n t .

D istrict

P lym outh (M illb a y G . W . R . ) . — O n W ed n esd ay, Ju ly 2 1 s t , in t h e A m b u l a n c e C a d e t H e a d q u a r s e r s , N o r t h - r o a d , P lym o u th , C o u n ty C o m m issio n e r L t.-C o l. T . P. S . W a r d , C o rp s O fficers, D iv . S u p ts ., D iv . m e m b e r s a n d frien d s m et to d o h o n o u r to M r. W illia m J o h n R ic h , A m b u l a n c e O fficer, w h o w a s p la c e d on B r i g a d e R e s e r v e a t his o w n r e q u e s t a fte r 45 y e a r s of a c tiv e service. M r . R i c h e n r o l l e d in t h e B r i g a d e in F e b r u a r y , 1 8 9 8 . D u r i n g his s e r v ic e h e o b ta in e d th e S e r v ic e M e d a l a n d 5 S e r v i c e B a r s ; h e w a s a l s o a p p o i n t e d H o n o r a r y B r o t h e r in 1932. O f the G rea t W e s te rn R a ilw a y A m b u la n c e a w a rd s, M r . R i c h o b t a i n e d t h e 1 5 y r . G o l d M e d a l , 20 y r . G o l d B a r , 2 5 y r . G o l d M e d a l , 30 y r . a n d 3 5 y r . G o l d B a r s . I n t h e y e a r 1900 M r . R i c h w e n t to th e S o u t h A f r i c a n W a r a s a m e m b e r of th e P ly m o u th St. Joh n A m b u la n c e B r ig a d e U n it. T h is w a s r e c o r d e d o n a B r o n z e T a b l e t in t h e P l y m o u t h G u i l d h a l l b y th e C i v ic A u th o r itie s a t th a t tim e. C o u n ty C o m m issio n er L t.-C o l. W ard presented an E le ctric T a b le L a m p a nd a b o o k of N atio n a l S a v in g S ta m p s to M r. R ic h a n d a p u rse to M rs. R ic h . T h e C o m m issio n er p aid g r e a t trib u te to M r . R i c h ’s a c ti v it ie s a s a m e m ber, w h ic h w a s fo llo w e d b y v a r io u s s p e a k e r s . M r. R ic h su ita b ly responded.

F I R S T

N o.

X D istrict W a r e . — C o u n ty C o m m issio n e r H . L a n g l e y Jo n es in spected m e m b e rs of A m b u la n c e a n d C a d e t D iv is io n s from W a r e , H e r t f o r d , H o d d e s d o n a n d S t a n d o n a t a p a r a d e in t h e g r o u n d s of th e P rio ry , W a r e , on S a t u r d a y , J u ly 10th. T h e C o m m issio n er w a s acco m p an ied by C o u n ty S u rg e o n W . N o rm a n B o o th , C o u n ty O fficer E . K e ig h t le y a n d C o u n ty C a d e t S e c re ta r y M iss D . S p a rk e s . C o r p s O fficer T . C. F o r b e s w a s in c h a r g e o f t h e p a r a d e . A fter the in sp ection M r. L a n g le y J o n es in spected tr a n s port u n its, w h ile D r . N o r m a n B o o th , a ssiste d b y D r . G . W . S t e w a r t a n d D r . C . S t . A . V i v i a n , w a t c h e d f ir s t a i d d e m o n stration s of b a n d a g i n g a n d stre tch e r b e a rin g by th e C a d ets. M r. L a n g l e y J o n e s t h a n k e d th e officers fo r a r r a n g i n g th e p a r a d e , th e m e n fo r p a r a d i n g , a n d t h e s p e c t a t o r s for th eir su ppo rt. H e co n g ra tu late d the A m b u la n c e a n d C a d et D iv is io n s o n th e ir e n t h u s ia s m a n d efficien cy. A F e te a n d D o g S h o w w a s held on J u ly 17 th , o r g a n is e d by m em b e rs of W a r e D iv isio n and th e B ritish R e d C ro ss S o ciety, w ith a few h elp ers fr o m o th e r C iv il D e fe n c e services. T h e o p en in g ce rem o n y w a s perform ed by A n n e L a d y B ro c k e t (C o u n ty P resid en t of th e B . R . C . S . ) . S h e s p o k e o f the v aried h elp w h ic h the tw o o r g a n is a tio n s w e r e g i v i n g to th e P r is o n e r s of W a r a n d s t r e s s e d th e h e a v y a n d c o n t in u a l d r a in w h i c h is i m p o s e d u p o n t h e o r g a n i s a t i o n s ’ f i n a n c i a l r e s o u r c e s . A G u a rd of H o n o u r w a s fo rm e d b y m e m b e rs of R e d C ro ss N u rse s, St. Joh n m e m b e rs a n d c a d e ts u n d e r C o rp s O ffice r T . C. Forbes. A D a n c e w a s h e l d in t h e e v e n i n g , w h i c h a t t r a c t e d a record cro w d , a n d both F e te a n d D a n c e p ro ved a g r e a t su ccess, a n d th e C o m m it te e w e re a b le to h a n d ^ 3 4 3 to the Fund'

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S u p p l y — D etection o f P o l l u t io n .

L a s t m onth w e d ea lt w ith th e v a rio u s so u rce s of su p p ly a n d it w a s n o t e d t h a t n o n e c o u l d b e g u a r a n t e e d a g a i n s t c o n tam in ation . I t is e s s e n t i a l t h e r e f o r e , t h a t w a t e r f r o m a n e w s o u r c e s h a l l b e t e s t e d , a n d if n e c e s s a r y , p u r i f i e d , b e f o r e t h e t r o o p s a r e a l l o w e d t o u s e it . T w o m e t h o d s a r e u sed for d etection : (1 ) a s t r o n g so lu tio n of salt, fo llo w e d b y a c h e m ic a l e x a m i n a t i o n ; (2) a s o l u t i o n o f F l u o r e s c i n , w h i c h w i l l s h o w c o l o u r in w a t e r w h e n u s e d , e v e n in t h e p r o p o r t i o n o f 1 p a r t in 1 0 m i l l i o n s . N a t u r a l l y t h e l a t t e r m e t h o d is q u i c k e s t a n d m o r e c o n v e n i e n t f o r t h e m e d i c a l o r d e r l y , t h e r e f o r e it is t h e one g e n e ra lly adop ted . S u p p o s e , f o r e x a m p l e , a w e l l is t o b e u s e d b u t is f o u n d to be, o r s u s p e c t e d of b e in g , p o llu te d . A carefu l e x a m in a tion of th e s u r r o u n d in g s w o u ld be m a d e fo r th e p o s sib le so u rce of pollutio n. P e r h a p s it i s c a u s e d b y s e w a g e ; d i s c h a r g e s fr o m n e a r b y in d u s tr ia l b u ild in g s ; o r a l e a k a g e into the w ell of s u r fa c e w a t e r c o n ta m in a te d b y a n im a l e x c r e ta , d ead v e g e ta tio n , etc. A F l u o r e s c i n s o l u t i o n m a d e u p o f 1 lb. F l u o r e s c i n a n d 1 lb . c a u s t i c s o d a t o t e n g a l l o n s o f w a t e r is t h e n p o u r e d o v e r t h e s u s p e c t e d a r e a , a n d if c o l o u r b e c o m e s v i s i b l e in t h e w e l l , t h e n it p r o v e s t h a t a r e a t o b e t h e s o u r c e o f p ollu tio n. T h e f o l l o w i n g t r e a t m e n t w o u l d t h e n b e g i v e n :— F irst, a n y d eb ris lik e ly to b e the c a u s e w o u ld be r e m o v e d . N e x t, a b o u t h a lf a b arre l of lim e w o u ld be t h r o w n d o w n . T h e w e l l w o u l d t h e n b e p u m p e d o u t , a l l o w e d t o r e f il l a n d t h e lim e tre a tm e n t rep ea ted . T h i s s h o u ld be a llo w e d to sta n d 24 h o u r s , a n d t h e n t h e w e l l p u m p e d o u t u n t i l c l e a r o f l i m e . W a t e r w h i c h is r e q u i r e d in t h e q u i c k e s t p o s s i b l e t i m e m u s t b e p u r i f i e d b y m e t h o d s w h i c h a r e n o w g e n e r a l l y a d o p t e d in the A rm y. P u r i f i c a t i o n is c a r r i e d o u t in t w o p a r t s : 1 s t , c l a r i f i c a t i o n ,

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a n d 2nd, sterilisation . T h e f i r s t is t o d e a l w i t h s u s p e n d e d m a tte r , d e a d a n d a liv e ; a n d th e s e c o n d to d e s t r o y p a t h o g e n ic or d isease p ro d u cin g g e rm s . F i l t r a t i o n is t h e m e t h o d u s e d in t h e s e r v i c e f o r c l a r i f i c a t i o n , a n d a l l w a t e r - t a n k t r u c k s a n d w a t e r - t a n k tr a ile r s a r e fitted w it h s p e c ia l filte rs w h i c h c a r r y o u t f i l t r a t i o n a s t h e t a n k s a r e fil le d . B e s id e s th e r e g u l a t i o n filters h o w e v e r , im p r o v i s a t i o n s a r e p ossible, s u c h a s filte r in g t h r o u g h a b la n k e t. P ro b a b ly th at w o u ld be a b o u t the o n ly m e a n s a v a ila b le to th e H . G . o r d e r ly , w h o w ill no d o u b t e v o l v e s o m e m e t h o d to s u it the c a s e if 1 k n o w a n y t h i n g o f t h e m e d i c a l s e r v i c e . N e x t m o n th I w ill deal w ith sterilisation . C.

S p r e a d b u r y (S erg t.), S ch o o l H o u se , N oel-road , W .3 .

Letters to the Editor. W e a r e in n o w a y r e s p o n s ib le fo r th e o p in io n s e x p r e s s e d , or the sta te m e n ts m a d e , b y C o rre s p o n d e n ts .— E d it o r .

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S ir , — S p e a k i n g of t h e A . R . P . a p p o i n t m e n t s a t a r e c e n t “ C o m i n g of A g e ” D in n e r a t M irfieid , C o lo n e l G . H . L . H a m m e r t o n ( C o u n t y S u r g e o n ) s a id h e w a s n o t p r o u d of them . B e fo re the w a r th e G o v e r n m e n t a s k e d the m e m b e rs o f t h e O r d e r to a r r a n g e fo r th e t e a c h i n g o f G a s P r e c a u t i o n s to th e g e n e r a l p u b lfc , a n d t h e y a n s w e r e d th e a p p e a l . S in ce then a ll th e a p p o in tm e n ts, w ith a n ice fa t s a la r y , w e r e g iv e n to o th e r s , a n d th e m e m b e r s o f th e O r d e r o f S t. J o h n w e r e n ot co n sid ered. I d o n ’t t h in k t h a t is r i g h t a n d fa ir, a n d I t h i n k s o m e t h i n g s h o u l d b e d o n e a b o u t it , s a i d t h e s p e a k e r . T h a t is a n e x t r a c t fr o m a lo c a l p a p e r a n d m a d e m e g o fu r th e r in to th e q u es tio n . W h a t a re the facts ? In 193 5 B r i g a d e H e a d q u a r t e r s s e n t o u t in s tr u c tio n s for a ll m e m b e r s to s t u d y G a s Y V a rfa re a n d A i r R a i d P r e c a u t i o n s a n d to o b ta in a certifica te to p r o ve efficien cy, w h ic h th e m e m b e r s did w ith t h e e n t h u s i a s m w h i c h is c h a r a c t e r i s t i c o f t h e B r i g a d e . I n 1 9 3 9 w e w e r e h a n d e d o v er lo c k , s t o c k a n d b arre l to th e H o m e O ffice w ith o u t a n y g u a r a n te e (e x ce p t th a t w e w e r e g u a r a n teed t h o r o u g h ly tra in ed ), a n d fr o m th e H o m e O ffic e w e w e r e p la ce d u n d e r th e d irectio n s of M e d ic a l O fficers of H e a lt h w h o h a d , in a g r e a t n u m b e r o f c a s e s , n o t t a k e n a n y i n t e r e s t w h a t e v e r in A . R . P . , a n d i n c o n s e q u e n c e w e w e r e a g a i n h a n d e d o v e r t o t h e t e n d e r m e r c i e s of a C h i e f C l e r k w h o o n l y t o o k h is F ir s t A id C e r ti f ic a t e b e c a u s e h e w a s o r d e r e d to d o so T h e la te C h ie f C o m m is s io n e r s a y s in h is fa r e w e ll m e s s a g e t h a t h e is s o r r y w e w e r e n o t a l l o w e d t o e n r o l a s a b o d y a n d w o r k u n d e r o u r o w n officers ; th e “ little m a n ” fa ils to c o m p r e h e n d w h y it w a s p o s s i b l e t o h a n d o v e r a n a r m y o f 120,000 f u l l y t r a i n e d p e r s o n n e l w i t h o u t a n y s a f e g u a r d , a n d t h in k s th e r e w a s s o m e w e a k n e s s (a n d n o t in th e r a n k a n d fil e). N o w w e a r e b e in g h a n d e d o v e r to th e R e s c u e S e rv ic e , a n d o n c e a g a i n to t a k e o r d e r s fr o m m e n w h o h a v e no k n o w le d g e of F ir s t A id ; a n d th e “ little m a n ” is f e e l i n g v e r y so r e a b o u t th e w h o le affair. S u r e l y t h e O f f i c e r s a n d N . C . O . ’s s h o u ld be g i v e n a r a n k e q u iv a le n t to t h a t h e ld in th e B rig ad e. If th e O ffic e r s a n d N . C . O . ’s c a n r e c r u i t a n d tr a in a n a r m y o f 120,000 in p e a c e t i m e , w h e n t h e t e n d e n c y o f m o s t of th e p o p u latio n w a s for e a s e a n d e n jo y m e n t, s u r e ly th ey s h o u l d b e g i v e n s o m e c r e d i t f o r it w h e n t h e c r i s i s is u p o n u s ; b u t w e fin d t h e l o c a l a u t h o r i t i e s p u t t i n g t h e i r o w n u n tra in ed m en a n d w o m e n in to E x e c u t iv e jo b s , a n d n a t u r a lly w e fe e l a g r i e v a n c e . W e w e l c o m e t h e n e w C h i e f C o m m i s s i o n e r . H e h a s d one a g r e a t jo b , a nd w e trust he w ill s tr a ig h te n o u t a g r i e v a n c e w h i c h r u n s all t h r o u g h th e B r i g a d e h e n o w c o m m a n d s .— Y o u r s tru ly,

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M a n y a m b u l a n c e e n t h u s ia s t s in th e N o r th E a s te r n A r e a w ill be d e lig h te d to k n o w th at H is M a je s t y the K i n g h a s b e e n g r a c i o u s l y p le a s e d to s a n c tio n th e p r o m o t io n of M r. G . H . O a k e s , S h ip p in g F o r e m a n , H u ll, from S e r v in g B ro th e r to O ffic e r B ro th e r. M r . O a k e s o b t a i n e d h i s c e r t i f i c a t e in 1 9 0 1 , a n d s in c e t h a t y e a r h a s p a s s e d 35 r e - e x a m in a ti o n s . H e w a s a p p o i n t e d D i s t r i c t S e c r e t a r y a t H u l l in 1 9 2 0 a n d g r a n t e d t h e d i g n i t y o f H o n o r a r y S e r v i n g B r o t h e r in 1 9 2 3 — a s p l e n d i d r e c o r d o f d e v o t i o n t o d u t y in t h e c a u s e o f fir s t a i d . H is M a je s ty th e K i n g h a s a ls o b een g r a c io u s ly p leased to b e s to w th e d ig n ity of S e r v in g B ro th e r u p o n M r. A . E . A rm s tro n g , E n g in e E x a m in e r (D istrict S ecretary), H e a to n ; M r . W . L a w s o n , F i t t e r , H a r t l e p o o l ; M r . J. S . R i c h a r d s o n , C a r e ta k e r , S u n d e rla n d ; M r. C. W . S m ith , P ain ter, D a r l in g to n , and M r. A. L . W h ite , C h a r g e in a n P lu m b er, W e s t H a r t l e p o o l , in r e c o g n i t i o n o f t h e i r s e r v i c e s t o t h e S . J . A . A . o v e r a l o n g p erio d of ye ars. A V e l l u m V o t e of T h a n k s h a s a ls o b e en a w a r d e d to M r. S. P. T h o m p s o n , D is tric t S e c re ta r y , D a rlin g to n .

It is v e r y p l e a s i n g to n o te t h a t d e s p ite th e m a n y c a lls u p o n m e m b e r s o f t h e s t a f f w h o a r e i n t e r e s t e d in f i r s t a i d , it h a s a g a i n b e e n p o s s i b l e t o h o l d a c o m p e t i t i o n in a l l t h e s i x d istricts, n a m e ly , D a r lin g t o n , H u ll, L e e d s , M id d le s b r o u g h , N ew ca stle and Y o rk . T h e s t a g in g of th e tea m tests w a s p articu larly ou tstan d in g. W e e x te n d o u r sin ce re th a n k s to th e d o cto rs w h o g a v e th e ir v a lu a b le tim e to ju d g e th e co m p e titio n s.

D u r in g th e h a lf y e a r en ded M a r c h 31st, 1943, m em b e rs of th e N o r th E a s te r n A r e a s ta ff b e c a m e en titled to L o n g S e r v ic e G o ld A w a r d s a n d w ill he p r es en te d w ith certificates, w h ic h w ill be e x c h a n g e d for the a p p ro p ria te g o ld to k e n s as soon as c irc u m sta n c e s perm it. W e r e g r e t th a t p ressu re on sp a ce preven ts us g i v i n g a fu ll list o f t h e re cip ien ts. T h e fo llo w in g are the totals : 43 G o l d M e d a l s , 10 2 0 - y e a r B a r s , 2 2 5 - y e a r B a r s , 5 3 0 -y e a r B a rs and 2 35-year Bars.

S O U T H E R N W i m b l e d o n F i r s t A id C l a s s .— T h e p r e s e n t a tio n of a w a r d s f o r 1 9 4 2 / 3 , in c o n j u n c t i o n w i t h a S o c i a l a n d D a n c e even in g , to o k p la ce a t C o m p to n H all, Co m pton -road, W i m b l e d o n , on S a t u r d a y , J u ly 24th, b e fo re a la r g e g a t h e r i n g of m e m b e r s a n d th eir friends. It w a s g r a t i f y i n g to s e e s o m a n y p r e s e n t , b e a r i n g in m i n d t h e s t r e s s o f a b n o r m a l tim e s, w ith o fficials a n d e m p lo y e e s on w a r duties. I t w a s p r e s i d e d o v e r b y M r . A . W . O s b o r n e in t h e a b s e n c e of o th e r officials. H e w e lc o m e d M iss G rin d le y fro m the W e lfa r e D e p t., W ate rlo o , St. J o h n A m b u la n c e C e n t r e , w h o h a d k i n d l y c o m e a l o n g to p r e s e n t th e a w a r d s in p la c e o f M r. U z z e ll, w h o w a s a b s e n t o n A . R . P . d u ties. T h e c h ie f a w a r d w a s a 2 1-y e a r s G o ld M e d a l to M r. E. M itc h e ll, w h o h a d re n d ered y e e m a n se rv ic e to h is fe llo w c o m r a d e s o v e r t h a t l o n g period. A g o o d tim e w a s en joyed b y a ll p resen t.

M o r e t h a n 50 p e o p l e w i t h m i n o r i n j u r i e s r a n g i n g f r o m c u t f i n g e r s t o f a i n t i n g fi ts w e r e a t t e n d e d b y S t . J o h n A m b u la n c e m en on D u r d h a m D o w n , B ristol, on A u g u s t M o n d a y aftern oon .

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V it a m in s , of w h ich w e h a v e b e co m e in c re a s in g ly con sciou s d u r in g recen t years, a re su b sta n c e s of a c o m p le x co m p o sitio n f o u n d in v a r i o u s f o o d s t u f f s , a n d a r e e s s e n t i a l f o r t h e m a i n t e n a n c e of h e a lt h . T h e v e r y n a m e is d e r i v e d f r o m t h e w o r d v i t a l w h i c h m e a n s s o m e t h i n g n e c e s s a r y t o li f e .

K n o w le d g e of the e x isten c e of v ita m in s g r e w o u t of a n u m b e r of a tte m p ts a t v a r io u s tim e s to feed a n im a l s on n e w diets. I t w a s o b s e r v e d in t h e ’ 8 0 ’s o f l a s t c e n t u r y t h a t p u r e c a rb o h y d ra te s , p rotein s a n d fa ts w e r e n ot e n o u g h to k e e p a n im a ls h ealth y. S o m e a c c e s s o r y fo o d s u b s ta n c e s w e r e m issin g. I n E n g l a n d ( 1 9 0 6 - 1 2 ) it w a s f o u n d t h a t a s m a l l a m o u n t of m ilk a d d e d to th e diet c a u s e d a n im a ls to flo urish a n d put on w eigh t. G e r m a n y a n d A m e r i c a too, w e r e e x p e r im e n t in g a b o u t th is tim e on th e su b ject. I t w a s f o u n d in N o r w a y i n 1 9 0 7 , t h a t s c u r v y c o u l d b e i n d u c e d in g u i n e a - p i g s b y w i t h h o l d i n g g r e e n s t u f f . I n 1 9 1 5 it w a s f o u n d t h a t n o t o n e , b u t a t l e a s t t w o a c c e s s o r y s u b s ta n c e s w e r e n e c e ss a r y . T h e s e w e r e t e rm e d fatso lu b le A a n d w a te r-so lu b le B , th e latter b e in g fo u n d later to c o n sist of B , B 2 a n d C . B , and B 2 h av e so m etim es been term ed F a n d G (S h e rm an ). T h e p r o p e r t i e s o f c o d - l i v e r o i l w e r e d i s c o v e r e d in 1 9 2 1 . B y 1922, v ita m in s A to E h ad been d iscovered, th e latter a n o t h e r f a t - s o l u b l e o n e , f o u n d n e c e s s a r y f o r f e r t i l i t y in r a t exp erim en ts. ( T h e rich e st k n o w n so u rces of E a re w h e a t g e r m a n d le ttu c e leaves). T h e e vid e n ce of a n y h u m a n r e q u i r e m e n t o f v i t a m i n E is v e r y c o n f l i c t i n g . T h e n u m b e r of v ita m in s n o w k n o w n h as e xte n d ed v it a m in D to D 5 a n d v i t a m i n B to B 7 a n d r e a c h e s d o w n th e a lp h a b e t to K a n d P. C u rio u s ly e n o u g h , v itam in s a re on ly form ed b y v e g e tab les, a n im a ls h a v e to g e t th e m fro m th e food th ey eat excep t vitam in D . W i t h t h i s , in a d d i t i o n t o t h e v e g e t a b l e s o u r c e , t h e u l t r a - v i o l e t r a y s in s u n l i g h t a c t u p o n s u b s t a n c e s in t h e a n i m a l a n d h u m a n b o d y a n d p r o d u c e D in t h e t i s s u e s d irectly. A rtific ia l ir r a d ia tio n is a ls o u se d to p r o d u c e v it a m in D in food stu ffs. V i t a m i n s a r e p r e s e n t in t h e i r g r e a t e s t q u a n t i t i e s i n f r e s h foods. A l l t h e v i t a m i n s a r e p r e s e n t in f r e s h m i l k , p r o v i d e d t h a t t h e a n i m a l s u p p l y i n g t h e m i l k is g e t t i n g e n o u g h v i t a m i n s itself. T h e a b s e n c e o f a n y o n e v i t a m i n in t h e d i e t c a u s e s i t s s p e c i f i c d e f i c i e n c y d i s e a s e , a n d in t h e c a s e o f c h i l d r e n m a y lea d to irr ep a ra b le h a rm . V it a m in s A a n d D , th e a n im a l p ro d u ct v itam in s, a re n e c e s s a r y for g e n e r a l g r o w t h . A also g o v e r n s the con d ition of th e m u c o u s m e m b r a n e in its fu n c t io n o f r e s i s t i n g in fe ctio n . T h e D g r o u p , t h e f i v e f a c t o r s D , . s is n e c e s s a r y f o r b o n e fo r m a tio n a n d the h e a lth of th e blood str e a m . T h e deficien cy d is e a s e of D is w e ll k n o w n — R ic k e t s . T h e rich est k n o w n s o u r c e s o f A a r e t h e liv e r fa t s of m a n y m a m m a l s a n d fishes ( t h e r e is a h u n d r e d t i m e s a s m u c h A in h a l i b u t l i v e r a s t h e r e i s in c o d l i v e r ) a n d e g g s . V e g e ta b le s and green stuffs h ave a g o o d A content. V i t a m i n D is f o u n d i n l a r g e s t a m o u n t s i n h a l i b u t a n d c o d l i v e r o il. H a l i b u t l i v e r o il is e i g h t y t i m e s s t r o n g e r t h a n c o d l i v e r o i l in i t s D c o n t e n t , a s w a s f o u n d a t t h e c o st o f a n u m b e r of c h ild r e n ’s liv e s in C a n a d a a f e w y e a r s a g o w h e n t h e y w e r e g i v e n t h e s a m e d o s a g e o f h a lib u t oil a s t h a t p r e v io u s ly g i v e n of co d liv e r oil. C a lcificatio n of the b re ast w a s ca u se d b y the e x c ess of D 2 . V i t a m i n s B , a n d B 2 a r e f o u n d in l a r g e s t a m o u n t s i n t h e w h e a t g e r m , e g g s a n d yeast. T h e y a re n e c e ssa ry for g o o d

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The Gear illustrated (A.B.C.D.) carries tw o stretchers on one side of Ambulance, leaving oth er side clear for sitting patients. The UP AND DOW N action is quick and easy for loading o r unloading. S h o w s t h e tw o s tr e tc h e r s in p o sitio n S h o w s t h e to p s tr e tc h e r lo w e re d r e a d y fo r lo a d in g . I l l u s t r a t e s t h e s a m e G e a r w ith th e to p s tr e tc h e r f ra m e h in g e d dow n for u s e w h e n o n ly o n e s tr e tc h e r c a se is c a rr ie d . D .

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W here Ambulances are required to carry four beds two Gears are fitted, one on EITHER SIDE, and th e same advantages apply as described above. Full catalogue o f Ambulance Equipment No. 7A w ill be sent on request.

G R E A T P O R T L A N D ST., LONDON, W .1 Telegraphic Address:—

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n e rve co n d itio n a n d d ig e stio n . B t th e a n tin e u ritic v itam in , g u a r d s a g a in s t B e ri-B e ri, a d isease (w h ic h ta k e s t w o fo rm s a “ D r y ” and a “ W e t ” ; the “ D r y ” in vo lvin g le g m uscle w a s t i n g a n d p a in fu l s w e llin g s , the “ W e t ” a c c o m p a n ie d b y d r o p s y ) o c c u r r i n g in c o u n t r i e s w h e r e t h e s t a p l e i t e m o f d i e t is p o l i s h e d r i c e . B 2 is t h e P e l l a g r a p r e v e n t i n g v i t a m i n . P e l l a g r a i s a d i s e a s e o f B 2 d e f i c i e n c y o c c u r r i n g in t r o p i c a l a n d su b -tro p ical cou n tries. I t is c h a r a c t e r i s e d b y e r u p t i o n s on the s k in a c c o m p a n ie d b y d iso rd ers of th e d ig e stio n an d n ervous system . T h e v i t a m i n B g r o u p is n o w k n o w n a s t h e B c o m p l e x , ( B , t o B ). V i t a m i n C is t h e f r e s h f r u i t a n d v e g e t a b l e v i t a m i n . For m a n y y e a r s it w a s k n o w n t h a t S c u r v y ( t h e v i t a m i n C d e f i c i e n c y d ise a se ) co u ld be p r ev e n te d by fresh fruit a n d v e g e t a b le s a n d “ lim e ju ic e .” T h is “ lim e ju ic e ” (really the ju ice of the M e d i t e r r a n e a n le m o n , a t t h a t tim e ) w a s is s u e d to th e c r e w s o f E n g l i s h s a i l i n g sh ip s o n l o n g v o y a g e s to p r e v e n t s c u r v y . H e n c e the n a m e of “ L i m e y ” d erisiv ely g iv e n b y the A m e r ic a n s to th ese sh ip s a n d th eir c re w s . For years tom a toes a n d o r a n g e s w e re k n o w n a s cu ra tiv e and p rev en ta tive a g e n t s f o r S c u r v y b e f o r e t h e r e a s o n — d e f i c i e n c y in v i t a m i n C — w a s d iscovered. C o n s id e ra b le w o r k h as been d on e on v ita m in C d u r in g the past few years. It h as been fo u n d th a t in activ atio n by o x i d a t i o n o f t h e v i t a m i n C in f r u i t a n d v e g e t a b l e s is g r e a t e r in a l k a l i n e s o l u t i o n s a n d l e s s in a c i d s o l u t i o n s . ( T h e oldf a s h i o n e d p i n c h o f s o d a in t h e g r e e n s w a t e r t o “ i m p r o v e t h e c o lo u r ,” k ille d the C). T h e lo n g e r fru it a n d v e g e ta b le s a r e c o o k e d , t h e m o r e C is d e s t r o y e d . A l s o , if f r u i t a n d v e g e t a b l e s a r e b r u i s e d , e n z y m e s ( c h e m i c a l f e r m e n t s f o r m i n g in liv in g cells) set to w o r k a n d d e s tro y th e v ita m in C co n te n t ; b u t if t h e h e a t in c o o k i n g is r a i s e d t o j u s t u n d e r b o i l i n g p oint, th e e n z y m e s a r e th e m s e lv e s d es tro yed . A s e a r l y a s 1 9 1 2 it w»as d i s c o v e r e d t h a t C is a b s e n t in s e e d s b u t is p r o d u c e d b y g e r m i n a t i o n . T h e v it a m in C c o n te n t is e x p r e s s e d in t e r m s of th e a m o u n t o f a s c o r b i c a c i d p r e s e n t in m . g . p e r 100 g m . o f f r u i t or v eg eta b le . P u r e a s c o r b i c a c i d , it m a y b e m e n t i o n e d in p a s s i n g , is n o w a v a i l a b l e a n d c h e a p , a n d a p p a r e n t l y d o e s n o h a r m e v e n i f t a k e n in e x c e s s . R e c e n t w o r k h as e stab lish ed th a t of c o m m o n so u rces o f C , t h e h i g h e s t is t h a t o f h a w - b e r r i e s a n d r o s e - h i p s (50 0 m . g m . ); n e x t c o m e s t h e b l a c k - c u r r a n t (30 0) ; t h i r d l y , t h e o r a n g e a n d l e m o n (40-60) ; (a m e d i c a l j o u r n a l h a s r e c e n t l y s t a te d t h a t m a r m a l a d e r e t a i n s m o s t of its v it a m in C c o n t e n t, th e peel b e in g a v a lu a b le part). T h e C c o n te n t of o th e r fruits a n d v e g e ta b le s v arie s c o n sid erab ly. T h e ap p le com es a lo n g w a y d o w n t h e li s t , t h e b e s t , i n o r d e r o f C m e r i t a r e : B r a m l e y ’ s S e e d l i n g ( 3), B l e n h e i m O r a n g e , N e w t o n W o n d e r , t h e n t h e m u c h p r i z e d C o x ’ s O r a n g e P i p p i n r u n n i n g a b a d f o u r t h ( 1 ‘6). T h e p e a r ’s v a l u e is l o w t o o . T w o o u n ce s of p a rsle y g iv e s a n a d e q u a te v ita m in C in t a k e for a d a y . T o m a to e s retain th eir C content w h e n tinned, b u t tin n ed fruit an d v e g e ta b le s do not retain th eir C c o n t e n t i n d e f i n i t l y , a n d s h o u l d b e u s e d w i t h i n a y e a r o r so . P o t a t o e s h a v e a C v a lu e u p to 20 ju s t u n d e r th e s k in . A s u r p r is in g recen t R u s s ia n d isco v ery , con firm ed by w o r k e r s in t h i s c o u n t r y , i s t h a t t h e w a l n u t in t h e g r e e n s t a g e , w h i l e t h e s h e l l is s t i l l s o f t , h a s a c o n t e n t o f 1 , 0 8 0 . I t is b e s t u t i l i s e d b y p i c k l i n g a s it l o s e s t h i s h i g h C v a l u e a s it r i p e n s . A c o u r a g e o u s e xp erim en t w a s carried out by an A m e rica n d o c to r u p on h im se lf, w ith the a s s is ta n c e of tw o c o lle a g u e s w i t h i n t h e l a s t t h r e e y e a r s in c o n n e c t i o n w i t h v i t a m i n C . H e w e n t o n t o a d i e t d e l i b e r a t e l y , a n d c o m p l e t e l y l a c k i n g in C. I t w a s n o t u n t i l t h e fif th m o n t h t h a t h e s h o w e d s i g n s of ill-h e a lth a r i s i n g fr o m th is d eficien cy . B y th at tim e sm all e x p e r im e n t a l w o u n d s o n his b a c k fa ile d to h e a l p r o p e rly (the s c a r c o v e r i n g a m a s s o f u n o r g a n i s e d tissu e ), a n d he felt tired q u ic k ly a fte r e xercise. H e presen ted , h o w e v e r , n on e of the clin ica l s ig n s of sc u rv y . T h e ex p e rim e n ts w e re then d isco n t i n u e d a t t h e e n d o f t h e fif th m o n t h .

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V i t a m i n K is n o w g e n e r a l l y a c c e p te d a s a n anti-h aem o rrh a g ic factor. V i t a m i n P ( f o u n d in a s s o c i a t i o n w i t h C ) , m o s t d o c t o r s n o w b e l i e v e , is a f a c t o r in m a i n t a i n i n g c a p i l l a r y r e s i s t a n c e . O f c o u r s e , o n a n o r m a l h e a l t h y b a l a n c e d d i e t , t h e r e is n o n e ed to w o r r y a b o u t v ita m in s , b u t a t p r es en t, o w i n g to w a r c o n d i t i o n s , w e a r e in a p o s i t i o n s o m e w h a t a n a l a g o u s to t h a t o f t h e l i v e s t o c k o f t h e ’ 8 0 ’ s , i n s o f a r t h a t w e a r e in n e e d o f t h o s e “ a c c e s s o r y s u b s t a n c e s ” b e i n g a d d e d in m a n y c a s e s to o u r diet ; b u t w ith th e im p o r ta n t d ifferen ce th a t w e n o w p o s s e s s su ffic ie n t k n o w l e d g e to b e a b l e to r e m e d y th e d eficien cy w ith scien tific p rep a ra tio n s.

Reviews. C i v i l D e je n c e : a B a s ic T r a in in g M a n u a l.

B y L t.-C o m m ander F. A. M. Eden, R. N. London : Jordan & Sons Ltd. P r ic e 21- n e t ; by p o st 212 .

T h is book, w h ich h a s been com p iled b y a re co g n ised e x p e r t , w a s f ir s t p u b l i s h e d in S e p t e m b e r , 1 9 4 2 , a n d h a s a l r e a d y r e a c h e d its s e c o n d e d i ti o n — s u r e p r o o f o f its u s e f u l n ess an d pop ularity. T h e te x t h as b een t h o r o u g h ly revised a n d several c h a p t e r s c o m p le te ly re - w ritte n to b r i n g th e b o o k in to lin e w ith th e la tes t d e v e lo p m e n ts of C iv il D e fe n c e p ractice. C o n s e q u e n t l y , r e a d e r s o f F i r s t A i d w i l l fi n d in o n e v o l u m e in fo r m a tio n w h ic h c o v e rs th e b a s ic t r a i n i n g r e q u ir e d b y all b ra n ch e s of C ivil D e fe n ce . ■

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T h e H o m e S e rv ice A m b u la n c e C o m m itte e of the O rd er o f St. J o h n a n d B r it is h R e d C r o s s S o c ie t y c a ll a tte n tio n to the fa ct th a t a m b u la n c e s r e t u r n in g e m p ty to L o n d o n from d istricts o u tsid e th e M etro p o lita n a re a cou ld be used for the c o n v e y a n c e of p atien ts fro m th e co u n try to th e L o n d o n ho sp ita ls.

D e a t h o n S e r v i c e .— W e r e g r e t to a n n o u n c e th e d e a th , w h ile on fly i n g d uties, of P ilo t O ffic e r R . K . B e tc h le y , R . A . F . (N o . 126 B a r c la y s B a n k D iv isio n ). H e w a s s e r v i n g in C o s ta l C o m m a n d , a n d o n ly a w e e k b e fo re h is d ea th h ad a t t a c k e d a U B o a t c a u s i n g it t o c r a s h d i v e , a n d h a d s e t t h e a c c o m p a n y i n g “ f l a k ” s h i p o n fi r e. O u r sin cere s y m p a th y g o e s o u t to h is fa m ily .

A n A p p r e c ia t io n . — C a p ta in C o le, M .O ., K . O . S . B . , B y w ell, a s k s us, t h r o u g h th e m e d iu m o f th is J o u r n a l, to t h a n k J o h n Jarvis, F ir s t A id A tte n d a n t, W e s t M y la n d C o llie ry , N o rth u m b e rla n d , a n d m e m b e rs of th e S . J . A . B . on t h e p r o m p t a n d b r illia n t first a id re n d e r e d a t a r e c e n t a c c id e n t w h ic h befell s o m e of th e “ l a d s ” of tbe K . O . S . B . o n a S h o o t i n g R a n g e , w h e n t h r e e w e r e k i l l e d a n d fi v e wounded. S c u n t h o r p e ’s E m e r g e n c y F i r s t A i d H o u s e s . — S c u n t h o r p e A . R . P . a u t h o r i t i e s h a v e s p e n t £ 7 1 0 in m e d i c a l s u p p l i e s a n d e q u i p m e n t t o fit u p t h i r t y - o n e e m e r g e n c y fi r st aid points a t h o u se s sc a tte r e d o v er the to w n . T h e occu p iers h a v e a g r e e d to s to r e th e e q u i p m e n t a n d to p r o v id e a r o o m fo r th e tr e a t m e n t of c a s u a ltie s in e m e r g e n c y . T h i s is a lo c a l s c h e m e to s u p p le m e n t th e o rd in a r y C ivil D e fe n c e F ir s t A id P osts. A ld e r m a n H . V . T o m b s , the A . R . P . C o n tro ller, s ta te s th a t th e w a r d e n s h a v e co llected ;£ 8 7 0 fr o m th e p u b lic to e q u ip t h e s e p oin ts, a n d th e b a la n c e o f ; £ 1 6 0 h a d been in v e s te d fo r r e p la c e m e n ts .

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Queries and Answers to Correspondents Q u e r i e s w i l l b e d e a l t w i t h u n d e r t h e f o l l o w i n g r u l e s :— L e tte rs c o n ta in in g Q u e rie s m u s t b e m a r k e d o n th e to p l e f t - h a n d c o r n e r o f t h e e n v e l o p e “ Q u e r y , ’’ a n d a d d r e s s e d t o F i r s t A id , 46 , C a n n o n - s t r e e t , L o n d o n , E . C . 4 .

2. — A l l Q u e r i e s m u s t b e w r i t t e n o n o n e s i d e o f p a p e r o n l y . 3- — A l l Q u e r i e s m u s t b e a c c o m p a n i e d b y a “ Q u e r y C o u p o n ” c u t f r o m t h e c u r r e n t i s s u e of t h e J o u r n a l , o r, in c a s e of Q u e rie s fro m a b ro a d , fro m a re c e n t issu e.

4. — T h e T e x t b o o k t o w h i c h r e f e r e n c e m a y b e m a d e i n t h i s c o l u m n i s t h e 39 t h ( 1937 ) E d i t i o n o f t h e S . J . A . A . M a n u a l of F i r s t A id to t h e In ju r e d .

Treatm ent of Carbolic Poisoning. B .T .

(B irm in g h am ).— T h e recen tly by a S .R .N . P o i s o n s :—

a tta ch e d sta te m e n t w as m a d e in t h e c o u r s e o f a l e c tu r e o n

“ Y o u r S t. J o h n T e x t b o o k in s p e a k i n g of t h e t r e a t m e n t fo r C a r b o lic A cid P o is o n in g , i n s tr u c ts y o u to g iv e h a p in t of M e d ic in a l P a ra ffin , o r 1 ta b le s p o o n fu l of E p s o m o r G l a u b e r S a l t s in a t u m b l e r f u l o f m i l k o r w a t e r . I s a y — d o n ’t d o a n y s u c h t h i n g ! T h e s t o m a c h h a s a lr e a d y b e e n in ju r e d by th e c o rro s iv e a c tio n of th e acid , a n d th e r e s u l t i n g e ffe rv e s c e n c e of t h e E p s o m S a l t s w ill o n ly te n d to p e rfo r a te th e o r g a n . ” T h e r e a re p o sitiv ely no g r o u n d s for th e s ta te m e n t th a t p e rfo r a tio n of th e s to m a c h m i g h t re s u lt fro m th e a d m i n i s t r a tio n of E p s o m S a l t s in t h e c a s e of C a r b o lic A c id P o i s o n i n g ; a n d th e S .R .N . s h o u ld h a v e o b ta in e d m ed ic al ad v ice before s h e a tte m p te d to c o n tro v e rt th e T e x tb o o k .— N . C o r b et F

letcher

Exam ination Howler. M .R . (C a n n o n S t.).— In a recen t e x am in atio n I ask e d a c a n d id a te h o w he w o u ld pro ceed to tre a t a p a tie n t suffer in g fro m s p ra in e d a n k le. H e c o m m e n c e d h is a n s w e r :—

W ith a sp r a in e d a n k le I w o u ld f i r s t rem ove the foot I " b u t a b r u p t l y s to p p e d w ith a lo o k of s u r p r is e w h e n th o s e in h is im m e d ia te v icin ity b u r s t o u t l a u g h in g . Good!

N e x t , p l e a s e ! !— N . C . F .

Bleeding from Lungs. S .N . (N e w c a s tle ).— In a re c en t co m p etitio n , I fo u n d a m a n ly in g o n h is b a c k , c o u g h i n g a n d s p ittin g u p b r i g h t re d and f r o th y blo o d . On e n q u irin g I fo u n d th a t he w a s a T . B. s u b ject a n d also th a t he h a d a frac tu re d r ig h t patella. A c c o rd in g to th e m a r k in g s h e e t I s h o u ld h a v e a p p lie d s m e llin g sa lts to th e n o se a n d s p rin k le d th e face w ith co ld w a te r . I did n o t do eith er, m y re a so n s b e in g th a t th e s m ell in g sa lts m ig h t m a k e th e p a tie n t c o u g h m o re , a n d also th a t I w a s u n d e r th e im p ressio n th a t no d irect or in d irect stim u la tio n s h o u ld be g iv en u n til th e h a e m o rrh a g e is c o n tr o lle d . I s h o u ld be p le a se d w here, I w e n t w ro n g . Y our arg u m e n ts c o rre c t.— N .C .F .

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Treatm ent of Epilepsy. W . S . ( C o v e n t r y ) . — O n J u n e 26 t h I t o o k p a r t i n a c o m p e t i t i o n w h ic h w e w on. O n e o f t h e o r a l t e s t s w a s :— “ H o w w o u ld y o u tre a t a case of E p ilep sy ? ” A fter g iv in g

R I D tre a tm e n t rem em ber H ow stitu tio n a l

a c c o r d i n g to T e x tb o o k , th e d o c to r to ld m e to n e x t tim e to re m o v e th e cause. c a n a fir st a i d e r r e m o v e a c a u s e w h i c h is c o n ? T h a n k in g you fo r p a s t favours.

C learly you h a v e m is u n d e rsto o d th e criticism of y o u r e x a m i n e r , b e c a u s e n o d o c to r w o u ld te ll y o u , a first a id e r, to r e m o v e th e c a u s e of E p ilep sy . I s u sp e c t, th e re fo re , th a t y o u failed to s tre s s th e n e ed to p ro te c t y o u r p a tie n t b y r e m o v in g c a u s e s of in ju ry s u c h a s m ig h t re s u lt d u r in g th e co n v u lsiv e s ta g e , fro m th e p a tie n t s t r i k i n g p ieces of f u r n itu r e in h is im m e d ia te v ic in ity .— N .C .F .

Treatm ent of Fractured F e m u r. F .G . ( M itc h a m ) .— A t a r e c e n t E x e r c i s e a m e m b e r of m y s q u a d h a d to a tte n d to a p a tie n t su ffe rin g fro m fra c tu re d h e a d of th e fe m u r. H e t r e a te d a s fo r f r a c tu r e of f e m u r a n d sp lin ted a cco rd in g ly . A t th e d iscu ssio n h eld a fte rw a rd s h e w a s to ld t h a t h e s h o u ld h a v e tr e a te d th e p a tie n t a s fo r f r a c tu r e of p elv is. W e w elco m e y o u r c o m m e n ts a n d d ecisio n . M y d iff ic u lty is t o a p p r e c i a t e h o w o n e a r t h a n y o n e — be h e d o c to r o r first a id e r — c o u ld m a k e s u c h a d ia g n o s is , w h ic h in fa c t c o u ld o n ly be e s ta b lis h e d b y x - r a y e x a m in a tio n . In a c tu a l c irc u m s ta n c e s a n d esp ecially u n d e r a ir ra id c o n d itio n s , a n in ju r y in th e r e g io n of th e h ip jo in t (u n le s s th e re w a s m a r k e d s h o rte n in g of lim b ) w o u ld be m o s t s u g g e s tiv e of f r a c tu r e d pelvis a n d w o u ld rig h t ly b e tr e a te d a s s u c h . — N .C .F .

Schafer, Silvester or Howard. P . M . (B o lto n ). — In th e la s t p a r a g r a p h of th e re p ly w h ic h w a s p u b lis h e d u n d e r th e a b o v e h e a d i n g in th e J u n e is su e of F ir s t A id , th e r e w o u ld s e e m to b e a ty p o g r a p h ic a l e rro r. W h i l e t h e c o n t e x t is p e r f e c t l y c l e a r y o u a r e c r e d i t e d w i t h w ritin g — “ O f co u rse you k n o w th a t a p a tie n t w h o c a n n o t b e t u r n e d on h is back ( m y i t a l i c s ) o w i n g t o a n o p e n a b d o m in a l w o u n d . . . .” I t a k e it t h a t y o u a c t u a lly w ro te — “ o n h is fa c e .” A m I rig h t ? Y e s ; a n d y o u r l e t t e r is a p p r e c i a t e d . —

N.C.F.

Fracture of Pelvis. W . P. (B risto l).— I h a v e b een r e q u e s te d by a te a m of B. R .C .S . m e m b e r s , w h o a r e t r a i n i n g f o r a c o m p e t i t i o n , t o a s k if y o u w o u ld be g o o d e n o u g h to g iv e u s a r u l i n g o n th e f o l l o w i n g p o i n t s :— Is it c o rre c t to tie th e k n o t of th e t r i a n g u l a r b a n d a g e ( w h ic h is u s e d fo r s u p p o r t i n g a f r a c t u r e d p e lv is) in f r o n t of t h e b o d y o v e r th e m u s c u l a r w a ll of th e a b d o m e n o r o n th e sid e o v e r th e p elvic b o n e ? B o th th e S t. J o h n a n d B .R .C .S . T e x tb o o k s s e e m to s u g g e s t t h e f o r m e r b u t s o m e of o u r m e m b e r s c o n te n d t h a t th e b a n d a g e s h o u ld b e t ie d o n t h e s id e , e s p e c i a l l y w h e n t h e f r a c t u r e is k n o w n to b e o n o n e s id e only. W i t h a f r a c tu r e d pelvis th e tie d off o n t h e f r o n t a n d in th e a b d o m e n , b e c a u s e th is p o sitio n u n if o r m c o n tro l of th e f r a c tu re , w h ic h c a n o n ly b e d ia g n o s e d b y

tria n g u la r b a n d a g e m u s t be m i d d l e l i n e o f t h e p a t i e n t ’s of th e k n o t p ro v id e s a m o re th e e x a c t site a n d e x te n t of x - r a y e x a m i n a t i o n . — N .C .F .

L a y Instructor Certificate. I.V . ( C a m b r id g e ) .— F r o m a re fe re n c e in th e c o lu m n s of th e J u n e issu e of F ir st A id , I u n d e r s ta n d t h a t B r ig a d e O fficers a r e t a k i n g th e e x a m in a ti o n for th e L a y I n s t r u c to r C ertificate. A s I g a t h e r th a t th is o n ly p e rm its in s tr u c tio n fo r th e p r e lim in a r y c o u rs e s of first a id , I w o n d e r w h y O fficers w h o ta k e th e certificate w a n t to s te p d o w n . I s h o u ld h a v e th o u g h t th a t th e y s h o u ld w a n t to s te p up . W h a t is t h e o b je c t of t h is c e r tific a te ? W e are g e t t i n g v a r io u s a n s w e r s b u t n o b o d y s e e m s fu lly to u n d e r stan d . Y o u r rep ly , th e re fo re , w ill b e m u c h a p p re c ia te d .

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V I R S T

l t w o u l d a p p e a r t h a t y o u h a v e b e e n m i s i n f o r m e d a s to th e c h a r a c te r of th e e x a m in a tio n for L a y I n s tr u c to r C ertifi cate. I t s c h ie f o b j e c t is t o e n s u r e t h a t t h e C o u n t y C o m m is s io n e r s s h a ll h a v e re a d ily a v a ila b le a list of m e n a n d w o m e n m e m b e r s of th e B r i g a d e w h o h a v e p ro v e n b y e x a m in a tio n t h a t th e y a r e efficient a n d q u a lifie d to le c tu re o n th e S h o r t C o u r s e of t h e H o m e O ffic e a n d o n t h e P r e l i m i n a r y ( b u t n o t th e A d u lt S ta n d a r d ) C o u r s e of F i r s t A id of th e S t. J o h n A m b u la n c e A sso ciatio n . I n o t h e r w o r d s , t h e p o s s e s s io n o f t h e c e r t i f i c a t e ( w h ic h is a w a r d e d o n ly t o t h o s e w h o f a c e a n d p a s s a s t i f f e x a m i n a t i o n ) is n o t a s t e p d o w n b u t r a t h e r a s t e p u p , b e c a u s e l a y in d i v i d u a l s m u s t h a v e a v e r y c o m p le t e k n o w l e d g e o f fir s t a id if t h e y a r e to l e c t u r e in t h e s e s im p lif ie d a n d a b b r e v i a t e d c o u r s e s o f fir s t a i d . — E d i t o r .

Tra nsp o rt of Fractured Spine. J . T . ( W a r r i n g t o n ) . — I r e c e n t ly g a v e a first a id t e s t w h ic h c au s e d g r e a t c o n tro v e rs y a n d w o u ld a p p re ciate y o u r o p in io n . D ia g n o s is : H is to ry from p atie n t, c lear s y m p t o m s o f a f r a c t u r e o f s p i n e i n t h o r a c i c r e g i o n , p a t i e n t ’s p o s itio n (on b a c k ) . O n c o m p le tio n of d ia g n o s i s p a tie n t la p se s in to u n c o n sc io u sn e ss. W h ic h m e th o d of tr a n s p o r t is to b e a d o p t e d ? M y r u l i n g w a s t h a t h e s h o u ld b e r e m o v e d in s u p i n e p o sitio n. C riticism from s q u a d s w a s th a t th e p ro n e p o sitio n s h o u ld b e a d o p te d a s d ia g n o s is w a s c o m p le te b efore p a tie n t b e c a m e u n co n sc io u s. M e a n w h i l e w e t h a n k y o u in a n t i c i p a t i o n of y o u r r e m a r k s a s to a b o v e p ro b le m a n d re a so n s for su c h ad o p tio n . T h e T e x tb o o k in s tru c ts y o u to s ele c t th e s u p in e p o sitio n fo r p a tie n ts w h o , s u ffe rin g fro m s p in a l in ju ries, a r e in sen sib le. I t d o e s s o b e c a u s e in s u c h c i r c u m s t a n c e s it w o u ld n o t b e p o s sib le fo r a first a id e r to m a k e a d efin ite d ia g n o s is . W hen, h o w e v e r , t h e d i a g n o s i s h a s b e e n m a d e , a s in t h e c a s e q u o te d , t h e p o s i t i o n o f p a t i e n t d u r i n g t r a n s p o r t is q u a l i f i e d b y t h e p o sitio n of th e s p in a l in ju ry . In o th e r w o rd s, I a g re e w ith th e co n te n tio n of y o u r s q u a d s th a t su ch p a tie n t sh o u ld be r e m o v e d in p ro n e p o s itio n .— N .C .F .

Stimulants w ith Internal Haem orrhage. A .B . ( N o r w i c h ) . — A s a m e m b e r of th e B . R . C . S . I w o u ld lik e t o p a y t r i b u t e to y o u r Q u e r y C o l u m n , t h e a n s w e r s in w h ich a re m o st in te re stin g a n d e d u catio n al. Now 1 w o u l d l i k e t o p r e s e n t m y p r o b l e m a n d t o a s k if w e s h o u l d g iv e s t im u la n ts to a p a tie n t s u f fe rin g fr o m in te r n a l haem orrhage. A t a re c e n t p ra c tic e o u r in s tru c to r to ld u s th a t th e a d m i n i s t r a t i o n of s t i m u l a n t s to s u c h a p a tie n t w o u ld h e lp to c o u n te ra c t s h o c k a s p a tie n t h a d a s u b n o rm a l tem p eratu re. I d isa g re e d a n d said th a t th e a d m in is tra tio n of a s t i m u l a n t w o u ld c a u s e a n in c re a s e in th e h a e m o r r h a g e b y its a c tio n o n th e h e a r t. P l e a s e tell m e w h i c h a n s w e r is t h e r i g h t o n e . Y o u r a n s w e r w a s c o rre c t.— N .C .F .

C a lc iu m Carbide Poisoning. H.

R . (S h effield ).— I h a v e h e a r d sev e ra l s u g g e s tio n s w ith r e f e re n c e to th e t r e a t m e n t of C a l c iu m C a r b id e P o is o n in g ; a n d I s h a l l b e g r a t e f u l if y o u w i l l t e l l m e t h e c o r r e c t trea tm en t.

L i t t l e is k n o w n a b o u t t h e t r e a t m e n t o f C a l c i u m C a r b i d e P o is o n in g (w h ic h m a y p ro v e fa ta l in th r e e o r fo u r h o u rs ) ex cep t th a t tre a tm e n t m u s t be im m e d ia te a n d prev en t th e p ro d u c tio n of a cety len e g a s. T h e su b ject h a s been u n d e r d is c u s s io n in th is c o lu m n d u r i n g th e p a s t te n y e a rs. T h e n e t r e s u l t of th e s e d is c u s s io n s is t h a t g ly c e r in e ( w h ic h a b s o r b s w a t e r ) is r e g a r d e d a s t h e id e a l a n tid o te fo r u s e b y first a i d e r s w h o s h o u l d a d m i n i s t e r it fre e ly . T his

R I D d o n e th e y s h o u ld ta k e s te p s to m a k e th e p a tie n t v o m it a n d so e m p ty th e sto m a ch . If g l y c e r i n e is n o t a v a i l a b l e , t h e n m e d ic in a l p araffin m ig h t be u s e d fo r th e s a m e p u rp o se , a l t h o u g h , of c o u r s e , t h i s r e m e d y is i n s o l u b l e in w a t e r a n d a lc o h o l.— N .C .F .

H um o ur in First Aid. A . H . ( C h a r l t o n ) . — A y o u n g l a d y in m y office, a n e n t h u s i a s t i c m e m b e r of th e G ir ls ’ T r a i n i n g C o rp s, h a s re c e n tly t a k e n a c o u r s e in first a id a n d h a d h e r e x a m i n a t i o n th e o t h e r day. I w a s in te r e s te d in h e r p r o g r e s s , a n d w a s o n ly too p le a se d to h e lp h e r w ith a n y d ifficulties w h ic h s h e fo u n d a s sh e p ro g re s se d w ith th e su b ject. F in ally c a m e th e e x am in atio n . O n th e fo llo w in g m o r n i n g I a s k e d h e r s o m e of th e q u e s tio n s w h ic h s h e h a d been a sk e d a n d h o w sh e h a d a n sw e re d th em . O ne rep ly I g o t w a s " A n d o h ! I h a d 1o p a t a C a ta lin a on the h ea d f o r the p r a c tic a l test. ” Good !

N e x t, p le a s e !

1— N . C . F .

Th re e -M a n or Three-Blanket D rill. F .C . (C ro y d o n ).— C a n y ou p le a se g iv e a n y in fo rm a tio n re s p e c tin g th e T h r e e - B la n k e t M e th o d u s e d for r e s u s c ita t i o n i n c o n n e c t i o n w i t h S c h a f e r ’s m e t h o d o f a r t i f i c i a l resp iratio n ? T h i s q u e r y h a s b e e n p u t to C ivil D e fe n c e w o r k e r s re c e n tly ; b u t n o o n e s e e m s to h a v e h e a r d a b o u t it. A s t h e m e t h o d is b e i n g i n c o r p o r a t e d in a f o r t h c o m i n g t e s t , i n t e r e s t e d p e r s o n s feel h a n d i c a p p e d . So we s e e k y o u r k i n d help . A s I k n o w n o th in g a b o u t a T h re e -B la n k e t m eth o d 1 p a s s e d y o u r q u e r y to C a p t a in A l w j n B isc o e of th e R o y a l L ife S a v i n g S o c ie ty to w h o m w e a r e in d e b te d fo r th e f o llo w in g e x p l a n a t i o n :— “ W h i l s t a T h r e e - B l a n k e t m e t h o d is u n k n o w n t o m e a l s o , I t h i n k t h a t y o u r c o r r e s p o n d e n t is c o n f u s i n g t h i s w i t h o u r T h r e e - M a n D rill fo r b la n k e tin g p a tie n t. C o v erin g p a tie n t a n d so m a i n t a i n i n g t h e b o d y h e a t is a m o s t i m p o r t a n t p a r t o f S c h a f e r ’s m e t h o d o f a r t i f i c i a l r e s p i r a t i o n . A t th e o u t s e t, t h e r e f o r e , it is d e s i r a b l e t o la y t h e p a t i e n t o n a b l a n k e t p ro v id in g th a t th is do es n o t en ta il delay. T h e R .L .S .S . a d v o c a te a T h r e e - M a n D rill for p r a c tis in g th is c o v e r in g w ith b la n k ets. F o r d e t a i l s s e e p a g e s 28 a n d 56 o f t h e S o c i e t y ’s b o o k l e t A r t ific ia l R e sp ir a tio n , are you p r e p a r e d ? " - — N . C . F .

Aggravation of Fractured Patella. O.

M . ( E a s t H a m ) . — W e s h a l l b e g r a t e f u l if y o u w ill k i n d l y ex p lain h o w a fra c tu re of p atella m a y be a g g r a v a te d by m o v e m e n t of p a tie n t.

T h e s t r o n g m u s c le s o n th e a n te r io r a s p e c t of th e th i g h in th e ir lo w e r p a r t s p r e a d o u t in to a s h e a th of fib ro u s tis su e w h i c h e n c a s e s t h e p a t e l l a a n d is a t t a c h e d to t h e h e a d of t h e tib ia . W h e n t h e p a t e l l a is b r o k e n , t h i s s h e a t h w ill k e e p t h e f r a g m e n t s t o g e t h e r ; a n d t h e d a n g e r o f a g g r a v a t i o n ( t h a t is, s e p a r a t i o n of t h e f r a g m e n t s ) re s ts , n o t b n s id e - to - s id e m o v e m e n t s a s w i t h f r a c tu r e s of t h i g h a n d le g , b u t o n flex io n of th e k n e e -jo in t w h ic h th e p a tie n t m a y a tte m p t, a l t h o u g h h is l i m b is m o r e o r le s s h e lp le s s . T o g u a r d a g a i n s t th is, w e k e e p th e lo w e r lim b fu lly e x te n d e d o n a s p lin t a n d ra is e d , a n d w e e l e v a t e t h e p a t i e n t ’s h e a d a n d s h o u l d e r s . — N . C . F .

44 FIRST A I D ” QUERY and REPLIES COUPON. To be cut out and enclosed with a ll Queries. Aug., 1943.

JOHN BALE MEDICAL PUBLICATIONS MANUALS OF FIRST AID. By N. CORBET FLETCHER, M.B., B.C., M.A.(Cantab.), M.R.C.S. A ID S

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O n e o r o t h e r o r a ll o f t h e t h r e e r a c e s o f g e r m s , S t r e p t o c o c c i , S t a p h y l o c o c c i a n d B . p y o c y a n e u s a r e f o u n d in e v e r y s k i n i n f e c t i o n c o m m o n t o t h i s c o u n t r y , a n d A N T I P E O L O I N T M E N T c o n t a i n s t h e antibodies ( a n t i v i r u s ) o f t h e s e g e r m s . H e a l i n g is e x p e d i t e d b y t h e p r o v e d i n g r e d i e n t s o f t h e o i n t m e n t , a n d s e p t i c d e v e l o p m e n t is s t o p p e d o r p r e v e n t e d b y it s a n t i v i r u s s t e r i l e v a c c i n e f i l t r a t e s . A N T IP E O L O I N T M E N T is u n s u r p a s s e d f o r B U R N S a n d S C A L D S , f o r i t is m i c r o b i c i d e a n d n o n - a d h e s i v e , a n d d r e s s i n g s d o n o t r e q u i r e t o b e c h a n g e d every day. W O U N D S , B U R N S , e t c , W I L L N O T T U R N S E P T I C if tre a te d w ith A N T I P E O L O I N T M E N T .

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N UM BER.

F irst-A id In s tru c to rs R e s u s c i t a t i o n b y R o c k i n g : A d a p t a t i o n f o r F i r s t A id

L e tte rs to th e E d ito r

...

S .J.A .B . H e a d q u a rte rs a n d D is tric t R e p o rts

S u g a r D ia b e te s (D ia b e te s M ellitu s)

R .l.P .

R ailw ay A m b u la n c e N ew s

T h e H o m e G u a r d a n d F ir s t A id

R eview s

Q u e r ie s

and

A n sw ers

C o rresp o n d f

r s :—

S tra in s a n d R u p tu r e d M u sc le s

E x am in a tio n H o w ler

F r a c t u r e s of C l a v ic le a n d H u m e r u s

S ig n s a n d S y m p to m s of S h o c k

F ix a tio n of F r a c tu r e d P a te lla

A lco h o l a s D is in f e c ta n t

U s e s of W itc h H a z e l

EnU ndat 1 \_Stationtrs' H a l l \ r

. .

H u m o u r in F i r s t A id

S tre tc h e r D rill

F r a c t u r e s of P e lv is a n d F e m u r

T r a n s p o r t ef F r a c tu r e d

S p in e

PRIC E [4 /- P e r

THREEPENCE

A n n u m , P o st

F ree

EDITORIAL.

F.R.S.A.

R EADER S.

A n n u a l S u b s c r i p t i o n is 4 s . p o s t f r e e ; s i n g l e c o p i e s

A ll

F.R.San.l.,

SE PT E M B E R , 1943.

N O T IC E F IR S T AID

SCOTT,

N o se B le ed in g

F i r s t A id a n d D r u g s

I n the consideration of any matter to which importance may be attached, it is difficult, when space is limited to one column of a newspaper, fully to set out all the points involved. There exists always the danger of misunderstand ing, and this seems to be the case in connection with the editorial entitled “ Instructors in First A id,” which appeared in our August issue. In this we emphasised the need that existed for more widespread instruction in first aid, and we did go so far as to say that, in the case of industrial acci dents, there were, in every well-appointed factory or works, those who were competent to deal with them in their early stages. There could have been nothing in that to suggest that medical aid was un necessary, the use of the words “ early sta g e s” suggesting precisely the opposite. On the question of instructors, our sole point was that there were not sufficient competent persons to go round, and it was necessary that many more should be trained. As to the training of instructors that would of course be in the hands of the doctors, and in their hands alone. That such is the case is undeniable, and nothing we adduced in our statements pointed to any desire to oust the medical man. Not only must instructors be inclose touch with the doctors, but they must carry out their wishes in every way and must hand their “ patients” over to them immediately they arrive. Any instructor who neglects to do this is not only treading on danger ous ground but subverting the most elementary of the principles on which first aid is based. As to our remark that the most erudite persons are not necessarily the best of teachers, surely there is no need to labour a point which is commonly accepted in every profession, and cannot be construed into an incitement to the appointment of laymen for instructional purposes. It is one of those remarks of universal application into which those who are so minded may read anything. At the present time, there is a shortage of doctors for every class of work, and none can foresee what is going to happen if bureaucracy is to win the day, and the medical becomes a State service, under the immediate control of W hitehall. That is a matter, First-A id In stru ctors,

IXtSf

however, with which we shall be dealing later, when the actual occasion arises. We trust that we have made our position clear, and that readers will understand that we realise to the full, and have always realised, that instruction in first aid must be left entirely in the hands of the medical profession.

R e s u s c it a tio n b y R o c k i n g : A d a p t a t io n f o r F i r s t Aid.

ir ,—

n o e x p e n s e in c u rre d in c o n v e r tin g A rm y ty p e s tre tc h e r s in to ro c k in g stretch ers. W e h a v e trie d it o u t in p r a c tic e a n d w e t h i n k t h a t it w o r k s . I t m a y b e o p e n t o s o m e g r a v e c r i t i c i s m — if s o , it c a n b e e a s i l y s c r a p p e d . W e c l a i m n o p a t e n t r i g h t s , b u t , if a c c e p t a b l e , i t m i g h t p e r h a p s b e k n o w n a s t h e “ K irk c o n n e l” a d ap tatio n .

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F ig .

W e h a v e r e c e i v e d p e r m i s s i o n f r o m t h e E d i t o r o f t h e B r itis h M e d ic a l J o u r n a l t o p u b l i s h t h e f o l l o w i n g l e t t e r f r o m D r . B o w m a n E d g a r , w h ic h a p p e a re d in th e B .M .J for J u ly 24 t h , 1943 : — S

A I D

I t it s e e m s o u l y f a i r t h a t t h e m e n w h o h a v e w o r k e d fo r a f o r w a r d s te p in first a id s h o u ld b e k n o w n ; th e ir n a m e s a r e S e r g ts . A. M c A n e s p ie a n d J. T o r r a n c e , a n d C o rp l. D . H a s tin g s of th is b a tta lio n , a lo n g w ith M r. R o b e r t M c C o r m ic k , C iv il D e f e n c e F i r s t A id P o s t C o n tr o lle r , U p p e r N i t h s d a le . T h e s k e tc h of th e g a d g e t h a s b e e n m a d e b y L ie u t. G . B ro a d fo o t, K e llo h o lm . — I a m , e tc .,

D r . N . H o w a r d M u m m e r y ’s r o c k i n g a p p a r a t u s f o r E v e ’s m e t h o d o f r e s u s c i t a t i o n ( J u n e 19 , p . 759 ) w o u l d a p p e a r t o b e e x c e lle n t for, a s h e say s, r e s c u e s ta tio n s , a lso sh ip s, h o s p ita ls , etc. I t is, h o w e v e r , n o t p a r t i c u l a r l y s u i t a b l e a s a p o r ta b le a d j u n c t to first a id . T h e N . C . O . ’s o f t h e m e d i c a l s e c t i o n o f t h i s b a t t a l i o n , a l o n g w i t h t h e d i r e c t o r of t h e C iv il D e f e n c e f i r s t - a i d p o s t s in th e d is tric t, h a v e g iv e n s o m e tim e to th e s tu d y of th e p o s s i b ility of a p p l y i n g t h is r o c k i n g m e t h o d to first aid . They b e lie v e it to be, fr o m w h a t th e y h a v e re a d o n th e su b je c t, th e m o s t efficient m e th o d y e t k n o w n . T h e t e c h n i q u e is e a s y to lea rn . I t is m u c h le ss a r d u o u s a n d m o r e fo o lp ro o f t h a n a n y p re v io u s f o r m of artificia l re s p ir a tio n , a n d , o n c e it h a s b e e n s e t in m o tio n , it c a n b e c a r r ie d o n b y q u ite u n t r a in e d p e rso n n el. F o r th e s e r e a s o n s it w o u ld a p p e a r to b e th e m e th o d of c h o ice.

H ol e s drilled . c o u n t e r s u n k to f it I" Screw Neils

\'U

F ig .

T o ta k e th e p lace of th e r a th e r c u m b e rs o m e a p p a r a tu s d e s c rib e d b y D r. H o w a r d M u m m e r y w e a r e h a v i n g a little “ g a d g e t , ” of w h i c h I e n c l o s e a s k e t c h , a t t a c h e d to all o u r s tre tc h e rs of th e A rm y ty p e — a p a ir to e a c h s tre tc h e r. I t is, in e s s e n c e , m e r e l y a g r i p to s lip o v e r a n y a v a i l a b l e pole, h a y f o r k h a n d le , fen ce, ro p e , p a lin g , e tc ., so t h a t th e r o c k i n g of th e s tr e tc h e r m a y b e c a r r ie d o n. The gadget is of t h e “ la z y -b lo c k ” p a tte r n , a n d h a s b e e n m a d e fo r m e b y M r. R o b t. C o lq u h o u n , c h ief e n g in e e r of M e s srs. B aird a n d D a l m e l l i n g t o n ’s F a u l d h e a d C o l l i e r i e s . It c o n sis ts of a b a s e p l a t e w h i c h is f i x e d t o t h e c e n t r e o f e a c h s t r e t c h e r p o l e b y fo u r s c r e w n ails. F r o m th e p late a ris e s a n a tta c h m e n t f o r f i t t i n g o v e r t h e p o l e , b a r , e t c . , o n w h i c h t h e r o c k i n g is to be d o n e . I t is e a s y to m a k e , a n d t h e r e s h o u ld b e little o r

B ow m an

E dgar,

M .O ., 4th B a ttn ., D u m frie s h ire , H .G . K irk co n n el, D u m friesh ire. [S in ce p u b lic a tio n sh o w n th a t th e g a d g e t wood. T h is h a s th e m o re e asily o b ta in e d , w o o d w o r k in s t i n c t s , it

of th e a b o v e, f u r th e r e x p e r im e n t h a s c a n b e e q u a l l y w e ll m a d e o u t of h a r d a d v a n t a g e o v e r stee l of b e in g m u c h it c a n b e f a s h io n e d by a n y o n e w ith is c h e a p e r , l i g h t e r , a n d , w e b e l i e v e

w ill p ro v e e q u a lly e fficient.]

D r . B o w m a n E d g a r s e n d s u s t h e f o l l o w i n g n o t e s :— S u g g e ste d

T e c h n iq u e

fo r

F ir s t

A id

T eam s.

T h e fo llo w in g a re th e s te p s w h ic h m ig h t b e fo llo w ed b y a n y F i r s t A i d T e a m o f f o u r i n a p p l y i n g E v e ’s m e t h o d :— T h e p a t i e n t , h a v i n g b e e n r e m o v e d f r o m t h e c a u s e of t h e a s p h y x i a , S c h a f e r i s c o m m e n c e d i n s t a n t l y b y N o . 3 a n d is a p p l i e d f r o m the sid e o f t h e p a t i e n t o p p o s i t e t o t h e p r o p o s e d f u lc r u m , i.e ., th e pole, ro p e , fe n c e, e tc ., o n w h ic h th e a c t u a l r o c k i n g is t o b e p e r f o r m e d . S p a c e f o r t h e o p e n s t r e t c h e r is le ft o n t h e g r o u n d b e tw een th e c asu a lty a n d th e fu lcru m . T h e p a t i e n t ’s h e a d , t u r n e d to t h e sid e, re s ts o n t h e u p p e r of h is t w o f o r e a r m s , w h ic h a r e fo ld ed o n e o n to p of Ih e o th e r. W h i l e S c h a f e r is b e i n g c a r r ie d o n , N o s. 1 a n d 2 p r e p a re th e s tr e tc h e r w ith b la n k e ts a n d p la c e it in p o s itio n a s above. N o . 4 is, i n t h e m e a n t i m e , l o o p i n g b a n d a g e s ( r o p e s , s t r a p s , e t c .) r o u n d t h e e l b o w s a n d a n k l e s of t h e u n c o n s c i o u s m an. T h is b e in g d o n e , h e p re p a re s to g r a s p th e p a tie n t a b o v e th e k n e e s , fro m th e s a m e sid e a s N o. 3 . T h e o th e r t w o m e m b e r s o f t h e t e a m (1 a n d 2 ) , n o w a t e i t h e r s i d e o f th e h ead , g ra s p th e su p erim p o se d fo rea rm s w ith o n e h a n d a n d p l a c e t h e o t h e r u n d e r t h e i n j u r e d m a n ’s c h e s t . B o th fo re a rm s a re to b e s u p p o rte d so th a t th e y m a y n o t be d is p la c e d a n d s o a llo w t h e h e a d to fa ll f o r w a r d . W h e n a ll is r e a d y , a n d j u s t a s t h e o p e r a t o r c o m p le t e s t h e p r e s s u r e s t r o k e , t h e o r d e r to “ l i f t ” is g i v e n . The o p e r a to r s lip s h is tw o h a n d s u n d e r t h e a b d o m e n a n d pelvis, a n d , a ll li f t i n g t o g e t h e r , t h e p a t i e n t is s m a r t l y t r a n s f e r r e d to th e stretch er. N o. 3 a t o n ce b r in g s h is h a n d s b a c k to th e S c h a fe r p o sitio n a n d re s u m e s th e a rtificial re s p ira tio n . If th e m o v e m e n t h a s b e e n “ slic k ly p e r f o r m e d ,” p ra c tic a lly n o loss of r h y t h m s h o u ld o c cu r. N o s. 1 a n d 2 n o w firm ly b in d th e e lb o w s to th e s tr e tc h e r h a n d le s w h ile N o. 4 d o es th e s a m e to th e a n k le s. A s s o o n a s th e s e a r e s e c u re d , a n d a t th e e n d of th e S c h a f e r p r e s s u r e s t r o k e , t h e s t r e t c h e r is s m a r t l y lif te d o n to t h e f u l c r u m b y 1 a n d 2 a t t h e h e a d a n d 4 a t t h e feet. N o. 3 , a fte r re m o v in g h is h a n d s fro m th e p a tie n t, m a k e s s u r e t h a t t h e a d a p t a t i o n d e s c r i b e d a b o v e fits s n u g l y o v e r th e fu lcru m .

F I R S T I n c i d e n t a l l y , it m a y b e m e n t i o n e d t h a t a n u n e x p e c t e d t i m in g te s t b y a s p e c ta to r (C o lo n el, R .A . M .C . ) g a v e th e t i m e f r o m t h e d e c k t o f i r s t “ r o c k ” a s 37 s e c s . , ^ w i t h o u t a n y loss of S c h a f e r r h y th m . W ith p ra c tic e th is tim e could be c u t w i t h o u t a n y difficulty. T h e f o llo w in g f u r t h e r p r o c e d u r e is t a k e n f r o m th e e x c e l l e n t d e s c r i p t i o n o f E v e ’s M e t h o d b y S u r g . - L i e u t . G . H . G i b b e n s , R . N . V . R . ( B . M .J . , 26 / 12 / 4 2 , 751 ). H e says “ A n y a v a ila b le m a n s ta r ts to ro c k th e s tre tc h e r a t t h e r a t e o f a c y c l e e v e r y 4 o r 5 s e c s . , t h a t i s , 12 t o 15 d o u b le ro c k s p e r m in . T h e p u m p in g m o v e m e n t sh o u ld be starte d ab ru p tly , a lm o st ro u g h ly , so th a t th e a b d o m in a l c o n te n ts b e g in to m o v e e a r ly in th e s tro k e , At first t h e h a n d l e s of t h e s t r e t c h e r s h o u l d b e a l l o w e d to rest on th e d e ck a t th e en d of th e h e a d d o w n stro k e, t h e s t e e p a n g l e o f 50 d e g r e e s g i v i n g v e r y e f f i c i e n t c h e s t d ra in a g e . L a t e r , it is e a s i e r t o c h e c k t h e h a n d l e s a t a f o o t f r o m t h e d e c k , t h i s s l o p e o f 30 d e g r e e s i s e f f i c i e n t a n d is le s s w o r k f o r t h e o p e r a t o r . W h e n r o c k i n g is i n p r o g r e s s , t h e m a n ’s c l o t h e s m a y b e r e m o v e d , h e m a y be g e n tly ru b b e d d o w n , a n d effo rts m a d e to w a r m h im u p .”

Letters to the Editor. W e a re in n o w a y re sp o n sib le fo r th e o p in io n s e x p re sse d , or th e s ta t e m e n ts m a d e , b y C o rre s p o n d e n ts .— E d ito r .

H IS T O R Y

O F

T H E

O RD ER.

D e a r S ir , — I n t h e A u g u s t i s s u e o f F i r s t A i d , t h e r e is a n e x c e l l e n t article by D r. C o rb et F le tc h e r on th e F u tu r e o f th e S .J .A .B ., in w h ic h h e s a y s t h a t n e w ly e n r o l le d m e m b e r s s h o u l d b e to ld s o m e t h i n g a b o u t t h e w o n d e r f u l h i s t o r y of t h e O r d e r . I s it p o s s ib le to r e a d a b o u t t h i s w o n d e r f u l h i s t o r y ? I b e lie v e t h e r e a r e l a r g e v o l u m e s o n t h e s u b j e c t , b u t is t h e r e a n y t h i n g in a c o n c is e a n d b rie f f o r m ?— Y o u r s fa ith f u lly , D o n a ld

S au n d ers.

[ O u r c o r r e s p o n d e n t w ill fin d t h e h i s to r y of t h e S . J . A . B . s e t o u t in “ T h e S t. J o h n A m b u l a n c e A s s o c ia tio n : I ts H is to r y a n d I t s P a r t in th e A m b u la n c e M o v e m e n t ” b y D r. N . C o r b e t F l e t c h e r , p r i c e 3 s. 6 d . , w h i c h i s a d v e r t i s e d i n F i r s t A id .— E d it o r .] TRA N SFERRED

T H E

RESCU E

SQUADS

D e a r S ir ,— S in c e t h e t r a n s f e r o f F . A . P . m e n to t h e R e s c u e S q u a d s , th e re n a tu r a lly h a s b e e n m u c h d is c u s s io n a n d c ritic is m in c o n n ec tio n w ith th e m a tte r, b e tw e e n th e m e n c o n ce rn e d . I th e re fo re d e c id e d to w r ite to t h e officers of t h e S . J . A .B . a n d th e B .R .C .S . s ta tin g th ese g rie v a n c e s, h o p in g th a t so m e jo in t a c tio n w o u ld be ta k e n to re m e d y th e p o sitio n . H o w e v e r , I h a v e s i n c e r e c e iv e d m y A u g u s t c o p y o f F i r s t A id , a n d w a s p le a s e d t o n o t ic e t h a t o u r a t t i t u d e is n o t c o n fin e d to t h is d i s t r i c t . I a m r e fe r r in g , o f c o u r s e , to th e le t t e r s i g n e d “ 1910 . ” I n s u p p o r t of th is, I e n c lo se a co p y of th e le tte r w h ic h I h a v e s e n t to t h e lo c a l B r i g a d e o fficers, a n d w h i c h I h o p e y o u w ill p rin t, b e c a u s e , a f te r a ll, w e s h a ll, a s D r. C o r b e t F le tc h e r sa y s in h is a rtic le , b e w a n te d a f te r th e w a r. (W e a re w a n ted n o w , of c o u rs e , fo r th e w o r k s h o p , p u b lic d u tie s , s e ll in g flag s, e t c . , b u t n ot if t h e r e i s a n a i r r a i d . ) H o w , then, c an w e h o n e s t l y a p p r o a c h t h e p u b l i c f o r s u p p o r t , if t h e y d o n o t s e e u s in a c t io n a s first a i d e r s in th e s e t r y i n g d a y s ?— Y o u r s faith fu lly , S g t.

L y c e tt.

C rew e. [W e re g re t th a t o w in g to p re s s u re o n sp ac e , w e c a n n o t p u b lish th e le tte r m e n tio n e d by o u r c o rre s p o n d e n t ab o v e. — E d ito r .]

R I D

S t . J o h n A m b u l a n c e B r ig a d e HEADQUARTERS AND DISTRICT REPORTS. No. I (Prince of Wales’s) District 2 5 t h ( F i n c h l e y a n d S o u t h g a t e ) C a d e t D iv is io n .— W h e n th e E a s t B a r n e t N u r s in g D iv isio n re c e n tly h e ld a m e e tin g fo r p o te n tia l c a d e ts a n d th e ir p a re n ts , e ig h te e n c a d e ts fro m th e a b o v e D iv is io n w e r e in v ite d to g iv e d e m o n stratio n s. I n tr o d u c e d b y D / O S. H . C o llin s a n d C / D / O M is s K . C le a s b y , t h e g i r l s p e r f o r m e d r e s u s c i t a t i o n d rill, tr e a t e d a first a id case, sh o w e d h o m e n u rs in g b a n d a g in g , b a th e d th e baby, tr e a t e d in f a n tile c o n v u ls io n s a n d d id s q u a d d rill. T e a a n d c a k e s w e re th e s ig n a l for a “ g e t- to g e th e r ” a n d th e F in c h le y a n d S o u th g a te cad ets, m u c h to th e ir d elig h t, w e re lite ra lly b o m b a rd e d w ith “ w h y s ” a n d “ w h e re fo re s .” D u rin g th e ev en in g , C ad e t S g t. E d n a S a y w a s p re sen te d w ith h e r G ra n d P rio r B ad g e . T h e s p o n s o r s a r e w i s h e d e v e r y s u c c e s s , a n d it is h o p e d to see a flo u r is h in g C a d e t D iv is io n in E a s t B a r n e t in th e n e a r fu tu re

County of Hampshire. I s le o f W ig h t A r e a .— T h e a n n u a l d is tr ib u tio n of a w a r d s to m e m b e rs of th e R y d e A m b u la n c e D iv isio n to o k p la c e in th e T o w n H a ll re c e n tly , a n d a ttr a c te d a g o o d a tten d an ce. T h i s w a s th e first tim e th is D iv is io n , t h e R a ilw a y m e n ’s D i v i s i o n a n d t h e C a d e t A m b u l a n c e C o r p s h a d c o m b in e d u n d e r th e n e w S u p t ., M r. A. M a y b u r y . A pre s e n ta tio n w a s m a d e to M r. G W . S lo a c o m b e , th e la te S u p t., w h o recen tly retired a fter m a n y y e a r s ’ activ e a n d e n th u sia s tic service. T h e M ay o r p resid ed a t th e d istrib u tio n , s u p p o rte d by th e M ay o ress (M rs. W ee k s) a n d o th e r n o tab le p erso n s. The M a y o r s a id it w a s v e ry p le a s in g to b e a s s o c ia t e d w ith th e th re e d iv isio n s a t t h a t jo in t m e e tin g . H e p a i d t r i b u t e to S u p t . S l o a c o m b e ’s l o n g a n d d e v o t e d s e r v i c e , a n d s a i d t h e y w e re very p leased th a t S u p t. M a y b u ry h a d u n d e r ta k e n th e w o rk , w h ic h h e h o p e d w o u ld lo n g c o n tin u e to h a v e th e s u p p o r t it m e r ite d fr o m m a n y fr ie n d s b o th in w a r a n d p e ac e . A d d re s s e s o n th e h is to r y of th e B r i g a d e b y D r. C a r p e n te r, a n d its w o r k in c o n n e c tio n w ith th e r a ilw a y s b y M r. G a r d e n e r w e r e lis te n e d to w ith g r e a t in te re s t. T h e M a y o r p re s e n te d D r. C a r p e n t e r w ith a W a r r a n t of A p p o in tm en t, a n d th ere w ere a b o u t 70 o th e r a w a rd s.

County of Lancashire. T h o r n to n C le v e le y s .— T h is D iv isio n , w h ic h h a s b e en in e x is te n c e fo r 20 y e a r s , h a s b e e n m a k i n g r a t h e r s lo w b u t sure pro gress. B e f o r e t h e w’a r a n o p t i o n o n a p l o t o f l a n d w a s s e c u re d a n d a w o o d e n h e a d q u a r te r s b u ilt. T h is served its p u r p o s e fo r a tim e , w h e n it w a s fo u n d i n a d e q u a t e fo r th e D i v i s i o n ’s r e q u i r e m e n t s , c o n s e q u e n t l y , t h e S o c i a l C o m m i t t e e , u n d e r A m b . O fficer A. H o u ld s w o r th , la s t y e a r s e t o u t to ra is e m o n e y to b u y o th e r la n d in p r e p a r a t i o n fo r b u ild in g a p e r m a n e n t a n d m o re s u ita b le h o m e fo r th e D iv isio n . L a s t y e a r £50 w a s ra ise d , a n d th is y ear, u p to A u g u s t 1s t , a f u r t h e r s u m o f £ 7 0 h a s b e e n r a i s e d . W i t h t h i s s u m a p lo t of l a n d h a s b e e n p u r c h a s e d , a n d th e c o m m itte e h a v e d e c id e d to h o ld a s e r ie s of d a n c e s a n d o th e r fo r m s of a m u s e m e n t in a f u r t h e r e n d e a v o u r to r a is e fu n d s . A m o d e rn W a ltz c o m p e titio n w a s h e ld re c e n tly in th e local P u b lic L e c tu re H a ll. F o r th is th e h all w a s p a ck e d , n o t o n ly b y local m e m b e r s b u t w ith d a n c e r s fro m a w id e a re a aro u n d . A g o o d n u m b e r of S e rv ic e m e n a t t e n d e d to s u p p o rt th e V ic e -P re s id e n t, C o u n c illo r A. J. K eisb y . M rs. M c K i n l e y , t h e S u p e r i n t e n d e n t ’s w i f e , g a v e t h e p r i z e f o r

F I R S T

d a n c i n g a n d a ls o s p o t p rizes. T h e e v e n i n g e n d e d w ith all v o t i n g t h a t it w a s t h e b e s t d a n c e e v e r h e ld in t h e d is tr ic t.

County of Stafford. T ip to n and D is tr ic t C o r p s .— H i g h - r a n k i n g la d y officers of th e S ta f f o r d s h ir e o r g a n i s a t i o n , in c l u d i n g th e C o u n te s s of D a r t m o u t h (V ice-P resid e n t), B re n d a Lady H ic k m a n , a n d M rs. D u d s o n (L a d y S u p t.), v isited th e M .E .C . s p o rts g r o u n d , O c k e r H ill, on S a tu rd a y , A u g u s t 21 st, o n th e o c c a s io n of th e s e c o n d a n n u a l p a r a d e , in s p e c tio n a n d p r e s e n ta tio n of m e d a ls a n d tr o p h ie s in c o n n e c tio n w ith th e T ip to n a n d D is tric t C orps. M e m b e rs of th e v ario u s a m b u la n c e , n u rs in g a n d cad et d iv is io n s p a r a d e d in f r o n t of th e p a v ilio n , a n d w e re in sp ec te d b y th e C o u n ty O fficers, w h o w e re c o n d u c te d a lo n g th e r a n k s by C o rp s S u p t. E . D a k in . A n a d d r e s s of w e lc o m e w a s g iv e n b y M r. C h a s . H e a th c o c k ( P r e s i d e n t of th e C o rp s). L a d y D a rtm o u th p re sen te d th e m e d a ls a n d tro p h ies w o n in t h e v a r io u s C o r p s c o m p e titi o n , h a v i n g a s m ile , a w o r d of c o n g r a t u l a t i o n , a n d a h a n d s h a k e fo r e a c h of th e recip ien ts. S h e su b se q u e n tly a d d re sse d th e a ssem b ly , an d co n c lu d ed by s a y in g sh e w a s s u re th e y w e re very g ra te fu l fo r all t h a t h a d b e en d o n e fo r th e m b y M r. H e a t h c o c k a n d h is late b ro th er. S u b s e q u e n tl y m e m b e r s of th e C o rp s a n d th e ir fr ie n d s e n jo y e d t h e a m e n itie s of th e s p o rts g r o u n d . A w h is t d riv e w a s h e ld in t h e M .E .C . c a n t e e n , a n d a d a n c e in th e s p o rts p a v ilio n .

County of Worcester. B r ie r le y H i ll.— N o t c o n te n t w ith p e rfo rm in g th e h attric k , B rie rle y H ill D iv is io n s of th e S .J .A .B . h a v e w o n a f o u r t h c o u n t y final in W o r c e s t e r s h i r e . T h is w a s fo r th e “ C h ris to p h e r D a r b y ” S h ield , a h a n d s o m e tro p h y g iv e n by th e la te D r. D a r b y , of L y e , w h o fo r a n u m b e r of y e a r s w a s a c o u n ty s u r g e o n in th e B r ig a d e . T h e fin a l o n S a t u r d a y , A u g u s t 28th , w a s a t th e B a x t e r C hurch R o o m , B u ll R in g , K id d e rm in s te r. It w as an in d iv id u a l c o m p e titio n , a n d h a d n o t b e e n h e ld sin ce th e w ar, b u t in a c c o r d a n c e w i t h t h e d e c is io n t a k e n to r e - c o m m e n c e c o m p e t i t i o n s t h i s y e a r i t w a s d e c i d e d t o h o l d it. A la rg e c r o w d of s p e c ta to r s in c lu d e d m a n y B r i g a d e O fficers. A t th e co n clu sio n of th e c o m p e titio n , te a w a s serv ed by m e m b e r s of K id d e r m in s te r N u r s i n g D iv isio n , a n d a fte r th e in te rv a l L a d y C o u n ty O fficer D r. M rs. P o r te r a n n o u n c e d th e r e s u l t s a s f o l l o w s :— S g t . P h i l p o t t , p r a c t i c a l t e s t 78 £ m a r k s , o r a l t e s t s 77 m a r k s , t o t a l 155 £ ; S g t . N o r t h w o o d , 70 , 76 , 146 ; b o t h o f B rie rle y H ill D iv isio n ( r e p r e s e n tin g th e n o r th of th e c o u n ty ) ; L a d y A / O W i s d o n ( D r o i t w i c h ) , 54 £ , 70 , 124 J ; C p l . C r o s s ( K i d d e r m i n s t e r D i v i s i o n ) , 33 £ , 59 , 92 £ ( r e p r e s e n t i n g t h e s o u th of th e c o u n ty ). A t o t a l o f 200 m a r k s w a s o b t a i n a b l e . L a d y C o u n ty S u p t. M rs. A. H. L e c h m e r e a f t e r a few c o n g ra tu la to ry rem a rk s, p re s e n te d th e tro p h y to S e rg t. P h ilp o tt.

County of Warwick. B i r m in g h a m ( N e w S t . ) . — A p l e a s a n t e v e n i n g t o o k p l a c e a t th e W a r w ic k R o o m , Q u e e n s H o tel, on S a tu rd a y , S e p te m b e r 4th , w h e n g o l d l o n g s e r v ic e a w a r d s a n d e x a m i n a t i o n a w a r d s u 'e r e p r e s e n te d b e fo re a n a u d ie n c e of o v e r 100 m e m b e rs , th e i r w iv e s a n d frien d s. M r. T . F in c h , S ta tio n M aste r, N e w S t., p resid ed over t h e m e e t i n g , a n d C o l. S i r B e r t r a m F o r d , T . D ., D . L . , L L . D ., C o u n ty C o m m is sio n e r S .J .A .B ., B ir m in g h a m C o u n ty , w as m e t by D iv isio n al S u p t. W . H . A n d rew s. A f te r i n s p e c t i n g th e g u a r d of h o n o u r of N e w S t. L . M .S . D iv is io n , C o l. F o r d t o o k h is s e a t in t h e r o o m . A v ariety c o n c e rt th e n follo w ed .

R I D G o ld l o n g s e rv ic e a w a r d s w e r e p r e s e n te d b y C ol. S ir B e r t r a m F o r d t o W . H . R o e , 30 y e a r s ; M e s s r s . W . N . L a u g h e r , H . H a w k e r , A . L . M o r r i s , 15 y e a r s . E x a m in a t i o n a w a r d s w e r e p r e s e n t e d t o 1s t , 2 n d , a n d 3 r d y e a r s t u d e n t s , by M iss H a rris . S u b s e q u e n t y e a r a w a r d s w e re p re s e n te d by J. B. D u n k le y , P re s id e n t, N e w S t. L . M .S . D iv ., w h o r e c e i v e d t h e B r i g a d e ’s o f f i c i a l b a d g e f r o m C o l . S i r B e r t r a m Ford. T h e a r r a n g e m e n t s w e r e c a r r ie d o u t b y M r. A. L . M o rris , C lass S ecretary .

West Riding of Yorkshire. W e t h e r b y C a d e t N u r s in g D iv isio n h a s h a d a su cc e ssfu l c a re e r th is year. T w o C ad ets h a v e starte d g e n e ra l tra in in g in h o s p i t a l ; a ll C a d e t s p a s s e d t h e H o m e N u r s i n g e x a m i n a tio n . E i g h t p a s s e d t h e e x a m i n a t i o n o n t h e K n o w l e d g e of t h e H i s t o r y o f t h e O r d e r o f S t . J o h n o f J e r u s a l e m , 13 t h e C h ild W e lfa re e x a m in a tio n , a n d 3 h a v e ju st g a in e d th e A d u lt C e rtific a te in H y g ie n e . T h e D i v i s i o n w a s i n s p e c t e d o n M a y 26 t h b y C o u n t y C a d e t O fficers L a d y M o u n tg a r r e t a n d M rs. A y k ro y d a n d D is trict O fficer M rs. L o d g e . L a d y M o u n tg a r r e t s p o k e to th e C a d e ts , e n c o u r a g i n g th e m to g o o n w ith th e ir g o o d w o rk . C a d e ts h a v e t a k e n p a r t in v a rio u s p a r a d e s d u r i n g th e y ear, w h e n th e y s h o w e d in th e ir b e a r in g th e g o o d tr a in in g g iv e n th e m b y M iss W a n s b r o u g h , w h o h a d s p e n t sev e ra l n ig h ts d rillin g th e C ad ets. T h e D i v i s i o n is n o w s t a r t i n g a c t i v i t y a g a i n a f t e r t h e s u m m e r b r e a k w ith F i r s t A id le c tu r e s fo r p r o b a tio n e r s a n d H y g ie n e for C a d e ts . G i r l s b e t w e e n 11 a n d 16 m a y b e c o m e p r o b a tio n e r s , a n d a f te r g a i n i n g F i r s t A id C e rlific a te s a r e a cc e p te d a s C ad ets.

East Riding of Yorkshire. C ity o f H u ll.— D u r in g th e p a s t y e a r C a d e t D iv ision s h a v e b e e n f o r m e d t h r o u g h o u t t h e C ity of H u l l a n d o r g a n i s e d by re p re s e n ta tiv e s of t h e H u ll C o rp s w ith S u p t. B u rn le y O fficer in C h a r g e . C o m p e titio n s w e re a r r a n g e d d u r in g th e m o n th s A p ril to A u g u st. A ll C a d e t D i v i s i o n s in t h e C i t y w e r e i n c o r p o r a t e d , i n c l u d i n g th o s e a t t a c h e d to th e P o lic e C o rp s , S . J .A .B ., a n d a p o lice re p re s e n ta tiv e w a s a m e m b e r of th e C o m m itte e . F if te e n D iv is io n s c o m p e te d in th e first c o m p e titio n — a le a g u e to u r n a m e n t— th e w in n e r of e a c h sec tio n e n te rin g th e sem i-fin al. T h e sem i-fin a lists w e re B o u le v a rd B v N o rth e rn D iv isio n s a n d S u tto n v B ev e rley R d . D iv isio n s. T h e final w a s b e tw e e n B o u le v a r d B a n d S u t t o n D iv is io n s. A fte r a n in te re s tin g te a m te s t fo llo w ed b y in d iv id u a l te sts, B o u v e la r d B te a m a tta c h e d to th e P o lice C o rp s, w e re d e c la re d th e w in n ers. W e h o p e to p u b lis h th e t e a m te s t in o u r n e x t num ber. A n e lim in a tin g te s t to o k p la c e a t e a c h D iv isio n , th e w i n n e r e n t e r i n g t h e fin al. A s fa r a s p o ssib le th e C a d e t O fficers of th e tw o C o rp s w e r e in te r c h a n g e d to j u d g e th e D iv is io n a l tests. T h e a w a r d s w e r e a s f o l l o w s :— T o B o u l e v a r d B — D r . R y m e r S h ie ld a n d to e a c h m e m b e r of th e te a m a n e n g r a v e d silv er m e d a l a n d a s a v in g s c ertificate k in d ly g iv e n b y D r. R y m er. E a c h m e m b e r of th e S u tt o n D iv is io n t e a m re c eiv ed a n e n g r a v e d silv er m e d a l. T h e P rio ry C u p w a s p re s e n te d to C a d e t L a n c a s te r, B o u le v a r d B D iv is io n , fo r g a i n i n g t h e h i g h e s t n u m b e r of m a r k s in th e in d iv id u a l te s t ; a n d th e In d iv id u a l C u p to C a d e t W illis. A ll p r e s e n t w e r e p le a s e d t h a t g r e a t p r o g r e s s h a d b e e n m a d e d u r in g th e year, a n d h o p es a re e n te rta in e d for a n even b e tte r fu tu re. P u b lis h e r s Note.— W ill readers please note that all back numbers of “ First A id ” are now out of print and cannot be supplied. W ill South African and other Colonial readers please add to their remittances, “ o r English equivalent.”

F I R S T

S u g a r D ia b e te s (D ia b e te s M ellitus). B y W IL L IA M

N O RTH .

T h e f a c t t h a t t h e fir s t a i d e r m a y h e c a lle d u p o n a t s o m e t i m e to d e a l w it h a c a s e o f s u d d e n c o ll a p s e , o r e v e n c o m a , in a s u ff e r e r fr o m t h e d i s e a s e c o m m o n ly k n o w n a s s u g a r d i a b e te s , j u s t i f ie s t h e a c q u is i t io n o f a s u f f i c ie n t ly g o o d w o r k i n g k n o w l e d g e o f t h e d is e a s e . . . D i a b e t e s m e l li t u s is a m o r b id c o n d it io n in w h i c h t h e b o d y is u n a b le to m e t a b o lis e s u g a r e f f ic ie n t ly . I t is a w a s t i n g d is e a s e , w i t h t h e s y m p t o m s o f p a s s i n g l a r g e q u a n t i t ie s o f u r in e ( p o ly u r ia ) , t h i r s t a n d h u n g e r , t o g e t h e r w it h s u g a r in t h e u r in e ( g l y c o s u r i a ) . T h ro u g h o u t lite ra tu re from th e earliest tim es th e re a re re fe re n c es to a m y s te r io u s d is e a s e , w h ic h w a s a c c o m p a n ie d by th e p a s s a g e of l a r g e a m o u n ts of u r in e a n d o th e r d ia b e tic c o n d itio n s. T h e s w e e t ta s te of d ia b e tic u rin e w a s m e n t i o n e d b y t h e I n d i a n p h y s i c i a n , S u s r u t a , a b o u t A . D . 500 , a n d b y t h e P e r s i a n , A v i c e n n a , a b o u t A . D . 1000 . I n E u r o p e it a p p e a r s to h a v e b e e n first r e c o r d e d b y t h e E n g l i s h p h y s i c i a n , T h o m a s W i l l i s , i n 1679 . I t w a s a n o t h e r h u n d r e d years, h o w e v er, b efore a n o th e r E n g lis h d o cto r, D o b so n , c arried o u t e x p e r im e n ts t h a t e n a b le d h im to p ro v e th a t th e s w e e tn e ss o b se rv e d b y W illis w a s d u e to s u g a r . T h is su g ar, k n o w n a s d e x tro s e , g lu c o s e , o r g r a p e s u g a r , is o b ta in e d from th e carb o h y d ra te s (starch y m aterials), w h ich a re ta k e n a s food, b u t a c e r ta in a m o u n t is d e riv e d f r o m th e p ro te in p a r t of t h e d ie t a s w e ll. T h i s a b n o r m a l s u g a r c o n t e n t in t h e u r i n e is d u e t o t h e fa i l u r e of a s m a l l g r o u p of c ells in t h e p a n c r e a s ( t h e in s u la e e o r i s l e t s o f L a n g e r h a n s ) t o p r o d u c e a s u b s t a n c e t h a t is re sp o n sib le for th e s u g a r ta k e n in to th e b lo o d b e in g b u r n t u p in to e n e r g y a n d b e in g m a d e u s e of by th e b ody. T h i s s u g a r a c c u m u l a t e s in t h e b lo o d , a n d is e x c r e t e d b y th e u rin e. T h e first s u g g e s t i o n t h a t t h e p a n c r e a s w a s n e c e s s a r y for c o m p le te u tilis a tio n of c a r b o h y d r a te s in a n i m a l b o d ie s w a s m a d e b y B r u n n e r i n 1682 . T h e re la tio n sh ip of th e p a n c r e a s to d ia b e te s w a s first s u g g e s t e d b y a n E n g l i s h p h y s i c i a n , C o w l e y , i n 1788 . I n 1889 e x p e r i m e n t s s h o w e d t h a t c o m p le te re m o v a l of th e p a n c r e a s of a n i m a l s r e s u lte d in a c o n d itio n p ra c tic a lly id e n tic a l w ith d ia b e te s in m a n . M a n y a tte m p ts w e re s u b se q u e n tly m a d e to o b ta in th e s u b s t a n c e m a n u f a c t u r e d b y t h e i s l e t s o f L a n g e r h a n s , b u t it w a s n o t u n til u n c e a s i n g effo rts o n th e p a r t of a y o u n g C a n a d ia n d o cto r, F r e d e ric k B a n tin g , th a t th is w a s a c c o m p l i s h e d i n 1922 . T h i s d is c o v e ry w a s c a lle d in s u lin , a n d w ill r e m a in o n e of th e g r e a t e s t d isco v e ries of a ll tim e . T h e r e is a n i n t e r e s t i n g c o n n e c t i o n b e t w e e n d i a b e t e s a n d p e rn ic io u s an aem ia. T h e d is c o v e re r of th e t r e a t m e n t for th e la tte r, a y o u n g A m e r ic a n d o c to r, M in o t, w a s h i m self a s u ffe re r f r o m d ia b e te s , b u t w a s e n a b l e d b y i n s u li n to c a rry o n h is re s e a rc h w o rk a n d m a k e h is a lm o s t e q u a lly g r e a t life -sa v in g d is c o v e ry of th e t r e a t m e n t of p e rn ic io u s an aem ia, a d is e a s e w h ic h , lik e d ia b e te s , m e a n t h ith e rto a n inev itab le a n d lin g e rin g d e ath . T h e o n s e t of d i a b e t e s is g r a d u a l . I t m a y s e t in m o r e r a p id ly a f te r a s u d d e n e m o tio n , in j u r y o r s e v e re chill. The th i r s t is o fte n d istressin g , th e ap p etite m a y be e n o r m o u s , t h e t o n g u e is d r y , r e d a n d g l a z e d , a n d t h e s a l i v a is s c a n t y . T h e p a tie n t u su ally b eco m es very th in a n d w asted . M o s t s e r i o u s of t h e c o m p l i c a t i o n s o f s e v e r e d i a b e t e s is c o m a , w h i c h is c a u s e d b y p o i s o n i n g of t h e b lo o d b y a c i d o s i s b r o u g h t a b o u t t h r o u g h fa ts n o t b e i n g d e a l t w ith in th e n o r m a l m anner. A t first t h e c o n d i t i o n is o n e o f c o l l a p s e r a t h e r t h a n t r u e c o m a , a l t h o u g h l a t e r t h e p a t i e n t is c o m p l e t e l y co m a to se . T h e r e is d if f ic u lty of b r e a t h i n g , t h e p u l s e g r o w s w eak, and th e p atien t g r a d u a lly lo ses co n scio u sn ess. W ith o u t m ed ical tre a tm e n t d e a th m a y o c cu r w ith in tw e n ty -

R I D

fo u r h o u rs. T h e c o m a m a y co m e on w ith o u t w a rn in g , or th ere m a y be h eadache, th ic k speech, a n d a s ta g g e rin g g a it, before th e c o m a c o m e s on. In o th e r cases, th ere m a y b e w e a k n e s s , g i d d in e s s , a n d liv id h a n d s a n d feet, e sp e c ia lly a f te r e x e r tio n p r e c e d i n g th e o n s e t of th e c o m a . T h e r e is a p e c u l i a r s w e e t o d o u r e m a n a t i n g f r o m t h e b r e a t h a n d th e sk in . N o a g e is e x e m p t f r o m t h e d i s e a s e , b u t i t o c c u r s m o s t l y b e t w e e n t h e a g e 50 - 60 . T w ic e as m a n y m a le s as fem ales a r e affected . T h e t r e a t m e n t of d i a b e t e s is t h e c o n t r o l o f d ie t, a n d in sev e re c ase s th e a d m in is tra tio n of in su lin . T h i s b r i n g s u s to t h e ty p e of c o m a w e a r e m o s t lik e ly to m e e t in d ia b e tic c a s e s — h y p o g ly c c e m ia , w h ic h , a s th e n a m e i n d i c a t e s , is a c o n d i t i o n in w h i c h t h e r e is a d e f ic ie n c y of s u g a r in th e blo o d . T h is co n d itio n a p p e a rs w h e n e ith e r th e p a tie n t h a s t a k e n to o l a r g e a d o s e of in s u lin (u s u a lly s e lf -a d m in is te r e d , in tw o , o r e v en th re e , d a ily d o s e s ) o r h a s fa ile d to t a k e a m e a l h a lf - a n - h o u r o r so a f te r t h e in je c tio n , o r h a s i n d u l g e d in m o r e e x e r t i o n t h a n u s u a l . T h e face u s u a lly flu sh es w ith a s w e a tin g w h ic h m a y be v ery m a r k e d ; th e p a tie n t feels g id d y , a n d h a s a d is tin c t s e n s e of p h y s ic a l c o l d n e s s a b o u t t h e l i m b s , a n d t h e r e m a y b e b l a n c h i n g of th e face. T h e r e is t h e p e c u l i a r s w e e t s m e l l in t h e b r e a t h to o . S o m e t i m e s t h e first s y m p t o m is a f e e lin g of n e r v o u s n e s s o r d is t i n c t t r e m u l o u s n e s s , s o t h a t t h e p a t i e n t fin d s it im p o s sib le to c o -o rd in a te h is m o v e m e n ts , th is b e in g o ften a c c o m p a n ie d b y d is t u r b a n c e of s i g h t , i.e., d o u b le v isio n . T h e s y m p t o m s u s u a l l y o c c u r 3— 5 h o u r s a f t e r t h e i n j e c t i o n o f in su lin . L a te r, co n fu sio n a n d d e liriu m m a y o ccu r, w ith fin al c o lla p s e a n d u n c o n s c io u s n e s s . C o n v u lsio n s a re rare. H y p o g ly c c e m ic c o m a m a y e asily b e c o n fu se d w ith d ia b e tic c o m a , b u t u s u a l l y t h e p a t i e n t , if s e e n i n t i m e , c a n h e l p w i t h th e h isto ry . T h e t r e a t m o n t o f h y p o g l y c o e m i a is t h e a d m i n i s t r a t i o n o f s u g a r b y t h e m o u t h if t h e p a t i e n t i s c o n s c i o u s . Two lu m p s sh o u ld be ta k e n as soon as th e sy m p to m s a p p e a ra n d , if n e c e s s a r y , r e p e a t e d t w e n t y m i n u t e s l a t e r if t h e s y m p t o m s still p e rs is t. If t h e p a t i e n t is s e e n b e f o r e h e h a s b e c o m e u n c o n sc io u s , h e w ill in d ic a te , v e ry o fte n , th e p o c k e t in w h ic h h e k e e p s t h e s u g a r , if h e h a s f a i l e d t o t a k e i t h i m s e l f a t t h e onset. H e m a y b e a b le to in d ic a te th e w h e re a b o u ts o f s u g a r o n h is p e r s o n , e v e n if h e is u n a b l e t o h e l p h i m s e l f t o it. (A ll d i a b e t i c s c a r r y s u g a r f o r t h i s p u r p o s e . ) If th e p a tie n t h a s re a c h e d th e c o m a to se s ta g e before b e in g s e e n b y th e first a id e r, of c o u r s e th e s p e c ia l t r e a t m e n t, o th e r th a n g e n e r a l ru le s for th e tr e a tm e n t of a n u n c o n s c i o u s p a t i e n t , is o u t s i d e h i s s c o p e . T h e a id of a d o c to r m u s t be s o u g h t im m e d ia te ly fo r th e n e c e s s a ry in t r a v e n o u s i n j e c t i o n of g l u c o s e .

R.I.P. M rs.

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T h e h i g h r e g a r d in w h ic h th e la te M rs. O liv e G . K n o t t w a s h eld w a s e v in c ed b y th e la r g e a n d re p re s e n ta tiv e a tte n d a n c e a t th e f u n e ra l, w h ic h to o k p la c e in B a r n s t a p l e re c e n tly . M rs. K n o t t w a s th e w ife of M r. F r e d G . K n o tt, of B e a r S tr e e t, D iv . S u p t. of th e B a r n s t a p l e S .J .A .B . S he w as on th e D ev o n staff as L a d y C o rp s S u p t. fo r th e N o rth D e v o n A re a , a n d s h e p la y e d a p r o m i n e n t p a r t in C ivil D e f e n c e w o r k in th e d is tric t. T h e in t e r m e n t in th e c e m e te r y w a s p re c e d e d b y a s e rv ic e i n S t . M a r y M a g d a l e n e ’s C h u r c h , w h i c h w a s c o n d u c t e d b y th e V ic ar (th e R ev. R . A. H . B ate, R .A .F .) . M e m b e r s of th e N u r s i n g D iv is io n f o r m e d a g u a r d of h o n o u r o u tsid e th e ch u rch . T h o s e p re sen t a t tb e in te rm e n t in clu d ed th e M a y o r a n d M a y o r e s s of B a r n s ta p le a n d a v e ry l a r g e n u m b e r of L a d y C o u n ty O ffic e rs a n d h i g h officials of t h e A m b u l a n c e a n d N u r s in g S erv ices. T h e flo ral tr i b u te s w e re v e ry n u m e ro u s .

F I R S T

R a ilw a y A m b u la n c e N e w s . GREAT WESTERN H o n o u r s .— A s a r e s u lt of r e c o m m e n d a ti o n s m a d e b y th e C e n t r a l A m b u l a n c e C o m m i t t e e , t h e f o l l o w i n g m e m b e r s of th e s ta f f h a v e b e e n a d m i t t e d a s S e r v in g B r o th e r s of th e O r d e r of S t. J o h n of J e r u s a l e m , in r e c o g n itio n of th e e x c e p tio n a l se r v ic e s w h ic h th e y h a v e r e n d e r e d to th e m o v e m e n t o n th e G . W . R . o v e r a l o n g p e r i o d o f y e a r s :— M r. J. A. M a r t i n , C le r k , S t a f f a n d E s t a b l i s h m e n t O ffice, A ld e rm a s to n ; M r. W . H o o k in s , P a s s e n g e r G u a rd , P e n a r th T o w n ; M r. F . H a tto n , G o o d s G u a rd , S h r e w s b u ry ; M r. W . J . P r ic e , S i g n a l m a n , B a l a ; M r. A. E . W illia m s , S ta tio n M a ste r, G resford. M r. C. W . H ip k in s , A .R . P . C o n tro l, P a d d in g to n S ta tio n , h a s a lso b e e n a d m itte d to th e O r d e r a s a S e rv in g B ro th e r, o n th e r e c o m m e n d a t i o n of th e S .J .A .B . H e is D is t r i c t O fficer to th e N o. 1 L o n d o n D is tr ic t of th e B r ig a d e . A ld e rm a n D . M . C h a p m a n , of C ra d le y H e a t h , w h o retired fro m th e positio n of G .W .R . G o o d s A g e n t at N e t h e r t o n i n 1932 , h a s b e e n p r o m o t e d b y t h e O r d e r o f S t . J o h n fr o m th e G r a d e of S e r v in g B r o th e r to t h a t of O fficer ( B r o th e r ) , o n th e r e c o m m e n d a t i o n of th e S .J .A .B . A l d e r m a n C h a p m a n g a i n e d h i s fir s t a i d c e r t i f i c a t e in 1892 , a n d i s t h e h o l d e r o f t h e G . W . R . 15 - y e a r m e d a l a n d 20 y ear bar. A t t h e p r e s e n t t i m e h e h o l d s t h e p o s i t i o n of C o u n ty O fficer for N o r th W o r c e s te r s h ir e in th e S .J .A .B .

T h e L o rd M a y o r of P ly m o u th (L o rd A sto r) recen tly p re s e n te d a w a r d s to m e m b e rs of th e G .W . R . A m b u la n c e S erv ice a t P e n n y c o m e q u ic k . In th e c o u rs e of h is o p e n in g a d d r e s s , t h e L o r d M a y o r s a i d :— “ Y o u h a v e t h i s f e e l i n g t h a t it is n o t o n ly a n i m p o r t a n t w o r k in w a r tim e , b u t a w o r k y o u w ill n e e d in p e a c e tim e . T h i s w a r is b e i n g w a g e d a s m u c h in t h i s i s l a n d a s it is overseas. R e c e n tly , in a n a ir r a id in t h e S o u th - W e s t, th e in c o n v e n ie n c e a n d s u ffe rin g of m a n y p eo p le w e re m itig a te d b y th e efficient a n d r e a d y h e lp of th e a m b u l a n c e b r i g a d e . ” T h e r e w e r e n i n e a w a r d s f o r 15 y e a r s ’ e f f i c i e n t s e r v i c e , f i f t e e n f o r 20 y e a r s ’ s e r v i c e , f o u r f o r 25 y e a r s ’ s e r v i c e , f o u r f o r 30 y e a r s ’ s e r v i c e , o n e f o r 35 y e a r s ’ s e r v i c e , a n d o n e f o r 40 y e a r s ’ serv ice. T h e c h a i r m a n w a s M r. J. S. P . P e a rs o n , D iv . S u p t. of th e G .W . R .

N e w to n A b b o t.— O n F r i d a y , A u g u s t 27 t h , n in ety m e m b e r s of th e N e w t o n A b b o t G . W . R . c la ss w e re p re s e n te d w ith a w a r d s b y H . A. G . W o r t h , E s q ., D iv . S u p t., E x e te r , H e c o n g r a t u l a t e d t h e c l a s s o n t h e i r e n t h u s i a s m a n d effici en cy , h a v in g o b ta in e d 100 p e r c en t, p a ss e s for certificates, v o u c h e r s , m e d a llio n s , etc. O p p o rtu n ity w a s a lso ta k e n to s h o w a p p re c ia tio n to D r. S c r a s e , w h o t h i s y e a r c e l e b r a t e d h i s 40 y e a r s ’ a s s o c i a t i o n w ith th e class. M r. F . N o rth c o tt, C la ss S e c re ta ry , p re s e n te d D r. S c ra s e w ith a few of h is fav o u rite b o o k s a n d b o o k to k en s. D r. S c r a s e s u i t a b l y r e s p o n d e d , a s s u r i n g a l l p r e s e n t o f t h e j o y it g a v e h im in a s s i s t i n g w ith s u c h n o b le w o rk . T h e m e e tin g w a s p resid ed o v e r by T . W . H a ll, E sq ., A sst. L o co . S u p t.

LONDON & NORTH EASTERN N . E . A r e a C e n t r e . —- T h e f o l l o w i n g a r e e x t r a c t s f r o m t h e C e n t r e S e c r e t a r y ’s A n n u a l R e p o r t f o r 1942/43 :— D u r i n g t h e 1942-43 s e s s i o n a t o t a l o f 145 c l a s s e s w e r e conducted. T h e n u m b e r o f s t u d e n t s w h o w e r e s u c c e s s f u l in

R I D p a s s i n g t h e e x a m i n a t i o n d u r i n g t h e s e s s i o n w a s 2 , 345 , m a d e u p a s f o l l o w s : — C e r tif ic a te s , 228; v o u c h e r s , 243; m e d a l l i o n s , 230 ; l a b e l s , 1 , 6 4 4 ; a d e c r e a s e o f 747 o n t h e 1941/2 s e s s i o n , w h ic h w a s to be ex p ec te d h a v in g r e g a r d to th e la rg e n u m b e r of th e s ta f f w h o h a v e jo in e d th e F o r c e s . T h e resu lts a r e to b e c o n s id e re d h i g h ly s a tis f a c to r y fo r th e f o u r th y e a r of th e w a r . T h e g r a n d to ta l of a w a r d s g a in e d s in ce th e fo r m a t io n o f t h e C e n t r e i n 1895 i s n o w 76 , 095 . T h e F i r s t A i d r e t u r n s f o r t h e y e a r e n d e d J u n e 30 t h , 1943 , t o t a l 60 , 976 — m a k i n g a g r a n d t o t a l o f 2 , 235,211 c a s e s t r e a t e d s i n c e J a n u a r y , 1896 . D u r i n g t h e y e a r 43 m e d a l s , t e n 20 y e a r s ’ b a r s , t w o 25 y e a r s ’ b a r s , f i v e 30 y e a r s ’ b a r s , a n d t w o 35 y e a r s ’ b a r s h a v e been approved. — —

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T h e H o m e G u a rd a n d F ir s t Aid. W a t e r S u p p l y — S t e r il is a t io n .

F o llo w in g clarific a tio n , w h ic h w e h a v e le a r n t d e a ls w ith th e s u s p e n d e d im p u r itie s in w a te r , w e n o w c o m e to s te r ilis a tio n w h i c h is e s s e n t i a l fo r t h e d e s t r u c t i o n o f p a t h o g e n i c g e r m s . C h l o r i n e is t h e m e d i u m u s e d fo r t h i s p u r p o s e in t h e A r m y . I t c a n b e u s e d i n t h r e e f o r m s : ( 1) C h l o r i n a t i o n ; ( 2 ) S u p e r C h lo rin atio n , co m b in ed w ith d e -ch lo rin atio n ; and ( 3) C h lo ram in atio n . F o r ch lo rin atio n , b le a c h in g p o w d er, w h ic h c o n tain s 25 p e r c e n t , c h l o r i n e ( t h e b a l a n c e b e i n g l i m e ) , i s u s e d . A H o r r o c k s t e s t is c a r r i e d o u t t o fin d h o w m u c h is n e e d e d to s t e r i l i s e 100 g a l s , w a t e r . T h is test a llo w s for 1 p a rt p er m illi o n f r e e c h l o r i n e , a n d is d o n e b y m e a n s of t h e H o r r o c k s t e s t b o x , w h i c h is s u p p l i e d t o e a c h w a t e r t a n k t r u c k , a n d w h ic h s h o u l d b e in t h e h a n d s o f H o m e G u a r d b a tta l i o n s a lso . C h lo rin a tio n , h o w e v er, ta k e s s o m e tim e a s th e w a te r m u s t be left a t le a s t h a lf a n h o u r b e fo re u s e. S u p e r- c h lo r in a tio n , w h ic h g iv e s tw o p a r ts p e r m illio n free c h lo rin e , t a k e s o n ly h a lf th e tim e , b u t o w in g to th e ta s te w h i c h it g i v e s t h e w a t e r , re q u ire s d e -c h lo rin a tin g w ith so d iu m th io su lp h a te. T h i s is s u p p lie d in ta b le t fo r m , tw o t a b l e t s b e i n g r e q u i r e d p e r 100 g a l s . T h i s is t h e m e t h o d m o s t g e n e r a l l y u s e d in t h e A r m y o w in g to its q u ic k n e s s . T h e th ir d m e th o d , c h lo r a m in a tio n , is c a r r ie d o u t b y a d d i n g tw o ta b le ts of a m m o n i u m c h lo rid e , p lu s tw o s co o p s o f b l e a c h i n g p o w d e r p e r 100 g a l s , w a t e r . T h is form s c h lo r a m in e , w h ic h is v e ry effectiv e b u t t a k e s m u c h l o n g e r to act. N o H o r r o c k s te s t is n e e d e d , h o w e v e r . T h e s e th re e m e th o d s a re u s e d w h e n d e a lin g w ith la rg e q u a n titie s of w a te r, b u t fo r s m a ll q u a n titie s th e re a re o th e r a n d sim p le r m e a n s. O n e is b y i n d i v i d u a l w a t e r s t e r i l i s i n g outfits, m o stly in ta b le t fo rm , a n d c a n be u s e d by e a c h m a n fo r s te r ilis in g th e c o n te n ts of h is w a te r -b o ttle . A n o th er m e t h o d is t o c a r r y o u t t h e H o r r o c k s te s t, p u t t h e r e q u i r e d a m o u n t o f p o w d e r i n t o a w a t e r - b o t t l e a n d fill w i t h w a t e r , m a k in g a s tr o n g so lu tio n . A s c o o p of t h i s s o l u t i o n is a d d e d t o e a c h m a n ’s w a t e r - b o t t l e , a n d a f t e r h a l f - a n - h o u r , o n e s o d . th io su lp h a te ta b le t ad d ed . T h i s is su ffic ie n t to d e a l w ith 400 w a t e r - b o t t l e s . A t h i r d , c a l l e d t h e B l a c k c u p m e t h o d , c a n h a r d l y b e d e s c r i b e d h e r e , a s it is n e c e s s a r y to u n d e r s t a n d th e c o n te n ts of th e H o r r o c k s b o x . I w o u ld a d d in p a s s i n g , t h a t t h e H o r r o c k s t e s t is v e ry s im p le , full in s t r u c t i o n s a r e in c lu d e d in e v e r y b o x , a n d a l t h o u g h th e se h a v e n o t y e t b e en issu e d to th e H o m e G u a rd , I t h i n k it w o u ld fu lly r e p a y t h e M e d ic a l O r d e r l y to tr y a n d o b ta in o n e t h r o u g h h is B a tt. M e d ic a l O fficer, o r B a tt. C o m m ander. T h e y c a n b e p u r c h a s e d c o m p l e t e f o r 46 / - . I t r u s t th e s e n o te s o n w a t e r s u p p ly h a v e p ro v e d of in te re st. A s I h in te d in th e first p la c e , o n ly th e f r in g e of th e

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The COMPLAINTS OF MEN, WOMEN AND CHILDREN. Their Cause, Treatment and Cure. A f e w ot the S u b jects tre a te d : G a s W a r f a r e , F ir s t A id W h a t to D o in E m e r g e n c i e s In flu e n z a , C o ld s, etc. M ea sles, M u m p s , C a ta r r h C orns a n d W a rts P h y sical C u ltu re T r e a t m e n t fo r all S k in D is e a s e s T h e L u n g s , P leu risy H y g ie n e, A n ato m y , P h a rm a c y

T h e P r in c ip le s of N u r s i n g T h e Eye, th e E a r T h e T h ro a t, th e N ose T h e C h est, th e H e a r t T h e S to m a c h , th e L iv er T h e T e e th , th e M u scles In fa n t W elfare H o m o e p ath y , N e u ra sth en ia 375 P r e s c r i p t i o n s , e t c . , e t c .

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s u b je c t c o u ld b e to u c h e d in m y lim ite d sp a c e . N ex t m o n th I h o p e to r e t u r n to l e g i t i m a t e first a id m a t t e r s . F in ally , I t h a n k m y m a n y c o rre s p o n d e n ts fo r th e ir v a lu a b le c o -o p e ra tio n , a n d lo o k fo r w a r d to f u r t h e r le tte rs fr o m th e m . C.

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Reviews. A id s to M e d ic in e f o r N u r s e s . L o n d o n : B ailliere,

By M a rg a re t H itch , S .R .N . T in d all & Cox. P r ic e q j- n e t ; by

p o st {/6. T h i s u s e f u l littl e b o o k , w h i c h is n o w in its s e c o n d e d itio n , is i n t e n d e d to b e a n “ a i d ” t o M e d i c a l N u r s i n g a n d n o t m e re ly a te x tb o o k . It c e r ta in ly a c c o m p lis h e s its p r i m a r y o b je c t of b e in g a g u i d e to n u r s e s in th e ir u n d e r s t a n d i n g of m e d i c a l c a s e s ; a n d b y s o d o i n g it w ill i n c r e a s e th e i n t e r e s t a n d e ffic ie n c y of n u r s e s in th is m o s t i m p o r t a n t p a r t o f th e i r w ork. O n t h e w h o l e t h e r e is little c h a n g e in t h e s u b j e c t m a t t e r b u t a g o o d d e a l h a s b e e n d o n e in t h i s e d itio n t o e l a b o r a t e a n d e lu c id a te c e r ta in se c tio n s in a w a y w h ic h w ill in c re a s e th e v a lu e of th e b o o k . I t s u s e f u l n e s s is e n h a n c e d b y a fu ll a n d co m p le te index.

A P o ck e t M e d ic a l D ic tio n a r y . B y L o i s O a k e s , S . R . N . , D . N . , a n d T h o m a s B. D av ie, M .D ., F . R .C .P . E d in b u rg h : E . & S. L i v in g s to n e . P r ic e y / - n e t ; by p o st y / y . T h i s m o s t u se fu l d ic tio n a ry , w h ic h c a n b e c a r rie d in th e p o c k e t a n d s tu d ie d a t o d d m o m e n t s , h a s r e a c h e d its s ix th e d itio n w ith in th e s p a c e of te n y e a r s, s u r e p ro o f of its u s e f u l n ess a n d p o p u larity . A s a p reface to th e d ic tio n a ry p ro p er, w h ic h c o n ta in s m o s t of th e c o m m o n te r m s a n d d efin itio n s c o n n e c t e d w i t h m e d i c i n e a n d s u r g e r y , it i n c l u d e s a n u m b e r o f h e lp fu l lists, s u c h a s a b b r e v i a t i o n of d e g r e e s , & c., a b b r e v i a t i o n of m e d i c a l t e r m s , t a b l e s of w e i g h t s a n d m e a s u r e s , & c. It c o n c lu d e s w ith elev en e q u a lly u sefu l a p p e n d ic e s , a m o n g w h ic h a re tra y s p re p a re d fo r n u r s in g te c h n iq u e s , s o m e p o iso n s a n d th e ir a n tid o te s, d ie ta ry ta b les, & c. I n s h o r t , r e a d e r s of F i r s t A id a n d e s p e c i a l l y t(io se w o r k i n g in h o s p i t a l s a n d first a i d p o s t s w ill find t h i s d i c t i o n a r y q u i t e i n d i s p e n s a b l e to t h e i r w ork.

D u r i n g t h e w e e k e n d i n g A u g u s t 28t h t h e s e r v i c e s of t h e S t . A n d r e w ’s A m b u l a n c e A s s o c i a t i o n ( G l a s g o w b r a n c h ) w a g o n s w e r e r e q u i s i t i o n e d 455 t i m e s , 281 b e i n g f o r a c c i d e n t s a n d 174 f o r c a s e s o f i l l n e s s r e q u i r i n g r e m o v a l t o h o sp ital. C o r r e c t i o n . — I n o u r A u g u s t i s s u e , p a g e 18 , w e i n a d v e r t e n t l y s t a t e d t h a t m o r e t h a n 50 p e r s o n s w i t h m i n o r in ju rie s w e r e a tte n d e d b y S t. J o h n A m b u la n c e m e n o n D u r d h a m D o w n , B risto l. T h e a m b u la n c e m en w h o dealt w ith th e s e c a s e s w e r e m e m b e r s of th e B risto l C ity a n d M a r in e A m b u la n c e C orps. T h e S t. J o h n A m b u la n c e B rig a d e C a d e ts celeb rate th e ir tw e n ty -first b irth d a y th is y ear. I n 1922 t w e l v e C a d e t A m b u l a n c e D iv is io n s (for b o y s) a n d e i g h t C a d e t N u r s i n g D iv isio n s (fo r g irls) w e re re g is te re d . T o -d a y th ere a re n e a r l y 700 o f t h e f o r m e r a n d m o r e t h a n 900 o f t h e l a t t e r i n E n g l a n d a n d N o r t h e r n I r e l a n d , w i t h a t o t a l s t r e n g t h of m o r e t h a n 32,000 b o y s a n d g i r l s . T h e re a re m a n y o th ers in W a l e s a n d o v e rs e a s .

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A d v e rtis e m e n ts .

A d v e r tis e m e n ts w ith re m itta n c e sh o u ld be s e n t t o F irst A i d , 46, C a n n o n S treet, L o n d o n , E .C 4 3d. p e r w o r d , m i n i m u m 4 s .

Q A A C o n c e r t T i c k e t s 5/ 6 . M e m o s , R u b b e r S t a m p s , R o l l Z U U T ick ets, S a m p le s — “ A ” T ic e s , 11 , O a k l a n d s G r o v e , L o n d o n , W . 12 . IR S T A ID C O M P E T IT IO N S are w on by good coach in g . A n y F ir s t A id er (eith er sex) m a y co ach a n y a m b itio u s te a m — m ale, fe m a le , o r m ix e d — to e a rly su ccess. C o m p etitio n e x p erien ce n o t n ecessary w ith n ew G u id e ( a d a p ta b le to a n y te x t-b o o k ). F o r particu lars, sen d stam p ed e n v e l o p e t o : — R . J e f i f e r y , 5 , A v e n u e G a r d e n s , L o n d o n . W .3

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T H E O LD E S T T R A IN IN G C EN TR E IN G R E A T B R IT A IN The S .M .A .E . (Swedish Massage and Electrical) Institute is the oldest of its kind in Great Britain, having been established for a quarter of a century. Many of the W orld’s leading Masseurs and exponents of Manipulative Therapy have been trained by the S .M .A .E . Institute. Write without delay for FR EE Booklet No.

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R I D Signs and Sym ptom s of Shock.

Queries and Answers to Correspondents Q u e r i e s w i l l b e d e a l t w i t h u n d e r t h e f o l l o w i n g r u l e s :—

1- — L e t t e r s c o n t a i n i n g Q u e r i e s m u s t b e m a r k e d o n t h e t o p le ft-h an d c o rn e r of th e envelope “ Q u e ry ,” a n d ad d re sse d t o F i r s t A i d , 46 , C a n n o n - s t r e e t , L o n d o n , E . C . 4 .

2. — A l l Q u e r i e s m u s t b e w r i t t e n o n o n e s i d e o f p a p e r o n l y . 3. — A l l Q u e r i e s m u s t b e a c c o m p a n i e d b y a “ Q u e r y C o u p o n ”

W . K . ( N u n e a t o n ) .— I n a r e c e n t c o m p e titio n I w a s a s k e d to sta te th e s ig n s a n d s y m p to m s of sho ck . I gave as my a n s w e r t h e s i g n s a n d s y m p t o m s o n p . 44 o f t h e T e x t book. O n receiv in g m y m a r k in g sh eet I found th a t th e a n s w e r r e q u i r e d w a s t h a t g i v e n o n p . 165 f o r f a i n t i n g . W i l l y o u p l e a s e t e l l m e if m y a n s w e r w a s t h e c o r r e c t o n e o r if t h e j u d g e ( w h o w a s n o t a d o c t o r ) w a s r i g h t i n h i s m a rk in g sh ee t? O n y o u r s ta te m e n t of facts you g a v e th e rig h t a n sw e r. — N .C .F .

c u t f r o m t h e c u r r e n t i s s u e o f t h e J o u r n a l , o r , i n c a s e of Q u e rie s fro m a b ro a d , fro m a re c e n t issu e.

Strains and Ruptured M uscles. N .S . ( E a s t H a m ) .— W e w e re re c e n tly d is c u s s in g th e re a so n w h y t h e T e x t b o o k in its s u g g e s t e d t r e a t m e n t of s tr a in s a n d r u p t u r e d m u s c l e s ( p . 98 ) a d v o c a t e s t h e a p p l i c a t i o n of a h o t c o m p r e s s . A s w e c o u ld no t a g re e , w e decided to a p p r o a c h y o u o n th is p o in t ; a n d w e t h a n k y o u in a n tic ip a t io n of y o u r k in d a n d h e lp fu l rep ly . W ith a s tr a in e d o r r u p tu r e d m u s c le , b lo o d collects a t th e s e a t of in ju ry a n d b y c a u s in g p re s s u re a g g r a v a t e s th e p a in a s s o c ia te d w ith th e s tr e tc h in g o r r u p t u r e of th e m u s c u l a r fibres. I n t h e s e c i r c u m s t a n c e s w e a p p l y m o is t h e a t o v e r t h e in j u r e d p a r t f o r t h e p u r p o s e o f c a u s i n g t h e s u p e r f ic ia l ( a n d , a s a n a t u r a l s e q u e n c e , t h e d e e p ) b lo o d v e s s e l s t o d i l a t e a n d s o t o d r a w b lo o d f r o m t h e s e a t o f i n j u r y w it h c o n s e q u e n t r e lie f o f p a in .— N . C o r b e t F l e t c h e r .

Exam ination How ler. M .R . (C a n n o n S t.).— In a re c en t e x a m in a tio n I a sk e d one c a n d i d a t e w h a t s h e w o u l d d o if s h e h a d t o t r e a t a p a t i e n t s tru c k by lig h tn in g . T o th is sh e g a ily re p lied — “ /

Fixation of Fractured Patella. F .A . ( T h o r n t o n H e a t h ) . — I s h o u l d b e v e r y g r a t e f u l if y o u w o u l d t e l l m e if t h e r e a r e a n y a d v a n t a g e s i n t y i n g t h e k n o t of t h e b a n d a g e , a p p l i e d t o k e e p t h e f r a g m e n t s of t h e p a te lla in a p p o s itio n , o n t h e side. I h a v e h e a r d it s a i d t h a t to tie t h e k n o t in fr o n t a s s h o w n in t h e T e x t b o o k is v e r y p a in f u l, w h e r e a s w h e n tie d o n t h e s i d e it is m u c h m o r e c o m f o r t a b l e . B y ty in g o u r k n o t b elo w th e k n e e c a p w e o b ta in a m o re c o m p le te c o n tro l of th e f r a g m e n t s of th e f r a c tu r e d p a te lla t h a n w e c a n w i t h t h e k n o t in a n y o t h e r p o s itio n . F u rth er, 1 q u e s t i o n if t h e k n o t , w h e n p r o p e r l y t i e d , d o e s i n f a c t c a u s e p ain fu l p re s s u re .— N .C .F .

Alcohol as Disinfectant. M .P . ( E a s t F i n c h le y ) .— M a n y first a id te x tb o o k s r e c o m m e n d t h e u s e of a lc o h o l in its v a r io u s f o r m s a s a d is in f e c ta n t of t h e s k in . I s h a l l b e g r a t e f u l if y o u w i l l t e l l m e h o w a l c o h o l a c t s a n d p r o d u c e s its effects. A lc o h o l is a n e x c e l l e n t s k i n a n t i s e p t i c b e c a u s e it d i s s o lv e s fats, e n te rs th e s w e a t a n d s e b a c e o u s d u c ts a n d q u ic k ly ev ap o rates. It, th e re fo re , co o ls th e sk in , w h ic h c o n se q u e n tly b e co m es pale fro m c o n tra c tio n s of th e s m a ll blo o dv essels a n d in d irec tly c a u s e s less s w e a t to b e e x c re te d . A lcohol h a s th e p o w e r o f t a k i n g u p w a t e r ; a n d it p r o d u c e s its a n t i s e p t i c a c tio n b y r e m o v in g w a t e r fro m g e r m s w h ic h a r e th u s k illed . — N .C .F .

sh o u ld firs t tu r n o ff the cu r ren t I " Good!

N ex t, p le a s e !

!— N . C . F .

Fractures of C la v ic le and Hum erus. A H . (C h a rlto n ).— A t a recen t B rig a d e P rac tic e w e w ere d e a lin g w ith in ju rie s to th e u p p e r lim b s a n d th e ir tr e a t m e n t in first a id . W e d e a lt w ith a fr a c tu re d clav icle a n d th e n w e n t o n to f r a c tu r e s of th e h u m e r u s . One m e m b e r t h e n a s k e d w h a t w o u ld b e th e c o rre c t w a y to t r e a t a c a s e in w h ic h t h e i n ju r i e s w e r e d i a g n o s e d a s b e i n g s im p le f r a c tu r e s of c la v icle a n d of u p p e r - th i r d of th e h u m e r u s o n th e s a m e sid e. A n u m b e r of d ifferen t s u g g e s tio n s c a m e fo rth . A s, h o w e v e r, w e c o u ld n o t a g r e e satisfacto rily , w o u ld y o u p le a se let u s h a v e y o u r v a lu a b le s o lu tio n of th e p r o b le m ? O b s e r v i n g t h e G e n e r a l R u l e s fo r F r a c t u r e s a n d in p a r t i c u l a r N o . 3 , T e x t b o o k — p p . 66 - 69 , I c o n s i d e r t h a t all th a t c o u ld b e d o n e w ith o u t ris k of fu r th e r in ju ry w a s to im m o b ilise th e u p p e r lim b o n th e in ju r e d sid e b y b a n d a g e s ro u n d th e lim b a n d tr u n k a b o v e a n d b elo w th e elb o w . T h e b ra c e s o n th e in ju re d sid e w o u ld , of course, b e u n f a s t e n e d if w o r n . A d e cisio n d e p e n d s o n th e d e g re e of s h o c k p re sen t. If s h o c k is n o t m a r k e d a n d p a t i e n t is a w a l k i n g c a s e , I w o u l d s u p p o rt th e lim b in a S t. J o h n s lin g a n d s te a d y th e fra c tu re d h u m e r u s w i t h a b r o a d b a n d a g e r o u n d li m b a n d b o d y (a s in ( a ) 1 , o n p . 82 o f T e x t b o o k ) . If, h o w e v e r , s h o c k is s e v e re a n d p a t i e n t is a s t r e t c h e r c a s e , t h e n I w o u ld a c t a s y o u s u g g e s t .— N .C . F,

Uses of W itch Hazel. W . N . ( R o s s e n d a l e ) . — P l e a s e t e l l u s if W i t c h a n t i s e p t i c , a n d if n o t , w h a t a r e i t s u s e s ?

H azel

is a n

W i t c h H a z e l is n o t a n a n tis e p tic . It c o n tain s tan n ic a c id w h ic h g iv e s it a s t r i g e n t a n d s ty p tic p ro p e rtie s . D ilu ted w i t h w a t e r , it m a y b e u s e d fo r b r u is e s o r s t r a i n s , fo r c a p i lla r y b le e d in g fro m s m a ll w o u n d s, or for b le e d in g from n o se or to o th s o c k e t.— N .C .F .

H u m our in First Aid. E .J . (B e c c le s ).— A m e m b e r of a N u r s i n g D iv is io n in S u ffo lk w a s seen recen tly by a sm all boy, d riv in g a n a m b u la n c e to a s e rio u s a c c id e n t w h e re a m a n w a s ly in g fa ta lly in ju re d . T h e b o y w a s h e a r d t o r e m a r k — " S e e , there

g o es one o f the tou g h la d ie s o f S t. J o h n , a n d she drove str a ig h t throu gh the crow d, a n d g o t d ow n to h elp w ith o u t t u r n in g a h a ir / ” T h e s a m e m e m b e r a n d h e r s i s t e r w e r e in a b o a t o n th e riv er, w h e n th e y s a w a c o w s w i m m i n g a fte r th e m , “ m o o i n g , ” e v id e n tly in g r e a t d is tr e s s a n d t r y i n g to a ttra c t a tten tio n . S h e w a s w a n tin g to e x p la in th a t sh e c o u l d n ’t g e t u p t h e b a n k . S o th e tw o “ re s o u rc e f u l” a n d “ sy m p ath etic ” n u rse s tu rn e d th eir b o a t ro u n d an d in v ite d th e c o w to fo llo w , w h ic h s h e g r a te f u lly d id , a n d w a s g u id e d to a m o re c o n v e n ie n t la n d in g place. A fter a p p ly in g th e u s u a l re m e d ie s fo r s h o c k , th e siste rs c o n tin u e d on th e ir w ay, th e co w a p p aren tly b e in g n o n e th e w o rs e for th e e x p erie n ce .

Good!

Next, please! !— N.C.F,

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36 Stretcher D rill. W .B

( B e r m o n d s e y ) — A t a H o m e G u a r d C o m p e titio n in first a id , w e h a d to lo a d a m b u l a n c e ; a n d t h e s l i n k s w e r e ju s t placed on th e stre tc h er. I d id n o t t h i n k t h a t th is w a s rig h t. In d e e d , I said th a t B e a re rs N os. 2 a n d 4 sh o u ld t u r n to t h e r i g h t , k n e e l o n left k n e e s , p a s s lo o p of g r i p p late en d over th e n e a r h a n d le , g r ip p late d o w n w a rd s, c a r r y s lin g u n d e r a n d o v e r o p p o s ite h a n d le clo se u p to c a n v a s b a c k to th e n e a r h a n d le r o u n d w h ic h tw o o r th r e e t u r n s a r e m a d e , p a s s t h e t r a n s v e r s e s t r a p r o u n d t h e p o le b e tw ee n th e ru n n e rs a n d tra v e rse a n d fa sten b u ck les o u ts id e th e s lin g b e tw e e n th e p oles. T h is done, th e B e a re rs rise to g e th e r. I w a s t o l d t h a t t h i s is n o t d o n e n o w ; a n d I a w a i t y o u r ru lin g w ith in terest. W h a t y o u w e r e t o l d i s q u i t e c o r r e c t ; a n d if y o u r e f e r t o p . 226 o f t h e T e x t b o o k y o u w i l l f i n d t h a t t h e r e is n o w n o i n stru c tio n fo r fix atio n of s lin g s .— N .C .F .

Fractures of P elvis and F e m u r. S. B. (S t. S ti t h i a n s ) . — A t a r e c e n t D iv is io n a l P r a c tic e I re a d o u t th e q u e ry w h ic h w a s p u b lish ed u n d e r th e ab o v e h e a d i n g i n t h e J u l y i s s u e of F i r s t A id , to a s q u a d a n d to ld t h e m to tr e a t th e case. C o rp o r a l H o p p e r a n d h is m e n th e n p ro c e e d e d to a p p ly t w o s p lin ts r e a c h i n g fro m th e a r m p i t s to b e y o n d t h e fe e t, o n e o n e a c h s id e of p a t i e n t . H e p o in ted o ut t h a t th e f r a c tu r e d f e m u r w a s lia b le to a g g r a v a t i o n a n d t h a t s o m e t h i n g m u s t be d o n e to c o n tro l th e f r a c tu r e d p e lv is to s a v e in ju r y to th e o r g a n s w ith in th e pelvis. A lso , h e i n s tr u c te d h is m e n , o n e to p r o te c t th e in ju r e d lo w e r lim b , o n e to p lace a b ro a d b a n d a g e r o u n d th e pelv is, a n d o n e to d r a w fo o t in to lin e w ith its fellow a n d to a p p ly f ig u r e - o f - e ig h t b a n d a g e r o u n d foot a n d a n k le . N e x t, a ll s e t to w o r k to b a n d a g e a n d s p lin t a s laid d o w n in t h e T e x t b o o k w ith th e a d d itio n a l s p lin t a l o n g u n i n j u r e d s i d e a n d u s i n g p l e n t y o f p a d d i n g t o fill u p t h e h o llo w s. W h e n th e y fin ish ed I re a d y o u r rep ly . H av in g h e a r d th is th e m e m b e r s of th e s q u a d r e a lly be lie v e t h a t fo r o n c e th e y e x c e lle d e v e n “ N . C . F . ” in r e n d e r i n g first aid . I t h o u g h t t h a t m a y b e n e x t m o n t h th e y w ill r e q u ir e t r e a t m e n t fo r s h o c k ; a n d I in v ite y o u r c o m m e n t s please. In c id e n ta lly y o u r re p lie s to o u r q u e r ie s a r e of u n to ld h elp . F r o m y o u r s t a t e m e n t of fa c ts it w o u l d s e e m t h a t C o r p o r a l H o p p e r a n d his m e rry m e n w e re g u ilty of w a s t i n g tim e w h e n th e y a p p lie d th e s p lin t o n th e u n in ju r e d sid e, a n d th e r e b y d e l a y e d t h e r e m o v a l of a s e v e r e l y s h o c k e d p a t i e n t to h o s p i t a l , u n le s s (I h e s it a te to s a y so) h e w a s a f r a id t h a t th e m e m b e r s of h is s q u a d w o u ld r o u g h h a n d le th e p a tie n t d u r in g tr e a t m e n t a n d tra n sp o rt. F u r t h e r , h is f a ith in th e b ro a d b a n d a g e r o u n d p e l v i s — “ t o s a v e i n j u r y t o t h e o r g a n s w i t h i n ” is n o t e w o rth y . A s a fa c t, th is b a n d a g e is t h e le a s t i m p o r t a n t ite m in t h e t r e a t m e n t of f r a c t u r e d p e lv is ; a n d a n y r i s k of c a u s i n g in ju ry to th e in te rn a l o r g a n s co u ld o n ly a ris e fro m m a ltr e a t m e n t d u r i n g s p l in tin g a n d b a n d a g i n g of th e fr a c tu r e d fe m u r. S o o n c e a g a i n I r e p e a t t h a t if t h e f r a c t u r e d f e m u r i s t r e a t e d p r o p e r ly a s la id d o w n in th e T e x tb o o k , n o a g g r a v a t i o n of th e f r a c tu r e d p elv is w o u ld re s u lt. P r o s i t ! !— N . C . F .

Transport of Fractured Spine. C . S . ( M i d d l e s t o w n ) . — I a m w r i t i n g re t h e q u e s t i o n o f r e m o v a l o f c a s e s of f r a c t u r e of s p i n e , a s o m e w h a t c o n t r a d i c t o r y c o n d itio n of t h i n g s h a v i n g a r is e n fr o m t h e in s tr u c tio n p o in t of v iew , m y F ir s t A id P a rtie s b e in g la rg e ly c o m p o sed of coal m in e rs. W e n o w h a v e tw o

en tirely

d ifferen t

p o licies,

A I D re g io n s h o u ld be tra n s p o rte d ly in g on th e b a c k ra th e r t h a n o n t h e fa c e, e x c e p t in c i r c u m s t a n c e s w h ic h m a k e m o v in g h im to th is p o sitio n d a n g e r o u s , in w h ic h c a s e h e w ill b e p la c e d o n t h e s t r e t c h e r in t h e p o s itio n fo u n d , in o r d e r to o b v ia te th e n e c e s sity of h a v i n g to b e n d o r s tra ig h te n o u t th e sp in e .” ( R e c o m m e n d a t i o n of t h e C. S. C o m m itte e of th e M e d ic a l R e s e a r c h C o u n cil). T h e s e in s t r u c t i o n s a r e to b e e l a b o r a t e d in t h e r e v i s i o n o f H a n d b o o k N o . 10 . 2. F ir s t A i d in C o a l M in e s . — P a g e 81 , S e c t i o n “ C a s e s of fr a c tu r e d sp in e, e x c e p t in th e c erv ic al re g io n , s h o u ld be tr a n s p o r te d in p r o n e p o s itio n .” N o w , w h a t is t h e p o o r c o a l m i n e r — C . D . F . A . P . m a n to d o ? H e w ill i m m e d i a t e l y a s k , a f t e r a le c tu re , “ W h i c h m e t h o d is t h e r i g h t o n e ? A re b o th c o rre c t ? ” A p o i n t w ' h i c h n o w a r i s e s i s :— T h e C . D . m e s h t y p e s tr e tc h e r te n d s, a f te r a little u se, to s a g c o n sid e ra b ly , d u e to s tr e tc h in g of th e w ire . I t is a d ifficult m a t t e r to a p p ly b o a r d s , e tc ., to m a k e it r i g i d a n d still b e a b le to l o a d it i n t o a n a m b u l a n c e ( u n l e s s b o a r d s a r e a p p l i e d len g th w ay s). T h is s a g g in g g iv e s s o m e m e a s u r e of h y p e r e x te n sio n w ith a p a tie n t ly in g p ro n e , th e po sitio n n o w d efin itely n e g a tiv e d in C. D e fe n ce . I s it n o t a p i t y t h a t o n e m e t h o d c a n n o t b e t a u g h t to all c lasses, so o b v ia tin g m u c h m is u n d e rs ta n d in g a m o n g s t th e m en ? Y o u r d i f f i c u l t y a r i s e s b e c a u s e F ir s t A i d in C o a l M in e s w 'a s p u b l i s h e d i n p e a c e t i m e p r i o r t o t h e p r e s e n t i n v e s t i g a t i o n by th e M ed ic a l R e s e a r c h C o u n cil. C o n s e q u e n t l y it m a y w e ll b e th a t, w h e n a n e w e d itio n of th is b o o k a p p e a r s , e x p e r t o p i n i o n w 'il l h a v e b e e n s t a b i l i s e d a n d o n e m e t h o d t a u g h t . M y p e r s o n a l o p in i o n is t h a t s u c h p a t i e n t s s h o u l d b e r e m o v e d a s f o u n d a n d t h a t i t m a t t e r s l i t t l e w’h e t h e r p a t i e n t i s o n h i s b a c k o r fa c e p r o v i d e d t h a t t h e s p i n a l c o l u m n is p r o p e r l y im m o b ilis e d . — N .C . F .

Nose Bleeding. H . H . ( O u t w o o d ) . — P l e a s e tell u s w h i c h k i n d of h a e m o r r h a g e o c c u rs w h e n a m a n , w h ile w a s h i n g h is face, s u d d e n ly sta rts b le e d in g from th e nose. W e w e re a sk e d th is q u e s t i o n r e c e n t l y a n d s a i d t h a t it is e i t h e r c a p i l l a r y o r a r t e r i a l b u t w e w e r e to ld t h a t it is u s u a l l y v e n o u s . W e t h a n k y o u fo r y o u r re p lie s to q u e rie s w h ic h a re of g r e a t h e lp in s e tt lin g d is c u s s io n s. S p o n ta n e o u s b le e d in g su c h a s y o u d esc rib e very c o m m o n ly t a k e s p la c e fro m a r u p t u r e d v a ric o se v e in in th e m u c o u s m e m b r a n e of th e s e p tu m of th e n o se. A rterial b le e d in g m a y a r is e a s th e re s u lt of a b lo w o n th e n o s e .— N .C .F .

Firs t A id and D rugs. W . N . ( R o s s e n d a l e ) . — I r e a d t o - d a y :— “ T h a t a s a r e s u l t o f A n g l o - A m e r i c a n s c ie n tific c o - o p e r a t i o n , it w a s h o p e d to o b ta in p u r e p e n ic illin — m o r e efficient lif e - sa v in g d r u g th a n even th e su lp h a g ro u p .” I w o n d e r if w e c o u l d h a v e a n a r t i c l e in F i r r t A id o n t h i s p a r t i c u l a r d r u g ? T h e a c tio n a n d a d m i n i s t r a t i o n of d r u g s a r e th e c o n c e r n of d o c to r s a n d tr a in e d n u r s e s , a n d a r e b e y o n d th e sc o p e of first a id . F o r t h i s r e a s o n y o u r r e q u e s t c a n n o t b e g r a n t e d in th is jo u r n a l w h ic h is d e v o te d to th e a d v a n c e m e n t of first a id . -— E d i t o r .

“ FIRST A I D ” QUERY and REPLIES COUPON.

f o l l o w s :— 1. C i v i l D e fe n c e . — T h e W e s t R i d i n g C o u n t y M . O . H . in f o r m s m e t h a t “ E v e r y c a s e of f r a c tu r e d s p in e in a n y

To be cut out and enclosed with a ll Queries.

Sept.,

1943 .

JOHN BALE MEDICAL PUBLICATIONS MANUALS OF FIRST AID. By N. CORBET FLETCBER, M.B., B.C., M.A.(Cantab.), M.R.C.S. AID S

FIR ST-AID .

Seven th E d itio n . I s . 3 d . post 2 d . F ir s t-A id S im plified and Ta b u la te d , w ith A id s to M e m o ry . “ Col. S ir James C antlie contributes an introduction and we endorse his good opinion o f the book." — L a n c e t ,

A ID S

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FIR ST-A ID .

P o st free, 18. 3 d .

Prob lem s In S tu d y , T re a tm e n t and E x a m in a tio n solved l o r S en io r Stu de nt “ W ithout doubt the book w ill be or great service in the training o f those /or whom it is designed. — B r i t i s h M e d i c a l J o u r n a l .

CO M M O N

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T h ir d E d itio n . 1 s. 3 d . p ost 2 d . E rro rs in F ir s t-A id D etailed and Explained. 41 This book gives a clearer insight into the methods a n d difficulties O) emergency treatm ent by laymen than the official Textbook itself." — L a n c e t .

AM BULANCE

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(S tre tc h e r, In d iv id u a l an d Q u e s tio n — S ix F old ers). P r ic e 6d. ea ch , net, post Id. E a c h F o ld e r con tain s sp e cial a rtic le on C o m p e titio n s N o . i , T r a in in g o f C o m p etitio n T e a m s ; N o . 2, C o n d u c t o f T e a m in C o m p e titio n R o o m ; N o . 3, C om m on E rro rs in C o m p etitio n ; N o . 4, F u rth e r E rro rs in T r e a t m e n t ; N o . 5, H is t o r y o f C o m p etitio n T e s ts ; N o . 6, P re p a ra tio n o f T e s ts.

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(Patent Number 53165 of 28/7/39.) INCURVED EDGE OF SOCKET /

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O n e o r o t h e r o r all o f th e th r e e races o f g e r m s , S tr e p t o c o c c i, S ta p h y lo c o c ci a n d B. p y o c y a n e u s a r e f o u n d in e v e r y s k in in fe c tio n c o m m o n t o t h i s c o u n t r y , a n d A N T I P E O L O I N T M E N T c o n t a i n s t h e antibodies ( a n t i v i r u s ) o f t h e s e g e r m s . H e a l i n g is e x p e d i t e d b y t h e p r o v e d i n g r e d i e n t s o f t h e o i n t m e n t , a n d s e p t i c d e v e l o p m e n t is s t o p p e d o r p r e v e n t e d b y its a n t i v i r u s s t e r i l e v a c c i n e f i l t r a t e s . A N T I P E O L O I N T M E N T is u n s u r p a s s e d f o r B U R N S a n d S C A L D S , f o r i t is m i c r o b i c i d e a n d n o n - a d h e s i v e , a n d d r e s s i n g s d o n o t r e q u i r e t o b e c h a n g e d every day. W O U N D S , B U R N S , e t c , W I L L N O T T U R N S E P T IC if treated w ith A N T I P E O L O I N T M E N T .

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(A s u s e d b y R e d C ro s s a n d F irs t A id O r g a n iz a t i o n s , P o li c e F o r c e s , F i r e B r i g a d e s , E l e c t r i c i t y U n d e r t a k i n g s , G a s C o m p a n ie s , e tc .)

with detailed text accom panying it. 6 /-

Post Free each OR

11/7 the two.

BAILLIERE, T I N D A L L & C O X 7 & 8, HENRIETTA STREET, LONDON, W.C.2.

F IR S T

A ID

3n6eperu!tfni Journal jo r the A m b u lance attb 3ftu rsin £ B ern ices Ed ito r:

No. 592.— V

o l.

W A LTER

SCO TT,

N O T IC E

READERS.

F I R S T A ID is published on the aoth of each m onth. A n n ual Subscription is 4s. post free ; single copies 3d.

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A ll R eports, & c., shonld be addressed to the E d ito r at the address below , and should reach him before the 8th of each month, and must be accom panied (not necessarily for publication) by the name and address of the Correspondent. Subscriptions, Advertisem ents and other business Com m unications connected w ith F I R S T A I D should be forwarded to the Publishers. D A L E , R E Y N O L D S & C o ., L t d ., 46, C a n n o n S t r e e t , L o n d o n , E .C .4 . Telegraphic Address— “ Twentv-four, London." Telephone— City 3710.

TH IS

N U M B ER .

E d it o r ia l —

T h e D isab le d N u rs e I m p r o v i s a t i o n in M o d e r n F i r s t A id T h e H o m e G u a r d a n d F i r s t A id S .J.A .B . H e a d q u a rte rs a n d D istric t R ep o rts P o in ts o n B o n e s for B e g i n n e r s

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L e tte rs to th e E d ito r

D r. R y m e r C a d e t S h ield C o m p e titio n

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Q u e r i e s a n d A n s w e r s t o C o r r e s p o n d e n t s :— T h a n k s to th e D o c to r

L o a d in g A m b u lan ce

E x a m in a tio n H o w le r

A n t i s e p t i c T r e a t m e n t of W o u n d s T r e a t m e n t of S h o c k a n d F r a c t u r e s

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P o is o n in g ...

R e g i s tr a tio n of A ss o c ia tio n A w a r d s

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L a y In s tr u c to r C ertificate

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E x te n s io n of F r a c tu re d F e m u r ...

A ir E x c h a n g e in A rtificial R e s p ir a tio n V e ssel U s e d in B lo o d T r a n s fu s io n

F r a c t u r e s of P a te lla a n d F e m u r

F r a c tu re s of C lav icle a n d H u m e r u s

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G a s P o iso n in g a n d B ro k en N eck T r e a t m e n t of P h o s p h o r u s

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PR1CB THREEPENCE

(4 /- P e r A n n u m , P o s t

F ree

EDITORIAL.

S o u th e rn

F.R.S.A.

O CTO BER, 1943.

C O N TEN TS

F.R.San.l.,

48 48 48

F r a c t u r e of A r m a t E lb o w

...

I m r h e r s io n in S t r o n g A cid

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the risks attendant upon

The D isa b led the profession of nursing are N urse. many and varied is a statement

of that self-evident nature which does not call for amplification, and welcome is the announcement that arrangements have been made between the Ministry of Labour and National Ser vice and the Ministry of Health under which State registered nurses who on account of disability are not fit to return to their previous nursing work, but who are suitable for employment as sister tutors, health visitors or industrial nurses, may receive training for that purpose. It is anomalous to a degree that one who has spent many years of her life, and possibly the best of those years, should find herself, through no fault of her own, on a labour market which has no place for her. Hospital authorities have now been invited by the Ministry of Health to inform nurses who are undergoing treatment about the arrangements that have been made, and any such nurse who wishes to apply will be interviewed in hospital by a representative of the Ministry of Health. A disabled nurse who is not receiving treatment in hospital and who being unfit to resume her normal occupation wishes to apply for training of this kind should write, with full particulars of her case, to the Chief Nursing Officer and Principal Matron of the Ministry of Health, Whitehall, S .W .l, who will arrange for her to be interviewed and, if she is considered suit able, to enter a course of training. Similar arrange ments for the training of disabled nurses will shortly, we are informed, be made in Scotland. Concessions have been made to meet the case of disabled nurses who are not able to take advantage of any of the courses of training for the profession referred to, and they may apply to the Ministry for training in some other occupation either under the scheme of “ Further Education and T rainin g” recently announced by the Government or under the interim scheme of training for the disabled. We understand that it is now possible in the case of disabled persons to provide a variety of courses, and arrangements will be made for nurses who may be found suitable to take courses for such occupa tions as hospital almoner, radiographer, masseuse,

F I R S T

and chiropodist. The cost of a training course together with maintenance allowances, will be paid by the Departments concerned. From this, and other matters in connection with the well-being of the profession, it will be recognised that good may come even out of such a vile thing as war, for it is indisputable that had things proceeded in the old jog-trot fashion, questions such as care of the dis abled, increased salaries, security of tenure, and so forth would be long ere they received consideration. There are, of course, (there always will be) many matters still calling for attention, but the past year or two has witnessed the introduction of much that has been of distinct advantage to the profession.

I m p r o v i s a t i o n in M o d e rn F i r s t Aid. M .O .,

By BOW M AN EDGAR. 4th B a ttn ., D u m fr ie s s h ire

H .G .

I n a n e a r l i e r i s s u e of F i r s t A id I g a v e a r e s u m e of t h e p o s s ib il itie s of I m p r o v i s a t i o n , a n d o ff e r e d t o s e n d p a r t i c u l a r s to th o se in te re sted . S o g r e a t w a s th e n u m b e r of such r e q u e s ts t h a t I d e c id e d to p u b lis h o u r id e a s in t h e fo r m of a sm all brochure. T h i s h a s , u n f o r tu n a te ly , p ro v e d to b e i m p o ssib le , so p e r h a p s c o r r e s p o n d e n ts w ill fo r g iv e th e d e la y in a c c e d i n g to th e ir r e q u e s ts . T h e first i n s t a l m e n t d e a ls w ith t h e u p p e r p a r t of t h e b o d y , t h e l o w e r li m b s w ill b e d e a l t w i t h n e x t m o n th . T h e w h o le t r e n d of m o d e r n first a id is t o w a r d s s im p lifi c a t i o n . r a p i d i m m o b i l i s a t i o n a n d g e n e r a l efficien cy . The d a y s of o n ly sp e c ia l ( t r i a n g u l a r o r o th e r) b a n d a g e s a n d sp e c ia lly m a d e s p lin ts a r e over. T o - d a y th e first a id e r m u s t b e a b le to t u r n to u s e a n y t h i n g w h i c h lies to h a n d . Shock, t h a t d a n g e r o u s r e s u l t of F e a r , P a i n a n d C o ld , c a n b e m u c h re d u c e d by e a rly fix atio n of fra c tu re d o r serio u sly la c e ra te d lim b s. T o th is e n d Im p ro v isa tio n p lay s a n im p o r ta n t p a rt. S o f a r a s th e A r m y a n d H o m e G u a r d a r e c o n c e rn e d , it is n o w p o s s ib le to im m o b il is e a n y f r a c tu r e , e x c e p t th e S p in e , w ith n o o t h e r e q u i p m e n t s a v e th e e v e r y d a y o u tfit of th e so ld ier. l t is i n t e r e s t i n g to c o n s id e r h o w m u c h c a n b e d o n e w ith th is a p p a re n tly m e a g r e k it. T h r e e t y p e s o f S lin g a r e a v a i l a b l e .

R I D s e c u r e ly h e l d in p o s itio n b y t h e u s e of t h e l i g h t l i n i n g o f t h e steel h e lm e t. T h e d r e s s in g , F . F . D . o r sh ell, h a v i n g b e e n a p p lie d , th e l i n i n g is a d j u s t e d so a s to p r e v e n t p r e s s u r e o n th e w o u n d , a n d th e b a n d a g e , a fte r b e in g looped ro u n d th e b a s e o f t h e l i n i n g , is t ie d b e l o w t h e c h i n . T h u s s lip p in g of t h e d r e s s i n g is p r e v e n t e d .

Fracture of Lower Jaw. 1. T h e “ b a r r e l b a n d a g e ” , m a d e w i t h a s h e l l - d r e s s i n g , s e e m s to b e th e id e a l a p p lic a tio n fo r th is ty p e of in ju ry . M o d e r n o u t l o o k o n th is f r a c t u r e (v id e “ F i r s t A id a n d t h e M e d i c a l P r a c t i t i o n e r , ” P r a c titio n er , 1943 ) i s , t h a t t i g h t b a n d a g i n g is n o t o n l y p a i n f u l b u t d i s t i n c t l y h a r m f u l . S o it fo llo w s t h a t e fficien t p a d d i n g b y t h e s h e ll - d r e s s in g , a l o n g w ith c o m fo rta b le fix atio n by th e b a n d a g e of th a t d re s s in g s h o u ld p ro v e to b e c o m f o r t in g a n d all sufficient. T h e “ b a r r e l b a n d a g e ” i s , o f c o u r s e , m a d e a s f o l l o w s :— A d ju s t th e d re s s in g c o m fo rta b le a r o u n d th e in ju re d ja w , th e b a n d a g e en d s p o in tin g u p each ch eek . A s k th e p a tie n t to h o ld th e b a n d a g e s in th is p o sitio n . T ie th e e n d s in a h a lf k n o t o n th e to p of th e h e a d . O p e n o u t th e h alf-k n o t a n d c a r r y th e fo r w a rd loop d o w n a r o u n d th e fo re h e a d , th e b a c k lo o p is s l ip p e d b e h i n d t h e o c c i p u t. N o w , h o ld in g a n end of th e b a n d a g e in e a c h h a n d , a d j u s t a n d t i g h t e n th e lo o p s above th e ears. T ie off o n to p of s k u ll w h e n c o m fo rta b le .

2. A n e x c e l le n t e m e r g e n c y s u p p o r t f o r f r a c t u r e d l o w e r ja w can be m a d e by h o ld in g tw o p u ll-th ro u g h s to g e th e r by th e ir m id p o in ts. T i e a k n o t 2-3 i n c h e s t o e a c h s i d e o f t h i s centre. T h e p o in t of th e ja w slip s in to th e lo o p th u s fo rm ed , a n d th e e n d s a re c arrie d u p, one over th e tem p les a n d t ie d o n t h e t o p of t h e s k u l l , t h e o t h e r is t ie d a t t h e o ccip u t. T h e free e n d s of th e s e tw o c o rd s a r e th e n tied to g e th e r. P a d d in g c a n b e su p p lie d b y c a m o u fla g e n et, h a n d k i e s , etc.

Fracture of Clavicle. P la c e a n a m m u n itio n p o u c h a s fa r u p in th e a x illa a s p o ssib le. L a y th e fin g e r-tip s of th e in ju r e d h a n d o n th e u n in ju re d co llar-b o n e. S lip t h e lo o p o f a rifle s l i n g o v e r t h e p o in t o f t h e e lb o w o n th e in ju r e d sid e. C a rry th e e n d s of th e slin g u p w a rd s, th e s h o rte r e n d b e h in d , th e lo n g e r in fro n t. T h e la tte r ru n s u p th e fo r e a rm a n d h a n d , th u s b in d in g th e m to th e c h est. T i e off th e e n d s of s l i n g o v e r th e b a c k of t h e u n in ju r e d sh o u ld er. U s e th e w a ist-b e lt to pu ll b a c k th e p o in t of th e e lb o w , th u s b r a c in g th e s h o u ld e r a n d fix in g a r m to c h est.

Fracture of Both Clavicles. S lip w e b -e q u ip m e n t s lin g s o v e r e a c h s h o u ld e r, tie th e m b e h in d so a s to b ra c e s h o u ld e rs b a c k . T i e lo o se e n d s to g eth er. S u p p o r t b o th a r m s in n e t s lin g .

(a ) C a n b e f o r m e d b y f a s t e n i n g t h e w r i s t b u t t o n of th e b a ttle d re ss to th e b u tto n -h o le of th e o p p o site b re a st

Fractured Clavicle and Shoulder on same side.

pocket. (b) T h e “ n a r r o w - b a n d a g e ” ty p e of s lin g , a s fo r f r a c t u r e o f s h a f t of h u m e r u s , is m a d e f r o m t h e w a i s t b e l t a s f o l l o w s :— S l i p t h e f r e e e n d o f t h e b e l t t h r o u g h th e g u a rd . P a s s t h e w r is t t h r o u g h t h s lo o p th u s form ed. T ig h te n a n d a d ju st a ro u n d w rist a s neces sary. C a r r y lo n g e n d of b e lt r o u n d n e c k a n d b u c k le a t o p p o s ite s id e of n e c k o r c h e s t, a s d e sir e d . (c ) N e t S lin g f o r i n j u r e d f o r e a r m . U s in g th e h e lm e t c a m o u fla g e n et, fa s te n th e u p p e r n e t c o rd o v e r t h e b u tto n s of th e b r e a s t p o c k e t. L a y th e in ju red a r m a c r o s s m id d le of n e t a s it lies a c r o s s th e c h est. T a k e u p lo w e r b o r d e r of n e t o v e r f o r e a r m a n d e lb o w . F a s t e n to s a m e b u tto n s . A d ju st ro u n d elb o w a n d h a n d

D o u p s h o u ld e r s a s in p re v io u s ite m . P a d w ith a m m u n itio n p o u c h b e tw e e n b ro k e n a r m a n d ch est. C over upper a r m w i t h o p e n g a i t e r a n d fix w i t h r i f l e - s l i n g a r o u n d c h e s t . W r is t s u p p o rte d in b e lt-slin g .

a s necessary. N o te .— B o th fo re a rm s c a n b e s u p p o rte d in o n e net

Head Injuries. L a c e r a te d w o u n d s o r fra c tu re d sk u ll. S u c h in ju ries m a y be p ro tected a n d

th e

d re ssin g s

Fracture of Shoulder Blade. P a d w ith n e t, h a n d k i e s , o r a n y t h i n g so ft. O pen g a ite r o v e r in ju r e d b o n e to re s tric t m o v e m e n t. F i x w ith rifleslin g . F ix a r m to c h e s t b y w a ist-b e lt ro u n d a r m a n d ch est.

Fractured Humerus. F o ld g a ite rs fo u r tim e s. O n e m a k e s in n e r a n d th e o th e r o u te r sp lin t. F ix w ith p u ll-th ro u g h , h a n d k ie s, bo o tlaces, etc. S u p p o r t w ris t in b elt slin g .

Fractured Forearm. B a y o n e t, h eld w ith b e y o n d elb o w , m a k e s a n b a rd fo rm s a n e q u ally grass, hay or an y th in g

h ilt in p a lm a n d p ro te c te d p o in t ex cellen t in n e r sp lin t. T he scab efficient o u te r s p lin t. P a d w ith soft. T ie on w ith p u ll-th ro u g h s,

h a n d k ie s, la c es, etc.

F ix to sid e in n e t-s lin g by b e lt r o u n d

a r m a n d c h est.

Fractures or Injuries of the Hand. C a n b e w e ll s u p p o r te d b y p a d d i n g w i t h a first-field d re s s in g a n d u s in g a b a y o n e t fro g a s sp lin t. S lip p in g one o r t w o "fingers t h r o u g h t h e e y e o f t h e f r o g . T i e eflf w i t h t h e b a n d a g e of th e F . F . D .

Fractu re d Ribs. A re e asily a n d c o m fo rta b ly tre a te d by o p e n g a ite rs b o u n d firm ly o n b y w e b -slin g s. T h e c o m f o r t of th e p a tie n t is t h e t e s t of t h e f i r m n e s s w i t h w h i c h t h e g a i t e r s s h o u l d b e fixed. S u p p o r t th e a r m o n th e in ju re d sid e in a n e t-s lin g . If d e s i r e d , fix a r m t o c h e s t b y w a i s t - b e l t , rif le o r w a t e r bo ttle slin g .

T h e H o m e G u a rd a n d F i r s t Aid. A n s w e r s t o Q u e r ie s .

W h i le d e a lin g w ith th e q u e stio n of w a te r su p p ly a n d p u rific a

tio n , I h a v e re c e iv e d s e v e ra l le tte rs r e q u e s ti n g a d v ic e o n s im ila r q u e s tio n s , so w ill e n d e a v o u r to a n s w e r t h e m in th e p re se n t issu e. F ir s t, th e n , t h e w e a r i n g of first a id b a d g e s . A rm y C o u n c il in s tru c tio n s d is tin c tly s ta t e t h a t h o ld e rs of S t. J o h n A m b u l a n c e o r R e d C ro s s c e rtific a te s, a r e e n title d to w e a r t h e b a d g e o n t h e l e f t s l e e v e o f t u n i c , j u s t a b o v e t h e cuflf. O ffice rs a r e n o t ju s tifie d , t h e r e f o r e , in r e f u s i n g to p e r m i t th is , a s a p p e a rs to b e th e c ase in m a n y u n its. M y o w n C .O . for i n s t a n c e , n o t o n l y e n c o u r a g e s it, b u t e v e n p a y s e x a m i n i n g fees, a s h e c o n s i d e r s , q u i t e r i g h t l y , t h a t t h e s t a n d a r d r e a c h e d b y c e r tific a te d p u p ils is a v a l u a b l e s t e p t o w a r d s effic ie n c y in th e u n it. A n u m b e r of M e d i c a l S e r g e a n t s a s k if t h e r e is a d i s tin g u is h in g b a d g e o r b ra ssa rd , w h e n th ey a re a c tin g as in stru c to rs o r B att. M ed ical O rd erlies. N o n e w h a tev e r ! I t is th e o ld g r o u s e a b o u t t h e S .B . b r a s s a r d a ll o v e r ag ain . T h e M .O . on ly , w e a r s th e G e n e v a C ro s s, all o th e r ra n k s sh o u ld w e a r th e S .B . b ra s sa rd , in c lu d in g s e rg e a n ts . M y c o r r e s p o n d e n t s c o n t e n d t h a t if t h e y h a v e r e a c h e d t h e s ta n d a r d n e c e s sa ry to ju stify th e ir a p p o in tm e n t a s lay in s tr u c to r s , t h e n it is s o m e w h a t i n s u l t i n g to b e cla ss ifie d a s stretch er b earers. I h eartily concur, b u t th e s a m e a r g u m e n t h o ld s g o o d for a n y H .G . m e d ic a l o rd e rly w h o h a s re a c h e d th e a d v a n c e d s ta n d a r d , w h e th e r N .C .O . o r n o t. T h e ir r e s p o n s i b i l i t i e s , if e v e r c a l l e d o u t , w o u l d b e t r e m e n d o u s — f a r in e x c e s s of th e o ld s tr e tc h e r b e a re rs.

P h o sp h o ru s B u r n s . — E x t e n s i v e N o r t h o v e r p r a c t i c e a l w a y s c a r r i e s t h e r i s k of p h o s p h o r u s b u r n s , a n d s o m e d if f e r e n c e of o p in io n e x ists a s to tr e a tm e n t. T h e co p p er su lp h a te m e th o d — f a v o u r e d b y t h e A m e r i c a n s , I b e l i e v e — is s till c o n s i d e r e d th e b e st in th is a re a . F o r th o se u n its w h o h a v e n ot yet b een i n s t r u c t e d i n t h i s , t h e t r e a t m e n t i s a s f o l l o w s :— ( 1) T h o r o u g h l y s w a b b u r n s w i t h a s a l i n e s o l u t i o n , m a d e b y d is s o lv in g o n e te a s p o o n fu l of s a lt in a p in t of w a te r . ( 2 ) A p p l y c o p p e r s u l p h a t e s o l u t i o n (5 p e r c e n t . ) , a n d a l l o w t o r e m a i n o n b u r n s f o r not more t h a n t w o m i n u t e s . W a s h off w ith s alt so lu tio n a g a in . ( 3) D r e s s a s o r d i n a r y b u r n .

W .

S p read b u ry

HEADQUARTERS AND DISTRICT REPORTS.

N o. I (P rin ceof W ales’s) D istrict N o . 81 ( C r o y d o n ) C a d e t N u r s i n g D i v i s i o n . — T h e f i r s t e n r o l m e n t o f N o . 81 ( C r o y d o n ) N u r s i n g C a d e t s t o o k p l a c e o n S a t u r d a y , S e p t e m b e r 25 t h , i n S . S a v i o u r ’s S c h o o l s , W e s t C roydon. O w i n g to th e in d is p o sitio n of th e L a d y A r e a C a d e t O fficer, M rs. P e te r C h e y n e y , th e c e r e m o n y w a s c o n d u c te d by L a d y D is tr ic t O fficer M iss W a t e r s . About a hundred p a re n ts, te a ch e rs a n d frien d s w e re p resen t. A d i s p l a y of b a n d a g in g , co u n try d a n c in g a n d first a id fo llo w e d th e en ro lm en t. A m o s t s p e c t a c u l a r p a g e a n t , d e p i c t i n g all a s p e c ts of th e C a d e t m o v e m e n t , w ith t h e K n i g h t s of S t. J o h n in t h e b a c k g r o u n d , b r o u g h t to a n e n d a m o s t s u c c e ss fu l a fte rn o o n . M iss W a te r s c o n g r a tu la te d th e C a d e ts o n th e ir s m a r t a p p e a r a n c e , e i g h t e e n o f t h e t w e n t y m e m b e r s b e i n g in u n ifo rm . T h is D iv isio n w a s o n ly re g is te re d in M ay .

C / N 54 a t t a c h e d t o N . 16 ( H a m p s t e a d ) N u r s i n g D i v i s i o n . — O n S e p t e m b e r 23 r d , a m o s t s u c c e s s f u l W h i s t D riv e w a s a r r a n g e d b y th e C a d e t O fficers, a n d w a s h e ld a t F i r s t A id P o s t “ F , ” B e r r i d g e H o u s e , N . W . 6 , b y k i n d p e r m is s io n of M .O .H . D r. O l d e r s h a w a n d M iss S a m u e ls ( C o m m a n d a n t P o s t “ F ” ). A p a rt fro m h elp ers fro m th e p a re n t b o d y a n d C a d e ts , th e re w e re a lso p re s e n t D is tric t O fficer M rs. R a y n e r, w h o m a d e a s h o rt a n d in te re s tin g speech, D iv . S u p t. M iss F in c h a n d o th e r B r ig a d e O fficers, a s w ell a s C a d e t S u p t. M iss B u rley . A ll a v a i l a b l e t a b l e s w e r e filled a n d t h e s u m o f 10 s . c o llected to w a r d s C a d e t fu n d s.

County of Bedford. L o n d o n R o a d ( B e d fo r d ) D iv is io n .— N e w A m b u l a n c e a n d N u rs in g C ad e ts w ere en ro lled a t th e L o n d o n R o a d (B e d fo rd ) D iv isio n of th e S .J .A .B ., in th e S ilv e r J u b ile e S c h o o l o n S e p t e m b e r 20 t h . T h e cerem ony w as opened by th e L a d y C o u n ty C a d e t O fficer J u n io r C o m m a n d e r M rs. H u g h M c C o rq u o d a le , w h o in s p e c te d th e D iv isio n . M r. W m . V e a ts , C a d e t S u p t., in a s h o r t sp e e c h , s ta t e d t h a t h e s t a r t e d t h e D i v i s i o n i n N o v e m b e r , 1942 , w i t h s e v e n m em bers. N o w , w i t h a p p r o x i m a t e l y 150 m e m b e r s , i t w a s p r o b a b l y o n e o f t h e l a r g e s t D i v is i o n s in t h e C o u n ty . H a n d ic r a f ts m a d e by th e C ad e ts a n d ju v en iles w e re on view , a n d th e s e w e r e p u t in to c o m p e titio n s l a te r o n in th e ev en in g . A fte r a d e m o n s tra tio n of ro ller b a n d a g i n g b y th e C a d e ts a n d N . C . O . ’s , P r e l i m i n a r y a n d H o m e N u r s i n g C e r t i f i c a t e s w e re p re s en te d b y M rs. M cC o rq u o d a le , w h o a fte rw a rd s a d d re sse d th e ch ild ren . S h e p raised th e ir w o rk a n d re m in d e d th e m th a t th e y b e lo n g e d to a w o n d e rfu l fello w sh ip . T h e n e w C a d e ts th e n m a r c h e d o n to th e p la tfo r m for en ro lm e n t, a n d after receiv in g th e ir e n ro lm e n t b o o k s a n d certificates fro m M rs. M c C o rq u o d a le , re p e a te d a fte r h e r th e ir C o d e of C h iv a lry . A fter th is c e re m o n y a s h o r t p ra y e r w a s sa id a n d th e s tir r i n g m a r c h “ K n i g h t s of S t. J o h n , ” w a s sung. A m o n g th o se p re sen t w e re th e M ay o r a n d M ay o ress (A id . a n d M rs . F . A. R ic k a r d ) .

County of Gloucester.

A p a il of w a t e r s h o u ld , of c o u rs e , a lw a y s b e o n th e sp o t, i n t o w h i c h t h e b u r n t p a r t s c a n b e p l u n g e d i m m e d i a t e l y , if necessary. C.

S t . J o h n A m b u l a n c e B r ig a d e

(S erg t.),

S c h o o l H o u s e , N o e l - r o a d , W . 3.

G l o u c e s t e r R o t o l D iv is io n .— T h e a n n u a l i n s p e c t i o n of th e A m b u la n c e a n d N u r s in g D iv isio n s w a s h eld on S u n d a y , O c t o b e r 3 r d , a t 11 a . m . T h e I n s p e c t i o n O ffic e r w a s C o l. S le e m a n , C .B ., C .B .E ., M .V .O . (C h ief C o m m issio n e r B rig a d e O verseas), a c c o m p a n ie d by D r. B a rre tt C ard ew ,

F I R S T

M .C ., F . R . S . C . E . (C o u n ty C o m m is sio n e r), M iss D . F a b e r (L a d y C o u n ty S u p t.), M r. E. O . C a m e r o n (G e n . S ecty . a n d V ic e P r e s id e n t) , M r. W ilk in s o n (S e c u rity O fficer) a n d D r. H . G . D o w le r (D iv . S u rg e o n ). A le tte r of a p o lo g y w a s re c eiv ed fro m M r. R . S ta m m e r s (G en. M a n a g e r a n d P resid en t). S u p t. D e n t c o m m a n d e d th e p a r a d e , L a d y D iv . S u p t. W a k e l a n d b e in g in c h a r g e of th e N u r s i n g D iv isio n , th e re b e i n g a l t o g e t h e r 67 m e m b e r s p r e s e n t . A f te r a n e x te n s iv e in s p e c tio n , C o l. S l e e m a n , a d d r e s s i n g th e D iv is io n s, s a id h o w p r o u d h e w a s o n th e o c c a s io n of his s e c o n d v is it t o R o t o l t o find s u c h a h i g h s t a n d a r d of w o r k a n d discip lin e, b u t a lso th e sp irit w h ic h a n im a te d th e h isto ric and an cien t O rder. A s C h ief C o m m is s io n e r, B rig a d e O v e r se a s, h e h a d tra v e lle d t h r o u g h th e D o m in io n s a n d B ritish C o m m o n w e a l t h of N a tio n s , b u t h e c o u ld ju s tifia b ly s a y th a t h e h a d n e v e r s e e n s u c h a h i g h s t a n d a r d of e ffic ie n c y . C o n t i n u i n g C o l. S l e e m a n s a i d h e w o u ld lik e to c o m m e n d t h e D i v i s i o n a l S u r g e o n , D i v . S u p t . , O f f i c e r s a n d N . C . O . ’s fo r th e v e ry h i g h s t a n d a r d of t r a i n i n g a s re fle c te d a t th e in sp ectio n . D r. B a rre tt C a rd e w also a d d re sse d th e co m p an y . M r. E . O . C a m e r o n s a id t h a t it w a s h is first a p p e a r a n c e a t a D iv is io n a l fu n c tio n , s in c e h e h a d b een h o n o u r e d a s V iceP resid en t. I t to o k h im b a c k m a n y y e a r s to h is b o y h o o d d a y s w h e n h e le a r n e d th e r u d im e n ts of first a id w ith th e B oy S c o u ts. D r. H . G . D o w le r, o n b e h a lf of th e D iv isio n , th a n k e d C o l. S l e e m a n a n d t h e O ffic e rs p r e s e n t fo r t h e h o n o u r b e s to w e d u p o n th e m by th e ir p resence.

County of Leicester. C i t y o f L e i c e s t e r . — T h e first a n n u a l in s p e c tio n of th e C ity o f L e i c e s t e r E l e c t r i c i t y D i v i s i o n of t h e S . J . A . B . w a s h e ld a t th e C en tra l G e n e ra tin g S ta tio n by C o m m issio n e r G. F. B ro w n e , a s s is te d b y C o rp s S u p t. J. J. D e x te r , a n d C o rp s S g t. M a jo r P eel. A f te r w a r d s , th e C o m m is s io n e r u n v e ile d a ro ll of h o n o u r of m e m b e r s of th e D iv isio n s e r v in g in th e F o r c e s . Com m issio n er B ro w n e c o m p lim e n te d m e m b e rs on th eir s m a r t tu rn -o u t.

A I D T h e L a d y B la n c h e C o b b o ld , C o u n ty P re s id e n t, v isited t h e g ir l s fo r te a , a n d a f t e r w a r d s w a tc h e d th e m b e in g d rilled , by a n A rm y D rill S e rg e a n t. O t h e r v isito rs w h o h e lp e d w ith in s tru c tio n a n d re c re a tio n w e re C o u n ty O fficer M iss B a ld w in , R ev . T a tte rs a ll, M iss N. M iller a n d M iss W ilb y . C o u n ty S u p t. M iss P a r k e r a n d C o u n ty C a d e t O fficer M iss B o tw o o d w e r e in c h a r g e , w h ile p o s ts of Q .M ., M . O . , e tc ., w e r e filled b y D i v i s i o n a l officers. T h e h e lp of th e school d o m e stic staff w a s m u c h ap p reciated .

West Riding of Yorkshire. A i r d a l e C o l l i e r i e s . — T h e fifth i n t e r - c o l l i e r i e s a m b u la n c e c o m p e titio n in c o n n e c tio n w ith th e A ird a le C ollieries, L td ., to o k p la c e a t th e W e lfa re H a ll, A llerto n B y w a te r, n e a r C a s t l e f o r d , o n S a t u r d a y , S e p t . 25 t h . T h e w i n n e r s w e r e : 1, A l l e r t o n B y w a t e r 136 i p o i n t s ; 2 , F r y s t o n 114 £ ; 3 , W h e l d a l e 109 L H . B a rk e r, A lle rto n B y w a te r, w o n th e in d iv id u al c o m p e t i t i o n w i t h 2 H p o i n t s o u t o f a p o s s i b l e 30 .

P o n t e f r a c t a n d D i s t r i c t C o r p s .— T h i s C o rp s r e c e n tly a r r a n g e d a f l a g d a y i n i t s a r e a a n d c o l l e c t e d ,£ 105 14 s . f o r t h e A id to R u s s i a F u n d . A T e a a n d C o n fe re n c e of O fficers, S e c re ta r ie s a n d T r e a s u r e r s o f t h e C o r p s w a s h e l d o n O c t o b e r 2n d . C orps S u p t. T . C. A m e ry p re sid ed . T h e C h a ir m a n s a id th a t a s n o in sp ec tio n s h a d b e en h eld d u r i n g th e w a r, th e a r e a s ta ff s e e m e d to b e lo s in g to u c h w ith th e C o rp s , a n d D r. B ev e rley h a d w is h e d to m e e t th e O fficers t o d i s c u s s t h e p r e s e n t a n d f u t u r e a c t i v i t i e s of t h e B r i g a d e . T h e f o llo w in g p re s e n ta tio n s w e r e m a d e — 6 b a r s to serr v i c e m e d a l s a n d 1 2 m e d a l s f o r 15 y e a r s s e r v i c e . D r. B ev e rley d r e w a tte n tio n to th e im p o r ta n c e of th e C a d e t m o v e m e n t, a n d o b s e rv e d t h a t c o u rs e s of in s tr u c tio n w e r e b e i n g h e l d fo r all C a d e t O f f i c e r s a n d t h o s e i n t e n d i n g to ta k e up th e w o rk . M an y m a tte rs w e re raised by m e m b e rs a n d d e a l t w i t h b y t h e a r e a staff.

P o in ts on B o n e s f o r B e g in n e rs .

County of Suffolk. I p s w i c h .— O n a re c e n t S u n d a y , t h e m e m b e r s of Ip s w ic h

D iv isio n m e t fo r th e a n n u a l in sp e c tio n w h ic h to o k p lace a t C h r i s t c h u r c h P a r k , w h e r e th e E a r l of C r a n b r o o k , C o m m is s io n e r fo r S u ffo lk , s u p p o r te d by th e C o u n ty O fficers to o k th e g e n e ra l sa lu te a n d in sp ected th e p arad e. A t th e clo se of th e in s p e c tio n , th e C o m m is s io n e r e x p re ss e d h is th a n k s fo r s u c h a g o o d m u s te r a n d h o p e d th a t th e C a d e ts w o u l d jo in a n a d u l t D iv is io n w h e n t h e t i m e c a m e fo r t h e m to tr a n s f e r , a n d p ro v e th e m s e lv e s w o r th y m e m b e r s of S .J .A .B . T h e t o t a l n u m b e r o n p a r a d e w a s 236 . T o clo se th e s u m m e r p r o g r a m m e of C h u r c h P a r a d e s th e in s p e c tio n w a s fo llo w e d by a D r u m h e a d S erv ice, w h ic h w a s c o n d u c t e d b y t h e R ev . H a r o l d G re e n , V ic a r of S t. N ic h o la s C hurch. T h e P a r a d e m a rc h e d b a c k to th e A m b u la n c e H e a d q u a rte rs a n d w e re d ism issed by th e C o rp s S u p e rin te n d e n t F. E. G o ddard.

O n S e p t e m b e r 18 t h , f o r t y - t h r e e N u r s i n g C a d e t s , r e p r e s e n tin g tw e lv e S u ffo lk D iv isio n s, m e t a t K e s g r a v e A re a S ch o o l, n e a r Ip sw ic h , for a tr a in in g w e e k -e n d . I t is h o p e d t h a t a s a r e s u lt t h e r e w ill b e a n in c r e a s e in th e n u m b e r s o f N . C . O . ’s . A n in te re s tin g tim e w a s sp en t a n d m a n y n e w frien d sh ip s w ere g a in e d . E m p h a s is w a s laid o n th e n e c e ssity f o r t h e S p i r i t u a l a s w e ll a s t h e p r a c t i c a l s i d e o f life b e i n g a n e s s e n t i a l p a r t o f a g o o d f o u n d a t i o n f o r life a h e a d .

T h e r e a r e a b o u t 200 b o n e s i n t h e h u m a n s k e l e t o n . B ones c o n sis t of a n i m a l a n d e a r th y m a tte r . I n c h i l d r e n ’s b o n e s a n i m a l m a t t e r p r e d o m i n a t e s , w i t h t h e r e s u l t t h a t t h e y m e r e l y c r a c k o r b e n d w h e n v i o l e n c e is a p p lied , s u c h fr a c tu re s b e in g called “ g r e e n s ti c k .” In e ld e r ly p e r s o n s t h e p r o p o r t i o n of e a r t h y m a t t e r is g r e a t e r , w h ic h c a u s e s th e m to s n a p m o re easily , b u t r e ta r d s p r o g r e s s of a c tio n . T h e s k e l e t o n is a f r a m e w o r k of b o n e s . O n it th e b o d y is b u i l t a n d c o n s i s t s o f m u s c l e s , a r t e r i e s , v e i n s , n e r v e s , e t c . , w h i l e e n c l o s i n g a ll is t h e s k i n . T h e sk e le to n d e te rm in e s th e size a n d s h a p e of th e b ody. In ta ll p e o p le th e b o n e s in th e lim b s a r e l a r g e r t h a n in t h o s e of s m a l l e r s t a t u r e . T o th e b o n e s a r e a tt a c h e d th e m u s c le s w h ic h “ p u ll ” in v a rio u s d ire c tio n s. I n w a l k i n g , f o r e x a m p l e , t h e l e g is s te p p e d fo r w a r d ch ielly by m u s c le s s tr e tc h in g fro m p e lv is to fr o n t of t h i g h , w h ile t h e k n e e is b e n t b y t h e m u s c l e s w h ic h a r e a t t a c h e d to th e b a c k of th i g h a n d e n a b le th e to e s to c le a r th e g ro u n d . T h e b o d y is r a i s e d o n t h e to e s, b e h in d , a n d c a r r ie d f o r w a r d m a in ly b y th e m u s c le s in th e calf. O f t h e e i g h t b o n e s i n t h e c r a n i u m , a n d t h e 14 b o n e s i n t h e f a c e , o n l y o n e is m o v e a b l e , n a m e l y t h e l o w e r j a w . T h is j o i n t is m a i n l y a h i n g e j o i n t , b u t a l l o w s a g o o d d e a l o f s i d e to -s id e m o v e m e n t, w i t h s o m e b a c k w a r d a n d f o r w a r d a s w ell a s its c h a r a c te ris tic u p -a n d -d o w n m o v e m e n t. T h e bones o f' t h e c r a n i u m a r e s o c lo s e ly i n t e r l o c k e d t h a t they' a r e a s o n e J bone. T h e j o i n t s a r e s a w - l i k e o r lja v e t h e a p p e a r a n c e of b e in g stitc h ed , th e ir u n io n s b e in g called “ s u tu r e s .”

F I R S T B ones a re called “ lo n g ,” “ fla t,” “ ir r e g u la r ,” a c c o rd i n g to th e ir size a n d s h a p e . L o n g b o n e s a r e lo n g n a r r o w a n d h o llo w . T hey are fo u n d in th e a r m a n d f o r e a r m a n d in th e th ig h a n d leg , a n d a s s m a l l l o n g b o n e s in t h e f in g e r s a n d to es. T h e s h o r t b o n e s a r e th o s e of th e w ris t (c a rp a l b o n e s) a n d th e a n k le (ta rs a l bones). T h e flat b o n e s a r e c la v ic le ( s h o u l d e r b la d e ) a n d th e s te r n u m (b r e a s t bone). T h e irr e g u la r bo n es a r e th e v e rte b ra e (b o n es of th e sp in e). B o n e s , l ik e o t h e r p a r t s of t h e b o d y re c e i v e n o u r i s h m e n t fro m th e b lo o d t h r o u g h th e s m a l l b lo o d v e ss e ls in th e p e rio ste u m , th is b e in g th e s h e a th w h ic h co v ers th e bone. B o n es a lso p ro v id e p ro te c tio n for im p o r ta n t o r g a n s su c h as th e b ra in , th e s p in al cord a n d th e o r g a n s w ith in c h est a n d abdom en. T h e b o n e s o f t h e s p i n e a r e 7 c e r v i c a l , 12 d o r s a l , 5 l u m b a r , w h i l e t h o s e o f t h e p e l v i s a r e 4 i n n u m b e r (2 o s s a in n o m in a ta , 1 s a c r u m , a n d 1 coccyx). T h e cerv ical (fro m cerv ix th e n e c k ) v e rte b ra e a re u p p e r m o s t ; th e d o rs a l a t th e b a c k a n d th e l u m b a r in th e lo in s ; w h ile th e o s s a i n n o m in a ta (o r h a u n c h b o n e s), th e s a c r u m (or r u m p b o n e ) a n d th e co ccy x (o r tail piece) fo rm th e b o n e y b a s i n t h r o u g h w h i c h w e i g h t is t r a n s m i t t e d to t h e l o w e r lim b s. T h e v e rte b ra e h a v e e a c h a p ro jectio n , o r “ p r o c e s s ” w h ic h s t a n d s o u t a n d w h i c h c a n e a s ily b e felt u n d e r t h e s k i n r u n n i n g d o w n th e w h o le l e n g th of th e s p in a l c o lu m n . T h e v e r te b ra e a r e piled u p o n e o n to p of th e o th e r. B e t w e e n e a c h is a p a d - l i k e p ie c e of g r i s t l e , w h i c h s e r v e s t h e p u rp o s e of a b u ffer a n d h e lp s to b r e a k th e fo rce of a b lo w s u c h a s w o u ld b e re c e iv e d a s th e r e s u lt of a fall f r o m a h e i g h t o n to t h e feet. If th e s p in e w e re a so lid b o n e th e fo rce w o u ld be c a rrie d u p to th e s k u ll w ith o u t in te rru p tio n a n d c au se fra c tu re th ere. T h r o u g h t h e v e r te b r a e , t h e r e r u n s a n o p e n i n g in w h ic h is p r o t e c t e d t h e m a r r o w o r s p i n a l c o r d . T h e first, o r u p p e r m o s t v e r t e b r a is c a l l e d t h e a t l a s . T h e h e a d r e s t s o n it a n d f o r m s a j o i n t , t h r o u g h w h i c h t h e n o d d in g m o v e m e n ts of th e h e a d t a k e s place. T h e s e c o n d v e r t e b r a is t h e a x is . T h is h a s a to o th -lik e p ro je c tio n o n its u p p e r s u r f a c e a n d a c t s a s a p iv o t b y w h ic h th e s id e - to -s id e m o v e m e n t s o f t h e h e a d a r e effected . T h e 12 p a i r s o f r i b s j o i n t h e 12 d o r s a l v e r t e b r a e b e h i n d . T h e u p p e r 7 rib s jo in in f r o n t th e s t e r n u m ( b r e a s t b o n e ) ; th e n e x t 3 in fr o n t a r e jo in e d b y c a r tila g e (g ristle ) e a c h to th e o n e a b o v e ; a n d th e r e m a i n i n g 2 of th e 12 a r e s h o r t a n d u n a tta c h e d in fro n t, for w h ic h re a s o n th e y a r e c a lle d “ free ” o r “ flo a tin g .” T h e c la v ic le (c o lla r b o n e ) jo in s th e s t e r n u m a t its in n e r e n d , a n d th e s c a p u l a ( s h o u ld e r b la d e ) a t its o u t e r .e n d . It d oes n o t fo rm a jo in t w ith th e h u m e r u s ( a r m bone). T h e s c a p u la jo in s w ith b o th clav icle a n d h u m e r u s . T h e h u m e r u s h a s , o n its u p p e r e n d , a r o u n d s m o o th h e a d w h i c h fits i n t o a c u p - l i k e h o l l o w in t h e s c a p u l a . T h is c a v i ty is s h a l l o w a n d t h e jo in t v e r y free , its s t r e n g t h b e i n g d e p e n d e n t o n t h e s t r o n g m u s c l e s w h ic h p r o te c t it a t t h e fro n t, th e b a c k a n d th e o u tsid e. W h e n t h e a r m is r a i s e d to t h e h o r i z o n t a l , t h e h u m e r u s is b r o u g h t u p t o t h e p a r t of t h e s c a p u l a p r o j e c t i n g o v e r t h e s h o u ld e r jo in t. W h e n i t i s r a i s e d s t i l l h i g h e r t h e s c a p u l a is c a r r i e d w i t h it. I n th e f o r e a r m th e r a d iu s lies o n t h e t h u m b sid e, a n d t h e u l n a lies o n t h e little f in g e r sid e . T h e r a d i u s h a s , o n its u p p e r en d , a s m o o th disc-lik e e d g e w h ic h to u c h e s a sm o o th c o n cav e su rfa c e o n th e u ln a. T h e r a d i u s a t i t s l o w e r e n d is b ro a d , a n d a lo n e fo rm s a jo in t w ith th e c a r p a l (w rist b ones). I n i t s l o w e r e n d t h e r e i s a s h a l l o w h o l l o w i n t o w h i c h fits t h e lo w er en d of th e uln a. W h e n t h e p a l m of t h e h a n d is u p w a r d s ( s u p i n a t i o n ) t h e tw o b o n e s of fo r e a rm a r e p a ra lle l. W h e n t h e h a n d is t u r n e d so t h a t t h e b a c k p a r t is u p p e r m o s t ( p r o n a t i o n ) t h e r a d i u s

4 i r o t a t e s l e n g t h w i s e , its l o w e r e n d m o v i n g a c r o s s to t h e o th e r s id e of th e lo w e r e n d of th e u ln a . In p ro n a tio n , th e u p p e r e n d of th e r a d iu s d o e s n o t m o v e its p o sitio n . I t m e re ly tu r n s o n its a x is w h ile its lo w e r e n d (a s th e b o n e ro ta te s ) tra v e ls r o u n d th e lo w e r e n d of th e u ln a , w h ic h r e m a i n s fixed a t its pivot. T h e u l n a d o e s n o t f o r m j o i n t w i t h t h e c a r p a l b o n e s ; it re s ts o n t h e r a d i u s a t its lo w e r e n d . T h e e ig h t sm all carpal (w r i s t) b o n e s , in t w o r o w s of f o u r e a c h , jo in in t h e first r o w , t h e e n d o f t h e r a d i u s , a n d i n t h e s e c o n d r o w , t h e five m e t a c a rp al (m eta, beyond) bones. M o v e m e n t a t th e w ris t ta k e s p lace b e tw e e n th e ra d iu s a n d first ro w , b e tw e e n th e tw o r o w s th e m s e lv e s , a n d b e tw e e n th e second ro w a n d m e ta c a rp a l bones, g iv in g g re a t freedom . T h e jo in t a t th e w ris t a c ts a s a d o u b le h in g e join t. T h e five m e t a c a r p a l b o n e s f o r m t h e p a l m , w h i c h of co u rse in c lu d e s th a t of th e th u m b . T h e p h a la n g e s (fin g e r b o n e s) a r e fo u r te e n in n u m b e r , th r e e to e a c h fin g e r a n d tw o to th e t h u m b ; a n d th e y s it o n e o n to p of e ac h o th e r. T h e fin g er jo in ts a re h in g e jo in ts. T h e p e lv is (p e lv is , a b a s i n ) is s h a p e d l ik e a b a s i n . I t is f o r m e d a t t h e s i d e s b y t h e t w o h a u n c h b o n e s , i n t o w h i c h is w e d g e d a t th e b a c k th e s a c ru m , lik e th e k e y sto n e of a n a rc h ; w h i l e in t h e f r o n t t h e h a u n c h b o n e s m e e t in w h a t is c a l l e d th e s y m p h y s is p u b is. T h e h a u n ch bones a rc h in g ro u n d and o u t w a r d s g iv e th e b a s in - lik e s h a p e to th e p elvic c av ity . T h e p e lv ic c a v i t y c o n t a i n s t h e b l a d d e r a n d a p o r t i o n of t h e i n t e s t i n e s ; a n d it is v e r y s t r o n g l y g u a r d e d b y t h e l a r g e b o n e s w h i c h f o r m it a n d w h i c h d i r e c t t h e w e i g h t of t h e b o d y u p o n th e lo w e r lim b s. O n t h e o u t e r s id e of e a c h h a u n c h b o n e t h e r e is a d e e p cu p -lik e so ck e t (a c e ta b u lu m , a cu p , e tc .,) w h ic h fo rm s a b a ll-a n d -s o c k e t jo in t w ith th e fe m u r (th ig h bone). The r a n g e o f m o v e m e n t is n o t s o e x t e n s i v e a s t h e s i m i l a r j o i n t a t th e s h o u ld e r ; a n d m o re o v e r th e h ip -b o n e c a n n o t m o v e a s th e scap u la can. T h e f e m u r is t h e l o n g e s t a n d s t r o n g e s t b o n e i n t h e b o d y ; a n d it r u n s fr o m h ip to k n e e - jo in t. I t s u p p e r e n d is r o u n d e d i n t o a s m o o t h b a ll l ik e h e a d w h i c h is j o i n e d t o its s h a f t b y a n a rro w p o rtio n k n o w n a s “ th e n e c k .” T h e p a t e l l a ( k n e e - p a n ) i s a s m a l l b o n e w h i c h is s o m e w h a t t r i a n g u l a r s h a p e a n d lies in fr o n t of t h e k n e e - jo in t, its b r o a d e n d b e i n g u p p e r m o s t . T h e u p p e r e d g e of th e p a t e l l a is a t t a c h e d to t h e t e n d o n w h i c h s t r a i g h t e n s t h e le g , a n d t h e l o w e r t o t h e l i g a m e n t s w h i c h b i n d it t o t h e t i b i a ( o r s h in bone). T h e i n n e r s u r f a c e o f t h e p a t e l l a is v e r y s m o o t h a n d c o v e re d by sy n o v ia l m e m b r a n e lik e t h e r e s t of th e jo in t. I n fr o n t it p la y s o n a l a r g e s u r f a c e of t h e e n d o f t h e f e m u r , w h e n th e k n e e is b e n t a n d s t r a i g h t e n e d . T h e tw o b o n e s of th e le g a r e th e tib ia in f r o n t a n d th e fib u la (fib u la , a c la s p , b u c k le o r b r o o c h ) o n th e o u t e r sid e. T h e tib i a lies v e ry n e a r t h e s u r f a c e ju s t b e lo w t h e s k i n a n d its s h a r p r i d g e c a n b e e a s ily felt r u n n i n g d o w n th e f r o n t of t h e l e g . T h e fib u la lies a little b e lo w th e k n e e a t its u p p e r e n d a n d h a s n o s h a r e in t h e f o r m a t i o n o f t h e k n e e - jo in t. Its lo w er en d h o w ev er, fo rm s o u te r a n k le. T h e ta r s a l (a n k le ) b o n e s a r e se v e n in n u m b e r , a r e s m a ll a n d irre g u la r, a n d h eld to g e th e r by lig a m e n ts . T h e la rg e st is t h e b o n e of t h e h e el. T h e m e ta ta r sa l (m eta, b ey o n d ) b o n es fo rm th e foot. B eh in d th ey jo in fo u r ta rs a l b o n es a n d first to e b o n e s . T h e p h a l a n g e s of fo o t (to e f o u r t e e n in n u m b e r a n d a r e t h e s a m e a s t h o s e in

t h e s o l e of in f r o n t th e bones) are th e h a n d .

R ed C r o s s a t H u d d e r s fie ld .— M rs. A. O x ley , 11, G r e e n w o o d S tr e e t, P r im r o s e H ill, H u d d e r s f ie ld , n o tifies u s t h a t w i t h p e r m i s s i o n , s h e is a t t e m p t i n g t o f o r m a D e t a c h m e n t of th e R ed C ro ss S o ciety a t H u d d e rsfie ld . S h e w o u ld lik e m e n w h o h o ld F i r s t A id C e r tif ic a te s , a n d in p a r t i c u l a r , m e m b e r s of th e F i r s t A id a n d R e s c u e S e rv ic e s of C iv il D efen ce, to c o m m u n ic a te w ith h e r a t th e a b o v e a d d re ss , g i v i n g p a r tic u la r s of a w a r d s held.

F I R S T

Letters to the Editor. W e a r e in n o w a y re s p o n sib le for th e o p in io n s e x p re ss e d , o r th e s ta t e m e n ts m a d e , b y C o rre s p o n d e n ts .— E d ito r .

S i r , — I n S e p t e m b e r i s s u e of F i r s t A id y o u w e r e n o tif ie d to p u b lish T h o rn to n -C le v ele y s A m b u la n c e D iv isio n h a d p u r c h a se d th e ir lan d . I w o u ld lik e y o u to c o n tr a d ic t th is, a n d s t a t e t h a t w h e n s a m e is b o u g h t it w ill b e a j o i n t a f f a i r of b o t h A m b u la n c e a n d N u r s in g D iv isio n s. A t p re se n t, w e d o n o t o w n b u i l d i n g la n d n o r h a v e w e a B u i l d i n g F u n d in o p e r a tio n y et. I w o u l d b e m o s t g r a t e f u l if y o u w ill i n s e r t t h i s i n y o u r n e x t is s u e .— Y o u rs truly, W.

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M c K in le y (S u p t.).

DEAL.

D e a r S ir , — I w a s g re a tly in te re s te d a n d a lso s y m p a th e tic w ith th e v ie w s of y o u r c o r r e s p o n d e n t u n d e r th e a b o v e h e a d i n g in th e A u g u s t n u m b e r o f F i r s t A id . A few fac ts s h o u ld , I th in k , b e m a d e k n o w n to th e p u b lic , of th e v a lu a b le w o r k d o n e b y m e m b e r s of th e O r d e r a t th e o u tb r e a k of w a r, w o r k t h a t n o o th e r e x is tin g o r g a n is a tio n c o u ld h a v e u n d e rta k e n . O n A u g u s t 25 t h , 1939 , a l l m e m b e r s o f a c e r t a i n S o u t h L o n d o n D iv isio n receiv ed a te le g r a m to re p o rt a t th e T o w n H a ll th a t evening. O n ly a v e ry fe w m e m b e r s w e r e a b le to a tte n d , b u t a f u r th e r m e e tin g w a s a r r a n g e d for th e fo llo w in g evening. T h i s m e e t i n g w a s w ell a tte n d e d . T h e C ouncil p u t th e ir d ifficu lty b e fo re th e s e m e m b e r s . In sh o rt, th ey h a d b e e n o rd e re d to s ta ff a n d r u n sev e n S tr e tc h e r P a r ty D e p o ts. T h e y h a d n o tr a in e d m e n of th e ir o w n a n d a p p e a le d to th e D iv isio n to h e lp th e m . A t t h a t m e e t i n g 18 m e m b e r s v o l u n te e r e d to g iv e t h e i r fu ll tim e , m a n y of th e m g i v i n g u p g o o d s itu a tio n s to d o so. T h e s e 18 m e n , w i t h t h e h e l p o f a f e w p a r t - t i m e r s , f o r m e d th e ex ecu tiv e of th e sev en d e p o ts a n d s ta rte d th e ir d u ties a t once. I n less th a n a m o n th th e y h a d o v e r a th o u s a n d m e n to su p e rv ise , tra in a n d o r g a n is e in to a serv ice w h ic h w o u ld p ro v e th e m s e lv e s of h e lp in th e e v e n t of a ir ra id s. T hese r e c r u its h a r d l y k n e w w h a t th e w o r d s “ first a i d ” m e a n t — th e re w e re tin k e rs, tailo rs a n d c a n d le stic k m a k e rs , acto rs, a rtis ts a n d all s o rts a n d c o n d itio n s of m e n . A t tim es th e p o s itio n of S u p e r i n t e n d e n t of th e s e D e p o ts s e e m e d w ell n ig h i m p o s s i b l e — t h e a g e s o f t h e 18 S . J . A . B . m e n w e r e o n a n a v e r a g e o n l y a b o u t 21 o r 22 . A ll d u e h o n o u r s h o u l d b e a c c o rd e d to th e se m e n . B u t n o w I c o m e to th e “ r a w d e a l ” p a r t of th e sto ry . I t s e e m e d t h a t a s so o n a s th e C o u n cil c o u ld g e t m e n qualified in first a id , th e S .J .A .B . m e n w e r e d is p e n s e d w ith . Of c o u rs e , s e v e ra l w e r e c a lle d to t h e S e rv ic e s b u t n o t a ll. To d a y , t h e r e i s n o t o n e o f t h e s e m e n i n t h e C o u n c i l ’s e m p l o y . S o fa r a s I k n o w , n e ith e r th e O r d e r o r th e D iv isio n h a s even b e e n t h a n k e d b y th e C o u n c il fo r r e n d e r i n g to th e m a serv ice t h a t t o o k m e n y e a r s of p r e - w a r p r a c t i c e a n d s t u d y in t h e i r o w n t i m e , t o fit t h e m f o r t h e w a r e m e r g e n c y t h a t a r o s e in A u g u s t , 1939 . H o w e v e r , le t m e r e m in d “ 1910” t h a t m e m b e r s of th e O r d e r d o n o t a s k fo r re c o g n itio n for th e ir serv ices, th e ir a im is to t r a i n t h e m s e l v e s to b e o f u s e to t h e i r f e l lo w m e n in tim e s of n e ed ; b u t I d o a g r e e t h a t a little e n c o u r a g e m e n t w o u ld b e of g r e a t v a lu e .— Y o u r s faith fu lly ,

“ Div.

H on. S ec. ”

K i l l e d o n A c t i v e S e r v i c e .— P te . H . G i b s o n , 2n d W e s t Y o r k s . R e g t ., a n d fo rm e r ly of H u n s l e t a n d H o lb e c k D iv isio n , L e e d s C o r p s , S . J . A . B . , r e p o r t e d m i s s i n g in L i b y a in J u n e , 1942 , n o w p r e s u m e d k i l l e d w h i l e s t r e t c h e r - b e a r i n g .

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D r. R y m e r C a d e t S h ie ld C o m p e tit io n . T eam T e s t — F in a l .

A s y o u a r e g o i n g to y o u r first a id c la s s , y o u fin d th is b o y ly i n g o u t s id e a c h e m i s t s s h o p ; h is left l e g a p p e a r s to b e b ro k e n , a n d h is r ig h t h a n d re sts in a pool of co rro siv e acid ( s p irits of s a lts ) w h ic h h a s r u n fr o m th e b r o k e n b o ttle n e a r h im . A ct a s y o u w ould. Y o u h a v e y o u r e q u ip m e n t w ith you. T i m e 20 m i n u t e s . Q u ic k a p p ro a c h to p a tie n t ... ... ... W a r n h i m t o lie s till ... ... ... S t a t e t h a t y o u a r e first a id e rs a n d s p e a k e n c o u r a g i n g ly N o te pool of a c id a n d d a n g e r of b r o k e n g la s s ... D e c id e to m o v e th e p a tie n t fr o m th e d a n g e r ... O b t a i n w a t e r a n d flo o d t h e h a n d i m m e d i a t e l y ( w a r m w a te r av ailab le ) ... ... ... G e n tly d r a w fo o t of in ju r e d lim b to th e o th e r a n d s e c u re to g e th e r w ith fig u re 8 b a n d a g e ro u n d a n k le s a n d feet ... ... ... ... B ro a d b a n d a g e ro u n d b o th k n e es ... ... C a r e f u l l y lift p a t i e n t f r o m d a n g e r a n d l a y o n b l a n k e t C a re b e in g ta k e n to av o id acid a n d b ro k e n g la s s ... R e m o v e p a t i e n t ’s c o a t i n c a s e t h e s l e e v e h a s s o a k e d a n y acid ... ... ... ... C o v e r p a tie n t a s m u c h a s p o ssib le ... ... B a th e h a n d w ith a lk a lin e lo tio n p re p a re d by d isso lv in g a d e s e rts p o o n fu l of b i- c a r b o n a te of s o d a o r w a s h i n g s o d a in a p in t of w a r m w a t e r ... ... C o v e r th e b a c k of h a n d w ith s tr ip s of lin t, lin e n o r gauze ... ... ... ... S o a k e d in a w a r m f r e s h s o lu tio n of b i- c a r b o n a te of s o d a C over th e d re s s in g w ith c o tto n w ool ... ... A p p ly b a n d a g e fo r th e h a n d (c o rrec tly ) ... ... P la c e a r m in a la r g e a r m s lin g ... ...

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4. — T h e T e x t b o o k t o w h i c h r e f e r e n c e m a y b e m a d e in th is c o l u m n i s t h e 39 t h ( 1937 ) E d i t i o n o f t h e S . J . A . A . M a n u a l of F i r s t A id to th e In ju r e d .

Thanks to the Doctor.

S o u t h e r n R a ilw a y . V i c t o r i a A m b u la n c e C l a s s .— A v e ry c o n g e n i a l g a t h e r i n g of m e m b e r s of t h e a b o v e c l a s s t o o k p l a c e in t h e A m b u la n c e R o o m a t V ic to ria S ta tio n re c en tly , w h e n th e a w a r d s g a in e d by th e c lass m e m b e rs d u r in g th e p re v io u s sessio n w e re p re se n te d by M r. J. B rid g e r. M r. E . U zzell, C e n t r e S e c r e ta r y a n d W e lf a r e O fficer p re s id e d , a n d s u p p o r tin g h im w e r e M r. W . W o o d , S u p t. P o lic e D e p t., V ic to ria , a n d M r. A d a m s , E n g i n e e r ’s D e p t , a n d M i s s W . G r i n d l e y , A s s i s t a n t C en tre S ecretary . T h e C h a i r m a n a n n o u n c e d th a t a s M r. B rid g e r w o u ld s h o r tly b e l e a v i n g V ic to ria , to t a k e u p d u tie s a s A s s is ta n t C e n tra l D iv isio n al S u p t. a t R ed h ill, he to o k th e e arliest o p p o r tu n i ty of c o n g r a t u l a t i n g M r. B r i d g e r a n d w is h in g h im e v e r y s u c c e s s in h is n e w s p h e r e of a ctiv itie s. T h is w as h e a r t i l y e n d o r s e d b y all p r e s e n t a n d M r. B r i d g e r re p lie d su itab ly . T o each of th e re c ip ie n ts, M r. B r id g e r a lso g a v e e n c o u r a g in g w o rd s, a n d a m o n g th e m a n y a w a rd s p resen ted w a s a G o l d M e d a l f o r p a s s i n g 21 e x a m i n a t i o n s g a i n e d b y D e te c tiv e W o o d w a r d of th e P o lice D e p a r t m e n t a t V ic to ria . M r. W o o d a d d e d w o r d s of a p p r o b a tio n o n b e h a lf of th e C h ief of P o lice.

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J .W . (B a rro w -in -F u rn e ss).— R e a d in g th e lectu re by S ir H e n r y L . M a r ty n in th e J u ly issu e of F i r s t A id , I b e c a m e e sp e c ia lly in te r e s te d in th e p a r a g r a p h c o n c e r n i n g th e c le a n s in g of w o u n d s, in w h ic h h e s ta te s th a t “ . . . t h e r e is n o k n o w n a n t i s e p t i c y e t i n v e n t e d , w h i c h is c a p a b le of k illin g b a c t e r ia in a w o u n d w ith o u t a t th e s a m e tim e k illin g th e tissu es th e m s e lv e s .” (1) W h e n first l e a r n i n g a b o u t a n tis e p tic s , I w a s told t h a t t h e y w e r e s u b s t a n c e s h a v i n g t h e p o w e r t o restrain t h e d e v e l o p m e n t of g e r m s . T h i s b e i n g s o , is it c o r r e c t t h a t fo r first a id p u r p o s e s th e a p p lic a tio n of a m ild , n o n i r r i t a t i n g a n t i s e p t i c is b e n e f ic ia l, b e c a u s e it s l o w s u p t h e d e v elo p m en t of g e rm s , a n d th u s g iv es th e tissu es a c h a n c e to b rin g u p re-in fo rcem en ts ? I p re s u m e th a t ev en a m ild a n tis e p tic dev italizes th e s u r r o u n d in g tissu es s o m e w h a t, b u t I also p re s u m e th a t th e y h a v e a c h a n c e of q u ic k e r r e c o v e r y a s th e y a r e c o n s ta n tly b e in g su p p lied by th e b lo o d stre a m ? (2) I s h o u ld lik e to a d d t h a t I m o s t f r e q u e n tly u s e a crifla v in e , s o m e tim e s a s a s o lu tio n , a n d s o m e tim e s as m a d e u p b y c h e m i s t s w i t h a c r e a m o r je lly b a s is , a n d it s e e m s b o t h s o o t h i n g a n d e ffectiv e. (3) C o n c e r n i n g s a l i n e s o lu ti o n , d o e s n o t t h e c o n tin u e d u s e of th is c a u s e th e e d g e s o f th e w o u n d to b eco m e sore a n d irrita ted ? I have h eard nurses say t h a t t h e y h a v e h a d t o a p p l y v a s e l i n e r o u n d t h e e d g e s of th e w o u n d w h e n a p p ly in g salin e d re ssin g s. I th a n k you fo r th e g r e a t h elp w h ic h I h a v e received fro m y o u r q u e ry c o lu m n . ( 1) T h e l e c t u r e r p u t s i n t o a f e w w o r d s t h e w h o l e difficu lty c o n c e r n i n g th e a n tis e p tic t r e a t m e n t of w o u n d s . F o r th is r e a s o n th e T e x t b o o k r e c o m m e n d s t h e u s e of m ild a n tis e p tic s , c h o ic e of w h ic h it le a v e s to th e le c tu r e r s a n d w h ic h fo r first a id p u r p o s e s a r e p r e v e n tiv e r a t h e r t h a n p o w e r ful a n d a c tiv e . I n o t h e r w o r d s it s e e k s to a v o id f u r th e r in fe c tio n p e n d in g m e d ic a l a s s is ta n c e ; a n d e x p e rie n c e s h o w s t h a t t h e s e c a u s e l ittl e , if a n y , i n j u r y t o t h e w o u n d a n d s u r r o u n d in g sk in . ( 2 ) A c r i f l a v i n e s o l u t i o n ( 1 - 1 , 000 ) i s a m i l d a n d u s e f u l a n t i s e p t i c b u t a s y o u k n o w , th is is u s e d u n d e r in s t r u c t i o n s of d o c t o r o r t r a i n e d n u r s e a n d is n o t p a r t o f t h e n o r m a l e q u i p m e n t c a r r ie d b y a first a id e r. ( 3) A n y w e t d r e s s i n g c o n t i n u o u s l y r e - a p p l i e d w i l l t e n d t o i r r i t a t e t h e e d g e s of a w o u n d b u t t h i s c o m p l i c a t i o n w ill n o t a r i s e a f t e r t h e a p p l i c a t i o n o f a s i n g l e d r e s s i n g a s is r e c o m m e n d e d in th e T e x t b o o k .— N .C . F .

Treatm ent of Shock and Fractures. W . R . ( B a r n s l e y ) . — T h e fo ll o w i n g p r o b le m is c a u s i n g m u c h c o n tr o v e r s y in o u r F i r s t A id R o o m a n d y o u r r u l i n g o n t h i s p r o b l e m w o u l d b e g r e a t l y a p p r e c i a t e d :— “ A m a n h a s b een b u rie d d u r in g a n a ir raid a n d w h e n h e w a s e x tric a te d h e w a s fo u n d to be su ffe rin g fro m s im p le fra c tu re s of b o th fe m u rs a n d sim p le fra c tu re s of fifth a n d s i x t h r ib s o n b o t h s id e s . H e is u n c o n s c i o u s a n d su fferin g fro m s h o c k .” T h e T e x tb o o k say s th a t w h e n y o u h a v e im m o b ilised th e f r a c tu r e s y o u m u s t a p p ly c o ld to th e affected p a rt. A lso it s a y s t h a t w h e n t r e a t i n g s h o c k y o u m u s t a p p ly h o t w a te r b o ttle s b e tw e e n th e le g s a n d d o w n b o th sid es of th e body. W h ic h of th e se tre a tm e n ts w o u ld you a p p ly in a c a s e lik e th is ? N o w h e r e d o e s t h e T e x t b o o k te ll y o u to a p p ly c o ld to s im p le f r a c tu re s of t h i g h b o n e s o r rib s. I t a k e it, th e re fo re , t h a t you w e re th in k in g a b o u t th e tr e a tm e n t of co m p lic ated f r a c tu r e s of ribs. W ith s im p le fra c tu re s of th ig h b o n e s a n d c o m p licated f r a c t u r e s of r ib s o n b o th sid e s , s h o c k w ill b e p r o f o u n d a n d w ill call fo r p re fe re n tia l tr e a tm e n t. T h e c o ld c o m p re s s for th e r ib s w ill h a v e little effect in th e s e c ir c u m s ta n c e s ; a n d , a s a first a id e r, I w o u ld o m it it a n d c o n c e n tr a te o n t r e a t m e n t of s h o c k , p l a c i n g h o t w a t e r b o ttle s b e tw e e n le g s, to sid es of b o d y a n d t o f e e t ( T e x t b o o k , R u l e 1 , p . 45 ).

A I D S u c h a c t i o n is c o m p a t i b l e w i t h t h e g e n e r a l s c h e m e o f th e T e x t b o o k w h ic h tells u s to m o d ify th e g e n e r a l r u le s in a c c o r d a n c e w ith t h e p rin c ip le s of first a id b y t h e e x e r c is e of o u r q u a l if ic a tio n s a s first a i d e r s . — N . C . F .

Gas Poisoning and Broken Neck. H . B . ( B a r n a r d C a s tle ) .— P l e a s e c o u ld y o u tell m e h o w to tre a t a p erso n a sp h y x ia te d by coal g a s a n d su fferin g from a f r a c tu r e of c erv ic a l r e g io n of s p in a l c o lu m n (b r o k e n n e c k ) c a u s e d by s tr ik in g th e b e d rail w h ile e n d e a v o u rin g to t u r n off g a s ? F o r r e s c u i n g p e o p le f r o m c o a l g a s it is c u s t o m a r y t o - d a y to u s e t h e re m o te b r e a t h i n g a p p a r a t u s ; a n d in th e c i r c u m stan c e s n a m e d , th e re scu e r sh o u ld w e a r a m a s k a n d ta k e in to th e g a s - la d e n r o o m a s e c o n d m a s k fo r th e v ictim . B o th re s c u e r a n d p a tie n t w o u ld th e n be b re a th in g p u re a ir w h e re b y t i m e is a l l o w e d f o r r e m o v a l o f p a t i e n t . T h i s c o u ld b e effected by w o rk in g a b la n k e t u n d e r th e p a tie n t a n d so d r a g g in g h im in to p u re a ir .— N .C .F .

Treatm ent of Phosphorus Poisoning. W .L . ( N e a t h ) .— R e c e n tly a t B r i g a d e P r a c tic e w e failed to a g re e a s to th e c o rre c t tr e a tm e n t of P h o s p h o ru s P o is o n i n g ( T e x t b o o k p . 174 ) e s p e c i a l l y w i t h r e f e r e n c e t o R u l e 1 — “ A d o p t g e n e r a l ru les w h ic h a p p ly .” S o in o r d e r to s a tis f y e v e r y o n e , w ill y o u b e s o k i n d a s to d e ta il t h e g e n e r a l r u le s w h ic h w o u ld a p p ly w ith such a case ? T h e T e x t b o o k ( p . 174 ) t e l l s y o u t o t r e a t a s f o r i r r i t a n t p o is o n in g ; a n d th e re fo re th e g e n e r a l ru le s w h ic h a p p ly a re t o s e n d f o r d o c t o r , t o g i v e e m e t i c if p a t i e n t i s c o n s c i o u s , t o a d m in is te r E p s o m o r G la u b e r sa lts a fte r e m e tic a c ts, to sav e v o m it a n d to tre a t sh o ck . T h e r e is f u r t h e r a s p e c ific w a r n i n g to w i t h h o l d o ils w h ic h m i g h t d is s o lv e t h e p h o s p h o r u s a n d s o f a c ilita te its a b s o r p t i o n . — N . C . F .

Registration of Association Aw ards. H . P . ( B o d m in ) .— I to o k m y first a id w ith th e G . W . R a i lw a y C en tre. T h e n I jo in ed th e B rig a d e w ith w h ic h I o b ta in e d m y v o u c h er a n d m ed allio n . A fte rw a rd s I realised th a t I w a s lo s in g facilities b y n o t t a k i n g m y e x a m in a tio n s w ith th e G .W . R . C e n tre ; a n d so I h a v e sin ce o b ta in e d lab els w ith th e la tte r. P l e a s e tell m e h o w I s t a n d fo r m y B r ig a d e serv ice c h ev ro n . If y o u t a k e a n e x a m in a ti o n u n d e r a R a i lw a y C e n t r e y o u sh o u ld a r r a n g e for th e s u rg e o n -e x a m in e r to be s u p p lie d w ith th e a p p ro p ria te B rig a d e F o r m s w h ic h h e s ig n s in trip licate. T h i s w ill e n s u r e y o u r s u c c e s s in t h e a n n u a l r e - e x a m in a tio n s b e in g reco rd ed b o th by th e R a ilw a y C en tre a n d by th e B r ig a d e .— E d ito r .

L a y Instructor Certificate. M .D . (C h e ste r) a n d o th e rs .— C o u ld y o u k in d ly a d v ise m e w h e re to m a k e th e n e c e s sa ry a p p lic a tio n to q u a lify a s a L a y I n s t r u c t o r in first a i d ? A c tu a lly I a m a m e m b e r of th e B .R .C .S . C a n y o u a l s o p l e a s e tell m e t h e p r o c e d u r e fo r t a k in g th e q u a lify in g e x a m in a tio n fo r th e c ertificate ? T h e L a y I n s t r u c t o r C e r t i f i c a t e is a n a w a r d w h i c h is re s e rv e d fo r (a n d c a n o n ly b e o b ta in e d by ) m e m b e rs of th e B r i g a d e a f te r p a s s i n g a stiff e x a m in a ti o n . A r r a n g e m e n ts for th e e x a m in a ti o n a r e m a d e b y th e C o u n ty C o m m is s io n e r to w h o m ap p licatio n s h o u ld be m a d e th r o u g h th e C o rp s or D iv is io n a l S u p e r in t e n d e n t.— E d ito r .

Fractures of Patella and F e m u r. L .A .

(B elfast). — R e c e n tly a t B r ig a d e P rac tic e discu ssio n a ro se a b o u t th e c o rrect tre a tm e n t of fra c tu re d p a te lla w h ic h w a s a s s o c ia te d w ith a s im p le f r a c tu r e of f e m u r of t h e o th e r lim b . O n e t e a m p u t u p b o th f r a c tu r e s a s laid d o w n in th e T e x tb o o k , r a is in g th e lim b w ith th e fra c tu re d p a te lla. O u r te a m p u t u p th e fra c tu re d p a te lla, ap p lied e x te n sio n to fo o t of lim b w ith f r a c tu r e d f e m u r a n d tie d b o th feet to g e th e r. T h is done, o u r te a m ap p lied th e lo n g sp lin t for fr a c tu re d f e m u r b u t d id n o t p u t th e b a n d a g e ro u n d

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IR S T A ID C O M P E T IT IO N S are w on by good coach in g . A ny F ir s t A id e r (e ith e r sex ) m a y c o ac h a n y a m b itio u s te a m — m a le , fe m a le , o r m ix e d — to e a rly su ccess. C o m p etitio n ex p erie n ce n o t n ece ssa ry w ith n e w G u id e (a d a p ta b le to a n y te x t-b o o k ). F o r p a rticu lars, sen d sta m p e d e n v e l o p e t o : — R . J e f f e r y , 5 , A v e n u e G a r d e n s , L o n d o n . W .3

O M e m b e r s of S .J .A .B . F o r S ale. A m b u la n c e O fficer U n i f o r m s u i t a b l e f o r a m a n a b o u t 5 ft. 7 in . o r 5 ft. 8 in . i n h e i g h t , 38 i n . c h e s t , 38 i n . w a i s t , 28 i n . l e g . H at All p r e - w a r c l o t h , a l s o S a m B r o w n B e l t ( B l a c k L e a t h e r ) , a n d o n ly w o rn o n six o c casio n s. O f f e r s t o :— C o r p s O f f i c e r A. W . F r e e , R o c k s i d e H o u s e , A s k e r n , N r . D o n c a s t e r .

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b o th k n e e s b e ca u se of th e fra c tu re d p atella. W i l l y o u p l e a s e t e l l u s if w e s h o u l d h a v e a p p l i e d t w o s p lin ts to th e fra c tu re d fe m u r sin ce w e could n o t u se th e o t h e r l i m b if w e r a i s e d i t ? W i t h t h i s c o m b i n a t i o n o f i n j u r i e s t h e f r a c t u r e d f e m u r is th e m o r e lia b le to a g g r a v a t i o n a n d c o n s e q u e n tly d e m a n d s preferen tial tre a tm e n t. In th e se c irc u m s ta n c e s I w o u ld c o n tro l th e fra c tu re d p ate lla w ith a fig u re-o f-eig h t b a n d a g e a n d t h e n p ro c e e d to t r e a t th e f r a c tu r e d f e m u r a s la id d o w n in th e T e x tb o o k . B y so d o in g I sh o u ld k n o w th a t th e frac tu re d p atella w a s p ro tected from a g g ra v a tio n . In c id e n ta lly th e b a n d a g e ro u n d b o th k n e e s w o u ld n o t a d v e rse ly affect th e b ro k e n p a te lla.— N .C .F .

Extension of Fractn re d Fe m u r. S. R . (L e e d s ). — R e c e n tly w e h a d a d is c u s s io n o n th e tr e a t m e n t of a s im p le f r a c tu r e of f e m u r a t o u r F i r s t A id P o st. O n e of o u r le a d e r s s a id t h a t th e a p p lic a tio n of e x te n s io n w a s e a s ie r s a id th a n d o n e a s th e p a in suffered by p a tie n t w o u ld b e so in te n s e e v e n w ith all c a r e a n d g e n tle n e s s . H a v i n g a p p lie d e x te n s io n in a n a c t u a l c ase , th e p a tie n t b e in g a d m itte d ly very d r u n k , I a r g u e d th a t I a g r e e d th a t t h e p a i n w o u l d b e i n t e n s e b u t t h a t N a t u r e h a d a w a y of re n d e rin g th e p a tie n t u n co n scio u s. Y o u r le a d er w a s q u ite rig h t w h e n h e said th a t ex te n sio n of a f r a c tu r e d f e m u r m a y b e e a s ie r s a id t h a n d o n e . H e for g o t, h o w e v er, th a t th e T e x tb o o k in stru c tio n s a re th a t e x te n s i o n is t o b e a p p l i e d (1) w i t h g r e a t c a r e , (2) w i t h o u t u s i n g fo rce in o r d e r t h a t th e lim b m a y b e b r o u g h t in to a s n a t u r a l a p o s it io n a s p o s s ib le , a n d ( 3) w i t h o u t l e t t i n g g o fo o t u n ti l lim b h a s b e en sp lin ted . I f t h e s e t h r e e c o n d i t i o n s a r e o b e y e d , t h e n t h e p a i n is n o t lik e ly t o b e i n c r e a s e d ; a n d f u r t h e r it d o e s n o t fo llo w t h a t th e r e w o u ld b e a n y d e g r e e of in s e n s ib ility a s th e r e s u lt of th e actio n t a k e n — N .C .F .

Fractures of C la v ic le and H um erus. H . S . ( K i n g ’s L y n n ) a n d S . D . ( B i r m i n g h a m ) . — R e c e n t l y a t B r ig a d e P r a c tic e 1 to ld th e m e m b e r s of a s q u a d of o u r D i v is i o n to t r e a t a p a t i e n t f o r s im p le f r a c t u r e s o f left c la v ic le a n d o f left h u m e r u s ( m i d d l e of s h a f t) . T h e y p l a c e d t h e p a t i e n t ’s a r m a t r i g h t a n g l e s a c r o s s th e b o d y a n d fa s te n e d a b a n d a g e ro u n d elb o w a n d body to k e e p t h e f r a c tu r e d clav icle a t re st. N e x t th e y ap p lied a n o th e r b ro ad b an d ag e round lim b (above b ro k en h u m e r u s ) a n d b o d y t o fix t h e f r a c t u r e . I to ld th e m t h a t t h e y s h o u l d h a v e first p la c e d t h e li m b in a s m a l l a r m s l i n g a n d t h e n a g o o d p a d in t h e a x illa ; a n d t h a t a f te r a p p ly in g th e th re e sp lin ts to th e fra c tu re d h u m e r u s th e y s h o u l d h a v e fixed l im b to t r u n k w i t h b r o a d b a n d a g e ro u n d elb o w a n d tru n k . Y o u r k i n d r u l i n g w ill be a p p re ciate d . T u t ! T u t ! ! W h at next ? 1 d o n o t lik e y o u r s m a ll a r m s lin g w h ich w o u ld p ress on th e b ro k e n c o llarb o n e or v o u r “ g o o d p a d ” in a x i l l a w h i c h m i g h t a d v e r s e l y a ffe c t t h e i r a c t u r e d h u m e r u s , b e t h e f r a c t u r e in m i d d l e of s h a f t o r in u p p e r th ird . W i t h th is c o m b in a tio n of in ju r ie s th e f r a c tu r e d h u m e r u s is t h e m o r e l i a b l e to a g g r a v a t i o n a n d c o n s e q u e n t l y d e m a n d s p re feren tial tre a tm e n t. In th e se c irc u m s ta n c e s I s h o u ld tre a t th e f r a c tu r e d h u m e r u s a s la id d o w n in th e T e x t b o o k e x c e p t t h a t I w o u l d n o t s u p p o r t t h e l i m b i n a n a r m s l i n g b u t f le x fo re a rm a t r ig h t a n g le s to a r m a n d a p p ly a b ro a d b a n d a g e r o u n d lim b a n d b o d y to im m o b il is e th e f r a c tu r e d lim b . In s o d o i n g , I s h o u l d k n o w t h a t s o l o n g a s d u e c a r e is e x e r c i s e d d u r i n g t r a n s p o r t n o a g g r a v a t i o n of e ith e r f r a c tu r e w o u ld

R I D Vessel Used in Blood Transfusion. C . P . ( B a t h ) . — P l e a s e tell m e w h y t h e v e in is u s e d fo r b lo o d tran sfu sio n . T h e v e i n is u s e d b e c a u s e i t is e a s i l y l o c a t e d a n d q u i c k l y h e a l s .— N .C . F.

Fracture of A rm at Elbow. E .A . ( B i r m i n g h a m ) a n d S . G . ( W i l l e s d e n ) . — P l e a s e tell m e h o w t h e f ig u r e - o f - e i g h t b a n d a g e is a p p li e d to t h e h a n d a n d w r is t in c a s e of f r a c tu r e of a r m in v o lv in g e lb o w jo in t. I n o u r D i v i s i o n it is t h e p r a c t i c e t o a p p l y c e n t r e of b a n d a g e to h a n d first, to c r o s s o v e r a n d to tie o ff o n t h e w ris t. Is th is c o rre c t? A lso s h o u ld t h e t h u m b b e e n c lo s e d a s in t r e a t m e n t o f c r u s h e d h a n d ? Y o u r u l i n g w ill be ap p reciated . W ith fr a c tu re a t elb o w , th e fig u re-o f-e ig h t b a n d a g e s h o u ld b e a p p lie d to h a n d a n d w r is t a s is la id d o w n fo r f r a c t u r e of f o r e a r m ; a n d t h e t h u m b s h o u l d n o t b e e n c l o s e d b y th e b a n d ag e . W i t h a c r u s h e d h a n d t h e t h u m b is e m b r a c e d b y t h e b a n d a g e b e c a u s e it h a s to b e k e p t in c lo s e a p p o s i t i o n w ith th e fin g ers. Y o u r D iv is io n a l m e th o d of s t a r t i n g th e fig u re -o f-e ig h t b a n d a g e i s n o t c o r r e c t ; a n d F i g . 45 o f t h e T e x t b o o k c a n o n l y b e r e p r o d u c e d if t h e b a n d a g e i s a p p l i e d a s f o l l o w s :— T h e p a t i e n t ’s u p p e r l i m b b e i n g f l e x e d a t t h e e l b o w a n d th e p a lm of th e h a n d b e in g tu rn e d to w a rd s h is b o d y , a n a r r o w b a n d a g e is p l a c e d b e t w e e n l o w e r e n d of t h e f o r e a r m a n d th e b o d y w ith a s h o r t e n d w h ic h ju s t co v ers th e sp lin t. T h e l o n g e n d is t h e n b r o u g h t f r o m w i t h o u t in ( a n d o v e r t h e sp lin t), w r a p p e d firm ly tw ic e ro u n d th e lo w e r e n d of th e fo re a r m im m e d ia te ly a b o v e th e w rist, p a sse d a s a fig u re-o f-e ig h t ro u n d th e h a n d , a n d th e n b ro u g h t b a c k w ith a slo p in g tu rn to t h e lo w e r e n d of t h e f o r e a r m w h e r e th e tw o e n d s a r e tied off o n th e e x te rn a l sp lin t. I t is n o t e w o r t h y t h a t t h o u g h in th is in s t a n c e t h e t r i a n g u l a r is u s e d a s a r o l l e r b a n d a g e , t h e g o l d e n r u l e of a l w a y s b a n d a g i n g f r o m w i t h i n o u t is b r o k e n . — N . C . F .

Im m e rs io n in Strong Acid. H .L . ( L e i c e s te r ) .— W o u ld y o u be k in d e n o u g h to o u tlin e briefly t h e first a id t r e a t m e n t w h ic h y o u c o n s id e r b e s t for a p a t i e n t w h o h a s fa lle n i n t o a l a r g e v a t of s t r o n g s u lp h u ric o r n itric acid ? It w o u ld a p p e a r t h a t th e g e n e r a l fe e lin g of th o s e c o n c e r n e d is t h a t t h e w a t e r h o s e p ip e s h o u l d fir st b e u s e d fre e ly o r e v e n i m m e r s io n in a l a r g e co ld w a t e r v a t, i g n o r i n g th e p o ssib ility of a g g r a v a t i n g s h o c k . A n o th er s u g g e s t i o n t h a t s e e m e d w o r t h y of c o n s i d e r a t i o n is t h a t t h e p a t i e n t w h e n s tr ip p e d , s h o u l d b e w r a p p e d in b l a n k e t s , first b e i n g s o a k e d in a w a r m s o l u t io n o f s o d i u m b i c a r b o n a t e a n d p ro te c te d by d r e s s in g s , & c. W e sh all b e g r a te f u l for y o u r h e lp fu l c o m m e n ts . T h e c o n d itio n of s u c h p a tie n t w o u ld b e e x tr e m e ly s e rio u s u n l e s s i m m e d i a t e a c t i o n is t a k e n . T h e i m p o r t a n t p o i n t s , in m y o p in i o n , w o u l d b e (1) t o r e m o v e a ll c l o t h i n g w i t h o u t o n e s e c o n d ’s d e l a y , i n t h e h o p e t h a t p a r t s o f t h e s k i n w o u l d n o t b e a f f e c t e d , ( 2 ) t o w r a p p a t i e n t i n b l a n k e t s , a n d ( 3) t o a r r a n g e for h is im m e d ia te a n d sp e e d y tra n s fe r to h o sp ital. I a m a fra id t h a t y o u r s u g g e s t i o n s w o u ld in v o lv e c o n s id e ra b le d e la y in s u c h r e m o v a l a n d t h a t t h is m i g h t m a k e all th e d if f e r e n c e b e t w e e n life a n d d e a t h fo r t h e p a t i e n t . — N . C . F .

resu lt. — N .C .F .

A ir Exchange in Artificial Respiration. C .P .

( B a t h ) . — P l e a s e tell m e w h i c h m e th o d of artificial r e s p i r a t i o n — S c h a f e r o r E v e — g i v e s t h e g r e a t e r r a t e of a ir e x c h a n g e fo r e ac h resp iratio n .

I d o n o t k n o w t n e e x a c t f i g u r e s b u t I t a k e i t t h a t , if th ey a re p ro p erly carried o u t, b o th m e t h o d s w ill g iv e a p p ro x im a te ly th e s a m e ra te of e x c h a n g e .— N .C .F .

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S h ow s th e to p stretch er lo w ered re a d y for lo ad in g.

Illu stra tes th e sam e G e a r w ith the top stretch er fram e hinged down for use w hen o n ly one stretch er case is carried.

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FIRST AID ^ l ) e ^ r u ie p e n ik n f J o u r n a l f o r tlje A m b u l a n c e

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O n e o f o t h e r o r a ll o f t h e t h r e e r a c e s o f g e r m s . S t r e p t o c o c c i , S t a p h y l o c o c c i a n d B . p y o c y a n e u s a r e f o u n d i n e v e r y s k i n i n f e c t i o n c o m m o n t o t h i s c o u n t r y , a n d A N T I P E O L O I N T M E N T c o n t a i n s t h e antibodies ( a n t i v i r u s ) o f t h e s e g e r m s . H e a l i n g is e x p e d i t e d b y t h e p r o v e d S f -t h e o i n t m c n t > a n d s t P ti c d e v e l o p m e n t is s t o p p e d o r p r e v e n t e d b y i ts a n t i v i r u s s t e r i l e v a c c i n e f i l t r a t e s . A N T I P E O L O I N T M E N T is u n s u r p a s s e d f o r B U R N S a n d S C A L D S , f o r it is m i c r o b i c i d e a n d n o n - a d h e s i v e , a n d d r e s s i n g s d o n o t r e q u i r e t o b e c h a n g e d e v e r y d a y . W O U N D S , B U R N S , e t c , W I L L N O T T U R N S E P T I C if tre a te d w ith A N T I P E O L O I N T M E N T .

O P H T H A L M O - A N T I P E O L is a s e m i - f l u i d o i n t m e n t , m o r e c o n v e n i e n t t h a n t h e o r d i n a r y A n t i p e o l o i n t m e n t f o r o c u l a r i n f e c t i o n s a n d l e s i o n s . E y e s a ff e c te d b y s m o k e a n d d u s t are s o o th e d a lm o s t im m ed iately by th e a p p licatio n o f O p h th a lm o -A n tip e o l,' a n d the a n tiv iru s p r e v e n ts g e r m s f r o m dev elo p in g .

R H I N O -A N T I P E O L affords ra p id relief o f C O M M O N C O L D S , I N F L U E N Z A , A N D C A T A R R H . C o n ta in in g th e a n tib o d ie s o f th e g e r m s c o m m o n to ? T>r1(\crS ? DL*nOSi p h a iy n x (Staphlylococci, Strep to co c c i, B . p y o c y an e u s, p n e u m o c o c c i, p n e u m o b a c illi, e n te ro c o c c i, M . c atarrh a lis, B. P f e i f f e r ) , R h i n o - A n t i p e o l is n o t j u s t a p a l l i a t i v e , b u t is a r e m o v e r o f t h e cause o f t h e i n f e c t i o n . D u r i n g e p i d e m i c s i t is t h e id e a l p rev en tiv e o f m ic ro b e developm ent.

Cl i n i ca l S a m p le s o n r e q u e s t fr o m M E D IC O -B IO L O G IC A L L A B O R A T O R IE S L T D ., C a r g r e e n R o a d

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EDITORIAL.

C O N TEN TS

F.R.San.l.,

I t would be invidious to single P o lice First-A id out any special body of men for “ F in a ls.” mention in connection with first aid, and we have no intention of doing so ; but it must be agreed that the police forces of the country perform much good work in this direction, owing partly, of course, to their having opportunities which do not offer themselves to the ordinary civilian. Their aid is requisitioned in every manner of case, from the pedestrian who, having indulged too unwisely, may have received injury while in a helpless condition, to those un fortunates who may have found themselves in a blazing building and suffered more or less severe injury, to say nothing, in these latter cases, of the actual rescue work performed prior to the administration of first aid. Too, in these days, injuries from traffic occur by the thousand every year, the victims relying for aid on the members of the force in the great majority of instances. To quote from the speech of Mr. Herbert Morrison, Home Secretary and Minister of Home Security, speaking in London at the finals of the Metropolitan Police First Aid Competition, “ ‘ First Aid ’ might almost be made the slogan of the British police man. He is ready to give his aid in any emergency, and there is nobody who is more often first on the scene when distress occurs. He is there to help the old lady across the busy street, to stop the run away horse, to deal with the air raid victim, at the scene of a road accident or a crime, or to help the bewildered American soldier or country cousin up from the provinces to find his way through the maze of London’s streets.” Nothing is more sur prising than the keenness and enthusiasm which are displayed by the men of the police force in all parts of the country, and it is even related (Mr. Morrison referred to it) that on one occasion, when the men of Scotland Yard had the choice between giving up their first aid classes and losing their dinner hour, they plumped for the latter. Whether it is a fact or not, it makes a very pretty little picture and has truth for its foundation. In referring to “ the fine demonstration of first aid work afforded by the ‘ finals,’ ” Mr. Morrison dwelt (somewhat unnecessarily, maybe) upon the

F I R S T

importance of first aid in time of war when there is danger to life and limb at every turn, and when the arm-chair critic may at any moment be dis persed in space. The war has certainly been of the greatest assistance in stimulating the move ment, and we can hope that the restoration of peace will not be the precursor of a falling off. In Mr. Morrison’s words, “ whatever may happen, the police, we may be sure, will always be up to the scratch in this as in other respects.”

I m p r o v i s a t i o n in M o d e rn F i r s t Aid. M .O .,

By BOW M AN EDGAR. 4t h B a t t n . , D u m f r i e s s h i r e

H .G .

R I D S e c o n d ly , w e w o u ld n o t c a r e to t r u s t th e c o n tro l of a f r a c tu r e d f e m u r to th e flim sy b a n d a g e of a F irst-fie ld d r e s s i n g o r e v e n to t h a t of a S h e ll- d r e s s in g . S o m eth in g m uch m o r e s t a b l e is r e q u i r e d t o o v e r c o m e t h e p u l l of t h e l a r g e m u s c le s of th e th ig h . In p lace of th e R .A .M .C . m e th o d w e w o u ld s u g g e s t th e f o l l o w i n g :—

1. B y c a r e f u l e x t e n s i o n b r i n g t h e f e e t a s n e a r l y i n t o a p o s itio n a s p o ssib le, a n d k e e p th e m th e re b y ty in g th e b o o tlaces to g e th e r. 2 . R e m o v e t h e s l i n g a n d b e l t f r o m p a t i e n t ’s r i f l e ( s to rin g th e la tte r in h is b re a s t- p o c k e t fo r safety ), a n d a p p l y t h e rifle, t r i g g e r u p p e r m o s t , a l o n g t h e l e n g t h o f t h e in ju re d lim b . 3. T h e g a s - c a p e th ig h s a n d leg s.

com fy. In c a s e of f r a c tu r e of b o n e , c o m f o r t c a n o n ly b e o b ta in e d in t h r e e w a y s . c o n tro l 2. on th e 3. to g iv e

su itab le

sp lin tin g

o th er

of th e bone. A m p le p a d d in g to p re v e n t a n y p ossible p re s su re in ju red bone. S u ffic ie n tly firm a p p lic a tio n of th e p a d d e d s p lin ts p re s e n t c o m fo rt w ith o u t la te r p ain .

T h e c h ief m i s t a k e s

m ad e by a m a te u r

first a id e r s a re ,

I t h i n k :— (a) U n n e c e s s a r y h a n d l i n g a n d m o v in g of th e lim b . (b) In s u ffic ie n t s p lin t p a d d in g . •(c) S l a c k f i x a t i o n o f s p l i n t s . (d) F a i l u r e to c o n s u lt p a tie n t a s to h is c o m fo rt. A n d n o w to c o n tin u e w ith Im p ro v isa tio n .

Fractured Pelvis. T h is fra c tu re c a n be ex cellen tly co n tro lled a n d s u p p o rte d b y th e u s e of tw o g a i te r s a t th e s id e s o r o v e r th e site of f r a c tu r e . T h e g a i t e r s a r e a p p lie d u p a n d d o w n in th e a x is of th e b o d y . T h e y a re fa s te n e d a b o v e by th e w a istb e lt, a n d b e lo w b y a w e b - s l i n g a r o u n d t h e p elv is. T h e g a s - c a p e , fo ld ed in to a l o n g p a d , m a y b e p la c ed b e tw e e n th e th ig h s a n d le g s as p a d d in g . A n o t h e r w e b - s l i n g fixes t h e t h i g h s a b o v e t h e k n e e s , a n d t h e a n k l e s a n d f e e t c a n b e f a s t e n e d t o g e t h e r b y a rifleslin g o r p u llth ro u g h .

Fracture of Femur. F o r a t le a st tw o re a s o n s w e d o n o t a g r e e w ith th e m e t h o d of d e a l i n g w i t h a b r o k e n t h i g h - b o n e a s l a i d d o w n in t h e “ R . A . M . C . T r a i n i n g P a m p h l e t N o . 1. ” I n th e first p la c e th e rifle is s u e d to t h e H . G . d o e s n o t le n d itse lf to c o n tr o l b y t h e m u z z le b e i n g fixed in t h e g a i t e r a s d e s c r ib e d o n p a g e IS .

as a

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6. T w o w e b - s l i n g s f o r t h e “ f r a c t u r e - b a n d a g e s , ” o n e a b o v e a n d o n e b elo w th e b re a k . T h is w o u ld a p p e a r to be m o re re lia b le for th is d u ty th a n F. F .D . b a n d a g e s .

I t is, of c o u r s e , t o b e u n d e r s t o o d t h a t , w h i l e I m p r o v i s a t i o n s s a v e tim e a n d tr o u b l e in lo o k in g fo r s p lin ts , e tc ., th e y d o n o t d o a w a y w ith t h e n e e d fo r effic ie n c y a n d c o m m o n s e n s e . I t i s n o u s e d o i n g a b r i l l i a n t I m p r o v i s a t i n n if t h e r e s u l t is n o t c o m fo rtin g to th e p atie n t. T h e c o m f o r t of th e p a tie n t, f r o m t h e p la c e of a c c i d e n t to h i s b e d in h o s p ita l , is t h e te s t of o u r s u c c e s s a s first a id e r s . W e sh o u ld a s k th e in ju red m a n , a t e a c h s t a g e of d o in g h im u p — “ I s t h a t c o m f y ? ” A n d w e m u s t e n s u r e t h a t t h e fin a l r e s u l t is, a n d w ill r e m a i n ,

1. B y s u f f i c i e n t a n d

be used

4. L o o s e n t w o o r t h r e e o f t h e t u n i c b u t t o n s to a l l o w of t h e r i f l e b u t t b e i n g a p p r o x i m a t e d tq. t h e p a t i e n t ’s s i d e . The t u n i c b e lt is n o w f a s t e n e d o v e r t h e b u t t t h u s h o l d i n g it in p o sitio n . T h e b u tto n s a re th e n refasten ed . 5. T h e p elvis.

Pelvis and Lower Limb.

m ay

7. T h e g a i t e r s h o l d t h e l e g s t o g e t h e r b e l o w t h e k n e e s . 8. F i n a l l y , t h e f e e t a n d a n k l e s a r e t i e d t o g e t h e r b y a fig u re -o f-e ig h t c a r rie d o u t b y th e rifle-slin g . O r a p u llt h r o u g h m a y b e fix ed to t h e m u z z l e of t h e rifle b y a h a l f k n o t a n d u se d to fa s te n th e feet to g e th e r.

9. I n t h e c r o w n o f t h e s te e l h e l m e t w ill b e f o u n d a r u b b e r p ad , w h ich m ig h t m a k e a u seful p a d b e tw ee n th e m alleo li.

Fractured Patella. T h e l i m b is r a i s e d a fo o t o r s o f r o m t h e g r o u n d t o f a c ili t a t e a p p r o x i m a t i o n of t h e f r a g m e n t s . T h e rifle is l a id w i t h t h e b u t t e n d u n d e r t h e t h i g h a n d t h e m u z z l e u n d e r t h e feet. I t is t h e n f a s te n e d to t h e l e g b y t w o w e b - s l in g s , o n e a t t h e t h i g h , t h e o t h e r a t t h e foot. T h e f r a g m e n t s of th e p a te lla a r e d r a w n t o g e t h e r b y a fig u re-o f-e ig h t, m a d e by th e w a ist-b e lt p a s s in g belo w a n d ab o v e th e k n eecap . C o rrect p re ssu re sh o u ld be m ade b e f o r e t h e b u c k l e is f a s t e n e d . T h e f o o t i s h e l d o n t h e m u z z l e a s f o l l o w s :— A w e b s l i n g is p la c e d w i t h its m id d l e u n d e r t h e rifle m u z z le , o n w h ic h re s ts th e heel. T h e e n d s of th is slin g a re c a rrie d u p w a rd s to cro ss o v er on th e fro n t of th e a n k le , a n d a r e t h e n c a r r i e d d o w n w a r d s to t h e s o le o f t h e foot. T h e y a g a i n c ro s s h e r e a n d a r e tied off o v e r t h e m u z z le. If t e m p o r a r y e l e v a t i o n of t h e f o o t is d e s i r e d , a b a y o n e t m a y b e s t u c k p o in t d o w n in t h e g r o u n d w ith th e h ilt s t a n d in g p e rp e n d ic u la rly e r e c t— th e fo o t o n th e rifle-sp lin t c a n n o w be tie d to th e b a y o n e t by a p u ll- th r o u g h .

Fracture of Both Bones of the Leg. C a n b e c o n t r o l l e d in t h e s a m e m a n n e r a s f o r t h e F e m u r (see above). O r th e b ay o n et m a y be d ra w n fa r e n o u g h from th e s c a b b a r d to a llo w of a p u ll- to r o u g h b e in g p a s s e d t h r o u g h th e ho le in t h e b a y o n et cross-piece a n d fa sten e d to t h e b e lt- s lin g of th e tr o u s e r o n t h a t sid e. T he ex te n d e d b a y o n e t-in -sc ab b a rd splin t, w h ich s h o u ld re a ch from t h e sole-- t o m i d w a y u p t h e t h i g h , s h o u l d n o w b e e n c lo s e d in t h e l e n g t h w i s e fo ld e d g a i t e r s t o p r e v e n t i n j u r y to th e leg . T h e w h o le m a y n o w b e fixed to t h e le g b y t h e rifle -slin g ab o v e th e k n ee, tw o w eb -slin g s a s frac tu re b a n d a g e s ab o v e a n d b elo w th e site of fra c tu re , a n d th e w a ist-b e lt c a n fa s te n feet a n d a n k le s to g e th e r b y a fig u re-o f-e ig h t.

F I R S T

A I D

Fracture or Wounds of the Foot. W e v e n tu re to s u g g e s t th a t th e b est sp lin t fo r s u p p o rt of a n i n j u r e d f o o t is t o b e o b t a i n e d b y u s i n g t h e s o l e o f h i s boot for th a t p u rp o se, c u ttin g a w a y th e p a rts of th e up p er w h ic h a re n o t re q u ired . If th e b o o t-s o le is n o t o b ta in a b le, th e n a fo ld ed A m m o -p o u c h w o u ld m a k e q u ite a n efficient s p lin t. F ix in p o s itio n b y w e b -s lin g s , p u llt h r o u g h , etc. T h u s w e find th a t , w ith a little i m a g i n a t i o n , i n g e n u i t y a n d c o m m o n s e n s e , it is p o s s ib le to “ do-up, ” very e fficien tly , a n y ty p e of f r a c t u r e , e x c e p t i n g t h e S p in e , w ith no o th e r e q u ip m e n t sa v e th a t w h ic h a so ld ie r c a rrie s w ith him . I t is t o b e n o t e d t h a t n o m e n t i o n h a s b e e n m a d e of p a d d in g in th e d e s c rip tio n of th e a b o v e m e th o d s . It is' of c o u r s e , u n d e r s t o o d t h a t s u f fic ie n t p a d d i n g , t o r e n d e r th e s p l i n t i n g t h o r o u g h l y c o m f o r t a b l e , m u s t b e i n s e r t e d in every case. If s u c h s im p le m e t h o d s a r e a b le to f a c ilita te g o o d e m e r g e n c y F i r s t A id in t im e of w a r , it s h o u ld n o t be b ey o n d th e p o w e rs of e n th u s i a s ts to th in k o u t s im ila r easy a n d useful Im p ro v isa tio n s to d e al w ith fra c tu re s a n d o t h e r e m e r g e n c i e s w h i c h o c c u r a l l t o o f r e q u e n t l y i n c i v i l lif e .

T h e H o m e G u a rd an d F i r s t Aid. T h is m o n t h I s h o u l d l ik e to r e p o r t o n t h e a n n u a l c u p c o m p e t i t i o n f o r M e d i c a l S e c t i o n s a t t a c h e d t o t h e 10 t h M i d d l e s e x H . G . T h i s c u p is p r e s e n t e d b y t h e B a t t a l i o n C o m m a n d e r , L i e u t.- C o lo n e l M o s s , w h o h a s a l w a y s t a k e n a liv ely in te r e s t in t h e i r w o r k . T h e c o m p e titio n is r u n o n p r o g r e s s i v e lin e s, e a c h y e a r th e te st b e in g m o r e a d v a n c e d t h a n th e p re v io u s o n e . T h is p re v e n ts t h e s e c tio n s f r o m j u s t s t a n d i n g still w h e n a c e r ta in s t a n d a r d is r e a c h e d , a s is o fte n t h e c a s e w i t h first a id o rg a n isatio n s. N a t u r a l l y , t h e i n c r e a s i n g d e g r e e o f e fficien cy th u s o b ta in e d , te n d s to g iv e s a tisfa c tio n a n d in c re a se d c o n fidence to t h e officers a n d m e n a lik e , of t h e u n its fo r w h ic h they a re re sp o n sib le . A s I h a v e so o fte n sa id , H .G . m e d ic a l sec tio n s c a n n o t afford to b e j u s t satisfied w ith m a s t e r i n g th e te x tb o o k . W h i l e t h i s is e s s e n t i a l a t t h e o u t s e t , F i e l d t r a i n i n g , c a l l i n g for m o r e in itia tiv e , k n o w s n o e n d . B u t I d ig re s s ! T h e ab o v e test th is y e a r co n sisted of f o u r p a r t s : ( 1) O r a l ; ( 2 ) P r a c t i c a l , c o v e r i n g a l l t y p e s o f i n j u r y ; ( 3) S p e c i a l s p l i n t i n g , i n c l u d i n g t h e T h o m a s a n d rifle s p l i n t s ; a n d ( 4) R e s c u e a n d D r i l l . In som e cases no re g u la r e q u ip m e n t w a s p e rm issib le — th is to te st im p ro v isa tio n . T e n te a m s to o k p a rt a n d co m p etitio n w a s e x trem ely keen. “ D ” C o m p a n y (m y o w n un it) w h o h a d w o n th e c u p for tw o y e a r s in s u c c e s s io n , w a s n a r r o w ly b e a t e n in to s e c o n d p lace by “ E ” C o m p a n y . T h i s w a s d u e to th e in c re a se d in tere st a n d e n th u s ia s m o n th e p a rt of th e o th e r u n its, w h ic h w a s all to th e g o o d , a n d th e 1 0 th c a n n o w b e s u r e of re a lly effic ie n t s e r v i c e s h o u l d it e v e r b e n e c e s s a r y . T he squads w ere s m a r t a t d rill, a n d th e ir v a r io u s m e th o d s of re s c u e in te re s tin g , r a n g i n g a s th e y d id fro m th e u s e of th e F ir e m a n ’s L i f t , t o c r a w l i n g t o c o v e r w i t h t h e “ w o u n d e d ” o n their b a c k s . S e v e r a l o f f i c e r s w i t n e s s e d t h e t e s t s , i n c l u d i n g t h e B a t t;. C o m m a n d e r , a l s o t h e S e c t o r M . O . a n d C o m p a n y M . O . ’s w ere p re sen t. F in ally , th e S ecto r C o m m a n d e r, w h o p re sen te d th e c u p , vo iced h is a p p re c ia tio n a n d p le a s u re a t th e h ig h d e g r e e ot efficiency s h o w n b y all c o n te s ta n ts , a n d esp ecially a t th e p r o g r e s s m a d e d u r i n g th e p a s t y ear. C.

S p read b u ry

(S e rg t.),

S c h o o l H o u s e , N o e l - r o a d , W . 3,

S t . J o h n A m b u l a n c e B r ig a d e HEADQUARTERS AND DISTRICT REPORTS.

N o. I (P rin ceof W ales’s) D istrict N o . 91 N ( P a l m e r s G r e e n ) . — T h e c h o i c e o f A l d e r m a n V . J . W e s t l a k e a s M a y o r o f S o u t h g a t e f o r 1943-44 w i l l b e a p o p u la r o n e w ith m e m b e r s of th is D iv isio n a s it b r i n g s w ith it a n h o n o u r t o t h e i r o w n D r . L . W e s t l a k e , w h o is h e l d in g r e a t e s te e m a n d affectio n b y all m e m b e rs , b o th n u r s i n g a n d a m b u lan ce. D r . W e s t l a k e ’s a s s o c i a t i o n w i t h t h e B r i g a d e d a t e s b a c k to t h e la s t w a r w h e n s h e w o r k e d v e ry h a r d a s first a id lectu rer. H e r m e m b e r s h i p in t h e B r i g a d e c o m m e n c e d in 1933 w h e n s h e b e c a m e D i v i s i o n a l S u r g e o n t o t h e 91 s t N u r s i n g D iv isio n . A l d e r m a n a n d D r . W e s t l a k e c a m e t o S o u t h g a t e i n 1913 fro m T a u n t o n a n d h a v e s p e n t th e w h o le of th e i r m a r r i e d life t h e r e . T h e D o c t o r ’s w o r k a s l e c t u r e r d u r i n g t h e p r e s e n t w a r h a s b een very c o n sid e ra b le a n d m a n y c a n d id a te s a re g ra te fu l to h e r fo r th e ir s u c c e ss in g a i n i n g first a id a w a r d s a s th e resu lt of h e r ex cellen t te a c h in g .

N o . 175 ( T e d d i n g t o n ) . — A d i s p l a y o f f i r s t a i d w a s g i v e n by th is D iv isio n a t th e B a p tist H a ll, C h u rc h R o a d , T e d d in g to n , o n O c to b e r 4th , to m a r k th e ir p r o m o tio n to D iv is io n a l statu s. A m o n g o th e r very m u c h a p p re c ia te d item s th e re w a s a d is p la y of b lin d fo ld b a n d a g j n g , a n d w h ils t a t e a m of m e m b e r s w e re o u ts id e th e h all, th e a u d ie n c e w e re a s k e d to c h o o se th e ir in ju r ie s fo r th e te a m to d e a l w ith o n c o m p e titio n lin es. A t th e c o n c lu sio n , M r. S y d n e y J . W a r r e n , A s s is ta n t C o m m is s io n e r , w h o h a d p re v io u s ly in s p e c te d th e m e m b e r s of th e D iv isio n , c o n g ra tu la te d th e m o n th e ir s m a r tn e s s a n d p raised th e h ig h s ta n d a rd of th e ir w o rk . H e also p resen ted th e m w ith a S t. J o h n A m b u l a n c e F l a g o n b e h a lf of M rs. B o w d e n , w ife of M r. C. G . B o w d e n th e A m b u la n c e O fficer in C h a r g e . T h e a u d i e n c e c o n s i s t e d o f r e p r e s e n t a t i v e s o f t h e 84 t h ( T w i c k e n h a m ) D i v i s i o n , 151 s t ( M o i e s e y ) D i v i s i o n , t h e T e d d i n g t o n S e c t i o n o f t h e 63rd ( T w i c k e n h a m ) N u r s i n g D iv is io n , 142 n d ( W h i t t o n ) N u r s i n g D i v i s i o n , t h e T w i c k e n h a m , T e d d in g to n a n d H a m p to n s D iv isio n , B .R .C .S ., th e A m e ric a n M e d ic a l C o rp s, th e T e d d i n g t o n S e c tio n M e tr o p o lita n P o lice, C iv il D e f e n c e S e r v ic e s , W o m e n s ’ V o l u n t a r y S e r v ic e s , 3rd M id d le se x B a t ta li o n H o m e G u a r d , a n d first a id w o r k e r s fr o m lo c a l b u s in e s s firm s.

County of Cambridge. Pye. — In creased m e m b e rsh ip a n d c o n tin u ed useful ser vice, a s w e ll a s c o m p e t i t i o n s u c c e s s e s , w e r e r e p o r t e d a t t h e g e n e r a l m e e t i n g of th e P y e A m b u la n c e D iv isio n . The P r e s id e n t (M r. C. O . S ta n le y ) w a s in th e c h a ir. D iv . S u p t. A n d e r s o n s ta t e d in h is r e p o r t t h a t t h e r e h a d b e e n five p r o m o t i o n s d u r i n g t h e y e a r . A c e r ta in a m o u n t of c o m p e titio n e x p e rie n c e h a d b e e n g a in e d , a s in th e C o rp s c o m p e t i t i o n ; t h e D i v i s i o n t o o k 1s t , 2 n d , 3 r d , a n d 4 t h p l a c e s , th e w in n in g te a m b e in g le a d by C o rp o ra l S c a rle tt. A c o n sid e ra b le n u m b e r of p u b lic d u tie s h a d b een p e r fo rm e d a t s p o rts m e e tin g s , e tc ., a n d all m e m b e r s w e re in th e A R .P ., eith e r B o ro u g h o r F a c to ry . D u r i n g t h e y e a r , 22 m e m b e r s o f t h e D i v i s i o n g a i n e d H o m e N u r s i n g C e r t i f i c a t e s a n d 32 w e r e s u c c e s s f u l a t t h e a n n u a l first a id r e - e x a m i n a t i o n . C o rp o ral W ilso n h a d been su c c e ss fu l in g a i n i n g th e a w a r d , l e c tu r e r A . R . P . T h e C h a irm a n e x p re sse d p le a su re a t th e satisfacto ry m a n n e r in w h ic h th e D iv is io n w a s b e i n g r u n , s t a t i n g t h a t

F I R S T

th is w a s d u e in th e first p la c e to th e s p le n d id le a d e r s h ip g iv e n b y D iv. S u p t. A n d e r s o n . H e w a s p le a se d to see th a t th e D iv i s i o n m a n a g e d t h e i r o w n a f f a ir s s o w ell.

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o f C o rn w a ll.

R e d r u t h . — T h e p io n e e r D iv is io n in th e W e s t of E n g l a n d

— R ed ru th A m b u la n c e D iv isio n , c e le b ra te d th e ir g o ld e n ju b ile e t o w a r d s th e e n d of la s t m o n th . T h e D i v i s i o n w a s f o r m e d o n O c t o b e r 18 t h , 1893 , a t a m e e t i n g c a lle d a t th e s u g g e s t i o n of th e la te D r. C. R . L a u rie . T h e o n l y s u r v i v i n g f o u n d e r m e m b e r is M r . J. F . R a s h l e i g h of W e s t E n d , R e d r u th . F o r ty - o n e m e m b e r s of th e D iv is io n a r e s e r v in g w ith th e F o r c e s , a n d t w o , A. B . A. H o d g e , R . N . , a n d S i g m n . D . S ib t h o r p e . R o y a l C o r p s of S i g n a l l e r s , h a v e lo s t t h e i r lives. S i n c e 1937 t h e D i v i s i o n h a s b e e n i n t h e c h a r g e o f S u p t . C . C . P e l l o w e , w h o h a s b e e n a m e m b e r f o r m o r e t h a n 20 years.

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o f H e rtfo rd .

L e t c h w o r t h . — T h e L e tc h w o r th D iv isio n of th e S .J .A .B .

h a s b e e n h o n o u r e d b y h a v i n g f o u r of its m e m b e r s s u c c e s s fu lly p a s s th e e x a m i n a t i o n fo r th e L a y I n s t r u c t o r s C e rtific a te . T h e e x a m in a tio n w h ich w a s c o n d u cted by D r. C ra g g s, a s s is te d by D r. K e r r of K n e b w o r th , c o n s is te d of p ra c tic a l, o ral, w ritte n , p r e p a r in g a n d g iv in g a le c tu re tte . T h e resu lts w e re p a s s e d o n to S t. J o h n A m b u la n c e H e a d q u a r t e r s for fin a l e x a m i n a t i o n . T h e s u c c e ss fu l c a n d id a te s w e re A m b u la n c e O fficer K . C. W a r n e r a n d S e rg e a n ts R. W . B arn es, W . S a v a g e , J. S eato n . R e f re s h m e n ts w e re su p p lie d d u r in g th e c o u rse b y M rs. C raggs. T h e in a u g u r a l m e e tin g of th e S .J .A .B . C a d e t D iv isio n w a s h eld recen tly a t th e R ep o rt C en tre, L e tc h w o rth . T here w a s a g o o d a tte n d a n c e , a n d th e s p e a k e rs in c lu d e d M iss S p a r k s , C o u n t y C a d e t S e c r e t a r y ; L a d y S u p t . M rs . D a m e s of th e H a r lo w D iv isio n ; M r. W . E . D o u g la s , C o u n ty C o rp s O fficer, a n d o th e rs . T h e m e e tin g w a s very successful a n d t h e C a d e ts s h o u ld flo u rish u n d e r th e v e ry a b le g u i d a n c e of S e rg e a n t J im m y S eato n . T h e D iv is io n w a s r e p r e s e n te d b y s o m e of its m e m b e r s a t th e s p e c ia l s e r v ic e fo r t h e B r itis h R e d C r o s s a n d S t. J o h n A m b u l a n c e , w h ic h w a s h e ld in t h e C a t h e d r a l , S t. A lb a n s , o n S u n d a y , O c to b er

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16 t h .

o f N o rfo lk .

19 t h , M r . H . A . M i t c h e l l ( c h a i r m a n of C r o m e r U . D . C . ) p re s e n te d lo n g s erv ice a w a r d s to m e m b e r s of th e C r o m e r D iv isio n of th e S .J A B. Am ong th e m w e re th re e b a rs for th re e m e m b e rs of th e R a n d a ll f a m i l y , w h o s e t o t a l s e r v i c e i s 95 y e a r s , a n d i n c l u d e s 40 y e a r s ’ serv ice fro m th e fo rm e r s u p e r in te n d e n t a n d p re s e n t s e c re ta ry , M r. R . L. R a n d a ll. H is tw o so n s, A m b u la n c e O fficer T . L . R a n d a ll a n d C p l . R . E . R . R a n d a l l , h a v e 35 a n d 20 y e a r s ’ s e r v i c e resp ectiv ely . E a c h receiv ed a b a r to a lo n g serv ice m e d a l, a s d i d S u p t . F . R . C a r t e r (35 y e a r s ) , a n d A m b u l a n c e O f f i c e r F . H . P e a r c e (20 y e a r s ) . S g r . J. H . T a r l i n g a n d P te . G. B o l d e r o r e c e i v e d a m e d a l f o r 15 y e a r s ’ s e r v i c e . C ro m e r. — O n O cto b er

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o f S urrey.

G u i l d f o r d . — A t t h e i n v i t a t i o n o f t h e o f f ic e r s , p a r e n t s of t h e G u ild f o r d S .J . A. C a d e ts a t t e n d e d a m e e t i n g a t th e A m b u la n c e H a ll, L e a s R o a d , recently. In a n in tro d u c to ry sp eech C a d e t S u p t. F . B o lto n stressed th e im p o rta n c e of p a re n ta l c o -o p eratio n a n d th e e n c o u r a g e m e n t o f t h e i r s o n s in lo y a lty t o t h e o r g a n i s a t i o n to w h i c h th e y b e lo n g e d a n d its c u r r i c u l u m . T h e re w a s also a ta lk by C a d e t O fficer T . H ir s t, in w h ic h h e o u tlin e d t h e a c tiv itie s

R I D u n d e r t a k e n sin ce th e fo r m a tio n of th e D iv isio n a s w ell a s th e w in ter p ro g ra m m e . T h e p a re n ts to o k a d v a n t a g e of th e o p p o rtu n ity to d iscu ss w ith th e officers th e ir v ie w s o n p o in ts of m u t u a l in te re s t. I n t h e N e w Y e a r a c o u r s e of in s tr u c tio n w ill be s t a r t e d f o r b o y s b e t w e e n 14 a n d 16 w h o a r e d e s i r o u s o f j o i n i n g t h e D iv isio n .

County of Stafford. T a m w o r t h .— T h e a n n u a l in s p e c tio n of th e a b o v e A m b u la n c e a n d N u r s in g D iv is io n s w a s h e ld re c e n tly in th e g r o u n d s of T h e L o d g e , A s h l e y R o a d , b y p e r m i s s i o n o f t h e A s s i s t a n t C o m m is s io n e r (D r. D . M cC o ll) a n d M rs. M cC o ll. The i n s p e c t i n g officer w a s D r. R ic h a r d , C o u n ty S u r g e o n . M any h i g h o fficers w e r e p r e s e n t. D r . R i c h a r d in h is a d d r e s s , r e m a r k e d t h a t h e w a s satisfied a lik e w ith th e t u r n o u t in g e n e r a l a n d th e w o r k p e r form ed. I t h a d b e e n a p le a s u re to h im to c o n d u c t th e in sp ec tio n . H e t h e n p r e s e n t e d 5 l o n g s e r v i c e r i b b o n s f o r 15 y e a r s ’ serv ice, a n d 2 L a y I n s tr u c to r s ’ C ertificates. M rs. E . V. de H a m e l, donor, p resen ted tw o su rg ical h a v e r s a c k s to th e N u r s i n g D iv isio n . T h e f o l l o w i n g p r e s e n t a t i o n s w e i e t h e n m a d e : 13 F . A . C ertificates, 5 P r e lim in a r y C ertific a te s, 3 V o u c h e rs, 4 M e d a l lio n s, a n d 6 L a b e ls . I t w a s a n n o u n c e d t h a t i n t h e N u r s i n g S e c t i o n , 21 can d id ates passed th eir ex am in atio n .

County of Worcester. D u d le y a n d D i s t r i c t . — T h e la st S .J.A .B . co m p etitio n fo r th e C o u n ty of W o r c e s te r fo r th e p r e s e n t s e a s o n w a s h e ld in t h e C o u n t y H i g h S c h o o l, S to u r b r i d g e . T h e tro p h y at sta k e , a very h a n d s o m e o n e w a s th e “ C a p ta in a n d M rs. L echm ere ” Cup. T h e re w e re fo u r c o m p e tin g te a m s, tw o fr o m t h e S o u th a n d tw o f r o m th e N o r th of th e c o u n ty . T h e r e w a s a v e ry l a r g e a t t e n d a n c e of s p e c ta to rs . C o u n ty C o m m issio n e r D r. F. L. N e w to n w a s th e ju d g e fo r th e te a m te st a n d C o u n ty O fficer D r . M rs. P o r te r th e in d iv id u al test ju d g e . A fte r tea, w h ic h w a s s e rv e d b y th e m e m b e rs of th e S t o u r b r i d g e N u r s i n g D iv is io n a t th e c o n c lu sio n of th e c o m p etitio n , D r. N e w to n said th a t h e w a s v ery p le a se d th a t th e C o u n te ss B e a u c h a m p th e ir P resid e n t w a s w ith th e m . He a ls o t h a n k e d a ll t h e o fficials w h o h a d h e lp e d to m a k e t h e co m p etitio n su ch a success. M iss M . H . W a lto n (C o u n ty S e c re ta ry ) th e n a n n o u n c e d t h e r e s u l t a s f o l l o w s : T . W . L e n c h ’s A m b u l a n c e D i v i s i o n , a t o t a l o f 166 m a r k s ; B r i e r l e y H i l l N u r s i n g D i v i s i o n , a t o t a l o f 130 m a r k s . T h e C o u n te ss B e a u c h a m p p re s e n te d th e c u p to th e w in n i n g te a m , a n d in a g r a c e f u l s p e e c h , t h a n k e d all fo r g iv in g h e r s u c h a w o n d e rfu l w e lco m e. S h e w a s v e r y i n t e r e s t e d in th e ir w o rk a n d a n y th in g s h e c o u ld d o to h e lp th e m s h e w o u ld g la d ly do. S h e c o n g ra tu la te d th e co m p etito rs on t h e ir h i g h d e g r e e of skill.

East Riding of Yorkshire. H u m b e r s id e . — T h e a m b u l a n c e se rv ic e of th e a b o v e C o rp s is n o w a w e ll- e s t a b lis h e d f e a t u r e , a n d t h e p ro o f of its n e c e ssity , in a n a r e a s u c h a s it c o v ers, lies in th e fa c t t h a t d u r i n g t h e t w o m o n t h s it h a s b e e n in o p e r a t i o n it h a s r u n a lm o s t 2 ,0 0 0 m ile s c o n v e y in g civ ilian sic k a n d ro a d c a s u a ltie s to h o sp ita l. T h a t it is a p p r e c i a t e d is s h o w n b y t h e a m a z i n g fin an cial re s p o n se th e re h a s b e e n fo r its p ro v isio n . T h e r e h a s b e en a n e q u a lly g r a tif y in g re s p o n se to a n a p p e a l fo r d riv e rs a n d a tte n d a n ts , a n d th e a m b u la n c e m a in t a i n s a 24 h o u r a d a y s e r v i c e w i t h v o l u n t a r y h e l p e r s f r o m t h e six D iv is io n s c o m p r is in g t h e C o rp s , a n d fr o m C o rp s O fficers.

F I R S T

D e r m a t o l o g y an d t h e P u b lic H e a lth . [F ro m a L e c tu re d eliv ered by R o b e r t K la b e r, M .D ., F . R . C . P . , D . P . H . , a t th e R o y a l I n s titu te of P u b lic H e a lth a n d H y g ie n e, on W e d n e sd ay , N o v e m b er 3 r d , 1943 , w i t h M a j o r - G e n e r a l R . J . B l a c k h a m , C .B ., C .M .G ., C . l . E . , D .S .O ., in th e C h a ir. |

T h e im p o r ta n c e o f th e s tu d y o f d is e a s e s o f th e s k in , e s p e c ia lly in r e la t i o n t o t h e p u b lic h e a lt h , h a s n o t y e t r e c e iv e d t h e r e c o g n it i o n it d e s e r v e s . T h e r e a r e m o r e t h a n 400 d i f f e r e n t d i s e a s e s o f t h e s k i n . F o r tu n a t e ly o n ly a s m a ll n u m b e r of th e s e a r e of s e rio u s im p o r t to th e p u b lic h e a lth . T h e v a s t m a jo rity of s k in d is e a s e s a r e n o t a s s o c ia te d w ith a n y th in g m a n ife stly “ w ro n g w ith th e b lo o d .” They do n o t re s u lt d ire c tly fro m c o n ta c t w ith d irt. M ost are n e ith e r c o n ta g io u s n o r in fectio u s. I s tre ss th e se deeplyro o te d e r r o n e o u s id e a s to e m p h a s is e th e w id e s p r e a d i g n o r a n c e still p r e v a l e n t in m a n y q u a r t e r s . T h e c o n f u s e d a c c e p ta n c e of th e s e illu s io n s is in p a r t r e s p o n s i b l e f o r s e v e r a l u n s a t i s f a c t o r y f e a t u r e s in d e r m a t o l o g y . I t h a s re s u lte d in th e s u b je c t b e i n g “ n o t q u ite n ic e ” for d isc u ssio n in p u b lic o r s o m e tim e s , o n e fe a rs, in W h ite h a ll. C o n c e n tr a tio n of t h o u g h t o n th e d ie t, th e d irt, a n d th e su p p o se d ly d is o rd e re d b lo o d to o o fte n m e a n s im p r o p e r or u n satisfacto ry tre a tm e n t. W h e n d i s c u s s i n g t h e s o c ia l o r d o m e s t i c c a u s e s of d erm a titis, D r. K la b e r said : “ T h e n th e re a re w h a t m a y be d e sc rib e d a s th e so cia l o r d o m e s tic c a u s e s of d e rm a titis . T h e n u m e ro u s a n d h ig h ly a lk a lin e a n d m u c h -ad v ertised p rep a ra tio n s w h ic h m a k e d o m e stic w a s h in g so m u c h e asier ; c ertain d a n g e r o u s h a ir dyes to w h ich s o m e p erso n s a re a c u te ly sen sitiv e ; th e m o d e rn a n d a llu rin g lip stic k s ; so m e dyed fu r s ; a n d so fo rth . “ T h e h a z a r d s a s s o c ia te d w ith th e u s e of s o m e of th e se p r e p a r a tio n s a r e w ell k n o w n . B u t n ew p ro d u c ts a re co n s ta n tly b e in g offered to th e p u b lic, s o m e tim e s w ith o u t th e ir k n o w le d g e of th e n o v e lty o r th e h a z a r d in v o lv ed . T h u s , in A m e ric a q u ite re c e n tly m a n y c a s e s of d e rm a titis fo llo w ed th e use of a n e w sy n th etic ‘ fin ish ’ fo r u n d e rc lo th e s a n d sto ck in g s.” S c a b ie s h a s b e e n r e c e n t ly m u c h in t h e p u b lic e y e a s w ell a s in its s k in . W e h a v e h a d a S c a b ie s O r d e r , s c a b ie s c linics, a n d a sca b ie s s k in . S c a b ie s h a s b e en m a d e n o tifiab le by s o m e lo c a l a u th o r itie s w h o h a v e p ro v id e d a d e q u a t e facilities for tr e a tm e n t. I t is s t i l l t o o e a r l y t o e s t i m a t e t h e r e s u l t s of these m e a su re s. In d e e d , in th e a b s e n c e of g e n e r a l n o tifica tio n t h e r e is a s y e t n o re lia b le y a r d s tic k . P e d ic u lo s is w a s d e s c rib e d b y S h ip le y a s o n e of th e m in o r h o rr o rs of w a r . U n t i l t h e e v a c u a t i o n o f c h i l d r e n i n 1939 it w a s n o t r e c o g n is e d , e x c e p t b y th e m e d ic a l se rv ic e (school), h o w g r e a t a p a r t h a d b e e n p la y e d b y s ch o o l n u r s e s in m a i n ta in in g a lo w in c id e n ce of th is co n d itio n . T h e new p a ra siticid e s m a y m a k e tr e a tm e n t e asier, b u t u n til th e g e n e r a l s t a n d a r d s of h y g ie n e a n d e d u c a tio n h a v e b e e n f u r th e r r a is e d , in t o w n a n d c o u n tr y , w e s h a ll still be d e p e n d e n t o n th e v ig ila n c e of s ch o o l n u r s e s a n d te a c h e rs . In th e p a s t th e b a rb e rs ’ sh o p s h a v e b een freq u en tly b la m e d , n o t w ith o u t re a so n , fo r c o n v e y in g th is a s w ell a s o th e r in fe c tio n s. T h e re has, how ever, been a s trik in g a n d s p o n ta n e o u s a d v a n c e in th e s ta n d a r d s of sa lo o n h y g ie n e , a n d in fe c tio n s fro m th is s o u rc e h a p p ily s e e m m u c h less c o m m o n th a n h ith erto . C a ttle r in g w o r m in m a n a rise s la rg e ly fro m n o n c h a la n c e o n t h e p a r t of t h e s m a l l f a r m e r , w h o is l ittl e c o n c e r n e d b y t h e o c c u r r e n c e of th is d is e a s e in h is h e rd . I t te n d s to clear u p s p o n t a n e o u s l y w h e n t h e b e a s t s a r e t u r n e d o u t to g r a s s in th e sp rin g . T h e re f o r e h e fails to c a r ry o u t t r e a tm e n t w h ic h is b o t h s i m p l e a n d e ffectiv e. W h e n th e h u m a n sk in becom es i n f e c te d , h o w e v e r , t h e r e a c t i o n is m o r e v i o l e n t a n d p r o l o n g e d .

M o s t of th e o th e r a n i m a l r i n g w o r m s a r e d e riv e d fro m cats a n d dogs. T h e P e rs ia n k itte n s e e m s to b e p a rtic u la r ly dangerous. T h e s e c a t a n d d o g r i n g w o r m s m a y affect a n y p a r t of th e b o d y . T h e y can rarely be d istin g u ish ed from th o s e of h u m a n o r ig i n w ith o u t s p e c ia lis e d c u ltu r e m e d ia a n d exp erien ce. T h e resp o n sib le c a t or d o g m a y s o m e tim e s s h o w n o o b v io u s s ig n s of in fe c tio n , a n d e v e n th e v e te r in a r y s u r g e o n ’s o p i n i o n m a y b e u n c e r t a i n . T h e in c id e n c e of s c a lp r i n g w o r m , lik e t h a t of p e d ic u lo sis, h a s b een very g re a tly re d u c ed by th e w o rk of th e school n u r s in g serv ice. R i n g w o r m of th e g r o in s s e ld o m affects g ir l s o r w o m e n . S o m e o n e o n c e s a i d t h a t i t w a s e n d e m i c a t a l l t h e b e s t b o y ’s sch o o ls. I t is n o t i m p o s s i b l e t o c o n t r a c t t h i s f o r m o f r i n g w o rm fro m la v a to ry seats. I t is, h o w e v e r , m u c h m o r e lik e ly to b e tr a n s m i t t e d fro m th e free in t e r c h a n g e of s p o r ts s h o rts a n d flan n els. T h i s y o u th f u l h a b it c a n n o t b e to o stro n g ly d isco u rag ed . R i n g w o r m of th e to e s a n d feet h a s in c re a s e d in in c id e n c e in t h i s c o u n t r y s in c e t h e l a s t G r e a t W a r . In th e U n ite d S t a t e s of A m e r ic a its in c id e n c e h a s b e e n v a r io u s ly e s t i m a t e d a t 65 p e r c e n t , t o 90 p e r c e n t , o f t h e w h o l e p o p u l a t i o n . In t h e U n i t e d S t a t e s it h a s b e c o m e f a m i l i a r t o e v e r y l a y m a n a n d a d v e r t i s e m e n t m a n a g e r u n d e r t h e n a m e o f “ a t h l e t e ’s f o o t . ” T h e r e is littl e d o u b t it is m o s t e a s i l y a n d o f te n c o n t r a c t e d in s w i m m i n g b a th s a n d g y m n a s i u m s . T h e u s e of r u b b e r sh o es, b y p r e v e n tin g th e e v a p o r a tio n of s w e a t, u n d o u b te d ly m a k e s th e s k in m o re a ttra c tiv e to th is fu n g u s . Its sp read s e e m s a t p r e s e n t to b e o n e of th e p e n a ltie s in v o lv e d in c o n v e rtin g a C. 3 in to a n A .l p o p u la tio n . T h e m o re w id e s p re a d p ro v isio n of s w i m m i n g p o o ls a n d g y m n a s i u m s m a y b e e x p e c te d to s p r e a d t h e in fe c tio n still f u r t h e r u n til its in c id e n c e a p p r o a c h e s t h a t in A m e r ic a . W h ile th e r e a r e a v a rie ty of effective t r e a t m e n t s , th e p r e v e n t i o n of t h e s p r e a d of t h i s c o n d i t i o n is e x c e e d i n g l y d ifficu lt. T h u s , th e p ro v isio n of a n tis e p tic p a d d lin g p o o ls th r o u g h w h ic h b a th e rs m u s t p a ss before e n te rin g th e s w im m i n g b a t h is n o t l i k e ly to p r o v e h e l p f u l u n l e s s t h e f e e t a r e im m e r s e d th e r e fo r a t le a s t 10-20 m in u te s .

St. J o h n A m b u la n c e A s s o c ia tio n . P e t e r b o r o u g h .— D r. W . M a rsh a ll p resid ed a t th e a n n u a l m e e t i n g of th e P e t e r b o r o u g h C e n tr e of th e S .J .A .A . w h ic h w a s h eld a t th e C o w g a te R o o m s on S u n d a y , O c to b er 31 s t . H e w a s s u p p o r t e d b y a l l t h e o f f i c e r s , w h o w e r e r e

e lected . M r. F o w le r, th e H o n . S e c re ta ry , in tr o d u c in g h is a n n u a l r e p o rt, s a id : “ I n th is tim e of w a r th e title of th e O r d e r of S t. J o h n s e e m s to fall in to th e b a c k g r o u n d a n d to b e s u p p l a n t e d b y its p a r t n e r in t h i s g r e a t w o r k , t h e R e d C ro s s . T h e title of th e W a r O r g a n is a tio n of th e R e d C ro ss a n d O r d e r of S t. J o h n is r a t h e r lo n g a n d u n w ie ld y a n d e v e r y o n e , in c lu d i n g th e m e m b e r s of S t. J o h n , d e s c r ib e s t h e w o r k a s ‘ R e d C r o s s . ’ T h e P e t e r b o r o u g h C e n t r e o f S t. J o h n is s till r u n n i n g i n d o u b l e h a r n e s s , a n d h a s c a r r i e d its fu ll s h a r e of th e h e a v y b u rd e n s b r o u g h t a b o u t by w a r c o n d itio n s, e sp ecially th e e x tra d u tie s placed u p o n th e m e d ic a l pro fessio n , n u rs in g staffs a n d o th e rs . W e a r e still u n a b le to u s e t h e H e a d q u a rte rs w h ich w e p u rc h a se d fo u r y e ars a g o , b u t th e y a re b e in g u s e d b y th e C o u n ty C o m m itte e to c a r r y o n a n o t h e r p a r t of t h e w o r k of t h e W a r O r g a n i s a t i o n . ” T h e re h a d b een tw e n ty -e ig h t co u rses of le c tu re s a n d e i g h t y - n i n e e x a m i n a t i o n s , a n d a m o n g t h e 766 f i r s t a i d a w a r d s w e r e 252 f i r s t a i d c e r t i f i c a t e s . T h e a w a r d s for th e w a r p e r i o d t o t a l l e d 3,470 t o d a t e . T h e r e w e r e 453 a w a r d s f o r H o m e N u r s i n g a n d t h e R a i l w a y s h a d a d d e d a n o t h e r 119 . M r. F o w le r g a v e in te re s tin g fig u res of m e m b e rs h ip a n d v a rio u s a m o u n ts co llected o n fla g d a y s a n d a t fo u r g a r d e n fetes. H e s a id t h a t in th e N u r s i n g C o r p s a ll officers a n d m e m b e r s w e r e w o r k i n g w ith k e e n n e s s a n d effic ie n c y ; h a r d l y

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a m e m b e r in th e C o r p s w a s n o t d o in g e ith e r fu ll-tim e o r p a rt-tim e d u ty a t eith e r F .A .P ., h o sp ital or conv alescen t hom es.

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E x p e r e n t ia D o cet. By

D o u g l a s B r i t t e n o f 29 , R o c k R o a d , M i d s o m e r N o r to n , h a s b e e n a w a r d e d a p a r c h m e n t v o te of t h a n k s b y t h e c o m m i t t e e of t h e S .J . A A. fo r “ v a lu a b le a n d g r a t u i t o u s serv ices.” H e h a s o r g a n i s e d m a n y first a id c la s s e s s in c e t h e w a r i n t h e N o r t o n - R a d s t o c k d i s t r i c t , a n d g i v e n o v e r 200 e v e n in g s to tr a in in g stu d e n ts. A w a r d e d t h e B r itis h R e d C r o s s C e r tif ic a te a t t h e a g e of 12 y e a r s , h e h a s b e e n a m e m b e r o f t h e S . J . A . A . f o r 25 y e a r s , g a i n i n g h i s c e r t i f i c a t e i n 1920 , a n d t h e v o u c h e r , m e d a l l i o n a n d la b e ls a t p e rio d ic a l e x a m i n a t i o n s sin ce.

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M r. G . S te p h e n s , C h ief of P o lic e ,r e c e n tly p re s e n te d M r. S . B a r r e t t , A . R P . H e a d q u a r t e r s , P a d d i n g t o n , w i t h t h e 35 y e a r B ar. In m a k in g th e p re s e n ta tio n , M r. S te p h e n s c o n g r a t u l a t e d M r. B a r r e t t o n h is l o n g s e rv ic e in th e a m b u l a n c e m o v em en t. O w i n g t o t h e l a c k of g o l d t h e a w a r d w a s in t h e f o r m of a certificate.

L O N D O N , M ID L A N D & S C O T T ISH I t i s w i t h r e g r e t t h a t M r . M i l b u r n ’s r e s i g n a t i o n a s H o n o r a r y S e c r e ta r y of th e N o. 1 ( L o n d o n ) L .M .S . A m b u la n ce D istric t h a s been accep ted c o n se q u e n t u p o n his r e tir e m e n t fro m th e R a ilw a y S erv ice. M r. T . E. M ilb u rn h a s b een a sso c ia te d w ith th e R a ilw a y A m b u la n c e M o v em en t, fo rm erly on th e L. & N .W . R a i lw a y a n d la tte rly w ith th e L M .S . O r g a n is a ti o n , fo r p r a c t i c a l l y 40 y e a r s , a n d f o r o v e r 30 y e a r s h e h a s a c t e d i n th e h o n o ra ry c ap a c ity as D istric t A m b u la n c e S ecretary . D u r i n g th is lo n g p erio d , M r. M ilb u rn h a s g iv e n of h is b e s t in t h e f u r t h e r a n c e of t h e w o r k o f t h e a m b u l a n c e m o v e m e n t a m o n g s t th e r a ilw a y staff, w h ils t in a d d itio n h e h a s b e e n v e ry clo se ly a s s o c ia te d fo r m a n y y e a rs w ith th e a c tiv itie s of th e S t. J o h n A m b u la n c e B r ig a d e . F o r these s e r v ic e s h e r e c e iv e d w ell d e s e r v e d r e c o g n itio n by a d m is s io n a s a m e m b e r o f t h e O r d e r in t h e g r a d e of S e r v i n g B r o t h e r in 1917 a n d f u r t h e r p r o m o t i o n t o O f f i c e r B r o t h e r i n 1940 . M r. C. H o p k in s , a m e m b e r of th e s ta f f of t h e L a b o u r a n d E sta b lish m e n t D e p artm e n t a t W atfo rd H ead q u arters, h a s b e e n a p p o i n t e d t o s u c c e e d M r . M i l b u r n a s f r o m t h e 1s t O cto b er. M r . H o p k i n s is a S e r v i n g B r o t h e r o f t h e O r d e r of S t J o h n , th is r e c o g n itio n h a v in g b e en c o n fe rre d u p o n h im fo r serv ice s re n d e re d to th e m o v e m e n t in p a s t y e ars.

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I w o n d e r h o w m a n y s u r g e o n s l e c t u r i n g in F i r s t A id to C ivil D e fe n ce P e rso n n e l, m o n th a fte r m o n th , for fo u r lo n g y e ars of w a r h a v e , so fa r, fo u n d th e m s e lv e s a s e rio u s c a s u a lty a t t h e te n d e r m e rc ie s of th e ir d iscip les. It h a s p ro b ab ly h a p p e n e d o ften e n o u g h , fo r th e n a m e s of d o c to rs a r e n o t lai k i n g fr o m th e R o ll of H o n o u r of civ ilia n d e a d a n d in ju r e d ' It c an seld o m , h o w ev er, h a v e o ccu rred u n d e r c irc u m s ta n c e s w h ic h a llo w e d of s u c h c o ld ly c ritic a l o b s e r v a tio n b o th of th e s y m p to m s a n d s e n s a tio n s of th e v ic tim a n d of th e w o r k of p a r t tim e F i r s t A id P o in t p e rs o n n e l, a s in th e fo llo w in g in cid en t. 1 h a d re tire d a fte r tw e n ty -fiv e y e a rs of C o n s u ltin g S u r g e r y in th e y e a r b e fo re th e w a r a n d m a d e m y h o m e in a c h a r m i n g w e s t c o u n ty v illa g e a s d e e p in th e h e a r t of th e c o u n t r y a s it s e e m e d p o s s ib le to g e t . T h e v illag e w a s seven m ile s fro m th e n e a re s t to w n , ra ilw a y o r d o c to r, b o a ste d th re e t i n y s h o p s , a p o s t office a n d s o m e t h r e e h u n d r e d i n h a b i t a n t s . I h a d l o n g felt t h a t w a r w a s i m m i n e n t a n d h a d b e e n a m o n g th e e a r lie s t of th o s e w h o s e voices w e r e ra is e d in th e w i l d e r n e s s in a n e ffo rt t o s t i m u l a t e a l e t h a r g i c p u b lic to in te r e s t in its o w n d e fe n c e . A s a c o n se q u e n c e I very soon f o u n d m y self a t w o r k in m y n e w h o m e d e te r m in e d to c re a te , a t a n y ra te , in m y o w n v illa g e , a F i r s t A id P o in t w ith su fficien t tr a in e d p e r s o n n e l to d e a l efficiently w ith c a s u a ltie s u n til su c h tim e a s h e lp co u ld re a c h th e m . F r o m th e first a fa ir n u m b e r of th e i n h a b ita n ts b e c a m e i n t e r e s t e d in th e w o r k a n d e v e n in t h e fa c e o f m ild lo c a l rid icu le c o n tin u e d to p ra c tic e a n d a tte n d r e g u la r w e e k ly lectu res. A s th e first th r e e w e a r y y e a r s of w a r d r a g g e d s lo w ly p a s t, th e p a rty w e n t t h r o u g h m a n y v icisitu d es. P eo p le m o v e d f r o m t h e d i s t r i c t , s o m e w e r e c a l l e d u p , a f e w fell b y th e w ay sid e co n v in ced th a t th e y w o u ld n ev er be n eed ed b u t a lw a y s a fa ith fu l n u c le u s c a rrie d on a n d n o w a n d a g a i n a n e w face a p p e a re d a m o n g th e m . B y th is t i m e all h a d q u a lifie d b o th in first a id a n d in h o m e n u rs in g , se v e ra l e v en h e ld P ro ficien cy C ertific a te s a n d th e y w e r e w illin g e n o u g h to fo r m a D e t a c h m e n t of th e B ritis h R e d C ro ss w h e n th e o p p o rtu n ity w a s offered to th e m . T h e n c a m e t h e d a y s o f t h e tip a n d r u n r a id , w h e n o u t of c lear sk ies a n d w ith no w a rn in g w h a tev e r, c a m e th e ro a r of lo w fly in g p la n e s , th e r a ttle of m a c h in e g u n s a n d th e c r a s h of t h e b o m b s . V illag e a fte r v illag e w a s sh o t u p o r b o m b ed , a n d a lth o u g h w e o u rse lv es suffered n o th in g w o rs e th a n c a n n o n fire, m i n o r c a s u a l t i e s f r o m n e i g h b o u r i n g h a m l e t s so o n b e g a n to b e b r o u g h t to th e P o in t. I t w a s th e n , I th in k , fo r th e first tim e t h a t th e v illa g e a s a w h o le really a p p re c ia te d th a t th e re w a s a w a r on, a n d th a t a l l i d e a s o f “ U s ’ll n i v e r b e b o m b e d ’e r e ” f i n a l l y d i s a p p e a r e d fro m th e m in d s of e v en th e m o s t o p tim istic. T h e re c am e a d a y w h e n th e n e arest m a rk e t to w n w as h e a v ily a t t a c k e d , a n d th e p e rs o n n e l, c alled in to re in fo r c e th e s ta f f of th e lo cal h o s p ita l, s a w , fo r th e first tim e , th e re a litie s of to ta l w a r. T h e y b e h a v e d m a g n ific e n tly , flin ch ed fro m n o t a s k h o w e v e r h o rrib le, a n d e m e rg e d a t th e e n d of a g ru e llin g fo u rte e n h o u rs w ith a n e w fo u n d co n fid en ce a n d th e re a lis a tio n th a t n e a rly fo u r y e ars of m o n o to n o u s tr a in in g h a d been m o re th a n re p a id . I h a d lo n g w o n d e re d w h a t th e re a c tio n of th e se p eo p le w o u ld b e w h e n faced w ith th e re a l th in g . I k n e w w ell e n o u g h th a t n o n e of th e m h a d p ro b a b ly ev er seen a n y th in g w o rse th a n a c u t fin g er a n d th a t no o p p o rtu n ity w o u ld o c cu r to g iv e th e m even th e p re lim in a ry b lo o d in g of th e p ro b a tio n e r n u r s e in t h e m i n o r c a s u a lty w o r k of a h o s p ita l o u t p a tie n t de p artm en t. I k n e w th a t w h e n th e y d id g o in to a c tio n th e y w o u ld d o so to face h o rr o r s a t w h ic h e v e n th e m o s t h a r d e n e d s u rg e o n m ig h t re a so n a b ly react.

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W O M E N O V E R 40 w i l l f i n d t h e i r d i f f ic u ltie s r e g a r d i n g h e a l t h f r a n k l y discussed.

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m ore than comes up to m y expectations, and I shall c e rta in ly recom m end the v o lu m e s.”

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T h e ra id ta u g h t m e all th a t I w a n te d to k n o w , a n d fro m t h a t d a y I h a d n o f e a rs a s to th e i r a b ility to c o p e w ith a n y t h i n g t h a t I m i g h t d e m a n d of th e m . T h e la st a n d h a rd e st te st o n ly r e m a in e d — h o w th e y w o u ld d e al w ith s e rio u s c a s u a l tie s in t h e field its e lf, w h e n n o t a c t i n g d i r e c t l y u n d e r m y o w n co n tro l. I w as soon to learn ! R a ts , w e a r e to ld b y a b en ificien t G o v e rn m e n t, a re a N a t i o n a l M e n a c e in c a p i t a l l e t t e r s , a n d t h o s e of u s w h o live in th e c o u n tr y a r e left in little d o u b t u p o n th e m a t t e r w h e n w e d isco v er th a t o u r s c a n ty a n d v ery p recio u s p o u ltry ra tio n s a re b e g in n in g u n a c c o u n ta b ly to d is a p p e a r. Q u ie t o b s e rv a tio n o n e e v e n in g s h o w e d a really m a g n ifi c e n t fello w e m e r g i n g fro m a d itc h b o r d e r in g m y c h ic k e n ru n w ith d e s i g n s u p o n th e r e m a i n s of food in th e tr o u g h s . S ince th e d is a p p e a r a n c e of L iv e rp o o l V ir u s fr o m th e m a r k e t I h a v e a lw a y s b e e n tim id of th e u s e of o th e r p o is o n s h o w e v e r safe t h e y m a y b e s a i d t o b e if c o n s u m e d a c c i d e n t a l l y b y o t h e r d o m estic a n im a ls. In a v illag e s w a r m in g w ith d o g s a n d c ats th e y a r e n o t p o p u lar. 1 d e te r m in e d , th e r e f o r e , to la y fo r th is f a t h e r of all th e ra ts fro m th e s h e lt e r of a n e a r b y s h e d w ith a rev o lv er, a w e a p o n to w h ic h I w a s w e ll a c c u s to m e d a n d w ith w h ic h I k n e w m y s e lf to b e a fa irly a c c u r a t e sh o t. O n e c h a m b e r o nly w a s lo a d e d a n d th a t, fo r s a fety s a k e , la y fo r th e tim e b e in g w ith a n e m p ty c h a m b e r b e tw e e n it a n d th e firin g p o sitio n . I s to o d silen tly w a itin g a n d w a tc h in g fo r th e ex p ec te d e m e r g e n c e of m y fr ie n d fro m h is h o le s o m e six y a r d s a w a y on m y rig h t. A n d th e n th e u n e x p e c te d b e g a n to h a p p e n . A soft b u t u n m is ta k e a b le s q u e a k c a m e from th e d itch b e h in d m e a n d a b o u t th r e e y a r d s o n m y left a n d I t u r n e d to see a g re y nose e m e rg in g . A s I d id s o m y left l e g w e n t b a c k b u t, u n fo r tu n a te ly fo r m e, p la n te d itself u p o n a n a l m o s t p erfectly ro u n d s to n e a n d m y a n k le g a v e w a y a t o n ce w ith a n a g o n i s i n g s t a b of p a in . T h i n g s b e g a n to h a p p e n e v e n m o r e q u ic k ly . T h e s u d d e n p a in e v id e n tly c a u s e d m y fin g e r to c o n tr a c t u p o n th e tr i g g e r a n d so th ro w th e c a r trid g e in to th e firin g p o sitio n. T h r o w n o ff m y b a l a n c e I fell f o r w a r d s o n t o m y left k n e e a n d h e a r d th e c r a s h of th e s h o t b e n e a th m e a s m y h a n d s in v o lu n ta rily w e n t fo rw a rd s, a n d , a second later I fo u n d m y s e lf o n t h e g r o u n d w ith m y left l e g fu lly flex ed b e n e a t h m e a n d t h e s m o k i n g r e v o l v e r still in m y h a n d .

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Perform ance of Schafer’s Method. F W . ( B i r m i n g h a m ) . — 1 h a v e b e e n t a k i n g a c l a s s of W a r d e n s i n S c h a f e r ’s M e t h o d o f A r t i f i c i a l R e s p i r a t i o n a c c o r d i n g to t h e T e x tb o o k , w h ic h tells u s to p la c e t h e h e a d to o n e sid e. I w a s a s k e d if t h e r e w a s a n y p a r t i c u l a r s i d e i n w h ic h to p la c e th e h e a d , to w h ic h I rep lied “ N o .” W h e n th e m e n w e n t fo r th e ir e x a m in a ti o n s , th e C hief W a r d e n t o l d t h e m t h a t t h e y m u s t a l w a y s p u t t h e p a t i e n t ’s h e a d o n t h e l e f t s i d e b e c a u s e if i t w a s p l a c e d o n t h e r i g h t s i d e t h e y w e r e a p t t o b r e a k t h e p a t i e n t ’s n e c k . W o u ld yo u k in d ly g iv e m e y o u r v e rd ict on th is p o in t ? T h e r e a r e n o g r o u n d s fo r t h e s u g g e s t i o n t h a t in th e p e r f o r m a n c e o f S c h a f e r t u r n i n g t h e p a t i e n t ’s h e a d t o t h e r ig h t m ig h t b r e a k h is n e c k .— N . C o r b e t F le t c h e r .

Exam ination How ler. M .R . (C a n n o n S t.).— In a re c en t e x a m in a tio n 1 a sk e d a c a n d id a te h o w h e w o u ld tre a t a p a tie n t su fferin g from shock. H e r e p l i e d “ K e e p p a tie n t w a rm . ” W hen, h o w e v e r, I p re s s e d h im to tell m e h o w h e w o u ld d o th is , h e e l e c t r i f i e d m e b y s a y i n g — “ I w o u ld f i l l the hath w ith b o ilin g w a ter a n d p la c e the p a t ie n t th erein / / ” Good!

N e x t , p l e a s e ! !— N . C . F .

A u x ilia ry Brigade Service. D .O . (W e llin g b o ro u g h ).— I h a v e been a n a u x ilia ry m e m b e r of th e B r ig a d e fo r th r e e y e a r s a n d h a v e n o w jo in e d th e N u r s in g D iv isio n . C a n y o u p l e a s e te ll m e if a l l t h e d u ties w h ich I h av e p erfo rm ed d u rin g th ese th re e years w ill c o u n t to m y c r e d it ? A s t h e d u t i e s w e r e n o t p e r f o r m e d u n d e r i n s t r u c t i o n of B r i g a d e O fficials th e y c a n n o t b e p la c e d to y o u r c r e d it.— E d ito r .

B r ig a d e R o m a n c e . to C a d e t O fficer J o a n R o y s to n a n d P te . F r e d . M a r s to n , b o th of th e H u d d e r s f ie ld C o rp s, S .J .A .B ., o n th e ir m a r r i a g e a t S t. B a r n a b a s C h u rc h , C ro s s la n d -M o o r, C o n g r a tu la tio n s

o n N o v e m b e r 6 th . A v e r y l a r g e c o m p a n y of m e m b e r s of t h e C o r p s a t t e n d e d . T h e b r i d e s m a i d s w e r e C a d e t O f f i c e r S . B e r r y a n d t h e b r i d e ’s siste r, M iss M . R o y sto n . T h e b r i d e g r o o m is s e r v i n g in t h e R .A . M . C . , a n d it w a s v e ry fittin g th a t h is b e st m a n s h o u ld b e c o m r a d e P te. R . T . K im p to n , R .A .M .C . T he groom s m e n w e r e P t e s . H . E v a n s , R . A . M C . , a n d J . JolifFe, S . J . A . B . B o t h t h e b r i d e a n d b r i d e g r o o m h a v e b e e n m e m b e r s of t h e H u d d e r s f i e l d C o r p s f o r 10 y e a r s . E v id en c e of th e esteem in w h ic h th e y a r e h e ld w a s p ro v id e d by th e fa c t t h a t a m o n g s t th e m a n y g u e s ts w e re L a d y D is tric t C a d e t O fficer M rs. C u m m i n g - B e l l a n d L a d y D iv . S u p t. M iss D . C h e e th a m . A m o n g s t th e m a n y p re se n ts w e re a S a la d B ow l from th e N u r s in g C a d e ts a n d a C ase of C u tle ry fro m th e C en tral D iv isio n .

Perforated Gastric Ulcer. F .S . ( W a lla s e y ) .— A t a r e c e n t c o m p e titio n a frie n d of m in e also a B rig a d e m e m b e r, co rrectly d ia g n o se d a p erfo rated g a s tr ic u lcer. I n t h e t r e a t m e n t a s p e r T e x t b o o k , “ if t h e s e a t o f t h e h a e m o r r h a g e is k n o w n a p p l y a c o ld c o m p r e s s , ” t h e D o c t o r w o u l d n o t h a v e it, a s h e m a i n t a i n e d t h a t a c o ld c o m p re s s o n th e s to m a c h w o u ld in c re a s e s h o c k e sp ecially b e in g so n e a r th e s o la r p lex u s. Y o u r r e m a r k s o n th is p o in t

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p a s s e s h i s l e f t h a n d a c r o s s t h e p a t i e n t ’s c h e s t a n d g r a s p s h is r ig h t sh o u ld e r. H e b rin g s h is r ig h t a rm b e n e a th t h e left s h o u ld e r th u s s u p p o r t i n g th e h e a d . T h o s e p r e s e n t w e r e u n a n i m o u s in e x p r e s s in g th e o p in io n t h a t th e p a s s i n g of th e left h a n d a c r o s s th e p a t i e n t ’s c h e s t a n d g r a s p i n g t h e r i g h t s h o u l d e r p u t a n u n d u e a n d u n n e c e s s a r y s t r a i n u p o n N o . 4. A ll a g r e e d t h a t t h e p a t i e n t c o u ld b e lifted m o r e e x p e d itio u s ly a n d w i t h f a r l e s s s t r a i n o n N o . 4 , if t h e l e f t h a n d w e r e p a s s e d u n d e r t h e u p p e r p a r t of th e t r u n k . L iftin g w ith th e p a l m of t h e h a n d u p w a r d s is a m o r e n a t u r a l m e t h o d t h a n re a c h in g o v er a n d c lu tc h in g th e o th e r sh o u ld er. C a n y o u e x p la in , p lease, th e re a s o n fo r th e in s tru c t io n b e i n g s o f r a m e d a n d h o w it is a n i m p r o v e m e n t on th e easier a n d m o re n a tu ra l m eth o d ? T h e T e x tb o o k in stru c tio n s a re b a se d on m a n y years e x p e r ie n c e in t h e u s e of t h e s tr e tc h e r ; a n d th e g e n e r a l c o n s e n s u s o f o p i n i o n is t h a t t h e s e in v o lv e le ss s t r a i n o n B e a r e r N o . 4. — N . C . F .

Burst Varicose Vein. F .C . (M e lto n ).— A t a re c e n t c la ss, th e fo llo w in g q u e stio n s w e r e a s k e d :— (11 I s i t p o s s i b l e f o r a v a r i c o s e v e i n t o b u r s t w i t h o u t b r e a k in g th e sk in , a n d w h a t w o u ld be th e s ig n s a n d sy m p to m s ? (2 ) W o u l d t h e p a t i e n t , a f t e r a w h i l e , s h o w t h e s i g n s o f i n t e r n a l b l e e d i n g if i t w a s n o t c o n t r o l l e d ? Y o u r r e m a r k s w ill b e n o te d w i t h in te re s t. ( 1) I t i s p o s s i b l e f o r a v a r i c o s e v e i n t o b u r s t a n d t o c a u s e h a e m o r r h a g e b e n e a th th e u n b ro k e n sk in . T h e re su lt w o u ld b e a b ru ise, th e a r e a of w h ich w o u ld v a ry w ith th e a m o u n t of b lo o d w h ic h h a d e s c a p e d fro m t h e v essels. (2) T h e r e w o u l d n o t b e m a r k e d s i g n s of i n t e r n a l b l e e d i n g b e c a u s e th e e s c a p e of b lo o d w o u ld b e a rre s te d b y th e re su ltin g p re ssu re — N .C .F .

Th om a s Splint. G .V . ( W a tf o r d ) .— W ill y o u p le a se g iv e y o u r ad v ic e o n th e fo llo w in g p o in ts w h ic h h a v e a ris e n a t th e C .D . A m b u lance D e p o t to w h ic h T h o m a s S p lin ts h a v e been s u p p l i e d :— ( 1) A t w h a t s t a g e d u r i n g th e ap p lic atio n of a T h o m a s S p l i n t is t h e p a t i e n t p la c e d o n t h e s t r e t c h e r ? T h e T e x t b o o k is n o t c le a r . (2) H o w c a n th e fo o t b e m a d e r ig id ? The Hom e O f f i c e h a s s u p p l i e d s p l i n t a n d e x t e n s i o n b a r b u t no

s tirr u p . ( 1) W h i l e I a g r e e t h a t t h e i n s t r u c t i o n s i n A p p e n d i x I I I o f t h e T e x t b o o k a r e n o t q u i t e c l e a r o n t h i s p o i n t , i t is o b v i o u s th a t th e p a tie n t m u s t n o t be lo a d e d o n th e s tre tc h e r u n til th e f r a c tu re h a s b e e n c o n tro lle d by th e T h o m a s S p lin t. T h i s is c l e a r if y o u r e m e m b e r t h a t t h e T h o m a s S p l i n t i s a s u b s t i t u t e f o r t h e s p l i n t s r e f e r r e d t o o n p . 89 o f t h e T e x t b o o k a n d t h a t th e lim b m u s t be re n d e re d a s im m o b ile a s p ra c tic a b le before t h e p a t i e n t is m o v e d , a s p e r i n s t r u c t i o n s o n p. 66. ( 2) T h e s t i r r u p is p a r t o f t h e e q u i p m e n t a n d s h o u l d h a v e b een su p p lied . I n its a b s e n c e it w ill b e fo u n d t h a t t h e s lin g m e n t i o n e d i n C l a u s e 5 ( d ) o n p . 253 o f t h e T e x t b o o k a n d t h e f ig u r e - o f - e ig h t b a n d a g e n a m e d in C la u s e 8 w ill s e rv e to c o n tro l th e fo o t.— N .C .F .

Points on Bones. G .A . ( O v e r s e a l ) . — I n t h e a r t i c l e w h i c h in t h e O c t o b e r is s u e o f F i r s t A i d i s p u b l i s h e d u n d e r t h e t i t l e P o in ts on B o n e s fo r B e g in n e r s , I n o t e a n e r r o r . O f c o u r s e , th e flat b o n e s a re th e s te r n u m a n d th e sc a p u la a n d n o t a s stated . W e th a n k y o u for y o u r le tte r a n d fo r c o rre c tin g a n error. — E

d it o r

A I D I d o n o t k n o w a n y i n s t r u c t i o n s w h i c h tell y o u to p la c e b a n d a g e s d ire c tly o v er fra c tu re s ; a n d I c a n o n ly s u g g e s t th a t y o u fo llo w th e in s tr u c tio n s of th e T e x t b o o k .— N .C .F .

Fractures of F e m u r and Pelvis. F . B. ( B l a c k b u r n ) . — A t a r e c e n t E x e r c is e a t o u r F i r s t A id D e p o t w e h a d to tr e a t a p a tie n t s u ffe rin g fro m sim p le f r a c tu r e s of r i g h t f e m u r (th r e e in c h e s a b o v e k n e e jo in t) a n d of le ft p elv is. O u r i n s t r u c t o r s d iffe re d in t h e i r t r e a t m e n t . One a d v is e d t r e a t i n g th e p elv is first a n d th e n s p lin tin g th e frac tu re d fem u r. T h e o th e r ad v ised tw o lo n g sp lin ts o n e to c o n tr o l th e f e m u r a n d th e o t h e r t h e p elv is. P lease t e l l u s w h a t y o u r t r e a t m e n t w o u l d b e , a n d if w i t h t h e p e lv is s p lin te d t h e r e is r i s k of p r e s s i n g t h e p elv ic f r a g m e n ts in to th e b la d d e r. W i t h th is c o m b i n a t i o n o f i n j u r ie s ( a s I w r o t e in t h e J u l y i s s u e o f F ir s t A id ) t h e f r a c t u r e d f e m u r is m o r e l i a b l e to a g g ra v a tio n a n d co n seq u en tly d e m a n d s p referen tial tre a t m e n t. I s h o u l d t r e a t t h e f r a c t u r e d f e m u r a s la id d o w n in t h e T e x t b o o k a n d k n o w t h a t t h e f r a c t u r e d p e lv is is p r o p e rly c on tro lled . Y o u w ill n o te t h a t b o th in ju r ie s r e q u ir e a b a n d a g e r o u n d t h e p e l v i s w h i c h , if p r o p e r l y a p p l i e d , w o u l d n o t p r e s s t h e p elv ic f r a g m e n t s in to th e b l a d d e r ; a n d a lso t h a t th e e x a c t site of f r a c tu r e of p e lv is c a n o n ly b e d i a g n o s e d b y x - r a y ex am in atio n . T o m e t h e l o n g s p l i n t a l o n g t h e o t h e r s i d e of b o d y is a s h e e r w a s t e of t i m e . — N .C . F .

Raising of Fractured Leg. A. W . ( C h a t h a m ) . — P l e a s e tell m e w h y t h e T e x t b o o k te lls u s n o t to ra ise a fra c tu re d lo w e r lim b d u r in g o u r tr e a tm e n t a n d tr a n s p o r t, e sp e c ia lly in v ie w of th e fa c t t h a t th e foot o f t h e p a t i e n t ’s b e d i s r a i s e d w h e n h e i s a d m i t t e d t o h o sp ital. R a i s i n g of th e lo w e r lim b s c a u s e s m o v e m e n t in th e jo in ts a b o v e t h e f r a c t u r e a n d th e r e f o r e is c o n t r a r y to t h e i n s t r u c t i o n s i n R u l e 5 a o n p . 67 o f t h e T e x t b o o k . O n th e o th er h a n d r a i s i n g a b ed o n b lo c k s d o e s n o t h a v e th is effect.— N .C . F .

Th e Future of the Brigade. D . S . ( B i r m i n g h a m ) . — W i t h r e f e r e n c e t o D r . C o r b e t F l e t c h e r ’s m o s t i n t e r e s t i n g a r t i c l e o n T h e F u t u r e o f the S t. J o h n A m b u la n c e B r ig a d e , w h i c h w a s p u b l i s h e d i n A u g u s t is s u e of F ir s t A i d , I s u g g e s t t h a t a v e rv u se fu l m e m b e r s h i p a f t e r t h e w a r f r o m C ivil D e f e n c e U n i t s is lik e ly to b e l o s t f o r t h e f o l l o w i n g r e a s o n :— M a n y o f u s in C . D . F i r s t A id P a r t i e s h a v e a s o u r c o lle a g u e s m e n a n d w o m e n w h o w e a r th e S t. J o h n B a d g e o n t h e i r u n i f o r m s , 75 p e r c e n t , o f t h e s e p e o p l e a r e i n e fficie n t in first a id a n d p a r t i c u l a r l y in c a r r y i n g a n d lo a d in g . T h e o t h e r 25 p e r c e n t , a r e m a g n i f i c e n t a n d a c t a s in stru c to rs. I w o u ld s u g g e s t t h a t b e c a u s e th e se p eo p le w e a r th e S t. J o h n B a d g e ( w h a t q u a lific a tio n th is im p lie s, 1 d o n o t k n o w ) w e e x p ec t th e m to h a v e a g o o d a v e r a g e p ra c tic al k n o w l e d g e o f f i r s t a id ., a n d if t h e y a r e n o t e f f i c i e n t t h i s b a d g e sh o u ld b e d e n ie d th e m . T h o s e of u s w h o w o u ld join th e B r i g a d e a f t e r th e w a r a r e n o t to o i m p r e s s e d w i t h t h i s v i e w o f it, a n d c o n s id e r t h a t in th e in te r e s ts of th e B r i g a d e th e b a d g e po sitio n sh o u ld b e e x p la in e d . In c o n clu sio n I w o u ld a d d th a t th is m a in ly a p p lie s to th e d ire c te d m e m b e r s s e n t to u s d u r i n g th e la s t tw e lv e m o n th s. T h e S t. J o h n b a d g e w o r n o n C . D . u n i f o r m is a b a d g e of m e m b e r s h i p of t h e B r i g a d e a n d n o t of t h e effic ie n c y of its w e a r e r to r e n d e r first a i d . — E d it o r .

Treatm ent of Fractures.

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A .G . ( W a r e ) . — P l e a s e te ll u s if i n t h e t r e a t m e n t o f f r a c t u r e s it is n o w c o r r e c t to a p p ly b r o a d b a n d a g e s d ir e c tly o v e r th e fra c tu re s in s te a d of ab o v e a n d b elo w as w e h a v e a lw ay s b een ta u g h t.

J . W . ( I l k e s t o n ) . — P l e a s e te ll m e w h a t is t h e c o lo u r of t h e b lo o d w h ile it is c i r c u l a t i n g in t h e b o d y a n d b e f o r e it c o m e s in to c o n ta c t w ith th e a ir. S o m e s a y t h a t it is. g re e n , o r a n g e a n d v a rio u s o th e r c o lo u rs,

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4 5 , O X F O R D 8T R E E T , L O N D O N , W . l . ’G ra m s: “ Bayleaf, L ondon." ’P h o n e: Gerrard 3185 & 2313.

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A s t h e T e x t b o o k t e lls y o u , t h e b l o o d w h e n c i r c u l a t i n g in t h e v e s s e l s v a r i e s f r o m b r i g h t t o d a r k r e d ; a n d i t s c o l o u r is d e p e n d e n t o n t h e o x y g e n ( w h i c h m a k e s i t b r i g h t r e d ) o r of i m p u r i t i e s ( w h i c h m a k e s it d a r k r e d ) p r e s e n t a t a n y g i v e n p o in t. I s u sp e c t th a t y o u a re th in k in g a b o u t th e v a rie d co lo u rs a s s o c ia te d w ith a b r u is e w h ic h r e s u lt f r o m c h a n g e s in th e re d b lo o d c o rp u s c le s a fte r th e ir e s c a p e fro m th e b lo o d v e ss e ls.— N .C .F .

Suxgeons and the Brigade. A .E . ( B a r k i n g ) . — T h a n k y o u fo r y o u r a rtic le in A u g u s t issu e o f F i r s t A i d e n t i t l e d T h e F u tu r e o f the S t. J o h n A m b u la n ce B r ig a d e . O n e .s t a t e m e n t w a s of p a r t i c u l a r in te re s t to m e , v i z : “ T h e m a jo r ity of S u r g e o n s a r e e a g e r to h e lp a n d to g iv e of th e ir s p e c ia l k n o w l e d g e . ” T h e D iv is io n to w h ic h I b e lo n g e d h a d th r e e d ifferen t S u r g e o n s d u r in g th e se v e n te e n y e a rs I h a d th e priv ileg e of b e i n g in it ; a n d I c a n o n ly r e c o lle c t t h e m g i v i n g t h r e e lectu res d u r in g th a t p erio d — th e y w e re very g o o d . W e, t h e N . C . O . ’s , a s k e d f o r m o r e ; b u t t h e D o c t o r s w e r e a lw a y s to o b u sy . I d o w a n t to s tre s s th e p o in t th a t, h o w e v e r g o o d th e S u p e r i n t e n d e n t i s , i t i s t h e S u r g e o n ’s i n t e r e s t a n d p r a c tic a l h e lp t h a t c a n m a k e a t h o r o u g h l y g o o d a n d efficient — a n d t h a t m e a n s a h a p p y — D iv isio n . In y o u r la st p a r a g r a p h y o u s ta te a fact to w h ic h I h a v e d ra w n a tte n tio n tim e a n d tim e a g a in , n am e ly , th a t u n less th e S u r g e o n ( w h o is t h e te c h n ic a l h e a d ) a n d th e S u p e r i n t e n d e n t ( w h o is t h e e x e c u t i v e h e a d ) r e a lly c o - o p e r a te , n o D iv is io n can be tru ly “ h a p p y a n d p ro sp e ro u s.” F u r t h e r , i t i s m y e x p e r i e n c e t h a t if t h e S u r g e o n i s p r o p e r l y t r e a t e d a n d m a d e t o feel t h a t h e / s h e is a n a c t i v e m e m b e r of th e D iv isio n a n d a n e s s e n tia l p a r t of th e o r g a n is a tio n , h e /s h e w ill g iv e a d e q u a t e a s s is ta n c e a s in th e c a s e w h ic h I q u o te d in m y a rtic le . — N .C . F .

Nam es of Bones. J . W . ( I l k e s t o n ) . — ( 1) P l e a s e t e l l m e w h o g a v e t h e n a m e s t o th e b o n e s a n d w h e re d id th e y o rig in a te . W a s it fro m th e L a t i n t o n g u e o r w e re th e n a m e s ju s t c h o s e n to su it th e d o cto rs ? A l s o ( 2 ), p l e a s e t e l l m e w h a t a r e t h e t w o h o l e s i n b o tto m c o r n e r s of th e p e lv is— ? o b t u r a t o r fo r a m e n . D o e s a n y t h i n g p a s s t h r o u g h t h e s e h o l e s o r a r e t h e y filled u p w ith m u scles ? I a w a i t w ith in te re s t y o u r k in d rep lies w h ic h w ill b e m u c h a p p re c ia te d . ( 1) T h e t e r m s u s e d i n t h e d e s c r i p t i o n o f b o n e s o r i g i n a t e d fr o m th e L a t i n t o n g u e w h ic h in th o s e f a r off d a y s w a s th e l a n g u a g e of s c ie n c e . (2) E a c h of t h e l a r g e o p e n i n g s in l o w e r p a r t of r i g h t a n d left ilia c b o n e is c a lle d t h e o b t u r a t o r (o r th y r o id ) f o r a m e n . It re p re se n ts a n in te rv a l b e tw ee n th e p u b is a n d isch iu m a n d th o u g h m o s tly clo sed b y th e o b tu r a to r m e m b ra n e , tra n s m its th e o b tu r a to r v essels a n d n erv e. In cid en tally , th e te rm o b t u r a t o r m e a n s “ s to p p e d u p ” a n d th y ro id “ in f o r m of a sh ield .”— N .C .F .

Escape of Blood. L .A . ( B a t h ) . — P le a s e tell m e w h e r e th e b lo o d g o e s w h e n a n a r t e r y of th e a r m is t o r n a n d th e r e is n o e x t e r n a l w o u n d . I n th e c irc u m s ta n c e s n a m e d , b lo o d w o u ld e sc a p e a m o n g t h e t i s s u e s of t h e p a r t a n d r a i s e a t e n s e s w e l l i n g w h i c h is c a lle d a “ b l o o d - t u m o u r ” a n d w h ic h w ill v a r y in size w ith th e vessel in v o lv ed . F u rth e r, th e sw ellin g m a y b ecom e l o c a l i s e d o r if e x t e n s i v e m a y o b s t r u c t t h e m a i n a r t e r i a l s u p p l y of th e lim b a n d c au se g a n g re n e . I n e ith e r c as e e arly su rg ic al i n t e r f e r e n c e is i n d i c a t e d . — N . C . F .

Effects of Fractured T h ig h . D . T . ( B i r m i n g h a m ) . — A t a r e c e n t p r a c t i c e t h e q u e s t i o n of tr e a tm e n t of sim p le fra c tu re of th ig h (a c co m p an ie d b \ 2* i n c h e s o f s h o r t e n i n g ) c a m e u n d e r d i s c u s s i o n . I t w a s c o n te n d e d t h a t th e fig u re -o f-e ig h t b a n d a g e ro u n d feet a n d a n k le s w o u ld n o t b e su fficien t to h o ld th e e x te n sio n

A I D a n d so p e r m it th e r e m o v a l of p a tie n t o n a c c o u n t of th e s tr o n g th ig h m u s c le s fle x in g th e u n in ju r e d lim b a t th e knee. Y o u r r u l i n g w ill b e a p p re c ia te d . I t is n e w s to m e t h a t a f r a c tu r e of o n e t h i g h w ill c a u s e th e m u s c le s of th e o th e r a n d u n in ju r e d t h i g h to c o n t r a c t .— N .C .F .

E v e ’s H ocking Method. H .D . (C o lc h e ste r).— W o u ld y o u k in d ly p a ss y o u r o p in io n on D r . E v e ’s r o c k i n g m e t h o d o f a r t i f i c i a l r e s p i r a t i o n , a s it is b e i n g d e m o n s t r a t e d b y t h e A . R . P . C a s u a l t y S e r v i c e in a n d a ro u n d th is d istrict. M y p e r s o n a l o p i n i o n i s t h a t t h e E v e ’s r o c k i n g m e t h o d falls w ith in th e s a m e c a te g o r y a s th e T h o m a s S p lin t ; a n d t h a t b o th m e th o d s of t r e a t m e n t s h o u ld b e re s e r v e d for s p e c ia lly t r a in e d s q u a d s of first a id e r s . T h e c o n clu sio n s of P ro fesso r H . C o rd ier, M .D . , p u b l i s h e d i n t h e S e p t e m b e r 25 t h i s s u e o f t h e B r it is h M e d ic a l J o u r n a l a r e a s f o l l o w s :— ‘ ‘ E v e ’s r o c k i n g m e t h o d c e r t a i n l y h a s g r e a t p r a c t i c a l a d v a n t a g e s b u t th e e x p e r im e n ta l c r ite r ia so f a r e m p lo y e d to s t u d y its p h y s io lo g ic a l e ffic ie n c y s e e m to m e in s u ffic ie n t to p ro v e its s u p e r io r ity to o t h e r m e th o d s of a rtificia l re s p ir a tio n . A m o r e c o m p l e t e e x p e r i m e n t a l s t u d y is n e c e s s a r y b e f o r e its efficiency c a n b e d e t e r m i n e d . ” — N . C . F .

Fractures of A r m and Shoulder-Blade. W .K . (E a s tle ig h ).— In a re c en t co m p etitio n , a m a n w a s fo u n d ly in g o n th e g r o u n d (u n c o n s c io u s ), h a v i n g fallen from a la d d e r on w h ic h h e w a s w o rk in g . H e re c e iv e d a c o m p o u n d f r a c tu r e of th e left a r m ( u p p e r t h i r d ) w i t h a r t e r i a l b l e e d i n g , a l s o a f r a c t u r e of t h e left s h o u ld e r b la d e . ( 1) W h i c h w o u l d b e c o r r e c t , d i g i t a l p r e s s u r e o n t h e s u b c la v ia n a rte r y , in re la y s, in p r e fe re n c e to p a d a n d b a n d a g e to a x illa r y a r te r y , a s o w i n g to c o m p o u n d fr a c t u r e of a r m ( u p p e r t h i r d ) it w o u ld b e u n w i s e to a p p ly th e o th e r b a n d a g e over th e elb o w w ith fo rea rm (acro ss th e bo d y ) a n d d r a w i n g th e a r m in t i g h t to th e b o d y ? ( 2) F r a c t u r e d l e f t s h o u l d e r b l a d e w o u l d r e q u i r e b r o a d b a n d a g e o v e r f r a c tu r e , a n d a r m s u p p o r t in a S t. J o h n s lin g , w h e r e a s f r a c t u r e of left a r m ( u p p e r th ir d ) w o u l d r e q u i r e b r o a d b a n d a g e o v e r f r a c t u r e , lev el w ith to p of s h o u ld e r a n d s e c u re a r m to body, a n d s u p p o rt a r m in s m a ll slin g . W h ic h s lin g w o u ld b e c o rre c t to u se ? A s th is co n te st s e e m e d to ra is e th e se q u e rie s a n d leav e th e m o pen for d isc u ssio n . I s h a ll b e v e ry g l a d of y o u r o p in io n . (1) I a g r e e ; a n d I c o n s i d e r t h a t y o u r s u g g e s t i o n of co m p re ssio n of th e su b cla v ia n a rte ry by relay s of a ss is ta n ts is c o r r e c t . ( 2) W i t h t h i s c o m b i n a t i o n o f i n j u r i e s , t h e f r a c t u r e d a r m is t h e m o r e l i a b l e t o a g g r a v a t i o n d u r i n g t r e a t m e n t a n d tra n s p o rt a n d c o n se q u e n tly d e m a n d s p referen tial tre a tm e n t. A s a first a id e r, th e re fo re , I w o u ld u s e th e s m a ll a r m s lin g . — N .C .F .

N o t e . — O w i n g to th e la r g e n u m b e r of q u e rie s re c eiv ed , a n d o u r lim ite d s p a c e , a n u m b e r h a v e u n a v o id a b ly b e e n h eld over.

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G a u n t H o u s e , 28 O r c h a r d S t r e e t , B r i s t o l I

“ S A N O I D ” INTERLOCKING EXTENSION

SPLINTS

(Patent Number 53165 o f 28/7/39.) INCURVED EDGE OF SOCKET

TRANSVERSE G R OO V E OF .S P L IN T

IN C U R V E D E D G E O F SOCKET

S .1343 “ S A N O ID ” INTERLOCKING EXTENSION SPLINTS W ith Metal sock ets for jointing. 2 pieces 2 5/8ths. in. x 3/16ths. In. x 15 in. 2 pieces : 2 5/8ths. in. x 3 /l6 th s . in. x I3J in. I p iece : 2 5/8 th s. i n x 3 /l 6 th s. In. x

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I piece : 2 5/8chs. in. x 3 /l6 th s. in. x 6 in. 2 W ebbing Straps w ith m etal buckles : 18 in. x I in. 2 W ebbing Straps w ith m etal buckles : 27 in. x l£ in. 3 sockets. A By this Invention Splints made in any con ven ient lengths make f \ rigid connections by means of incurved op posite edges of th e m etal sock ets or sleeves firmly engaging w ith transverse grooves in the surfaces of the Splints w hen pressed hom e into th e socket. U nlike the ordinary sock etted Splint, this type is rigidly coupled togeth er and held against relative displacem ent but can be disengaged by pulling apart w ith sufficient force. N .B .—To ensure perfect locking it is im perative that the Splint should be correctly inserted in the sock et. I.e., BY MAKING CERTAIN THAT THE INCURVED EDGE OF METAL SOCKET ENGAGES WITH THE TRANSVERSE GROOVE OF THE SPLINT. Price : C om plete w ith tw o pairs of straps • - 4 / - per set. W ith o u t straps - - - - * - - - 3 / - per set.

★ ★

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M inor

u ries

“ Elastoplast ” wound dress ings stay in place, are quickly applied and stretch with the movement of the skin.

Remove protective muslin.

2. Place antiseptic

Pad on wound. 3. Press down

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byD A LB , R

FIRST AID ^ t j e J ttb tp e n te itf J o u r n a l / o r rtje A m b u l a n c e

N o .

594,

V o l.

L .]

a tib J f r u r s i t t g p e r u k e s

D E C E M B E R ,

Ju st

1943.

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O n e o r o t h e r o r all o f th e th re e races o f g e r m s , S tr e p to c o c c i, S ta p h y lo c o c ci a n d B. p y o c y a n e u s a re f o u n d in e v e r y s k in in fe c tio n c o m m o n t o t h i s c o u n t r y , a n d A N T I P E O L O I N T M E N T c o n t a i n s t h e antibodies ( a n t i v i r u s ) o f t h e s e g e r m s . H e a l i n g is e x p e d i t e d b y t h e p r o v e d i n g r e d i e n t s o f t h e o i n t m e n t , a n d s e p t i c d e v e l o p m e n t is s t o p p e d o r p r e v e n t e d b y i t s a n t i v i r u s s t e r i l e v a c c i n e f i l t r a t e s . A N T IP E O L O I N T M E N T is u n s u r p a s s e d f o r B U R N S a n d S C A L D S , f o r i t is m i c r o b i c i d e a n d n o n - a d h e s i v e , a n d d r e s s i n g s d o n o t r e q u i r e t o b e c h a n g e d e v ery day. W O U N D S , B U R N S , e t c , W I L L N O T T U R N S E P T I C if tre a te d w ith A N T I P E O L O I N T M E N T .

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R H I N O -A N T I P E O L affords ra p id relief o f C O M M O N C O L D S , I N F L U E N Z A , A N D C A T A R R H . C o n ta in in g the a n tib o d ie s o f the g e r m s c o m m o n to infections o f th e n o s e a n d p h a la n x (Staphlylococci, Strep to co c ci, B. p y o cy an eu s, p n e u m o c o c c i, p n e u m o b a c illi, e n te ro c o c c i, M . c atarrh a lis, B. P f e i f f e r ) , R h i n o - A n t i p e o l is n o t j u s t a p a l l i a t i v e , b u t is a r e m o v e r o f t h e cause o f t h e i n f e c t i o n . D u r i n g e p i d e m i c s i t is t b e id e a l p rev en tiv e o f m ic ro b e d evelopm ent.

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" FIRST AID ” WALL

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L e tte rs to th e E d i to r

T h e C o tto n W o o l S a n d w ic h

F.A . P u z z le C o rn e r

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R ev iew 's

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D E C E M B E R , 1943.

N O T IC E

E d it o r ia l —

F.R .Sin.l.,

C o r r e s p o n d e n t s :—

R esu scitatio n E x a m in a tio n H o w le r F r a c tu r e d L e g a n d T o r n V a ric o se V ein H y p n o t i c P o i s o n s ... A R e a d e r ’s D i l e m n a C o m p r e s s io n of T e m p o r a l A rte ry T r e a tm e n t of B ru ises P a ra ly s is of L im b s in A p o plex y H u m o u r in F i r s t A id C a p a c ity of L u n g s ... A m o u n t of B lo o d in B o d y ... C arb o n M o n o x id e P o iso n in g F r a c tu re d F e m u r a n d S p ra in e d A n k le F r a c t u r e o f B o t h C l a v i c l e s ... M e th o d of C h a n g in g O p e ra to rs G a s P o iso n in g a n d B ro k en N eck L a y I n s t r u c t o r C e r t i f i c a t e s ... E lectric S h o c k a n d A sphyxia S y n co p e, S h o c k a n d C o llap se T ria n g u lar B andage

68 68 68 68

70 70 70 70 70 70 70 70 70 72 72 72 72 72 72 72

to the profession was

A m plification the announcement that (to quote of the “ N u r se s’ the heading of the many comC harter.” mentatory and commendatory

articles upon it which appeared in the press) “ 17,000 nurses were to share ,£500,000 pay increase.” It does look, at long last, that the profession is to come into its own, and that the Government is at last seriously con cerning itself with salaries, conditions of service, uniforms, hours of work, night duty, holiday pay and sick pay— to mention the more important matters having immediate effect upon the members of theprofession. The new national scales to which we refer are recommended by Lord Rushcliffe’s Committee in a report published as a White Paper and accepted by the Government. Mr. W illink, Minister of Health, is asking all employ ing authorities to adopt the scales with retrospective effect to April 1 this year, and has agreed to meet half the extra cost, which is estimated at £500,000 a year. Among those who are affected by the new scale, the following may be cited: Nurses employed in the public health services, including health visitors, superintendents of infant welfare, regis tered nurses in dental work, school nurses and nurses in V.D. clinics ; district nurses and district nurse midwives ; State-registered nurses in day and residential nurseries, and male nurses in hospitals and public assistance institutions. Hospital nurses generally and midwives have already been put on national scales, and the new report completes what has been called the “ nurses’ charter.” The total cost of all the increases is about £',750,000 a year, and the new scales will apply in England and Wales generally with extra allowances in some cases in the London area. In most instances they will mean undoubtedly substantial increases. There will of course be a certain amount of disappoint ment, together with something in the way of heart burning and bickering at the amount and allotment of the scales, but we do consider that on the whole, and on a dispassionate and non-partisan view of the matter, the Government are to be congratulated upon their decisions. Of course, in times like the present, a few millions more or less are of small

F I R S T

moment, for there are appalling calls upon the country’s finances. W e are confident that the members of the profession will, as a body, accept the increased salaries and emoluments and the general bettering of conditions in the right spirit. W e had almost said “ gratefully ” ; but that is not the word to use when nothing above one’s dues is accorded.

E x p e r e n t ia D o ce t. Bv

T H E

V IC T IM .

( Continued, from p a g e 5 b . )

T h e first t h i n g t h a t I re a lis e d w a s th a t, a p a r t fro m th e a n k le , 1 h a d n o p a in w h a te v e r in sp ite of th e fa c t th a t a g la n c e a t m y left k n e e s h o w e d tw o n e a t h o le s w h e r e th e '45 c a l i b r e b u l l e t h a d d r i l l e d i t c l e a n l y f r o m s i d e t o s i d e . I f e l t r a t h e r g l a d a b o u t t h a t a n d f o r a m o m e n t s u r v e y e d it w ith c o m p lete d e ta c h m e n t. I h a d a lw a y s , in le c tu r in g to F i r s t A id P e rs o n n e l, im p r e s s e d u p o n th e m t h a t local p a in , e x c e p t in c e r ta in r a r e in s ta n c e s , w a s u n u s u a l in w o u n d s fro m b u llets or b o m b fra g m e n ts . I k n e w fro m tw e n ty -fiv e y e a rs e x p e r ie n c e of s u r g e r y in p e a c e a n d w a r t h a t it w a s tr u e , b u t a lw a y s a t t h e b a c k of m y m in d I w o n d e r e d h o w t r u e it w o u ld b e “ W h e n it h a p p e n e d to o n e s e lf . ” N ow I knew , and w as d u ly in te r e s te d in t h e b e a u tif u l e x a m p le of lo cal s h o c k . B y th is tim e I w a s b e g in n in g to re alise o n e o r tw o o th e r th in g s. F i r s t l y , t h a t if I d i d n o t g e t h e l p , a n d t h a t q u i c k l y , th e re w a s g o in g to be tro u b le. A h e a v y c a lib re rev o lv er b u l l e t t h r o u g h a k n e e j o i n t , e s p e c ia lly in a d i r t y c h i c k e n y a r d , m i g h t e a s i l y c o s t t h e l i m b a n d e v e n life. P ain w as i n e v i ta b ly g o i n g to b e s e v e r e a s s o o n a s t h e p h a s e of lo c a l s h o c k p a ss e d , a n d a lr e a d y s y m p to m s of g e n e r a l s h o c k w e re b e c o m in g o n ly to o o b v io u s. M e m b e r s of m y F i r s t A id P a r t y w e r e a m o n g m y close n e ig h b o u rs a n d h elp w a s soon a t h a n d . M y first r e q u e s t w a s fo r m o rp h ia , a n d h a lf a g r a in so o n re d u c e d m e to th a t c o n d i t i o n in w h i c h it is p o s s i b l e f o r t h e i n j u r e d m a n t o b e in c o m p le te c o m f o r t a n d y e t o b s e r v e d is p a s s io n a te ly all th a t g o e s on a ro u n d h im . B y t h a t t i m e a ll t h e c la s s ic a l s y m p t o m s of s h o c k w e r e ap p aren t. I felt a s t h o u g h it w e r e a n A rc tic w i n t e r in s te a d of a h o t s u m m e r e v e n in g , w a v e s of g id d in e s s a n d n a u s e a s w e p t o v e r m e a n d I w o n d e re d h o w m a n y of th e p a r ty w o u ld r e m e m b e r m y oft r e ite r a te d o r d e r s t h a t w h e n first h a n d l i n g a s h o c k e d c a s u a lty th e y w e r e to t h i n k o n ly of th e fo u r g r e a t c a u s e s of s h o c k — H a e m o r r h a g e , P a in , C o ld a n d F e a r. H o w o fte n h a d I s e e n in e x e r c ise s a n d p ra c tic e s , p eo p le w h o b la n d ly left th e ir m o c k c a s u a ltie s e x p o s e d to all th e w in d s of H e a v e n w h ile th e y e n e rg e tic a lly sp lin te d s o m e im a g in e d fractu re. I t h o u g h t ev e n of th e u n fo rg iv e a b le sin w h ic h I h a v e see n c o m m itte d by so m a n y — th a t of carefu lly b la n k e tt i n g a s tr e tc h e r w h ile th e c a s u a lty r e c e iv in g first a id lay exposed. T h e p a rty h o w e v e r w e re r u n n in g tr u e to form . T h e i r le a d e r w a s a lre a d y b y m y sid e s littin g u p th e tro u s e r le g a n d su rv e y in g w ith a p rofessional eye tw o n eat h o l e s f r o m w h i c h , I feel s u r e to h e r d i s a p p o i n t m e n t , n o t o n e s p o t of b lo o d e m e rg e d . H o w o fte n h a d 1 told th e m , I a lw a y s felt s u r e to t h e i r c o m p le te d isb elief, t h a t s e v e re h a e m o r r h a g e a t le a s t w a s u n u s u a l in w a r w o u n d s u n le s s a l a r g e vessel w as dam aged. M ea n w h ile , b la n k e ts h a d been sw a th e d a ro u n d m e le a v in g o n ly 'th e le g exp o sed , w h ile h o t b o ttles w h ic h m u st h a v e b o iled by m a g ic , w e re tu c k e d b esid e m e. I l a y in c o m p a r a t i v e c o m f o r t w a t c h i n g a s f r o m a n o t h e r

A I D w o rld th e p a rty w o rk in g u p o n m y leg. I c o u ld a l m o s t feel th e th o u g h ts c h a s in g o n e a n o th e r th r o u g h th e m in d of th e leader. W h a t h a v e I b e e n to ld to d o w ith a n y w o u n d ? C o v e r it a t o n c e w i t h a s t e r i l e d r e s s i n g . R ig h t. T w o shell d re s s in g s p u t on w ith o u t to u c h in g th e sterile s u rfa c e s a n d m a d e fa st w ith a t r i a n g u l a r b a n d a g e so lv ed t h a t p ro b le m a t once. T h e n e x t q u e stio n w a s not n e arly so easy a n d I s y m p a t h i s e d m e n t a l l y w i t h h e r d if f ic u ltie s , a l t h o u g h I w a s in n o c o n d itio n to so lv e h e r p ro b le m s . She k n ew th a t she had to m o v e m e s o m e tw e n ty m ile s by a m b u la n c e to th e n e a re s t la r g e h o s p ita l a n d t h a t e fficient s p lin tin g w a s e ss e n tia l. She k n e w to o t h a t th e flex ed k n e e s h o u ld b e s t r a i g h t e n e d a n d th a t th e d o in g so w o u ld be no fu n a n d g a m e s. S h o u ld it be a T h o m a s o r a c o m fo rta b ly p a d d e d b a c k sp lin t w ith a footp iece a n d sid e sp lin ts ? T e c h n i c a l l y t h e a n s w e r d e p e n d e d u p o n t h e d e g r e e of d a m a g e to th e jo in t. U n d o u b t e d l y , if t h e b o n e s h a d b e e n s h a t t e r e d , a T h o m a s w a s t h e r i g h t a n s w e r , b u t t h e l o o k of t h e j o i n t d i d n o t s u g g e s t it. T h e e x it w o u n d w a s n o la rg e r t h a n th e e n tr a n c e a n d o b v io u sly n o m a s s of s h a tt e r e d b o n e f r a g m e n ts h a d d riv e n o u tw a r d s w ith th e e m e r g in g p ro jectile. A c t u a l l y the' s t e e l c o a t e d b u l l e t h a d d r i l l e d i t s w a y n e a t l y t h r o u g h o n e c o n d y le of t h e f e m u r a n d , t h e jo in t b e in g fully flexed, h a d e m e r g e d t h r o u g h t h e l i g a m e n t u m p a te lla e w i t h o u t to u c h i n g th e tib ia. W h e th e r o r n o t th e ir k n o w le d g e allo w e d of a n a c c u ra te d ecisio n , I d o u b t, b u t w h a t I d id a d m ir e w a s th e fa c t th a t th ey m a d e th e ir decisio n w ith o u t h o ld in g a m o th e rs ’ m e e tin g a b o u t it. H o w o fte n d o es o n e see th e b a d ly tra in e d p a rty a r g u i n g v o lu b ly a s to w h e t h e r a c e r ta in t h i n g s h o u ld o r sh o u ld n o t be done, a n d I h a v e a lw ay s m a in ta in e d th a t I w o u ld r a t h e r a le a d e r c a p a b le of m a k i n g a d ecisio n a n d c a r r y i n g it o u t p r o m p t l y , e v e n if it b e w r o n g , r a t h e r t h a n o n e w h o w o u ld h e s ita te a n d sp lit h a ir s u p o n u n im p o r ta n t te c h n ica lities. A t a n y r a te in m y c a s e th e r e w a s n o a r g u m e n t a n d a b a c k s p lin t a p p e a re d w ith sid e p ieces, fro m th e h a n d s of a p a n tin g m essenger. N o w t h e w o u l d - b e f ir s t a i d e r is c a r e f u l l y i n s t r u c t e d b y h is p a sto rs a n d m a ste rs, th a t before s p lin tin g a fra c tu re — or e q u a lly a n in ju r e d jo in t— it m u s t b e s t r a i g h t e n e d b y firm a n d s te a d y tra c tio n , a n d 1 h a d o ften w o n d e re d h o w h e w o u ld fa c e u p to it in a c tu a lity . D e lib e ra te ly to c a u s e a c o n scio u s p a tie n t p a in calls fo r v ery c o n sid e ra b le n e rv e h o w e v e r c o m fo rtab le th e su b se q u e n t re su lt m a y be. T h e a m a te u r alm o st i n v a r i a b l y t e n d s t o d o o n e o f t w o t h i n g s , e i t h e r , f e a r f u l of c a u s i n g p a in , h is effo rts a t e x te n s io n a r e t r e m b l i n g a n d in effective, o r d e t e r m i n e d to b e d e c isiv e , h e b e c o m e s r o u g h . M y p a rty w ere m a k in g no m ista k es, h ow ever, a n d I n o tic e d w ith c o n s id e ra b le joy th e w a y in w h ic h th e ir le a d e r h a d by n o w p u lled h e r p a rty to g e th e r a n d w a s u tilis in g e ac h o n e to th e b e st a d v a n ta g e . L e a d e rs h ip h a d a lw a y s s e e m e d to m e to be th e m o st difficult t h i n g in th e w o rld to te a c h . S o m a n y people in te r p re t it to m e a n w h a t in fa c t is t h e la s t t h i n g t h a t it d o e s m e a n — n a m e ly a fu ssy s u p e r v is io n of th e u n i m p o r t a n t d e ta ils of o th e r p e o p le s w o r k . T h e y a p p e a r to b e to ta lly u n a b le to see th e w o o d fo r th e tre e s a n d c a n s e ld o m b e m a d e to a p p r e c i a te t h a t it is n o t t h e w o r k of t h e in d iv id u a l t h a t m a t t e r s b u t t h a t of th e u n ified w h o le. S p lin ts, p a d s a n d b a n d a g e s lay n e a tly b e sid e m e , th e s t r e t c h e r , b l a n k e t t e d a n d w i t h h o t w a t e r b o t t l e s u p o n it, la y r e a d y a t m y fe e t, a n d I c o u ld a l m o s t s w e a r to t h e g l e a m of d e t e r m i n a t i o n i n t h e l e a d e r ’s e y e s . S h e d id it, to o , m a g n i f i c en tly . W ith h e r sec o n d in c o m m a n d s te a d y in g th e foot a n d h o ld in g it firm a t th e a n k le , h e r o w n s t r o n g h a n d s slid u n d e r t h i g h a n d l e g a n d I felt t h e m h e ld in a g r i p w h i c h a t o n c e g a v e m e co n fid e n t k n o w le d g e th a t I n e ed fe a r n e ith e r te m e rity o r ro u g h n e ss. W ith o n e s tea d y m o v e m e n t th e lim b w a s s tra ig h t, w ith littl e m o r e t h a n a s i n g l e s t a b of p a i n , a n d I fe lt it l o w e r e d w ith o u t a ja r on to th e sp lin t, re a d y p a d d e d , w h ic h w a s

F I R S T slip p e d b e n e a t h it. E v e n th e p ad b eh in d th e k n e e a n d th a t b e n e a th th e T e n d o A chillis, k e e p i n g th e p o in t of t h e h eel ra is e d c le a r of th e sp lin t, n e e d e d o n ly fr a c tio n a l a d j u s t m e n t , a n d in le ss t h a n a m i n u t e s id e s p lin ts a n d p a d s w e r e in p o sitio n a n d t h e w h o le m a d e fa s t w ith b a n d a g e s . W i t h th e le g s e c u re ly c o n tro lle d fr o m w ell u p th e th i g h to t h e fo o t, n o t h i n g w a s to b e g a i n e d b y t y i n g t h e l e g s t o g e t h e r a n d a l m o s t b e f o r e I r e a lis e d it I f o u n d m y s e l f lifted s m o o t h l y o n to t h e k n e e s o f t h r e e of t h e w o m e n a n d t h e n c e to th e s tre tc h e r. H o w I m e n ta lly c o n g r a t u l a t e d m y s e lf u p o n t h e p o lic y w h ic h 1 h a d a lw a y s in siste d u p o n in t r a i n i n g th e p e rso n n e l of F ir s t A id P o in ts o v e r a v e ry w id e a re a .

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Reviews. A d v a n c e d A . J?. P . Q u estio n s A n s w e r e d . B y R . D . W o r m a l d , M .A ., L .A .R .P ., a n d J. M . Y o u n g M .A ., L . A .R . P . L o n d o n : Jo rd a n & S o n s L td. P r ic e 2/6 ; by p o s t 2IS. E a r l y in th is w a r th e s e a u t h o r s c o m p ile d a b o o k le t w h i c h t h e y c a l l e d 250 A . R . P . Q u estio n s A n s w e r e d . They h a v e n o w p r o d u c e d a m o r e a d v a n c e d s e t w h i c h c o n t a i n s 400 q u estio n s a n d a n sw e rs . T h e s e d e a l w ith F i r s t A id in A ir R aid s ; L ig h t R es c u e W o r k ; th e use of ropes, k n o ts, la s h in g s a n d o th e r e q u ip m e n t of th e H e a v y R e s c u e S e rv ic e s ; F ire S erv ices ; D e c o n ta m in a tio n a n d In c id e n t C o n tro l. T h e boo k p ro v id es a re a d y m e a n s of te s tin g th e k n o w le d g e g a i n e d a t le c tu re s , a n d w ill a ls o e n s u r e a c o n v e n ie n t b a s is for r e v is io n c la s s e s .

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T h e a u t h o r , w h o is F i r s t A id a n d A . R . P . O ffice r, L o n d o n A m b u la n c e S erv ice, s e ts o u t in a c le a r a n d c o n cise w ay th e tra in in g of co m p e titio n te a m s. H e d e a ls w ith h is su b jec t in th re e m a in p a rts. I n th e first h e re fe rs to th e ru les a n d r e g u la tio n s , th e te sts (te a m a n d in d iv id u a l, a n d t r a n s p o r t ; in th e s e c o n d h e d e sc rib e s th e n e c e s s a r y q u a lifi c atio n s of th e m e m b e rs of th e te a m ; a n d in th e th ird h e e la b o r a te s o n p o in ts in f o r m in g a d ia g n o s i s a n d in e x a m i n a tion ro u tin e , H e rig h tfu lly cla im s th a t h a rd w o rk a n d c a re fully p l a n n e d t r a i n i n g p r o v i d e t h e k e y n o t e o f s u c c e s s ; a n d h e r e c o r d s h is be lie f t h a t c o m p e titio n t r a i n i n g is b y f a r t h e m o s t e ffectiv e m e a n s of i m p r o v i n g th e th e o r e tic a l a n d p r a c tical a b ility of t h e first a id e r.

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by p o st 1 /-. T h i s b o o k h a s b e e n c o m p i l e d b y t h e a u t h o r , w h o is C a s u a lty S e rv ic e s S ta f f O fficer a n d F i r s t A id I n s t r u c t o r fo r th e B o ro u g h of W a n d s w o rth . It h a s been w ritte n w ith th e o b ject of h e lp in g th e in d iv id u a l m e m b e r s of a c o m p e titio n team , a n d p a rtic u la rly th e lead er ; a n d th e in fo rm a tio n a n d a d v i c e w h i c h it c o n t a i n s is b a s e d o n p r a c t i c a l e x p e r i e n c e . C o n s e q u e n t l y , t h e s e n o t e s w ill p r o v e o f r e a l v a l u e to first a id e rs w h o a r e a n x io u s to d e v e lo p th e i r k n o w l e d g e a n d ex p erien ce. R en e w a l

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S t . J o h n A m b u l a n c e B r ig a d e H EA D Q U A R TER S AN DD ISTR ICT R E PO R TS. No. I (Prince of Wales’s) District 58/5 ( W e s t e r n P o s t a l a n d S t . M a r y l e b o n e ) . — O n W e d n e s d a y a f t e r n o o n , N o v e m b e r 17 t h , 44 m e m b e r s o f H . M . F o rc e s d re s se d in “ H o s p ita l B lu e ” w e re su cc e ssfu lly e n te r t a i n e d b y t h e S t . M a r y l e b o n e D i v i s i o n s , S . J . A . B . , a t 30 , G lo u c e s te r P lace, W . l . T h e b o ro u g h w a s re p resen ted by H is W o r s h ip th e M a y o r a n d L a d y M a y o r e s s M rs. S tiles-A llen , th e B ritish R e d C ross by L a d y S u ird a le a n d M rs. F e w ster, w h ile W . L . D a v ie s E s q ., P o s tm a s te r , a n d W . F . G a b b ita s a t t e n d e d o n b e h a lf of th e W e s t e r n D i s t r i c t P o s t O ffice. • T h a n k s to th e e n e r g ie s of D iv is io n a l S u p t. W . V . M. A llen , s p le n d id a r r a n g e m e n t s w e r e m a d e to g iv e th e s e b o y s a n d g irls a real b re a k fro m h o sp ita l ro u tin e. A su m p tio u s te a w a s p ro v id ed by S g t. J. C. M a y e rs w h o se h a r d w o rk w a s re w a rd e d by th e h a p p y faces p e rfo rm in g co n tin u e d ja w exercise. L ig h t e n te rta in m e n t w a s p ro v id ed by F r e d C la rk a n d h is P o s ta l C o n c e rt P a r t y w h o k e p t th e g u e s ts in h ig h s p irits, e sp e c ia lly so w h e n B illy W illia m s g o t o v e r w ith “ O n th e ro a d to M a n d a la y .” A t 4 .3 0 p . m . E . N . S . A . t o o k o v e r b e i n g r e p r e s e n t e d b y : A lfred G r a n t , c o m p e r e , s i n g e r a n d s to ry te lle r, M iss S te lla S w a in e , pian ist, a n d G ip sy L illian , acco rd io n ist. T h i s trio w a s e x c e lle n t f a r e a n d th e i r h a r d w o r k is w o r t h y of s p e c ia l m en tio n . T h e in e v ita b le e n d c a m e a ll to s o o n , w ith S u p t. A llen e x p la in in g th a t h o sp ita l ru les fo rb ad e th e c o n tin u a n c e of th e p a r t y b e y o n d 5.30 p . m . . T h e rep ly c a m e fro m a p a tie n t, w h o in w e ll-c h o s e n w o rd s , t h a n k e d all re s p o n s ib le fo r a g r a n d aftern o o n . T o t h e s t r a i n o f “ F o r h e ’s a j o l l y g o o d f e l l o w , ” fo llo w ed b y “ T h e K i n g , ” th e c u rta in w a s r u n g d o w n o n a very p le a sa n t g a th e rin g . T h i s o p p o r t u n i t y is t a k e n t o e x p r e s s t h a n k s to t h e m a n y frien d s w h o s e n t g ifts of c a k e , ta rts , ja m , te a , s u g a r a n d c i g a r e t t e s , e t c ., a fine g e s t u r e to a w o r t h y c a u s e .

C ou n tyof N orth ,E ast an dM id-D evon . A t th e a n n u a l m e e tin g of th e S id m o u th A m b u la n c e D iv i sio n , o v e r w h i c h M r. B e r n a r d H e a p e p re s id e d , t h e a c c o u n t s w e re p r e s e n te d b y M r. J. E. M u m m e r y , th e t r a n s p o r t a c c o u n t s h o w i n g a b a l a n c e o f £ 3 0 9s . 6 d . , a n d t h e g e n e r a l f u n d a c r e d i t o f ; £ 458, t h i s l a t t e r b e i n g h e l d i n r e s e r v e t o w a r d s t h e p u r c h a s e of a n e w a m b u la n c e . M r. A. H . B ailey , p r e s e n ti n g th e s e c re ta ria l a c c o u n t, s t a t e d t h a t t h e y e a r ’s w o r k h a d b e e n s a t i s f a c t o r y . The s t a n d a r d of e fficiency h a d b e e n w e ll m a i n t a i n e d , t h a n k s to th e tim e a n d h a rd w o rk p u t in b y S u p t. A. W . Iiis h . S ix n e w m e m b e rs h a d b een e n ro lled , all of w h o m h a d p a sse d th e ir first e x a m in a ti o n . T h e n u m b e r of m e m b e rs n o w serv i n g w i t h t h e F o r c e s w a s 17 . I t h a d j u s t b e e n le a r n t o n e of th e m , M r. R id o u t, h a d d ie d in a c tio n . O n b e h a lf of th e O r d e r h e e x te n d e d to t h e re la tiv e s t h e i r s in c e re s y m p a t h y . A n o u ts ta n d in g e v en t w a s th e p re s e n ta tio n of L o n g S erv ice M e d a l s f o r 15 y e a r s ’ s e r v i c e t o S u p t . A . W . I r i s h , A m b u la n c e O fficer W . T u r n e r , S e rg t. P arso n s,* S e rg t. H a r t a n d C p l. O ld re y . T h e a m b u l a n c e h a d t r a v e l l e d 1,743 m i l e s , c a r r y i n g 141 p a t i e n t s . S u p t. Irish said th e w o rk of th e B rig a d e , u n d erstaffed a s it w a s , h a d b e e n v e r y h e a v y . T h a n k s t o t h e e f f o r t s of M iss P a g e , th e B rig a d e w a s a t p re s e n t b e tte r h o u s e d th a n e v er before. In c o n clu sio n , h e sp o k e of th e g o o d w o rk d o n e by th e A m b u lan ce S a v in g s G ro u p .

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C ou n tyof H am p sh ire. A n u m b e r of C a d e ts of th e A ld e rsh o t N u r s in g D iv isio n

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w e r e e n r o l l e d o n S a t u r d a y , N o v . 27 t h , a t t h e H o l y T r i n i t y H all. C o u n ty C a d e t O fficer M iss M a c k e n z ie , w h o p re s e n te d th e c e rtific a te s of m e m b e r s h ip , c o m p lim e n te d th e C a d e ts a n d th e O fficer (M rs. B ish o p ) o n th e v e ry s m a r t p a r a d e , a n d s a i d :— “ I w a n t y o u to t h i n k w h a t m e m b e r s h i p of th e S t. J o h n m eans. I t m e a n s , a m o n g s t o t h e r t h i n g s , m e m b e r s h i p of o n e of t h e g r e a t e s t s o c i e t i e s of c h i v a l r y a n d h u m a n i t y e v e r c re a te d by m a n a n d in sp ire d by th e C h ris tia n Id eal. I t is a s o c ie ty c r e a t e d b y t h e id e a ls of a f e w m e n n e a r l y 1 ,0 0 0 y e a r s a g o in P a le s tin e to h e lp th e ir le ss f o r tu n a t e fello w m e n a n d w om en. F r o m th is g r e w th e g r e a t a n d p o w e rfu l I n te r n a tio n a l B ro th e rh o o d k n o w n th ro u g h o u t th e w o rld as th e O r d e r of th e H o s p i ta l of S t. J o h n ot J e r u s a l e m , c h a m p i o n s of t h e C h r i s t i a n c iv ilis a tio n , a n d in p r e s e n t t i m e s t h e St. S t. J o h n A m b u la n c e A s s o c ia tio n a n d S t. J o h n A m b u la n c e B rig a d e w h ich h av e s p r u n g fro m th e O rd e r. Y ou have b e e n p r iv i le g e d to b e c o m e a m e m b e r o f a w o r l d - w i d e b r o t h e r h o o d , p l e d g e d t o t h e s e r v i c e t o m a n k i n d a n d t o t h e G l o r y of th e F a ith .” A t t h e c o n c l u s i o n o f M i s s M a c k e n z i e ’s s p e e c h , t h e C a d e t s f o r m e d a S t. J o h n C ro s s w ith ro lle r b a n d a g e s . T h e C ad ets w h o p assed th e e n tra n c e e x a m in a tio n s w ere Jo ce lv n K ay P u g h , A n n M a c k a y , V alerie L ay, T h e lm a G o r d o n , P h y llis C ritta ll, V a le r ie V V arne, S te lla G re e n , G w y n e t h B all, S h irle y L a y , S te lla M a c k e n z ie a n d D o re e n F le n d ic a tt.

County of Lancashire. A t h e r t o n ' . — A s m a l l s t a i n e d g l a s s w i n d o w in t h e p o r c h of H o w e b r id g e C h u rc h w a s u n v eiled a n d d ed icated on S u n d a y a f t e r n o o n , N o v e m b e r 28 t h , t o t h e m e m o r y o f M a r y A n n e P a s q u ill, L a d y S u p t. of th e A th e r to n S t. J o h n A m b u la n c e N u r s i n g D i v i s i o n i r o m 1929 t o 1943 , a n d C h r i s t o p h e r R o b i n s o n , S u p t . o f t h e A t h e r t o n D i v i s i o n f r o m 1920 t o 1930 . T h e w in d o w w a s d e d ic a te d d u r i n g a sp ec ia l serv ice w h i c h w a s h e ld in H o w e b r i d g e C h u r c h a n d w h i c h w a s a t t e n d e d by m e m b e r s of th e A th e r to n S .J .A .B . a n d N u r s i n g D iv isio n . B efo re th e se rv ic e a p a r a d e of th e D iv isio n w a s h e ld a t “ T h e H in d le s ,” a n d w a s in sp e c te d by C o m m is sio n e r W . G . S m i t h , O B. E . T h e w in d o w b e a r s th e fa m ila r e ig h t p o in te d silv er c ro ss of t h e S . J . A . B . w i t h t h e L a tin m o tto “ Pro U tilita te H o m i n u m ” ( F o r th e serv ice of m a n k in d ) . U n d e r n e a t h is th e in s c r ip tio n : T h i s w in d o w w a s g iv e n b y th e m e m b e r s of th e A th e rto n A m b u la n c e a n d N u r s in g A sso c ia tio n D iv isio n s a n d o t h e r f r ie n d s in g r a t e f u l m e m o r y of M a r y A n n e P a s q u ill, L a d y S u p e r i n t e n d e n t , 1929 - 1943 , a n d C h r i s t o p h e r R o b i n s o n , S . B . , S u p e r i n t e n d e n t , 1920 - 1930 . ” T h e c h u rc h serv ice w a s c o n d u c te d by th e R e v . C. K . K. P r o s s e r , V ic a r of H o w e b r id g e , a n d M r. C le m e n t F le tc h e r read th e lessons. D u r i n g th e s i n g i n g of a h y m n th e V ic a r a n d r e p r e s e n ta tiv e s of th e D iv isio n p ro c e e d e d to th e c h u r c h p o rc h , w h e re th e w in d o w w a s u n v e ile d a n d d e d ic ate d . A n a d d re ss w as a fte rw a rd s g iv e n by C o m m issio n er S m ith , w h o also p aid trib u te to th e tw o la te m e m b e rs .

County of Northampton. R o t h w e l l . — A m o s t i m p o r t a n t d a y in th e a n n a l s of th e B r i g a d e in N o r t h a m p t o n s h i r e o c c u r r e d o n S u n d a y , O c t o b e r 17 t h , w h e n G r a n d P r i o r C a d e t B a d g e s — t h e f i r s t e v e r t o h a v e b e e n w o n in t h e c o u n t y — w e r e p r e s e n t e d to c a d e t s of th e R o th w e ll A m b u la n c e a n d N u r s in g C a d e t D iv isio n s, b y th e L o r d L i e u t e n a n t of th e c o u n ty , T h e M o s t H o n . T h e M a r q u e s s of E x e te r , K .G ., C .M .G ., K .S t .J ., w h o w a s a c c o m p a n ie d by th e M a r c h io n e s s of E x e te r, O .S t .J ., C o u n t}' P r e s id e n t. T h e c erem o n y w as w itn essed by re p re sen ta tiv e cad ets f r o m a ll C o r p s of t h e c o u n ty , a n d all D iv is io n s of th e K e tte r in g C orps. P r e v io u s to t h e p r e s e n ta tio n L o r d E x e te r in s p e c te d th e c a d e ts , a n d a n u m b e r of th e m g a v e a n e x c e lle n t d e m o n s t r a t i o n of fire f i g h t i n g , r e s c u e , f ir s t a i d a n d h o m e

n u rsin g .

R I D T h e L o r d L ie u te n a n t w a s w e lc o m e d to R o th w e ll by C a d e t O fficer J. C. L . A u stin , w h o re fe rre d to th e g r e a t h o n o u r a n d c o m p lim e n t h is L o r d s h ip h a d p a id to th e C a d e t D iv is io n s of th e B r ig a d e , in a t t e n d i n g to p r e s e n t th e B a d g e s . A v o te of t h a n k s to L o r d E x e t e r w a s p ro p o s e d by C o u n ty C o m m issio n e r D r. E. H . S h a w , J .P ., a n d seconded by L a d y C o u n t y S u p t . M r s . 1. J e n n i n g s , M . B . E . I n a d d itio n to th o s e m e n tio n e d a n u m b e r of o th e r d is tin g u is h e d v isito rs w e re p re sen t. T h e a r r a n g e m e n ts fo r th e w e e k e n d w e re in th e h a n d s of C a d e t O fficer J . C. L . A u s tin a n d L a d y C a d e t S u p t. M rs. E.

A u stin .

County of Sussex. T h e i m p o r t a n c e of t h e c o n t i n u e d e ffic ie n c y o f t h e St. J o h n A m b u la n c e B r i g a d e in S u s s e x w a s a p p a r e n t a t th e O f f i c e r s ’ T r a i n i n g C o u r s e h e l d o n N o v . 2 7 t h a n d 28 t h a t t h e P e lh a m S tre e t C o u n ty S chool, B rig h to n . A b o u t 100 o f f i c e r s a t t e n d e d , a n d s o m e o f t h e t o p i c s d i s c u s s e d w e r e P r o v is io n of A m b u la n c e S e rv ic e s, g e n e r a l D iv i s io n a l ro u tin e , sp ecial tra in in g s u b je c ts to be p a ss e d o n a t o n c e , a n d m a t t e r s to b e p r e p a r e d fo r i n t r o d u c t i o n i m m e d i a te ly th e w a r is e n d e d . T h e S .J .A .B . in S u s s e x h a s a n e x c e lle n t re c o rd . D ur i n g 1942 , i t s a m b u l a n c e s e r v i c e c o n v e y e d 7,055 p a t i e n t s a d i s t a n c e c o v e r i n g 114,131 m i l e s . P ractically every m e m b e r is to - d a y r e n d e r i n g s e r v ic e e i t h e r w i t h H . M . F o r c e s o r o n e of th e o th e r W a r S erv ices. M e m b e r s h a v e u n d e r t a k e n C iv il D e fe n c e d u tie s in e v ery d istric t. S u c h a r e c o r d is a s o u r c e o f g r a t i f i c a t i o n t o a l l m e m b e r s of t h e B r i g a d e in S u s s e x , w h e r e m e m b e r s c e r t a in ly m a i n t a i n th e m o tto of its O r d e r , “ F o r th e F a i t h a n d fo r th e S e rv ic e of M a n k i n d . ”

West Riding of Yorkshire. H u d d e r s fie ld C a d e t s .— T w en ty -fo u r can d id ates passed t h e i r f ir e - f i g h t i n g t e s t in t h e e x a m i n a t i o n fo r S t. J o h n A m b u la n c e B r ig a d e C a d e ts h eld re c en tly . T h e e x am in atio n w as u n d e r th e d ire c tio n of th e D iv is io n a l O fficer, H u d d e r s f ie ld D D iv isio n , N .F . S . , w h o r e p o r te d t h a t th e c a d e ts w e r e w ell ab o v e th e a v erag e , a n d w e re k een a n d in tellig en t. In th e e x a m i n a t i o n a l l t h e c a d e t s o b t a i n e d 75 o r m o r e m a r k s . T h e f o l l o w i n g w e r e s u c c e s s f u l :—

A m b u la n c e C a d e ts .— S erg ts. J. W h ite ly a n d P. L a v e n d e r , C p l. K . H a r r i s o n , C a d e t s B . H a r r i s o n , D . H a i g h , B. B eev ers, D . R o b e rts, D . H a rr is o n , S. W h ite ly , P. W a d e , L. C l a r k , P . B r o o k , R . W i l l i a m s , P . W a r d . J . N orclifife, C. C ap p ell, A. G u m b y a n d W . M c D e rm o tt. N u rs in g C a d e ts.— S erg ts. M. G reen a n d S. C o w h am , C p ls. M . L a y c o c k a n d M . D a y , L /C p l. D . W a l k e r a n d C a d e t N. Sykes.

P it s m o o r .— C o u n ty C a d e t O fficer W . B a n h a m o fficiated a t th e first r e - e x a m in a tio n of th e P it s m o o r A m b u la n c e C a d e t D iv isio n h e ld re c en tly , w h e n h e in s p e c te d th e D iv isio n , w h o p a ra d ed 68 m em b ers. T h o s e p r e s e n t in c lu d e d D iv . S u r g e o n P. N . G rin li n g a n d D iv . S u p t. G . B u x to n . C a d e t S u p t. R . W a i n w r i g h t a n d A c tin g C a d e t O fficer W . R i g b y w a s in c h a r g e of th e p a r a d e . *

A C o u r s e of L e c t u r e s f o r O ff i c e r s of N u r s i n g U n i t s of th e W e s t R i d in g of Y o r k s h ir e w a s h e ld a t th e H o te l M e tro p o l e , L e e d s , d u r i n g t h e w e e k - e n d D e c e m b e r 4 - 5 t h , 1943 . O v e r 150 O f f i c e r s f r o m a l l p a r t s o f t h e W e s t R i d i n g o f Y o r k s h ire a tte n d e d a n d w e re w e lc o m e d by a m e s s a g e fro m th e L a d y L o u is M o u n tb atten . T h e C h air w as ta k e n

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F I R S T C o m m is sio n e r M r. H . L . T h o r n to n , a n d on th e S u n d a y by th e L a d y D is tric t S u p t. M rs. B irk b e c k . M a n y in te r e s tin g le c tu re s w e re d e liv e re d b y s p e c ia lis ts in th e i r o w n s u b je c ts , a n d i n c l u d e d t h e f o l l o w i n g : H o w to te a c h first a id a n d h o m e n u r s i n g ; B lo o d t r a n s f u s io n ; O r g a n isatio n of N u r s i n g D iv is io n s ; I m p o r ta n c e of t h e C a d e t M o v e m e n t ; P r a c tic a l in s tr u c t i o n in D iv is io n a l d rill ; L e a d e r s h i p ; T r e a t m e n t of w a r w o u n d s ; V e n e r e a l d is e a s e ; H is to r y of th e O r d e r ; T r e a t m e n t of b u r n s ; O v e r s e a s c iv ilia n relief w o r k ; C h ild w e lfare. L a d y C o u n tv O fficer M iss A sh b e rr y p ro p o se d , a n d L a d y C o u n ty O fficer M iss U n t h a n k s e c o n d e d , a v e ry w a r m v o te of t h a n k s to L a d y D is tric t S u p t. M rs. B ir k b e c k fo r th e e x c e lle n t o rg a n is a tio n of su ch a n in stru c tiv e c o u rse a n d fo r h e r e n e r g e t i c a n d i n s p i r i n g w o r k in t h e W e s t R i d i n g a t all tim es.

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“ H o m e G u a r d e r ” s h o u l d r e m e m b e r t h a t , o w i n g to th e ir sp ec ia l c h a ra c te ris tic s, w a r w o u n d s o ften r e q u ire m u c h d ifferen t t r e a t m e n t to t h a t g iv e n in s tr e e t a c c id e n ts . The d a n g e r f r o m s e p s i s i s m u c h g r e a t e r , e s p e c i a l l y if f i g h t i n g is t a k i n g p la c e in o p e n , c u ltiv a te d c o u n try . T h e p rev alen ce of d u n g , e tc ., fo r i n s t a n c e , l e a d i n g t o g a s g a n g r e n e ; t h e d a n g e r of t e t a n u s a n d o th e r d is e a s e s u s u a ll y a ss o c ia te d w ith th e s e c o n d itio n s m a k e it e ss e n tia l t h a t n o t o n lv m u s t th e first a i d e r w o r k s k ilfu lly a n d q u ic k ly , b u t th e p a tie n t m u s t b e in th e h a n d s of th e s u r g e o n a s s o o n a s p o ssib le. N o a t t e m p t s h o u ld b e m a d e to c le a n s e th e w o u n d by w a s h i n g it. C l o t t i n g s h o u ld b e e n c o u r a g e d a n d fu ll u s e m a d e of t h e o f f i c i a l f i e l d d r e s s i n g s . T h e d o c t o r m a y fin d it n e c e s s a r y to p e r f o r m e x c is io n , w h e n h e w ill r e m o v e t h e c lo t a n d all d e a d t i s s u e s , o n w h i c h th e g e r m s feed, a n d ty i n g off a n y d a m a g e d v essels. T h is s h o w s h o w e s s e n t i a l i t i s t o s t a t e o n t h e p a t i e n t ’s l a b e l t h e d ate a n d tim e h e w a s w o u n d e d , as th e d o c to r c a n th e n ju d g e th e e x te n t of e x cisio n , a n d w h e t h e r th e w o u n d s h o u ld b e a llo w e d to d r a in , a s is n e c e s s a r y in p a r t i c u l a r fo r o ld e r w ounds. I n s t r e e t a n d t o w n f i g h t i n g t h e r e is, p e r h a p s , le ss d a n g e r fro m sep sis, b u t o w i n g to th e w e a p o n s u sed , lik e g r e n a d e s a n d lig h t a u to m a tic s , m u ltip le in ju rie s a re to be re c k o n e d w ith , a n d th o u g h e a c h in d iv id u a l w o u n d m a y n o t a p p e a r serio u s, to g e th e r th e y m a y be d a n g e ro u s . G r e a t c a r e in h a n d l i n g is e s s e n tia l, a n d s h o c k t r e a t m e n t m u s t b e g iv e n im m e d ia te ly , fo r w ith th e lo ss of b lo o d a n d a c c o m p a n y i n g p a in t h is w ill i n v a r ia b ly b e s e v e re . The p r o m p t a c t i o n o f s t o p p i n g o r r e d u c i n g t h e b l e e d i u g 'w il l h e l p t h i s , a n d if m o r p h i a c a n b e a d m i n i s t e r e d , i t w i l l d e a d e n t h e p ain a n d g iv e fu r th e r a ssista n c e . T hen, as reg ard s ban d ag in g . It sh o u ld be re m e m b e re d t h a t w h e n t h e b o d y is w o u n d e d a n d b l o o d e s c a p e s , t h e l a t t e r te n d s to clo t a n d p lu g th e w o u n d . T h e b lo o d vessels s u r ro u n d in g , th e n d ila te a n d b r in g a n in c re a se d s u p p lv o f w h ite b lo o d cells, w h i c h d e s t r o y g e r m s a n d f o r m a s o r t of b a r r i c a d e b e tw ee n th e so u n d a n d d ead tissu es. T h e s ig n s of th is process a re th e sw e llin g , re d n e ss a n d in c re a se d h e a t ro u n d th e w o u n d . O n n o a c c o u n t m u s t first a id in te r f e r e w ith th is, th e r e f o r e w a t c h t h e b a n d a g i n g clo sely . A bandage a p p lie d firm ly in t h e first p la c e m a y b e u n c o m f o r t a b ly a n d d a n g e r o u s ly tig h t in h a lf a n h o u r.

A I D

Letters to the Editor. W e a r e in n o w a y re s p o n s ib le fo r th e o p in io n s e x p re s s e d , o r th e sta te m e n ts m ad e, b y C o rre sp o n d en ts.— E d ito r .

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D e a r S ir , — In y o u r O c to b er issu e a c o rre sp o n d e n t ask s, “ w h i c h m e t h o d o f a r t i f i c i a l r e s p i r a t i o n — S c h a f e r ’s o r E v e ’s — g iv e s th e g r e a t e r r a te of a ir e x c h a n g e fo r e a c h r e s p i r a tio n ?” I n h is rep ly , y o u r H o n . M e d ic a l A d v ise r s ta te s , “ 1 t a k e it t h a t b o th m e th o d s g iv e a p p r o x i m a t e l y th e s a m e r a te of e x c h a n g e . ” I n t h e B . M . J . o f O c t o b e r 16 t h , 1943 , P r o f . M c I n t o s h , o f O x fo rd , r e p o r ts re s u lts of e x p e r im e n ts o n th is p o in t. He says, “ E v e ’s r o c k i n g s t r e t c h e r m e t h o d , w i t h t h e p a t i e n t p r o n e , r o c k e d t h r o u g h 90 d e g s . , g a v e a n e x c h a n g e o f 580 c . c . , S i l v e s t e r ’s m e t h o d , 400 c . c . , a n d S c h a f e r ’s , 340 c . c . ” T h e s e re s u lts m a y b e of in te re s t to y o u r q u e stio n e r. Y o u r s faith fu lly , B o w m a n E d g a r , M .B ., C h .B .

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S c h o o l H o u s e , N o e l - r o a d , W . 3. P u b lis h e rs N o t e .— W ill readers please note that all back numbers of “ First Aid ” are now out of print and cannot be supplied. W ill South African and other Colonial readers please add to their remittances, “ or English equivalent.”

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A s o n e o f t h o s e w h o h a v e b e e n t e a c h i n g E v e ’s m e t h o d o f re s u s c ita tio n in th e C o lc h e s te r d is tr ic t fo r o v e r tw o y e a r s, m a y I b e p e r m i t t e d t o r e p l y t o H . D . ( C o l c h e s t e r ’s ) q u e r y i n y o u r i s s u e o f N o v e m b e r , a n d t o a d d t o D r . C o r b e t F l e t c h e r ’s rep ly . S in c e P r o f e s s o r C o r d i e r p u b lis h e d h is a r t ic le in t h e B r itis h M e d ic a l J o u r n a l , P r o f e s s o r M a c k i n t o s h o f O x f o r d h a s c a r r ie d o u t f u r t h e r e x p e r i m e n t s r e p o r t e d in t h e s a m e j o u r n a l o n O c t o b e r 16 t h , i n w h i c h h e s h o w e d t h a t t h e v e n t i l a t i o n b y E v e ’s m e t h o d w a s o v e r a p i n t , b u t t h a t S c h a f e r ’s m e t h o d o n ly p r o d u c e d a little o v e r h a lf a p in t of a ir e n try . I n a d d i tio n to th is , m a y I a d d t h a t in a h a lf d e a d b o d \ t h e s tiffn e s s o f t h e d y i n g m u s c l e s , e s p e c i a l l y w h e n c o ld a s in d r o w n in g , te n d s to p r e v e n t c h e s t e x p a n s io n w h e n th e p r e s s u r e i n S c h a f e r ’s m e t h o d i s r e l e a s e d , b u t t h a t t h i s d o e s n o t i n t e r fere in th e s a m e w a y in ro c k in g . M oreover, D r. E v e cla im s t h a t r o c k i n g h e lp s th e b lo o d to c irc u la te in t h e b o d y o w i n g to t h e n o n - r e tu r n a c tio n of th e v a lv e s in t h e v e in s, w h ic h a llo w t h e b lo o d to flow d o w n to t h e h e a r t f r o m t h e le g s w h e n t h e h e a d i s d o w n , s o t h a t t h e r e is a m e a s u r e o f a r t i f i c i a l circu latio n . A g r e a t a d v a n t a g e o f r o c k i n g is t h a t it c a n s o q u i c k l y b e ta u g h t to a n in ex p erien ced b y stan d e r. T h e m o s t serio u s d is a d v a n t a g e is t h a t s o m e f o r m o f a p p a r a t u s is r e q u i r e d o n w h ic h to ro c k th e s tre tc h e r, a n d s o m e fittin g to h o ld th e m to g e th e r. M a n y v ery in g e n io u s g a d g e t s h a v e b e e n dev ised , s u c h a s t h a t d e s c r ib e d in th e O c t o b e r is su e , b u t th e y all h a v e th e s a m e fa u lt, t h a t t h e y a r e n e v e r fo u n d fitted to t h e s t r e t c h e r w h i c h is b r o u g h t a l o n g in t h e h u r r y of t h e e m e r g e n c y . I t is b e tte r in m y m in d fo r t h e first a i d e r to m a k e u s e of h is t r a i n i n g in i m p r o v is a t io n , a n d r i g u p , s a y , a h a n d c a r t o r a h u r d l e o n a w a ll, t h a n to te ly o n sp e c ia l a p p a r a t u s , w h ic h w ill b e fo u n d m o s t u s e f u l, k e p t fo r e x a m p l e , b y t h e d o c k s i d e in h a rb o u r areas. W ith r e g a r d to th e d rill r e c o m m e n d e d b y D r. B o w m a n E d g a r , I t h i n k t h i s is of g r e a t i m p o r t a n c e . C orporal M ayes of th e W iv e n h o e D iv isio n k i n d ly w o r k e d o u t fo r m e a n o t h e r m e th o d , w h ic h I s h o u ld lik e to s u b m it a s a n a lte rn a tiv e . W h i l e S c h a f e r ’s m e t h o d i s b e i n g c a r r i e d o n , a n d w h a t e v e r a p p a r a t u s is a v a i l a b l e f o r r o c k i n g is b e i n g p r e p a r e d , r o ll t h e p a t i e n t o n to a h a lf ro lle d u p b l a n k e t , t a k i n g a d v a n t a g e of th e in sp ira tio n p a u s e in th is w a y : A s th e o p e ra to r s w in g s b a c k , lift u p t h e o p p o s ite s id e of t h e p a t i e n t to t h a t o n w h ic h t h e o p e r a t o r is k n e e l i n g a n d p u s h u n d e r t h e r o l l e d b l a n k e t ; n o w c h a n g e o p e r a to r s a n d a t a c o n v e n i e n t m o m e n t lift u p th e o th e r sid e a n d pull th e b l a n k e t r i g h t th r o u g h . T o lift t h e p a t i e n t o n t h e b l a n k e t o n to t h e s t r e t c h e r , p la c e t h e s tr e tc h e r a t t h e h e a d of th e p a tie n t in lin e w ith h im

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a s fo r lo a d in g . S t i l l k e e p i n g u p S c h a f e r ’s m e t h o d , t h r e e h e l p e r s lift t h e p a t i e n t a b o u t a f o o t o f f t h e g r o u n d w h i l e a f o u r th slid es th e s tr e tc h e r b e n e a th , th e o p e r a to r m e a n w h ile k n e e lin g on o n e k n e e so th a t h e c a n g iv e o n e e x p ira tio n w h ile t h e p a t i e n t is s u p p o r t e d o n t h e b l a n k e t o ff t h e g r o u n d . To d o t h i s it is n e c e s s a r y t o k e e p t h e b l a n k e t q u i t e t a u t u n d e r th e abd o m en . T o lift t h e s t r e t c h e r w i t h t h e p a t i e n t o n to t h e tr e s tle , th r e e s te p s a r e t a k e n in t im e w ith re s p ir a tio n . T h e first o n e lif ts u p d i e s t r e t c h e r o n l y a b o u t n i n e i n c h e s , a n d it is h e ld th e re w h ile th e o p e ra to r, k n e e lin g o n o n e k n e e g iv e s o n e e x p ira to ry stro k e . T h e s e c o n d s t e p t a k e s t h e s t r e t c h e r to w a is t h e ig h t, th e o p e ra to r ris in g to h is feet a n d th e n g iv in g th e n e x t e x p ira to ry stro k e . T h e t h i r d s t e p is a s id e s t e p o v e r th e tre s tle p la c e d b e fo re h a n d clo se to th e m id d le of th e stretch er. It w ill b e fo u n d , by th e w a y , t h a t th e b e st p o sitio n fo r t h e t r e s t l e is n o t t h e e x a c t m i d d l e , b u t a l ittl e n e a r e r t h e h e a d e n d — o n th e steel A .R .P . s tr e tc h e r a b o u t th e th ird f a s t e n i n g of t h e w ire m e s h to th e s id e tu b e . I n t h i s d r il l t h e r e is n o n e e d to lo s e e v e n o n e b r e a t h t h o u g h of c o u rs e th e a m o u n t of p re s s u re p o ssib le o n a b l a n k e t in m i d - a i r is le s s t h a n it is o n h a r d g r o u n d . By b e i n g t h e p a t i e n t I h a v e s a t i s f i e d m y s e l f t h a t S c h a f e r ’s m e t h o d o n a s u s p e n d e d b l a n k e t is effective. Y o u r s faith fu lly , W a lte r

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A I D A n y m a l e p e r s o n o f 18 y e a r s o r o v e r ( s u b j e c t t o c e r t a i n c o n d i t i o n s n o t a p p e r t a i n i n g t o t h e w a i t e r ’s l e t t e r ) m a y b e c o m e a m e m b e r of a n A m b u la n c e D iv isio n of th e S t. J o h n A m b u l a n c e B r i g a d e if h e h a s o b t a i n e d t h e n e c e s s a r y F i r s t A i d C e rtific a te is s u e d b y th e S t. J o h n A m b u l a n c e A s s o c ia tio n o r B ritis h R e d C ro s s S ociety. A s th is c e rtific a te m a y be o b ta in e d a fte r a t t e n d i n g six D o c t o r ’s l e c t u r e s , a n d a l s o a m i n i m u m o f s i x h o u r s p r a c t i c a l i n s t r u c t i o n , a n d t h e n p a s s i n g t h e n e c e s s a r y e x a m i n a t i o n , it m u s t b e e x p e c te d t h a t th e p e r s o n is n o t a fu lly q u a lifie d “ a m b u l a n c e m a n ” in all its b ra n c h e s . T h e S t. J o h n A m b u l a n c e B r i g a d e is a n o r g a n i s a t i o n w h e r e t h e e n l i s t m e n t o f m e m b e r s is p u r e l y v o l u n t a r y , a n d it m u s t b e a s s u m e d , th e re fo re , t h a t a n y p e rs o n w h o a p p lie s for m e m b e rs h ip h a s a d e sire to s tu d y th e su b je c t fu r th e r a fte r h a v i n g re c e iv e d h is first c ertific a te . O n th is a c c o u n t, I w o u ld s u g g e s t to D . S. th a t h e sh o u ld p a s s o n to th e s e a p p a r e n t l y raw ' first a id e r s t h e b e n e fit of h is m o r e e x te n s iv e k n o w le d g e , w h ic h I a m s u r e w ill b e t h a n k fu lly re c e iv e d a n d d ig e s t e d b y th e s e d ire c te d m e m b e r s of h is F i r s t A id P o s t . — Y o u r s faith fu lly , D iv is io n a l

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I w 'a s v e r y i n t e r e s t e d t o r e a d t h e l e t t e r p u b l i s h e d in y o u r S e p te m b e r issu e from D r. B o w m a n E d g a r d e a lin g w ith a n i m p r o v i s e d m e t h o d o f p e r f o r m i n g E v e ’s R o c k i n g M e t h o d of R e s u s c i t a t i o n , a n d feel t h a t s o m e o f y o u r r e a d e r s m a y a lso b e in te re s te d in a n o th e r im p ro v isa tio n w h ich th e S h a r s t o n ( M e n ’s ) D e t a c h m e n t ( B . R . C . S . ) d e v i s e d l a s t M a y a n d p e r f o r m e d a s a n e x h ib itio n a t a lo cal S h o w in A u g u s t. T h e p a t i e n t is la id fa c e d o w n w a r d o n a n im p r o v is e d s tre tc h e r m a d e by tu r n i n g tw o tu n ic s (o r ja c k e ts) in sid e o u t a n d f a s te n e d t o g e th e r c o lla r to c o llar, artificial re s p ira tio n i s c o m m e n c e d i m m e d i a t e l y b y S c h a f e r ’s m e t h o d . M ean w h ile tw o b ro o m s tic k s o r s im ila r s to u t p o les a r e p a sse d t h r o u g h t h e s le e v e s o f t h e c o a t s a n d t h e p a t i e n t s e c u r e d to th is s tre tc h e r b y t r i a n g u la r b a n d a g e s , tw o c ro s s in g th e s h o u ld e rs fa sten e d to th e e n d s a n d m id d les of th e stick s, o ne a cro ss th e b u tto c k s also s e c u rin g th e a rm s a n d one a cro ss th e an k le s. W h e n th ese b a n d a g e s a re secu red , one o p e r a to r s t a n d s a t e a c h s id e of th e p a tie n t, g r a s p s th e b r o o m s ti c k w ith o n e h a n d a t th e m id d le o r p o in t of b a la n c e a n d o n t h e w ' o r d o f t h e o p e r a t o r p e r f o r m i n g S c h a f e r ’s m e t h o d , on th e p re ssu re “ o f f ” m o v e m e n t (in sp ira tio n ) th e o th er t w o r a is e t h e p a t i e n t f r o m t h e floor h e a d first a n d c o m m e n c e t h e r o c k i n g m e th o d in th e s a m e r h y t h m , th e th ir d o p e r a to r s ta n d s b y to ta k e o v e r fro m o n e o r th e o th e r a s re q u ire d . W i t h p ra c tic e , th e tim e ta k e n to im p ro v is e th e s tre tc h e r a n d secu re th e p a tie n t can be red u c ed to th re e m in u tes, an d t h e a i r e x c h a n g e is v e r y e ffe c tiv e . T h e b i g a d v a n t a g e o f t h i s m e t h o d i s , w e fe®l, i t s e a s y i m p r o v i s a t i o n , a n d t h e r e is n o n e c e s s i t y t o c a r r y a n y a p p a r a t u s f o r its p e r f o r m a n c e . W e l a r g e l y o w e t h i s m e t h o d t o o n e of o u r m e m b e r s , P te . B u c k le y , w h o , w h e n w e w e r e first e x p e r i m e n t i n g , s u g g e s t e d t h e u s e of t h e “ S c o u t ” s tre tc h e r . Y o u rs faith fu lly , W . A . W r ig h t s o n , C o m m an d an t. N o rth e n d e n , M an c h e ste r. T H E

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B R IG A D E .

S ir ,— T h e r e m a r k s of D .S . ( B i r m i n g h a m ) call for a rep ly , a n d I h o p e t h a t th e fo llo w in g in fo r m a tio n w ill e n lig h te n h im so m e w h a t.

A f e w y e a r s a g o a t O ly m p ia , d u r i n g o n e of th e fr e q u e n t e x h ib itio n s of th e p r e - w a r p e rio d , a m e m b e r of S t. J o h n w a s faced w ith a n u n u s u a l e m e rg e n c y . A ch ild , w h o h a d ju s t s w a llo w e d a n open safety-pin, w a s b r o u g h t in to th e a m b u la n c e ro o m b y its m o th e r. H e ro se to th e o cca sio n w ith v ery c o m m e n d a b le re so u rc e , a n d g a v e th e ch ild c o tto n w ool a n d b re a d to eat, w a s h e d d o w n w ith w a te r. T h e pin w a s s u b s e q u e n t l y s a f e ly r e c o v e r e d , e m b e d d e d in a m a s s of c o tto n w ool. I n A p ril th is y e a r th e w rite r c a m e a c ro ss in te re s tin g c o n f ir m a tio n of th e efficacy of th is t r e a t m e n t . A d o c to r, in a l e t t e r t o t h e B r it is h M e d ic a l J o u r n a l ( M a r c h 20 / 4 3 ), d e s c r i b e d a c a s e t h a t o c c u r r e d i n 1936 i n v o l v i n g a s o m e w h a t s im ila r p ro b le m — th e s w a llo w in g of p in s. In h is o p e n in g p a r a g r a p h , h e s a y s — “ T h e s w a llo w in g of s h a r p - p o in te d fo re ig n b o d ie s p re s e n ts a p ro b le m to th e p ra c titio n e r, o ften a t a m o m e n t ’s n o t i c e , a n d p r o v i d e s a s o u r c e o f a n x i e t y t o h im , h is p a tie n ts, a n d th e ir relativ es. I h a v e recen tly been s tr u c k by th e fact th a t so few d o c to rs re a lise th e v a lu e of th e co tto n w ool s a n d w ic h . T h e fo llo w in g c ase ex em p lifies th e v a lu e of s u c h .” T h e d o c to r th e n g o e s o n to d e s c rib e a c a se tr e a te d a t th e W h i te h a v e n a n d W e s t C u m b e r l a n d H o s p i ta l in S e p t e m b e r , 1936 . A d re s sm a k e r w as ra d io g ra p h e d th ere because sh e h a d sw allo w ed “ a p in .” T h e film d e m o n s t r a t e d t h e p r e s e n c e o f 23 p i n s a t a l l a n g l e s w i t h i n t h e g a s t r o - i n t e s t i n a l tra c t. T h e S ister ra d io g ra p h e r p ro m p tly g a v e th e p a tie n t a series of s m a ll c o tto n w ool s a n d w ic h e s, h a v in g im p r e g n a te d t h e t e a s e d - o u t c o t t o n w o o l w i t h b a r i u m s u l p h a t e i n o r d e r , if po ssib le, to fo llo w th e p r o g r e s s of th e p in s. T h e p r o g r e s s of th e p in s w a s e asily c h e c k e d e a c h d a y b y ra d io lo g ic a l m e a n s, th a n k s to th e b a riu m . G ro u p s of p in s w e re e v a c u a te d in tu rn a t d a ily in terv als, w r a p p e d in c o tto n w ool. I n th r e e d a y s all h a d b e e n e v a c u a te d , “ w ith o u t a n y p a in o r o n e d ro p of blood b e in g s h e d .” A m o n th a fte r th e lette r m e n tio n e d above, th e sa m e jo u rn a l p u b lish ed a n o th e r lette r on th e su b ject, th is tim e fro m a lad y v e terin ary su rg e o n . S h e s ta te d th a t a m o d ifica tio n of th is m e th o d h a s b e e n in u s e in th e v e te r in a r y p ro fe s s io n fo r s o m e tim e. D o g s a n d cats, s h e said, o fte n s w a llo w p in s a n d n eedles, U s u a lly th e se a r e fo u n d w ith th e p o in ts

F I R S T

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embedded in the walls of the mouth or pharynx, but some times they reach the stomach. In these cases the animals are given twenty to thirty small pellets of tightly rolled cotton wool, lubricated with lard or vaseline, followed in about an hour by a dose of liquid paraffin. The pins and needles are delivered in due course, neatly wrapped up in the centre of a roll of cotton wool. “ This treatment has saved many patients from the surgeon’s knife,” the veterinary surgeon concludes. The foregoing establishes that the ambulance man’s treatment was sound, but would have been improved from the point of view of palatability if the cotton wool had been teased out between thin bread and butter. Even so, it was a jolly good show ; let us hope that we fellow first-aiders will be able to demonstrate equal presence of mind and resource if faced with other first aid problems of a like urgency.

F .A .

P u zzle

C o rn e r.

W e have received the following from Inspector W. H. White, X. Div. M.S.C., prepared for one of his Revision Classes as a change from the usual routine Question and Answer :— 1 . Try cold first ........ 2 . Figure of eight for .... and double it fo r....... 3 . Pad sizes : four by two by two ......

4. 5.

6. 7. 8. 9. 10 . 11 . 12 . 13 . 14. 15 . 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35.

billiard ball ...... tennis ball small or large is needed for ..... ring pad for ...... The first is sleep, the others are ...... He throws his arms about ....... He burns like the desert ........ This is always present ......... This is sometimes absent ... do not despair do _ You note this first in every case .... Stop it ..... A large towel will do .... Refuse these for ...... This should be covered quickly _ No leg pull for ...... Don’t fish for .... With all the help available ... Up into the air ...... Heat has done this but apply hot flannels _ You must try to prevent this .... Raise or lower ... a matter of colour .... Onlyr two of you yet you supply a four ...... Let him sleep ... but keep this one awake .... It is marked by extreme thirst .... Give fluids freely' for .... It must have length, width & firmness, how much.... This is the only time when you hit your patient .... To give or not to give _ how do you know .. ? This is not your job, don’t do it .... Think of the “ Derby” _ He carried the world, it carries _ If it does not sxxxx, bxxx, or ixxxxxxx it is perfect. These are frowned upon ............ Don’t try to take his place he knows more than you ... Use this one, he knows less than you .... Four under, two over ...

R I D

Queries and Answers to Correspondents Q u e r i e s w i l l b e d e a lt w i t h u n d e r t h e f o l l o w i n g r u le s :— 1 . — L e t t e r s c o n t a i n i n g Q u e r i e s m u s t b e m a r k e d o n t h e to p le f t - h a n d c o r n e r o f t h e e n v e lo p e “ Q u e r y , ” a n d a d d r e s s e d to F i r s t A i d , 4 6 , C a n n o n - s t r e e t , L o n d o n , E . C . 4 . 2 .— A l l Q u e r i e s m u s t b e w r i t t e n o n o n e s id e o f p a p e r o n ly . 3 .— A ll Q u e r ie s m u s t be a c c o m p a n ie d b y a “ Q u e r y C o u p o n ’ c u t f r o m t h e c u r r e n t is s u e o f t h e J o u r n a l, o r , in c a s e o f Q u e r i e s fr o m a b r o a d , fr o m a r e c e n t is s u e .

4 . — T h e T e x t b o o k to w h ic h r e f e r e n c e m a y b e m a d e in this c o lu m n is t h e 3 9 th ( 1 9 3 7 ) E d it io n M a n u a l o f F i r s t A i d t o t h e I n ju r e d .

th e

.S .J .A .A

Resuscitation. H.M. (Tipton). — With reference to the article which was published in the September issue of F i r s t A i d under the title “ Resuscitation,” I shall esteem it a favour if you would report upon the advisability of using this method of artificial respiration on (1) very young children, (2) aged people and (3 ) casualties with severe head injuries or severed arteries. The methods of Schafer and Eve are similar in that both rely on pressure of the abdominal organs upon the diaphragm; and the modifications necessitated by the conditions named by y’ou apply to each. Tbe time however, is not ripe for the expression of a definite opinion, as Eve’s method is not yet universaly accepted and his apparatus is not always avail able.— N . C o r b e t F l e t c h e r . Examination Howler. L.R. (Charlton Park).— In a recent examination I asked a candidate how he would compress the carotid artery and was vastlyamused when he replied :— “ A p p ly tourn iquet ro u n d neck a n d tighten it fo r tw enty m i n u t e s ” Good! Next, please! !— N.C.F. Fractured Leg and Torn Varicose Vein. C.T. (Ulster).— I am in a house alone with an elderly lady who trips over an object, falling and breaking her leg, and at the same time sustaining a lacerated wound involving a varicose vein near the fracture. How should I proceed before leaving the patient to telephone for the doctor? Should I elevate the limb? Meanwhile please accept my thanks. Proceed as is laid down in the General Rules for Treat ment of Fractures on pp. 66 and 67 of the Textbook. In other words, place patient on back (head to side) control the bleeding (without raising the limb), tie both limbs together, wrap patient warmly and then telephone for doctor.— N.C.F. Hypnotic Poisons. A.B. (Bedford).— (1 ) Will you please clarify the wording of the last paragraph on page 169 of the Textbook, and tell me if the signs mentioned belong to Irritants and Hypnotics, or to the two groups of the latter— Opium preparations and tablets, etc., for relief of pain ? Also (2 ) may I ask why it is that in this instance, stertorous breathing goes with a weak and slow pulse and a livid face, instead of the usual flushed face and full pulse ? Please accept my thanks in anticipation of your kind replies to both queries. (1 ) The signs and symptoms under “ Hypnotics” refer to the two groups of Hypnotics— the Opium group and the sleep inducing group— and not to the Hypnotic and Irritant Poisons. (2 ) On this point I think that the description is not strictly correct and that when in such a case the face is livid

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and the breathing stertorous, the pulse will be slow and full. At any rate I have never seen the combination of stertorous breathing and weak pulse ! !— N.C.F. A Reader’s Dilemna. H.P. (Cockfield).— 1 am a young boy just over sixteen years of age and am greatly interested in first aid and home nursing. I have attended lectures on both subjects for three years, and I am quite sure that I could pass any examination for boys of my age. But you see, I live in a little village where there is no S.J.A.B. or S.J.A.A. examiner. As I am very keen to gain my certificates I will be glad if you could en lighten me on this point. You do not say who has given the lectures which you have attended. If these have been given by a doctor he could notify the Chief Secretary of the Association who would arrange an examination by another doctor nearby. So far as the home nursing certificate is concerned you can be examined in this subject by the District Nurse.— N.C.F. Compression of Temporal Artery. E.J. (Staines).— Having learned much from your answers to correspondents, I ask you please to answer this query :— The Textbook tells us to put pad and bandage on temporal artery as most suitable. Do you consider that the bandage should go straight round the head and be tied off on pad or that with centre of bandage on pad the ends should be taken to the other side and twisted. Then one end being passed over the head the other under the chin and finally tied off on the pad. I know that both methods seem sound but would the first method be as satisfactory as the second method, which seems to have more control of the pad ? Your kind reply will be much appreciated. Experience proves the first method (by which the band age is carried straight round the head and tied off on the pad) is quite satisfactory, and that if this is applied properly, the pad will not slip.— N.C.F. Treatment of Braises. R.E. (Aberavon).— With reference to treatment of bruises, for which equal parts of water and methylated spirits are advocated in the Black Book, or ice or cold com presses, the reason for this being that they all cause constriction of vessel wall. The addition of methylated spirits to the water, according to your W h y a n d W h ere fore in F i r s t A id , increases this action through evapora tion. Could you tell me please in what way, or why does the addition of spirits to water increase the above action of constriction ; what action has the spirits on the water to bring about this effect on a bloodvessel ? 1 know from experience that if spirits of above type are added to water in equal quantities it causes or creates terrific heat which threatens to crack any glass vessel. I should have thought that surgical spirits used by itself would be sufficiently cold enough to cause any con striction through evaporation, as it seems very much colder than water when applied “ neat ” on the skin. When you refer to the generation of heat, you are prob ably thinking of spirits of salts which is a corrosive and will have this effect if mixed with water. When methylated spirit is added to water no heat is evolved. The effects of methy lated or surgical (which contains 95 per cent, methylated) spirit are that heat is absorbed from, the tissues and brings about the evaporation of the liquid.— N.C.F. Paxalysis of Limbs in Apoplexy. A.E. (Rhondda).— Among the signs and symptoms of Apoplexy the Textbook (p. 1 6 6 ) tells us that one side of the body is more limp than the other. Will you please tell me how a first aider can diagnose this condition if the patient is unconscious ? If the patient is unconscious, it would, in my opinion, be

R I B

extremely difficult for a first aider to detect the difference in limpness between the two sides of the body. Indeed, recogni tion of this sign can only be learned by long experience ; and doctors, when making this test, raise the limb three or four inches and then let it fall on the bed or couch, watching closely to see how it falls.— N.C.F. Humour in First Aid. J.C. (Bishopsgate).— In a recent Police examination a mem ber was asked to state the difference between stupor and coma. He replied— “ T h e difference between day-duty a n d n ig h t-d u ty ! ” Good !

Next, please 1 !— N.C.F. Capacity of Lungs. R. E. (Aberystwyth).— Please tell me what is the capacity of one lung in residual, tidal and complementary air. As the tidal lung capacity is— residual air, 1 0 0 cubic inches ; tidal air, 30 cubic inches; and complementary air, 100 cubic inches— the capacity for one lung would be approximately one-half.— N.C.F. Amount of Blood in Body. W.W. (Kettering).— At a recent Divisional Practice one member asked (1) what is the total amount of blood in the body of an average adult, while another asked (2) how much blood the left ventricle empties into the,aorta at each contraction. As no one could supply the correct answers, we submit the questions to you and thank you in advance. 1 also do not know the answers, but 1 have submitted your queries to an expert, whose replies are as follows — “ (1 ) The amount of blood in the body of an average adult is 6 litres (approximately 10 pints). (2 ) The amount of blood pumped by the heart is from 4 to 6 litres per minute at rest. Under conditions of active exercise this amount is greatly increased. From this it follows that, at rest, the amount of blood pumped into the aorta would be half the total amount, and at each contraction would be 80 to 100 cc per minute (approximately 3 ounces).”— N.C.F. Carbon Monoxide Poisoning. T.A. (Southgate).— Please would you tell me if it is advisable to use carbon monoxide (in conjunction with artificial respiration) to resuscitate a patient asphyxiated by carbon monoxide ? At present I am of opinion that it is definitely not, although I would use oxygen if it was readily available. Meanwhile may I thank you for the help I have received from the Query column in the past ? Experience teaches us that it is good treatment to ad minister oxygen with 5 per cent, carbon dioxide in combintion with artificial respiration in cases of carbon monoxide poisoning.— N.C. F. Fractured Femur and Sprained Ankle. B. B. (Bath).— In a recent examination I had for my practical test a fracture of the femur with a sprained ankle on the opposite foot. I treated the fractured femur firs t accord ing to the Textbook, and finally applied a cold compress to sprain. As there were already two bandages round the ankles tied off as a figure-of-eight and a pad be tween, I didjnot think it necessary to apply a third band age. Our little section have had many discussions on this point, and we cannot agree on the treatment, some saying the sprained ankle should have been treated first with a tight bandage and cold compress, even i f the s p ra in w as on the sam e fo o t as the fra c tu re d fe m u r.. Also would it be possible to draw the fodt in line with its fellow, as stated in the Textbook, if there was ' a sprain on one foot or the other ? We should be very grateful if you will tell us the correct treatment. With this combination of injuries I should act as you

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EMERGENCY TREATMENT OF SKIN INJURIES Be prepared for an em ergency and keep C u ticu ra Brand O in t m ent in you r First A id K it. It brings instant soothin g relief to cuts, burns, skin lacerations— prevents spread of infection, quickly heals. O btain able at all C hem ists and S tores.

F I R S T

did, because the fractured femur is more liable to aggrava tion and calls for preferential treatment. Traction on the foot, whether sprained or not, is still necessary ; but with the former you would modify your method of holding the foot and do your utmost to avoid un necessary pain.— N.C.F. Fracture of Both Clavicles. E. B. (Glazebrook).— The Textbook gives the treatment for a fracture of the collar-bone, but does not say how a patient suffering from a fracture of both collar-bones should be treated. 1 should be obliged if you will tell me which is the most efficient way of controlling these fractures. This combination of injuries occurs so rarely that refer ence to it has wisely been omitted from the Textbook. If, however, you should have to treat the combination, you can follow the instructions which used to figure in the Text book, and which reads as follows :— “ When both collar-bones are broken, keep the shoulders back by narrow bandages tied round each arm (close to the shoulder), passed across the back, over the opposite arm and tied together in front. The forearm should be raised and supported by the bandages.”— N.C.F. Method of Changing Operators. G.A. (Overseal).— The Textbook does not state any method by which the operators can most efficiently be changed during performance of Schafer’s artificial respiration. I shall, therefore, welcome your suggestions. Mean while I thank you for your help in the last 28 years and I hope that I shall continue to learn much from your instructions in the Query Column for another 28 years ! You will find the best description of the way to change operators on p. 53 of the A . R . P . B ooklet which is published by the Royal Life Saving Society and which tells you every t h in g about Schafer’s artificial respiration. This reads as follows :— “ While working, instruct one or more of your helpers to watch your actions very carefully while you explain the general idea underlying them. When at lasl you tire, ask him to kneel down on the opposite side of the patient and (during the relaxed or ‘ off’ position) to place his hands accurately over yours. Work thus together for a few cycles to establish the sense of your rhythm in his muscular move ments ; and at a later ‘ off’ position withdraw your hands leaving his to slip down into their place. Then take your well earned rest, while still supervising your assistant and preparing to take over again.” On your last point you are hopeful for both of us !— N.C.F. Gas Poisoning and Broken Neck. C.M. (Sheffield).— I am a member of the B.R.C.S. ; and I write to ask about the treatment of the case with which you dealt in your reply published under the above head ing in the October issue of F i r s t A i d . T o me it would seem that your previous correspondent wanted to know which method of artificial respiration should be applied. As my previous correspondent has not written again, I take it that I gave the answer which he desired. You, how ever, would seem to have misread his query which sought to ascertain how a patient with a broken neck should be removed from a gas-laden atmosphere. In reply to your query, any first aider should know how to treat asphyxia when patient has been removed to fresh air and has to be kept on his back. You will find the necessary instructions in this connection on pp. 2 3 2 and 233 of the B.R.C.S. Textbook and if you want further details you can look up p. 149 of the St. John Textbook.— N.C.F. Lay Instructor Certificate. C.M. (Sheffield).— In the query, which was published under the above heading in the October issue of F i r s t A i d , a member of the B.R.C.S. asked if (and how) he could qualify for the Lay Instructor Certificate which, from the

R I D

Editor’s reply, I gather is strictly reserved for members of the Brigade. He may, however, be interested to know that three years ago the B.R.C.S. introduced for its members an Instructor’s Examination in First Aid. We thank you for your letter and for the syllabus of examination which you enclosed. From the latter it seems that the B.R.C.S. examination consists in the main of a lec ture, whereas for the Lay Instructor Certificate a candidate must obtain 75 per cent, of marks in practical and oral tests (Part I), in a lecture test (Part II) and also in a written paper test (Part III). Finally, while the B.R.C.S. Instructor may give half the six lectures for the Adult Course, the St. John Lay Instructor is not so allowed, all six lectures being given by a medical practitioner.— Editor. Electric Shock and Asphyxia. A.E. (Rhondda).— Please tell me what is the cause of asphyxia in the case of electric shock. Electricity passing through the body has the effect of stopping the action of the nerve centres which are situated in the brain and which preside over the circulation and breath ing.— N.C. F. Syncope, Shock and Collapse. A.E. (Rhondda).— Lastly please tell me how Syncope, Shock and Collapse differ from each other. (1 ) Syncope is a temporary (may be fatal) depression of the Brain Centres, associated with disturbance of the heart’s action and sudden interference with the circulation in the brain. (2 ) Shock is a profound (may be momentary) depression of the Brain Centres which disturbs the action of the heart ; usually gradual in onset and associated with marked fall in body temperature ; may precede and terminate in Collapse ; very liable to relapse ; insensibility not a marked or constant feature. (3 ) Collapse is an extreme (may be rapidly fatal) depres sion of the Brain Centres and of the Heart ; usually gradual in onset ; often secondary to Shock but different in that in sensibility and muscular relaxation are more marked and more constantly present ; most liable to sudden relapse.— N.C.F. Triangular Bandage. P.M. (Caistor).— I read recently in a contemporary journal that the triangular bandage was invented by (and named after) a Dr. Esmarch, Professor of Surgery in the Uni versity of Kiel. I shall be grateful if you will tell me if this statement is correct. The triangular bandage was invented in 1831 by a Dr. Mayor, of Lausanne, Switzerland, who gave it the name “ handkerchief bandage.” Under this title it was popular ised by Dr. Esmarch, of Kiel, who in or about 1875 taught its usefulness to the German Army, and so describes it in his “ F i r s t A i d to the I n j u r e d '' which was translated from the German by H.R.H. Princess Christian and published in London in 1 8 8 2 . Consequently, the bandage was for many years unfairly called “ Esmarch Bandage,” this being its name in the original issue of the Textbook (1 8 7 8 ), through which the St. John Ambulance Association introduced the bandage into this country. As the result of protests, which I made in this column, the name “ Esmarch” was afterwards deleted from the Textbook, the 3 6 th Edition (1 9 1 9 ) being the first edition in my possession in which it was called “ the triangular bandage. ”— N.C. F.

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ATLAS EVERY FIRST AIDER and Student N urse should possess this Atlas. The plates are beautifully coloured and v ery clear w ith lift-up parts show ing th e internal anatom y of th e abdom en and chest. The te x t gives a clear and accurate account of th e anatom y and physiology of th e fem ale body.

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1944.

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THIS BOOK is o u t to

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" FIRST AID ” WALL

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DIAGRAMS

CONTENTS : THE TEAM Som e Prelim inary A dvice ; THE COM PETITION RO O M Points to W atch ; D O C T O R A N D A M B U L A N C E H ow to A ct ; THE C O N S C IO U S PATIENT H ow to Handle. T reatm ent for Shock ; U N C O N S C IO U S PATIENT Examination and T reatm en t ; G EN ERAL PO IN TS ; STRETCHER W O R K .

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THIS NUMBER.

E d it o r ia l —

Youth Organisations Experentia Docet St. John Ambulance Association S.J.A.B. Headquarters and District Reports Letters to the Editor ... Osteoarthritis... Waltham Holy Cross Civil Defence Service London and North Eastern Railway Steel, Peech and Tozer First Aid Services Reviews The Home Guard and First Aid

. .

73 74 74 75 76 76 77 78 78 78 80

Q u e r i e s a n d A n s w e r s t o C o r r e s p o n d e n t s :—

Treatment of Fractures Examination Howler Stretcher Bearers and Fire Guard Treatment of Fractured Patella Status of Ambulance Attendant Fractured Clavicles and Crushed Hand Asphyxia and Crushed Ribs Causation of Collapse Effects of Sodium ... Successful Artificial Respiration Compound Fracture of Skull .j. The Future of the Brigade ... Multiple Injuries and Transport Performance of Schafer’s Method Complicated Fracture of Clavicle Pain in Insensibility Effects of Cyanide of Potassium Temperature of Blood

1944

l^ T T .

F.R .S.A .

E ’t i t ''» d a t V sta tm u r i H m B\

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EDITORIAL.

FIRST AID is published on the aoth of each month. The Annual Subscription is 4 s. post free ;single copies 3 d . Its aim and object being the advancement of Ambulance Work in all its branches, the Editor invites Readers to send Articles and Reports on subjects pertaining to the Movement and also welcomes suggestions for Practical Papers. All Reports, &c., should be addressed to the Editor at the address below, and should reach him before the 8th of each month, and must be accompanied ( not necessarily for publication) by the name and address of the Correspondent. Subscriptions, Advertisements and other business Communications connected with FIRST AID should be forwarded to the Publishers. DALE, REYNOLDS & Co., L t d . ,

CONTENTS

F.R.San.l.,

JA N U A R Y

Vm T V O L . L,.

NOTICE

W ALTER

80 80 80 82 82 82 82 82 82 82

. ...

84 84 84 84 84 84 84 84

T h e war has brough t about a Y o u th definite ch an g e in the relations O r g a n i s a t io n s , between this country and the U n ited States of A m erica. T h ere has alw ays existed that bond which obtains between people of the sam e ancestry sp e a k in g the sam e la n gu a ge, but the bond has been considerably strengthened, and we now have a continuous flow of com m unication between the two countries. O n ly a w eek or two a g o a woman architect left these shores to study A m erican m ethods, and now we have the visit of another, M iss L ou ise M orley, of the U . S . A . Office of W a r Inform ation, whose mission is to investigate the w o rk in g of our Y o u th O rgan isatio n s w hich, it is scarcely necessary to say, have as their basis an intense hatred of a n y th in g ap pro xim atin g to H itlerism and the vaporous out pourings w hich have em anated from his subservient henchm an, M ussolini. O n e of her first visits was to the L iverp o ol headquarters of the S t. John A m b u lance B rigade, where representatives from the G irl Cadet D iv isio n s of the L iverpo ol N u rsin g Corps g a v e dem onstrations. O u r purpose in reporting her activities is to stress the im portance of visits such as hers, in cem en tin g the bond w hich already unites the two nations. W e are not, of course, so prolific in organisations as our Am erican cousins. O ur traditions are of much lo n ger gro w th , but in A m erica every bo y and girl belo n gs to some association or another, and they g iv e practical effect to their m em bership, w hile, in this country, this is o n ly too often regrettably half-hearted. One A m erican organisation deserves a word of special m ention. It is known as the “ F o u r H ’s C lu b ,” the aitches representing head, hands, heart and health, translatable into “ C lear H ead, Clean H an ds, W a rm H eart, S tu rd y H e a lt h ” — som ew hat childish in its conception perhaps to our notions, but none the less a vigoro us and em in en tly practical body w hich is perform ing m uch of a useful nature. It need scarcely be said that in these m ultifarious organisations, first aid form s a prom inent feature. T o sum up, the im portance of such co-operation between the two countries cannot be overestim ated. Personal contact is not an ea sy m atter now, but with the resum ption of norm ality difficulty w ill have

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vanish ed, and we m ay look forward with assurance to a period of useful intercom m unication. Solid arity in the Y o u th M ovem ent is o n ly one of the m any w a y s in which the relation between the two countries can be im proved ; indeed it is o n ly upon that and an alo go u s m ovem ents that future peace can be assured in this harassed and perplexed world. T h e y are a strik in g contrast to the m ethods of the pro fessional politicians.

E x p e re n tia B y

D ocet.

TH E VICTIM.

( Concluded, from page 63. J There is still maintained by the powers that be, the policy that members of First Aid Points are not expected to leave their Points and deal with wounded in the Field. I have seen this policy gravely set out in official memoranda which stated dogmatically that wounded would be brought to the Points by members of the Rescue Services. Did they really imagine that the trained personnel of a Point in some village or small market town would be content to wait quietly in their Points while the wounded lay in the ruins waiting for the arrival of a First Aid Party, the nearest of which was often as much as ten miles away ? The personnel of these parties are largely part time and even to mobilise them for tip and run raids in the day time, from fields and shops, takes a considerable time, quite apart from the journey from base to incident ! In the face of official disapproval, therefore, I had trained the personnel of every Point over a very wide area that they were to be pre pared to look after themselves entirely for the first vital hour after a tip and run raid. This meant that they must know (1 ) how to lift a patient on to a stretcher ; (2) how either to carry it themselves or instruct the “ intelligent bystander” to carry it ; (3 ) how to lift a patient from stretcher to bed ; (4 ) how to load an ambulance. It was not easy at first. The Victorian impression that for a woman to lift might entail life long damage, took a lot of eradicating but they soon began to appreciate that once they had learned the secret of how to do it, no more effort was entailed than in lifting wash tub or coal scuttle. They very soon, too, began to realise that if carrying a heavy man on a stretcher was too much for four women, it became childs play with two additional bearers on either side. Demonstrations by a party of four women who had worked through very heavy attacks upon a large city and none of whom were of exceptional physique, were of immense value. To see them lift a heavy man on to a stretcher, lift the stretcher and run it with one smooth movement into the top runners of an ambulance, the whole in such a way that a glass of water balanced upon the patient would have remained unspilled, was a lesson in attainable perfection. It is a matter upon which even good First Aid Parties have often had far too little training. Trigg Lifts have improved matters but even so the tendency remains to con sider the lifting and smooth transport of the patient of infinitely less importance than first aid. In actuality it is always of equal importance, and in certain cases, such as chests, of infinitely greater. There is a not unreasonable tendency to imagine that the poor broken body of the air raid casualty protected from immediate obvious pain by either local shock or morphia can be handled in any way, provided no additional pain is apparently caused.

JL1 &

No greater fallacy exists and it must always be remembered that the shock from which a patient is suffering, even if apparently protected from pain by complete uncon sciousness, will be enormously increased by the slightest rough handling or jolting. I was to have a clear demonstration of the truth of my own theories. By this time, installed upon the firm comfort of an A. R. P. stretcher, I had been carried smoothly to my house and lay warm and comfortable, absorbing cups of sweet tea, the while one of the first aid party swiftly turned back the dressing and dusted both wounds freely with powdered sulphonamide. From now on I knew that I must pass from the hands of my Civil Defence Personnel and rely for trans port upon local sources, by no possible means could I claim to be an air raid casualty. The civil ambulance arrived and the first snag was apparent at once, the runners had not been adjusted to take an A. R. P. stretcher and 1 had to be transferred to a St. John’s. Nothing so modern as a Sorbo rubber mattress had reached these depths of the country and no arrangements of blanketting or boarding were going to result in the happy mean between a sagging and a hard base. There is no question whatever, but that the modern A.R.P. stretcher is out and away the most comfortable and efficient ever produced. By the time I had been carried a hundred yards to the nearest point to which the ambulance could be brought and loaded aboard, I was very conscious of my leg, and before ten miles had been covered 1 was once more in a condition of severe shock. The unfortunate attendant did his utmost, but water and sal volatile are poor things at best and a surgeon is a difficult person to overrule. Realising the approach of the ambulance to a village pub, I demanded a halt and sent for the stiffest double— or quadruple whisky which could be produced. I can imagine the horror of my well trained readers ! It arrived however, was duly absorbed, and I passed once more into blissful tolerance of pot holed roads, rousing only at my destination. I have always felt considerable doubt as to whether hot sweet tea was really the best treatment for shock ! !

S t . J o h n A m b u l a n c e A s s o c ia t io n . B a r n s t a p l e . — Tributes to the efficiency of the adminis tration and to the public-spirited zeal of the uniformed voluntary ambulance personnel were paid at the annual meet ing of the Barnstaple S.J.A.A., held in the Commercial-road Headquarters of the movement. The Mayor of Barnstaple (Alderman C. F. Dart, J.P.,' C.C.), who, as President, took the chair during the opening part of the meeting, voiced the feelings of the Borough Coun cil and the burgesses, and reiterated the view he expressed a year ago that the Council would, in their re-planning scheme to be put into effect after the war, incorporate provision fora new Health Centre housing such services as the St. John Ambulance Association and Brigade, the Red Cross and V.A.D., in addition to the official health and sanitary departments. He advised the Association and the Brigade to seek con tact with the Red Cross organisations, and with them, to give the Council a lead by indicating their accommodational needs and plans for future activities in the service of the public. Sundry excellent reports were given. The Motor Amb. Com. reported a journey mileage of 9 , 7 0 7 . A total of 478 patients (61 P.A.C. cases, 11 Service, 152 Hospital Aid Society, and 254 private) had been carried. Officers and committees were then elected. At the outset of the meeting those present stood in silence in memory of members of the Association who had passed away during the year.

F I R S T

S t.

J o h n A m b u la n c e

h ead q u ar ter s

a n d

B rig a d e

d is t r ic t

r epo r ts

No. I (Prince o f Wales’s) District No. 1 4 8 N ( T e d d i n g t o n ) D i v i s i o n . — Teddington now has its own S.J.A.B. Nursing Division. It was inaugu rated at the British Legion headquarters in High-street on Thursday, December 9 th, with a visit from Lady District Officer Miss West. There is also to be a separate Tedding ton Cadet Division, but the enrolment of the cadets has had to be deferred until the new year. Ambulance Officer C. G. Bowden, in charge of the men’s division was in the chair. Addressing the cadets, Lady District Officer Miss West told them that when they were enrolled they would be members of the oldest charitable organisation there was. She wanted them to make the Teddington Division one of which they could be proud. After presenting certificates to cadets, Miss West made a presentation to Lady Ambulance Officer Mrs. Dorothy A. Jackson, who is in charge of the new division, as a token of appreciation of the work she has done for the members. She has just completed IS years with the Brigade, and is thereby entitled to the long service ribbon. This is the third Divi sion she has had charge of. The gift took the form of a fountain pen. In making the presentation. Miss West mentioned that she herself had been 30 years in the Brigade. Mrs. Jackson, in reply, said she had enjoyed every one of her IS years in the service, first as an ambulance sister, then as an officer. She was sure the new division would be a great success. County o f Berkshire. Mrs. Porter, M.B.E., who has been Acting Lady County Supt., has now gone on to the Brigade Reserve after 32 years continuous service, and her place has been taken by the Hon. Mrs. Leslie Gamage. R e a d i n g . — In the two months from October to Decem ber, 1 9 4 3 , £ 5 0 0 was collected by members of the Corps for the St. John and Red Cross Prisoners of War Next-of-Kin Parcels Scheme. W i n d s o r . — A competition was held on November 2 8 th, between St. John Divisions and Detachments of the British Red Cross Society. The competition was won by members of the Windsor Nursing Division, S.J.A.B.

County o f Lancashire. L i v e r p o o l . — Miss Louise Morley, of the U.S.A. Office of War Information, who is in this country to investigate the working of our Youth Organisations, paid a two days’ visit to Liverpool on December 2 0 th and 2 1 st. One of her first visits was to the S.J.A.B. Headquarters, where representatives from each of the Girl Cadet Divisions of Liverpool Nursing Corps demonstrated the various aspects of Cadet Training. Triangular and roller bandaging, splinting, artificial respiration, first aid in a street accident, preparation of a fracture bed and reception of the patient, and washing a baby and preparing its feed were included. Six Boy Cadets were present and demonstrated handseats and the blanketing of a stretcher. Miss Morley inspected a display of handwork and cookery by the girls. The handwork included knitting, embroidery, new and made-over garments and toys.

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After visiting the First Aid Station at the Headquarters, staffed by the Nursing Corps, Miss Morley addressed the Cadets, telling them something of the Youth Movements in America and of the life of the ordinary American boy and g ’rl-

Commissioner W. G. Smith, Asst. Commissioner Col. Simpson, County Surgeon Dr. Murray Cairns, the Corps President, Helena, Countess of Sefton, and Col. MacPhail (Chairman of the Association) were present to meet Miss Morley. County of Leicester. The young Leicester ambulance and nursing cadets derived as much pleasure in preparing and producing enter tainments and providing good fare as the 3 0 0 old age pensioners who were their guests at two large Christmas parties. Two hundred pensioners in the Belgrave area turned up at Belgrave W. M.C., where, following a tea provided by club and Brigade members, they were entertained by the Kerry troop of dancers, and Miss Violet Lorcen, vocalist. The Rev. D. E. K. Llewelyn was a visitor during the afternoon, as were the Supts. of the Ambulance and Nursing Divisions. At West Humberstone Adult School, the Arthur Faire nnrsing cadets and the Moat-road and G. F. Bourne boy cadets entertained 100 pensioners with song, music and nativity play. A group of juniors presented “ The Mad Hatter’s Tea Party,” which was greatly enjoyed by the old folk. The boys, under Supt. Heighton, gave a bandaging display. Similar parties have been arranged for the Aylestone, St. Leonard’s and Braunstone areas. County o f Sussex. B r i g h t o n . — For the first time in the history of the St. John Ambulance Brigade or British Red Cross Society cadet divisions in Sussex, representatives of both organisations met in a first aid competition at the Royal Pavilion recently. A team of S.J.A B. girl cadets beat the opposing ream of girls from the B.R.C.S. by obtaining 146 £ points to 103 £, while the St. John boys’ cadet team also emerged victorious over their Red Cross opponents, scoring 155 i marks against 1 3 0 . The competition consisted of an individual test and a realistically staged team test, in which the “ casually” had supposedly been injured while riding a cycle. Each team went confidently about the work of caring for the “ patient”, and in only one case did he “ die” ! Dr. J. Thwaites, who, with Mr. N. McLean, judged the competition, announced that the standard attained was ex tremely high. The tests were arranged as an experiment by Miss D. Gore-Browne, R.R.C. (deputy president), Dr. F. H. Stutta ford (corps surgeon and superintendent), and a small com mittee, and proved a great success. A cup was presented to each winning team by Miss Gore-Browne, the donor.

County of Worcester. Miss E. Ollis, Div. Supt. (now on Reserve) of the Dudley Nursing Division of the S.J.A.B. has been notified by the Secretary General of the Venerable Order of St. John of Jerusalem, that H.M. The King has sanctioned her promo tion in the Order from Serving Sister to Officer (Sister) for services rendered in the cause of humanity. Miss Ollis was one of the members who joined the Dudley Nursing Division when formed in 1 9 1 5 , thereby being a member for 28 years. After holding several offices Miss Ollis became Div. Supt. in 1 9 2 0 . She holds the Service Medal and 2 Stars, and was awarded the Silver Jubilee Medal in 1 935 . Miss Ollis went on Reserve in March, 1 9 4 3 . She is still greatly interested in the work.

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L e tte rs

th e

E d it o r .

We are in no way responsible for the opinions expressed, or the statements made, by Correspondents.— E d i t o r . TR EA TM EN T FOR PHOSPHORUS BURNS. D e ar S ir,—

It has been pointed out to me, that in the October issue of F i r s t A i d , when describing the CuSO., treatment for Phosphorus burns, I omitted the word “ sterile ” from the 1 st part of treatment (Saline solution). This was, of course, an error, and should read : “ 1 teaspoonful of salt in a pint of s te rile water.” I would point out however, that bearing in mind the far greater danger of infection likely from war wounds, Home Guard medical units are trained from the start, to use sterile water for a ll medical purposes, whenever practicable, and few but the untrained, would have omitted to use it. However, as it is the latter we are trying to help, I apologise for the omission, and thank the Brigade Officer who pointed out the error. Incidentally, it is interesting to note that my small contributions are read and criticised by others besides the Home Guard.— Yours faithfully, C . W. S p r e a d b u r y . E V E ’S ROCKING METHOD. D e a r S ir ,—

Following your publication of the “ Kirkconnel ” sug gested technique for Eve’s method of Artificial Resuscitation for teams of four, may I add the following rider ? Once bearers have accustomed themselves to working in teams and have grasped the general technique, it can be pointed out that, in an emergency, two bearers should have a patient “ rocking” as, if not more, quickly than four bearers. This may be achieved by making use of the stretcher straps with which to bind the one arm and leg on the same side to the stretcher. Immediately this is accomplished, rocking should begin. Thus there need be no waiting or searching for bandages, etc., with which to prevent slipping. Rocking having been started, the spare bearer should slip bandages, ropes, etc., over the free arms and tie them to the stretcher handles— as opportun ity arises. The patient is q u ite safe though only fastened by one arm and leg. Any reasonably efficient pair of bearers should have no difficulty— working smoothly and not injuring the patient — in having him rocking in 2 0 to 25 seconds. This is equal to 4 to 5 breaths, which should satisfy the most impatient bystander who, himself doing nothing, calls loudly for “ someone to do something.” Yours faithfully, B o w m a n E d g a r , M.B., Ch.B. TH E

FU TU RE

TH E

BRIGADE.

D ear S ir,—

I have read with keen interest D .S.’s (Birmingham) comments on the above subject in the November issue, also the previous article by our most worthy Dr. Corbet Fletcher. Whilst I agree that recruitment could be made from the C.D. First Aid Parties which are now merged with the Rescue Service, a large number of these members have been brought in under the compulsory enrolment scheme. Several others holding the St. John Ambulance First Aid Certificate, in some cases as many as 14 years have elapsed since it was first obtained, yet the Association has issued its badge to those members to wear on the C.D. uniform. No annual re-examination has been taken, and they are not much better than pew entries ipto the service,

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D.S. has probably had the above type as colleagues in his unit, since he states that 75 per cent, are inefficient. The Brigade Badge is quite distinct from the Association Badge. The former requires the standard of efficiency to be maintained as a member by passing the annual re-examina tion, and in that case could only qualify for the Cloth Badge for the C. D. uniform ; whereas the Association Badge can be obtained by anyone possessing the First Aid Certificate, however long the period since the last exam, was taken. The last clause stating that the “ St. John Badge worn on C.D. uniform is a badge of membership of the Brigade and not of the efficiency of its wearer to render first aid ” is to me incorrect. There are two distinct badges, as previ ously stated, and the one who wears the St. Jahn Ambulance Brigade Badge is, by virtue of its issue to him, accredited as an efficient member by hfs annual re-examination. The Association Badge does not necessarily infer that the holder is efficient in first aid. Trusting this information may help to clear the air. Yours faithfully, Wigan. W m . P a r k i n s o n , Corps Sec.

O s te o a rth ritis . [From a Lecture delivered by Matthew B. Ray, D.S.O., M.D., M.R.C.P., in the Lecture Hall of the Royal Institute of Public Health and Hygiene, 2 8 , Portland Place, W .l, on Wednesday, November 1 0 th, 1 9 4 3 , with the Rt. Hon. Lord Horder, G.C.V.O., M.D., F.R.C.P., in the Chair.] H e r e d i t y seems to play a part in the causation of osteo arthritis, but there are no controlled statistics available. In my personal experience patients very frequently state that a similar form of arthritis runs in their family. With regard to age incidence, osteoarthritis is essentially a disease of late middle life when early degenerative changes first make their appearance. Traumata are important causative factors. Under this term are included not only bruises and injuries to joints, but also any long continued stress or strain. Certain occupa tions are very apt to bring about the condition in individuals who by reason of their work are liable to joint strains. It has been said that every trade has its own particular form of arthritis. While changes suggestive of a toxic or infective element may be superimposed, there seems to be no evidence at all to suggest that focal sepsis plays any causative role in osteo arthritis. The subjects of osteoarthritis are usually well-nourished, robust individuals of a somewhat plethoric type. The onset of the condition is, as a rule, slow, progressive, and insidious. Constitutional symptoms are almost entirely lacking in osteo arthritis ; and, to state the matter shortly, it is almost entirely a disease of joints. The locol treatment ot the osteoarthritic hand should be directed to the avoidance of stiffness so far as is possible. Paraffin wax melted and applied in successive coats to the hands has proved very effective in relieving muscular spasm and rendering the fingers more supple. Much the same effect can be obtained by immersing the hands, enclosed in rubber gloves, in hot w'ater for about 20 minutes every day. After the hands have been removed from the water and the gloves taken off they can be well massaged with wintergreen oil. Osteoarthritis of the elbow joint is usually an occupa tional affection, in that it is associated with long continued strains at work. Blacksmiths who are constantly wielding heavy hammers seem specially prone to it, As the condition

F I R S T

is largely occupational, every endeavour should be made in the early stages to relieve the strain on the joint by periods of rest or even change of work, if possible. Active move ments in hot water are also very helpful, and if these can be carried out in a pool bath with the under-water douche so much the better. Osteoarthritis of the shoulder joint is in most instances probably occupational, as it has been repeatedly seen in plasterers and painters who have to work with their arms above their heads for long periods. Treatment is the same as for the arthritic elbow joint. As some degree of osteoarthritis of the spine is so com mon in the later decades of life one might almost say that with advancing years some amount of change is physiologic rather than pathologic. Arthritis of the hip-joint is much commoner in men than in women. It is essentially a disease of middle life or old age. As regards treatment, the two chief indications are the relief of pain and the avoidance of fixation in a bad position. Since the foot and ankle are more exposed to stress and strain than any other part of the body it necessarily follows that osteoarthritic changes are extremely common. Treat ment should aim at keeping up the mobility of the foot as long as possible. G eneral T reatment.

Physiotherapy includes all methods based on the utilisa tion of (i) the energy of heat, as in the use of hot air, vapour, or hot water, locally or generally applied ; (ii) the energy of movement, as in manipulations and exercises, frictions, per cussion by douches, and the action of whirling water ; (iii) radiation, employed as heat, light, and invisible rays from arc, mercury vapour, or other lamps ; and (iv) electricity applied to resolve exudations and promote nutrition, to cause movement in muscle fibres, or to raise the temperature of deep-seated parts. The value of the pool bath has already been men tioned, and it is only necessary to refer to it again to urge the provision of such baths in all centres of popula tion. A hot or warm pool bath should find a place in every public bathing establishment. For some un explained reason the therapeutic pool which has been described has never caught on in this country. Only a few institutions have installed them. So far as is known there is only one in London. This form of treatment is extensively used in the United States as clearly shown by the reply to a questionnaire addressed to 100 prominent institutions which indicated that two-thirds had had therapeutic pools for on an average five years. Weight reduction, where possible, is usually highly beneficial as it obviously relieves the strain on the joints of the lower extremity. Rest without weight-bearing is more often required than complete rest from all kinds of movement. If rest is unduly prolonged without at the same time keeping up the tone of the muscles which control the joint, infinite harm may be done. Counter-irritation is an old and well-tried treatment for the relief of pain. As no known drug has any influence on the inter-articu lar changes in osteoarthritis, it necessarily follows that their employment must be limited to the treatment of any general symptoms that may arise.

F o u n d . — Bronze Medallion, B.R.C.S. Blood Transfu sion Service, engraved Awarded to W. S. J. Webber for 10 Transfusions. Owner can have same on applying to Supt., No. 2 Depot, Leyton C.D., Hainault Road, E .ll,

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W a l t h a m H o l y C r o s s C iv il S e rvice . T he W a l th am

M ethod of P lacin g U nder a C a su a lt y .

D efen ce

B lanket

object attained by the Waltham method of placing a blanket under a casualty lying on the ground is the provision of immediate anti-shock treatment with the absolute mini mum of movement of the casualty (it being unnecessary to raise any part of a casualty’s body more than one inch from the ground), It also provides for a blanket lift in serious cases without aggravating injuries. The casualty can be wrapped in a blanket in 15 seconds. Procedure :—

The

W h e n C a s u a l t y is o n

B ack.

1 . A blanket is laid flat on the ground lengthwise

beside the casualty, i.e., the blanket hems at the head and feet. 2 . Two attendants, one on each side of the blanket and facing the same hem, take hold of the blanket with both hands at point 18 in. from the hem, their outer hands taking the edge of the blanket and their inner hands some 12 in. in from the edge, both pairs of hands making a fold across the width of the blanket by lifting it slightly from the ground. The blanket is then rolled towards the hem, both attendants retreating towards the middle of the blanket, until only 2 in. of the hem end of the blanket remains outside the roll. This procedure should be repeated at the other end of the blanket. 3 . The first attendant then brings the rolled blanket towards the casualty so that the lines of the rolls is at right angles to the body, with one roll towards the natural hollow in the small of the back, and the other roll towards the natural hollow under the buttocks and remains kneeling at the casualty’s side, facing the hips, holding one roll of the blanket in each hand. The second attendant then straddles the casualty, facing the casualty’s head so that his one foot is close to the thigh, jut below the hip, and the other close to the casualty’s body a little higher than the waist. He then places his hands well under the casualty, his left hand next his left foot and his right hand next right foot. In lifting the casualty he must apply a straight lift, raising the casualty’s buttocks not more than 1 in. from the ground. The first attendant then pushes the rolls of the blanket halfway under the casualty and, going round the casualty’s feet to the other side, again taking hold of the rolls of the blanket, draws it through so that the middle of the blanket is under the casualty. The second attendant then gently lowers the casualty on to the blanket. 4 . Both attendants then position themselves at the level of the casualty’s head, facing the casualty’s feet, kneeling on their inside knees with their inside hands steadying the casualty’s shoulders and, with their outside hands, take hold of the hem protruding from the rolled blanket as close as possible to the body. Both attendants then pull the hem towards themselves, the blanket unrolling as they do so, until it is quite flat under the casualty’s back and puckered under the neck. 5 . The first attendant then lifts and supports the casualty’s head with both hands about 1 in. from the ground, whilst the second attendant draws the blanket under the head and out until taut. 6. This procedure is repeated with the lower roll, puck ering the blanket under the hollow of the ankles, steadying the feet and drawing the blanket taut. W h e n C a s u a l t y is o n S id e .

The blanket is laid flat on the ground lengthwise beside the casualty, at his back. Each attendant takes hold

F I R S T

of a hem IS in. from one edge, and they make one length wise roll in the same way as for the breadthwise roll. 2 . They then place the roll of the blanket as close as possible to the back of the body and very gently roll the casualty on to his back. This will expose the protruding edge of the rolled blanket, which should be gently drawn out until taut. The casualty is then lying face-upwards on the middle of the blanket. 3 . In the case of a smashed jaw, or other injuries which prevent the casualty being placed on his back, the lengthwise roll of the blanket should be placed close to the front of his body, and he should then be gently rolled face-downwards, when a comfortable blanket lift will be possible.

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S t e e l,

Peech & T o z e r S e r v ic e s .

F irs t

A id

We have received the following from Mr. Gyril T. Gregory of Rotherham, First Aid Organiser, Steel, Peech & Tozer :— “ I am enclosing details of two of our training schemes which we have used very successfully at Steel, Peech & Tozer, The Ickles, Sheffield, for our works first aid services. “ No. 1 consists of a question to which the answer is yes or no, and 5 seconds are allowed to answer. “ No. 2 . On occasions the class is thrown open to any member who cares to act as instructor or lecturer for the hour ; all agree to obey his instructions for 45 minutes, this W h e n C a s u a l t y is F a c e -d o w n w a r d s . includes myself, then for the remaining 15 minutes the class 1. If the injuries allow, turn the casualty on to his side is allowed to criticise or praise his methods, with myself act ing as chairman. In this way a potential No. 1 may be and proceed accordingly. discovered, while it gives confidence to the others. If the injuries will not permit of the casualty being turned, the Waltham method cannot be used, and the “ Several more have been used with success and I hope casualty will therefore be immediately lifted on to a these two will serve some useful purpose for the benefit of blanketed stretcher by some other approved method. others. Publicity ought to be given to more schemes how ever small, because some first aider, somewhere, will find it (The above method of blanketing has been devised by new and interesting.” the Officers and personnel of the Waltham Cross Civil Defence Service.) T r a i n i n g S c h e m e No. 1 .— Yes or No (5 seconds allowed). Page. 15

London

and N o rth R a il w a y .

Ea ste rn .

The continued keen interest shown by L.N.E.R. Scottish employees in the first-aid movement under the auspices of the St. Andrew’s Ambulance Association is indicated by the number of awards made in 1 9 4 3 . The results achieved are regarded as most encouraging, since all the training under taken is voluntarily carried out by the staff in their leisure time, which in these days, is considerably curtailed by additional working hours and time given up to other services in the war effort. The number of the various awards made were as follows : Bar to L.N.E.R. Long Service Gold Medal (35 years) 2 , (30 years) 4 , (25 years) 1 , (20 years) 12 ; L.N.E.R. Long Service Gold Medal, 15 ; S. A. A. A. re-examination voucher or section efficiency test qualification (3 years and over), 858 ; S. A. A. A. Medallion (2 years), 45 ; S. A. A. A. Certificate (1 year), 6 1 . In addition, a large number of proficiency awards were gained by non-railway employees, to whom the railway com pany were able to extend facilities for attending the classes.

23 25 29 31 31 33 -34 34 36 43 44 45 47 214 15 191 165 124

I p s w i c h . — Awards won by Ipswich members of the L.N.E.R. Ambulance Division were presented at the County Hotel, Ipswich, by Dr. H. McEwan. Mr. Maude, Goods Agent, presided, supported by Mr. Coops, First Officer, and Messrs. F. Spalding and W. H. Brown, joint secretaries. Several members of the East Suffolk Police last season attended lectures and practises. The awards were :— Nine First Aid Certificates, 5 Vouchers, 22 Labels. Special awards for 35 years’ service, 11 . During the evening a programme was presented by the Celebrities’ Concert Party.’

Publishers Note.—Will readers please note that all back numbers of “ First Aid ” are now out of print and cannot be supplied. Will South African and other Colonial readers please add to their remittances, “ or English equivalent."

161

Question. Does the redressing of wounds come under the head ing of first aid ? Should severe bleeding receive the first attention in all cases ? Is ammonia a stimulant ? Are there 32 bones in the spine ? Are the floating ribs attached to anything ? Has a person 14 true ribs ? Has a normal person 52 phalanges ? Is the pelvis composed of 11 bones? Does the femur compose two different kinds of joints ? Is the fibula part of the knee joint ? Is shock always present after an accident ? Is a red face a sign of shock ? Is the treatment of shock different for a woman ? Would you cover a cold compress with cotton wool and bandage ? With a loaded stretcher, is the correct order “ March ” ? When a first aider has handed over to a doctor should he go away ? Should you use a feather bed in case of nursing accidents at home ? Is this correct ? (Fainting is a sudden depression of the nervous system). When applying pressure on femoral artery, do you press on to the femur ? Is it advisable to leave an hysterical girl alone ?

R e v ie w s . T reatm en t a n d R e m e d ie s Jo r P o iso n in g . By A. E. Hawkins. London : The Fountain Press. P r ic e gd. This is a useful chart which has been compiled by a Divi sional Supt. of the St. John Ambulance Brigade, and which shows at a glance the signs and symptoms and the treatment of 30 different poisons, all arranged in alpha betical sequence. It is well prepared and printed ; and it can be pinned to the wall for handy and quick reference. The one mistake which we have noted is the statement that in cases of prussic acid poisoning artificial respiration must be carried out at the rate of 20 movements to the minute.

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Queries and Answers to Correspondents Queries will be dealt with under the following rules :— 1 .— Letters containing Queries must be marked on the top

has been proved in the Regular Army that a very high percentage of casualties are caused by individual careless ness, especially habit forming tendencies, which are quite easily observed by the enemy. Cigarette smoke pall over latrines, for instance, can be easily spotted. Failure to move around with minimum exposure also accounts for man}' casualties. The Home Guard, with less training, despite their relatively high efficiency, might easily fail victims to such circumstances, and it is even more essential for the medical service to use meticulous care. Remember, you are not a large or easily replaced unit, and the lives of your comrades may easily depend on your initial treatment. Hence, battlecraft should be an essential part of your training. Those of you who have trained for the proficiency badge will easily understand its value. And what of the wounded man ? He also has his duty, if conscious, both to himself and to his unit. He should know how to apply his field dressing properly and stop bleeding as much as pos sible, if this is practicable. If he cannot walk, he should try and attract attention without being conspicuous to the enemy. For this reason, and also because he must guard against loss of blood and shock, he must make no un necessary movement. All ranks of the H.G. should have elementary first aid training, and senior N.C.O.’s of the Medical Section, where an M.O. is not available, should try and arrange with the C. O. for this to be given. The system of treatment and evacuation of casualties in most areas for the H.G. is as follows :— When a man is wounded he should receive first aid treatment from himself or his comrades if the unit stretcher bearers are not immediately available. These will take over, give any further skilled treatment where necessary, and transport him back to the C.C.P., where the M.O. will probably take control. The casualty will then be removed as soon as possible to hospital by the Civil Defence or by other local arrangements. As obviously circumstances may delay this evacuation, the medical unit should make abso lutely sure that their C.C .P.’s are suitable for harbouring the wounded for some considerable time, if necessary— means of keeping the patient warm ; hot water available ; good shelter ; cleanliness, etc. It

C. W. Spreadbury (Sergt.), School House, Noel-road, W . 3 . Every week more than Z/1 ,0 0 0 is collected in Liverpool for the Red Cross Penny-a-Week Fund, the money being contributed by industrial workers and householders.

Classified A dvertisem ents. Advertisements with remittance should be sent to First Aid, 46, Cannon Street, London, E.C 4. 3d. per word, minimum 4s. Q A A Concert Tickets 5 /6 . Memos, Rubber Stamps, Roll ZUU Tickets, Samples— “ A ” T i c e s , 11 , Oaklands Grove, London, W. 1 2 .

IR ST AID COM PETITIONS are won by good coach ing. Any First Aider (either sex) may coach any ambitious team— male, female, or mixed— to early success. Competition experience not necessary with new Guide (adaptable to any text-book). For particulars, send stamped envelope to:— R. Jeffery, 5 , Avenue Gardens, London. W .3

left-hand corner of the envelope “ Query,’’ and addressed to F i r s t A i d , 4 6 , Cannon-street, London, E.C. 4 . 2 .— All Queries must be written on one side of paper only. 3 .— All Queries must be accompanied by a “ Query Coupon ”

Treatment of Fractures. T. H. (Darlington).— In your reply to the query which was published in the November issue of F i r s t A i d , you stated that you did not know any instructions which tell us to place bandages directly over fractures. May I, there fore, remind you of the article which appeared in the June 1941 issue of F i r s t A i d and which was written by Dr. D. S. Todd-White. In it he suggests that with a fractured femur a broad bandage may be placed round both thighs. Will you please give a ruling on this point as I have been interested in the Query Columns for many years ? There is a difference between instructions and sugges tions. Of course, it is known and understandable that under air-raid conditions splints may not be available in all cases and that some modification of the instructions of the Text book have to be made, as in the instance which you quote. In ordinary first aid work, however, your actions must be governed by the Textbook.— N. C o r b e t F l e t c h e r . Examination Howler. H.H. (West Riding).— The amusing howler which you related in the December issue of F i r s t A i d reminds me of one which was perpetrated at a recent examination and also concerned the carotid artery. In this instance the examiner asked a candidate what he would do if he could not control bleeding from the carotid artery by digital pressure. The latter promptly replied to the amusement of all within hearing — “ I w o u ld at once com press the su b cla v ia n a ite ry ! ” Good !

Next, please ! !— N.C.F.

Stretcher Bearers and Fire Guard. J.M. (Keighley).— I wonder if you could answer this question for me on behalf of members of our Division of S.J.A.B. A number of us are registered as voluntary stretcher bearers at the local hospitals and have a rota of duty for emergency at the hospital. We go on duty one night from 9 p.m. until 6 .3 0 a.m. the following morning, every fourteen days. This arrangement has stood from August 1940 until to-day. Now the local Fire Guard Officer says that we must undertake fire guard duties. We are on call for sirens or emergency convoy work any day or night. Brigade Regulations exempt us from Home Guard and Civil Defence duties if we are registered Stretcher Bearers.. So are we exempt from fire guard duties ? We want to help the hospital all we can, but if we have to be fire guards every day, will we be able to serve two masters ? I wonder if you could oblige us with an answer. I am a regular reader of F i r s t A i d and realize that this is not a first aid but a Brigade question. By law, voluntary work must amount to 48 hours each month, and it would appear from your letter that you are

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only doing 19 hours. If, however, the hospital authorities see fit to give you a note certifying that, apart from the time spent in the hospital on rota, you are also available for emergency duty, this may alter the position of affairs. Further, the Minister of Home Security has recently decreed that volunteers should not be asked to remain at their posts provided that they are within easy call should the need arise. — E d ito r.

Treatment of Fractured Patella. D.H. (Southbourne).-— In the treatment of a fractured patella I shall be obliged if you will tell me (1) what height the foot should be from the ground and (2) what amount of padding should be placed between the heel and the splint. (1 ) The reason for the elevation of the foot from the ground is to relax the muscles on the front of the thigh and so to prevent traction on the upper fragment of the fractured patella. Consequently the exact number of inches does not matter, though the Textbook suggests “ pillow, roll of clothing, &c.,” which amounts in practice to 10 or 12 inches. (2 ) The padding should be just sufficient to raise the heel off the splint and will vary with the development of the patient. Incidentally I have never yet seen this done in examinations for Association awards, the heel being invariably left in contact with the splint !— N.C.F. Status of Ambulance Attendant. H.H. (Wallington).— I will be much obliged if you can give a definite ruling on the following queries :— (1 ) Who takes, and is responsible, for the casualty sheet in the case of a Civil Defence Ambulance ? (2 ) Under what authority should the driver enter the details and take charge of the sheet ? (3 ) What is the priority status re attendant and driver of a Civil Defence Ambulance ? It is not possible to give definite rulings on your three points as circumstances vary in different areas. The questions refer to matters which fall within the jurisdiction of (and will be determined by) the Station Ambulance Officer. Further, there is no official priority status for either driver or attendant. — E d ito r.

Fractured Clavicles and Crushed Hand. E.A. (Bath).— In a recent examination I had to put up fractures of both clavicles and a crushed hand. I attended to the clavicles first, while the patient was made to support the crushed hand. I passed a narrow fold bandage beneath the armpits, round each shoulder, without pads under the arms, tying ends off across the back, with a pad beneath knots. Next, I treated the crushed hand as stated in Textbook. Then I tied the arms round the trunk with 3 . broad fold bandages. We have discussed this at our practice classes and would be very glad if you would tell us the correct treat ment. Some say that a sling should have been used, with both hands placed in it and the knot tied at the back of the neck. Also should the crushed hand have been treated first? Thank you for the great help we have received from your query column. With this combination of injuries the fractured clavicles are the more serious injuries and demand preferential treat ment. So you were quite right in leaving the crushed hand until the clavicles had been controlled. Incidentally, those who suggested the use of a sling were guilty of meddlesome first aid, since they forgot that the sling would press on the broken clavicles. Your suggested treatment would probably have resulted in the prevention of aggravation of the injuries, but I think that it was rather cumbersome and I do not like the knot being tied “ across the back.” Indeed, I consider that better results would have been obtained if you had adopted the

A I D

treatment which used to figure in the Textbook and which I have several times in the last year or two described in this column, the last being in the December issue of F i r s t A i d . In short, you should keep both shoulders back by narrow bandages tied round each arm (close to the shoulder), passed across the back, over the opposite arm and tied together in front. This done you should treat the crushed hand as laid down in Textbook, and then you should undo the knot which you have just tied, raise the forearms, support them by the two bandages and finally retie the knot. Thereby, I think that you would complete a neat and efficient piece of first aid. — N.C.F. Asphyxia and Crushed Ribs. C . S . (Bromley).— After a recent A.R.P. Exercise a con troversy arose as to the correct method of artificial respiration which should be used on a patient with crushed ribs. I would very much appreciate your advice on this subject. With this combination, Schafer is the correct method of artificial respiration because pressure is exerted on the Joins and involves no risk of further aggravation of the injured ribs.— N.C.F. Causation of Collapse. J.L. (Cymmer).— We have often been informed by our Lecturer that “ Collapse is caused by the dehydration of the body, or, in other words, by the loss of the body’s fluids.” In the official Textbook we find collapse referred to in different ways on pp. 4 2 , 1 5 2 , 1 6 8 , 170 and 174 . In the handbook Com m on E r r o r s in F i r s t A id , it is stated on page 45 that “ Collapse is one of the ? degrees of depression of the nervous system which accompany injury and disease.” All this leaves us rather mystified as to the real nature of collapse, for assuming that our Lecturer’s definition is correct we would like to know how collapse can occur without any apparent loss of the body’s fluids. We await your answer with interest. Dehydration does not necessarily mean a loss of fluid from the body although it can occur in consequence of pro fuse perspiration or excessive diarrhoea. What often happens in Collapse is that the blood stagnates within the body and is not circulating through the body. To me, therefore, de hydration is rather a symptom than the cause of Collapse. In these circumstances it may occur as the result of severe haemorrhage, grave physical injuries or an upset of brain or nervous system, e.g., effects of poison.— N.C.F. Effects of Sodium. R.M. (Cambridge).— Here is a first aid problem which I hope you will be able to solve for a friend of mine who works in a chemical works— the problem of burns with sodium. It is a metal that burns to make caustic soda ; if water is put on the burn it fizzes and makes caustic even fiercer. This is very dangerous if allowed to get in contact with the eyes. I would be very much obliged if you could give me some information on this subject. You do not say on what point you want information. It is quite correct that sodium has a burning effect on the skin consequent on its caustic properties. Should this occur then the immediate treatment is the application of a dilute acid solution, e.g., vinegar and water.— N . C . F . Successful Artificial Respiration. A. B. (Bedford).— I shall be grateful if you will please answer the following two queries which 1 was asked at a class and which I could not answer :— (1 ) What is the longest known period of time artificial respiration has been performed to end in success? (2 ) How long can the human body be left under water to stand any chance of recovery by means of artificial respiration ?

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While I also cannot answer your queries authoritatively, 1 know (1) that in treatment of cases of asphyxia due to electric shock the rescuers are advised to persevere with artificial respiration for the minimum period of four hours ; and (2) that victims have been restored to life after sub mersion for ten and even fifteen minutes.— N.C.F. Compound Fracture of Skull. F.H. (Dorking).— At a recent Practice the question arose as to whether a dressing should be applied first to a wound of fractured skull before adding a ring pad, or some lint and cotton wool be placed inside the ring pad, after putting this into position. Your kindly advice will be very much appreciated. All wounds must, as you know, be protected against in fection at the earliest opportunity. When treating a com pound fracture of skull, therefore, I would paint wound with antiseptic, apply clean dry dressing and then fix the ring pad in position.— N.C.F. The Future of the Brigade. P.M. (Harrogate). — With reference to the query answered under the above heading in the November issue of F i r s t A i d , 1 would like to point out that the St. John badge worn on C . D. uniform is usually an Association and not a Brigade badge. Further, while I agree that there are good and bad in every organisation, I would also point out that Brigade members must retain a high standard of efficiency by passing an annual re-examination. On the other hand, many Association members are content with one certificate which lasts for all time. We thank you for your letter and for pointing out that (as we are well aware) the Brigade does make every effort to maintain the knowledge and efficiency of its members.— E d ito r .

Multiple^Injuries and Transport. W.W. (Darlington).— At a recent competition the patient was supposed to be suffering from fracture of cervical vertebrae, fracture of pelvis with injury to bladder and also from concussion which quickly changed to com pression of the brain. The judge, a layman, gave marks for raising the head of the stretcher while being marched a distance of twenty yards to the ambulance. Please tell me if this would aggravate the fractures or not. The raising of head of stretcher in this instance would not have any harmful effect on the fractures ; and your query is a repetition in another form of the problem with which I dealt in the November issue of F i r s t A i d under the heading R a is in g o f F ra c tu re d L eg . Further, if, as I suspect, the judge was seeking to treat the compression of brain, very little benefit would result by raising the head of the stretcher for such a short distance. It would, however, be grossly unfair to criticise on this score the decision of the judge.— N.C.F. Performance of Schafer’s Method. B.C. (Marlborough).— With reference to the query which you answered under the above heading in the November issue of F i r s t A i d the Royal Life Saving Society in its Artificial Respiration Drill, instructs its members to place the patient’s head on the left cheek. This is done for uniformity of class work so that, when turning the patient into the supine position for promotion of circula tion, the head would be in the most suitable position. You will, 1 know, agree that if the patient s head is facing towards the operator when he turns the patient, there may be danger of injury to the patient’s neck. While I agree that, if patient is to be turned on to his back from the left side, the placing of his head upon his left cheek will facilitate the movement, I must emphatically dis

A l t )

agree that, when the right cheek is on the ground, any serious damage would result to the patient’s neck ! Certainly the most careless operator would not succeed in breaking the patient’s neck as was said to have been stated in the previous query. To me the instruction to protect patient’s head and face during the turning on to his back really means that, unless this is done, the patient may sustain wounds of scajp or face, and further, that his nose and mouth may come in contact with the ground which might aggravate matters in the presence of sand or mud.— N.C.F. Complicated Fracture of Clavicle. H.W. (Bulwell).— In the case of a complicated fracture of clavicle piercing the subclavian artery and causing arterial haemorrhage beneath the skin, would the result ing escape of blood gain entrance to the chest cavity ? If so please tell me what would be the result and the possible first aid treatment. Complicated fracture of clavicle involving the subclavian artery is a very rare accident. Should it occur, a small quantity of blood might find its way into the chest cavity but none into the lung tissues. Since the inner end of the broken clavicle is drawn upwards by the neck muscles, pressing the torn artery on to the first rib can still be maintained, and the pressure must be maintained until patient has been removed to hospital.— N.C.F. Pain in Insensibility. H.W. (Bulwell).— Can an unconscious person feel pain? Also would pain cause an unconscious person to return to consciousness ? Your kind replies to my two queries will be much appreciated. Insensibility indicates a condition in which the functions of the brain are in abeyance. It follows, therefore, that an unconscious person cannot feel pain and that he would not be restored to consciousness by the pain.— N.C.F. Effects of Cyanide of Potassium. F.G. (Ossett).— At a recent Divisional Practice we had an interesting discussion on poisoning by Cyanide of Potassium. Some members said that the poison killed the white cells of the blood first but others said that the red cells were killed first. As a regular reader of F i r s t A i d I await your ruling on this point. Cyanide of Potassium has an immediate effect on the brain centres especially those which control the circulatory and respiratory systems, the result being that with fatal doses the victim will die forthwith. Consequently the suggestions made in your letter are not correct.— N.C.F. Temperature of Blood. F.G. (Ossett).— Please tell me which registers the higher temperature, the blood in the arteries or that in the veins. As far as 4 know, the temperature is the same.— N.C.F.

N o t e . — Owing to the large number of queries received, and our limited space, a number have unavoidably been held over. These will be published in due course.— E d i t o r .

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CONTENTS d it o r ia l

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NUMBER.

—

First Aid in Extremis

Load Stretcher by Two Bearers ... Nigeria’s Gift to Red Cross and St. John...

S.J.A.B. Headquarters and District Reports

Police Ambulance News

Great Western Railway

The Home Guard and First Aid The Mauve Indelible Copying Pencil

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EDITORIAL

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FIRST AID is published on the aoth of each month. A nnual Subscription is 4s. post free ; sin gle copies 3d.

F.R.San.L,

90 :—

Boracic Lint Examination Howler Treatment of Fractures

Cigar Ash in Beer...

Compound Fracture of Ribs

Stertorous Breathing Simple Fractures of Both Legs Shock from Abdominal Injury

94 94

Air Exchange in Artificial Respiration

Treatment of Crush Injuries

Mystery of Lay Instructor Certificate

Effects of Drowning Definition of “ F it”

B.R.C.S. Certificate

Control of Carotid Artery

Lay Instructor

Treatment of Fractured Leg

N o t h in g has more astonished the male portion of the population than the w ay in w hich the women have adapted them selves to war needs and conditions. A s has been said, we are all engineers now, and the tim e when the women regarded their husbands as individuals especially hefty and pow erful— b ein g convinced on their arrivin g home that they had at least assem bled a couple of steam rollers and a locom otive durin g the d a y — has lo n g since passed, never to return. W o r k of every kind, in factory and w orkshop, is bein g undertaken b y the wom en, w ho have in num berless cases proved the absolute eq u ality of the sexes." B u t there is more than that. In tim es of stress and d an ger— when the stoutest heart m ay becom e appalled— the women have com e to the scratch in a m anner which calls for universal adm iration, and we feel that a special tribute must be paid to the nurse w ho went, in the dead of a dark nigh t, to the rescue of the crew of an A m erican bom ber w hich crashed over a v illa g e in the H om e Counties. S h e is, we are informed, a M rs. D a ly , a 2 4 -years old secretary w hose husband is se rvin g in the arm y overseas. S h e joined the R ed Cross in 1 9 3 9 . A t the sound o f the crash she grabbed her first-aid kit and scram bled in the dark throu gh woods and tan gled undergrow th to the plane. T h e re she worked for two hours before the doctor and am bulances arrived. S h e found the airmen ly in g near their plane, w hich was turned on its side and blazin g. O ne of them had a com pound frac ture of the leg, and was in great a g o n y . S k ilfu lly Mrs. D a ly applied a tourniquet and splints. T h en she w as ordered to m ove aw ay as am m unition in the plane was expected to explode. W ith the help of soldiers she transferred the men to an im provised stretcher and continued her first aid, in the course of w hich she applied a splin t to a broken arm and dressed a w ounded shoulder, broken ribs and a badly cut face. A t the conclusion of this m agn i ficent w ork the am bulance arrived and the men were removed to hospital where, we note with satisfaction, all are m ak in g good progress. H ow differently matters w ould have turned out had it not been for her prom pt action, and for the train F i r s t A i d in E x tr e m is .

Fjl R S T

in g she had received in first aid. T h is is, of course, o n ly one instance of the work w hich women are perform ing in all parts of the country, and we cite it as a strik in g exam ple of coolness in the face of danger, of skill, and of entire disregard of self in the performance of an act w hich has well been defined as one of extrem e ga llan try. Mrs. D a ly w ill possibly receive some decoration for w hat she did on that dark w inter’s n igh t, but her best reward will be in the know ledge of the lives she saved and the noble manner in w hich she placed the calls of h um anity before every other consideration. H ero ism is certain ly not the attribute of one sex only.

Load

S t r e t c h e r by T w o

B ea re rs.

W e have received permission from the Editor of the B r it is h M e d ic a l J o u r n a l to publish the following letter from Dr. Bowman Edgar, which appeared in the B . M . J . for Decem ber 2 5 th, 1 9 4 3 . S ir,—

The following method of loading stretcher when only two bearers are available is suggested as an improvement on the present, generally accepted, R.A.M.C. mode of pro cedure. The modern trend of first aid is towards simplicity, ease of performance, and economy in personnel—-i.e., two bearers per stretcher. The method described renders the task of loading a heavy patient quite an easy matter for two light bearers. B la n kets : Prepare stretcher with two blankets in the usual manner. Blanket No. 1 lies across the stretcher ; No. 2 , folded in three, lies downwards from shoulders to feet. The lower ends of No. 2 are opened out to provide

folded over on itself till its edge lies over the left pole. Arrange the right side of the blanket in similar fashion (Fig. 2 ). The free edge, which protrudes from the middle of these folds, are the “ trigger edges,” for on these being pulled, the whole blanket flattens out. T o Load. 1 . Carefully turn patient on to his side and raise arms above shoulders. Place prepared stretcher along side patient’s back. 2 . Raise stretcher to the perpendicular against his back. (Pressure between pressure and back keeps the lower blanket folds in position.) 3 . Bearers stand behind stretcher, holding upper blanket folds against pole with outer hand to keep them in place (i.e., No. 1 bearer, at foot, uses his left hand ; No. 2 , at head, uses his right). 4 . Reaching downwards over the stretcher No. 1 grasps with his right hand the folds of the injured man’s trousers immediately above the gaiters. In similar manner No. 2 grasps the waist-belt with his left hand (Fig. 3 ). 5 . Then, h old in g the p a tie n t a g a in st the stretcher (no lifting is required), the bearers allow the latter to resume its normal position on the ground. 6. The casualty is now on the stretcher and can easily be assisted to assume his most comfortable position on the middle of No. 2 blanket. 7 . The “ trigger edges ” on each side are now pulled out, thus freeing the blanket, which can be tucked round the patient as desired. The advantages of this method of loading would appear to be :— (a ) It is extremely easy to carry out and imposes the minimum of effort on the bearers ; two light bearers can deal with a heavy man. (b) Harmful movement or disturbance of the casualty is practically n i l ; therefore there is no increase of shock. (c) As there is no carrying of the patient by bearers, the margin of safety for him is much increased.— I am, etc., B owman

E d g a r , M .B .

M.O., 4 th Battalion Dumfriesshire H.G. Kirkconnel. P. S.— Since writing the above I have tested the sug gested “ load” in the following manner:— Two recruits who had joined only a fortnight before with no knowledge of stretcher work, one weighing 9 st. 2 lb. and the other 9 st. 3 lb., were asked to load a sergeant who weighs 16 st. 7 lb. Using the above method no difficulty at all was experienced. An attempt to load by the R.A.M.C. method was distinctly a failure.

N i g e r i a ’ s G i f t t o R e d C r o s s & S t. J o h n Chief Commissioner, Southern Provinces, Nigeria (retired), formally presented to Major-General Sir John Kennedy at the Red Cross and St. John Headquarters an ambulance subscribed for by the people of Warri and Burutu. When the war is over the ambulance will be returned to Warri and Burutu for the benefit of patients there. Major-General Sir John Kennedy expressed the thanks of Red Cross and St. John to the donors, saying that the gift came at a most opportune time, when they were forming a pool of ambulances for the benefit of sick and wounded which the coming great conflict was bound to produce. S ir W illia m H u n t,

No. 2 BEARER

No.l&EAftl

later cover for the latter. Now carry the left free end of No. 1 across the stretcher and back again till it lies over, and an inch beyond, the left pole (Fig. 1 ). The folded edge, which now lies approximately over the centre of the stretcher, is

C o r r e c t i o n . — In our last issue, under Liverpool, in Headquarters and District Reports, Col. MacPhail is spoken of as Chairman of the Association in Liverpool. This should have been “ Chairman of the Trustees.” County Surgeon W. Murray Cairns is Chairman of the Association.

F I R S T

S t.

Jo h n

A m b u la n c e

H EADQU ARTERS

AND

B rig a d e

D IS T R IC T

REPORTS.

N o. I (Prince o f W ales’s) District No. 163 (Wanstead and Woodford).— At the presenta tion of first aid certificates to cadets of the above Division, on Friday evening, January 2 1 st, at South Woodford Senior School, a deal of interest was given to the proceedings by the presence of a nephew of the late Nurse Cavell ; the nephew, a member of the Metropolitan Police Force, is a Serving Brother of the Order of St. John. The presentation was made by Chief Inspector Farthing of the Metropolitan Police, also a Serving Brother, who before presenting the awards, gave a very homely talk to the cadets on the usefulness of first aid and his general experiences in this direction as a Police Officer. Councillor Galbraith in thanking the Chief Inspector for his presence, wished him every success in his forthcoming work with A. M .G.O.T., and laid stress on the link between the cadet movement and the general work of the Youth Committee. No. 11 (Borough o f Wembley).— A social and dance was held at Terry’s Restaurant, Sudbury, on the occasion of the annual presentation of awards for efficiency, on January 22nd. After several musical items had been perfectly rendered, Div. Supt. W. Thompson opened the proceedings with a message of regret from Assistant Commissioner S. J. Warren that he was unable to be present. After touching on the activities of the Division during the past year, Supt. Thomp son said the Wembley Division was keeping its head well above water despite the fact that fifty members were now serving in H.M. Forces. Awards for efficiency were presented to members by Mrs. R. Tudor Edwards. The high spot of the evening was reached when Supt. Thompson remarked how pleased he was to announce that their Divisional Surgeon— Doctor R. Tudor Edwards— had been awarded the honour of Serving Brother of the Order, and this certificate of appointment was duly presented to the Doctor by Lady Supt. Miss M. E. Duligall. Supt. Thomp son then said that in the absence of Assistant Commissioner Warren, he also had the honour of asking the Doctor to accept the long service certificate, awarded for fifteen years service as Divisional Surgeon. Doctor Tudor Edwards in a well chosen speech said how pleased he was to give his service to No. 11 , despite the claims of doctors in war time. Dancing and social good fellowship took up the re mainder of a thoroughly enjoyable evening. No. 175 (Teddington).— The first annual general meet ing of this Division, which was attended by the Assistant Commissioner, Mr. Sydney J. Warren, was held on Monday, January 2 4 th, at their Headquarters, the British Legion, Teddington. The Secretary’s Report revealed that although 4 members were on active service, and the majority of the remainder were on part-time civil defence work, they had performed 542 public duties, and had a total of 450 drill attendances to their credit. The Treasurer stated that although the year had not been a full one (the Division was not inaugurated until June 2 4 th, 1 9 4 3 ), it had been financially successful. The Ambulance Officer-in-Charge, Mr. C. G. Bowden, welcomed the visitors, especially Mr. Warren who had twice within the past six months inade the long tedious journey in the black-out to be with the Division. He thanked all those

R I D

8 7

who had helped the Division, and offered the congratulations and best wishes of the members to the newly-formed 148 (Teddington) Nursing Division, many of ■whom were present, and spoke of the cordial relations existing between these two Divisions. Mr. Warren said he was delighted to be present at the first annual general meeting. As a new Division, he thought it right to remember their previous experience as a Section of the 84 (Twickenham) Division, and he wished to thank the Acting Supt. of that Division, Mr. G. Ewer, for the way he helped in putting the new Division on its feet. He was delighted to hear that the two Divisions had settled the question of their boundaries and other problems amicably. Mr. Ewer said he welcomed the opportunity of giving his public blessing to the new Division. Mrs. D. A. Jackson, Lady Ambulance Officer-in-Charge of the Teddington Nursing Division, thanked Mr. Bowden for the kindly reference to her Division and spoke of her confidence that the two Divisions would work well together. Mr. Warren presented service chevrons to Privates Bartholemew, Gibbs, Slack and Spalding ; re-examination awards to members of the Division, and preliminary first aid certificates to a number of cadets.

C/N 54 a t t a c h e d t o N. 16 ( H a m p s t e a d ) N u r s i n g — On January 2 9 th the Hon. Mrs. Copland-Griffiths (Lady Supt.-in-Chief, Overseas) gave a stimulating address on Brigade work Overseas, to Officers, Ambulance and Nursing Cadets of Northern area, who were invited by the Officers and Cadets of the above Division. They were informed that membership Overseas was 7 5 ,0 0 0 , and that Cadet Divisions were first started in India in 1925 which included every race, colour and creed, dealing chiefly with casualties caused through riots, floods, bites from crocodiles, dogs and snakes. In Burma 2 Divisions are flourishing and when Japan attacked the Burmese, the Rangoon members attempted to cross the mountains into India, and by helping other refugees kept up the Brigade traditions of service and courage ; un fortunately they have not been heard of since. In sparsely populated Australia the first Grand Prior Badge was awarded in 1 9 3 3 . The chief duties of Australian members include fighting forest fires, treating shark bites, controlling and policing life-saving squads, and helping the flying doctors and nurses who tend the sick in remote places which may be as far away as 6 0 0 miles from the nearest hospital. In New Zealand the proportion of the Brigade is 6 to the thousand, as against 4 over here. This small Colony is very Brigade minded, and has won 350 Grand Prior Badges. Adult Divisions have been formed in all universities, and Cadets in schools. Transvaal has the largest membership, and 11 Military hospitals staffed and financed by the Brigade. When war was declared the Brigade in South Africa was taken over by the Government. Great skill in first aid is needed to deal with people badly mauled by lions, tigers, or trampled on by elephants. One hour after Pearl Harbour was attacked, Canadian Brigade members attended to survivors from shipwrecks, and worked in shifts of 24 hours ; they also manned the Atlantic and Pacific Coasts, A.R.P. and First Aid Services. Ski-ing accidents in Quebec and Montreal are also treated by Brigade members. In Bermuda, Cyprus and Ceylon, Brigade members are also rendering efficient service. Cadets were asked to correspond with members Over seas. At the close of the address, prayers were offered for the 4 ,5 0 0 members of the S.J.A.B. thought to be in Japanese hands D iv is io n .

F I R S T

A War Service Badge (fourth for the Division) was pre sented to Nursing Cadet Anna Wisla, of Hampstead. On the platform were Miss Walker L. D. Supt. No. 1 Dist. (Retired), Mr. Collins, D.O., Miss Cleasby, L. D.O. i/c Cadets N. Area, Miss Finch, L. Supt. Hampstead N. 1 6 , Miss Burley, Supt. i/c C/N 5 4 , Miss Housden, L.A.O. N. 1 6 , and Mrs. Milburn, L. Supt. Highgate. No. 84 ( T w i c k e n h a m ) . — The annual general meeting of this Division was held at York House on January 3 1 st, with President Councillor C. VV7. Beckett in the chair. The membership is now 8 2 , 41 of whom are in H.M. Forces ; 1 ,4 0 6 public duties were covered during the year, and 739 casualties attended to. Five public classes had been conducted at which 114 candidates were successful in obtain ing certificates. Ambulance Officer Mr. Chandler (Whitton Section) had conducted three resuscitation classes, and eight members had obtained badges. The Treasurer reported a balance at Dec. 3 1 st, of ^ /9 8 13 s. Id. plus £ 5 5 s. 9 d. money in hand. Mr. S. J. Warren congratulated the Division on their hard work, and the formation of the Teddington Division, making special mention of the efforts of Divisional Supt. G. Ewer, complimenting him on his promotion. A / O Mr. Chandler gave a favourable report on the Whitton Section, as did Cadet Officer A. F. Cook of the Cadet Section. After presentation of annual awards by Mr. Warren, a successful meeting closed with refreshments. County o f Berkshire. The Hon. Mrs. Leslie Gamage was appointed Lady County Supt. in August, 1 9 4 3 . This was not made clear in our notice which appeared in the issue of January, 1 9 4 4 . R e a d i n g . — The Nursing and Ambulance Cadets of the Reading Corps were given a party on December 2 7 th, through the kindness ot Mr. and Mrs. Prew and the Com mittee of the Greyfriars Fire Guards. A very enjoyable afternoon was spent, with games and competitions arranged by the Officers. The County Com missioner, Mr. C. A. Poole, M.A., and Lady County Cadet Officer Mrs. Poole, paid a short visit during the afternoon, and thanked Mr. and Mrs. Prew and Committee for all they had done to make the party such a success. The afternoon ended with all sitting down to tea.

O b i t u a r y . — We regret to announce the death of Amb. Officer Francis H. Webb of the Great Western Division, Reading Corps. He took his first aid certificate in April, 1 9 2 0 , and joined the Brigade on June 3 0 th of the same year. He was promoted to Corporal in 1927 ; Sergeant in 1 9 3 3 . He was awarded his long service medal in 1 936 , and owing to his great love of and interest in cadets, he was appointed Cadet Supt. in 1 9 3 9 . He was also further promoted to Ambulance Officer in 1 9 4 3 . The funeral took place on Thursday, January' 13 th, at the Henley' Road Crematorium, Caversham, Reading. County Officer F. A. C. Jarvis represented the County Com missioner who was unable to attend, and a Guard of Honour was formed by Officers and members of the Reading Corps and Cadets.

A I D

Dr. John Williams the Corps Surgeon-Supt. set the test and the adjudicator was Dr. L. A. Gillet. One of the Moreton teams was successful with 164 points out of a possible 2 0 0 , a Wallasey team being next with 144 . The winning team distinguished itself by completing the test in 8 minutes, the time allowed being 20 minutes. Supt. W. E. Lewis of Moreton Ambulance Division had promised that if a Moreton team should win, he would buy each boy a medal, and both medals and trophy were presented on Tuesday evening, January 2 5 th, at Moreton Divisional Headquarters, by Dr. John Williams. Tne function was well attended, among those present being County Officer R. E. Anthony, Dr. Gillet, Corps Officers Gorst and Carr. Unfortunately Supt. W. E. Lewis was unable to attend owing to illness, and his place was taken by A/O E. Rowlands who acted as host. The cadets who were responsible for placing the first name-plate on the trophy are as follows : Cpl. T. Mercer (leader), Cpl. R. Heslin, and cadets G. Harding and L. Cooke. County o f Hampshire. B a s i n g s t o k e . — The annual general meeting was held on January 4 th, with Div. Supt. S. Wilde in the chair, assisted by County Officer N. R. Turnbull. Also present were Rev. B. S. Lombard, Vice President, and Amb. Officer L. P. Botting, Div. Secretary', and 45 members of the Division. During 1943 the Division’s Ambulance covered a record distance of 1 3 ,0 5 5 miles in transporting over 400 patients. Thanks were due to the Venture Bus Co. for the free use of a garage. The strength of the Division is now 82 of whom 27 are serving in the Forces ; 47 members passed their annual re-examination and 3 members passed the examina tion for Lay Lecturers. Ambulance Officer L. P. Botting was created a Serving Brother of the Order, and Div. Supt. S. Wilde awarded a Certificate of Honour. County Officer N. R. Turnbull said the Division was well on its way to the endowment of a second bed in the Malta Hospital.

H o u n d a n d N e t l e y . — Thursday, January 13 th, marked a happy occasion in the history of this Division, when twentyone Home Nursing Certificates were awarded to members of a newly-formed Nursing Division. Mrs. Clayre was pro posed President, with Mrs. Gosling as Div. Supt., Mrs. Wheeler, Secretary, and Mrs. Sanger, Treasurer, also Sister I. Ware, Vice-President. Mr. Stephen Clarke, Vice-President of the Ambulance Division, opened the meeting which was held in the Jubilee Hall, introducing Mrs. Clayre who presented the certificates and one pendant. Mr. A. Bright, Div. Supt., in his report on the y’ear’s work, said that it had been a most successful year, both for attendance and interest, the average attendance being 26 meetings per year and Divisional Exaininations passed with credit ; 105 cases had been efficiently dealt with by the Divi sion and four public duties performed. The Div. Supt. ended his report by expressing the great hopes that were placed in the young people in continuing the building up of the Division. Mrs. Gosling proposed a vote of thanks to Mrs. Clayre, which was unanimously supported.

County o f Hertford. County o f Cheshire. — The Wallasey Corps Competition for Ambulance Cadets was held recently'. Three teams from W a ll a s e y and two from Moreton Division were the con testants for the trophy which was given by Mr. Laurie of Wallasey. W

a lla s e y .

W a r e . — Lady Corps Officer Miss D. Sparkes invited t h e Ambulance Cadet Officers of the county to a meeting to form a County Ambulance Cadet Council. After unanimous agree ment, the following Officers were elected : C/Supt. T. Peitingell as President, Amb. Officer Cull, Vice-President, C/Supt. G. Henderson Smith, Secretary, C/Supt. H. Beaumont-

F I R S T

Smith, Publicity Officer, and Lady Corps Officer Miss D. Sparkes agreed to act as adviser to the Council. The main objects of this Council are to promote friendly inter divisional competition, combined county camp holidays, and the exchange of ideas and experiences for the mutual benefit of all Cadet Officers and Cadets. The Council gratefully accepted from the President the gift of a silver challenge cup for cadet competitions. The Council meetings have been well attended and quite success ful. It is believed that this Council is the first of its kind in the country. County o f Warwick. C o v e n t r y ( C e n t r a l ) . — An enjoyable time was spent b y all on the occasion of the dinner and dance held at the Masonic Hall on January 1 1 th, to present the awards to the winners of the “ Quiz” competitions which have been held weekly throughout the last eight months. The trophy, which was won by the Morris Engines Division team, was presented by the County Commissioner, Major E. S. Phillips, D.S.O., who congratulated the winners on their excellent work and efficiency. Corps Supt. L. T. March, in proposing the toast to the “ Quiz ” teams, spoke of the keenness and enthusiasm shown throughout the competition. He particularly mentioned the Rover team. The Central Corps now has over 6 0 0 members. The ambulances have moved over 1 2 ,0 0 0 patients during 1943 — 4 ,0 0 0 more than in the previous year. Great credit is reflected on the permanent and voluntary staff. Any transferred workers who are members of the Brigade, will be always made welcome if they care to contact Supt. Taylor, Ambulance Station, Swanswell Terrace, Coventry.

East R idin g o f Yorkshire. H u m b e r s id e .— A social evening arranged by the Humberside Corps S.J.A.B., was held in the Memorial Hall, Brantingham, on Saturday, January 2 9 ih, at which a large gathering of S.J.A.B. members in the Corps, and friends attended. The first step towards the extension of St. John activities in the district was made in January, 1 941 , when 7 enthusiasts signed the register, and extension has been so rapid that now there are 4 Nursing and 3 Ambulance Divisions, about 175 personnel, active and trained in the area constituting the Humberside Corps. Its activities have been many. A medical comforts depot has been established. An ambulance service for civilian sick and casualties has been opened which is proving an immense boon to the district. In the six months, during which this has been in operation, 120 cases have been transported in comfort and safety ; the work being done completely voluntarily by Divisional members and friends at any hour of the day or night. Various duties are performed regularly at Hospitals and Clinics by members. And a pro posal is on foot now for the acquisition of a house locally in Brough area as a Corps Headquarters and sick bay where minor sickness can be nursed. During Saturday evening when a whist drive, games, dancing and refreshments provided attractions for all, 7 warrants of appointment were presented also 1 fireguard instructor’s certificate, special grade. Among those who spent a most enjoyable evening were Assistant County Commissioner G. Edwards, Lady County Supt. Mrs. Edwards, and members of the County Staff.

County Officer F. R. Stent, officer in charge of the Bath City Division of the S J.A. B., has been promoted from the rank of Serving Brother to that of Officer in the Venerable Order of St. John of Jerusalem in the British Realm.

A I D

P o lic e

A m b u la n c e

N e w s .

M ETROPOLITAN SPECIAL CONSTABULARY. Nine teams entered theX Division First Aid Inter-Station Competition for the cup presented by Commandant E. B. Brown, B.E.M., L D.S., R.C.S., Director of Ambulanceand A. R P. The competition which had not been held since 1 9 3 9 , was held on Sundav, January 2 3 rd, at Wealdstone, and was set and judged by Commandant Brown. Eight teams took the floor, the winners being Harlesden (Captain S. C. A. Hine) ; runners un, Harrow, followed by Pinner, Uxbridge, Greenford and Harrow Rd. who tied for fifth place, Wealdstone, Wembley. The card said “ You four are called to the assistance of a workman who has fallen through the skylight into the room below, in an empty house. Your Station is 100 yards away ; 12 minutes.” The scene showed a patient huddled on the floor in slippers, severe bleeding, wristband round left wrist. Broken glass all round ; one bystander with broom.

G re a t W e s to rn R a ilw a y . Ambulance work has continued to be steadily maintained throughout the system during the past year, and in spite of difficulties entailed by war conditions, it is encouraging to note that some Divisions show an actual increase in exam ination results over the 1941-2 figures. It is appreciated that the results in general have only been achieved by the untiring efforts and high purpose of all concerned in the welfare of the first aid movement. The number of successful candidates was 6 ,0 9 6 , a decrease of 447 on the previous year. Of these students, 381 were recruits to the movement. The Athlone Bowl, awarded to the Division gaining the highest percentage of new members in proportion to the total number of adult staff employed, has this year been won by the South Wales Docks Division with a percentage of ’9 9 . This Division was previously successful in winning the Bowl in the years 1940 and 1 9 4 1 . The runners-up (for the second year in succession) are the Plymouth Division with a per centage of "8 7 . The practical value of the first aid movement continues to be manifested in the fine work of trained men and women members of the staff who serve in connection with A. R. P. posts, casualty clearing stations and first aid posts, and assist in the instruction of classes. For exceptionally efficient first aid rendered during the year 1 9 4 2 , the following awards have been granted :— 1 Gold Medal ; 1 Silver Medal ; 1 Bronze Medal ; 11 Certificates. No fewer than 568 gold efficiency awards or certificates in lieu thereof were granted during the year, made up as under :— 15 year gold medals, 2 4 0 ; 20 year gold bars, 203 ; 25 year gold medals, 72 ; 30 year gold bars, 39 ; 35 year gold bars, 10 ; 4 0 year gold bars, 4 . In appreciation of valuable services rendered to the G.W.R. Ambulance Centre over a long period of years, the following members of the staff have received recognition from the Order of St. John of Jerusalem :— O fficer f B ro t h e r). Mr. G. H. lies, Chief Clerk, Docks Manager’s Office, Cardiff. (Divisional Secretary, South Wales Docks Division).

F I R S T

A I D

S e rv in g B rothers. Mr. E. H. Lewis, Brake Examiner, Chief Mechanical Engineer’s Dept., Swindon. Mr. W. F. Burdett, Signalman, Traffic Dept., Saltney. Mr. J. Green, Oil Gas Maker, Chief Mechanical Engineer’s Dept., Exeter. Mr. F. Hatton, Goods Guard, Traffic Dept., Shrewsbury. Mr. W. J. Price, Signalman, Traffic Dept., Bala. Mr. A. E. Williams, Station Master, Traffic Dept., Gresford. Mr. W. Hookins, Passenger Guard, Traffic Dept., Penarth Town. Mr. J. A. Martin, Assistant Centre Secretary, Staff and Establishment Office, Aldermaston. V e llu m Vote of T h a n ks. Mr. F. E. Saunders, Acting Dock Foreman, Docks Dept., Swansea.

T h e H o m e G u a r d a n d F i r s t A id . D R ILL

REVISIONS.

T h is m o n t h I w a n t to d e a l w it h th e r e v is e d d rill for th e c o l l e c t i o n o f w o u n d e d , a s a d v i s e d f o r t h e s e r v i c e s in t h e fie ld .

It is realised that the original drill, as per textbooks, is not practicable under war conditions, as Medical Orderlies may have to work while exposed to fire, and must therefore take whatever cover is possible, and also get their patients under cover before attempting any but essential treatment. If, in practice, stretcher squads are taught this from the start, it will come natural should they experience the real thing. First of all, unless ordered otherwise by a superior officer, the senior N.C.O. or senior private, as the case may be, should assume the duties of No. 1 at the stretcher and should fully realise his responsibility, as the lives of his squad and his patient may depend on his initiative and efficiency. All the squad, however, should be trained to act as No. 1 . When practising collection of wounded by a squad of four (casualties having been placed), procedure is as follows :— The instructor will order “ For carriage, prepare stretcher,” which is passed on by No. 1 . This order will be followed by “ At the double, carry on 1 ” No. 1 will then order “ Follow me,” and the squad will double out and Ja il fia t just short of casualty. No. 1 will crawl forward and find out if casualty is still alive. If this is so, he will order “ No. 3 help me,” and together they will make complete ex amination of patient. At this stage, however, wounds are not dressed (unless there is dangerous bleeding). No. 1 will give order to Nos. 2 and 4 , “ Open and blanket stretcher,” which they should do while keeping as low as possible. All bearers should then take usual positions and lift patient on to stretcher. He should be transported to cover as quickly as possible and necessary wounds dressed. If any distance is to be covered, bearers should adopt the shoulder carriage. For two bearers only the procedure is similar, except that No. 1 , after ascertaining the condition of patient, will assist No. 2 to blanket stretcher. They will then lift patient on to stretcher, as illustrated on page 221 St. John’s Hand book, and No. 1 will order “ Hand carriage, lift,” followed by “ Adjust slings.” To slip the sling loops over handles, the bearers should learn to balance the stretcher handles on alternate knees. C. W.

(Sergt.), School House, Noel-road, W . 3 .

S p read b u ry

T h e M a u v e In d e l i b l e C o p y i n g By WILLIAM

P e n c il.

NORTH.

Two facts noted recently by the present writer led to a train of thought responsible for this article. The first was the case of a colleague in possession of an old-style mauve indelible copying pencil ; the second, another colleague who ran the point of a black copying pencil into the fleshy base of his thumb, the point breaking off, embedded therein. It may be mentioned that the latter case cleared up without untoward develoyments after the point had been removed ; the graphite preparation used in this type appears harmless. But if it had been the possessor of the first mentioned pencil who had embedded his pencil point in his hand, a serious injury may have resulted. Fortunately, there does not seem to be any of the old type mauve “ copying ” pencils on sale now ; their issue by Government departments was stopped some years ago, but there must be quite a number of this type of pencil in use in the country. In fact, an article appeared in the “ British Medical Journal” hardly more than two years ago dealing with this very problem, and the author appeared to regard the danger as still being sufficiently existent to describe its peculiar perils and special treatment. There is always the possibility that the first aider may come across a case of indelible copying pencil injury involving the mauve kind. The mauve indelible copying pencil “ lead” is com posed of a mixture of graphite and an aniline dye, produc ing the characteristic colour. Unfortunately, this dye, unlike so many aniline dye products used in modern medical practice, is most injurious to human tissue. If the broken off point of such a pencil were left in the wound, necro sis of all tissue in contact with it would ensue, including even bone. Attempts to remove the piece of point with splinter forceps would lead to a worsening of the injury, as the fragments of this type would shatter into tiny pieces, spreading the area affected, and accelerating the rate of tissue destruction. The only permissible first aid in this case is to prevent meddling with the foreign body and to get the patient to proceed to hospital for the only treatment that is efficacious — complete excision of the affected part. Interest attaches to the mauve aniline inasmuch as it was the first aniline dye to be discovered. W. H. Perkin, in 1 8 5 6 , attempted to prepare quinine from aniline. He failed in his original object, but he did produce Perkin’s mauve, and thus was born the vast aniline products industry of the present day.

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cut from the current issue of the Journal, or, in case of Queries from abroad, from a recent issue. 4 .— The Textbook to which reference may be made in this column is the 39 th (1 9 3 7 ) Edition of the S.J.A.A. Manual of First Aid to the Injured. Boracic Lint. W.N. (Rossendale).— I wish you would please let me know what is the object in making one side of pink lint fluffy, when, as I understand, it is not intended to put the fluffy side to the skin or wound. There is no definite ruling with reference to the applica tion of the smooth or fluffy side of boracic lint. Usually, however, the smooth side is placed on wounds and the fluffy side applied to the part when the lint is used for fomentations on the grounds that it contains more boric powder.— N. C o rb e t

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Examination Howler. H.H. (West Riding).— In a recent examination the doctor asked a member of the class to define a complicated fracture. He was much amused when the candidate replied A com plicated fra ctu re is one -which is only fo u n d in a m a n 's tru n k / ” Good! Next, please ! !— N.C.F. Treatment of Fractures. W.M. (Northern County).— I was much interested in the reply given by you under the above heading in the November issue of F i r s t A i d regarding the application of the broad bandages directly over fractures instead of above and below. Your correspondent probably has in mind the emergency method laid down in instructions by the Regional Training School Southend-on-Sea. I enclose two sheets of these instructions on the emergency treatment of fractures, issued by the Regional Training School showing illustrations of bandages applied directly over the fracture. Quite frankly this has given me cause for thought, and while we in the Civil Defence Casualty Service are expected to put these instructions into effect, I, for one, would appreciate the doctor’s views on the matter. With possible extensive swelling over and around the seat of the fracture, will not such a bandage, by direct pressure on the injury and surrounding swollen tissue, tend to increase pain and incidentally by increas ing pain, aggravate the condition of shock ? As an old first aider and a reader of F i r s t A i d for very many years past, I value greatly the replies given in the Query Column, which to us first aiders have been such an enormous source of help. In my replies to previous correspondence on this point it was stated that no general instruction had been issued for the modification of the treatment ; and for all general pur poses this still holds good. It is known, however, that the training given in the Civil Defence allows for bandaging without splints and a broad fold bandage being placed directly over the seat of the frac ture. This, however, is purely a wartime measure and is designed to meet instances where splints are not available and there is need to economise in the use of bandages ; but

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it cart be stated that this will not apply to peacetime measures. It is unlikely that any of these modified methods would aggravate the injury or increase the pain. There is, how ever, a slightly increased risk of aggravation during trans port as the fracture is not completely immobilised as would be the case where splints were used. Further, the modified method has not been: adopted as a general practice by the medical services with the Forces. In effect then, this means that whilst engaged on civil defence work, emergency civil defence measures should be adopted ; and for all other purposes splinting and bandaging should be carried out as laid down jn the Textbook.— N.C.F. Cigar Ash in Beer. R.R. (Sheringham).— As a member of the Brigade I should be glad to know if there is any foundation in fact of the belief that cigar , ash dropped into a person’s beer will cause him to become doped after drinking it. Thank ypu very much. Personally I do not believe that cigar ash could have the effect suggested when mixed with beer ; and I am not dis posed to try the effect of the mixture which would probably upset my stomach and make me vomit.— N.C.F. Compound Fracture of Ribs. H.W. (New Barnet).— Will you please comment on the treat ment of a case of compound fracture of ribs accompanied by severe haemorrhage ? In the body there are no pressure points to control the bleeding as there are in the limbs ; and direct pres sure is taboo because of the risk of causing injury to internal organs. This being so, would the application of a cold compress on the open wound be permissible and may we ignore the possibility of causing further shock ? The application of cold water dressings to an open wound is contrary to the principles of first aid. There is, therefore, no justification for the use of a cold compress in treatment of compound fracture of ribs. After all, the application of a cold compress is a minor detail in the treat ment of concealed (or internal) haemorrhage.— N.C.F. Stertorous Breathing. W.R, (Exhall).— It seems to me that stertorous breathing is only produced when the higher brain centres are in abeyance. If that is so, what produces that character of breathing ? Thank you for all past answers which are always helpful and make one keen in the work of helping suffering humanity. Breathing ceases when the higher brain centres, especially those controlling circulation and respiration, are in abeyance. It becomes stertorous only when a rise of pressure takes place within the brain and exerts its effects on these centres. — N.C.F. Simple Fractuxes of Both Legs. A.N. (Hull).— At a recent Divisional Practice we were told to treat a man for supposed simple fractures in the middle of the shaft of each leg. We could not agree as to whether four splints or only two outer splints should be used ; and so we submit the problem for your kind ruling. Were I in your place I should treat each fractured leg separately and then bind limb to limb. By so doing I should facilitate my task as a first aider and also that of the doctor who subsequently took charge of the patient.— N.C.F. Shock from Abdominal Injury. P.M. (Cardiff). — Please tell me what is the precise cause of shock in the case of a man who is winded and also injured in the lower abdomen which combination is often seen on the football field. You refer to two common causes of shock due to abdominal injury :— In the first as the sequel to a sharp and sudden blow on the abdominal wall (especially that part often called “ pit of

A I D

stomach ” ) shock results from irritation of the sympathetic nervous system and particularly the important portion of it which is known as “ the solar plexus.” As part of the shock there is a reflex stoppage of breathing which, as the most marked symptom, gives its name— “ winding ”— to the con dition. The effects vary from transient incapacity to fatal syncope ; and this often without any apparent lesion, i Iff . the second, these organs of the lower abdomen are really internal organs which in process of development pass outside the body and as such receive their nerve supply from the sympathetic .nervous system. Ip these circumstances you can now appreciate why, with thlsicorrtbination of injuries there is often present a grave degree of shock.— N.C.F. Air Exchange in Artificial Respiration. M.E. (Manchester).-n-In a query which was published in the October issue of F i r s t A i d , mention is made of Eve’s ' method of artificial respiration.' My colleagues and I know the Schafer method, but have never heard of the Eve method. Could you please enlighten us about it ? Eve’s method was described in the September issue of F i r s t A i d in an article which was headed— “ Resuscitation by Rocking.”— N.C.F. Treatment of Crnsh Injuries. C.G. (Ventnor).— The local rescue party has been instructed to place a tourniquet on a limb which has been badly crushed for any considerable length of time, before re leasing the limb from the pressure. The object of this is to prevent toxins developing in the crushed muscle from being absorbed into the circulation. Should the tourniquet be adjusted so firmly as to completely stop arterial circulation or only more loosely so as to prevent considerable outflow of venous blood and lymph from the damaged area? Also, should the tourniquet be released at 15 -minute intervals or not re leased until the patient arrives at the hospital ? If it is released there will be some inflow of toxins into the blood. If not, the limb will undergo gangrene. Is this method preferable to the other method which has been suggested, viz., to enclose the damaged limb in a very firmly compressing bandage from the toes, or fingers, to above the area of crush ? The treatment to which you refer is being taught throughout the Regional C.D. Schools and is based on experience gained during the heavy air raids when deaths occurred in hospitals in cases of crush injuries. The instruction affects cases in which a heavy weight has been pressing on a limb for some time pending the release of the victim. It does not refer to light pressure or to heavy pressure for a brief period. When heavy pressure has been prolonged, amputation is almost always indicated. When the tight ligature has been applied, it should not be released until arrival at hospital ; and this is not likely to aggravate the condition, because the circulation in the limb has already been cut off by the pressure.— N.C.F. Mystery of Lay Instructor Certificate. H.B. (Sheffield).— Can you please explain the mystery of the Lay Instructor Certificate ? I cannot find anyone who has a clear idea as to the motive behind it, though I have heard several conjectures, of which here are three : (A) That as Brigade members are having to pass on their knowledge in connection with Civil Defence work, some safeguard is necessary. (B) That owing to the shortage of medical men able to take on Brigade work, laymen will be able to fill the gap. (C) That it is to put Brigade members on an equal footing with members of the B.R.C.S. which has Lay Instructors. Your reply to C. M. (Sheffield) in the December issue of F i r s t A i d seems to support (C)and definitely “ washes

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out ” (B). So in that case it seems that the examination is a waste of time for both examiners and examinees. If a Lay Instructor is not an Instructor, what is he ? Under the Air Raid Precautions Act, firms are required to have a number of their employes trained in first aid. This requirement can be met by training them in the Short Course of Instruction, which can be given by lay personnel and for which no certificate of proficiency after examination is issued. It was, therefore, decided by the Chief Commissioner that steps should be taken to ensure that County Commis sioners should have immediately available lists of Brigade lay personnel who had proven by examination their ability to supply the necessary instruction. Further, these lists pro vide lay lecturers for the Preliminary Course of Instruction, which can be given by lay personnel but for which, to obtain a certificate, the candidate must have been examined and passed by a doctor. Even so your mystery is solved.— E d i t o r . Effects of Drowning. K.A. (Treorchy, Glam.).— Recently I was asked an unusual question which was to state how I should know the sex of a body which I saw floating in a lake some distance from the shore. I replied that a drowned woman floated on her stomach and a drowned man on his back. This was agreed by all present but I could not accept the suggested explanation that the prostate gland was responsible for this difference in the effects of drown ing on the two sexes because I do not think that a women possesses this gland. So I submit the point for your kind explanation. Tut ! T u t ! 1 Your answer was correct only on one point, namely that a woman does not possess a prostate gland. You will, therefore, be interested in the reply which 1 gave under the above heading in the May 1943 issue of F i r s t A i d and which reads as follows :— “ In a fatal case of drowning the body is submerged until the gases of putrefaction accumulate in sufficient quantities to make the specific gravity of the body less than that of the water in which it lies. This usually occurs within one week after which period the body rises to the surface. “ The bodies of men (unless there is an excess of abdominal fat) usually float in the prone position, with head and limbs below the level of the water— that is, face down wards. The bodies of women, however, on account of the fatty tissue in breasts and abdomen, usually float in the re cumbent position— that is, face upwards.”— N.C.F. Definition of “ Fit.” N.O. (Carlisle).— Recently at Divisional Practice, discussion arose as to the real meaning of the term “ fit.” As we could not agree we decided to seek your kind help. The root meaning of the term is “ a sudden attack of anything, such as laughter.” Applied to first aid, it is taken to signify “ a sudden seizure in which there is partial or com plete loss of consciousness, with or without convulsions.” The term is unscientific and is usually used by people who cannot discriminate between its various causes ; and it should not be used without a qualifying adjective— e.g., hysterical fit, apoplectic fit, epileptic fit and so on.— N.C.F. B.R.C.S. Certificate. D.D. (Clacton-on-Sea).— Please tell me if the procedure was correct with reference to a recent St. John examination held for members of a Mobile First Aid Post. Half of us hold the St. John certificate while the other half have taken the B.R.C.S. first certificate. All passed ; but now the Red Cross certificate holders are told that they will only get the St. John certificate, whereas the St. John certificate holders are to receive the voucher. If there has been a mistake please let us know how it can be rectified ; and meanwhile accept our thanks.

A I D

On your statement of facts there was a mistake, because your class secretary clearly did not know either that half of your members had already taken the B.R.C.S. first certificate or alternately that this is recognised by the St. John Ambu lance Association. It follows that all who passed qualified for the voucher which is the award for the second St. John examination. In these circumstances your class secretary should report the circumstances to the Chief Secretary of the Association, who, we expect, will be happy to rectify the mistake.— E d ito r .

Control of Carotid Artery. G.G. (Beith, N.B.).— An argument arose at our First Aid Post concerning the Examination Howler which was published in the Query Column of the January issue of F i r s t A id . We could not agree as to what a first aider could do if he failed to control bleeding from the carotid artery. Obviously the first aider in this report failed to controt the bleeding because he was not compressing Pressure Poini No. 1 . Once this was found, digital pressure would at once stop the bleeding. Hence the “ howler ” ! !— N.C.F. Lay Instructor. M.S. (Wigan).— Please tell us if an individual, not a member of the Brigade, can offer his services as a lay instructor of first aid supposing that he only possesses the St. John first certificate (1 9 4 1 ), and voucher (1 9 4 2 ). Is such individual qualified to instruct classes in first aid ? While I know no reason why a voucher-holder should not offer his services as lay instructor, I should not advise him to do so. The medallion of the Association was originally (1 8 7 9 ) introduced as the mark of the efficient first aider, it being ruled by the Executive Committee that " n o in d iv id u a l is deem ed p ro p e rly q u a lifie d to re n d e r f ir s t a id beyond a y e a r from the date o f h is certifica te." Further, in my youth I was taught that one must learn (and forget) a subject three times before one really knows anything about it ! Later (19051 the Association followed the example of the Brigade (which in 1889 first insisted on the annual re-examination of its mem bers) and introduced the label as the award for each examina tion passed annually by medallion holders.— N.C.F. Treatment of Fractured Leg. G.A. (Overseal).— When we have to treat a fractured leg other than single-handed, should the bandages be tied as they are put under the limb or should all bandages be first placed in position and then tied in the same order as they were passed under, as is the method in the treat ment for a fractured thigh. We await your reply and accept it as final. Also we thank you for the great help which you give in the Query Column. To me this is a minor detail ; and if the treatment is carefully carried out, one method is as good as the other.— N.C.F.

N o t e . — Owing to the large number of queries received, and our limited space, a number have unavoidably been held over. These will be published in due course.— E d i t o r .

“ FIR ST A ID ” QUERY and REPLIES COUPON. 7 o b e c u t o u t a n d e n c lo s e d w it h a l l Q u e r ie s .

Feb., 1944.

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ATLAS CVERY FIRST AIDER and Student N urse should possess this Atlas. The plates are beautifully coloured and v e ry clear w ith lift-up parts show ing th e internal anatom y of the abdom en and chest. T he te x t gives a clear and accurate account o f th e anatom y and physiology of th e fem ale body.

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affords rapid relief of COMMON COLDS, INFLUENZA, AND CATARRH. Containing the antibodies of the germs common to infections of the nose and pharynx (Staphlylococci, Streptococci, B. pyocyaneus, pneumococci, pneumobacilli, enterococci, M. catarrhalis, B. Pfeiffer), Rhino-Antipeol is not just a palliative, but is a remover of the couse of the infection. During epidemics it is the ideal preventive of microbe development. Clinical Sample, on request from M E D IC O -B IO L O G IC A L L A B O R A TO R IE S L T D ., Cargreen Road South N orw ood, London,

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Editedby N O R M A N H A M M E R , M .R .C.S., M a Jo r,la te R .A .M .C .,T.A . FIRST AID JOURNAL.— " O ne o f the most concise works on the subject p u b lish e d at a p o p u la r p r i c e ."

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FIRST A ID dje Ambulance aitf 3 Hursing ^ e rtrk w Editor I

to t V /-.T N o . 5 9 7 . --- V O L .

W A LTER

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CONTENTS

d it o r ia l

THIS

NUMBER.

—

The Prevention Factor

...

Recent Advances in First Aid Work in War

...

First Aid ... ... ... ... S.J.A.B. Headquarters and District Reports

••• ...

The Home Guard and First Aid

...

101

■ ■ ■

101

Priory for Wales

...

Reviews ... Haemorrhage ...

... ...

...

u e r ie s

a n d

n sw e r s

101

102

o r r e spo n d e n ts

:—

Blood in Arteries and Veins

...

104

Examination Howler ... Treatment of Abdominal Wounds

... ...

104 104

Injured Femoral and Fractured Femur

...

104

Effects of Sodium ...

...

Effects of Liquid Bromine ...

...

106

Treatment of Wounds ... The Textbook and the Journal

... ...

...

106

Loading Stretcher

...

Artificial Respiration

...

Action of Cocoa

...

•••

...

Action of Saccharin

...

Amputation of Foot Effects of Electrocution

... ..

106 106 106 106

•• •••

■ ■ ■ ...

1944

ly '+ ^ t.

F.R.S.A.

F.^t,r,dai 1 HaU\

IS Ia iio m r s

p ric e th re e p e n c e [4/- Per Annum, Post Frhe

EDITORIAL.

FIRST AID is published on the aoth of each month. The Annual Subscription is 4s. post free ; single copies 3d. Its aim and object being the advancement of Ambulance Work in all its branches, the Editor invites Readers to send Articles and Reports on subjects pertaining to the Movement and also welcomes suggestions for Practical Papers. All Reports, &c., should be addressed to the Editor at the address below, and should reach him before the 8th of each month, and must be accompanied ( not necessarily for publication) by the name and address of the Correspondent. Subscriptions, Advertisements and other business Communications connected with FIRST AID should be forwarded to the Publishers. DALE, REYNOLDS & C o ., L t d . , 46, C a n n o n S t r e e t , L o n d o n , E.C.4. Telegraphic Address— ” Twenty-four, London."

F.R.Sin.l.,

106 108 108

...

108

Priority in Despatch ... Treatment of Fractured Clavicle

...

108

Compound Fracture of Leg

...

108

T h a t prevention is better than T h e P r e v e n t i o n cure — better even than the F a c to r . prom ptest rendering of first aid — is a fact that adm its of no d is pute, and it is surprising, when one considers the introduction of safety appliances, the increased education of the workers, and the fatherly control exercised by the G overnm ent, that there is such an abnorm ally h ig h rate of casualties in industry. In one period of tw elve m onths the accident figure had risen to over 3 0 0 , 0 0 0 , which, if viewed o n ly from the hum anitarian standpoint, reveals a very terrible state of thin gs. In these tim es, unfortunately, hum anitarianism has but sm all appeal and a thousand or so, more or less, are of sm all concern. It is the loss of productive cap acity that counts, and it is surprisin g, se ein g w hat a loss there is in -w ages when that abnormal figure is taken into con sideration, that the workers do not interest them selves more in the matter. First aid has made great strides a m o n g them in recent years, but how m uch better it w ould be if the necessity of the rendering of this was notew orthy by its infrequency. A t a recent conference held under the auspices of the Nuffield O rgan isatio n , S ir M iles T h o m a s, the chairm an, pointed out that the m ost valuable con stituent of our industrial system was the w orker— m ale or fem ale, and it w as first ch arge on factory m anagem ent to sustain and protect them , to pro mote their w e ll-b ein g and to keep them safe. O n ly a safe factory could be an efficient factory. S lip shod surroundings from w hich d an ger hazards have not been ruthlessly removed lead to slipshod q u ality of output, and that is a condition that cannot for one m om ent be tolerated when q u ality of perform ance m ay mean life or death to the men in the firing line, no less than to the w orker on the factory floor. In v isu a lisin g how accidents m ay be reduced in the future, S ir W ilfred G arrett, H .M . Inspector of Factories, said it required train in g and experi ence to know where accidents happen, but the problem could be reduced alm ost to an exact science. Factories of sufficient size should establish S a fe ty Com m ittees, w ith trained accident officers, e n ab lin g closer statistical exam inations to be pro duced. T o us, there seem s no reason w h y in every

F I R S T

factory and w orks where m achinery is installed there should not be formed a com m ittee of the workers (both male and female) to review the whole m ethod of w o rkin g and especially the sufficiency and condition of the safety appliances, with power to com pel the workers to make use of them to the fullest extent. Chem ical hazards must not be over looked. T h e y are both numerous and com plex, and vary with the introduction of new production m ethods. S lo w or delayed action leads to contem pt of danger, and a workm an is m uch more likely to protect him self again st a substance which he knows w ill produce an unpleasant effect sharply than a g a in st a m etallic poison, the effect of w hich is cum ulative and slow in appearin g. T h e m ajority of accidents arise doubtless from n eglect of pre caution and carelessness, but the workm an is not iri the position alw ays to protect him self, and the d u ty devolves upon the m anagem ent to exercise every precaution possible to decrease the figures of the casu alty roll.

R ecent

A dvan ces in

F ir s t

A id

W ork

W ar.

By SIR H EN RY L. MARTYN, K.C.V.O., F.R.C.S. (Casualty Staff Officer, G Area, Devon C.C.) A STUDY of your query columns and of the carefully con sidered replies to the questions of correspondents by N.C.F., demonstrates an increasing interest in first aid personnel in the use of abbreviated methods in Civil Defence work as contrasted with the formal and more laborious technique of the St. John’s Textbook. This increasing interest has been largely actuated by the instruction originating, as the result ot experience in the handling of casualties under actual blitz conditions, from the various regional schools, and there is no question but that far greater attention should be given to them than they are at present receiving. As N C. F. points out in your February issue, under the heading of ” Lay Instructor,” the medallion of the Associa tion was originally introduced as the mark of an efficient first aider, it being ruled by the Executive Committee that “ no individual be deemed properly qualified to render first aid beyond a year from the date of his certificate.” Although the annual re-examination often proves im possible during wartime, revision courses in first aid are constantly necessary. Unfortunately, only too often these are based upon a weary reiteration of the St John’s Text book, which, although undoubtedly the best book of basic instruction for elementary candidates desiring to acquire a knowledge of first aid in civil life, is in urgent need of revision if it is to be regarded as a textbook for first aid under war conditions. Let us consider for a moment in what way the differ ence in the conditions of peace and war impose changes both in training and technique. The basic training of bt. John’s is largely, indeed almost entirely, concerned with the injuries incidental to civil life, in which probably the greatest forces imagined are those of a railway smash or a machine accident, forces not com parable for a moment with those of high explosive. The

A I D

circumstances under which the injury is received, generally speaking, are considered to be totally different from those of war, and the picture in the student’s mind is almost always based upon that of a single casualty in pacific sur roundings into which extraneous factors do not obtrude : moreover, the most careful limitation is placed— quite rightly — upon the responsibilities which he may assume, and it is impressed upon him that under no circumstances may he take upon himself those of a doctor. It this be the only training which the first aider re ceives to fit him for casualty work under blitz conditions, it is not surprising that he finds himself lost and be wildered when first he is called upon to deal with casualties in action. What vast variations must perforce be introduced by the factors of daikness, constant bombing, the threat of fire and falling buildings, and the number of cases with which he is called upon to deal in the shortest possible time. Be yond all this he must be prepared to make decisions and assume responsibilities infinitely greater than those formerly permitted to him, trusting in the certain knowledge that, provided that he does his best, no criticism will ever be justified. Apart from these differences between civil and war in juries, it is seldom appreciated how vastly progress in medi cal and surgical knowledge is imposing its own changes upon the technique of first aid. The treatment of war wounds has been completely revolutionised, many of the elaborate methods of splinting fractures in the field have been proved to be an unneces sary waste of vital time, and the handling of trapped casualties has been entirely changed by reason of research work only available within the last twelve months. Even so simple a matter as the blanketing of a stretcher has undergone modification to meet the requirements of blitz technique, and the eternal question of the best treatment of burns remains an ever present argument. Reviewing the whole position, therefore, it must be apparent to all that the training of first aid personnel, if they are to become proficient under war conditions, must be conducted upon totally different lines to those formerly adopted during peace. The first essential must always remain, namely, the basic training upon the lines of the St. John’s Textbook enabling the candidate to obtain an elementary certificate. Without such training the student will never gain either a knowledge of the essential groundwoik or the confidence which the possession of a certificate gives him. From this point, however, things are less easy. Either the student in the stress of war remains content with his certificate or, if he is keen, is only too often subjected to repeated courses of lectures, still based upon the bt. John’s Textbook, by virtue of which he duly acquires bigger and better certificates while completely unaware that the sub ject matter which he now knows word for word has in manv cases for years been completely out of date. While it is essential to insiil into the student during the elementary stages of his training the simplest possible principles of treatment expressed in the most dogmatic way, it must be kept ever before his mind that advances in knowledge and in the methods of application of that know ledge are constantly taking place, and that even the basic principles of his training are not necessarily inviolable. Thus when a first aider, rigidly trained in the exact technique of the textbooks, is suddenly told that it does not matter in the slightest degree whether, when treating a fractured leg, the bandages be tied as they are put under the limb or whether all the bandages should be first passed and then tied, or indeed in some cases whether a splint as such need be used at all, he is apt to be bewildered unless he has learned to distinguish the essential from the nonessential under war conditions. Once the stage of preliminary training is over the

F I R S T

method of teaching hy dogmatic statements and memorised lists of what to do and what not to do should be abandoned. The student in revision courses should be taken far more fully into the reasons why certain things are done or not done. If his intelligent interest can be aroused by such teaching he is likely to become infinitely more efficient and will the more willingly absorb and adopt constantly changing methods and advances in treatment rather than adhering to the rigid rule-of-thumb methods of his element ary tiaining. What an amazing romance of scientic achievement lies behind our present treatment of war wounds in the field. The instructions given in the textbooks as to the cleansing, bathing with antiseptics, etc., of the civil wounds are now applicable only to the most insignificant clean cuts and scratches of war. You are taught now that all that is necessary for the wounds of high explosive is the application of a dressing kept as sterile as possible in order to prevent further contamination. Even the necessity for extreme sterility is not unduly stressed, and the student is apt to be amazed when he is quite frankly told that if it is a question of controlling haemorrhage and saving life he may even compress a bleeding artery by pressure with his own fingers in the wound itself, even though his hand cannot by any possible chance be considered surgically clean. What is the justification for this extraordinary change in treatment, and why are antiseptics no longer relied upon ? During the first part of the last war we were accus tomed to follow the old routine. Wounds were cleaned by antiseptics under an anaesthetic, and during the progress of healing constant dressings and the use of varying antiseptics were continued. These methods proved quite ineffective, wounds took many months to heal, and deaths from blood poisoning were frequent. Towards the end of the war other methods were beginning to appear. Many small wounds were being cut out complete, and the resulting wound either sutured or allowed to heal cleanly from the bottom. The results showed promise, but it was not until the time of the Spanish war that the full value became apparent. During the siege of Barcelona a Spanish surgeon called Truetta did an immense amount of work in the Central Hospital. Not only did he operate upon a great number of cases, but he found time to keep careful records of his cases and subsequently to do considerable research work. ( T o b e c o n t in u e d . )

F i r s t A id . W e have received the following verses from Mr. S. Dodd of Wolverhampton :—

First, Aid. Bestir yourselves to tend and bind The maimed and broken on the way of life, Then, if you will, you of enlightened mind Ask why so much of pain and woe is rife. First, Aid, so runs the word of ancient lore, When Good Samaritan by wayside found One who had come by ill, Neighbour ! restore, Then work to make life’s highway safe and sound. First, Aid, to this the Order of St. John, Is pledged, nor dare it’s members turn aside From urgent human ill, Whilst yet there’s one Depending on their skill. For none must be denied. First, Aid, the Spirit of the Lcrd shall rest On all who spend their lives to help and heal. All human worth is measured by this test, For Christ himself, It was God’s sign and seal.

A I D

S t.

9 9

Jo h n

A m b u la n c e

H EADQUARTERS

AND

B rig a d e

D I S T R IC T

REPORTS.

N o . I (Prince o f W ales’s) District 1 2 0 r n ( B e x l e y ) . — On February 9 t h the above Division held its 12th annual general meeting under the chairmanship of Supt. F. G. Ellis. The Treasurer (Amb. Officer A. E. Aylott) reported that the balance sheet for the year showed exceptionally good progress. The Secretary (Sergt. E. A. Wheble) reported that there had been a net increase of 5 in the Division’s membership for the year, the roll now standing at 1 3 6 , and of these 74 mem bers were serving in H.M. Forces, an increase of 11 during the year, whilst 11 were full-time and 21 part-time A. R. P. workers, and 57 members were now in Brigade uniform ; 1 ,0 6 2 cases had been dealt with during the year, and the record number of 1,761 duties had been attended. Cadet Supt. E. Goodall (3 0 th Cadet Division) reported that there was a cadet membership of 4 0 with an average attendance of 2 8 . During the year the cadets had gained 114 certificates, 12 proficiency badges and Private J. Lloyd had gained the Grand Prior’s Badge. The Chairman of the Social Committee (Sergt. T. B. Paine) reported that during the 8 months of the year in which the Committee had been active, 6 whist drives had been held and one social evening. The Chairman, Supt. Ellis, congratulated the Division on its excellent reports and thanked the Committees for the work they had done, also Cadet Supt. Goodall and Cadet Officer Gravett for the great work they were doing among the boys who were well-trained and well-behaved and were a great credit to the Division.

O r p i n g t o n (100 /2 ).— Some idea of the splendid work this Division is maintaining was given at the annual meeting held at the British Restaurant, Orpington, on Saturday, February 2 6 ih. In his report the secretary, Mr. A. J. Uphill, commented on the record work of the ambulance drivers, who conveyed 5 00 patients and attended 91 accidents. The mileage was 10 ,54 7 .

The strength of the Division remained the same as last year with 82 members. Thirty-five members passed the annual re-examination. Cpl. Bilby passed the London A.R.P. examination and 14 N.C.O.’s and men passed the Royal Life Saving Society’s Respiration Service examination. Mr. G Eastlake Davis, in presenting the awards, said he was surprised at the wide scope of the Division. He expressed appreciation on behalf of the Council. The awards were : Royal Life Saving Society’s Respira tion Service Certificates, 11 ; Vouchers, 2 ; Medallions, 3 ; Labels, 3 1 . County o f Berkshire. During the week beginning January 3 0 th, 1 9 4 4 , the sum of ^ 1 .9 3 2 was collected at the local cinemas by members of the S.J A. B. and B.R.C.S. for the Red Cross and St. John Prisoners of War Fund. R e a d in g N u r s in g D i v i s i o n . — It has been necessary to split this Division owing to its large size and increasing num bers. Two new Divisions have now been formed, namely, the Reading South Nursing Division and the Reading West Nursing Division.

R eading T own “ B ” A mbulance D ivision .— T he Chief

IOO

F I R S T

Commissioner has approved the appointment of the Deputy Mayor, Mr. W. Mcllroy, as President of this Division. Members of the Division who recently took a course in Home Nursing under Divisional Surgeon C. A. Boucher, all passed for their certificates. W in d s o r N u r s in g D i v i s i o n . — A successful dance was given by the St. John’s Social Club at the White Hart Hotel on January 2 8 th. Over 300 people were present and Mr. Stovell w'as M.C. The Mayoress gave away the prizes won in various competitions.

County of Bristol. F i s h p o n d s . — A new feature in the above Division is the individual cup competition to he held annually, the first of which has just taken place, and proved most interesting and stimulating to the younger members of the Division. It was with that idea in view that Corps Officer Jefferies presented to the Division a cup which was proudly called the “ Jefferies Cup” and was keenly contested. J. Moss, a younger member of the Division, succeeded in winning it. Supt. W. Hobbs, B. E. M., of Butlers Division was the adjudicator, and he spoke highly of the efficiency of the competitors. A book on the “ History of the Order ” was also pre sented to the winner by Corps Officer Jefferies, and it is difficult to express in words the Division’s gratitude for the great work and service that this Officer has given to the Fish ponds Division in particular, and to No. 2 Corps as a whole. The “ Jefferies Cup” will alw'ays be a reminder of his loyalty and service, and a background for the efficiency and extension of good first aid.

County of Cheshire. P o r t S u n l i g h t . — A general meeting of the Port Sun light Corps took place on Friday, January 11 th, in the Hulme Hall, Port Sunlight. Corps Supt. H. O. Rothery presided. County Officer Anthony presented warrants of appoint ment and seavice aw'ards. He congratulated the recipients, especially Supt. Dodd w’ho had completed 25 years service in the Brigade. The Secretary (Corps Officer E. H. Alderson) then read his report, and stated that the Corps now comprised seven Ambulance Divisions, three Nursing Divisions, three Cadet Ambulance and two Cadet Nursing Divisions. At Decem ber 31 st, 1 9 4 3 , the membership numbered 312 officers and other ranks and 151 cadets. Of the seniors 74 are in the Forces, and 175 are serving in the Civil Defence Services. The Cadet Divisions of the Corps are going from strength to strength and were prominent in several parades including the Rally of the Central Wirral Youth Organisations which took place on the Port Sunlight Recreation Ground on June 2 6 th last year on the occasion of the visit of the First Lord of the Admiralty (The Rt. Hon. A. V. Alexander). The meeting was follow’ed by an excellent concert which was given under the direction of Mr. J. Reason of Port Sun light and which was attended by the President of the Corps (Rt. Hon. The Viscount Leverhulme) and Lady Leverhulme.

County o f Hertford. W a r e . — A well attended annual general meeting of the Ware Division was held in the Priory on February 8th, Dr. W. G. Stewart, M.B.E., Divisional Surgeon, presiding. In his report, Supt. T. H. Burgess stated that the Division now had 46 members, of whom 15 are serving in the Forces. Every available man is serving in the Civil Defence services. The motor ambulance travelled 9,0 3 5 miles last year conveying 455 patients, including 41 accident cases,

Cadet Supt. H. Beaumont-Smith reported on the progress during the year of the newly formed Cadet Division which now has nearly 40 members. The cadets receive training in first aid, home nursing and many other subjects in which they can gain badges for proficiency. All the boys have shown a tremendous keenness and several have gained pro ficiency in more than one subject. The Ware Cadet Division was the first Ambulance Division in the county to have one of its members awarded two Proficiency Badges for passing in 8 subjects. During the evening the chairman presented first aid certificates including 5 vouchers, 1 medallion and 16 labels. Pte. S. E. Clark has gained the Brigade’s Long Service Medal for 15 years efficiency, but as he is now serving in the Forces the presentation had to be postponed. County of Lancashire. L i v e r p o o l . — The Liverpool Corps was inspected by Lady Louis Mountbatten, C.B.E., Lady-Supt.-in-Chief, on Satur day afternoon, February 2 6 th. The inspection was held in the big shed at No. 2 , South Canada Dock. Lady Louis Mountbatten was accompanied by Colonel, The Earl of Sefton and Lady Seftor., the Lady Mayoress of Liverpool and other distinguished persons. Visiting Divisions were present from Southport, Water loo, Warrington, St. Helens, Huyton, Prescot, and Widnes. The whole Parade was under the command of Corps Supt. W. E. Searl, Senior Corps Supt. of the Liverpool Brigade. The total number on Parade was approximately 2,000. Lady Louis Mountbatten made a wonderful tour of in spection, missing no detail and chatting in a charming man ner to officers and members of all ranks as she passed along. On completion of the march past which was led by the Nursing Corps, Lady Louis Mountbatten made a short, friendly, speech. She and her party were then entertained to tea at the Mersey Docks and Harbour Board Dockside Canteen. The musical arrangements for the inspection were successfully carried out by the Band of the A. T. & E. Com pany, and the Bugle Bands of the Cadet Units. Lady Louis Mountbatten greatly endeared herself to all members, and they look forward to her next visit to them.

County of Surrey. A d d i s c o m b e . — There was a large attendance of members at the annual general meeting of the above Division at the Addiscombe Methodist Hall, when District Officer E. J. Prew was in the chair. It was reported that during the past year 2 ,2 3 0 cases of first aid were treated by members, not including air-raid casualties, and of these 320 were removed to hospital, despite considerable depletion of personnel due to the demands of the National Services. The 21 years’ service of Nursing Sister G. Prew had brought recognition in the form of a gold service medal awarded by the Southern Railway Centre of the Association. She had treated 216 cases during the year. District Officer E. J. Prew, on behalf of the Trustees, reported that the Addiscombe Motor Ambulance Service, which had suffered a severe loss in the death of Mr. Lovell W. Vicars, S.B.St.J., had transported 1 ,0 3 6 patients over a total of 1 0 ,7 9 5 miles during 1 9 4 3 . The chairman paid tribute to the officers, N.C.O.’s and men of the Division, and felt confident that with the con tinuance of the voluntary and enthusiastic help of members, the Addiscombe Division would go on to even greater heights in its aim to alleviate suffering. County of Warwick. C o v e n try

( C e n tr a l) .

— At a recent meeting, Corps Supt

F I R S T

L. T. March paid tribute to the wonderful work being done by the Hospital Saturday Fund Nursing Division on trans port work. Mr. March said that there were about 30 nurses of the Division that formed mainly the night rota at the ambulance station, and most of them are at work all day, and gave up their evenings to stay at the station all night, a fact that is regarded with high appreciation, and in conjunc tion with drivers and attendants they have turned out no fewer than 2 ,0 0 6 times mainly during the night. The ambu lance fleet have transported a total of 12,341 cases during 1 9 4 3 , an average of 34 cases per day, and travelled no less than 9 8 ,6 7 6 miles, and in view of the fact that there is such a small skeleton staff left, more than 50 per cent, of this work was carried out by the voluntary personnel of the Brigade. The Coventry Central Corps is certainly doing a grand job, and the citizens should feel proud in the knowledge that these efficient and well trained men and nurses are always at hand for any emergency.

The “ F ig u r e o f E ig h t C a r r y ” for two bearers is more useful over a distance than ordinary hand carriage. To do this, join two stretcher slings or three belts (bearer’s and patient’s) together to form one big loop. This is crossed at centre to form a figure of eight. This cross is so placed, that one of the patient’s legs passes through each loop so formed. The bearers then place their ends of these loops over their outer shoulders and raise patient, who will be in a sitting position, leaving the outer hands of bearers free. In closing, let me remind instructors that when orderlies have mastered the various lifts and carries, they should be exercised with respirators in the “ Gas ” position. C. W.

T h e H o m e G u a r d a n d F i r s t A id . FU R TH ER

LIFTS AND CARRIAGE METHODS.

S i n c e writing last month’s article, I have studied and tested the method of loading stretcher when only two bearers are available, as suggested by Dr. Bowman Edgar in the issue for February. This is a decided improvement, and I have not the slightest hesitation in recommending it. My own unit has now adopted it, and it becomes an automatic amendment to my own article on the collection of wounded by two bearers. The old method was always decidedly awkward and difficult to the novice.

The “ B a ck L i f t " is very useful for a patient with, say, a wounded leg, if you are working alone, and provided he is conscious. First, help patient to stand on good leg. Then taking up position back to back and getting patient to stretch his arms sideways, bend down, and placing your hands under his arms, grip the upper arms near the shoulders. Bearer then bends forwards, pulling patient on to his back, and straightens his legs. He can be carried some distance in this manner. If the patient is unconscious or there are other injuries, some help is necessary for helping with the lift. The “ N e ck D r a g " is used for pulling a patient for a short distance to cover, from an exposed position, when un conscious. Turn patient on to his back, tie his wrists firmly with his hands clasped, kneel astride his body, pull his arms over your head, taking his weight low down on your neck Then crawl away on hands and knees, dragging patient with you.

S p read b u ry

(Sergt.),

School House, Noel-road, W . 3 .

P r i o r y f o r W a le s .

East R idin g o f Yorkshire. N o r th F e r r i b y . — The annual meeting of the North Ferriby and District Nursing Division was held recently at Mrs. Farrell’s, The Red House, attended by a large propor tion of members. Among interested visitors were Lady Atkinson, Lady County President ; H. Rankine, Humber side Corps ; and Miss E. G. Moore, Lady Corps Officer. Mrs. Jarman, Lady Divisional Supt., presided and pre sented the report of the year’s activities. This showed a total of 3 , 2 1 5 | hours duty performed by members in hospital wards, on ambulance, public and other duties. In support were A/O Mrs. Storey, Hon. Secretary, and A/O Mrs. Farrell, Hon. Treasurer, who each submitted illuminating statements as to the healthy state of the Division. Lady Atkinson congratulated the Division on its achieve ments and record, expressing her whole-hearted interest in the work Brigade members are doing.

10 1

A I D

ea th

o u n t y

r e a

— The annual meeting of this Division was held on January 3 0 th. The chair was occupied by the Vice President, Mr. Josiah Jenkins who was also supported by Divisional Supt. T. G. Bartlett, Ambulance Officer James L. Lewis, Sergeants Allan Harries and E. C. Thomas, and Corps Officer M. G. Thomas, M.E. The treasurer’s report was given by the auditors, who revealed that the Division still maintained a sound financial position. The Secretary then proceeded to give a brief review of the year’s working. Four new senior members and 2 new nurses were trained and qualified ; 24 senior members qualified at the annual re-exam., 19 senior members qualified in A.R.P. Gases examination, 16 senior members qualified in first aid in coal mines, 10 nurses qualified in both home nursing and first aid, 8 male junior cadets qualified in pre liminary first aid. A Nursing Cadet Division was established and 10 qualified in preliminary home nursing and first aid. During the course of the year, Mr. R. D. Morris, M.E., F.G.S., accepted the office as Hon. President and the Rev. John Jenkins accepted the position of Hon. Member. Mr. M. G. Thomas, M .E., was promoted to the rank of Corps Officer. Competition successes for the year were as follows :— Seniors, 1 st prize at Ystradgynlais Open Competition, 1 st prize at Briton Ferry Open Competition. A Divisional team representing Seven Sisters Colliery won the Evans and Bevan Cup for Inter Colliery Competitions. Nurses, 1 st prize at Seven Sisters, 2 nd prize at Neath. Male Cadets, 1 st prize at Seven Sisters. The only set back the Division has to record is the death on active service of one of its most popular members in the person of Corporal John Williams. The meeting ended with the Chairman complimenting the Division on a very successful year. O n llw v n

Seven

S is te r s .

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102

F I R S T

H a e m o rrh a ge . To the keen and enthusiastic first aider there are few more interesting- or absorbing studies than the subject of hasmorrhage, its various kinds and different methods of treatment. Most readers are conversant with the peculiar character istics of each variety. It is not proposed therefore, in this article, to enter into any detailed description of arterial, venous or capillary bleeding, but rather to endeavour to impress on readers the absolute necessity for maintaining their efficiency in this very important subject. A well-known authority on ambulance work says :— “ One of the chief obstacles to usefulness of volunteers in first aid is the natural dread of blood. The sight of an injured artery spurting with blood, is a sight enough to appal the stoutest heart and unnerve the steadiest hand. Many a one who would face without flinching, a case of fracture, or is coolness itself when dealing with a severe fit, quails at the sight of a gushing wound and turns away with blanched lips from a patient streaming with blood.” Many can doubtless recall their first course of lectures. The class as a whole went bravely through the ordeal of the descriptive account of the skeleton, etc., but. when at the second lecture the doctor commenced to describe the circula tion of the blood, one or more of the students were soon visibly affected and found it necessary to quit the lecture room. This dread of blood, is however, to a great extent a wise provision of Nature, as the sight of blood at once arouses u« to a sense of danger, and prompts us speedily to adopt efficient treatment, with a view to minimising its effects. That is the effect that the sight of blood would have upon the resourceful and skilled first aider. Should, however, this dread of blood be allowed to gain too pronounced an influence over us it will eventually result in less nerve power. This mav render the first aider so acutely nervous, that the assistance given may be made not onlv non-effective, but, in the case of some injuries, it may possibly increase the gravity of the danger. Continued practice, however, and a strong determination to overcome this failing, will, in time, enable these faint-hearted ones to acquire the habit of keeping a cool head and steady hands, when they find themselves confronted with the sight of blood. It is a somewhat common idea with many people that a case of bleeding left unattended must necessarily be fatal. This, however, is-not always so. In the case of an injury to one of the largest blood vessels, such as the femoral or carotid arteries, there is little doubt that if skilled assistance were not properly administered, the patient would undoubtedly bleed to death. Nevertheless with some cases, in which arteries are severed. Nature has the knack of assisting itself without artificial aid ; and this she often does in the interests of those, who, in their hour of need, are deprived of human assistance. It is our duty, therefore, to study Nature’s methods, to assist her operations, to remove obstacles from her path, and to regard her, as we should, as a skilled and sagacious colleague. If we do these things, we shall, in our subsequent treatment, interfere as little as possible with her handiwork, especially when our action bears the impress of efficiency. Now, what are the usual means whereby Nature usually brings about the spontaneous arrest of haemorrhage ? They are three in number and may briefly be described as follows : 1 . By the contraction of the cut ends of the wounded vessels. 2 . By the coagulation of the blood at the mouth of the injured vessels, the clotted blood thus forming a plug and thereby sealing up the vessel. 3 . By the tendency of the patient to faint. This necessarily has the effect of slowing the heart’s a tion, thereby retarding the flow of blood and thus favour

A I D

ing coagulation. In a case of this kind, therefore, it will at once be seen that the act of fainting is really beneficial. It follows, therefore, that the common practice on the part of ignorant, or untrained persons, to attempt to revive the patient by the administration of stimulants and by other means is entirely wrong and may have a tendency to start afresh the bleeding, thereby frustrating the well-intentioned efforts which Nature had made to effect it’s control. Now how are we to aid Nature’s methods ? Briefly put they are as follows :— 1 . Position. 2 . Pressure. 3 . Free circulation towards heart. 4 . The application of cold. With all these, most readers are well acquainted, and therefore it is not proposed to enter into lengthy explanations but to draw attention to one or two points which should be impressed upon your memories. 1. P o sitio n .— Never lose sight of this most necessary precaution. The raising of an injured limb (remember that blood finds it harder to flow upwards and that its progress is therefore materially retarded) ; and the placing of the patient in the best and most appropriate position, be this sitting, supine or semi-recumbent. In nose bleeding it is a common mistake to allow the patient to lean over a basin or the like in case some house hold or personal clothing be spoiled. See that the patient is placed on a chair with head back and arms above or resting on the head. At the same time, of course, applying cold compresses to the bridge of the nose and to the nape of the neck. 2. P re ssu re .— This may be of two kinds (a) direct by pad and bandage, digital, etc., or (b) indirect, i.e., digital or tourniquet on pressure point. Should the wound contain some foreign body or be too large for direct pressure, then we must resort to the indirect method. When applying a tourniquet make sure that the pad is on the right spot before tightening, and only exert enough pressure to stop the bleeding. So many are of the opinion that it is necessary to apply a tourniquet as tight as is possible, instead of only as tightly as to stop haemorrhage. j . F re e C irc u la tio n .— Always remember to loosen all re stricting articles of clothing— collars, belts, suspenders, tight socks, etc., with a view to securing free circulation towards the heart. 4. C o ld A p p lic a tio n .— The application of cold (water, ice, compresses) to a site assists in closing the ends of the minute capillaries which have been broken. A typical case is that of a “ black eye ” (bruising) where the blood vessels under the skin have been broken and the blood, although not escaping through the skin, is nevertheless escaping from the blood vessels. In internal haemorrhage an ice or cold water compress over the seat of injury is of the greatest assistance in stopping the escaping blood. OAA

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Blood in Arteries and Veins. N.O. (Harrow).— The blood in the arteries is bright red. A friend says that bright red blood is sometimes found in the veins. As I cannot accept this, I write to ask for your kind ruling. The name “ artery ” is given to those blood vessels which carry blood from the heart, while the name “ vein ” is allotted to those which carry blood to the heart. Consequently we find venous blood in the pulmonary artery which carries im pure blood to the lungs for purification ; and we find arterial blood in the pulmonary veins which return the purified blood from the lungs to the heart. In all the other arteries the blood is always bright red (or arterial) and in all the other veins it is always dark red (or venous).— N. C o r b e t F l e t c h e r . Examination Howler. M.R. (Cannon St.).— The amusing howler, which was pub lished in the December 1943 issue of F i r s t A i d and which told how a first aider proposed to control the carotid artery by means of a tourniquet round the un fortunate patient’s neck, reminds me of a similar mistake. Some years ago I was examining a class and asked a candidate how he would treat a patient suffering from bleeding from the tongue. I was much amused when he replied “ I w o u ld p la ce a to u rn iq uet ro u n d the tongue a n d heep it q u ie t ! ’’ Good!

Next, please ! !— N.C.F. Treatment of Abdominal Wounds. N.T. (Cardiff).— Please tell us why salt solution is suggested in the Textbook (p. 131 ) as the correct treatment of wounds of the abdominal wall accompanied by protrusion of the bowel. Thus far nobody has given me a satisfy ing answer ; and so I venture once again to ask your kind help. The salt solution, as suggested in the Textbook, is of the same consistency as the fluids of the body tissues. Con sequently it acts beneficially in that, when applied to wounds of the abdominal wall accompanied by protrusion of the bowel, it prevents extraction of salt from the tissues of the bowel.— N.C. F. Injured Femoral and Fractured Femur. G.E. (Northwich).— I will be glad if you will give me the correct treatment for a wound of the femoral artery accompanied by fractures of femur and of pelvis. The patient also needs a blood transfusion, immediately after having been treated and made ready for hospital. I am a H.G. instructor with 15 years unbroken ser vice in S.J.A.B. ; and I was asked the above question by my superior officer. I said that I would arrest bleeding first and splint the femur. He replied, however, that our Medical Officer does not accept this treatment and that the splint should not be used owing to transfusion having to take place.

F I R S T

A I D

105

W hat do yo u k n o w about I O D I N E Y

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F I R S T

Your query relates to a military rather than to a civilian problem in first aid. Further it is not clear from your letter what facilities exist in the circumstances named for giving a transfusion. If this is to be done in hospital, then the limb must certainly be controlled by a splint on the spot to prevent aggravation during treatment and transport. Should, how ever, a Mobile Transfusion Unit be available, it is still necessary, in my opinion, to splint the fracture pending the arrival of the Unit. This done, the bandages could then be loosened under the watchful care of the Medical Officer should he decide that transfusion is indicated without further delay.— N.C.F. Effects of Sodium. R. B. (Scunthorpe). — I read with interest your reply to the query which was published in the January issue of F i r s t A i d ; and, in order t o g o deeper into the matter, I wonder if I may be permitted to pass these comments :— The burning caused by solid sodium is due, in the main part, to oxygen atoms in the human tissues. If a dilute acid solution is applied before the remaining sodium is removed from the skin, I venture to suggest that an aggravation of the injury' will result from the chemical reaction of the sodium and the watery solution, which produces intense heat in such a confined area. Therefore, I suggest that the correct treatment would be first to remove the remaining solid particles in the quickest way possible (by the use of forceps, or by flooding with a stream of water) and then to apply the dilute acid solution to neutralise any caustic soda which may have been formed. I should like to add that no aggravation of the injury will result from flooding the area with water, as the sodium will be washed away before any heat reaction can assume sufficient propor tions to be harmful to the patient. It will then, of course, be necessary to treat the patient for the resultant burns. Many thanks for your letter which has been read with interest and agreement. The treatment given in my previous reply was for the burns and pre-supposed that any solid par ticles of sodium on the skin had already been removed.— N.C.F. Effects of Liquid Bromine. R . B . (Scunthorpe) — I wonder if you will be kind enough to give me guidance in a matter which I have failed to find official treatment, either in first aid books or medical works. During my work as an analytical chemist I have had to treat patients for burns caused by liquid bromine. I might add that a very severe burn quickly ensues from this liquid. I have always treated such injuries with sodium bicarbonate solution ; but I am not satisfied that this is the best treatment. One of our senior chemists assures me that a paste of quick lime is the correct treat ment. Will you give me your views on the subject please ? (N o te .— A. paste of quick lime will not burn the skin as the heat evolved in adding quick lime to water has subsided before the paste is applied.) The application of liquid bromine to the skin will pro duce an injury which, although analogous to a burn, is rather in the nature of a sore. There is no evidence that quick lime, even if available, would be particularly effective ; and I think that, for first aid purposes, it is wiser to stick to the bi carbonate of soda which is known to he soothing.— N.C.F. Treatment of Wounds. R. H. (Morley).— Would you please explain the two following paragraphs which are included on p 107 of the Text book, under the section— “ Objects of Treatment of Wounds ” ? In paragraph (b) we read the words “ by the addi tion of an antiseptic ” and in paragraph (d) we note the words “ or ointment.” I want to know how an anti

I I D

septic or an antiseptic ointment will introduce germs into the body ; and I await your kind reply with interest. You have misread paragraph (b) which does not say that an antiseptic may introduce germs. What it does say is that washing a wound with ordinary water may introduce germs and that this may be prevented by boiling the water or by adding an antiseptic to it. Next, as to paragraph (d) the Textbook does not refer to “ antiseptic ointment ” but only to “ ointment.” It is well known that any greasy surface such as results from the application of ointment may form a base in which germs may rapidly multiply. Hence the warning not to apply oint ment to any wound.— N.C.F. The Textbook and the Journal. A.T. (Birmingham).— The questions and answers given in F i r s t A i d have the St. John Textbook as their basis of information. In giving the details for the treatment of wounds, on pages 106 -7 , we are definitely instructed not to apply sticking plaster or ointment— a teaching which you have often substantiated in the query column. Is it not rather inconsistent for you to be confirming the Textbook rulings, whilst other pages of the magazine contain advertisements urging the first aider to use various preparations ? We fear that your suggestion of inconsistency is not understood. Since it was first published in July, 1 8 8 5 , F i r s t A i d , acting down the years on the advice of its Hon. Medical Correspondents (Drs. Heaton Howard, Frank Christian and Corbet Fletcher) has consistently regarded the St. JohnTextbook as the best and most useful guide to the art and practice of first aid.— E d i t o r . Loading Stretcher. G.A. (Overseal).— At one of our class meetings after a lengthy discussion we concluded with a difference of opinion on the following point :— What should be the position of a Bearer’s right knee in relation to his elbow— inside or outside— when lifting a patient on to a stretcher ? Personally, I think that outside the elbow is better, because it is more com fortable for the Bearer who can get lower down to his patient. Fig. 94 on p. 209 of the Textbook shows the Bearers with their elbows outside their right knees ; and experience has proved that this is an effective and comfortable position. It is, however, possible that you find it more comfortable to have your elbow inside the right knee. If this is so, I see no objection to your variation of the official method.— N.C.F. Artificial Respiration. W. P. (Bristol).— Having received assistance from yon on several occasions in connection with difficult questions on first aid, I would be grateful if you would once more come to my help on the following point :— In the pressure movement of Schafer’s method, is the diaphragm forced up to the arched position or is the diaphragm forced higher thus forcing out more air ? It is, of course, understood that under normal conditions a forced expiration can get rid of an extra 1 ,5 0 0 c.c. of air, leaving only 1,000 c.c. of residual air which cannot be expelled. The diaphragm is always arched but this arching is flattened during inspiration. In Schafer’s method the arch is forced higher into the chest cavity than is usual thus expelling air ; and it is the return of the arch to its normal position which results in inspiration.— N.C.F. Action of Cocoa. G.A. (Leeds).— Please tell me why cocoa is never included in the list of stimulants together with tea, coffee and meat extracts. Cocoa is a food and so cannot be regarded as a stimulant. — N.C.F.

F I R S T

TRAINING IN HYGIENE THE ROAD TO PROMOTION

107

A I D

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EMERGENCY TREATMENT O F S K IN IN JU R IE S Be prepared for an em ergency and keep C u ticu ra Brand O in t m ent in you r First Aid Kit. It brings instant soothin g relief to cuts, burns, skin lacerations— p reven ts spread of infection, quickly heals. O btain able at all Chem ists and S tores.

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Action of Saccharin. G.A. (Leeds).— Please tell me if saccharin has any value as a stimulant and also if it has any effect on diabetes. Saccharin is a chemical substance which, bulk for bulk, has a sweetening power from 300 to 500 times that of cane sugar. It is prepared from toluene, hasmo stimulant or food properties, and is used as a sweetening substitute for sugar, particularly in diabetic cases.— N.C.F. Amputation of Foot. R.L. (Londonderry).— A controversy has arisen in our Post as to the proper procedure to be adopted by a First Aid Party Leader in the following circumstances :— The F.A. P. and N.F.S., operating in a fiercely burning building, have removed and attended to all casualties. The F.A.P. are leaving when the roof crashes ; and one of the Party is trapped by a 3 -ton girder falling across his foot on a cement floor. All efforts to release him are without result and telephonic communications are disrupted. So a messenger has been despatched to the nearest Report Centre. Other girders may crash at any moment ; and the Fire Service Chief pronounces the building dangerous. If anything is to be done it must be done at once, and by those on the spot. What, in your opinion, should be the decision of the F.A.P. Leader ? One line of action suggested is that the limb should be amputated, using a knife or any suitable instrument available. This naturally brought forth many pro and contra arguments. So we decided to enlist your help, as we have here a great respect for your guidance to those who, like ourselves, are eager to be prepared for anything our duties as first aiders may present or demand. Your query suggests that in the circumstances named, a decision means the choice between the life or death of the victim. In point of fact, this is not true because, if a layman should attempt amputation of a limb or part of a limb, par ticularly with inadequate equipment, the patient though rescued momentarily, would die subsequently from haemorrhage, increased shock or sepsis. Further, as this was a major incident, I want to know why a doctor was not sent by the Report Centre when the First Aid Party was despatched.— N.C. F. Effects of Electrocution. F.J. (Barnet).— Recently I was giving instruction on electro cution and the resultant asphyxiation. A member of my class asked me if it was correct that in some cases a patient, having recovered from asphyxia, was placed in a rubber suit in hospital for 4 8 hours, as he had heard that it was so. Is it possible for a charge to be transmitted to the metal parts of the bed thereby involving any person approaching ? Personally I do not think this is so, the patient not being now in contact with electricity. Or is it just a “ bright lad ” of the class indulging in a little leg pulling ? Being unable to give a satisfactory answer I told him I would endeavour to find the reason. Thank you for your invaluable help in the past. You are correct in your opinion. The small amount of static electricity which remains in the body after partial electrocution is not sufficient to cause harm to others. In these circumstances the suggestion that such patients are placed in a rubber suit on admission to hospital seems to me to be somewhat facetious.— N.C.F. Priority in Despatch. T.B. (Barnard Castle).— I would like the favour of your valued judgment on the following : A team of four is called to attend at an upset motor wagon, casualties as follows :— No. 1 . Driver, pain at right lower ribs ; signs and

A I D

symptoms of internal haemorrhage ; semi-conscious. No. 2 . Fractured femur ; shock ; conscious. No. 3 ; Vertical wound in abdomen; no protrusion; unconscious. No. 4 . Right hand severed at wrist ; faint ; conscious. After four minutes a van arrives, cannot take two stretchers, but might take stretcher and one patient on floor of van. No signs of ambulance or other vehicle. What should be the order of treatment and despatch ? Hospital is five minutes journey. Please accept our thanks in anticipation of your kind ruling.

As it is possible for the first aiders in attendance to give some assistance to the second and third casualties pending the quick return of the van, I would select the first casualty as the stretcher and the fourth as the sitting case. Of course, the second and third casualties would have to be removed in the recumbent position.— N.C.F. Treatment of Fractured Clavicle. A.B. (Rotherham).— In a recent competition which was judged by a first aider, we had to treat a patient suffer ing from apoplexy and fractures of left femur and of right clavicle. The accident occurred in the open and there was no shelter available. 1n the circumstances we did not remove the patient’s coat in our treatment of the broken clavicle because of the risk of lowering the body temperature which might adversely affect the most serious condition, viz apoplexy. Afterwards we were amazed to hear the judge say in his comments that we had lost four marks for not removing the coat. On the facts stated I approve your action, and as a first aider I would not have removed the coat because this would take time and would delay the patients removal to hospital. — N.C.F. Compound Fracture of Leg. E.L. (Kingsbury)’— In a practice test the patient had a com pound fracture of leg with bone protruding. The injury was treated by straightening the limb, and then apply ing splints and bandages according to the instructions on pp. 91 and 92 of Textbook. Commenting on the test I said that I believe all judges would accept that method, but that I thought a better method is as follows :— Gently bend to straighten the limb if it eases the pain ; but stop before the bone re-enters the wound. Maintain support and prevent movement while the sound limb is brought into line with it ; bandage limbs above and below fracture, ankles, knees and thighs ; apply splint from armpit to below feet and secure by bandages round chest, ankles and feet, and pelvis ; turn patient on his back ; and support limbs with pillow. (Reference to dressing wound and padding is omitted to save space). Opinions are divided and I was asked if my method would be approved by a competent authority. To this I could not reply ; and so I would be pleased if you would kindly express your views upon it. To me there is little, if any, difference in the two methods described in your letter. Further, it would seem that the word “ straighten” has been confused with the word “ extend.” In no case should the protruding end of the fractured bone be drawn into the wound but usually it is possible to place the injured limb in line with its fellow with out exerting any extension.— N.C.F.

44 F I R S T

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FIRST AID Ifye |n6cpcn6citt Journal /or ftje Ambulance anb Jftursmcj perukes; N o . 5 9 8 , V o l.

L .]

A P R IL ,

1944.

ADVANCED A.R.P. QUESTIONS ANSWERED

TH E

T R A IN IN G F IR S T

A ID

C O M P E T IT IO N

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FIRST A ID JrofepenAen! ^onntdf^fbr tije Ambulance nab p u r s in g Editor 1

CQQ INO. o y o .

W ALTER

V(1 r T VOL. L .

SCOTT,

A P R II 1 9 4 4 IX I1^, 19 T t.

READERS.

CONTENTS

THIS NUMBER.

—

A National Ambulance Service ... Recent Advances in First Aid Work in War

... ...

110

Police Ambulance News ... ... S.J.A.B. Headquarters and District Reports

... ...

Ill Ill

Railway Ambulance News

109

...

113

Letters to the Editor ... ... St. John Ambulance Association...

... ...

113 113

Allergic Diseases ... ... ... 8 Qualifications for the First Aider in Verse

... ...

114

The Home Guard and First Aid

...

116

••

f 16

Reviews Q

u e r ie s

... a n d

n sw er s

... •••

■ ■ ■

o r r e spo n d e n ts

113

:—

Burns of Face and Compression

...

118

Examination Howler

...

118

Lay Instructor

...

118

Blitz First Aid ... ... Treatment of Black Eye ... Treatment of Dislocated Hip

••• ... ...

118

Humour in A.R.P. ... Examination of Fractured Pelvis

••• ...

... ...

118 120

Treatment of Scorched Lungs

...

118 118

....

...

120

Colour of Face in Asphyxia... ... Performance of Artificial Respiration

... ...

120

Eversion of Eyelids Temperature of Body Burns Due to Electricity

... ... ...

120

•••

...

120

Lay Instructor

...

... ... ...

f( S t a Et inot ne re er ds ' at 1 (4/. Phr PRICB THREEPENCE H a ll\ Annom, Post Frbb

EDITORIAL.

FIRST AID is published on the aoth of each month. Tbe Annual Subscription is 4S. post free ; single copies 3d. Its aim and object being the advancement of Ambulance Work in all its branches, the Editor invites Readers to send Articles and Reports on subjects pertaining to the Movement and also welcomes suggestions for Practical Papers. All Reports, &c., should be addressed to the Editor at the address below, and should reach him before the 8th of each month, and must be accompanied (not necessarily fo r publication) by the name and address of the Correspondent. Subscriptions, Advertisements and other business Communications connected with FIRST AID should be forwarded to the Publishers. DALE, REYNOLDS & Co., L td., 46, C a n n o n S t r e e t , L o n d o n , E.C.4. Telegraphic Address—“ Twenty-four, London." Telephone— City 3710.

d it o r ia l

F.R .S.A .

t \ r

NOTICE

F.R.San.l.,

120 120 120

T o o m uch stress cannot be laid upon the im portance of an am bulance service in d ays such as those the country is now p a ssin g throu gh . T h e road slau gh ter alone is sufficient to prove its absolute necessity, not o n ly in the bu sy streets of the towns but in th e m ost remote parts of the country, in the most sequestered lanes— everyw here indeed, where motor traffic finds its w a y . It is an indisputable fact that am bulances have not follow ed the pro gress w hich has marked advance in other veh icles. A s a correspondent points out, it m ust be re membered that the vehicles supplied for am bulance purposes in som e of the country districts were old cars, converted w ith a structure to carry stretchers. T h e s e vehicles are now five or more years older than when supplied. Furtherm ore, a certain am ount of the n o n -startin g trouble is due to the unsuitable places in w hich the veh icles are housed, and alth o u gh repeated application has been m ade to the authorities for im provem ents, little or noth in g has been done. W e have all of us seen antiquated vehicles of this kind and they certainly serve to inspire the reverse of enthusiasm in those who are w hole-heartedly e n g a g e d in first-aid work. T h e re was a time, some h alf-a-century or so a g o , when the fire brigade of rural and sm all urban districts were subjected to the m ost un grateful treatm ent. T h e fact that they were m aintained by volu n tary labour with voluntary funds was over looked and they were subjected to universal con tem pt and ridicule, not o n ly in the variety halls but in the press. T h e men were zealous in the performance of their duties and formed a bo d y (un fortunately, not united) of the utm ost usefulness. T h e y were, how ever, the butt of jo k es on their alleged inefficiency, the fact b e in g en tirely over looked that efficiency was possible o n ly w ith proper and sufficient equipm ent. It was realised on the outbreak of war, when everyone w as, so to speak, in the front line that such a state of th in g s could not be permitted to exist, that the fire-figh tin g services could not cope w ith the various troubles that m igh t arise (and did arise) an yw here at an y tim e. T h e result was that the N . F . S . was started A N a tio n a l A m b u la n c e S e r v ic e .

F I R S T

and is now in a very efficient state, due not o n ly to the new personnel infused into its ranks but to the lavish o utlay that has been expended on equipm ent. T h e re is not the least reason w h y the am bulance service, if it were placed on a national basis, should not becom e eq u ally efficient, with the most modern appliances in place of its far too great a quantity of old, tim e-worn vehicles and other equipm ent. T h e re would be no trouble about its personnel— the su p p ly of that is a foregone conclusion. W ith a N ation al Fire S ervice, a N ational F irst-A id S ervice and a N ational A m b u la n ce Service, the nation would stand prepared for every eventuality both in war and peace.

R ecent

A dvan ces in

F ir s t

A id

W ork

W ar.

By SIR H EN R Y L. MARTYN, K.C.V.O., F.&.C.S. (Casualty Staff Officer, G Area, Devon C.C.) ( C o n tin u e d from page 9 9 . ) The summation of his discoveries and that of others was that wounds due to high explosive must be regarded as in an entirely different category to those of civil life. Because of the tremendous force concentrated by the pro jectile in the small area of the wound the tissues, often for a depth of more than half an inch immediately sur rounding the wound, were killed, and into this mass of dead skin and muscle were ground enormous numbers of bacteria carried in from skin and clothing. No antiseptics applied to such a wound were capable of penetrating the dead tissues and destroying, or even limiting the growth, of the bacteria. For a certain period of about six to eight hours these invading bacteria tended to remain inactive and confined to the dead tissues in immediate relationship to the wounds, but after that time had elapsed they commenced both to increase rapidly in numbers and to spread into the surround ing and otherwise undamaged tissues of the body. Almost simultaneously with this advance in knowledge came the discovery of the large group of drugs, of which M and B is most familiar to the lay mind. These are not antiseptics in the accepted sense of the term, but they are nevertheless capable both when applied locally or taken by the mouth of preventing the spread and growth of bacteria. What vast changes these discoveries produced in the treatment of every sort of war wound. It became apparent at once that if a wound could be excised complete with all the dead tissues and the contained bacteria within 6 to 8 hours, the wound so created sprinkled with one of the newly discovered drugs, and the limb sub sequently completely immobilised in a plaster of Paris casing the ideal of the surgeon would result— a wound practically clear of infection, one that would heal cleanly with the minimum necessity for dressing in the shortest possible time and, above all, one that would occasion little chance of dangerous blood poisoning. The treatment has revolutionised our hospitals called upon to deal with air raid casualties. Seldom now do we see those ghastly suppurating wounds dragging their slow course to eventual healing over weeks and months, the

A I D

patient’s life a burden with constant painful dressings. Not only is the mortality of wounds vastly decreased, but the time of recovery shortened and the eventual result infin itely better. Now let us consider to what extent these things depend upon the work of the casualty services in the field. The main thing is that the casualty should be operated upon within the time limit of 6 to 8 hours from the receipt of his injury, during which the bacteria ground into his wound remain quiescent. No patient can be operated upon while still in a state of severe shock, and valuable hours may have to be devoted to resuscitation before any treatment of his wound can be undertaken, It is therefore clear that two things become of even greater importance than ever be fore—the limitation of shock and the speed with which the patient can be got into hospital. It is largely from this point of view that the modern abbreviated methods of first aid treatment in the field become of such great importance. Careful discrimination must ob viously be used in determining which cases warrant the employment of speedy methods, and in which shock would be dangerously increased by anything less than the most careful and full treatment in the field. I shall have more to say upon this point later on, but one example is now sufficient. In your February issue a correspondent raises the ques tion as to the wisdom of applying a broad bandage over the site of a fracture. The answer is given that such treatment — employed perhaps in bandaging an upper arm fracture to the side without using splints— would not be likely either to aggravate the injury or increase the pain. That being so, the method has great advantages over the formal splint ing since the time necessary to complete it is obviously very much less than that required by other methods. It is not only the point of view of conserving equipment that enters into the question but the still more important conservation of time. In short— the sooner a patient can be got on to the operating table and the less his shock when he reaches hospital, the greater will be his chance not only of life but of rapid recovery. Any methods therefore which can eliminate the laborious and unnecessary, with due regard to shock, should be brought into use on every possible occasion. Without entering into a detailed description of the numerous abbreviated methods of handling fractures taught in the Regional Schools, it may be profitable to review them generally. Any method advocated must conform as nearly as possible to the two primary requirements for the treatment of any fracture, namely, that the fracture itself and the joints above and below it must be immobilised, and that the risk of aggravation of the injury during transport must be reduced as far as possible. The elementary training of first aiders is largely influenced by the idea that these results can only be obtained by the use of rigid splints either real or improvised. Careful consideration however will show that this view may in many selected cases be changed without unduly risking an increase in shock.For instance in the case of compound fractures of the upper limb, unless accompanied by severe haemorrhage, the shock element is not likely to be predominant as it is invari ably in the case of fractures of the thigh, pelvis, or spine. As a general rule therefore, it may safely be assumed that abbreviated methods such as bandaging an upper arm fracture to the body with a broad bandage while the wrist is supported in a narrow arm sling, and the similar bandaging of a fractured forearm supported in a broad arm sling to the front of the body will be both harmless and speedy. On the other hand anything save the most careful splint ing of any fracture involving the femur before tbe case is moved from the site of injury is likely so to increase the shock that abbreviated methods will defeat their own ends.

F I R S T

This does not imply that improvised splints should not be employed rather than waiting for formal equipment, or that shortened methods such as the utilisation of broad band ages rather than several narrow ones, are not equally effec tive. The main point to be insisted upon is that speed plus the avoidance of shock is the essential factor, and that the exact and meticulous observation of routine is of very secondary importance. With regard to compound fractures of the leg involving both hones below the knee, I am strongly in favour of one of the abbreviated methods now advocated in preference to formal splinting in all cases. Not only is it quicker but it is definitely more effective in its control of the type of injury most commonly found. When a bomb fragment does hit a leg below the knee, the smash is generally very complete indeed, and the first aider is apt to find himself faced with a wound involving a considerable part of the limb, bones extensively fragmented, and in fact, very little left to which a splint can be securely fastened to give adequate support even if the sound leg be also included. The difficulty can be overcome very effectively by utilisa tion of the following method. Start by dressing the wound, straightening the smashed limb, placing it beside the sound leg and fastening the feet together. Now take a blanket and fold it to a width corresponding to the distance between the centre of the thigh and below the foot of the injured patient. Slip the folded blanket carefully beneath the legs leaving an equal length of blanket on each side. Roll the free ends of blanket inwards as tightly as possible until the rolls are closely against the sides of the legs. Complete by bandages passed beneath the blanket above and below the injury and above the knees tying very firmly over one of the rolls. The injured limb now lies in a gutter of blanket which supports it behind and between two tight rolls of blanket on either side providing the lateral support. ( T o b e c o n t in u e d .)

P o lic e A m b u l a n c e

News.

E le v e n teams competed in the V Division annual first aid competition, held at Barnes, on Tuesday, March 2 8 th, at Barnes District Garage. The team test took place on a small stage, depicting a room scene, complete with hearth and fire, and the “ patient”, who had fallen from a chair while hanging a picture, on the floor. The judge was Capt. T. R. H. Wrangham, County Surgeon, Western Area, S.J.A.B. Whilst this test was in progress, waiting candidates were competing in pairs in another part of the premises, where two casualties were provided. The judge for these events was Assistant Commissioner S. J. Warren, S.J.A.B. Out of a possible total of 340 for the double event the winners were Barnes A team with 295 ; second came the Putney team with a score of 2 8 0 . Other teams scored as follows : D. T. 5 team, 2 6 2 £ ; East Molesey, 262 ; Richmond S.C., 250 ; Richmond Police team, 2 4 8 ; Malden, 247 ; Wimbledon, 2 4 4 ; BarnesAux., 231 ; Malden S.C., 223 ; Molesey S.C., 1 6 9 . Supt. R. Donaldson, V Division Metropolitan Police, thanked Station Sergt. Rabson and his assistants for the excellent staging, the judges and the patients. In particular he welcomed Civil Defence members from Richmond, and commented upon their keenness and co-operation with the police in this most important field of work. Presenting the cup, medallions, and prizes, Chief Con stable Bennett said to-day, more than ever before, each citizen required practical experience of first aid.

111

A I D

S t.

Jo h n

A m b u la n c e

H EADQUARTERS

AND

B rig a d e

D IS T R IC T

REPORTS.

County o f Berkshire. There are thirteen Ambulance Divisions and seventeen Nursing Divisions in the county including Reading Corps which has five Ambulance and seven Nursing Divisions. The total number of members in the county including ambulance and nursing cadets is 1 , 529 . On March 1 Sth, eighty officers and members from Nursing Divisions in the county paid a visit to the West minster Hospital, London. Through the kindness of the House Governor and Secretary, Mr. Power, and the members of the nursing staff, they were personally shown round many of the most interesting departments of the hospital. R e a d i n g C o r p s . — 114 ambulance and nursing members are serving in H.M. Forces ; 106 on full-time and 367 on part-time war service. On March 1 8 th, at the Ambulance Hall, Chatham Street, a lecture on anaesthesia was given to members of the Corps by Dr. Ronald Jarman, one of the leading anaesthetists in London. He took as his main subject the anaesthetics which are administered by intravenous injection. He described the newest drug which is being used with such success on people seriously injured in air raids, as well as at the battle fronts. The County Commissioner, Mr. C. A. Poole, introduced the speaker.

R e a d in g T o w n “ B”.— Hon. Sergt. Walker, Treasurer of this Division, has resigned owing to pressure of work and ill health. Private Eric Coak has been appointed to take his place.

T h e a le N u r s in g D i v i s i o n . — A competition was held on March 1 1 th, when a shield was presented to the winning team by the County Commissioner, Mr. C. A. Poole. The shield was given by the President of the Division, Sir Felix Pole. Three teams entered the competition, and the captain of the winning team was Sergeant Glazier.

County o f Lancashire. B l a c k b u r n . — The first general meeting of the Black burn Aircraft Nursing Division, was held on March 15 th at one of the Company’s factories. Among those attending was Lady County Supt. Mrs. Edwards. Reports presented by Lady Divisional Supt. Mrs. Peace, Secretary Miss Collier and Treasurer Mrs. Hornby revealed a strikingly healthy new Division with a live membership of 29 and one probationer. Formed in July, 1 9 4 3 , with 19 members, the Division, already fully uniformed, is in addi tion to working a 55 hour week with domestic responsibilities too, doing regular weekend duties at the Works First Aid Post, Hull Royal Infirmary in the casualty and blood trans fusion wards, and at the Welfare Sick Bay, and helping as drivers or attendants for the ambulance services run by County Headquarters and by the Humberside Corps. The Division has had 100 per cent, pass in all examina tions and is at present taking a Gas Course for the St. John Ambulance Brigade A.R.P. Certificate. The financial position of the Division shows a balance in the bank of over ^jl00— a very fine achievement which reflects equally on the enthusiasm of the Treasurer and the co-operation of all members.

112

F I R S T

Votes of thanks to all visitors by Ambulance Officer Mrs. Longley closed an exhilarating general meeting. County of Oxford. W i t n e y . — On March 2 9 th the above Division held its 15 th annual meeting under the chairmanship of the Divisional

Surgeon Dr. Dagleish, supported by E. A. Huddleston, Esq., Vice-President, and the Divisional Supt., J. C. Chesterman. The Secretary reported that the strength of the Division was 38 (and 17 boy cadets) ; 15 members were serving in H.M. Forces, 2 were prisoners of war, the remainder were engaged in A.R.P. work and work of national importance. Cadet Supt. S. Collis reported that the 17 cadets had an average attendance of 1 6 . During the year they had gained the Preliminery Nursing Badge. The Treasurer reported a very satisfactory balance sheet. The Div. Supt. in his report stated that he felt very proud owing to this being an important year in the work of the Division, because it meant that a number of the rank and file would qualify for the coveted distinction of the Long Service Medal. He thanked all ranks for their loyalty and devotion to him and to their Divisional duties, and for the good comradeship which existed between all ranks. They had done excellent work during the 15 years the Division had been in existence, and although they had treated a very large number of cases, never once had he ever heard any complaint, which spoke volumes for their treatment, and he thanked them all very much. During the evening the Certificates and Nursing Badges were presented to the cadets, all of whom were successful. County o f Surrey. G u i l d f o r d . — Corps Supt. Julius D. Rutter of the above Corps notifies us that he has received interesting news from one of his members serving overseas, who writes to say that he has been awarded the Military Medal for his first aid work at Mt. Cammino in Italy. The member’s name is Guardsman F. Smith of No. 2 Coy., 6 Battn., Grenadier Guards, C.M.F. An extract from the letter reads :— “ You will be interested to hear that I have been awarded the M.M. for my first aid work on Mt. Cammino. As I owe my first aid training to St. John’s, I feel that Mr. Cheshire, Mr. Norton and yourself, also the rest of the members have done much to earn me this award, for which I gratefully thank you.”

County o f W arwick. C o v e n t r y . — At the very kind invitation of the Hospital Saturday Fund Committee, members of the Coventry (Central) Corps, who do transport duty at the ambulance station, attended a dinner given by the Committee at the Masonic Hall on the evening of March 1 4 th. Mr. Beesley the Chairman of the Committee, speaking after dinner, said how proud he and his Committee were of the wonderful work performed by the voluntary helpers both men and nurses in giving up so much time after working hours and he thanked personally, several to whom awards were made. Afterwards, Corps Supt. March in giving figures stated that many of the men and nurses had done over 3 ,0 0 0 hours duty during 1 9 4 3 , and had assisted in moving over 2 ,0 0 0 patients. County Transport Officer J. H. Harris also paid tribute as did County Officer Fowler. The evening ended with dancing and another very successful event concluded.

On Sunday, March 2 6 th, the Corps held a Church Parade to the Central Hall, in conjunction with other organisations, for tbe Red Cross and St. John Prisoners of War Fund.

A I D

Over 6 0 0 officers, men and nurses, also cadets were present on parade. Corps Supt. L. T. March was in charge of the men and cadets and Corps Supt. Mrs. Weston in charge of the nurses. Thanks are due to all concerned in giving up their leisure, and on such a beautiful day, to make the parade such a remarkable success, and Corps Supt. March would like to record his most grateful thanks to all for turning up in such good numbers. West R id in g o f Yorkshire. R ipon.— T he annual general meeting of this Division was held at Headquarters. Among those present were Div. Surgeon A. Carnegie Brown, Supt. W. Booth, Mr. J. T. Hirst (Hon. Treasurer), and A. Orton (Hon. Secretary). The Div. Surgeon and Supt. Booth thanked all the members and the ladies for their co-operation and the way in which they had carried out their duties during the past year. Supt. Booth also reported that another class of cadets had just finished their training and were due for examination. The Hon. Treasurer said that the year had been a record one both in work and finance. A total of ^ 6 5 0 was now in vested in Defence Bonds and the credit balance at the bank stood at £ i 9 6 . He reminded the meeting that after the war when conditions permitted, a large amount of this money would have to be used to purchase new equipment. The Hon. Secretary reported that the past year had been a record one, 371 patients had been carried a distance of 8 ,2 0 9 miles, and 30 road accidents covering a mileage of 534 were attended. The present strength of the Division was now 2 6 , of whom 12 were in the services and 7 in the A.R.P. The cadets had been very useful again, doing telephone duties and acting as attendants. Mr. Hirst reported that he had purchased some blankets through Headquarters, and was now awaiting word from them regarding the purchase of pillow slips and bandages. Northern Ireland (Ulster) District. At the annual meeting of the St. John Ambulance Brigade, held in Belfast on March 2 5 th, Mr. W. M. Brennen, F.R.C.S., Acting Commissioner, presided in the absence on active service of Lieut.-Col. Ian Fraser, O.B.E., D.S.O., F.R.C.S., Commissioner. Presenting the annual report, Mr. Brennen^ expressed pleasure at the number of divisions now operating, 121 in comparison with 108 in 1 942 . Unfortunately there was a slight fall in the number of personnel. The need for more members and the means by which new members could be interested, were discussed. The financial report, presented by Mr. A. W. Mann, M.P.S.I., Assistant Commissioner and Hon. Treasurer, was satisfactory, although the grant of ^J350 from the Ulster Joint Committee had been withdrawn. Reports also presented were Mrs. G. N. Wallace on the Nursing Division ; Mrs. Lockhart for the Girl Cadets ; and Mr. W. Wilton for the Boy Cadets. Mr. and Mrs. Mann were presented with a silver salver. Mr. Brennen congratulated them on their recent marriage, and wished them every happiness.

Colonel C. J. Trim ble. On the 1 6 th of last month, Col. Charles Joseph Trimble, C.B., C.M.G., L.R.C.P., attained the age of 88 years. On behalf of all ranks we extend hearty congratulations to the Colonel, who is still on the active list as Inspecting Officer for Lancashire. All wish him continued health and service He is known as the Grand Old Man of the Brigade.

F I R S T

Railway Ambulance News.

A I D

L e tte rs

th e

E d ito r .

W e are in no w a y respon sible for the opinions exp ressed, or the statem en ts m ade, b y C o rresp o n d en ts.— E d i t o r .

L .N .E .R . W a v e r l e y . — In the an n u al com petition of the W a v e rle y Statio n A m b u la n ce Section , five team s w ere exam in ed by D r. P. H . S co tt, M .B ., C h .B ., in oral, p ra ctical, and tra n s port w o rk . T h e w in n in g team w as A n d rew M orrison (cap tain), M iss C . Seath , M iss J. D ick , and M rs. J. W a tt. M rs. C r a ig , w ife of the statio n m aster of W a v e rle y Statio n , pre sented the cup to the successfu l team . M r. G . M. Johnston, D ist. S u p t., L .N .E . R . , E d in b u rg h , exp ressed gratifica tio n a t the am o u n t of w o rk accom plished b y the first aid students, and recalled som e in stan ces of h o w life had been saved by prom pt action by ra ilw a y servan ts. H e m entioned th at a ca m p a ig n w a s b e in g in itiated by the r a ilw a y com p an y to stim u late the in terest of the staff, w hen it w as hoped the n um ber of students w ou ld be in creased.

M ETHOD D ear

L O A D IN G

W IT H

TW O

BEARERS.

S ir ,—

O u r H o m e G u a rd stretch er bearers h a ve been p ra ctisin g D r. B o w m an E d g a r ’s m ethod of lo a d in g w ith tw o bearers, p ublished in F i r s t A i d for F eb ru a ry . P riva te K in s le y Sm ith s u g g e s te d th at the p atie n t’s belt be put round his chest for the lift, a s the lift from the w aist g a v e the p atient a go o d deal of distress. W e tried both m ethods on several m en and a ll com p lain ed of a “ ru sh of blood to the head ” w h en w a ist lifted and no d istress w hen the belt w a s round the chest. A t P riva te K in s le y S m ith ’s request I am s e n d in g you this s u g g e s tio n to m a k e a n y use of th a t you th in k fit. Y o u r s faith fu lly ,

W h en ra ilw a y w o rk e rs com peted a t C a m b rid g e on S a tu rd a y , A p ril 1st, in the a n n u a l com petition for the alnbulance shield, M arch Statio n not only carried o ff the honours, but, w ith their o th er team , w ere a lso the runners-up. F iv e team s from th e L .N .E .R . (G re a t E a stern Section) C en tre of the S .J .A .A . com peted, in the H o u g h to n H a ll, before a la r g e audien ce, in the event for the C a m b rid g e D istrict O fficers’ A m b u la n ce Shield. T h e M arch “ B ” team , g a in in g 165 points in the team test and 100 points in th e individual test, w ere w ell a cclaim ed w in n ers over th e M arch “ A ” team , w h o scored a total of 201 points. T h ird cam e C a m b rid g e “ A , ” fourth C a m b rid g e “ B ” (a team of three lad ies un der a m ale captain), and fifth K in g ’s L yn n . F o r the team test the p atient w a s a p ain ter w ho had suffered a fall. A ll his in ju ries w ere in dicated, and the tim e allo w ed w a s 18 m inutes. T h e ju d g e s w ere C a p ta in W . G o od ley, M .C ., and Mr. W . W a lsb y . W h en p resen tin g the shield, M r. J. P. A lix, ch airm an (district go o d s and p a ssen g e r m a n a ger) said it w a s the s ix teenth occasion on w h ich th e com petition h ad been held. H e co n g ra tu la te d the w in n ers and all the finalists, and w en t on to em ph asise the im p ortan ce in a m b u la n ce w o rk of b e in g ab le to a ct alon e and im provise. C a p ta in G o od ley sp ok e of the h ig h stan d ard sh o w n by the finalists.

GREAT

W ESTERN

A t a recent D iv isio n a l A m b u la n ce S ecretaries’ Conference, M r. H . A d am s C la rk e , the C h airm an , th a n k ed M r. J. L o n g , w h o la st yea r resign ed from the position of D iv. A m b. S e cre ta ry to the S w a n se a D ivisio n , fo r his w o rk d u rin g his ten ure o f office. M r. G . S. H o d d er, B risto l, supported by M r. W . J. W a ite, W o rcester, paid tribute to M r. L o n g ’s ser vice to the m o vem en t and a sk ed him to accep t, on b eh alf of th e D iv isio n a l A m b u la n ce S ecretaries, a D u n h ill pipe and lig h te r, w ith their best w ishes. M r. L o n g had a very lo n g and a ctiv e a m b u la n ce career, h a v in g passed his first a m b u la n ce exa m in atio n a t H ereford in 1 8 9 7 . H e form ed a class a t N eath in 1910 and for several y ea rs acted a s secreta ry to classes a t N eath , an d a lso rep re sented the L ocom o tive D ep artm en t on the S w a n s e a D ivisio n a l A m b u la n ce C om m ittee from 1913 until his app oin tm en t as D iv isio n a l S e cre tary in 1 9 3 6 . M r. L o n g holds the G .W .R . 15, 2 0 , 2 5 , 30 and 35 y e a r g o ld efficiency a w a rd s, and w as adm itted to the O rd er of St. John of Jerusalem in th e G rad e of S e rv in g B ro th e r in 1 9 2 4 . H e h a s g iv e n his services to the R ed C ro ss and St. John Joint C om m ittee and A .R .P . o rg a n isation s d u rin g the G re at W a r and the present w ar.

L a m b to n

(M rs.

L am b ton ).

C o m m a n d an t S X / 106, B .R .C .S . R otherfield, T u n b rid g e W e lls.

St. John Ambulance Association, W i s b e c h . — F o r the a n n u a l com petition for m em bers of the W isb e ch C entre, held on W ed n esd a y, M arch 2 2 nd, a ra th e r u n u su a l test w as set. A lth o u g h this test w as not so sp e cta cu la r a s those of p revious y ears, the problem w a s e x tre m e ly p ra ctical. T h e scen e w as set on the m ain n orth-south road, a b o u t tw o m iles from th e to w n ; the o n ly a v a ila b le equ ipm en t w a s th at of the St. John A m b u la n ce m an w ho, in ru n n in g from his house to h elp a w o b b lin g cy clist, slipped on a piece of o ra n g e peel and becam e a n o th er co m p licatio n for the F .A . p arty ! T h e in ju ries w ith w h ich the team s had to cope w ere not exten sive, the cy clist w a s su fferin g from cerebral haem orrhage, w h ile th e S t. Joh n A m b u la n ce m an had a sim p le fra ctu re of the kn ee-cap. E a ch team w as allo w ed 15 m in utes. D r. H . L . G room w a s the ju d g e , an d in his re m a rk s at the close of th e con test, told the co m p etito rs h o w m ost of them had “ com e u n s t u c k ” on th eir m ethod of e x a m in in g the u n con sciou s patient, and h o w o n ly one team h ad realised th at the cy clist w a s a cerebral haem orrh age ca se an d not m erely a “ d r u n k .” T h e doctor also criticised th e team s for fa ilin g to m a k e th e best use of the con sciou s p atien t w h o se h ouse and b ro th er w ere clo se by, and w h o could h a v e told them all th ey w an ted to kn o w . T h e la d ies’ team w h ich w on the R o th sch ild C u p w a s a W isb e ch N u rs in g D iv isio n team w h ich w a s a w a rd e d 80 m a rk s out of a possible 100. T h e G orefield team w h ich w on the E lg o o d C u p w as a w a rd e d 73 m ark s.

B i r m i n g h a m . — T h e a n n u a l report of th e B irm in g h a m C o u n ty C en tre of the S t. John A m b u la n ce A sso cia tio n records th a t 316 classes w ere held d u r in g the y e a r— a n in cre ase in a ll a ctiv ities over the p revious y ea r. T h e re w a s evid en ce of the con tin ued d em an d for in stru ctio n in the vario u s bran ches of first aid. T h e in crease in cla sses for boys and g ir ls w as due to the drive fo r cad ets in th e S t. John A m b u la n ce B rig a d e . T h e C o m m ittee feels “ th a t the B irm in g h a m C o u n ty C en tre is fu lfillin g its fu n ction s and p u llin g its w e ig h t in the g e n e ra l w a r effort, and thus h e lp in g to w a rd s th a t com p lete victo ry w h ich a ll a rd en tly d e sire ,”

ii4

F I R S T

Allergic Diseases. By

G eorge

W .

B ray,

M .B ., C h .B ., M .R .C .P .

(F ro m a lectu re delivered a t the R o y a l In stitu te of P u b lic H e a lth and H y g ie n e , P o rtla n d P la ce , L on d o n , W . l , on W e d n esd a y, F e b ru a ry 2 3 rd, 1 9 4 4 .)

term “ a l l e r g i c ” is app lied to a g ro u p of diseases ch a ra cterised by h yp ersen sitiven ess on the part of the sufferer to m a n y u su a lly h a rm less a rticles encoun tered in his diet or environm en t, and in cludes such a p p a ren tly diverse conditions a s a sth m a , h a y-fever, vaso m o tor rh in itis, eczem a, u rticaria, an d m ig ra in e . T h e ten den cy to develop a lle rg ic diseases runs p redom i n a te ly in som e fam ilies, w h o com p rise from 2 to 10 p ercen t, of the p opu lation of som e countries. In the m a jo rity of cases, and esp ecially those in w h ich an h e re d ita ry ten den cy cann ot be determ in ed, a definite h isto ry of som e severe illness sh o rtly before the onset of the a lle r g ic condition can be obtained. T h e com m on est sen sitisation is to som e a rticle of diet or to en viron m en t ; and the ca u sativ e su b stan ces m a y be divided for con ven ien ce into five g ro u p s :— (i) T h o s e a b sorbed by In h a latio n , such as a n im a l h airs, feathers, dusts, pollen s, m oulds and fu n g i ; (ii) those absorbed on in gestio n , such a s foods and d r u g s ; (iii) those absorbed from in jec tion, e .g ., sera, d ru g s , bites and stin g s ; (iv) those absorbed from in fection , v iz., b a cteria and w orm s ; and (v) those absorbed th ro u g h co n tact, such a s from fabrics, and chem i cal and p h ysical a g en ts. In certain less sen sitive in d ivid u a ls the g e n era l tendency is for th e body to o vercom e the ten den cy to rea ct by produc in g sufficien t ad ren alin e. If, d u rin g such tim e a s the bo d y ’s re sista n ce or a d ren alin e p ro d u cin g ca p a city is lo w ered, as o ccu rs d u rin g illn esses, m en tal o r nervous upsets, or endocrine disorders, or sta tes of fa tig u e , the a lle rg ic re actio n ensues. T re a tm e n t of the a cu te a tt a c k .— A ll a lle rg ic conditions respond to the a d m in istra tio n , of ad ren a lin e, if properly g iv en . M ost a lle r g ic con dition s are asso cia ted w ith a hypog ly c a e m ia , and repeated ad ren a lin e in jectio n s deplete the liv e r’s su p p ly of g ly c o g e n , so one to tw o tablespoon fu ls of g lu c o se tw o or th ree tim es a day help to lessen a n y ten dency to la ssitu d e and w ea k n ess. T re a tm e n t to prevent re cu rre n ces.— T h e first essen tial is to determ in e the sp ecific se n sitiz in g su b stan ces. O n ce th e ca u se h a s been d eterm in ed, treatm en t con sists in (i) d e a lin g w ith th e specific se n sitiz in g su b stan ces, and (ii) a v o id in g or re m o v in g co n trib u to ry factors. A ctiv e rem o val of the sp ecific sen sitizin g substan ces m a y be acco m p lish ed in the ca se of foods or d ru g s by their com p lete a vo id a n ce ; in the ca se of in h ala n t su b stan ces by the rem o val of pets and the su b stitu tio n of ru b b er for bed d in g , and g a rm e n ts of w ool, silk , cotton or flax in terch an ged a c co rd in g to the fin d in gs. A ctiv e rem o val of pollens or d u sts m a y be acco m p lish ed b y th e use of alle rg en -fre e ch a m b ers or m ech an ical filters. In d u st sen sitiv ity e lectrical va cu u m cle a n in g of th e hom e is ad visa b le, and the p rovid in g of a m in im um of a rticles of fu rn itu re in th e room , an a b sen ce of d u st-h o ld in g le d g e s, and a sm ooth un carpeted floor. O rris-ro o t free co sm etics can be obtain ed. P a ssiv e re m o va l m a y be a cco m p lish ed frequen tly by a d m ittin g the sufferer to a co n valescen t hom e or clin ic or b y a c h a n g e of altitu d e or clim a te som e of the w ell-k n o w n sp as or b y a sea v o y a g e . U n fo rtu n a te ly sym ptom s g e n e ra lly re cu r on the p atie n t’s return to his previous diet or en viro n m ent, u n less he h a s been a ctiv e ly treated a t the sam e tim e. T h e m a jo rity of a lle rg ic p atien ts sh o w a hyp ochlorh yd ria, so som e d ig e s tiv e h y d ro ch lo ric a cid before each m eal is The

R I D in dicated. M ost a lle rg ic con dition s are a sso cia ted w ith low ered m etabolism , so sm all doses of thyroid are frequen tly beneficial. S ep tic foci should be d ealt w ith on g e n e ra l p rin ciples. P ro lo n g ed fears and em otion s m a y p recip itate a lle rg ic responses by u s in g up a n y a v a ila b le a d ren alin e, so su ch facto rs need special atten tion . A g r e a t d ecrease in th e in ciden ce of a lle rg ic diseases w ou ld occur if m em bers of a lle rg ic fam ilies did not m arry. A s such a s u g g e s tio n is im p racticab le, g r e a te r efforts should be m ade to prevent sym pto m s d evelop in g in the children of such m a rria g es by p ro tectin g them from the com m enest causes. D u rin g p re g n a n cy and la cta tio n the m other should ta k e a w ell-b a lan ced and varied diet, a v o id in g a n y cra v in g for sp ecial foods and satu ra tio n w ith the variou s e g g -m ilk cocoa-cereal-cotton seed d rin k s on the m a rk et com m on ly recom m ended at this period. A fter birth the in fan t should only h ave m attresses, p illo w s, and eid erd o w n s w ith nona lle rg ic fillin g s ; rab b it w ool clothes and g lo v e s should be a voided, and h a ir a n im a ls and d u sty toys avoided. D u rin g the in fectious fevers of childh ood, the sam e p recau tio n s abou t b ed d in g should be observed ; and d u rin g g a s tr o in testin al upset a sufficien cy of g a s tr ic ju ice s sh ould be assu red and la r g e qu an tities of a n y food should g iv e p lace to as w ide an asso rtm en t as possible. W h en the tim e com es for ch o o sin g a career, fa rm in g and w o r k in g in d usty factories and w ith certain ch em icals, in w h ich a sso ciatio n w ith potent a lle rg en s is lik e ly to occur, should be avoided.

8 Qualifications for the First Aider in Verse. (1 )

O B S E R V A N T you should a lw a y s be, T o ta k e in a ll around you see, A lert, and q u ick you w ill detect W h a t’s w ro n g , and so yo u r facts collect.

(2)

B e T A C T F U L th at you m a y secu re T h e p atien t’s tru st, and to ensure A full acco u n t of a ll th a t’s done— T h e history, sym p to m s, d o n ’t m iss one.

(3 )

R E S O U R C E F U L , too, th a t yo u m a y use W h a t is to han d, you can n o t choose. S p lin ts, b a n d a g e s, a re n ’t on the spot, So im provise, use w h at y o u ’ve go t.

(4 ) D E X T E R I T Y w ill sh o w yo u r skill In k e e p in g p atient very still, E lim in a tin g needless pain, T h u s help to g e t him w ell a g a in . (5)

E X P L I C I T th at in struction s clear B e m ade to helpers s ta n d in g near, T o patient, too, th a t each m a y lend A ssistan ce a s you him attend.

(6)

D I S C R I M I N A T I O N w ill m a k e plain W h a t first to treat, so y o u ’d refrain F rom g iv in g aid to cases s lig h t T ill serious ones w ere m ade a lrig h t.

(7 )

Be P E R S E V E R I N G if not soon H e w a k en s up from o u t his sw oon . P ersisten cy oft w in s the day, So ca rry on, ’tw ill you rep ay.

(8)

S Y M P A T H Y the p atient needs. K in d ly w ord s a s w ell a s deeds. M a k e him feel h e ’s in g o o d care, H e lp him thus his pain to bear.

F I R S T

i i 5

A I D

HOUSEHOLD PHYSICIAN Describes In simple language with helpful coloured plates and diagrams

w ttp ’s

'.natrs

HOUSEHOLD

WKSOM

The C O M P LA IN TS OF M EN, W O M EN A N D CH ILD R EN .

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Their Cause, Treatment and Cure.

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PHYSICIAN HflSKUN

A jew ot the Subjects treated: G as W a rfa re , F irst A id W h a t to D o in E m e rg e n cies In fluenza, C olds, etc. M easles, M um ps, C a tarrh C orns and W a rts P h y sica l C u ltu re T re a tm e n t for all S k in D ise ase s T h e L u n g s , P le u risy H y g ie n e, A n atom y, P h arm a cy

T h e P rin cip le s of N u rsin g T h e E y e, the E a r T h e T h r o a t, the N ose T h e C h est, the H e a rt T h e S to m a ch , the L iv e r T h e T e e th , the M uscles In fan t W e lfa re H o m o ep a th y , N e u ra sth en ia 375 P rescrip tio n s, e tc ., etc.

THE YO U N G W IFE w ill find just the information she requires. MOTHERS who wish their daughters to develop naturally will find exactly the teaching they need.

W O M EN OVER 40 w ill fin d th eir d ifficu ltie s re g a rd in g h ealth fr a n k ly d iscu ssed .

■ rn-.i»c*

•*r«w^4i.v vnmuis'a«

■SEKSB*"*'•SSSSSfo*

HUNDREDS

PRESC R IPTIO N S— 375 p r o v e d rem ed ies.

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TESTIM ON IALS

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A D D R E S S ........................................................................................................

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i n t e l l i g e n t

SPARE T IM E OR W H O LE T IM E O C C U P A TIO N

G M

E e n

o m

e n

O U can m a k e M a ss a g e a sp are tim e or w h o le tim e o ccup atio n . T h e trained M asseu r is of in estim ab le valu e to F irst A id o rg an iza tio n s, N u r s in g H o m es, H ydro s, Sp orts and A th letic C lu b s, P h ysica l C u ltu rists, etc. T ra in w ith the S M A E In stitu te and rem em ber you h a ve

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LOSE

a s it g u a ra n te e s to co ach you un til su ccessfu l a t the exa m in atio n and y o u r D ip lo m a secu red dr retu rn s yo u r fees in full. TH E

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T h e S .M .A .E . (S w ed ish M a ss a g e and E lectrical) In stitu te is the old est of its kin d in G re a t B rita in , h a v in g been e stab lish ed for a qu arter of a cen tu ry. M a n y of the W o r ld ’s le a d in g M asseurs and exp o n en ts of M a n ip u la tiv e T h e ra p y h ave been trained by the S .M .A .E . In stitu te. W rite w ith o u t d elay for free-B o o k let "M A N IPU LA T IV E T H E R A PY AS A PROFESSION” This FREE Booklet tells you how to acquire the art of scientific massage by unique method of Home Study, and how you can establish a private practice of your own.

tin THE SMAE INSTITUTE

LEATHERHEAD 5 URREY

F I R S T

A I D

The Home Guard and First Aid. W h y is it th a t, even in th e field of F irst A id, w h ich su rely sh ould m ove fo rw a rd w ith e ve ry step m ade b y m odern m ed ical scien ce, so m a n y of us a re in clined to be “ dieh ard s ” ? I w a s so m ew h a t a m azed a t the reason s g iv e n for criticism of th e revised stretch er drill as outlined by m e in the F e b ru a ry issu e. B u t first, in self-defen ce, let m e m a k e one or tw o th in g s clear. T h e revised d rill, as quoted, is from th e official b o o k let issued for th e R .A .M .C ., and is n ow p art of their drill tra in in g , and is not m erely m y ow n idea, a s som e of m y critics seem to th in k . If this w ere so, I w ou ld h ave put it fo rw ard a s a su g g e s tio n , not in the p ositive m a n n er in w h ich it app eared. A lso , m y sm a ll con tribu tio n is intended p rim a rily for the H o m e G u a rd m edical u n its, w h o n ece ssa rily m u st tra in a lo n g R .A .M .C . lines. F ield procedure an d treatm en t of w ou n d s received in b attle m u st v a ry co n sid era b ly from th at u s u a lly adopted for civil a ccid en ts. B u t n ow for the reaso n s of criticism !

(1) “ It ig n o re s the fa ct th a t th ere m ust be g e n era l u n ifo rm ity of p ro cedure th ro u g h o u t both the civ il and m ilita ry s e r v ic e s .” W h y ? C o lla b o ra tio n , y e s — but su rely not u n iform ity of p ro ced u re ? T h e d rill w a s p rin cip a lly con cerned w ith the collection of w ou n ded, w h ich w ou ld be carried out by th e m ilita ry u n its. T h e civil service s w ou ld n o rm a lly ta k e o ver ca s u a ltie s from co lle ctin g posts ajter the w ou n ded had been b ro u g h t in and g iv e n , a t least, in itial treatm en t. And co n sid er th e effect, in these d a y s, of a squad m a k in g th eir app ro a ch to a ca s u a lty in the m a n n er a s ou tlin ed in the g e n e ra l tex tb o o k s. I am a fraid the re su lt w ou ld often be m ore fa ta l fo r rescu ers than for p atien t. M ed ical personnel, lik e the fig h tin g u n its, m u st ta k e a d v a n ta g e of a ll possible co ve r— h en ce the reason for fa llin g flat an d w o r k in g as m u ch a s possible in the prone position . T h e ch a n g e in p ro ced u re fo r N o. 1 is obvious. H e h a s to a scerta in first if the c a su a lty is alive before p ro ce ed in g farth er. S u rely the in feren ce is clear. A g a in , h o w can th ere be g e n e ra l u n iform ity betw een th e services w h en th eir very equ ipm en t is so m uch at va ria n ce. T o m ention one th in g o n ly : A ca su a lty h a s to be tra n sferred from the stre tch er service to the C .D . stretch er before he can be rem oved by a m b u lan ce, sim p ly becau se th e C . D . a m b u la n ce h a s not been adap ted to ta k e the form er. A t lea st th is ap p lies in m ost areas. R e su lt : fu rth er d e lay and fu rth er discom fort for the patient. (2 ) “ It in troduces u n n ece ssa ry ch a n g e s in w ords of co m m an d , long established (the ita lics are m ine), and adds to re d u n d a n cy .” W h y th is g r e a t re lu cta n ce to b re a k a w a y from oldestablish ed ru les and w ord s of com m and ? T h e services a re in tro d u cin g new d rills, n ew co m m an d s and n ew m ethods of a tta c k and defence a lm o st every d ay. A nd w e should be in a sore p lig h t if they d id n ’t. W e first-aid ers h a ve ju s t g o t to m ove fo rw ard w ith them . I s tro n g ly ad vise m y critic to stu d y th e a rticle in the M arch issu e by S ir H e n ry L . M artyn , K . C .V . O . , F . R . C . S . , w h o is him self a C a s u a lty S ta ff O fficer in th e C iv il D efen ce. H e p la in ly illu stra te s the need for p ro g re ss in first a id procedure, and I a g r e e w hen he says th a t, a lth o u g h the St. John T e x tb o o k is th e b est b o o k for b a sic, e le m e n ta ry in stru ctio n fo r first aid in civ il life, it is in u r g e n t need of revision u n der w a r conditions. H o w ev er, desp ite the fo re g o in g re m a rk s, let m e say th a t I w elco m e such criticism s. O n ly by p o o lin g o ur ideas and op in ion s can w e re a lly sep a ra te the w h e a t from the c h a ff and decide w h ere im p rovem en t ends and red u n d an cy b e g in s. C. W . S p r e a d b u r y (S e rg t.), Sch oo l H o u se, N oel-road, W . 3.

R e v ie w s .

Bandaging Made Easy. B y M . F a b e r & F ab er. Price 2/6.

R . H o s k in g .

L on d o n :

T h is u sefu l little bo o k , w h ich is n ow in its sixth edition, h a s been revised and b ro u g h t up-to-date. It deals w ith the a p p licatio n of th e roller, tria n g u la r and sp ecial b a n d a g e s ; and the in stru ctio n s are set out sim p ly, yet co m p rehensively, so th a t it ju stifies its title, It w ill app eal a lik e to the student, to the nurse, and to the first aider.

Handbook of First Aid and Bandaging.

B y A . D . B elilios, M .B ., D . K . M u lvan y, M .B ., F .R .C . S ., and K . F . A rm stro n g , S .R .N . L on don : B a illiere, T in d a ll & C o x .

Price 4I6 postjree. T h is e xcellen t SOO-paged b o o k w as prepared to provide a com plete tra in in g in first a id ; and it is w ritten in such fashion th at it ca n be e asily un derstood by the first y ea r as w ell a s by the sen ior student. T o th e la tte r it h as proved m ost a ccep tab le becau se it g o e s fu rth er into the subject than do the authorised textb o o ks. Its real value, h o w ever, is as a w o rk of referen ce to w h ich the su rg eo n lectu rer and the advanced studen t m ay turn w hen th ey are confronted w ith difficulties, confident th a t it w ill supply the desired in form ation. T h e call for a second edition w ith in a brief period has g iv e n th e a u th o rs an opportu nity of m a k in g a com p lete re vision of the te x t and of b rin g in g it up-to-date. C o n se q u en tly they h ave added a description of th e cru sh in ju ry syndrom e, and h ave in cluded the use of soft paraffin for m inor burns of the face and h an d s. T h e y h a v e a lso re w ritten the section on b la st so a s to conform w ith the resu lts of recent research ; and th e y h ave described the r o c k in g m eth od of artificial respiration . W e foresee for th e b ook a con tin ued su ccess and popu larity.

Classified Advertisements. A d v e r tis e m e n ts w ith re m itta n ce sh o u ld be sen t t o F i r s t A i d , 3d . p e r w o r d , m in im u m 4s.

46, C a n n o n S tre e t, L o n d o n , E .C 4 .

o n A

C o n cert T ic k e ts S/6. T ic k e ts , S a m p les— G rove, L on don , W . l 2 .

ZUU

M em os, R u b b er S ta m p s, R o ll T ic e s, 11, O a k la n d s

“ A ”

I R S T A I D C O M P E T I T I O N S a re w on b y g o o d co a ch in g . A n y F irst A id er (either sex) m a y coach a n y a m b itio u s tea m — m ale, fem ale, or m ix ed — to e a rly success. Com petition exp erien ce not n ecessary w ith n ew G uide (ad ap tab le to a n y text-bo o k). F o r p articu lars, send stam ped envelope to :— R . Jeffery, 5 , A ven u e G ard en s, L on don . W .3

A N T E D L a d y O fficer’s C o stu m e com plete, approx. 38 in. bust, o th er m easurem en ts in proportion. M iss E. M oore, E llo u g h to n M ount, B ro u g h , Y o r k s ._______ A N T E D A m b u la n ce O fficer’s U n ifo rm . H e ig h t 5 ft. 1 0 £ in s., go o d condition. H o n . Sec. S ileby D ivisio n , N r. L eicester.

“ GAS—A Synopsis of Defence Against” E ssen tial F a c ts W ithout P ad d in g. B y John F en to n ,

m .b ., b . c h ., b . a . o . , d .p .ii.

P ric e l s . Id. post free. D ale, R e yn o ld s & C o. Ltd.,

46, C an non Street, London, E .C . 4.

F I R S T

117

R I D

W h a t do y o u k n o w ab o u t I O D I N E Y

OU a r e a lr e a d y f a m il ia r w i t h t h e u s e o f t i n c t u r e o f io d in e a s a w o u n d

m ycotic infections o f the skin. There are m any other uses. I f you think a b etter know ledge of

d r e s s in g . D o y o u k n o w s o m e o f t h e o t h e r

iodine w ould help you in your work, the

m e d ic in a l u s e s f o r io d in e ?

Iodine in other form s has been used

Iodine E ducational Bureau w ill be pleased

successfully in th e treatm en t o f rheum a

to supply, w ith ou t charge, further infor

tism , th e com m on cold, a th lete’s foot,

m ation. This offer is open to any full-tim e

m axillary sinusitis and as an inhalant for

Nurse or First-A id worker.

I o d i n e S T O N E

H O U S E

E d u c a t i o n a l B I S H O P S G A T E

B u r e a u L O N D O N

E . C

arters

I p. V A . . '

I b S M T U S :

PATENT

“ PORTLAND A M BU LA N C E G E A R TheGear illustrated (A.B.C.D.) carries tw o stretchers on one side of Ambulance, leaving other side clear for sitting patients. UP A N D D O W N action Is quick easy for loading or unloading. A.

Shows the two stretchers in position.

Ba Shows the topstretcher lowered ready for loading. Ca Illustrates the same Gear with the top stretcher frame hingeddown for use when only one stretcher case is carried. D. Shows the same position as in “ C only with cushions and back rest fitted for convalescent cases. W here Ambulances are required to carry four beds two Gears are fitted, one on EITHER SIDE, and the same advantages apply as described above.

Full catalogueofAmbulanceEquipment No. 7Awill be sent onrequest. G R E A T P O R T L A N D S T ., LO N D O N , W . t

Telegraphic Address:—

'P h o n e .* Langham 1049.

KARVAUD, WESDO, LONDON

F I R S T

Queries and Answers to Correspondents Q u eries w ill be d ealt w ith u n der the fo llo w in g ru les :— 1. — L e tte rs co n ta in in g Q u eries m ust be m a rk ed on th e top left-han d corn er of the envelope “ Q u e r y ,’’ and addressed to F i r s t Aid, 4 6 , C an n on -street, L on don , E .C .4 . 2 . — A ll Q u eries m ust be w ritten on one side of pap er only. 3. — A ll Q u eries m ust be acco m p an ied by a “ Q u e ry C oupon ” cu t from the cu rren t issue of the Jou rn al, or, in ca se of Q u eries from abro ad , from a recent issue. 4. — T h e T e x tb o o k to w h ich referen ce m a y be m ade in this co lu m n is the 39 th (1 9 3 7 ) E d itio n of the S .J .A .A . M a n u al of F irs t A id to th e In jured.

B u m s of F a c e and C o m p ressio n . A .B . (R o th e rh a m ).— A t a recen t cla ss m e e tin g w e bad to treat a supposed patient, th e card re a d in g a s fo llo w s :■ “ A fter an a ir raid this m an cam e s t a g g e r in g out of a b u rn in g b u ild in g and su d d en ly co llap ses on the p ave m ent. O n re a c h in g him , you notice th at his face and han ds are severely burned and th at his left heel is in a pool of blood. H e is uncon sciou s. T h e n earest hospital is one m ile a w a y ; and no doctor is a v a ila b le .” O n e xa m in atio n it w a s found th at patient w as s u fferin g from a burst varicose vein and had su stain ed a fra ctu re of th e sk u ll w ith com pression of the brain. A discussion a ro se (1) a s to w h ich w ou ld be the best posi tion for the left le g — elevated or low ered, and (2) w h ich is th e m ore serious co n d itio n — the severe burns to face and han ds or the com p ression of the brain. D iscu ssio n a lso to o k p lace (3 ) a s to w h eth e r or no the ju d g e w ould be in o rder in d e d u ctin g points for lo w e rin g the left le g and a t the sam e tim e for g iv in g points for d o in g so. W e th a n k you in a d va n ce fo r yo u r ru lin g s on. these problem s. ( 1) In view of the b lee d in g from the bu rst varicose vein a n d the p o ssibility of its recurren ce, the left le g should be k e p t raised th ro u g h o u t treatm en t and transp ort. L o w e r in g it w ou ld h a ve little no no effect on the com pression of brain . (2 ) F ro m the first aid point of v ie w the burns and the com p ression m ust be re g a rd ed as e q u ally serious because both m a y lead to fatal resu lts. (3 ) It is not cu sto m a ry both to a llo t m a rk s and also to in flict a p en alty for sins of om ission and com m ission in com petitions. — N . C o r b e t F le t c h e r .

E xam in ation H ow ler. M .A . (C a m b r id g e ).— In a recen t exa m in atio n I a sk ed a can d id ate h o w he w ou ld treat a p atient w ho had sw a llo w e d poison ; and I w as am used w hen he replied : “ I would, at once administer an anecdote ! ” G ood !

N e xt, please ! !— N .C .F .

L a y In stru ctor. A. F. (K e tte rin g ) — I w a s ve ry interested in the rep ly w hich you g a v e to the q uery published un der the above head in g in the F e b ru a ry issue of F i r s t Aid. S o th e A sso ciation still re g a rd s a re-exam in atio n essen tial fo r the co n tin u ation of efficiency in first aid. H o w then do the H om e G u a rd g e t A sso ciation b a d g e s to w e a r on th eir tun ics on the stre n g th of a 25 yea r old certificate and w ith ou t one re-exam in atio n since. I h a ve 15 y ears service to m y cred it in the B r ig a d e ; and at the b e g in n in g of m y ca re er I w a s told th a t the certificate is only a b e g in n in g and th a t it ju s t sh o w s th at one is ab le to ren der first aid. T h e re fo re, it is very n ece ssa ry to keep on w ith one’s studies.

A I D I should lik e an e xp lan a tio n of the s ee m in g ly ca su al issue of A sso ciation b a d ge s, and a w a it yo u r a n sw er w ith interest. T h e w e a rin g of the A sso ciation b a d g e is m erely an in d ication th a t th e in d ivid u al has passed an e xa m in atio n in first aid. T h is b e in g the case, he is m ore lik e ly to be of service in an e m e rg e n cy than one w ho has h ad no first aid tra in in g. It rem ains, how ever, the settled p olicy of the St. John A m b u lan ce A sso ciation to e n co u ra g e in d ivid u als to ta k e the a n n u al re-exam in atio n s and thus to keep them selves up-tod a te .— N .C .F .

Blitz F irst Aid. P .S . (N e w c a s tle ).— I h ave been e n d e av o u rin g to obtain a book w hich g iv es ca su altie s w ith th eir treatm en t under B litz or H om e G u a rd com bat con dition s (m odified e m erg e n cy treatm en t, as a g a in s t the stan dard textb o o k treatm ent of perfection). I w ondered if you h ave p ublished a b o o k w hich w ould help me, or if you could recom m end one. I can, of course, prepare these m yself for p ractices, but prefer to h ave the “ official ” treatm en t of the cases if possible. E xp erien ce has show n that a rg u m e n ts are com m on, even on the treatm en t as laid dow n in the T e x tb o o k and, w h ile a certain am o u n t of this is healthy, I do not w an t too m uch of the tim e a v a ila b le for p ractice to be spent in this m anner. W h ile I do not k n o w a n y b ook w h ich com p letely satisfies your requirem ents, I un derstan d that a n ew edition of A.R. P. Handbook No. io w ill be published in the n ear future. T h is sh ould g iv e you the in form ation w hich you d e sire.— N .C .F .

T reatm en t of B la c k E ye. A . H . (M ilv erto n ).— W h a t is the sp ecial virtue in ra w m eat

applied to a bru ise and esp e cially to a b la ck eye ? R e cen tly this treatm en t w a s advised for a b la ck eye tw en ty four hours old, w h ich p rocedure I opined a s of doubtful efficacy a t this s ta g e . Y o u r ru lin g w ill be w elcom ed. T h e ra w m eat w a s app lied cold and, on these gro u n d s, w a s credited w ith beneficial effects. Cold, a s you kn o w , acts by co n strictin g the blood vessels and th is prevents furth er escape of blood. It ceases to a ct a fte r tw en ty four hours w hen heat, w hich cau ses d ila ta tio n of the blood vessels, w ill prove m ore effective in cle a r in g up the bruise. — N .C . F.

T reatm en t o f D islo cate d Hip. W .S . (E x h a ll).— W h a t is the correct treatm en t for a patient w ho dislocates his hip in a m ine w h ere there is m uch ro u g h gro u n d to be tra v e lle d ? F u ll equipm en t is ava ilab le . T h is ca se w as a subject of discussion in our class recen tly ; and w e could not a g re e w here to ap p ly the splint. I s u g g e s t th at a lo n g splint be applied a lo n g the un inju red side a s for fractu red fem u r and fixed in posi tion w ith the sam e ban d a ges. W e th a n k you for a ru lin g on this problem and for all assistan ce g iv e n in the past. P erso n ally I w ould not use a sp lin t w hich w ou ld prob a b ly m a k e it difficult to ca rry out the in struction s of the T e x tb o o k (p. 9 6 ). T h e se require you to “ stea d y and sup port the lim b in the p osition w hich g iv es m ost ease to the p atient and to use p ad d in g s, w h ere n ecessary, in order to lessen the effects of jo ltin g d u rin g tra n sp o rt.” F u rth er, this in m y opinion, w ould best be done by a liberal use of tria n g u la r b a n d a g e s .— N .C .F .

H um our in A.R .P. R .H . (M o rle y )'— A t a recen t Q u iz P a r ty in o ur F irst A id P a r ty the query w a s a b ou t w ar g a s e s , and our doctor sa id — "B.B.C. is an irritant!" O ne sm a rt y o u n g m an

F I R S T

The

P a lla n t D e

m ent.

Luxe

U B a ll

R and

S o c k e t Tru ss

elim in ates the u su al discom forts. W e ig h s o n ly a few ounces but is a s s tro n g as the h eav iest T ru ss. C on trols m ost severe rupture. A llo w s com p lete freedom of m ove C an n o t slip. NO

HIP

PRESSURE

AN D

119

A I D

I A D A M , 18

TELEPHONE

By G. D O U G LA S

DREVER, M.B., Ch.B.

I. FR O N T VIEW. 2. BACK VIEW. 3. BONES O FTH E SKULL. 4.

ARTERIAL C IR CU LATION A N D PRESSURE POINTS. 5. TYPES OF FRACTURES (Each size 10 x 7 ^ ins.) Price per set of 5 cards in stout envelope Is. 6d. n et ; p o s ta g e 2d.

ISs. id. per doz.. postage 7d.; 30s. per 24. postage9d.; £3 per 50; £5 16s. per 100. Obtainable of all Booksellers.

(A r te r ie s C o lo u r e d ) Developed for Civil Defence, First Aid Courses, etc. 2/3td natural size. O n muslin, with rollers - - - - 10/- post free.

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MUSEUM 2703.

(D e p t. 498). 9, O x fo r d S t r e e t , L o nd on , W . l .

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to d ra g the pads out of position or cau se sw e a tin g or ch afin g . Ideal for h eavy w o rk . A bsen ce of pressure is a boon to R h eu m a tic sufferers. T e s t F R E E for 7 days before paym ent. Your Approved Society will pay part or whole cost. For Booklet send address and id. stamp which can be enclosed in unsealed id. envelope. BLUNDEN

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Bailey’s “ P r e m i e r ” S p lin t Set, comprising, 3 Finger, 16 Fore Arm, 16 Upper Arm, I Set (3 sizes) Angular Arm Splints, 6 Assorted Leg and Thigh ranging from 24'— 54", (44 Splints in all) - - - PRICE 21/-. (Post and Packing 2/-.) Tunstall Bandage W inder each 6/6

LO N D O N : H. K. LEWIS & C o. Ltd. 136, G ow er S treet, London, W . C. I.

Splinter Forceps, pair 3/St. John’s Pattern Tourniquet 1/9 each

Telephone : EUSton 4282 (5 lines)

Solid Steel Scalpels 5/- each

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Fitted Pouches and Haversacks always in stock.

Patent No. 544,164.

Let us quote for your First Aid requirements.

Sim p lifies the tran sp o rt of the injured, and is su itab le tor a d u lt and child a lik e. A d ju sta b le for a n y in ju ry a patient m a y have. E a sy to a p p ly in the d ark . A F irs t A id P a rty can ap p ly the h arn ess in half a m inute. H.H. Fitted with heavy webbing straps £2 0 0 per set. (Highly recommended.) (Can be decontaminated.) H.H. Fitted with leather straps £2 5 0 per set. Hutt’s Rescue slings for all positions 15/6 per set. Hutt’s Adjustable carrying slings 10/6 per set.

46, OXFO RD S T R E E T , LO N D O N , W .t. ’Grama: “ Bayleaf, London." 'Phone: Gerrard 3185 & 2313.

All orders sent carriage paid. Illustrated booklet with each order, or on application Direct from Patentee—

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Stretcher E xercises for the St. John A m b ulance Brigade.

FIRST

AID

—

A S y n o p s is o f W a r - t im e T r a in in g b y J O H N F E N T O N , m .b., B .c h ., b .a .o ., d .p .h . and L . A . H . S N O W B A L L , m .r.c .p ., F R .c .s.(E d .) P R I C E : 8d. p o s t free ( 7 s . 6 d. p e r d ozen ) F O R C I V I L D E F E N C E S E R V I C E S , E T C ., T R A I N I N G PublishedbyDale, Reynolds& Co., Ltd., 46, CannonStreet, London, E.C.4

EMERGENCY TREATMENT . OF SKIN INJURIES Be prepared for an emergency and keep Cuticura Brand O int ment in your First Aid Kit. It brings instant soothing relief to cuts, burns, skin lacerations— prevents spread of infection, quickly heals. Obtainable at all Chemists and Stores.

4d. post free

DALE,

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46, C A N N O N

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S T R E E T , L O N D O N , E . C .4

O IN TM E N T

F I R S T

120

It depends on the programme to which you are listening ! ”

re p lied — “ G ood!

N e xt, p le a s e ! !— N .C .F .

E xam in ation of F ra c tu red P e lv is. W .S . (E x h a ll).— P le a se tell us if it is w ith in the p rovin ce of first aid to use con join ed-pressure w h en w e exa m in e for fra c tu re of pelvis. W ith re g re t I do not k n o w w h a t is m ean t by the term “ co n jo in ed -p ressu re.” If, h o w ever, you are re ferrin g to com p ression of the pelvis w ith both han ds, then such m ethod of exa m in a tio n should be exercised “ w ith g r e a t c a r e ” and “ w ith o u t u s in g f o r c e ” a s in the a p p licatio n of exten sion (T e x tb o o k , R u le 4 , p. 66).— N .C .F .

T rea tm en t o f S co rch ed L u n gs.

A I D T em p eratu re o f B od y. E .S . (R e a d in g ).— A t D iv isio n a l P ra ctice la st w e e k th e qu es tion of the tem p eratu re of the body w a s in question. It is lo w est betw een 1 and 3 a .m . T h e question w a s then raised, w h a t happens in th e ca se of n ig h t-w o rk e rs ? Is . the tem p eratu re still lo w est betw een these hours, or betw een 1 and 3 p .m . ; and in eith er ca se w h y ? I h ave ask ed several people and each has g iv e n a different an sw er. M ay I therefore a s k your kin d help ? T h e body tem p eratu re of m an sh o w s variatio n s of several ten ths of a d e g re e a cco rd in g to the tim e of the day a t w hich the tem p eratu re is tak en . T h e h ig h e st tem p eratu re is obtain ed abou t six or seven in the e ve n in g and the lo w est a t abou t four or five o ’clo ck in th e m o rn in g (S ta rlin g ).

I h ave n ever heard of a ca se of scorch ed lu n g s ; and I believe th a t if the lu n g tissu e sh ould be so injured, the victim w ou ld not s u rv iv e .— N .C .F .

W ith these diurn al ch a n g e s in tem p eratu re are associated parallel va riatio n s in the rate of m etabolism a s show n by the elim in ation of carbon dioxide. T h e y are p ro b ab ly determ ined by the ch a n g e s in the m ovem ents and tension of the m uscles o ccu rrin g d u rin g the w a k in g hours. If th e h ab its of a m an or a n im a l be reversed so th at he sleeps in th e d a y tim e and perform s his n orm al vocation by n ig h t, it is possible to re verse a lso the direction of the d iu rn al va ria tio n s in tem p era ture. T h e tem p eratu re m ay be a lso affected tem p o rarily by vario u s a cts, such as the ta k in g of food or m u scu lar w o rk ; and the in flu en ce of the la tte r facto r is often very m a rk e d .— N .C .F .

C olo u r of F a c e in A sp h y x ia .

B u m s D u e to E le ctricity .

F .R . (B a th ).— A C ivil D efen ce Section here are a n x io u s to k n o w w h a t treatm en t to g iv e a c a su a lty w ith scorched or burned lu n g s . I find the question has arisen , o w in g to a lectu re g iv en b y a N .F .S . official. H e sp oke of the p ossibility of a N .F .S . m an m eetin g a b last of hot air, and su ffe rin g from scorch ed lu n gs. Is this a p ractical s u g g e s tio n ? seem s to be the q u e ry ; and if so, can any treatm en t be g iv en beyon d w ra p p in g up and q u ick tran sp o rt to a hosp ital or m edical a id post ?

M .B . (L e w is h a m ).— W h ile p re p a rin g a com p etition test recen tly, I w a s su rp rised to find that n ow here does the T e x tb o o k d escribe the colour of the fa ce in an asp h yxiated person. I t seem s s tra n g e th a t th is should be so. I a g r e e ; and in m y b o o ks and lectu res I h ave a lw a y s found it a usefu l aid to m em o ry to sp e a k of “ red, w h ite and blue ” faces and in th is w a y to cla ss ify the com m on varieties of in se n sib ility .— N .C .F .

P e rfo rm a n c e of A rtific ia l R espiration. P .B . (C o v en try ).— T h e T e x th o o k on p. 1 4 4 , w ith referen ce to S c h a fe r’s M ethod of a rtificia l resp iratio n tells us not to w a ste tim e by lo o se n in g clo th in g . Y e t on p. 149 in its descrip tion of S ilv e s te r’s M ethod, it defin itely in stru cts us to undo all tig h t clo th in g. T h is differen ce has a lw a y s puzzled m e ; and I shall be g r a te fu l if you w ill k in d ly exp lain the reasons. W ith th e S ch a fe r M ethod the prone p osition of the p atien t p rotects him from the added risk s of suffocation w hich m a y re su lt from the fa llin g b a ck w a rd s of his to n g u e and from p ressu re on his a ir p a ssa g es. It is, therefore, in accordan ce w ith P ro fesso r S c h a fe r’s in stru ctio n s to start operations at once and not to w a s te tim e by lo o se n in g clo th in g. W ith the S ilv ester M ethod the sup ine p osition of the p atien t an d the b a c k w a rd tilt of his head d efin itely expose him to these added risk s. It is, therefore, m ost n ecessary th a t step s be ta k en a t the o u tset to avoid them , by e xp lo rin g the m outh, by c o n tro llin g the to n g u e and by lo o sen in g all c lo th in g .— N .C .F .

E v e rsio n o f E y e lid s. M .N . (F in c h le y ).— T h e T e x tb o o k on p. 184 tells us th at in certain circu m stan ces it is ju stifia b le to evert the eyelids. P e rso n a lly I find this a m ost difficult operation, in spite of the in stru ctio n s g iv en . S o I sh a ll w elco m e yo u r help. E versio n of the eyelids is ren dered e asy if w e can p er su a d e the p atient to k e ep his eyes directed u p w ard s to w a rd s the c e ilin g w h ile w e are e x p lo rin g the lo w e r lid, and to keep them fixed on the g ro u n d w hile w e are e v e rtin g the upper lid. In other w o rd s, the p atien t m ust turn his eyes a w a y from the fo re ig n b o d y .— N .C .F .

P .B . (C a rd iff).— P le ase tell m e w h a t are the sig n s of burns cau sed by e lectricity and if the b u rn s are the sam e a s those w h ich re su lt from d ry heat. E lectricity m a y ca u se death from sh o ck w ith ou t a n y ab ra sio n of the su rfa ce. A g a in , it m a y cau se burns w h ich w ill va ry in severity w ith the stre n g th of the current applied and w h ich w ill presen t the u su a l s ig n s of a n y such in ju ry due to dry heat, n am ely red d en in g, b lis te rin g or c h a rrin g of the part w here co n tact ta k es place. M oistu re and m etals favo u r the con duction of the c u rre n t.— N .C .F .

L a y In structor. J .S . (P u rle y ).— I h ave been in vited to g iv e som e in struction in first aid to a g ro u p of people w ho w ill p ro bah ly find it difficult to atten d the u su a l B rig a d e or A sso ciation lectures. I hold the m edallion and tw o labels and feel quite confident abou t u n d e rta k in g th e course. D o B rig a d e ru les perm it m e to do this ? Secondly, is it possible for the students to obtain a n y certificate at the end of the course ; if so, b y w h o m m u st they be exam in ed ? W h ile there is n o th in g to stop you, a s a m em ber of the B rig a d e , g iv in g in struction in first aid, it is d esirable th at you should first prove yo u r a b ility to lectu re by ta k in g the L a y In stru cto r C ertificate. T h e m em bers of y o u r class, h o w ever, can only ta k e th e P relim in a ry C ertificate of the A sso ciation after e xa m in atio n conducted by a doctor w ho h as been selected by the C h ief S e c re ta r y .— N .C .F .

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A d o c u m e n t o f an e x t r e m e l y i m p o r t a n t n a tu re is th a t issu ed , N u rses. in form o f a m e m o r a n d u m , b y K i n g . E d w a r d ’s H o s p i t a l F u n d fo r L o n d o n (price 3d. p o st free : G e o r g e B a r b e r and S o n s , L td .) . It is en titled “ T h e S u p e r v i s i o n of N u r s e s H e a l t h , ” an d it c o n c e r n s i t s e l f , a m o n g o th e r m atters, w ith th e p r e v e n t io n o f tu b e r c u lo s is a m o n g the n u r s i n g staffs in g e n e r a l h o s p ita ls , the care o f s i c k n u rse s, an d the need for m e d ic a l e x a m in a t io n and s u p e r v is io n of th e h e a lth o f the n u r s i n g staff. In 1942 the F u n d ’s v is it o r s interested t h e m s e l v e s in v a r i o u s q u e s tio n s co n n e c t e d w ith the w e lfa r e o f the n u r s i n g sta ff in h o s p it a ls . They w e re im p re s se d w ith the s t a n d a r d o f h ea lth s u p e r v is io n at s o m e h o s p it a ls , and fo u n d that in c a se s of s e r io u s illn e ss h o s p it a l n u rse s a lm o s t i n v a r i a b l y r e c e iv e m ed ic al and n u r s i n g care o f a h i g h order. It a p p e a r s , h o w e v e r , ( s a y s the R e p o r t ) that there is no g e n e r a l l y a c c e p te d sta n d a rd fo r the s u p e r v is io n o f n u r s e s ’ h e a lth . F o r in s ta n c e , the r e q u i r e m en ts r e g a r d i n g the m e d ic a l e x a m i n a t i o n o f stu d e n t n u rse s b e fo r e a d m is s io n v a r y w i d e l y a t d ifferen t h o s p it a ls , the p rac tice w ith r e g a r d to im m u n is a t io n f o l lo w s no g e n e r a l rule, an d on s u c h q u e s t i o n s as ro u tin e m e d ic a l e x a m in a t io n an d th e k e e p i n g o f h ea lth reco rd s it m u st be a d m itted that o th er o r g a n i s a t i o n s — s c h o o ls , in d u stria l b o d ie s e m p l o y i n g la r g e n u m b e r s o f staff, e t c . , — h a v e been a llo w e d to lead the w a y . A m e d ic a l c o n t e m p o r a r y , in its re v ie w o f the M e m o r a n d u m , g o e s m u c h fa r th e r th an this, an d w e t h in k its v i e w o f the m a tter is w o r t h y o f q u o ta t io n , e v e n a l t h o u g h w e c o n s id e r th at the situ atio n d ep icted is s o m e w h a t o v e r s t r a in e d . “ the g r o s s n e g le c t of th e h e a lth o f n u r se s in the past, it is sa id , “ is o n e o f th e r e a s o n s w h y the p ro fess io n is u n p o p u l a r ; fo r w o r k e r s in e v e r y in d u s t r y h a v e c o m e to e x p e c t, q u ite r i g h t l y , that th e ir h ea lth and w e l l b e i n g are the r e s p o n s i b i li t y o f those w h o e m p l o y th em an d this is e s p e c i a ll y so in th o se s p h e r e s o f w o r k w h i c h i n v o l v e sp ecial dangers. M a tters h a v e i m p r o v e d g r e a t l y in the l a r g e r h o s p ita ls , b u t t h e y are not e v e n p a s s a b ly g o o d e v e r y w h e r e and th is m e m o r a n d u m sh o u ld s e r v e a useful p u r p o s e in s t i r r i n g u p the m a n a g e r s o f th o se in s titu tio n s w h i c h are l a g g a r d . ” W h ich The

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e v e r v i e w o n e ta k e s , it m u s t be a d m itte d th a t an a g r e e d m in im u m sta n d a rd o f h e a lth ca re is needed, an d th is the M e m o r a n d u m s u p p l i e s a s the r e su lt of th e d e lib e r a t io n s o f the c o m m it t e e ( c o n s i s t i n g of m en a n d w o m e n w ith n u r s i n g an d a d m in is tr a tiv e e x p e r i e n c e ) set u p u n d e r the c h a i r m a n s h ip o f S i r C h a rles B risco e. T h e M e m o r a n d u m is o n e w h i c h w ill r e p a y s t u d y a n d , a s fa r a s p o s s ib le , a f o l l o w i n g o f its r e c o m m e n d a t i o n s an d s u g g e s t i o n s . The C o m m i t t e e , it m u s t be a d d e d , d esire to e m p h a s is e th e fa c t t h a t t h e y h a v e h a d m a n y fa v o u r a b l e repo rts on the h e a lt h ca r e g i v e n to n u rse s, and th a t “ all the r e c o m m e n d a t i o n s c o n t a in e d i n t h e m e m o r a n d u m are b a se d on m e th o d s n o w i n p ractice, and th e y are offered to h o s p it a ls w i s h i n g to r e v ie w the s u p e r v is io n g i v e n to the h e a lth o f their staff, in the l i g h t o f r e ce n t a d v a n c e s in p r e v e n t iv e m e d ic in e and staff w e lfa r e w o r k . ”

Recent Advances in First Aid Work in War. B y S I R H E N R Y L. M A R T Y N , K . C .V . O . , F .R .C .S . (C a s u a lty S ta ff O fficer, G A rea, D evo n C .C .)

( Continued from page i n . ) I h ave h eard it a rg u e d , p erh aps not un reaso n ably, that it w ou ld be a poor c a su a lty service w h ich could not insure th at all its ca su a ltie s, w ith the excep tio n of those trapped, w ere not safe ly in hosp ital in fa r less than six hours w h atever m ethods w ere em ployed in the field. T h is is true but it does not b rin g in to acco u n t the vario u s facto rs w hich in crease the tim e la g a fte r the a rriv a l of the case in hosp ital before op eration can be un dertaken . E v e ry case w ill requ ire at least som e d e g re e of re su scita tion, all w ill need superficial cle a n sin g and p rep a rin g, save those so d esp erate to w hom little can be done before an anaesthetic is a d m in istered . U rg e n t cases m ust ta k e priority, no ho sp ital possesses eith er an unlim ited num ber of o p eratin g th eatres or an in ex h a u stib le su p p ly of su rgeo n s. A dd to these facts the realisation that no su rgeo n can cope w ith m ore than th ree cases per hour at the very m ost, m any m ay ta k e ve ry m uch lo n g er, and it w ill be app reciated th at if as m an y a s possible are to be operated upon w ithin the optim um period of even e ig h t hours a fte r injury-it is essen tial th a t every ca se sh ould reach the hospital w ith the m in im um of delay. H o w ev er va lu a b le such a b breviated m ethods m a y be they m ust, of course, n ever be em ployed in in ju ries such a s fra c tu re of the spine or pelvis. H ere the one and only con sid eratio n is to en su re th at the in ju ry is not m ade w orse in p rocess of m o v in g the c a s u a lty to hospital. It is p erfectly possible for a p artial fra ctu re of th e v erte bral colum n to o ccu r w h ich , by sim p ly b ru isin g the spinal cord , p roduces all the sym pto m s of a com p lete ru pture, in c lu d in g to ta l p a ra ly sis belo w th e in ju ry. S u ch cases, h o w ever, if han dled w ith su p rem e care, m a y reco ver com p letely w ith o u t a n y tra ce of w ea k n ess even re m a in in g . O n the o th er han d, the rem o val of such a case of p artial fra ctu re w ith o u t ca re m a y e a sily resu lt in the in ju ry b e co m in g com p lete, w ith th e resu lt th a t the p atient is condem ned e ith er to death or to a life of p erm an ent and in cu rab le p aralysis. S tic k a lw a y s to the rig id ru le, tre a t every ca se w hich

A I D h as been found buried beneath debris, esp ecially if un con sciou s and un able to d escribe his sym ptom s, a s one of possible sp in al in ju ry, 'a n d h an dle and m ove him lik e a piece of cra ck ed chin a. W ith such care the m ost a m a z in g recoveries ta k e place, and I h ave the clearest recollection of a y o u n g officer be lo n g in g to a P a ra ch u te B a tta lio n w ho, a s the resu lt of an accid en t on a m otor bicycle in T u n isia , sustain ed a partial fra ctu re of three verteb rae in his lo w er dorsal spine. R o u g h ly handled, such a ca se w ou ld h ave h ad little hope even of recovery, but, d ealt w ith from the first w ith the u tm o st efficiency, he w a s passed not only a s fit but a s fit to resum e duty w ith his beloved P a rach u te troops w ell w ithin tw elve m on th s of his acciden t. It is in the s u r g ic a l treatm en t after re a ch in g ho sp ital of m a n y such ca ses th a t th e g re a te s t a d va n ce h a s been m ade. A lth o u g h there can be no hope of re sto rin g the fun ction of a crushed sp in al cord, provided th is has not occurred even the m ost exten sive d a m a g e to the vertebral colum n itself m ay be m ade good. In th e hands of the O rthopaedic s u rgeo n , tiny electricallydriven ro tary sa w s are used to cu t a su itab le len g th from the p atien t’s ow n shin bone, le a v in g a tem p o ra ry g u tte r w h ich n ature very soon fills up. T h e piece of stro n g h e alth y bone th u s obtained is g ra fte d into the in jured verteb ra l colum n over the the full e xten t of the w eaken ed a rea, and, thus tran sp lan ted , g r o w s in the position in w h ich it has been placed, a c tin g a t the sam e tim e a s a sca ffo ld in g o ver w h ich n atu re form s fresh bone to fill the g a p . _ _ N ot so m an y y ea rs a g o the patient so in jured w ould have been condem ned to w ea r a leath er ja c k e t reinforced w ith steel to support for the rest of his days his w ea k en ed spine, but n o w a d ay s a su ccessfu l bone im p lan tatio n m ay restore him to com p lete n orm ality. T h e re is still, un fo rtu n ately, a ten dency to re g a rd all chest w ou n ds as cases d em an d in g u rg e n t p rio rity rem dval. T h is te a ch in g has been la rg e ly m odified by th e exp erien ce of the team s of sp ecialists in chest s u r g e r y w o rk in g chiefly in the L on don area. In these ca su altie s far the m ost im p o rtan t con sideration in th eir h a n d lin g is the question w h eth e r or not they can be m oved from the incident and transp orted by a m b u la n ce in th e sm ooth est and quietest possible w a y . A s a ge n era l rule the w ou nds th em selves fall into tw o types, the sm all punctured w ou n d and the la r g e g a p in g type in and out of w hich air is p a ssin g freely. T h e form er de m ands only a sim ple d ressin g , but in the la tte r it m u st be la r g e e n o u g h and firm en o u g h to be a irtig h t. If very g e n tly eased into the position in w hich the respiration is least em barrassed and treatm en t for sh o ck in stituted , the m ajority of such cases are fa r better left w h ere they lie until the w orst of the rush is over. If it is possible fo r a chest team to see such a ca se before it is m oved so m uch the better, but if not the ch an ces of su rviva l w ill be g r e a tly in creased if, in stead of ru s h in g it to h osp ital, tran sp o rt is not u n d ertak en un til the a m b u lan ce can m ove th ro u g h less co n gested streets, u s in g a rou te upon w h ich there is lea st debris to o ccasion jo ltin g , and never tra v e llin g a t m ore th an 10 m .p .h . E x p erien ce h a s show n th a t, a lth o u g h all the g a p in g typ e of w ou n ds require op era tion, m a n y of the p en etratin g th ro u g h and th ro u g h w ou n ds w ill reco ver w ith ou t s u r g ic a l in tervention. In the treatm en t of haem orrh age p ractical exp erien ce has show n the need for co n sid erable m odification in earlier tea ch in g . T h e re w as a ten dency a t the b e g in n in g of the w a r to picture every air raid c a su a lty a s ly in g in a pool of blood in the process of rap idly b leed in g to death. E ven to th is d ay if a student be a sk ed w h at h ap pan s to a patient if an a rtery be severed it is easily d etectab le from his a n sw e r th at his m ental im pression is th at of a d y in g m an. If a sk e d how a rte ria l haem orrh age should be controlled only too often

F I R S T com es the im m ediate a n sw e r— by pressure on the a rtery at the p ressu re point, or, fa ilin g that, by the app licatio n of a tourniquet. H o w g r e a tly has a ctu al exp erien ce m odified both these ideas an d treatm en t in the g r e a t m ajority of cases. S p e a k in g a s a w hole, in juries re su ltin g from h ig h e x p losive do not tend to be acco m p an ied by profuse haem orrhage. T h e sudden violent te a rin g of an a rtery results very frequen tly in e la stic recoil upon itself and the alm ost com plete prevention of bleedin g. T h e re w ill ce r tain ly be som e haem orrhage, but it is m ore o ften — even w hen a lim b is torn com pletey o ff— a slo w g e n era l ooze of blood ra th er than the violent sp u rtin g of an a rtery. C a ses are recorded in w h ich an arm has even been avulsed at the sh oulder w ith the loss of quite n e g lig ib le q u an tities of blood, and I h ave m yself seen a th ro u gh and th ro u g h w ound of a kn ee jo in t by a h eavy calibre bullet w hich drilled clean ly th ro u g h the fem u r from w h ich not one spot of blood w as visible a t eith er the w ou nd of en try or exit. A lth o u g h even an ooze of blood in a n y q u a n tity is by no m eans to be n eg lected , it is the rare ca se w ith profuse h a e m o rrh a ge from a b ig a rtery w hich occasion s real, im m ed iate and u rgen t an xiety. T h e type of w ound in w hich such bleedin g m ost com m only occurs is eith er the incised w ound from g la s s or m etal w hich divides an a rtery clean ly, or a sm all p en etratin g w ou nd w hich n icks the side of a la r g e vessel. In n either of these cases w ill e la stic recoil of the injured vessel be of in fluen ce in lim itin g th e hoem orrhrge as w ou ld have been the case if the vessel had been ro u g h ly torn acro ss, and it is in such cases as these that life is in im m inent d a n g er. It m ust n ow a d ays be im pressed upon c a su a lty person nel that the first line of defen ce is in the app licatio n of a la rg e pad and a very firm b a n d a g e to the w ound itself. T h is alon e w ill u su a lly be found to be sufficient, but if the pad becom es soaked it should not be rem oved but a fresh pad should be applied on top of the first and a g a in b an d aged .

(To be continued.')

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St. John Ambulance Brigade HEADQUARTERS

AND

D IST R IC T

R EPO RTS.

County o f Cornwall. C a m b o rn e .— T h e prom pt a ctio n of fo u r m em bers of C am b o rn e A m b u lan ce D ivisio n saved a w o m a n ’s life recently. C a lled out at m id n igh t, the party q u ic k ly rem oved a fem ale c a s u a lty to C a m b o rn e-R ed ru th M in ers and G en eral H o sp ital, and w ith in 30 m inutes she w as u n d e rg o in g a serio u s operation. T h e p atient has since m ade co n siderable p ro gress, and one of the doctors h a s than ked the a m b u la n ce partv. co n sis tin g of T ra n sp o rt O fficer H. E. L u k e , A m b u la n ce O fficer T . H. W illia m s, Pte. P. A n d rew s, and N urse M. H arvey, for their prom ptness and efficiency, w hich d o u b tless saved the w o m a n ’s life.

C ounty o f L ancashire. I r l a m . — A H ot Pot Su p p er and S o cial E v e n in g a rra n g e d by the L a n ca sh ire Steel C o rpo ratio n D ivisio n of the S.J. A. B. w as held on A pril 2 9 th a t the W o rk s R ecreation C lu b , at w h ich a la rg e g a th e r in g of m em bers, th eir w ifes and friends attended. T h e ch a ir w a s tak en by Sup t. A. F . W h itta k e r of the U rm ston D ivisio n . T h e T o a st, “ T h e O rd er of St. John and the A m b u la n ce B r ig a d e ,” w as m ade by E. Jones E sq ., C le rk to the Irlam U rban D istrict C o u n cil, to w hich Sup t. P a rtin g to n of the W o rk s D ivision , replied, after w h ich the D ivisio n al S u rg e o n , A. B. S D rysd ale, M .B ., C h .B ., presen ted m em bers w ith th eir a w a rd s for 1 9 4 3 . A fter the p resentation they w ere en tertain ed b y the “ N eon ites ” C o n cert P a rty from U rm ston . T h e a rra n g e m en ts w ere in the han ds of S g t. W . S tew a rt, Ptes. R ich ard son , L o c k e tt, and T h u b ru m . ---------------♦ ;

County o f N orth, E ast and M id -D ev o n .

R e v ie w s .

Nursing in Time of War.

B y P. H.' M itchin er, M .D ., F .R .C . S ., and E. E. P. M a cM an u s, S .R .N . L on d o n : 1. & A. C h u rch ill L td . Price 2/-

T h is excellen t little b ook on n u rsin g in w a rtim e has been com piled by a su rgeo n and a trained nurse. It is now in its second edition ; and it su cceed s in its purpose of a ffo rd in g help to those nurses and th eir assistan ts w ho have had no exp erien ce of this kin d. It sets out c le a rly and briefly the chief differences in tech n ique and m ode of life under im provised con dition s. F o r this reason it has proven . itself a m ost useful g u id e to all nurses, and e sp ecially to all " m em bers of the C ivil N u rsin g R eserve.

Practical Bandaging.

B y E ld r id g e L . E liaso n , M .D ., S c .D . L o n d o n : J. B. L ip p in cott C o m p an y. Price 10)6.

T h is w o rk , w h ich has now reached its sixth edition, h as been w ritten for studen ts and n urses in sim p le and n on tech n ical la n g u a g e . It deals fu lly and co m p reh en sively w ith p ractical b a n d a g in g , in clu d in g adh esive p laster-of-paris d ressin g s. It describes all the reco gn ised cla ssica l b a n d a g e s in com m on use ; and, in ad d ition , it co n tain s p ara g ra p h s or illu stra tio n s of m ethods or turns w hich h ave been found m ore efficient in the a u th o r’s exp erien ce. Ever}' effort has been m ade to have the illu stra tio n s ab so lu te ly correct ; and for th is reason all the d ra w in g s w ere m ade from a model d ressin g.

T o p sh a m .— T h e a n n u a l g e n era l m e e tin g of this D ivisio n w a s held on A pril 6 th , this co m p letin g the second year. T h e person n el is n ow 2 6 . O n e m em ber has been tran sferred to L on don an d tw o addition al m em bers w ere called up for m ilitary service. T h e re h ave been no ch a n g e s in o rig in a l ap p ointm ents d u r in g the past tw e lve m onths. A s in 1942/4 3 , the services of the D ivisio n co n tin u es to be lin k ed up w ith th e lo cal C ivil D efen ce o rg a n isa tio n , and, th o u g h o w in g to the lull in enem y a ir raid s on the W e st C o u n try, the m em bers had not been called into actio n , they had n everth eless very a ctiv ely pursued th eir co u rse of trainin g , w h ilst their services h a v e rem ained co n sta n tly a t the disp osal of the g e n era l public. In M ay, 1 9 4 3 , the can d id ates for th e vario u s appointm ents-in the D ivision w ere all su cce ssfu l in th eir e x a m in a tions and the positions d u ly confirm ed. In Jun e a C ad et Section w as form ed and by the close of the year, 19 lads had been su cce ssfu lly coach ed fo r certificates in e le m e n ta ry first aid. In Septem ber a G y m k h a n a w a s held in aid of funds w h ich proved m ost p o p u lar and w a s a m ost w o rth w h ile event, ben efittin g the D iv isio n ’s a cco u n t co n siderably. O u t of its proceeds w as passed over to th e P riso n ers of W a r F u n d s. In D ecem b er the y e a rly ex a m in a tio n to o k place w ith ou t a n y failu res.

C ounty o f Surrey. G u i l d f o r d . — G u ild fo rd S.J. A. N u r s in g C a d ets No. l a n d N o. 2 D iv isio n s h eld an enrolm en t cerem o n y on a recent

F I R S T S a tu rd a y a t th e H a ll in L ea s R o ad , w hen 24 n ew g ir ls w ere enrolled by C o u n ty O fficer M rs. B. C h a rrin g to n , in the presence of the D o w a g e r L a d y H a rco u rt, C o u n ty O fficer M rs. H a rp er, and C orps S u p t. M rs. H enry. A fte r the en rolm en t cerem ony each new' cad et w'as giv en the b ook of ru les and a b a d g e , and p relim in ary first aid certificates for hom e n u rsin g and h yg ie n e, presented by L a d y H a rco u rt. No. 1 D ivisio n n u rsin g cadets w ere also presented w ith p ro ficien cy strip es for 1 9 4 3 . F o u r g ir ls received co rp o ra ls’ stripes. C o rp s S u p t. 'Mrs. H e n ry a sk e d L a d y H a rco u rt to pre sen t a lo n g service b a r for 25 y e a rs ’ service to Corps O fficer M iss G . E lm es. A co n cert by the ca d ets in cluded a short sk e tch and a p h ysical tra in in g disp lay. A m o n g those present w ere Corps Sup t. J. D . R u tte r, D istrict O fficer C . E . C h ap lin , vicep resid en t of No. 1 D iv isio n M rs. W m . H a rv ey . In th e e v e n in g a su ccessfu l dan ce w'as held by the nurs in g cad ets, at w h ich 12 sailo rs w ere gu ests. Mr. Pope w a s M .C .

C ounty o f W arw ick. C o v e n t r y .— A t a recent m eetin g of the C o ven try (C en tral) C orps it w a s decided to com m ence the “ Q u iz ” le a g u e co m petitions a g a in , this h a v in g proved so su ccessfu l and en jo y able la st year. T e a m s w ill m eet a lte rn ate ly each w ee k on T u e sd a y s and T h u rsd a y s, and at th e end of the season the w in n ers and ru nn ers-up w ill each receive a trophy. T h e d ate of the a n n u a l inspection has been p rovision ally fixed for J u ly 8th, its ven ue has not yet been decided upon but w ill be ann oun ced later. A very w elco m e decision w as th at in spite of the w ar a C orps B and should be form ed. A g e n ero u s donor has prom ised to d efray all exp en ses, so an yon e in the B rig a d e in C o v en try w ho is in terested, should co m m u n icate u'ith Corps S u p t. M arch w ho has the project in han d. A lso M rs. M arch, w ho is w ell k n o w n in the m u sical w orld, h a v in g perform ed w ith h er L a d ie s ’ B a n d on the B .B .C . and. the s ta g e as D o ro th y H o lb ro o k ’s H a rm o n y H u ssa rs, has very kin d ly offered to a ssist and tra in the B an d , so su ccess is assured. T h e n ew s w ill be received w ith en th u siasm by all St. John m en, nurses and ca d ets in C oven try.

E ast R id in g o f Y orkshire. B la c k b u rn A i r c r a f t N 6. 1. — T h e first a n n u a l ge n era l m e etin g of the above D ivisio n w as held recen tly a t one of the C o m p a n y ’s w orks. T h e m e etin g w as attended by A sst. C oun ty C om m ission er G . E d w a rd s, C o u n ty S e cre ta ry A . R . L id g le y , Corps Sup t. H. R a n k in e , C orps O fficers VV. J. M ow forth and E. VV. Shoeb rid g e and D r. N. H o w a rd M um m ery, D iv isio n a l S u rgeo n . T h e a n n u a l report w as presented by D ivisio n al Supt. VVoolner w h ich show ed th a t it had been a very go o d and a ctiv e year. F o rm ed in M arch , 1 9 4 3 , the D ivisio n has a m em bership of over 4 0 , all of w hom are, in addition to their B rig a d e activ ities, d o in g vo lu n ta ry d u ty w ith one or other of the D efen ce o rg an isatio n s. T h e report of S e cre ta ry W a lk e r revealed a n in cre a sin g m em bership, w ith very fa ir a tten d a n ce at drills and practices, ta k in g into a cco u n t the difficulties of m em bers w ho are a ctiv ely e n g a g e d in other bran ches of service. In spite of all such dem an d s, som e 3 ,0 8 3 hours of duties w ere perform ed b y m em bers. T h e report of T re a s u r e r A. E llio tt show ed a v e ry sound finan cial position. D r. N. H o w a rd M u m m ery com p lim en ted the D ivisio n on its p ro gress and exp ressed his pleasure in b e in g associated w ith it on its inception. C o rp s Supt. R a n k in e told the m e e tin g w ith re gret, that o w in g to extre m e p ressu re of w o r k and ill health, Supt. W o o ln er had been com p elled to ten der his resign atio n , w hich had been re lu cta n tly accep ted. T rib u te s w ere paid to the w o rk he had done d u r in g the first y e a r of the D ivisio n , and

A I D to his lo yalty and reliability. T h e g ra te fu l th a n k s of the m em bers w ere accorded to him . A sst. C o u n ty C o m m issio n er E d w a rd s then presented his W a rra n t of A ppointm ent as Sup t. to M r. J. M cP h a il, pro m oted from A m b u la n ce O fficer, and he w a s assu red by all present of their lo yal co-operation in future days. It w as reported that steps are b ein g tak en to obtain un iform s for this D ivisio n . V o te s of th a n k s to all visitors con cluded a very in terest in g m eetin g. H u l l . — T h e death occurred on F rid a y, A pril 2 1 st, of M rs. H . R . H a ley , Corps Sup t. of H u ll N u rsin g C orps No. 1 , after only a few hours illness. M rs. H a le y h ad over 35 years service in the B rig ad e, and as the result of hard w o rk and g o o d leadership, served th rou gh o u t all the variou s ra n k s of the B rig a d e until she w as finally appointed Corps Supt. of the H u ll N u rsin g Corps. H er u n tirin g devotion to duty and lo yalty, earned her the respect of every m em ber of the B r ig a d e in the area. H e r o u tsta n d in g services w ere reco gn ised in 1937 w hen the O rd er of St. John adm itted her as a S e rv in g S ister of the O rder. S h e also held the K in g G eo rg e V C oron ation M edal for b ein g present on that duty. H e r loyal service w ill ever rem ain an in spiration to those w ho fo llo w in her stead. In the p assin g of M rs. H a le y , the B rig a d e has lost a va lu a b le officer and all the n u rsin g m em bers of the B rig a d e have lost a friend. A la r g e n um ber of officers and m em bers of all Corps w ere present a t the funeral.

N orth R id in g o f Yorkshire. E a s t C le v e la n d . — T h e an n u al m e etin g of the above D ivisio n w as held at h ead qu arters on T u e sd a y , A pril 18th. Corporal W . B ead n all, B rotton, w as in the chair. T h e secreta ria l rep ort w as g iv en by A m b u lan ce O fficer J. H . J a ck so n , L o ftu s, w ho stated th a t m em bership, thirtynine, w a s the sam e a s the previous year. H e com m ented upon the poor atten d an ce at drills th ro u gh o u t the year, w hich he attributed to a la rg e extent to the m any other ca lls upon the m em bers. T w e n ty -five m em bers w ere attach ed in a vo lu n ta ry ca p a city to the vario u s C ivil D efen ce services, and five w ere s erv in g in the F orces. T h e m otor a m b u lan ce report show ed a m ile a g e of 2 , 8 0 0 . T h e class w a s held d u rin g the year, and th irty can did ates qualified for various a w a rd s. T h e C h airm an presented the finan cial statem en t, w h ich w a s re g a rd ed a s satisfacto ry. T h e N u rsin g D ivisio n report w as g iv e n by L a d y A m b u lan ce O fficer K itch en er, and show ed a d ecrease in m em ber ship of four. F o rty-five p ractices w ere held d u rin g the year. All the m em bers had attended the requisite n um ber of drills, and a satisfacto ry finan cial position w as reported.

W est R id in g o f Yorkshire. H u d d e r s f ie ld . — W ith the appointm ent of D istrict O fficer H . H a rriso n , of H u ddersfield, to be A ssistan t C o m m issioner of the S o u th -W estern a re a of the W e st R id in g of Y o rk s h ire , a record is created in the S .J .A . B. w hich w ill probably never be repeated. T h e record is this : C h ief C om m ission er, C o u n ty C o m m issioner and A ssistan t C o m m issio n er are all from H u d d ers field. T h e C h ief C o m m issio n er is G en eral S ir C liv e L id dell, son of the late Colonel John L id d ell, of H u ddersfield, and the C o u n ty C o m m issio n er is M r. H . L . T h o rn to n , of S p rin g d a le, M elth am R o a d , H u ddersfield. T h e So u th -W estern a re a of the W e st R id in g of Y o r k shire com p rises H u ddersfield, D e w sb u ry , B a tle y and d istrict, B rig h o u se , E llan d , S o w erb y B rid g e , P enistone, Spen V a lle y , C oln e V a lle y , D en b y D a le, M eltham and H olm firth. T h e yea r 1944 m a rk s the 5 0 th a n n ive rsa ry of the fo rm a tion of the B rig a d e in H u ddersfield, and to m a rk the occasion , celeb ratio n s-are to be held in June as fo llo w s :—

F I R S T June 2 3 rd : D inner, principal g u e s t, C h ief C om m issioner. June 2 4 th : M eetin g, T o w n H all. June 2 5 th : A rea In spection, S .W . A rea, W .R . Y o r k s , in G reen ham P a rk , H uddersfield, by the C h ief C o m m is sioner, G en eral S ir C liv e Liddell.

Police Ambulance News. M E T R O P O L IT A N

S P E C IA L

CO N STABU LARY.

T h e an n u al com petitions of the above F o rce took place on S u n d a y , A pril 2 3 rd, w hen 11 team s entered the Senior event and 10 the Junior. T h ro u g h o u t the w hole proceedin gs a la r g e crow d w itn essed the w o rk of the team s, w hich w as of a very h ig h stan dard. M ajor V iv ia n R o g ers (C om m an dan t-in -C hief) presided at the presen tation cerem ony, b ein g supported by his officers. H e extended th a n k s to C ap t. W . G o od ley (C om m ission er, S .J .A .B .) for p ro vid in g such go o d ju d g e s , w hom he also th an k ed for th eir services. Sp ecial th a n k s w ere also extended to C o m m a n d an t E. B. B row n (D ire cto r of F irst A id and A .R .P .) for the hard w o rk he had put into the m ovem ent over a lo n g period. T h e resu lts o f the com p etitions w ere a s follow s :— Sen io rs— 1st and “ G ollin ” C u p, Y D ivision ; 2 nd and “ St. C l a i r ” C u p , D D ivisio n . J u d ges, M ajor A. C. W h ite K n o x and D r. W . D . Jen kin s J u n io rs— 1st and “ R it c h ie ” Cup. T D ivision ; 2 nd and “ M onro ” C u p, A D ivisio n . “ B row n ” E fficien cy C u p w a s w on by X D ivision. M ajor R o g e rs presented the trophies, a lso individual prizes, given by C o m m an d an t M onro. It is in te re stin g to note th at this is the first tim e th at the “ G o llin ” C u p has been w on by Y D ivisio n , w h ich a t one tim e w a s under the com m and of C o m m an d an t A. G ollin. T h e “ T ” D iv isio n In ter-S tatio n first aid com petition w as held at the canteen , M essrs. A. & F. P e a rs ’ F acto ry, L ondon R o ad , Islew o rth , on S u n d a y aftern oon , A pril 1 6 th, before w ell over 100 people. A m o n g st those present w as M ajo r V . B. R o g ers, D .S .O ., O .B .E ., M .C ., (C om m an d an t-in -C h ief of th e M etropolitan Sp ecial C o n sta b u la ry ). T h e ju d g e w a s C o m m an d an t B row n assisted by S ta ff In sp ector J. L u d g a te and S ta ff {nsp ector S. C . O pie. T h e com petition w a s s ta g e d in a different m ann er to the accepted first aid com petition, in p lace of the u sual team test fo llow ed by in dividual tests and a viv a voce for No. 5 of each team , the w hole team found th a t they had to deal w ith three in ciden ts a t the sam e tim e, w h ich g a v e , as the resu lt, a m ore re a listic presen tation of an a ctu al o ccurren ce lik e ly to be encountered. T h e test card read : T h e raiders passed h as sounded and a bom b has fallen , you h e ar sh outs for help, it is a cold day. T h e s e ttin g show ed the exterior of a house w ith a g a r a g e atta ch e d , en tran ce could be effected to the house and g a r a g e . T h e incidents : ( 1) A m an is found pinned dow n by his le g s un der a h e av y m ason ry p illar and he is in co n ta ct w ith a live e lectric cable. H e is su fferin g from a sp h y x ia , burns on left han d and sim p le fractu res of both leg s. (2 ) A w om an is found outside the house co m p lain in g of a “ fo reign b o d y ” in her left eye. (3 ) A m an com es out of the g a r a g e very scared , he falls and fractures his rig h t clavicle, a fte r h a v in g been b a ck into the g a r a g e to fetch a c a r ja c k to help raise the fallen m ason ry p illar in incident (1), he is a lso su fferin g from shock. T h e a w a rd s w ere, for the w inn ers, the “ O ’ R o u rk e B o w l” and runners-up, the “ F en n C u p ,” also token a w a rd s for each m em ber of the tw o team s. T h e total n um ber of m ark s possible w as 2 2 4 .

R I D

125

T h e resu lt w a s as fo llo w s :— 1 , T e d d in g to n 187 m a rk s ; 2 , H o u n slo w 153£ ; 3 , B ren tford 1 4 9 ; 4, E a lin g 1 2 3 ; 5, H a rlin g to n 1 0 2 . A t the con clusion of the co m p etitio n the C o m m a n d an tin -C h ief presented the a w a rd s and said h o w g la d he w as to be present and see such an e x ce lle n t sh o w of first aid, and w as very g la d to see that the a w a rd s w ere not b e in g won by the sam e S ta tio n s each year. C o m m an d an t B row n said h o w pleased he w as w ith the team s first aid, and a lso paid trib u te to In sp ecto r E s lic k for his s ta g in g of the incidents and effects.

The Home Guard and First Aid. seem s to exist a go o d deal of m isu n d ersta n d in g in vario u s parts of th e co u n try a s to the sta tu s of the m edical personnel of the H .G . A correspond en t, for in stan ce, w ho is a C o rp o ral w ith first St. Joh n ’s certificate, w a n ts to k n o w if he is classified a s S tre tch e r B e a re r or M edical O rd erly. O fficially, there is o n ly one M ed ical O rd e rly in the Battalion, and he is the B a tt. S e rg e a n t. A ll others are classified as S . B . ’s. T h is has been a bone of co n ten tio n for a lo n g w h ile, as it seem s th at no m a tter w h at exp erien ce a m an has h ad, or w h a t d e g re e of efficiency he h a s reach ed , it m a k e s no d if feren ce to his statu s, un less he is m ade B a tt. S e rg e a n t. S tra n g e ly e n o u g h , th is is g e n e ra lly an a d m in istra tiv e job, and en tails ve ry little p ractice in a ctu a l first aid tra in in g . W h en I use the term M edical O rd e rly in these a rticles, it is quite unofficial, and m erely ap p lies to m en wdio have reached a h ig h stan dard of efficiency, and w ho I th in k are entitled to that d e sign atio n . A n o th er question w as “ A m I p rotected un der the G en ev a C on vention ? ” Y e s , w h ile you are not c a rr y in g a rm s and if you are w e a rin g yo u r b rassard . C ertificates a re a v a ila b le , w h ich should be issued to m em bers of the m edical section , and should be carried by them if called out. T h e se certificates exp lain yo u r m edical statu s should you be captured . W h e th e r these th in g s w ould protect you these days I leave to yo u r opinion. A third question : “ A m I exp ected to ca rry a rm s or use t h e m ? ” Y e s , you are not a non-combatant body, and you can be called on to ta k e up a rm s if n ecessary, w hen you w ill discard y o u r S. B. brassard . T h is p a rtic u la rly applies to the protection of y o u r w ou nded and y o u r C .C . P. W ith re g a rd to a fu rth er question on th e official b rassard , it is an sw ered under question 1. O n ly M edical O fficers are a llo w ed to w e a r th e G en ev a C ross. A n o th er bone of contention, a s the R .A .M .C . personnel w ea r them , and the a u th o rities little realise th at g o o d exp erien ced first a id ers are kep t out of the H .G . m edical service by w h a t they con sider a slig h t. A nd old soldiers say, “ W h a t w as a S .B . in the la st lot, a n y w a y ?” T h e r e still

C. W .

Spreadbury

(S e rg t.),

S ch ool H o u se , N o el-ro ad , W . 3 .

M a y I be perm itted to rep ly to M rs. L am b to n w ith re g a rd to the m ethods of lo a d in g stre tch er by tw o bearers, a s described by D r. B o w m a n E d g a r . W h ile the belt round ch est w ou ld p ro b a b ly be a lrig h t, ?/ you had time to adjust it (rem em ber th is is p rim a rily for use in th e field), it is re a lly not n ecessary, a s the p atient should not a c tu a lly be lifted by the belt. H e is held a g a in s t the stre tch er w ith ju s t a s lig h t up w ard pull, and the stre tch er is low ered, t a k in g the p atient w ith it. T h e final p osition of p atient can be ca re fu lly ad ju sted a fte rw a rd s. It is re a lly an ad ap tatio n of the old m ethod of lo a d in g spinal c a s e s .— C . W .S .

126

F I R S T

L e tte rs

th e

E d ito r .

W e a re in no w a y respon sible for th e opinions exp ressed, or the statem en ts m ade, b y C o rresp o n d en ts.— E d i t o r . LOAD D

ear

STRETCH ER

2- B E A R E R S .

,—

I h a ve read the letter in yo u r A p ril issue in w h ich the statem en t is m ade th a t, in o ur s u g g e s te d new m eth od, “ the lift from the w a ist g a v e the p atient a g o o d deal of d istress ” and “ a ll (p atients) com p lain ed of a ru sh of blood to the head w hen w a is t-lifte d .” At the sam e tim e it is su g g e s te d th a t th e w aist-b elt be applied round the chest a s a rem edy to the ab ove phenom ena. In the first p lace I w ou ld point out th a t, in the o rig in a l te x t of in stru ctio n s, as published by me, point 5 reads

"holding the patient against the stretcher (no lifting is required), th e bearer a llo w s the la tte r to resum e its norm al p osition on the g r o u n d .” It is re a lly the force of G ra v ity plus the stretch er, not the b earer, w h ich load the patient. A nd this “ lo a d ” (w hen p rop erly done) is carried out in a sim ple, safe and co m fo rt ab le m ann er, w ith no “ d is t r e s s ” , no “ rush nf blood to the head ” and no in crease of shock. W h en I w as b e in g loaded, d u r in g the tryo u ts of the m eth od, I w ore no belt, and no b earer su g g e s te d th at I sh ould w e a r one, e ith er round m y w aist or a n y w h ere else. It is sim p ly not essen tial to the efficiency of the procedure. T h is m ethod of tra n sfe rrin g an in jured person from the g ro u n d to a stre tch er ap p ears to be so excellen t that it w ould a u to m a tica lly qualify to be the “ m ethod of ch o ic e ” no m atter h o w m any bearers are ava ilab le . M odern first aid aim s at sim p licity w ith econ om y of p er sonnel. W h y then should a 4 -bearer lift be ta u g h t or carried ou t w hen a 2-bearer one is e asier on the bearers and infinitely b etter fo r the patient in every w ay . T h e 4 -bearer load m ay g iv e e xa m in ers a go o d question fo r the tran sp o rt paper. P e rso n a lly , I h ave a lw a y s th an k ed p ro vid en ce th a t I h a ve never required to be loaded by this m ethod. W ith all but a very w ell trained 4 the o ulook for a b ad ly in jured ca se is not happy. W ith this n ew lo ad in g m ethod tw o n ovices can g e t an in jured m an onto a stretch er and do him no harm in so d o in g.

A I D p ow ers of im p rovisation, and our results in e xa m in atio n s has justified this m ethod. O n S u n d a y la st w e treated a supposed ca su a lty w ho had been shot in the lum ber re gio n , and w a s ly in g in a pit hole 3 ft. deep by 6 ft. w ide, the c a s u a lty him self w as ly in g on his side in a sh a llo w hole 4 in. deep by 2 ft. w ide. T h is w a s s p ru n g upon our m en w ith o u t a n y previous p ractice, and th e fo llo w in g happened •— (1) N o. 1 , re a lisin g th a t a stretch er w ou ld not g o into the pit, im m ed iately ordered stretch er to be prepared outside, p ro ceed in g him self to the ca su alty . (2 ) No. 1, re a lis in g the serious in ju ry, called his No. 3 an d im m ed iately laid h im self dow n on his stom ach by the side of ca su a lty , o rd erin g his N o. 3 to co ve r him w ith a b la n ket. (3 ) N os. 2 and 4 then rushed round to the o th er side of ca s u a lty and g e n tly turned him over on his side to w a rd s No. 1, at the sam e tim e p la cin g their resp irato rs in the required position. (4 ) No. 3 then turned his N o. 1 on his sid e so th a t his b a c k cam e flush w ith the respirato rs, then by g e n tle h a n d lin g No. 1 and c a su a lty w ere turned over, No. 1 a c tu a lly a c tin g as a stretch er. (5 ) N os. 3 and 2 to o k hold of each “ h ead ” side of blan ket (ly in g u n der patient and on top of N o. l ’s b a ck ), and No. 4 both feet ends of b lan ket. (6) No. 3 g a v e the order “ L ift c a s u a lty ,” thus en a b lin g N o. 1 to craw l out and ta k e one end of b la n k e t from No. 4 ; thus c a su a lty w a s lifted out of the pit and placed face d o w n w ard s on the a lrea d y prepared stretch er outside the pit. Q u ite probably your readers ca n s u g g e s t a better w ay , and it so I can a ssu re you there is no one w h o w ou ld be m ore w illin g to learn than our m edicals. Y o u r s faith lu lly, C. M . H ammond, C o m p a n y M edical S e rg t. “ B ” C o y ., 1 8 th B a tt. (N ’la n d ) H .G . A p ril 2 5 th, 1 9 4 4 .

Y o u r s faith fu lly , B o w m a n E d g a r , M .B . (M .O . 4 th B attn . D u m fries-sh ire H .G .)

R E C E N T A D V A N C E S IN F I R S T A I D W O R K IN W A R . D ear

S ir ,—

I w ou ld lik e to ta k e the opportu nity of ex p re ssin g m y th a n k s to you for e n a b lin g m e th ro u gh yo u r paper F i r s t A id to read such a splendid a rticle by S ir H e n ry L . M artyn, K C . V .O ., F .R .C S. H a v in g had m an y men th ro u g h m y han ds for tra in in g d u r in g th e w ar, I w a s a lw a y s p o in tin g out the n ecessity of f o r g e ttin g th eir tex tb o o k s, once th e m en had lea rn t the th in g s therein con tain ed, and it is n ow con sidered a crim e fo r a n y stu d en t to ca rry his tex tb o o k w ith him w hen on p arad e, and it is w ith pleasure I find such an a u th o rity a s S ir H e n ry L . M a rtyn co n firm in g m y m ethods. Y o u m a y be in terested to k n o w th a t on m a n y p arades th ree ca su a ltie s are placed in a field and labelled w ith sup posed in ju ries (u n kn o w n to the stretch er bearers), and upon th e o rder “ C o lle ct w ounded ” the squad are sent out w ith out b a n d a g e s, sp lin ts, or a n y o th er equipm en t excep t the stretch er and b la n k e ts. U pon a rriv a l a t the p lace w here the ca su a ltie s lie th e y m ust treat and con vey b a ck to C .C . P ., u s in g th e field d re ssin g of th e ca s u a lty (not their ow n ), shoe Jaces, belts, or a n y th in g th ey can find, thus im p ro v in g their

M rs. H o n o r B e ck w ith -S m ith , C o u n ty Sup erin ten den t for O xfo rd sh ire, h as been appointed A ssistan t Sup erin ten den tin-C hief, S .J .A .B ., and so becom es a ssistan t to L a d y L ou is M oun tbatten , S u p erin ten den t-in -C h ief, N u rs in g C o rp s and D ivisio n s, S .J .A .B . T h e re w as a la r g e atten d an ce a t the a n n u a l d an ce of the S .J .A .B ., held a t the G resh am H o tel, D u b lin , on A pril 2 1 st. O fficers on the C o m m ittee w ere : L a d y C a re w , C h a ir m an ; M rs. Seton P rin g le , V ic e -C h a ir m a n ; M iss G . M. B a rrin g to n , H on . O r g a n is e r ; M iss D . B la k e C a m p b ell, H on . S e cretary, and M iss L ilia E va n s, H o n . T re a su re r.

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F I R S T

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“ SANOID” INTERLOCKING EXTENSION SPLINTS

reasons w h y t h is book is indis p e n sa b le F ive a n d so m u c h in d e m a n d .

(Patent Number 53165 o f 28/7/39.) INCURVED EDGE OF SOCKET

1. 2. 3. 4.

Entirely new and up-to-date. Based on actual war experience. Designed to provide a complete and concise training. Covers all the ground for training recommended by : The British Red Cross Society, The St. John Ambulance Association, The Civil Nursing Reserve and the General Nursing Council. 5. Suitable for both advanced and elementary students.

TRANSVERSE GROOVE OF .SPLINT /

INCURVED EDGE OF SOCKET S. 1343 *'SANOID ” INTERLOCKING EXTENSION SPLINTS With Metal sockets for jointing. 2 pieces : 2 5/8ths. in. x 3/l6ths. In. x 15 in. 2 pieces : 2 5/Bths. in. x3/l6ths. in. x I3£ in. I piece : 2 5/8ths. i n.,x 3;l6ths. in. x In. I piece : 2 5/8ths. In. x 3/l6ths. in. x 6 in. 2 Webbing Straps with metal buckles : 18 in. x I In. 2 Webbing Straps with metal buckles : 27 in. x IJ in. 3 sockets. i By this invention Splints made in any convenient lengths make rigid connections by means of incurved opposite edges of the metal sockets or sleeves firmly engaging with transverse grooves In the surfaces of the Splints when pressed home into th« socket. Unlike the ordinary socketted Splint, this type is rigidly coupled ★ together and held against relative displacement but can be disengaged by pulling apart with sufficient force. N.B.— To ensure perfect locking It is imperative that the Splint ★ should be correctly inserted In the socket. I.e., BY MAKING CERTAIN THAT THE INCURVED EDGE OF METAL SOCKET ENGAGES WITH THE TRANSVERSE GROOVE OF THE SPLINT. Price : Complete with two pairs of straps - • 4/- per set. Without straps - - - - - - - 3/- per set. So/e M anufacturers

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248 Illustrations

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F I R S T

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THE SMAE INSTITUTE LEATHERHEAD

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130

F I R S T

R I D E p ile p sy and Its Stages.

Queries and Answers to Correspondents Q u eries w ill be d ealt w ith un der the fo llo w in g ru les :— 1 .— L e tte rs co n ta in in g Q u eries m ust be m a rk ed on the top left-h an d corn er of the envelope “ Q u e r y ,” a nd addressed to F i r s t A id , 4 6 , C an n on -street, L on don , E .C .4 . 2 .— A ll Q u eries m u st be w ritten on one side of paper only. 3. — A ll Q u eries m ust be acco m p an ied by a “ Q u e ry C oupon ” cu t from the cu rren t issue of th e Jou rn al, or, in ca se of Q u eries from abro ad , from a recent issue. 4. — T h e T e x tb o o k to w h ich referen ce m a y be m ade in this colum n is the 39 th ( 1 9 3 7 ) E dition of the S .J .A .A . M an u al of F irs t A id to th e In jured.

- G a s C o n tam in ated W ound. VV.A. (W e s tb u ry ).— A patient has a la r g e la cerated w ound acco m p an ied by haem orrh age and caused by a shell fra g m e n t. A lso , w ith in the w ou n d th ere is a patch of liquid m u stard g a s abou t the size of a florin. In these circu m stan ces w e w an t to k n o w if w e should ap p ly a n ti-g a s ointm ent to n eu tralise the action of the g a s ; and w e th a n k you for a ru lin g on this point. If the m u stard g a s in the w ou nd is not q u ic k ly n eu tra l ised, g r a v e resu lts w ill ensue. Y o u should therefore app ly a n ti-g a s ointm ent (N o. 5 ) and then treat w ou n d as laid dow n in the T e x tb o o k . T h is done you should m a rk your p atient w ith a “ C ” and tra n sfer him speedily to h o sp ita l.— N . C o r b e t F le t c h e r .

E xam in ation H ow ler. A. B. (H a m p ste a d ).— In a recen t first aid e xa m in atio n a m em ber of our cla ss w as a sk e d by the doctor to state w h a t he k n e w abou t the circu latio n . T o the surprise and a m u sem en t of the la tte r, the can d id ate replied :— “ The circulation is the number of copies of a paper sold daily, weekly or monthly as the case may be ! ” G ood!

N e xt, please ! !— N .C .F .

C o m p re ss io n of A x illa r y A rtery. W .A . (W estb u ry ). — D oes th e pad used for com pression of the a x illa r y a rte ry press on the a x illa ry p ressu re point only or does it com p ress the a rte r y a g a in s t th e h u m erus a s w ell ? M y tw o queries cam e from a W a rd en and a possible S t. John re cru it and w e a w a it your a n sw ers w ith in terest. If th e pad used is a b illiard ball-(or som e such su itab le a lte rn a tiv e) it w ill com press the a x illa ry a rte ry a t top of the a rm p it (P re ssu re Poin t No. 6). If, h o w ever, it is a la r g e pad such as a folded tria n g u la r b a n d a g e , then the p ressu re— if su cce ssfu l— is m ore lik e ly to be exerted on the b ra ch ia l a rtery at its o r ig in .— N .C .F .

A c rifla v in e a s A n tisep tic. W .C . (Q u een sb u ry). — B e in g v e ry received in the p ast from the Aid, I w rite to a s k if a criflavin e to be used in a F irs t A id R oom

Y e s . — N .C .F .

g ra te fu l for the help Q u e ry C o lu m n in F ir s t is a reco gn ised a n tisep tic for in d u strial acciden ts.

B .C . (W im b led o n ).— In a recent e xam in atio n I w a s asked w h a t w as th e ca u se of, and h o w I w ou ld reco gn ise an E p ilep tic fit. T h o u g h I g a v e m ost, if not all, the facts as stated on p. 160 of the Textbook> the doctor seem ed to exp ect m ore than I g a v e ; and so I w on der if you w ill b e ' g o o d e n o u g h to sup ply w h a t is m issin g from the description in th e T e x tb o o k . In first aid the cause of an y condition is eith er a ccid en t or disease. E p ilep sy, then, is due to disease, b e in g a “ brain storm ” w h ich resu lts from sudden failu re and loss of control of th e h ig h e st B rain Centres. It is a co m p aratively com m on disease ; and it is said to affect one person in every 1 ,5 0 0 in this co u n try, esp ecially y o u n g adults. A tta c k s of E p ilep sy m ay he m ild or severe. If m ild, then sudden, com plete and tran sien t in sen sibility is often the only sym ptom . If severe, then there are three definite s ta g e s :— (1) Sud den and com plete in sen sibility ; (2 ) C on vu lsion s w h ich consist of re g u la r, ra p id ly p assin g to irre g u la r m o ve m ents and are due to spasm of all the vo lu n ta ry m uscles of the body ; and (3 ) A u to m atic (or sleep) sta g e, d u rin g w hich the patient m a y act w ith ou t con sciou s k n o w le d g e and yet app ear norm al. T h e b itin g of the to n g u e and the E p ilep tic scream w h ich m ay herald the second s ta g e are evidence of the sp asm odic con traction of the m uscles co n tro llin g the ja w and breath in g . — N .C .F .

H ook-Pointed A w l in F in ger. E .S . (M oun t P le a sa n t).— W e w ould be pleased if you w ould g iv e a decision on the treatm en t of an in ciden t w hich h a s been the so u rce of a rg u m e n t betw een our m em bers. A m iddle a g e d m an w as b ro u g h t into the F irs t A id P o st w ith a new h o o k pointed leath er stitch in g a w l s tic k in g th ro u gh the m iddle of his in dex fin ger. T h e patient w a s pale and su fferin g pain and w a s therefore seated and g iv en a dose of sa l volatile. A cco m p a n y in g the p atien t w as a w o rk m a n w h o had b ro u g h t w ith him a n ew p air of c u ttin g pliers. T h e first aider, a m em ber of lo n g exp erien ce, then cut the ho o k off the a w l and the patient him self w ith d rew th e rem ain der. T h e tw o w ou n ds w ere treated w ith s u rg ic a l sp irit and a d ry d ressin g w as applied. T h e arm w a s supported in a s lin g and th e patient escorted to the m edical officer w hose s u r g e r y is a t th e top of the b u ild in g less than 5 m in utes w a lk from the F irst A id Post. T h e criticism is th a t, o w in g to the close p ro xim ity of a doctor on d u ty the patient should have been given th e sal vo la tile "and then tak en to the doctor for treatm ent. T h e defen ce is that, a s th e p atient w a s obviously shocked, he m ig h t e asily h ave fainted en route to the’ s u rg e ry , w hich m ig h t h a ve resulted in an u n lu ck y fall c a u s in g a te a rin g of the w ou nd, e tc., w h erea s the refnoval of the a w l co n sid erably restored the p atie n t’s peace of m ind.

Note.— T h e a w l blade w a s of the d eta ch a b le type and there is the s u g g e s tio n th at a fter re m o vin g the h an dle the rem ain d er of the blade m ig h t h ave been w iped w ith s u rg ic a l spirit and then passed on th ro u g h the w ound. Y o u r com m ents w ill be appreciated. O n the fa cts a s stated , I do not th in k th at a n y harm could possibly resu lt from the treatm en t w hich w as g iv en in the F irst A id Post. F u rth er, w ith referen ce to yo u r N ote, it is im m a teria l — as far as the patient is con cern ed — w h eth er the ho o k end of the a w l w as cut off or the h an dle rem oved and the rem ainder of the blade pushed th ro u g h the w ound. — N .C .F .

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Fitted Pouches and Haversacks always in stock.

Patent No. 544,164.

Let us quote for your First Aid requirements.

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R I D T h e T r i g g M e t h o d o f l i f t i n g p a t ie n t s h a s p r o v e n it s e lf m o s t u s e f u l a n d . s u c c e s s f u l in c e r t a i n r a r e e m e r g e n c i e s ; b u t a l m o s t t h e s a m e r e s u l t s c a n b e a c h ie v e d b y t h e u s e o f

P rio rity in T ransport. F . B . ( M o s e l e y ) . — A t a p r a c t i c e in o u r F i r s t A id D e p o t t h e o t h e r d a y t h e r e w a s a d i s c u s s i o n a b o u t p r i o r i t y in t r a n s p o r t in t h e s e c i r c u m s t a n c e s :— T h e r e w e r e t w o c a s u a l t i e s le f t — N o . 1 w h o w a s s u f f e r i n g fr o m f r a c t u r e d b a s e o f s k u l l a n d N o . 2 w h o h a d a b u r s t v a r i c o s e v e in . T h e a m b u la n c e w a s a v a ila b le b u t c o u ld o n ly t a k e o n e p a t i e n t . A s k e d w h i c h I s h o u ld p u t in t h e a m b u l a n c e , I s a id t h a t I w o u ld t a k e N o . 1 o w i n g to t h e d a n g e r o f i n j u r y t o t h e b r a in . T h e H e a d o f th e M o b i le U n i t , h o w e v e r , o v e r r u le d m e a n d s a i d t h a t N o . 2 c a s e s h o u ld b e r e m o v e d a t o n c e . P l e a s e t e ll u s w h i c h o f u s w a s r i g h t .

tr ia n g u la r b a n d a g e s . T o s u p p l y t h e s e s l i n g s t o a l l B r i g a d e u n it s w o u ld in v o lv e a c o n s i d e r a b le o u t l a y a n d w o u ld m e r e l y i n c r e a s e t h e q u a n t i t y o f e q u ip m e n t t o b e c a r r i e d o n t h e f a in t c h a n c e o f t h e ir b e i n g r e q u i r e d .— - N .C . F .

D a n g e r o f Hernia. N .O . ( L iv e r p o o l) .— In a re c e n t e x a m in a tio n I w a s a s k e d w h a t w a s t h e p r in c i p a l d a n g e r a s s o c ia t e d w it h a h e r n ia . A s I w a s n o t r e a d y w it h a s a t i s f a c t o r y a n s w e r , I p u t t h e q u e s tio n to y o u a n d s h a ll b e g r a t e fu l fo r y o u r a n s w e r.

O n th e fa c ts a s s ta te d I a g r e e th a t th e p a tie n t s u ffe r in g fr o m f r a c t u r e d b a s e o f s k u l l s h o u ld h a v e p r i o r i t y in t r a n s p o r t . P r o v id e d t h a t t h e b l e e d i n g fr o m t h e b u r s t v a r i c o s e v e in h a s b e e n p r o p e r ly c o n t r o ll e d o n t h e s p o t , t h e d e l a y in s e n d i n g t h e p a t i e n t t o h o s p i t a l w o u l d n o t a g g r a v a t e t h e c o n d i t i o n .— N .C .F .

T h e d a n g e r o f a r u p t u r e is t h a t t h e p r o t r u d i n g b o w e l m a y b e c o n s t r ic t e d b y t h e a b d o m i n a l m u s c l e s a n d r e s u lt in o b s t r u c t io n t o t h e c i r c u l a t i o n ( w it h s u b s e q u e n t s t r a n g u l a t i o n ) o f t h e b o w e l. T o g u a r d a g a i n s t t h is g r a v e c o m p lic a t io n , y o u a r e t o ld in t h e T e x t b o o k to k e e p t h e p a t ie n t r e c u m b e n t w it h t h i g h s a n d s h o u ld e r s r a i s e d — t o r e l a x t h e m u s c l e s o f t h e a b d o m in a l w a l l ; a n d to a p p l y c o ld c o n t i n u o u s l y t o t h e s w e l l i n g — to li m i t t h e lo c a l s u p p l y o f b lo o d . H o t f o m e n t a t io n s w o u ld h a s t e n t h is c o m p lic a t io n b y d r a w i n g m o r e b lo o d t o t h e p a r t .

T reatm en t of C ru sh ed Foot. L .C .

( C la p t o n ) . — I n a r e c e n t e x a m i n a t i o n , t w o o f th e c a n d i d a t e s w e r e a s k e d t o t r e a t a c r u s h e d fo o t . T h is t h e y d id in t h e a p p r o v e d T e x t b o o k m e t h o d , b u t w e r e in f o r m e d b y t h e e x a m i n i n g d o c t o r t h a t t h e y w e r e w r o n g a n d t h a t t h e b a n d a g e s h o u ld h a v e b e e n a p p lie d r o u n d t h e

— N .C . F .

a n k l e fir s t . I f t h e y w e r e f a ile d t h r o u g h t h is , w o u ld t h e r e b e a n y r e d r e s s o r c o u ld t h e y a p p e a l fo r a n o t h e r d e c is io n ? Y o u d o n o t s ta te w h e th e r th e

Use of P etrol for W ounds. B . C . ( S h e f f i e ld ) .— T h e o t h e r d a y a m e m b e r o f o u r c l a s s s t a t e d t h a t p e t r o l c a n b e u s e d a s a n a n t is e p t i c in t h e e m e r g e n c y tre a tm e n t of w o u n d s. A s th is s ta te m e n t w a s n o t a c c e p t a b l e t o t h e m a j o r i t y , w e d e c id e d to p u t t h e p o in t to y o u ,

t r i a n g u l a r o r t h e r o lle r

b a n d a g e w a s b e in g u se d . I f , t h e r e f o r e , y o u r e f e r t o t h e t r e a t m e n t o f c r u s h e d fo o t a s l a i d d o w n in t h e T e x t b o o k (p . 9 3 ), t h e n it is c o r r e c t to s t a r t b y p l a c i n g t h e c e n t r e o f a n a r r o w b a n d a g e o v e r t h e in ste p . O t h e r w i s e if t h e b a n d a g e is a p p lie d fir s t t o t h e a n k l e , t h e t w o e n d s c o u ld n o t b e tie d o f f o n t h e s p lin t . O n t h e o t h e r h a n d , if t h e r o l le r b a n d a g e is b e i n g u s e d , it is c o r r e c t t o s t a r t o n i n n e r s i d e o f t h e a n k l e a c c o r d i n g to t h e i n s t r u c t i o n s in t h e T e x t b o o k (p 2 6 8 ). I n a n s w e r to y o u r s e c o n d q u e r y , I c a n n o t i m a g i n e a n y d o c to r fa ilin g a n y c a n d id a te on s u c h a tr iv ia l m a tte r a s th e p o in t a t w h i c h a b a n d a g e s h o u ld b e c o m m e n c e d . If y o u r c a n d i d a t e s f a ile d , t h e n s o m e o t h e r a n d m o r e s e r io u s m i s t a k e

to r y o u r k in d r u lin g . P e t r o l is c e r t a i n l y a n a n t i s e p t i c a n d is s a id t o h a v e b e e n u s e d b y s o m e s u r g e o n s f o r t h e p r e p a r a t io n o f t h e i r p a t i e n t ’ s s k i n p r e v io u s to o p e r a t io n . F u r t h e r , to s o m e e x t e n t it w ill c o n tro l b le e d in g . C o n s e q u e n t l y p e t r o l— if a v a i l a b l e — c a n b e u s e d in t h e e m e r g e n c y t r e a t m e n t o f w o u n d s . T h e c h ie f d r a w b a c k to it s u s e , h o w e v e r , is t h a t it m a y .p r o v e a n i r r i t a n t ; b u t t h is is n e g l i g i b l e if, a s h a s b e e n c la im e d , p e t r o l c q n b e r e lie d u p o n t o w a r d o f f t e t a n u s in m o t o r a c c id e n t s in w h i c h w o u n d s a r e c o n t a m i n a t e d b y s o il fr o m t h e r o a d . — N . C . F .

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BIOLOGICAL M B f c PREPARATIONS A N TIP EO L 5SSSRB O IN T M E N T O n e o r o th e r o r a ll o f the th ree races o f g e rm s , S tre p to c o c c i, S ta p h y lo co cci an d B . p y o cya n e u s a re fo u n d in e v e r y sk in in fe ctio n co m m o n to th is c o u n try , and A N T I P E O L O I N T M E N T co n ta in s the antibodies (an tiv iru s) o f these g e rm s. H e a lin g is e xp e d ite d b y the p r o v e d ^ ,gx f A lentS o f . the o in tm e n t. and se p tic d e v e lo p m e n t is sto p p e d o r p rev e n te d b y its a n tiv iru s ste rile v a ccin e filtrate s. A N T I P E O L O I N T M E N T is u n su rp assed fo r B U R N S an d S C A T D S , f o r it is m ic ro b ic id e an d n o n -a d h e siv e , and d re ssin g s d o n o t re q u ire to b e ch a n g e d e v e ry d a y . W O U N D S , B U R N S , e t c , W I L L N O T T U R N S E P T I C i f treated w ith A N T I P E O L O I N T M E N T .

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FIRST A ID IlniJtepemJtfrtf JjurraJjor tije A m b u l a n c e

atib 3 H u r s i n g B e r n i c e s

I [Editor I WALTER SCOTT.

TUNE,

____________ N O T IC E

F.R.San.l., F.R.S.A.

1944.

L-staHontrs Hall\

PRICB th r eep en c e

[4/, Phr Annum, Post Free

R E A D E R S.

EDITORIAL. F IR S T AID is published on the a o th o f each m on th A n n u al Subscription is 4 s. post free ; sin gle copies 3d.

The

Its aim and ob ject bein g the advancem ent o f A m b u lan ce W ork in all its branches, the E d ito r in vites R eaders to send A rticle s and R eports on subjects pertaining to the M ovem en t and also w elcom es suggestions for P ractical Papers. A ll R eports, & c ., should be addressed to the E d ito r at the address b elo w , and should reach him before the 8th o f each m onth, and m ust be accom panied ( not necessarily fo r publication) b y the nam e and address o f the Correspondent. Su bscription s, A dvertisem en ts and other business Com m unications connected w ith F I R S T A I D should be forw arded to the Publishers. D A L E , R E Y N O L D S & C o ., L td ., 46 , C a n n o n S t r e e t , L o n d o n , E . C . 4 . Telegraphic A d d ress— “ T w en ty -fou r, L o n d o n ." Telephone— C ity 3710 .

CON TEN TS

TH IS

NUM BER.

E d it o r ia l —

V o lu n ta ry H o sp itals

133

R ecen t A d van ces in F irs t A id W o r k in W a r

134

S .J .A .B . H ead q u arters and D istrict R eports

135

L etters to the E d ito r

136

...

K n o w le d g e is P o w e r ...

137

T h e N ew 2 -B earer L o a d Stretch er

137

T h e H om e G u ard and F irst A id

138

R a ilw a y A m b u la n ce N ew s

138

Q u e r ie s a n d A n s w e r s t o C o r r e s p o n d e n t s :—

L a y In stru cto r C ertificate

...

142

E x a m in a tio n H o w ler

...

142

F irs t A id T e x tb o o k s

...

142

T re a tm e n t of B u rn s and S ca ld s

...

142

S ta tu s of C ad et O fficers

...

144

C o n ta ct w ith E lec tric C u rren t

...

144

T re a tm e n t ot A sp irin P o iso n in g

...

144

F ra ctu re s of L e g and F em u r

...

144

...

I t is w ell not to p lace too strict relian ce upon the utteran ce of statesm en w h en s p e a k in g in public, and w hen the M in ister of H e a lth a ssu res his au d ito rs that not o n ly has the G o vern m en t no in tention of d e stro yin g the vo lu n ta ry hosp ital system but “ h a s put fo rw ard proposals w h ich in its v ie w w ou ld h ave th e very opposite effect, ” one m ay be fo rgiv en for a sp ice of scep ticism . M r. W illin k states th a t un der the N a tio n al H e a lth S erv ice proposals vo lu n ta ry hosp itals w ou ld be ab le to preserve th eir c h a ra cte r and th eir self-g o v ern m en t w h ile a t the sam e tim e ta k in g the fu llest part in p ro vid in g the service, in plann in g the service, and in g u id in g the develep m en t of the service as a w hole. W e are a fraid th a t w e cann ot re g a rd the m atter w ith the needed co m p lacen ce, for w h ile the G o vern m en t m ay h a v e no m aleficent in tention it still rem a in s p ossible to question the resu lt of such a m om entous up h eaval a s is con tem plated. S aid M r. W illin k in a recent speech, “ ju s t a s the G o vern m en t has no in tention of in ju r in g the vo lu n ta ry hosp itals ” (w e sca rce ly see h o w this can be avoided under the proposed regim e) “ in the sam e w a y it has no d esire to d isco u ra g e in a n y w a y the sp irit of benevolence and vo lu n ta ry service w h ich in spires the vo lu n tary system . T h e W h ite P a p er therefore m a k e s it p erfectly c le a r th at the G o vern m en t’s finan cial proposals are d esign ed to lea ve room for part of the cost of the h o sp ital service to be m et from vo lu n ta ry co n tribu tio n s, and thus to p reserve a sphere fo r the operation of th a t go o d w ill and service w hich h ave a lw a y s been the m a in stay of the m ovem ent. It is said th a t som e people h a ve ta k en the W h ite P a p er as a s ig n a l for d isco n tin u in g their finan cial support fo r the vo lu n ta ry ho sp itals, and even c e a s in g to be m em bers of co n trib u to ry schem es, but it is to be hoped th a t th is is not re a lly h ap p en in g, not only in the in terests of the hosp itals but also in the in terests of the p atients th em selves if they a re m em bers of co n trib u to ry sc h e m e s .” W e fea r th a t it is h a p p e n in g to a re g retta b le exten t. W e quite fo llo w M r. W illin k w hen he tells us th a t the W h ite P a p er is not an A ct of P a rlia m e n t and th a t “ it rep resen ts w h a t the G o v e rn m ent believes to be the best m eans of b r in g in g a n atio n al health service into o p eratio n ,” an d som e a ssu ra n ce lies in the fact th a t the G o vern m en t’s proposals are n ow to be exam in ed and discussed in d etail w ith the rep resen tatives of the vo lu n ta ry hosp itals and oth ers con cerned, and, a fter that le g isla tio n , w hich it is hoped m a y be la r g e ly a g re ed w ill be fram ed , and subm itted to P arlia m en t. E ven w hen leg islatio n is in b e in g , he added, there w ill be m uch w o r k to be done before the n ew service can com e into operation, and th ere m ust be q u ite a lo n g period before an y new financial proposals m ade in th e W h ite P a p er can rep lace e x is tin g a rra n g e m en ts, and “ it w ou ld therefore be the h e ig h t of sh o rt-sigh ted n ess to d isco n tin u e a n y form of finan cial support to vo lu n ta ry h o sp ita ls sim p ly b ecau se of the a p p ea ran ce of the W h ite P a p e r .” O n this w e are in the fu llest a g re e m e n t w ith him .

V o lu n ta r y H o s p ita ls .

F I R S T

134

Recent Advances in First Aid Work in War. B y S I R H E N R Y L. M A R T Y N , K .C .V .O ., F .R .C .S . (C a su a lty StalT O fficer, G A rea, D evon C .C .)

( Continued from page i2 f.) P erson nel tend to be a fraid of ca u s in g the patient pain by a p p ly in g a firm b a n d a g e over a w ou nd. T h e re need be no a n x ie ty on th at score sin ce local sh o ck w ill have so num bed the part th a t, provided the lim b as a w hole is not ro u g h ly h an d led , firm pressure is m ore lik e ly to cau se co m fort and g iv e a fee lin g of sup port rath er than pain. A lth o u g h a k n o w le d g e of the e xa ct position of pressure points is of vita l im portan ce, and m ay w ell h ave to be b ro u g h t into use in the o ccasio n al case, the alm ost u n iversal ten dency of ca su a lty personnel to lo o k upon them as their first line of defen ce should be replaced by m uch g re a te r relian ce upon local p ressu re upon the w ou nd itself. A to u rn iq u et is a m ost d a n g ero u s w eapon, and a lth o u g h ca ses do o ccu r in w h ich the use of one is essen tial to save life such cases are rare indeed. N ot only do the w ell-kn o w n d a n g e rs e x ist of possible g a n g re n e , cru sh in g of tissues and in crease of sh o ck , in ju ry to nerves, e tc ., but it has nowbeen c le a rly proved that, in cases in w h ich a tourn iquet has been used, the risk s of su bsequ en t sepsis are en o rm ou sly in creased. T h e St. John to u rn iq u et is not n early such an easy in stru m en t to ap p ly w ith the pad over a pressure point as m a n y people fo n d ly im a g in e. U n less the pad be applied w ith extre m e a c c u ra c y so th at the a rtery is clean ly co m pressed, the result m a y w ell be th a t the return flow of blood from the lim b is alon e lim ited by com pression of the vein s, w ith the result th a t the h tem o rrh ag e is g re a tly increased. T h e issue of the m odern rubber ba n d a ge has rendered control of haem orrhage m uch easier, and in such cases in w h ich sim p le firm b a n d a g in g proves to be insufficient, it should be applied d irectly o ver the d ressin g and all the stan d a rd p recau tio n s associated w ith tourn iquet app licatio n em ployed. F o r all p ractical purposes only the presence of irrem o veab le fo reign bodies or la rg e fra g m e n ts of g la s s deep in the w ou nd render this m ethod un suitable. F a ilin g a ru b b er b a n d a g e , the sim ila r use of an im p ro vised to u rn iq u et is n ow recom m ended in preferen ce to the St. John type as b e in g easier to apply. It is b eco m in g m ore and m ore im p ortan t for the R e scu e services to be in tim a tely acq u ain ted w ith the m a n y question s w h ich surroun d the treatm en t of the trapped ca su a lty , and it m ay be w ell to su rvey them in som e d etail in order that they m ay be cle arly understood and not m erely a m atter of m ech an ical routine. I am not concerned eith er w ith m ean s of rescue or w ith pure first aid, but propose to consider only those curious and lesse r k n o w n phenom ena w h ich o ccu r w here an in d i vid u al is trapped beneath debris by p ressu re upon a lim b. T h is p ressu re m a y be exerted eith er by a beam or g ird e r w h ich pins the lim b beneath it or by the b u ry in g of a le g or arm beneath fallen m ason ry. In such a case tw o sep a ra te and distinct conditions have to be con sidered ; firstly, the g e n era l effects upon the p a tie n t’s body a s a w hole, and, seco n d ly, the resu lts upon the im prisoned lim b itself. If w e con sider first the ge n era l effects the picture m ay be so m ew h a t as follo w s :— A ca s u a lty is found trapped beneath a beam w h ich rests a cro ss the front of one th ig h p in n in g it firm ly a g a in s t ru bble beneath. T h e patient, th o u g h ce rtain ly shocked, ap p ea rs to be o th erw ise un inju red, but probably in sufficient pain and d istress to require m orphia. C o n sid erab le diffi

A I D c u lty is found in lib era tin g him , and som e hours p ass before he is freed. O n exam in atio n the com pressed lim b sh o w s very little in dication of g ro ss in ju ry, it is perhaps a little paler and colder than n orm al, perhaps sh o w s som e b ru isin g or local sk in abrasion s, but, co n sid erin g w h at he h as been th ro u g h , both local and g e n e ra l conditions app ear to be excellen t. T h e patient is rem oved to hospital, recovers Irom his sh o ck , and for three or four days seem s to be d o in g w ell, and th en — om inous ch a n g e s b e g in to appear. T h e urine becom es reduced in q u a n tity and the patient listless and drow sy. T h e q u an tity passed becom es m ore and m ore sca n ty, finally ce a s in g entirely, and the patient dies betw een the fifth and e ig h t days of U raem ia . It is hard ly possible to picture a m ore h e art-b re ak in g tra g e d y , both to the relatives w ho h ave th o u g h t of the p atient as safe and to the rescu e p arty w ho h ave risk ed their lives in hours of effort only to be finally th w arted of one m ore life to th eir credit. C a ses of this kin d h ave occurred w ith co n siderable frequen cy, and a s m any a s 66 per cen t, of ca su alties w ho h ave been trapped for any len g th of tim e develope sym ptom s of w h at is n ow k n o w n a s C ru sh Syndrom e. F ro m the first, m edical research has been con cen trated both upon s o lv in g the e x a ct causes of death and in deter m in in g the best m ethods of prevention, and, in the latter, rescue p arties a rc m ost in tim a tely concerned. In v estiga tio n s h a ve sh o w n that w hen liv in g m uscles a rc com pressed for a n y len gth of tim e certain d estructive ch a n g e s o ccu r w ithin them , w h ich result in the form ation of poisons, the e x a c t n atu re of w h ich is not yet fu lly kn ow n . A s the circu latio n is restored in th e liberated lim b these poisons are carried by the lym p h atics into the blood stream and thence to the kidn eys. P a rt of the stru ctu re of these o rg an s con sists of in finitely fine tubules, and in these the poisonous substan ces are deposited, both b lo ck in g and d e stro yin g them , w ith the result th at all excretion of urine finally ceases and the victim dies. T h e g re a te r part of the scien ce and art of m edicine is com m on sense, and the obvious and com m on sense m ethod of p reven tin g the p oison ing of the patient from his d a m a g e d tissues lies in en su rin g that from the earliest possible m om ent his system is co n stan tly Hushed w ith fluids— pre ferably a lk a lin e fluids— in order both to dilute the poisons and to keep his kid n eys a c tin g as freely a s possible. H en ce the issu e n ow to all rescue p arties of B ica rb o n ate of Soda and rubber tubes. T h e in stan t th at a ca su a lty is n ow reported a s lik e ly to be trapped for som e tim e and has no abdom inal in ju ry, is conscious, and in a condition to sw a llo w , he m ust be in duced to d rin k a so lu tion of b icarbo n ate of soda in the stre n g th of tw o teaspoon fuls to the pint. It is not a p lsasan t m ixture, but a s m uch as five pints should be g o t in if possible. It m ay be sw eeten ed w ith s u g a r or g lu co se , or the bicarbon ate m ay be added to tea or coffee, b u t the fluid m ust be d ru n k if it can p ossibly be done. If the a ctu al adm in istration is a w k w a rd on a cco u n t of d ifficulty of access, the ru bber tube should be used to a d m inister the fluid, a tta c h in g one end to the spout of a sm all teapot or feed in g cup and p a ssin g the other end th rou gh the debrjs to the p atien t’s m outh. In the o rd in a ry w a y an In ciden t M edical O fficer w ould be sum m on ed w h en the trapped ca su a lty is first reported, but 1 am a lw a y s im p ressin g upon c a su a lty personnel that they m ust be prepared to a ct on their ow n in itiative and to g e t on w ith the jo b if a doctor is not availab le. S uch cases as these require sp ecial treatm ent w hen they reach hospital, and they should be m ost care fu lly labelled a s to the tim e d u rin g w h ich they h ave been trapped, tim e released, n ature of in ju ry and the n ature and q u a n tity of fluids, to g e th e r w ith a note of a n y m orphia adm inistered. S everal question s h ave recen tly app eared in yo u r query

F I R S T co lu m n s a s to the treatm ent of the local in juries o cca sioned by pressure upon the lim bs of trapped casu alties. T h e m atter is not n early so e asy a s that of the g e n era l tre a t m ent by fluids, etc.

(To be continued.')

R I D

135

St. John Ambulance Brigade HEADQUARTERS

AND

D IST R IC T R E P O R T S.

No. I (Prince of Wales’s) District L e tte r s

th e

E d ito r .

W e are in no w a y responsible for the opinions exp ressed, or the statem en ts m ade, b y C o rresp o n d en ts. — E d i t o r . D R IL L

R E V IS IO N S .

D e a r S ir , —

It is in te re stin g to learn th ro u gh F i r s t A id that the D rill R evisio n s d ealt w ith by S e rg t. S p read b u ry in the F eb. issue had official authorisation . T h is Jail accompli renders discussion sterile ; but I w ou ld lik e to reply to his latest con tribution. T h e C ivil D efen ce S ervices a re to the H om e G u a rd w h at the R .A .M .C . is to fig h tin g units, and, excep t in special circu m stan ces, collaboration w ou ld be betw een H .G . and C .D . personnel. T h e m uddle about a m b u la n ce fittin gs could h ave been avoided y ears a g o ; and that in stan ce o u g h t to stand out as a con stan t rem in der th at un iform ity is the best aid to successfu l collaboration . S tretch er squads w ith m ilitary units h a ve a lw a y s realised the need for ta k in g cover, and, w hen in action , h ave found it n ecessary to fall flat rep eated ly before re a ch in g casu alties. T h e shoulder ca rry w a s adopted th ro u gh n ecessity, and w as in frequent use before it becam e re g u la rise d in drill. T h e need for revision is accepted by all ; and so fa r as the S .J .A .A . tex tb o o k is concerned, the com pilers are no doubt a w a re of its sh o rtco m in gs, but h ave th eir ow n diffi culties of com pilation. A s I see it, the vario u s exam in atio n au th o rities un der took to assist, and help to m ain tain , th at basic stan dard th at all critics a g re e should be first attained before m odifica tion ensues. Is it not ra th er the function of A .R .P . H a n d book No. 10 to provide the desired m odification ? No doubt in the third edition w e shall find all the latest resu lts of research em bodied in its recom m endations. O fficial publication s can be m ore e asily re-issued, and one w ay to overcom e the difficulties of re-exam in atio n for “ b ig g e r and better certificates ” of the S .J .A .A . w ould h ave been th ro u gh the issue of a C .D . proficiency ba d ge, retained o nly by those w ho keep a b reast of im provem ents by a tte n d in g revision courses a s m entioned by S ir H e n ry L . M artyn, K . C .V . O . , F .R .C . S ., in the M arch issue of F i r s t Aid. I w onder, how ever, h o w m an y tow n s are fo rtu n ate en o u g h to h ave M .O .’s able to spare the tim e n ecessary for such tra in in g ? A ll too frequ en tly it has devolved upon a S .J .A .B . m em ber. Y o u rs faith fu lly, James W o o d, A .R .C .S c ., D .F .C .

B oston, M ay 6th, 1 9 4 4 .

H .M . T h e K in g H onours Our D octor. W e feel sure that every one o f our th ousands o f readers w ill join us in tend erin g to Dr. N . Corbet F letch er, O .B .E ., our H on . M edical A d viser, heartiest congratulations upon the H on ou r conferred by H .M . T h e K in g, in a p p oin tin g h im an Officer o f T h e M ost E x cellen t Order o f the British E m pire. “ N .C .F ., W e Salute Y o u .”

A C h u rch P a rad e of the J oin t O rg a n isa tio n of the Red C ro ss and St. John w a s held a t St. S te p h e n ’s C h u rch on S u n d a y, M a y 7 th. T h e P arad e, 180 stro n g , a ssem b led o u t side th e C lin ic, Y o r k H ouse, T w ic k e n h a m , un der the co m m and of D iv. Sup t. G eo. W illo u g h b y , S .J .A .B , a ssisted by Mr. G. A. lie s , C o m m an d an t of the B .R C .S . T h e P a rad e w as inspected by C o u n cillo r C . VV. B e ck e tt, J .P ., President of No. 84 T w ic k e n h a m D iv isio n , w ho co n g ra tu la te d the p arade on their very sm art turnout ; they then proceeded to ch u rch headed by the band of the 2 7 th L ondon C o m p a n y H o m e G u ard under th e direction of their con ductor, M r. W r ig h t (by k in d perm ission of the C o m m a n d in g O fficer). T h e R e v. R u sse ll W h ite con ducted a very s tirrin g service. N e w N u rs in g D iv is io n . — A fter a y e a r of real effort on the part of the officers and m em bers of w h a t w a s the P e c k ham Section of the 6 9 th L e w ish a m N u rs in g D ivisio n , they are proud to be able to ann oun ce th at the 1 4 9 th P eckh am N u rsin g D ivision is now an accom plish ed fact, and P eckh am can n ow boast of h a v in g its very ow n N u rs in g D ivision . It h as been a m atter of g r e a t co n cern to m a n y that C a m b e rw ell, one of the la rg e s t B o ro u g h s, h as been w ith ou t a St. John N u rs in g D ivisio n . N o w that P e c k h a m ’s ow n D ivisio n has lau n ch ed out, officers and m em bers a lik e feel there w ill be m a n y and varied op portu nities for them to prove th eir u sefu ln ess. T o ta k e a d v a n ta g e of the o p p o rtu nities e ffectu ally, m ore w om en are w an ted to jo in the D iv i sio n — w om en o ver 18 y ea rs of a g e w ho are in terested in F irst A id and H om e N u rsin g and w ho are a n x io u s and keen to help others, esp e cially those in their ow n b o ro u g h . T h e D iv isio n has been very fo rtu n ate in g a in in g the g o o d services of M rs. E van C o o k (M atron of St. G iles H o s pital) and the M ayoress M rs. B. R oun d, w h o h ave very g r a c io u sly a g re e d to a ct a s P resident and V ice -P re sid e n t of the D ivisio n ; D r. D a n iel H u g h e s h a s also v e ry k in d ly a g re e d to becom e D iv isio n a l S u rgeo n . M eetin g s are held w e e k ly on T h u r s d a y s a t St. M a r k ’s C h u rch H a ll, H a rd e rs R o a d , P e ck h am , w h ere all p a rtic u la rs can be obtained fo r enrolm ent.

County o f Berkshire. D iv isio n a l S u rg e o n A . B u ch an a n B arb o u r, M .R .C .S ., L .R . C .P ., of M aiden head A m b u la n ce D iv iso n , has been appointed C o u n ty S u rg e o n in p lace of D r. J. G . B ird , w ho has resign ed . A m b u la n ce S ister C. E p pstein , of R e a d in g W e s t N u rs in g D iv isio n , w a s the B e rk sh ire rep resen ta tive of the St. John A m b u la n ce B r ig a d e a t the C en tral F la g D a y D ep ot, w hen H e r M ajesty the Q ueen visited the D ep ot and the P riso n er of W a r E x h ib itio n a t C la re n ce H o u se, St. Jam es P a la ce, on M a y 16 th. T w y f o r d . — O n M a y 9 th the C o u n ty C o m m issio n er, Mr. C. A . P oole visited T w y fo rd A m b u la n ce D ivisio n and pre sented three of the m em bers w ith 20 y e a r a w a rd s and three w ith m edallions. R eading. — O n S a tu rd a y , M a y 2 0 th, a t the A m b u la n ce H a ll, C h a th a m S treet, a co m p etitio n in F irst A id and H o m e N u rs in g w as held b etw een N u r s in g D ivisio n s of the R ead -

136

F I R S T

in g C o rp s. F o u r team s com peted, the F irst A id test b e in g p repared and ju d g e d by C o u n ty O fficer F . A. C. J arvis and C a d e t S u p t. M rs. M. B a iley , and the H o m e N u rs in g by S iste r V . M . Crofts. T h e team from T h e a le N u rs in g D ivisio n , captain ed by S e r g t. G lazier, w on the cup, w h ich w as presen ted by the C o u n ty C o m m issio n er, M r. C . A. P oole, and w ill be held fo r six m onths. A n in d ivid u al prize w as also g iv en to each m em ber of the team and to the tw o “ p atien ts” , w h o w ere m em bers of R e a d in g E a st N u rs in g C a d e t D ivision .

County o f H am p sh ire. S o u t h a m p t o n . — T he a n n u a l in spection of th e N u rsin g D iv isio n s of S o u th am p ton C o rp s w as held at M ount P leasan t S ch o o ls recen tly, the In sp e ctin g O fficer b e in g the H on . M rs. S. R . C u b itt (C o u n ty S u p t.). T h e C o u n ty S u p t. w a s w elco m ed by D r. W . L . M. B ig b y , C orps S u rg e o n , and a fte r the insp ection a m eetin g w a s held presided o ver by C orps Sup t. M is s F . M. T u tte . M rs. C u b itt th a n k ed the m em bers for the service b e in g rendered to the B rig a d e , and g a v e a m ost in te re stin g ta lk on E m e r g en cy H o sp ita l, O ve rsea s R elief, and P o st-w ar W o rk . M rs. C . C o w a rd , la te C orps O fficer, w as presented w ith a w r itin g case and cheque from officers and m em bers of the B rig a d e . M rs. C o w a rd rece n tly retired after 35 y e a rs ’ service w ith the B r ig a d e (32 y ea rs in the S o utham p ton Corps). T h e presen tation of a third bar to her S erv ice M edal (for 30 y e a rs ’ service) w as m ade to C o rp s S u p t. M iss T u tte , and a n ti-g a s and hom e n u rs in g certificates to m em bers of the S o u th am p ton No. 1 and 2 D iv isio n s.

C ounty o f Stafford. W a l s a l l . — A very in te re stin g d isp lay of F irst A id w o rk w a s g iv e n on M ay 1 1 th, 1 2 th and 13 th by the W a lsa ll, B lo x w ich and P a lfre y C a d e t D ivisio n s. A t the com m encem ent of p ro ceed in gs the C ad ets w ere p la y in g a m o ck g a m e of football, w hen suddenly an aero p lan e (p reviously placed in position on the gro u n d ) im a g in a rily app eared and crashed, b u rs tin g into flam es. T h e C a d ets im m e d iate ly left th eir g a m e and proceeded at the double to the in ciden t, c a rr y in g the patients to a p lace of safe ty . F irs t a id tre atm e n t w a s then carried o u t— one patien t re q u irin g a rtificial resp iratio n , and others re q u irin g treatm en t for a fra ctu red fem u r, a fra ctu red forearm , a fra c tured co llarbo n e and a b a d ly cut face. T h e d isp lay con cluded w ith the lo a d in g into a m b u lan ces and u n lo ad in g . T h e w o r k w a s carried out in a very cred itab le m anner, and lo u d ly app lau ded by several hundred spectators. C a d e t S u p ts. S. Cooper, W ilc o x and H u g h e s, to g e th er w ith C a d e t O fficers B. E . E va n s and W h iteh o u se, w ere respon sible for the a rra n g e m en ts.

C ounty o f W arw ick. C oven try C en tral C o r ps. A v e ry go o d turn out w as w itn essed on the occasion of th e “ S a lu te th e S o ld ie r” p arade on S a tu rd a y , M ay 6th. T h e m em bers p a ra d in g w ere p u rp o sely lim ited, but som e 250 officers, m en, n urses and ca d ets w ere on parade. M uch a p p lau se w a s show n by the cro w d s on rou te to the fine b ear in g and sm a rtn ess sh o w n b y all. T h e C ity of C o v en try C a d e t D iv isio n has n ow a p p ro x i m a te ly 160 boys un der th e very able com m and of C ad et Supt. W . G o d d ard , a ssisted by C ad et O fficers W in d rid g e and S m ith . M r. G od d ard is very w ell k n o w n for his u n tirin g efforts on beh alf of the boys, and is k e en ly interested in their w elfare. P a ren ts m e etin g s are held r e g u la r ly and a co m m ittee of the p aren ts help and ad vise on all m atters,

A I D

N orth R id in g o f Y orkshire. T h e S to ck to n and T h o rn a b y D ivisio n held its ann ual in sp ection on M on day, M ay 2 2 nd, w h en 32 officers, N .C .O .’s and m en, un der the com m and of D iv . Sup t. S. H . B riarw ood, w ere on parade. T h e in sp ectin g officer w a s C o u n ty C o m m issio n er F . P. W ilso n , assisted by C o u n ty S u rg e o n B. G . S . B e las and C o u n ty O fficer J. P earso n . A fter th e in spection tw o very in te re stin g presen tations took p lace under the ch airm an sh ip of H is W o rsh ip the M ayor of T h o rn a b y (Aid. H . D a cre, J .P .). T h e first w as the p resentation by th e C o u n ty C o m m issio n er to R eserve Sup t. J. W . C u m m in g s of his S e rv in g B roth er ribbon, w h ich hon our w a s gran ted him in F eb ru a ry last. T h e C o m m issio n er referred to Sup t. C u m m in g s ’ devotion to d uty d u rin g his 26 y e a rs ’ service w ith the D ivisio n , and cited it as an exa m p le to the y o u n g e r m em bers. Supt. C u m m in g s su ita b ly replied. T h e tit-bit of the even in g w as w h en the M ayor called upon D iv. S u rg e o n A. M a c K a y to present to the C o m m is sioner the deeds of their h ead qu arters. T h e se prem ises w ere opened in N ovem ber, 1 9 4 2 , and finally paid for in M arch , 1944 ; the cost (.£ 6 5 0 ) b e in g raised by m em bers of the D ivisio n and their m an y friends. T h e D iv. S u rg e o n said they had m uch to be proud of, but w ere not g o in g to rest on their la u rels but hoped to g o on from stre n g th to stre n g th in the g r e a t w o rk they had un d ertak en in the cause of suffer in g h u m an ity. In a ccep tin g the deeds, the C o m m issio n er paid tribute to all those w ho m ade this presentation possible, p articu lar th an k s b e in g g iv e n to the hon. solicitor, M r. N. J. Scott, for a r ra n g in g and ca rry in g out all le g a l w o rk g ra tis .

W est R id in g o f Y orkshire. H a l i f a x . — O n Sa tu rd a y, M ay 6th, the three Cadet D ivisio n s held an enrolm en t service in the H a lifa x L ite ra ry and P h ilosop h ical R oom s. A bout 70 cad ets w ere each pre sented w ith a first aid certificate, record card and a copy of the D ivisio n a l R u les. C o u n ty C ad et O fficer M rs. F ord, w ho had exam in ed the four C adet O fficers, M rs. R o th e ry , M iss C ro w th er, M rs. F letch er and M iss Jow ett, in troduced C an on P. E. Jam es, S e rv in g B ro th er of the O rd er and C orps C h ap lin. C an on P. E. Jam es con ducted th e cerem ony in a c c o rd an ce w ith the n ew C ad et M an u al. In his address Canon Jam es g a v e a ta lk on the m a k in g of the K n ig h t of O ld. A fte r the service a concert w a s g iv e n , o rg an ised by M iss V . L u x to n , A m b u la n ce Sister. M r. G ilb ert G led h ill, M .P . (C orps President) and Supt. N aylo r, A m b. O fficer N a ylo r and S u p t. M rs. S u tcliffe of H ebden B rid g e C orps w ere visitors.

T h e A rm le y and W o rtle y D ivisio n of th e L eed s Corps, S .J .A .B ., in spite of b e in g short handed by ca lls of H .M . F o rces, A .R .P ., and H om e G u ard duties, have by 3 con certs in the local cin em as, and a dan ce in the T o w n H a ll, handed over to the R ed C ro ss and S t. John W a r O rg a n isa tio n P riso n ers of W a r F u n d , th e sum of ,£ 2 4 6 w ith in the last 12 m onths. T h e fo llo w in g is the effort of the officers and m em bers of the S to ck to n and T h o rn a b y St. John N u rs in g D ivisio n to w a rd s T h o rn a b y “ S a lu te the S o ld ie r” w e e k :— W h ist drive, A p ril 11th, £ 2 7 ; D a n ce, A p ril 17 th, £\ 12 8 ; W h ist drive, A pril 2 6 th, £\ 17 7 ; W h ist drive, M ay 3rd, , £ 3 7 9 : C h ild re n ’s fan cy dress so cial, M ay-4 th, £ 4 6 9 ; B r in g and bu y sale, M ay 6th, £ 1 4 18 6 ; D an ce, M ay 8th, £ 5 1 10 ; Profit from sale of m in erals, 11 s. ; T o ta l, £ j 34 3 1,

F I R S T

Knowledge is Power. A fe w y ears a g o a la d y exp lo rer of w orld w ide repute related an incident in the course of an article published in th e Press, w hich h as com e very m uch to the fore in th e w rite r’s m ind w hen discussions h ave tak en p lace upon the d esirab ility of first aiders p o ssessin g advanced first aid k n o w le d g e , or even their acqu isitio n of s u rg ica l or clin ical facts. T h e incident referred to by the lad y exp lorer, occurred in the A u stra lia n B u sh . In the course of her jo u rn e y she cam e across a w om an w hose little son w as obviously suffer in g from an a tta c k of dip theria. T h e n earest doctor had been sent for but he w as seven ty m iles a w a y . W h ilst w a it in g for his return the d is tra u g h t m other sa w all the sig n s and sym ptom s of a sp h y x ia ta k in g p lace and w itn essed the ch ild ’s figh t for breath . A t last, o v e rw ro u g h t w ith a n x ie ty for his life, she ask ed the lad y exp lo rer to assist her to hold the child dow n w h ilst she m ade an incision in his throat, and he b e g a n to breath e m ore freely (a case of crude tracheotom y). W hen the doctor arrived on the scene, he w as am azed a t w h a t she had done and he questioned her a s to w h eth er she had ever perform ed an operation of th at n ature before. H e r rep ly w as in the n eg a tive and to the effect th at she had only read ab ou t it. T h e fo re g o in g is an e xa m p le of an unqualified person, w ho, h a v in g acquired som e k n o w le d g e of a certain op era tion, applied it under dire circu m stan ces and extrem e em ergen cy, th ereby s a v in g life. S u ch a parallel case could h a rd ly happen in our ow n coun try, excep t in the rem ote ru ral and m oun tain ous a reas of Sco tlan d , W a le s and Ireland. A qualified first aid er can , un doubtedly, if the slig h te st chan ce exists, save life, keep it in the body w h ilst a t the sam e tim e p re ve n tin g furth er a g g r a v a tio n of the in juries. In extrem e cases he becom es the “ life s a v e r ,” h o ld in g in his han ds a life, perhaps d elicately poised or eb b in g or flo w in g, until the e a g e rly a w a ite d a rriv a l of a doctor w hom he k n o w s w ill revita lise and fu rth er a n im ate the w a n in g life. A fte r such exp erien ces the a v e ra g e first aid er realises w h at little he k n o w s of the deeper and w on drous w o rk in g s of the hu m an body. A lth o u g h , lik e a craftsm an , he kn o w s his jo b w ell, very often he w ill ap p ly treatm en t not k n o w in g the deep u n d e rly in g cau se for its a p p licatio n . It is very m uch lik e try in g to solve a proposition of E u clid w ith ou t k n o w in g th e fu n d am en tal axio m s and m ath em atical rules upon w h ich it is based. C on sequently, the first a id er suffers from a sense of fru stratio n . Im p in g in g and finally b u rn in g itself into his mind is th e little w ord “ w h y .” U n a b le to con tain h im self a n y lo n g e r on the su bject, he seeks fu rth er e n ligh ten m en t th ro u gh the m edium of a dvan ced first aid m an u als, n u rsin g and m edical books and journals. T h is results in his o b tain in g a fu ller k n o w le d g e and deeper u n d erstan d in g of an atom y, p h y sio lo g y a nd the reason for s ig n s and sym ptom s fo llo w in g a ccid en t and illness. K n o w in g the reason “ w h y ” g iv e s one a sense of s a tis fa c tion ; in vo kes m ore keen n ess and en th u siasm , in addition to w hich, one feels m ore th at sense of “ b ein g so m eth in g of a m aster a t one’s c r a ft.” T h e re is also present in the first a id er’s m ind the fact th at there is the “ one in a m illion p ossibility ” th at w hen sk illed m edical aid is un o btain able, in a la st desperate extrem ity, he m a y be ab le to do so m e th in g beyond the ken of first aid, thereby s a v in g a life. T h e sense of perspective, h o w ever, is m ost essen tial for the en th u siast. T o realise the line of dem arcatio n betw een the la y first aid er and the doctor is of vital im portan ce. T o ven tu re no opinion outside the province of first aid ; to obey the do cto r’s in struction s and render all the in te llig e n t aid he possibly can w ill w in the d o cto r’s respect and approbation. U n fo rtu n ate ly there is the g re a t d a n g e r of th e first aider in possession of a few m edical facts, a tte m p tin g to put his ow n con struction upon a case, perhaps even to try and g iv e

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a d v ic e to th e d o c to r . S u c h a n a c tio n o n ly te n d s to lo w e r o n e in t h e e y e s o f t h e m e d i c a l p r o f e s s io n . I n c o n c lu s i o n , o n e c a n o n ly d e d u c e fr o m t h e f o r e g o i n g t h a t a fir s t a i d e r w it h a d e e p e r k n o w l e d g e o f a n a t o m y , a n d p h y s i o l o g y in i lln e s s a n d a c c i d e n t w o u ld p o s s e s s t h e r i g h t s e n s e o f p e r s p e c t iv e c o n c e r n i n g t h e r e l a t i v e p o s it i o n s o f t h e d o c t o r a n d l a y fir s t a id e r . I t w o u ld g i v e h im t h e p o w e r to r e c o g n i s e t h e e x t e n s i v e k n o w l e d g e , t r a i n i n g a n d e x p e r i e n c e r e q u ir e d f o r t h e m a k i n g o f a d o c t o r , a n d f i n a lly , in d ir e e m e r g e n c y , w h e n m e d ic a l h e lp is u n o b t a i n a b l e , e s p e c i a l l y u n d e r w a r t i m e c o n d it io n s , t h e a p p l i c a t i o n o f d e e p e r k n o w l e d g e m a y s a v e a lif e . K n o w l e d g e o f t h e d e p t h s o f fir s t a id u s e d a t t h e r i g h t t i m e , c a n b e a p o w e r f o r t h e g o o d o f m a n k i n d , p r o v id e d r e la t io n s h i p , p e r s p e c t iv e , t i m e a n d p la c e a r e k e p t c o n s t a n t l y in m i n d . — H . D . P o c h i n .

The New 2-Bearer Load Stretcher. F o l l o w in g m y letter, in last m o n th ’s issue of F ir st A id , in w hich I s u g g e s t that the n ew 2 -bearer load stretch er should be the “ m ethod of ch o ic e ,” I h a ve received an in te re stin g co m m u n ication from M ajo r D y so n H o ld sw orth , M .O . 8th (A von V a lle y ) Bn. H a m p sh ire H .G . (T h e ita lics are his.) In th is he s a y s :— “ In re g a rd to yo u r ‘ load stretch er by 2 -b ea re rs,’ a fte r m a n y tria ls w e find it to be (in o ur opinion) far better than any other method. In the F ield w e find th a t its a d v a n ta g e s a re :— “ 1. B earers do not require to k n eel on w et g ro u n d . “ 2 . B la n k e ts sca rce ly ever to u ch w et gro u n d . “ 3. H e a v y p atients can, a fte r a short e xp lan a tio n , be loaded by an y tw o in d ivid u a ls, irresp ectiv e of th eir w e ig h t or k n o w le d g e of F .A . w o rk , w ith no d a n g e r to the patient. “ 4 . H e a v y p atients can be tran sferred to stretch er w ith o u t effort. “ S. B e arers w ho a re u n able to kn eel or are w ou nded ca n ca rry it out. “ 6. O n slo p in g g ro u n d bearers can m a k e use of the slope to their very g r e a t a d v a n ta g e , ( e .g ., stretch er b elo w injured m an on slope). “ 7 . T h is w ou ld a p p ea r to be the ideal m ethod for u se by w o m e n .” M ajo r D y so n H o ld sw o rth finds that, w h en lo a d in g a h e av y p atien t, it is better to h ave the th u m b in front of, and the han ds behind, the stre tch er pole. T h is is a point w h ich e ach bearer should w o r k out for him self. I am very m uch indebted to th is M .O . for fu rn is h in g m e w ith the results of his tests. It is e x tre m e ly helpful to h ave the opinions of others an en t o n e’s ow n ideas. P erso n ally, h a v in g w atch e d n u m ero u s p atients b e in g m oved from g ro u n d to stretch er, I h a v e n ever been satisfied w ith a n y of th e m ethods in use. A ll of them are fa r from b e in g foolproof, in fa ct th ey are a tem p tatio n to fools. E x cep t w ith first-class team s, used to w o r k in g to g e th er, the 4 -bearer lift is sim p ly a s e e -s a w in g n ig h tm a re to the patient and a slo w la b orio u s jo b for the lifters. A s for the tw o -b e arer lift, it is, in the first place, u tterly useless fo r lig h t bearers and a m edium h e a v y patient. In addition there is no attem p t m ade in this lift to support the head. W h a t happens to the head of an un con sciou s patient a s it h a n g s b a ck w a rd s and d o w n ? H its the e d g e of the ca n v as I suppose, or forces the sm a ll bearer to do a “ rid e-aco ck-h o rse ” a ct on top o f th e in jured m an. A s for the la tte r’s “ hin n er-en ’, ” it does not seem to m a tter in the least if it tra ils in the m ud, a s w e h a ve often seen it do,

F I R S T A s a m atter of fact the new idea cam e w h ile w e w ere w a tc h in g an exh ib itio n of ‘ ‘ stretch er w o rk ” in w hich the old m eth ods w ere b e in g d em o n strated — s h o w in g us “ how it should be d o n e.” W e , (4 th Bn. D 'f’s H .G .) w ent on to show “ im p r o v is a tio n s ” im m ed iately a fte rw a rd s, and w e im p ro vised the sim p le m ethod there and then. It looked too darn ed sim p le to be p ra ctical or true, yet it w as w ell received by th e 80 H .G . M .O .’s present. T h e re w ill, of course, be circu m stan ces in w h ich it w ill not be possible to use it ( e .g ., a m o n g rubble, & c ., w here s tre tch er can n o t be g o t to p atien t’s back). B u t, in the vast m a jority of cases, it w ou ld ap p ea r to be infinitely sim pler, and e a sier on patient, bearers, and the nerves of a p y onlookers, than a n y other load a t present in use. F o r these reason s its adoption a s the id eal ‘ ‘ load ” seem s to be called for in the in terests of all concerned.

A I D possible, to con tin ue w ith advanced tra in in g. T h o se fa ilin g to reach the stan d ard w ou ld be the platoon S.B.’s, and w ou ld be the first selected if a ca ll to a rm s w ere m ade. T h e y w ou ld therefore con tin ue w ith their arm s tra in in g w hen ever the C. O . decided. I th in k this w ould h a ve tw o effects. O n e, it w ould en co u rag e those w ho w ere less en th u sia stic to reach the sam e h ig h stan d ard a s the others : and tw o , it w ould elim in ate the d a n g e r of the best m en b ein g selected for other duties w hen perhaps their k n o w le d g e w as m ost needed. If, how ever, all the section w ere able to q u a lify this d a n g er w ould not exist, and the h ig h stan dard reached w ould m ake such a section second to none. C. W . S p re a d b u ry (S e rg t.), Sch ool H ouse, N oel-road, W . 3.

B o w m an E d g a r , M .B . (M .O . 4 th B attn . D u m fries-sh ire H .G .)

Railway Ambulance News. The Home Guard and First Aid.

L .N E .R . the an n u al a m b u la n ce com petition of the M idland and G reat N orthern Joint L in e section of the L .N .E . R . w as revived on M ay 18th, team s from South L yn n , M elton C on stable, E ye G reen and S h erin gh am com peted a t A ilw yn H a ll, N orw ich. T h e ju d g e s , Cap t. W . G ood ley (C om m ission er of No. 1 D istrict) and D istrict S ta ff O fficer T . E. W a lesb y , c o n g ra tu lated the com petitors on the h ig h stan dard revealed in both team and in dividual w o rk . M r. H . G. R a m p lin g , D istrict Sup t. at N o rw ich , pre sented the prizes and com plim ented the s ta ff on the w a y they g a v e up spare tim e to first a id w o rk . T h e a w a rd s w ere : S h e rin g h a m , 119 points in team test, 124 points in in dividual test ; M elton, 123 and 85 ; E ye G reen , 117 and 90 ; South L yn n , 121 and 6 3 . M r. John F o sd ick , the leader of the S h e rin g h am team , w ho has qualified for a go ld m edal for 15 y e a rs’ go o d and con tin uous a m b u lan ce w o rk , w as presented w ith a certifi cate of reco gn ition . T w o m em bers of the S h erin gh am team w ho had the h ig h est in dividual m a rk s, 54 out of a possible 8 0 , received copies of “ T h e H isto ry of the O rd er of St. J oh n .” W hen

L e t m e open this m onth w ith an a p o lo g y . In the last issue I m ade a m is-statem en t (quite in ad verten tly), and a p p a r ently, ju d g in g by m y corresponden ce, caused m uch a n n o y a n ce a m o n g M edical O rd e rly Corporals in the H .G . I stated th at there w as, officially, only one Med. O rd erly, and he w a s the B a ttn . M ed. S e rg ea n t. T h is , of course, w a s in correct, a s “ R e g u la tio n s for the H .G ., 1 9 4 2 , ” clearly states “ one M ed. O rd e rly Sergeant for each B a ttn . and one M ed. O rd e rly Corporal for each p la to o n .” I can only say th at, h a v in g been a w a y and b e in g very late for press, I failed, in m y h u rry, to ve rify m y facts until too late to m ake the correction . I discovered it, h o w ever, w h en re a d in g my’ notes la te r, and im m ed iately w arn ed th e C orporal in qu es tion in a d va n ce of publication . T h e cu rio u s th in g is, th is question of Med. O rd erly V .S .B . has a lw a y s been a sore point w ith me. A nd here let m e rig h t a w a y correct a w ro n g im pression. I am not the B a ttn . M ed ical S e rg e a n t. M y contention is th at any first a id er a tta ch ed to the m ed ical service of the H .G ., and quite irrespective oj rank, should be classified a cco rd in g to his m erits and a b ility. O n ly in this w a y can w e hope to e n tice into the section those m en w ho a lrea d y h ave a w ide exp erien ce of first aid. And w ith so few M .O .’s a va ilab le in m an y q u a rters, th ese m en are u rg e n tly required, h o w ever keen th e in exp erien ced recru it m a y be. E sp ecia lly so w hen one realises th a t these m en cann ot con cen trate e n tire ly on th eir m edical tra in in g . T h e y h a ve still to ca rry on th eir field and arm s tra in in g . A nd co n sid erin g the h ig h stan d a rd reach ed in m a n y m ed ical section s, this reflects very m uch to th eir credit. L e t m e outline a s u g g e s tio n I m ade to m y ow n C o m p an y C o m m a n d er, and w h ich is re ce iv in g serio u s con sideration . B e a r in g in m ind the fact th at w e are a combatant section and can be called on to ta k e up a rm s at an y tim e in an e m erg e n cy , if this w ere done in d iscrim in atly it w ould serio u sly d isru p t the m ed ical w o rk of the section, and p er h a p s the m ost exp erien ced first a id ers w ould be affected. I s u g g e s te d therefore, th at all the section be g iv en a re a so n able tim e for in tensive tra in in g , a fter w h ich th ey w ould receive a fa irly s tiff test. A ll th ose w ho reach ed a certain stan d a rd a s decided by the M .O . w ou ld be con sidered the C o m p a n y Medical Orderlies. (T h is w ou ld h a ve to be a local a rra n g e m en t, of course, and w ould have no official statu s, o w in g to e x is t in g re g u la tio n s .) T h e s e men w ou ld be allo w ed , a s fa r as

L O N D O N , M ID L A N D & SC O TTISH B u x t o n . — T h e a n n u al din ner and presentation of a w a rd s of the B u x to n L .M .S . A m b u la n ce C en tre w as held a t the B u rlin g to n C a fe on T h u rs d a y eve n in g, M a y 11th. In the absen ce th ro u g h illn ess of M r. G. B rad sh a w , statio n m aster, the ch air w as tak en by M r. H . B irley, perm an ent w a y inspector, and the fo llo w in g a w a rd s w ere presented by the class lectu rer, D r. G . J. G riffiths :— V o u ch er, R . C ole ; m edallion s, D . F ra ser, E. W a ls h ; labels, J. A d sh ead , G . B ra d sh a w , E . B ram w ell, E. D rap er, T . F ra ser, F . H a y to , A. H e lliw e ll, H . H o rsfa ll, A. K itch en , E . L ee , S. L ee, C. P la n t, W . S m ith , I. Sm ith , R . W h ite head , H . H o yle, W . G ordon . D r. J. J. H a n n a presented lo n g service a w a rd s and co m petition prizes as fo llo w s : L o n g service go ld m edal (15 years), M r. G . B ra d sh a w ; lo n g service bars (20 years), M essrs. E. B ra m w e ll and A . A tk in . C om p etition : 1st prize, H . H o r s fall ; 2 nd, F . H a y to ; 3 rd, T . F ra ser.

“

G A S -a

S y n o p s is o f D e fe n c e A g a in s t ’ ’

By JOHN F E N T O N , M .B., B.Ch., B .A .O ., D.P.H . P R IC E : Is. Id. post free. ES S E N TIA L

FACTS

W IT H O U T

PADDIN G.

Published by Dale, Reynolds & Co., Ltd,, 46. CannonStreet, London, E.C.4.

F I R S T

y o

because it has proved to he a m ost effective antiseptic. W hat is its pharm acological action ? Medical science cannot agree on the answer, any more than it can explain precisely w hy rheum atism should often respond to treatm ent w ith iodine. W e know that life cannot exist w ithout io d in e ; but w h y? This problem is y et to be solved. R IM A R IL Y

Io d in e 2 O

S T O N E

A I D

s e

•39

IO D IN E ?

W hile iodine keeps so m any secrets, it discloses others. I f you think a better knowledge o f this fascinating elem ent would help you in your work, the IO D I N E E D U C A T IO N A L B U R E A U will alw ays be happy to answer your ques tions. This service is free to any m em ber o f the nursing profession or first aid worker.

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H e a d a c h e s re s u ltin g fro m o v e r w o r k an d fa tig u e re sp o n d r e a d ily to tr e a tm e n t w ith ‘ A n a d in .’ A b a la n c e d c o m b in a tio n o f a sp irin , p h e n a c e tin an d ca ffe in e , th is p r e p a r a t io n a c ts r a p id ly a n d e ffe c tiv e ly an d m a y b e re c o m m e n d e d w ith c o n fid e n ce. T h e c o n s titu e n ts o f ‘ A n a d in ’ are c a r e fu lly s ta n d a rd is e d . I t is n o t h a b itfo r m in O " a n d th e re are no h a rm fu l or u n p le a sa n t a fte r-e ffe c ts .

SKLEN PLASTIC BANDAGE REMOVER (non-inflam able)

A s o lu t io n fo r d is s o lv in g t h e a d h e s iv e o f p la s tic b a n d a g e s , e n a b lin g e a sy r e m o v a l o f t h e p la s t e r and s u b s e q u e n t c le a n s in g o f th e a d h e s iv e re m a in in g o n t h e sk in . Further information, samples and prices upon request.

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F I R S T

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“SANOID” RESPIRATOR FRAME Registered Design No. 806838 a r e e s s e n tia l t o a l l d iv is io n s

0 F

Price of Filter Masks (Respirator

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on Application

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a n d c a n b e O B T A I N E D fr o m

HOBSON & SONS (L O N D O N ) U N IF O R M

C L O T H IN G

This frame has been designed especially for the purpose of securely locating and thus preventing slip of Cotton W ool Filters or other Masks when used as Respirators in safeguarding workmen against dust arising from industrial operations. It possesses many advantages over other articles of a similar character Inasmuch as : It is rustproof and smooth, being flexible it readily conforms to contour o f the face thus ensuring correct positioning of the Mask. It is light, easy to adjust, and the lower portion fits comfortably under the chin thus anchoring both frame and filter.

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“ PORTLAND A M BU LA N C E C EA R The Gear illustrated (A.B.C.D.) carries tw o stretchers on one side of Ambulance, leaving other side clear for sitting patients. UP A N D D O W N action is quick easy for loading or unloading.

A. Shows the two stretchers in position' B. Shows the top stretcher lowered ready for loading. C. Illustrates the same Gear with the top stretcher frame hinged dmvn for use when only one stretcher case is carried. D. Shows the same position as in “ C only with cushions and back rest fitted for convalescent cases. W here Ambulances are required to carry four beds two Gears are fitted, one on EITHER SIDE, and the same advantages apply as described above.

full catalogueofAmbulanceEquipment No. 7Awill be sent onrequest.

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F I R S T

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h o u rs, m a y be re a d ily re lie v e d b y th e a d m in i

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EMERGENCY TREATMENT OF SKIN INJURIES

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Be prepared for an emergency! and keep Cuticura Brand O int ment in your First Aid Kit. It' 1 rings instant soothing relief to tuts, burns, skin lacerations— ' prevents spread of infection,* quickly heals. Obtainable at all Chemists and Stores, c i

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T h e S .M .A .E . (Sw ed ish M a ss a g e and E lectrical) In stitu te is the oldest of its kin d in G re a t B rita in , h a v in g been establish ed fo r a qu arter of a cen tu ry. M a n y of the W o r ld ’s le a d in g M asseurs and exp o n en ts of M a n ip u la tive T h e ra p y h ave been trained by the S .M .A .E . In stitu te. W rite w ith ou t delay for free B o o k le t “ M ANIPULATIVE T H E R A P Y AS A PROFESSION” This FREE Booklet tells you how to acquire the art of scientific massage by unique method of Home Study, and how you can establish a private practice of your own.

F I R S T

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Queries andAnswers toCorrespondents Q u eries w ill be d ealt w ith un der the fo llo w in g ru les :— — L etters co n ta in in g Q u eries m ust be m a rk ed on the top left-han d corn er of the envelope “ Q u e r y ,’’ and addressed to F ir s t A id , 46, C an n on -street, L on don , E .C . 4. 2 -— A ll Q u eries m ust be w ritten on one side of paper only. 3.— A ll Q u eries m ust be acco m p an ied by a “ Q u e ry C oupon ” cu t from the cu rren t issu e of th e Journal, or, in case of Q u eries from abro ad , from a recent issue. L — T h e T e x tb o o k to w h ich referen ce m a y be m ade in this colum n is the 3 9 th (1 937) E dition of the S .J .A .A , M an u al of F irs t A id to the In jured.

L a y In stru ctor C ertificate. J .C . (C en tra l M ed iterran ean F o rc e s ).— A s a re g u la r reader of F i r s t Aid w h ich is sen t to m e every m onth I notice th a t quite a lot of readers are a s k in g ab ou t the L a y In stru cto r C ertificate. A s a m em ber of the B r ig a d e and an a m b u la n ce m an of the L .M .S . R a ilw a y , I should like very m uch to k n o w if I can obtain the certificate. I hold the m edallion and label of the A sso ciation and in addition 1 am a second class N u rs in g O rd e rly R .A .M .C . I am very in terested in the a ctiv itie s of the S .J .A .B . and I hope to retu rn to them w hen this lot is over. I have w o rk e d in p ra ctically every D e p artm en t of the M edical C orps and I feel quite confident in p a ssin g a L a y In stru c to r exa m in atio n . I e a g e rly a w a it yo u r a n sw er to m y a irg r a p h and th a n k yo u in a n ticip atio n of your kind reply. In a n sw e r to yo u r q u ery, no a rra n g e m en ts h a ve been m ade for co n d u ctin g th e e xa m in atio n for the L a y In stru cto r C ertificate on beh alf of m em bers of the B rig a d e w ho are s e rv in g o verseas. C o n seq u en tly there are difficulties. If, h o w ever, y o u r M .O . is w illin g to u n d ertak e for the B r ig a d e yo u r e xa m in atio n in P a rt I (P ra ctica l and O ra l) and P a rt II (L ectu re), then the d ifficulties m ig h t be overcom e. S o obtain from yo u r M .O . a letter in w h ich he states his w illin g n e s s so to act, post it to yo u r D iv isio n a l Superin ten den t and a s k him to m a k e co n ta ct w ith the C o u n ty S u rg e o n w ho, if he app roves, w ill then send the n ecessa ry form s direct to your M .O . T h e latter w ill then return the form s d uly com pleted to g e th e r w ith yo u r an sw ers in P art III (W ritten paper) direct to the C o u n ty S u rg e o n w h o in his turn w ill com m u n ica te w ith the S u rg e o n -in -C h ief. If these con dition s are d u ly observed, w e do not th in k th a t a n y objectio n s w ill be raised ; and, if you p ass, the certificate w ill be posted by the C h ief to the C o u n ty C o m m issioner and u ltim a te ly to you. M ean w h ile w e hope that you h a ve a lrea d y received our a n sw er by a ir g r a p h .— E d ito r.

E xam in ation H ow ler. M .R . (C an non S t .) .— In a recent hom e n u rsin g exam in atio n I a sk e d one ca n d id ate w h y it is n ecessa ry for nurses to stu d y the diet of th e ir p atients. I could not refrain from la u g h in g w h en she rep lied — " I t teaches us how thev domesticate their food ! ” G ood 1

N ext please 1 !— N. C o r b e t F le tc h e r .

F irst A id T extb ooks. V .P . (M o reca m b e ).— T h e in te re stin g series of a rticles w hich a re n o w a p p e a rin g in F ir s t Aid and w h ich are con tributed by S ir H e n ry L . M artyn , in duces m e to ask , w hen are the tex tb o o k s g o in g to be revised in a cco rd a n ce w ith m odern m ethods and k n o w le d g e ? T h e ele m e n ta ry tra in in g should not stop w h ere it does now , b u t sh ould ca rry on to a p ra ctical app lication of m a teria ls th a t are lik e ly to be a v a ila b le in actu al cases. T h e b o o ks dism iss this m ost im p o rtan t a sp ect

A ID in a brief sentence or tw o, le a v in g to the im a gin atio n of the in stru cto r to fill in the blan ks. E ven n ow one sees com petitions set in w h ich the team s h ave n icely p ack ed satch els of first aid equipm ent a lrea d y to hand, and they proceed in a very efficient m an n er to dem on strate the ideal m ethod of tre a tin g a ca su alty. W e require m ore realism in tra in in g and tea ch in g first aid if it is to a ttra ct and to hold the attention of those vast num bers of recruits w ho h ave jo in ed the ra n ks of first a id ers since the b e g in n in g of the w ar. F in a lly , w h y do not the a u th o rities introduce an advan ced certificate for those w ho are tired of b ein g exam in ed in elem en tary first aid y ear a fter y e a r ? Y o u r letter is in te re stin g becau se you com plain that the first aid tex tb o o k s are out-of-date and then in your third p a ra g ra p h you m a k e a statem en t w h ich can only be tak en a s p ro vin g that they are s e rv in g the interests of first aiders a s they should ! N ext you sp ea k of a n n u a l re-exam in ation s in elem en ta ry first aid, fo rg e ttin g that, under the St. John A m b u lan ce A sso ciation at an y rate, there are none such but o nly an e xam in atio n for an elem en tary certificate w h ich is aw a rd ed to children under sixteen y ears of a g e ! F in a lly , you call for a certificate in advan ced first aid, fo rg e ttin g that first aid is a form of m edical service in w h ich la y persons raise (and doctors m odify) th eir k n o w le d g e to a fixed stan d ard and w h ich aim s at the p reservation of life, the prevention of a g g r a v a tio n of in ju ry or condition and the provision of proper transport. In short, advanced first aid is the treatm ent a dm inistered b y re g istered a n d q u alified m edical p ra ctitio n e rs! T ru th to tell, you put fo rw ard a com plain t w hich in recent m onths has appeared on tw o or three occasion s in the British MedicalJournal, and w hich w a s refuted by a laym an in its issue of M ay 2 0 th on the g ro u n d s that first aid te x t books are “ m erely m ethods of in stru ctio n .” F u rth er, on the question of im provisation, no tex tb o o k could in clude all possible variatio n s w h ich depend on the tim e, p lace and s u rro u n d in g s of the em erge n cy under treatm ent. T h e first aid textb o o ks g iv e the lead and all that is required is for the first aider to exercise his k n o w le d g e , com m on sen se and experien ce. In this connection I refer studen ts of the St. John T e x tb o o k to par. d on p. 2 1 , to rule S (a) on p. 6 7 , to pars. 1-5 on p. 223 and to other places. F u rth er, those w ho criticise the St. John T e x tb o o k are cle arly ig n o ra n t of its schem e w hich requires studen ts to m odify the g e n era l ru les of treatm ent in a cco rd an ce w ith the principles of first aid by the e xercise of their qualificatio n s as first aiders. S uch b e in g the case the T e x tb o o k (w hich is the first of the series) is still the best ; and it cann ot be accu sed of b ein g out-of-date. Indeed, the T e x tb o o k R evision C o m m ittee w ould, I exp ect, lik e to receive a list of co n stru c tive s u g g e s tio n s from the critics. In con clusion, those w ho are disturbed becau se in these y ears of w a r the T e x tb o o k in cludes the treatm en t of sn a k eb ite, either do not k n o w (or h ave fo rgo tten ) th at the T e x tb o o k is com piled for m em bers and ad h eren ts of the O rd er of St. John w ho are to be found th ro u g h o u t th e w orld w h erev er the B ritish fla g flies, and that it has been tran slated into a num ber of other la n g u a g e s . — N .C .F .

T reatm en t of B u rn s and Scalds. F. M. (Sutton). — I have been a reader of F i r s t A id for m any years and h a ve derived m uch benefit from yo u r Q u ery C olum n . W o u ld you, therefore, please assist me fu rth er w ith re g a rd to the fo llo w in g problem :— In a recent practice I w as told by our la y in stru cto r to treat a patient su fferin g from a burn on the hand. H a v in g carried o u t R u le s 1, 2 and 3 of the T e x tb o o k (p a g e 1 7 8 ) I dressed th e burn w ith strips of lint so ak ed in a fresh solution of bi-carb o n ate of soda of sim ilar s tre n g th and w arm th , m e n tio n in g th at I w ou ld keep them m o ist until m edical a id w a s obtain ed. I then covered the d re ssin g w ith a pad of cotton w ool and app lied a b a n d a g e lig h tly as described in R u le 4 (p. 1 7 9 ).

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T h e in stru cto r then told m e that I should not h ave covered the lint w ith cotton w ool a s it w ou ld abso rb the m o istu re w h en re -w e ttin g the d re ssin g and th at cotton w ool sh ould only be used w h en bi-carbon ate of soda and w arm stro n g tea are not a va ila b le . A p a rt from a p p e a rin g to deviate from the T e x tb o o k , it w ou ld ap p ear to m e th a t this is w ro n g as the cotton w ool w ou ld not only a ssist g r e a tly in e x c lu d in g a ir but w ou ld also g iv e added protection to the in ju red part esp e cially if b listers had form ed. M e an w h ile I th a n k you for a ll the a ssistan ce w hich you h ave g iv e n to the m em bers of m y team and m y s e lf ; and I hope th at you w ill be able to sp are a little sp ace to a n s w e r m y query. I a g re e en tirely w ith the ru lin g of yo u r in stru cto r ; and from th e w o r d in g of the in stru ctio n s on p. 179 of the T e x t book, I ta k e it th at cotton w ool and b a n d a g e are o n ly to be applied w hen b i-carbo n ate of so d a solution and w arm tea are not a v a ila b le a s d re ssin g s in the tre atm e n t of burns and s c a ld s .— N .C .F .

Status of C a d e t O fficers. E. F . (L iv e rp o o l).— I h ave been h a v in g a little a rg u m e n t re the in terp retatio n of the R e g u la tio n s g o v e r n in g the sta tu s of O fficers of C ad et D iv isio n s, and sh ould be very g la d to h ave y o u r opinion. T h e G o v e rn in g R e g u la tio n s are : P a ra. 105 G en eral R e g u la tio n s , and P a ra s. 2 8 , 32 and 33 of C ad et R e g u la tions, pp. 5 and 6. T h e g e n e ra l view in L iverp oo l is that a C adet O fficer is only an O fficer w hen he or she is w ith their C a d e t D ivisio n , and im m e d iate ly reverts to his (or her) su b stan tive ra n k w hen w ith the A d u lt D iv isio n on p arade or class. T h is seem s to m e to be a g r o s s m isre ad in g since p ara. 105 G en eral R e g u la tio n s say s : “ T h e ra n k s of . . . . C a d e t S u p erin ten d en t and C ad et O fficer are ad d ition al to establish m en t, and those h o ld in g such ap p ointm ents revert to th eir su bstan tive r a n k on resignation. D u r in g the tim e they hold such a pp o in tm en t th ey w ill be con sidered O fficers of the D iv isio n su p ern u m erary to e sta b lish m e n t.”

Cadet Regulations. P a ra . 2 8 . — “ . . . . on returning permanently to their D iv isio n s they w ill resu m e th eir su b stan tive r a n k .” P a ra. 3 2 . — “ B r ig a d e m em bers appointed to C adet un its a re seconded for th at purpose . . . . 1 T h e G en eral R e g u la tio n s m a k e cle ar the position of C ad et S u p erin ten d en ts and C a d e t O fficers, and their position in a D iv isio n , i.e ., d u rin g the tim e they hold such app oin tm en t th ey w ill be considered O fficers of the D iv isio n su p ern u m erary to e sta b lish m e n t.’ ” P a ra. 3 3 . — “ . . . . as re g a rd s parades, he or she is en titled to fall in in th e su p ern u m erary ra n k un der a u th o rity of p ara. 105 (su p ra ).” M y o w n view is th at such m em bers are O fficers of the D ivisio n and entitled to such ra n k and courtesies at all tim es w hen on p arade and not o n ly w hen w ith th eir C a d e t D ivisio n . It is clear, h o w ever, th at they h a ve no e xe cu tive a u th o rity in the A d u lt D ivisio n . S u ch m em bers o n ly revert to their su b stan tive ra n k on relinquish

ing their appointment.

It seem s to m e im possible to be both an O fficer, and not an O fficer a t the sam e tim e. A nd, furth erm ore, it is v e ry bad for d iscip lin e for C a d e ts to see th eir O fficers treated a s ra n k and file by m em bers of the A d u lt D iv i sion. A s one of them said : “ Of course our Officers are'nt really Officers, are they? ” O f course, w h a t is re a lly needed is a B r ig a d e O rd er c la rify in g the statu s o f all su p ern u m eraries. T h o u g h I th in k th at the re g u la tio n s are quite cle ar on the subject. I sh a ll m uch a p p reciate y o u r opinion, a s the qu es tion affects all su p ern u m eraries.

R I D Y o u r in terpretation of B rig a d e R e g u la tio n s w ith refer ence to the statu s of C ad et O fficers is correct. — E d i t o r .

C o n tact w ith E le c tric C urren t. A .S . (S to ck p o rt).— Y o u are called to the help of a m an found g r a s p in g a live e le ctric w ire. It p roves im possible to sw itch o ff the current. P lease tell us h o w it is possible to d is e n g a g e his han ds from th e w ire w ith o u t in ju rin g them . A lso w ill not the stre n g th of the cu rren t cause the han ds to adhere firm ly to the w ire ? Y o u r q uery is a n sw ered on p. 159 of the T e x tb o o k .— N .C .F .

T reatm en t o f A sp irin P oison ing. D .A . (F in ch le y ).— A sp irin is re ga rd ed a s a perfectly safe hom e rem edy ; and yet, tak en in la rg e r doses than norm al, it can produce som e a la r m in g sym ptom s. F u rth er it has becom e a p opu lar poison, b e in g often tak en by w ou ld-be suicides. T h is b e in g the case, it is u n fo rtu n ate th at the T e x tb o o k does not tell us a n y th in g about the poisonous effects of asp irin and their tre a t m ent. M ay w e a s k you k in d ly to rem edy th is om ission ? F irst, you do not k n o w y o u r T e x tb o o k , sin ce you h ave not yet realised that, acting on its instructions, you can treat a n y ca se of p o iso n in g w h eth er you k n o w the poison and its nam e or not ! In short, all you require to k n o w is the state of the p atien t’s m outh and lips. If these are burned then you m ust treat for C o rro sive P o iso n in g ; but if they are not burned, then you m ust treat for N on -C orrosive P o iso n in g. Secondly, there is a referen ce in the T e x tb o o k (p. 1 6 9 ) to asp irin a s a poison w h ich (1) does not burn, and (2) falls w ith in the second g ro u p of H yp n o tics b e in g “ one of those tab lets and preparations w h ich are used to relieve pain and in duce sle e p .” T h is b e in g so, you now k n o w h o w cases of p o iso n in g should be treated (T e x tb o o k pp. 170 to 1 7 3 ). T h ird ly , an ordin ary dose of asp irin m a y o cca sio n a lly (w ith som e susceptible in d ivid u als) g iv e rise to serious sym ptom s, of w h ich s w e llin g of the face, lips and to n g u e, n ettle rash, difficulty in s w a llo w in g a s result of co n gestio n of a ir p assa g es, rapid pulse, & c ., m a y b e present. W ith la rg e r doses th e sym ptom s are m ore g r a v e and u rg e n t. F u rth er, abd o m in al pain w ith vo m itin g m a y be m a rk ed and loss of con sciou sn ess m a y develop and be fo llo w ed by death in a state of c o lla p se.— N .C .F .

F ra ctu res o f L e g and F em u r. W .T . (S a n d w ic h ).— T h e o th er d a y I w a s a sk ed w h y in the treatm en t of a fra ctu red fem u r w e are ta u g h t a lw a y s to fix the sp lin t first and then the fra ctu re , w h erea s in the treatm en t of a fractu red le g w e first splin t the fractu re and then the splint. C ould you please g iv e us the reason for this differ ence in tre a tm e n t? In cid en ta lly, I h ave found g r e a t in terest in yo u r a n sw ers to queries for the p ast fifteen years. A n y m ovem ent of the p atien t is m ore lik e ly to cause co m p licatio n s d u rin g the treatm en t of a fractu red fem u r than d u rin g th a t of a fractu red le g . It is, therefore, considered a d visa b le to m odify the g e n e ra l ru le of fix in g the fra ctu re first, then the sp lin ts and la stly the lim b by fix in g the splints first in the treatm en t of fractured fe m u r.— N .C .F .

4 4

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I N J U R E D & SICK. p0^ , f# ^

An Advanced Ambulance Handbook,

Edited by N O R M A N H A M M E R , M .R .C .S ., M a jo r, lata R .A .M .C ..T .A . , AID JOURNAL.— “ One of the most concise works on the subject published at a popular price/'

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T h e w o rd s c h o l a r s h ip m a y be said to h a v e t w o d is tin c t m e a n i n g s a tt a c h a b le to it— the o n e the s u m o f the m en ta l a tt a in m e n t s o f the s c h o la r , or his s c h o l a r l y c h a r a c t e r an d q u a li t i e s — the o th e r m a in te n a n c e fo r a s c h o la r , a w a r d e d b y a u n iv e r s ity , c o l l e g e or o th e r e d u c a t io n a l e s ta b lis h m e n t , o r a su m of m o n e y paid to a s t u d e n t for h is a s s is t a n c e o r s u p p o r t in the p r o s e c u tio n o f h is stu d ie s, or m e r e ly a s a prize. T h e M edical Officer , in an e d ito ria l note, hea d e d “ N o p a y a s y o u learn fo r n u r s e s , ” c o m m e n t s u p o n the recen t a ctio n o f the N a t io n a l A s s o c i a t i o n o f L o c a l G o v e r n m e n t O fficers, s a y i n g “ N A L G O h a s w i t h d r a w n fr o m m e m b e r s h i p of th e R o y a l C o l l e g e of N u r s i n g R e c o n s t r u c tion C o m m i t te e , o f w h i c h L o r d H o r d e r is c h a i r m a n , as a r e su lt o f th e r e c o m m e n d a t io n in its r e c e n tly issu ed r e p o rt that, as a g e n e r a l rule, the s t u d e n t n u rse s h o u ld be req u ired to p a y for h e r t r a i n i n g . In a letter to the s e c r e ta r y o f the R o y a l C o l l e g e of N u r s i n g , the o r g a n i s i n g s e c r e ta r y e x p l a i n e d that the N a t io n a l E x e c u t i v e C o u n c i l c o u ld n o t a g r e e w ith this p r o p o s a l an d w is h e d p u b l i c l y to d is so c ia te itself fro m i t . ” T h e c o n te n tio n o f N a l g o a p p e a r s to be th at p a y m e n t o f fees fo r t r a i n i n g w o u ld tend to cre a te tw o cla s s e s o f st u d e n t n u r se s — an “ a r is to c r a c y ” w h o had paid for th eir t r a i n i n g and a “ c o m m o n a l t y ” w h o h a d been a ssisted b y s c h o l a r s h i p s an d g r a n t s , w h i l e the o p p o s i n g a r g u m e n t h as been that w h e n the n u r s i n g p r o fe ss io n is a d e q u a t e l y pa id , o ffe r i n g a se c u re c a r e e r fo r s u i t a b le e n tr a n ts, there w ill be no m o re reaso n fo r free t r a i n i n g th an in the ca se o f s t u d e n t s e n t e r i n g o th e r p r o fe s s io n s . It is s o m e w h a t d ifficu lt to k n o w w h a t to read into the a ctio n of th e N a l g o , b u t w e do not q u ite a g r e e w ith o u r m e d ic a l c o n t e m p o r a r y th at it s u p p o r ts the a c c e p t a n c e o f s c h o l a r s h ip s a s an a d m issio n o f in fe rio rity . W h a t e v e r r e g a r d m a y be paid to the s c h o l a r s h ip s y s t e m , the b e s t o w a l an d a c c e p t a n c e of a s c h o l a r s h ip h a s n o t h i n g o f c h a r i t y a b o u t it. A siz a r w a s a s t u d e n t w h o p a id red u ce d fees an d w a s h e n c e c h a r g e d w ith ce r ta in m en ia l offices. T h e w i n n e r of a s c h o l a r s h ip w ill p o s s ib ly p a y no fees at a ll, b u t he w ill b e r e g a r d e d h o n o r a b l y an d w ill in no c a s e be lo o k e d u p o n a s a s e r v a n t to h is fe llo w s . S i z a r s w e r e to be fo u n d a t C a m S c h o la r s h ip s ,

F I R S T

b r i d g e a n d D u b l i n , an d th ere w a s a s o m e w h a t s i m i la r o rd e r of s t u d e n t s at O x f o r d , th ese b e i n g d e n o m in a t e d s e r v ito r s . H a p p i l y s n o b b e r y is d a y b y d a y on th e d e c r e a s e and s u c h t h i n g s h a v e l o n g s in c e g o n e into d is u s e . T h e tim e m a y c o m e w h e n s c h o l a r s h ip s a ls o w ill be t h i n g s o f the past, the need fo r th em no l o n g e r e x i s t i n g ; until then th e y w ill c o n t in u e to be r e g a r d e d b y all r i g h t - t h i n k i n g p e o p le as m a r k s o f d is tin c tio n .

Recent Advances in First Aid Work in War. B y S I R H E N R Y L. M A R T Y N , K . C .V . O . , F .R .C .S . (C a su a lty S ta ff O fficer, G A rea, D evon C .C .)

( Continued from page JJS-J T h e first point w h ich needs to be clarified is that of the a d v isa b ility or o th erw ise of a p p ly in g a tourn iquet to the cru sh ed lim b prior to release. A letter upon this subject a pp eared in yo u r query co lu m n s of F eb ru a ry , 1 944. In A .R .P . H a n d b o o k No. 1 0 , 2 nd E d itio n , reprinted in Jan u a ry, 1 9 4 3 , it w ill be found th at in C h ap ter X I in stru c tions are g iv en th at this should be done, and this idea ap p ears to be still prevalent. In F e b ru a ry and M arch , 1 9 4 3 , how ever, the results of exten sive resea rch w o rk on a n im a ls w as published by several w o rk e rs. T h e se proved co n clu sively th at, co n trary to w h at had p revio u sly been ta u g h t, the m o rta lity a m o n g an im al su b jects to w hom tourn iquets had been applied w as in finitely h ig h e r than a m o n g those in w hom no con striction had been used and relian ce placed so lely upon dilution of the poisons re s u ltin g from cru sh in g on the lines a lread y described. L a r g e ly as a co n sequen ce of this research w o rk , a cir cu la r w a s issued on A u g u s t 2 1 st, 1 9 4 3 , by the M in istry of H e alth E m e rg e n cy M edical S erv ice a d v o ca tin g treatm ent by the use of a lk a lin e fluids, and, on A u g u s t 2 4 th, the M in istry of H o m e S e cu rity issued a n o th er c ircu la r to all L o ca l A u th o rities w h ieh co m p letely am en ded the in struction s g iv e n in C h ap ter X I of the 2 nd E dition of A .R .P . H a n d b o o k No. 10, re p la cin g them by orders for th e a d m in istratio n of bicarbon a te of so d a only. F rom this I hope that it w ill be c le a rly understood that the a p p licatio n of a to urn iquet to such cases p rior to release is defin itely co u n ter ordered, and it has been proved not o n ly to be useless in p re ve n tin g k id n ey d a m a g e by a b sorp tion of poisons but a ctu a lly to in crease the p atien t’s d a n g er. T h e m atter, it w ill be app reciated, is one of very g re a t im p o rtan ce, and is an in te re stin g exa m p le ot the need for the te a c h in g of all ca su a lty personnel to be kep t co n stan tly up to date. T h e re is one o th er p oint in connection w ith these in te re stin g ca ses w h ich is w o rth y of consideration, W h en the circu latio n in a lim b has been p artly ob structed by p ressu re for an y len g th of tim e, the ca p illa ries, those in fin itely sm a ll vessels w h ich form the n etw o rk of co m m u n ica tion s b etw een arteries and veins, becom e seri ou sly d a m a g ed . T h e ir delicate lin in g s are no lo n g e r im p er m eab le to the fluid part of the blood w ith in them , an d — as soon a s the com p ression of the lim b is released and cir cu la tio n restored — fluid b e g in s to escap e freely into the su rro u n d in g tissu es and the lim b becom es sw o llen and w a te r lo g g e d . Im m ed ia tely this a tta in s a n y d e g re e of severity the

A I D sw o llen tissues press upon the thin w alled vein s, w h ich be com e still m ore o bstructed, until finally the circu latio n en tirely ceases and g a n g re n e ensues. N ow in w h at w a y can the correct h a n d lin g of these cases from the m om ent of their release by the R escu e P a rty a ssist in re d u cin g these dan gers. It is obvious that the m ore rap id ly the circu latio n in the lim b is restored, before the recovery of the d a m ag ed capillaries has had tim e to ta k e place, the g re a te r w ill be the escap e of fluid from the blood stream into the tissues. A n y w ound m ust, of course, be dressed, but the lim b should be left outside the b lan kets and, if possible, elevated ; furth erm ore, no hot w ater bottles should be placed near the part. W h en the case reach es hospital, the lim b w ill very prob a b ly be w rapp ed in an e ia stic b a n d a g e from one end to the other, thereby e x e rcisin g a stead y uniform pressure w hich, w ith ou t lim itin g the circu latio n too m uch, perm its, by slow lo o sen in g of the turns, a g ra d u a l (rather than a sudden) rush of blood into the lim b. E levatio n o f the part w ill be continued, and in severe crush injuries ice p ack s m ay even be applied. T h e effect aim ed at, it m ust be noted, is com p letely different from that re su ltin g from the app lication of a to u rn i quet. T h e la tte r causes total cessation of the blood flow to the part an d — w hen it is loosen ed— in term itten t (lush ing of the part w ith blood. T h e m ethod a s described above never com p letely interferes w ith the blood sup ply, and p erm its of its slow but stead y restoration to norm al. T h e m an y question s in con nection w ith the treatm ent of burns are w ell w orth w h ile co n sid e rin g in som e detail, and I do not im a g in e that in a n y bran ch of s u r g e r y do g re a te r differences of opinion exist a s to the best treatm ent to be adopted. E ven in the lim ited field of first aid the a d vice g iv en to c a su a lty personnel has been ch a n ge d several tim es d u rin g the w ar. In the first edition of A R P H a n d b o o k No. 10 F irst A id P a rties w ere in structed ca re fu lly to rem ove the clo th in g from the affected part excep t w here it stick s ; to cu t around the a d h eren t pieces of cloth, le a v in g them in position w hen re m o v in g the garm en t. In the last edition of the H a n d b o o k (2 nd edition, re printed in Jan u a ry, 1 9 4 3 ) it is directed th a t “ clo th in g m ust not be rem oved un less ab so lu te ly n ecessary ” — an order evid en tly in d icative of a so m ew h a t belated app reciatio n of the g r e a t in crease of sh o ck lik e ly to resu lt from un n ecessary m anip ulation . In the e a rly edition it w as laid dow n th at the burnt area should a t once be covered w ith a dry d ressin g o r else im m ersed in w a te r in order to exclu de air a s soon a s possible, and that it should subsequ en tly be dressed w ith strips of lint so ak ed in eith er w arm or stro n g tea or bicarbon ate of soda, or strips im p regn ated w ith tan n ic acid jelly. A ll these in struction s h a ve n ow been replaced w ith the very m uch m ore sim ple order that dry unm edicated first aid d ressin g s should alon e be used, and, fa ilin g these, un m edicated sq u ares of lint should be em ployed and applied dry. It should be m ade clear, perhaps, that I am co n sid erin g only the burns w h ich are liab le to be m et w ith eith er in w a r or in b ig a ccid en tal fires. M y read ers m ust not im a g in e th at becau se th ey su cce ssfu lly applied som e house hold rem edy to som e m inor burn of civil life th at sim ilar m ethods are n ece ssa rily su itab le for burns w h ich m ay threaten life. N or for the m om ent am I in clu d in g the con sideration of burns due to phosphorus, a cid s or a lk a lis . W h erea s the local treatm en t of the burnt a re a is thus fa irly sim p ly disposed of, the in fin itely m ore im p o rtan t h a n d lin g of the d esp erately in jured c a su a lty dem an ds m uch g re a te r con sideration. D e ath of an in d ivid u al w ho has been rem oved b ad ly

F I R S T burnt from a blazing- b u ild in g is liable to ensue from an y of three causes. F irstly , sh o ck, the severity of w hich d irectly depends upon the area of sk in burnt ra th er than upon the depth of the burn. It is accen tu ated by the fear and horror a sso ciated w ith the circu m stan ces of the tra g e d y , b y the intense pain, and by the rapid loss of fluid w h ich occurs from the la r g e w ee p in g surfaces. T h e second m ost com m on cau se of death is that due to resp irato ry com p lication s, w hich m ay be app aren t a t once if due to p o iso n in g w ith carbon m onoxide or suffocation by sm oke, or to obstruction of the a ir p assa ges from s w e llin g re su ltin g from the in h alatio n of flam e or hot g a s e s . In ci den tally, death m ay o ccu r som e d a y s la te r as the result of in flam m ation of the lu n g s them selves. T h e third cau se w hich m ay result in a fatal term in a tion is blood p oison ing due to absorption of poisons from the burnt areas, but the frequen cy w ith w h ich this occurs app ears lik e ly to be co n siderably reduced sin ce the in troduction of the M and B g ro u p of d ru g s, and n ow of Pen cillin . W ith these points clear in our m inds, the treatm ent of the patient and the reason s thereof m a y be the m ore e asily understood. S h o ck is the first con sideration , and m ust be com bated, as u su al, by w arm th , blan kets, hot bottles, e tc., but, in vie w of th e rapid loss of fluid from the body, p articu lar atten tio n m ust be paid to re p la cin g this a s far a s possible by the free adm in istration of sw eetened d rin ks. L a te r on, in hosp ital, this w ill be reinforced by the tran sfu sio n of p lasm a. T h e facto r of fear in these cases w ill require every'effort a t reassu ran ce, and the im p ortan ce of this is apt to be fo rgo tten . In stan ces are recorded of patients h a v in g been rescued in a state b o rd erin g upon a cu te m an ia, and the e arly use of m orphia and other sedatives m ay be n ecessary. T h e se w ill serve not only to control the patient but also to reduce sh o ck by re liev in g the in tense pain, on accoun t of w hich the m ost g e n tle h a n d lin g is n ecessary. No attem pt w h ate ve r should be m ade to rem ove clo th in g, h o w ever badly ch arred , the victim should be enveloped in b lan kets, packed around w ith hot bottles, and rem oved to hospital a s an u rg e n t priority case. A s re g a rd s the local treatm en t of the burnt surfaces w h ich are exposed to air, such as the face, han ds, etc., un doubtedly the ap p licatio n of un m edicated d ry d ressin gs, such as the la rg e and m edium first aid d ressin g , or even dry lint, is the q u ick est and m ost effective. T h e y should be b a n d aged firm ly in p lace and face and eyes sim ilarly com pletely covered, le a v in g only o p en in gs for b re a th in g th ro u gh m outh and nose. In an y case, p ra ctically every victim w ill be a n a e sth e tised a fter he has sufficien tly recovered from his sh o ck in hosp ital, and, un der the a n aesth etic, the burnt a re a s w ill be clean sed, the tissu es a ctu a lly destroyed w ill be cut a w a y , and the area dressed by one or other of the vario u s m ethods now em ployed. A t the b e g in n in g of the w a r burns w ere la r g e ly dealt w ith by the m ethod then in favour, w hich consisted in a p p ly ing a ta n n in g a g e n t, such as tan n ic acid, to the surface. T h is resulted in the form ation of a la ye r of firm d ry m aterial all over the area, un der w hich h e a lin g p ro gressed w ith ou t the n ecessity for frequent painful d ressin g s. A lth o u g h this m ethod is still em ploj'ed in su itab le cases, it cann ot be u n ive rsa lly used. It w a s found, e sp ecially a m o n g airm en , w ho are liable to suffer from e xten sive burns of han ds and fingers, that the hard sheet of tanned m aterial w hich covered the fin gers w as liable so to in terfere w ith the circulatio n th at s lo u g h in g and even g a n g re n e occurred, to say n o th in g of the fact th a t s ca rrin g d u rin g h e a lin g w a s apt to produce perm anent deform ities.

(T o be c o n tin u e d .)

A I D

St. John Ambulance Brigade HEADQUARTERS

AND

D IS T R IC T

REPO RTS.

C o u n ty o f B e r k s h i r e . D u rin g the four w eek s sin ce it w a s presented to the coun ty, the M obile F irst A id P ost has been on d u ty on six occasion s, and has been used for the treatm en t of th irty-o n e m in or .cases of sick n ess and in ju ry. O ne n ew A m b u la n ce C ad et D iv isio n and th ree new N u rs in g C a d e t D iv isio n s h ave been re gistered . T h is m a kes a total of seven A m b u la n ce and nine N u rsin g C a d e t D iv isio n s in the coun ty, in clu d in g those in the R e a d in g Corps. R e a d i n g . — A m b u lan ce and N u r s in g C a d e ts of the R e a d in g C orps h a ve been g iv en the use of the s w im m in g b ath s a t R e a d in g Sch oo l. S p ecia l in stru ctio n s are b e in g g iv e n in life-sa vin g.

R e a d i n g E a s t N u r s i n g D i v i s i o n . — O n T u e sd a y e ven in g , June 1 3 th, m em bers celebrated the first birth d ay of the D ivisio n w ith an in fo rm al supper p arty. A la rg e iced c a k e w as provided w h ich w as d eco rated w ith the eig h t-p o in ted cross in the centre and one candle.

C o u n ty o f C h e s h ire . C h e a d l e a n d C i i e a d l e H e a t h . — O n Jun e 1 8 th, a t a w ell attended g a th e r in g of m em bers of this D ivisio n , A ld er m an B enn ett, J .P ., th e D iv isio n a l V ic e P resid en t, presented on beh alf of the D ivisio n , a cheque to M r. A. E . G u lw ell, until recen tly the D iv. Sup t. D iv isio n a l S u rg e o n K . D. B ean , w h o w as in the C h air, recalled the lo n g and stren u o u s period that M r. G u lw e ll had had d u rin g the seven y ea rs th at he w a s the Sup t. T h e present S u p t., M r. J. E llis M arsden recoun ted his e arly friendsh ip w ith M r. G u lw ell and the la tte r’s fine record a fte r he join ed the B r ig a d e in 1 9 2 3 , up to 1 9 4 3 , w h en he received the hon our of S e rv in g B ro th e r of the V en e ra b le O rd e r of the H o sp ita l of St. John of Jerusalem . A fter A id. B en n ett had m ade the p resen tatio n , M r. G u l w ell replied in a few w ords, p a y in g tribute to the p atience and sy m p a th y of M rs. G u lw e ll, w h o h ad n ever g ru m b le d or scolded a t his m any ab sen ces on A m b u la n ce an d B r ig a d e duties. A t the in vitatio n of the C h airm an , several m em bers exp ressed th eir a p p reciatio n of the w o r k done by M r. G u lw ell.

C o u n ty o f H e rtf o rd . W a t f o r d .— O n T u e sd a y , Jun e 1 4 th, C a d e t D istrict O fficer M iss C leasb y visited W a tfo rd for the enrolm en t of the n ew ly form ed W a tfo rd C ad et N u r s in g D iv isio n , w h ich to o k p lace in the school room a d jo in in g the C o n g re g a tio n a l C h u rch . M iss W a tts, the D iv . S u p t., w 'elcom ed M iss C le a sb y ; N u rs in g O fficer T o v e ll and A m b u la n ce O fficers Johnson and H u n t w ere present, to g e th e r w ith paren ts and friends of the cadets. T h e boy ca d ets then g a v e a d em o n stration of th eir sk ill in stretch er w o rk and the g ir ls in a d ia lo g u e w ritten by th em selves, disp layed th eir first aid k n o w le d g e . T h e p erform an ce w as a very cred itable one. A fte r this cam e the en rolm en t cerem ony, w hen M iss C le a sb y sp oke to the ca d ets of th e w on derful w o rk done by the S .J .A .B .

F I R S T

A vo te of th a n k s w as g iv e n to M iss C le asb y for co m in g and s ta r tin g th e n ew D iv isio n on its w ay , and the eve n in g closed w ith the s in g in g of G od S a v e the K in g .

C o u n ty o f L a n c a s h ir e . L i v e r p o o l . — A d em o n stration of w h a t the y o u n g g irls and boys of the S .J .A .B . are b e in g ta u g h t, w a s show n to the p ublic a t the P icton H a ll on S a tu rd a y , June 17th. T h e g ir ls ce rta in ly had a go o d k n o w le d g e of the w elfare and the feed in g of b aby, w h ilst the boys did their p hysical tra in in g w ell, and g a v e a g o o d d em o n stration of s ig n a llin g . B oth boys and g ir ls show ed a g o o d k n o w le d g e of first aid and artificial respiration . T h e L a d y Corps Su p t. (M iss E. A . C r a ig ) w ho w as p resent, deserves g r e a t credit for o rg a n is in g and a llo w in g the p ublic to see w h a t the y o u n g ste rs of the S .J .A .B . are d o in g, and how they are b e in g train ed to becom e future go o d citizens. T h e d em o n stration w a s not confined to an y one D ivisio n , but com p rised boys and g ir ls from north, south, east and w est L iverp oo l and its suburbs. L i v e r p o o l “ E ” C o r p s . — T h e L iverp oo l N u rsin g Corps held th eir an n u al C h u rch P a ra d e in the G ard en s of St. L u k e ’s C h u rch on S u n d a y , June 2 5 th, w hen th e V ic a r, the R ev. F . T a y lo r, M. A ., con ducted the service and g a v e the address. A b o u t 150 officers an d m em bers of the N u rs in g and C a d e t N u r s in g D iv isio n s w ere p resent, w ith the C orps officers and a n um ber of friends. T h e co llectio n for the O p h th alm ic H o sp ita l of the O rd er in Jeru salem am ounted to £ 6 6s. T h e w e a th e r w a s k in d , and all presen t enjoyed the service.

R I D W a k e fie ld . — O n S a tu rd a y , June 3 rd, a G ard en P a rty w a s held a t K ettleth o rp e H a ll, the hom e of M ajo r and M rs. G reav es, w ho kin d ly opened th eir d e lig h tfu l ga rd en to the W a k e field N u r s in g C a d ets and th eir g u e sts. W ith M iss C lin k e r, their S u p t., th ey w ere “ a ll o u t ” to raise m ore to “ S a lu te the S o ld ier ” than the .£ 5 3 th ey m ade la st year. A re a C o u n ty C ad et O fficer M rs. B everley, opened the p ro ceed in gs and a nice co m p an y spent an en jo yable a fte r noon. .£ 3 5 w as raised by the sale of flow ers from Chevet P a r k ; £ 1 1 from the sale of a V .A .D . doll, and £ 3 4 on the a ctu a l d ay, b rin g in g the total to £ 8 0 ; quite a p raisew orth y effort for N u rs in g C adets. B r a d f o r d . — O n S a tu rd a y , J u ly 1st, 14 boys w ere p re sented w ith their first aid certificates and enrolled into the S .J .A .B . C ad ets. T h e event to o k p lace a t U sh e r S treet C o u n cil School. T h e presen tation w as m ade by C o u n ty C a d e t O fficer M rs. F o rd , w ho w a s very pleased to be present as B o llin g A m b u lan ce C ad et D iv isio n is the first in B radford. A nother pleasan t surprise for M rs. Ford w a s to see all the cadets in uniform . A fter the presen tation, tea w a s provided for a p arty of ab ou t fifty, in clu d in g M rs. F ord, Corps Sup t. S. F irth , Corps O fficers H . B ray , J. D esm ond, D iv. Sup ts. J. W . R u sh and F. C a rr, a lo n g w ith relatives and friends of the cadets. T h e cadets g a v e a d isp lay of first aid w hich w a s very m uch appreciated.

Railway Ambulance News.

C o u n ty o f O x fo rd . C a s s i n g t o n a n d E y n s h a m . — T h e enrolm en t cerem ony of 30 recru its of this C a d e t D iv isio n to o k p lace la st m onth. T h e ca d ets m arch ed from th eir h ead qu arters under com m and of th eir officer, M r. R . J. B ru ce, S .J .A . B . , to the church w h ere the address w a s g iv e n by the R e v. T . B ran ck er, and th e lesson s w ere read by C ap t. G ly n e M orris of the U .S .A . A rm y . T h e enrolm en t cerem ony w as con ducted after the service on the V ic a r a g e la w n s by th e L a d y C ad et S u p t., M rs. T h o m so n , and the L a d y C ad et S e cre ta ry , M iss Corfield. A p resen tatio n w as m ade of o ver £ 2 by C ad ets O live H e d g e s and S u sa n P a rtrid g e , obtained by g a th e r in g and s e llin g w atercre ss for the P riso n ers of W a r F un d.

W e st R id in g o f Y o rk s h ire . W o r s b r o a n d D i s t r i c t . — A very p lea sin g cerem ony to o k p lace in th e A m b u la n ce H a ll on June 10 th, 1 9 4 4 , w hen the N u r s in g and C a d e t D iv isio n s w ere honoured by a return visit of H .R .H . P rin cess R o y a l, G .B .E ., Patron ess and D a m e C ro ss of the O rder. T h e P rin cess R o y a l w a s received by M rs. N orton, M .B .E ., D a m e of G ra ce, and other w ell k n o w n p erson ages. T h e sen ior D iv isio n s w ere inspected ou tsid e the A m b u la n ce H a ll, and an enrolm en t cerem o n y of 48 cadets w as ca rried out, th e ca d et b a d g e s b e in g presented by H .R .H . in the A m b u la n ce H a ll. A fte r a d e lig h tfu l p h ysical tra in in g d isp la y , e tc ., the P rin cess R o y a l presented a S .J .A .B . fla g to th e lo cal C a d e t D iv isio n , this b e in g the g ift of the V ice P resid en t, M rs. N orton. H .R .H . then in sp ected a Y o u th R a lly and M arch P ast of n ea rly a 1 ,0 0 0 yo u th s and g ir ls re p re se n tin g all the Y o u th G ro u p s of the D istrict. H e r R o y a l H ig h n e s s eve ry w h ere received a ro u sin g w elco m e and on her d epartu re the Y o u th G roup s form ed a g u a rd of hon our for the R o y a l visitor, and show ed their g r e a t a p p reciatio n of her visit by ro u sin g cheers as h er ca r carried her th ro u g h their ra n k s.

GREAT

W ESTERN

Mr. H . A. Payne, station m aster, presided at the recent presentation of a m b u la n ce a w a rd s. T h e a w a rd s w ere distributed by the lectu rer, D r. J. C. D ix e y, w h o m ade m ention of his h ap py asso ciatio n w ith the G .W .R . first aid m ovem ent. T h e ch a irm an presented M r. A . S. G ra n t w ith a w a lle t on beh alf of the cla ss m em bers in a ck n o w le d ge m en t of his w o rk as secretary. T h a n k s to D r. D ix e y w ere voiced by M essrs. I. H a rris and W . D oble. B a rn s ta p le .—

L O N D O N , M ID L A N D

& S C O T T IS H

T h e w o rk of the L .M .S . R a ilw a y A m b u lan ce M ovem ent in S co tlan d w as, a s in form er y ea rs, conducted u n der the auspices of the St. A n d re w ’s A m b u la n ce A sso ciation d u rin g the yea r ended M arch 31st, 1 9 4 4 . T h e in terest of the sta ff in first aid w o rk has been m a in tain ed but a g a in there has been a sm all d ecrease in num bers o w in g to w a r conditions and the m an y calls m ade on the sp are tim e of in dividuals. T h e n um ber of L o n g S ervice A w a rd s to m em bers of the sta ff in S co tlan d now total :— L o n g S erv ice M edals (15 years), 1 ,1 9 6 ; B a rs, 20 y e a rs ’ service, 716 ; 25 y ea rs, 449 ; 30 y ears, 280 ; 35 years, 122 ; 40 years, 32 ; 45 y ears, 6 ; 50 y ears, 2 . In addition, d u rin g the past yea r no few er than 98 vo lu n ta ry m edical service m edals w ere gra n ted to m em bers by the S. A. A. A. in respect of 15 y e a rs ’ efficient service.

D e r b y . — T h e a n n u a l presen tation of a w a rd s of the D e rb y L .M .S . O ffices A m b u la n ce C la ss to o k place a t D e rb y R a ilw a y In stitu te on June 2 8 th. Mr. W . B. C a rte r, D istrict G oods and P a s s e n g e r M a n a g e r, presided and th e fo llo w in g a w a rd s w ere presented by L t.-C o l. J. W . W a tk in s, D iv isio n a l Sup t. of O p eration :— 4 0 y e a rs ’ L o n g S ervice B ar, T . B u rn h am ; 15 y e a rs ’

F I R S T L o n g S erv ice G old M edal, W . H a tch ; V o u ch ers, 1 ; M ed al lions, S ; M edallion L a b e ls, 2 1 . In app reciation of his services to the cla ss a g ift w as m ade to the cla ss lectu rer, D r. P en n y ; w h ilst tributes w ere paid to the w o rk of the Secretary, Mr. W . H a tch and the la y in stru cto rs, M essrs. T . B u rn h am and G. D ale.

L .N .E .R . L

ong

er vic e

old

w ards

W e h ave received a list of the sta ff of the L . N .E .R ., N orth E astern A rea, w ho have becom e entitled to L o n g S e r vice G old M edals and B ars for the h alf y ea r ended M arch 31st, 1 9 4 4 , O w in g to pressure on space w e are com pelled to su m m arise these as fo llo w s :— G old M edals, 2 9 . B a rs— 20 years, 16 ; 25 years, 3 ; 30 years, 2 ; 35 y ears, 3 . It is very p lea sin g to note th at despite the m an y calls upon m em bers of the sta ff w ho are interested in first aid, it h as a g a in been possible to hold a com petition in all the six districts, n a m e ly :— D a rlin g to n , H u ll, L eed s, M id d lesbro u gh , N e w ca stle and Y o r k , w h ich h ave been w itn essed by la rg e audien ces of interested sp ectators. A rran ge m en ts h ave been m ade for a final com petition to be held a t Y o r k this m onth, w hen the w inn ers of the district com petitions w ill com pete.

A I D

an ce by civ il first a id p arties had to be refused. T h e re are m an y such cases. It is n ecessa ry to th o ro u g h ly un derstan d the role of the H .G . in all its p hases, not m erely stu d y o n e’s o w n lo cal con dition s, before w e can criticise th e la c k of u n i fo rm ity and collab o ratio n b etw een the tw o services. If un iform ity is so essen tial, w h o is to decide on its de tails w hen , g e n e ra lly s p e a k in g , each service is train ed fo r a definite section of first aid w o r k p ecu lia r to itself. A g a in , equ ipm en t a va ila b le to th e C .D .S . cann ot be carried by first aid un its in the field, and different m eth ods m u st be evolved. A pp roach and rescu e m eth ods m u st differ. (A propos of this, M r. W o o d u n n ecessa rily sta tes th a t field units h ave a lw a y s realised the need for ta k in g cover, fa llin g flat rep eatedly w hen a p p ro a ch in g ca su a ltie s, etc.) A gre ed . B u t only recen tly h a ve m ethods of treating and removing ca su altie s w h ile in the prone position been re g u la rise d in drill. Im pro visatio n and person al in itia tive , w h ile essen tial to all first aiders, can a lm o st be said to ta k e prior p lace in H .G . tra in in g — in fact, it is com m on to s ta g e com p etitions w h ere n o th in g b u t im p ro visatio n counts. T o sum up, let us co llab o rate w h en e ve r possible ; h e lp in g one a n o th er ; le a rn in g a ll w e can, each from the other. It is the w o rk th at is im p o rtan t, not the service ; but do not let us in sist on a b so lu te un iform ity. It ju st w o n ’t w o rk ! In clo sin g , I k n o w all H .G . F irst A id ers w ou ld w ish me, on th eir behalf, to exten d to D r. C o rb et F le tch e r our h eartiest co n g ra tu la tio n s on his a w a rd of the O. B. E . “ The best of lu ck , N .C F . , from us a l l.”

The Home Guard and First Aid. The

C .D .S .

and

C. W .

(S e rg t.), Sch ool H o u se, N oel-road, W . 3.

Spreadbury

H .G .

are, perhaps, few people w ho adm ire the splendid w o rk of the C .D .S . m ore than w e m em bers of the H .G ., w ho often find ourselves, e sp ecially in certain areas a t the present tim e, w o r k in g w ith them and for them ; and m ost va lu a b le are th e lesson s w e h ave learn t. B u t w h en d e a lin g w ith the relatio n sh ip betw een the tw o services, w e m ust v ie w th in g s in their true perspective. M r. Jam es W o o d m a k es the sw e ep in g statem en t that “ the C .D .S . are to the H .G . w h a t the R .A .M .C . is to the fig h tin g units ” ! E x cep t for th eir a m b u la n ce service, I sa y “ No, S ir ! ” H o w does he cla ssify the efficient m edical units a tta ch ed to a ll B a tta lio n s— efficiency g e n e ra lly g a in ed under adverse con dition s, w ith few qualified in structo rs and little support, and tra in in g not confined to a couple of p arades a w ee k , w ith all their atten d an t w astes of tim e on o th er connected duties. S u rely, these units are the R .A .M .C . of the service ? T h e o n ly difference is that, in stead of b ein g o rg a n ised under a sep erate con trol, each un it is self-con tain ed and com es under its ow n C o m p an y orders, both for tra in in g and in its op erational w o rk , w ith m edical direction by the B a ttn . M .O . E ven so, in certain areas, a t least, they m ust consider them selves m obile, and, in actio n , w ould have to be prepared for tran sfer to other C oy. a re as if such Coys, found th em selves in need of g re a te r m edical support. U n fo rtu n ately, the H .G . have no a m b u la n ce service, and this is w h ere the C .D . is of in estim able va lu e to us. A s re g a rd s co llabo ratio n and w o r k in g relation sh ip, in other respects th is n ecessarily varies g r e a tly in different areas. W h ere the H .C . a re d efen d in g built-up a re as, facto ry sites, e tc., th ey are in close co n tact w ith th e C .D .S . But w hen defended lo calities are situ ated in the open co u n try, C .D . a ssistan ce is not so e asily a va ila b le . I h a ve had per sonal exp erien ce of th a t, w h en , o w in g to the sp ecial n atu re of the defen ce a re a , even a m u b la n ces could not ap p ro ach w ithin a q u a rte r of a m ile and very w illin g offers of a s s is t

There

New Light on the Treatment of Shock By W IL L IA M

NORTH .

has recen tly been a series of letters and notes in the on the su b ject of the treatm en t of sh o ck . F rom this certain facts e m e rg e th a t are of g r e a t im p o rtan ce to the first aider. In brief, a n ew a ttitu d e a lto g e th e r is b e in g adopted in m odern m edical circles in the m a tter ; in the lig h t of recen t research w o rk on sh o ck , it is n ow held th at the a p p licatio n of h eat to a sh o cked p atient m a y ca u se m ore h arm than good. T h is , of course, cu ts rig h t across th e presen t T e x t book tea ch in g , but the facts as presented by th ese e x p e ri m ents seem in controvertible. H e re w e h a v e one of those cases in w h ich you h ave certain treatm en t accep ted u n q u estio n ab ly for m a n y y ea rs, based upon a theory th a t has n ow su d d en ly been exp loded. D u r in g the la st w ar the h e at tre atm e n t of sh o ck , esp e cially by ra d ia n t heat, w as rou tin e, and this w a s con tin ued to be the p ractice until quite recen tly. T h e a p p a re n tly im proved p ulse w a s rega rd ed as proof of the e fficacy of the treatm ent. N ow th is in crease in su p erficial circu latio n is reco gn ised as b e in g at the exp en se of the v ita l o rg a n s. It is said that a s m uch a s 500 c.cm . of blood m a y be diverted from the v ita l o rg a n s to the su rfa ce a re a s of the body by the a p p lica tion of h eat ; at a tim e w h en the bo d y can ill-afford this. It is now k n o w n th at in sh o ck there is d ilatio n of the p eri p heral blood vessels o w in g to the loss of v a s cu la r m u scle tone. T h is fu rth er w ith d ra w a l of blood from the vita l o rg a n s can but w orsen m atters. T h a t th a t is w orse from a th eoreti ca l point has been a m p ly proved b y recent exp erim en ts. T h e app licatio n of ra d ia n t h eat to n orm al persons w a s found to be h arm fu l even to them . W h a t w e are a c tu a lly d o in g is u p settin g N a tu re ’s b a la n ce in these cases.

T h ere

British Medical Journal

F I R S T

A lth o u g h it is not s u g g e s te d , of course, th a t w e g o as fa r to the opposite a s to freeze our patients, it has been found by recen t e xp erim en ts th at the ap p licatio n of cold to d o g s su ffe rin g from e xp erim en tal sh o ck w as beneficial ; th a t they su rvived lo n g e r w hen cold w a s applied than w hen heat w as app lied. F rom clin ical eviden ce n ow a va ila b le , w e m ay safely sa y th at un due heat is u n d esirab le, and th a t its reckless a p p licatio n m a y h a ve g r a v e con sequences. T h e first a id er’s best plan in the lig h t of n ew k n o w le d g e on th e su b ject is to be g u id ed by the requirem en ts of the in d iv id u a l p atien t— to ap p ly only such w arm th as m a y be ab so lu te ly n ecessary. T o quote the B.M.J. (N ov. 2 7 , 1 9 4 3 ): — “ If the patient co m p lain s of cold he sh ould be g iv e n e n o u g h cover and w arm th for com fort, but o verh eat should be re g a rd ed a s un desirable. In the absen ce of a n y s h iv erin g or other discom fort from cold, it is u n lik e ly that cold does m uch h a r m .”

L e tte r s to t h e

A I D

TRAINING IN HYGIENE THE ROAD TO PROMOTION T he possession of th e Diplom a of the Royal Institute of Public Health and Hygiene is a great help to Prom otion. It stamps one as an e x p e rt in Health M atters, and renders one eligible fo r M em bership of th e Institute.

C L O U G H ’S C O U R S E S ARE TH E

T h ere are 24 o r m ore com prehensive sets of w o rk . These ordin arily requ ire six m onths’ spare-tim e preparation. H ence v ery early joining is advised. T he C ou rses are very carefully drafted and a feature is made of solving th e individual difficulties of Students. A n y person o ver 18 years of age may en ter for th e Exam. A lso Classes for

E d ito r.

VERY L O W BOOKS

W e are in no w a y responsible for the opinions exp ressed, or the statem en ts m ade, by C o rresp o n d en ts.— E d i t o r . F IR S T

A ID

I w as m uch in terested in the letter of V .P . (M orecam be) and the reply. T o a certain exten t I a g re e w ith his point of view , but the stan d ard to w h ich he becom es advan ced lies in his ow n efforts. M y re g re t is th a t the S .J .A .A . does not provide stim u lu s to fu rth er stu d y by g r a d in g certificates. It w ou ld perhaps be as w ell here, for m e to state that as a first aider, I w ou ld not a ttem pt a n y treatm en t of w ound, fra ctu re or sudden illness, e tc., outside the scope of first aid and beyond the in struction s laid dow n in the T e x tb o o k , fully re a lis in g from exp erien ce that in m ost cases it w ou ld be d a n g ero u s so to do. T h e re fo re I a g re e , th a t as far a s the p ractical a p p lica tion of first aid is concerned there can be no advanced in stru c tion, b u t I do feel th a t fu rth er a d va n ce could be m ade in o th er d irectio n s, viz., theory and the w h ys and w herefors of the treatm ents. I do not th in k th a t an y harm could com e from first a id ers h a v in g a g re a te r k n o w le d g e of a n a to m y and p h y sio lo g y , in fact 1 th in k it w ou ld be beneficial, in so far th at it w ou ld help them to m ore fu lly a p p reciate the lim its of treatm en t in the T e x tb o o k . A n o th er direction th at an a dvan ced course could ta k e , w ou ld be th at of w a r in juries. E xcep t for som e A .R .P . p u b licatio n s, there is p ra ctically no in form ation a va ila b le on this su b ject, and in fact I h ave m et q u ite a n u m ber of first aid ers w ho h a v e no k n o w le d g e of open or tension pneum o th o ra x or its im m ediate treatm en t, and w ho do not k n o w the differen ce b etw een a p erfo ra tin g and p en etratin g w ou nd. A g a in , every d a y ailm en ts and w o rk sh o p acciden ts w ou ld provide am p le scope for e xp an sio n — of course only from th e point of view of u r g e n c y — th eir treatm en t is for qualified m ed ical m en obviously. I hold the L .C .C . T e a c h e r ’s C ertificate in first aid, and I h a v e been co a c h in g first aiders, chiefly in A .R .P . first aid, for som e y ea rs a t m y firm. I fu lly app reciate the need for co n sta n t stu d y and w ou ld w elco m e th e in struction and advice rom those qualified to g iv e this. I w ou ld lik e to ta k e this o p portu n ity of th a n k in g you for the a rticle s of S ir H e n ry L . M artyn , th ey have proved m ost helpful, and I e a g e rly a w a it each p u b lica tio n .— Y o u rs fa ith fu lly io n e l

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On F iv e Occasions Clough’s Students have H eaded the H ygiene List 89 Students have gained H o n o u rs, and in addition numerous Students have gained Passes.

NURSERY S C H O O L COURSES M A TR IC U LA TIO N E N G L IS H B IO LO G Y P R A C TIC A L P S Y C H O LO G Y

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IN S T IT U T E

LEATHERHEAD

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F I R S T

Queries andAnswers toCorrespondents Q u eries w ill be dealt w ith un der th e fo llo w in g ru les :— 1-— L etters co n ta in in g Q u eries m ust be m a rk ed on the top left-han d corn er of the envelope “ Q u e r y ,’’ and addressed to F i r s t Aid, 4 6 , C an n o n -street, L on don , E .C .4 . 2. — A ll Q u eries m ust be w ritten on one side of paper only. 3. — A ll Q u eries m ust be acco m p an ied by a “ Q u e ry C oupon ” cu t from the cu rren t issue of the Journal, or, in case of Q u eries from abro ad , from a recen t issue. 4 . — T h e T e x tb o o k to w h ich referen ce m a y be m ade in this colum n is the 39 th (1 9 3 7 ) E dition of the S .J .A .A . M a n u al of F irs t A id to th e In jured.

R ate o f C ircn lation . J .D . (G a te sh e a d ).— A t a recent lectu re g iv en by an O fficer of our D iv isio n in the B rig a d e , on th e circu latio n of the blood, he stated that it to o k the blood 2£ m in utes to circu late , I d isa g re ed w ith him s a y in g it only took 30 seconds, am I rig h t ? Y o u revive a v e x a tio u s problem w h ich w a s freely d is cu ssed in th is co lu m n in the M arch , A pril and M ay, 1943 issu es of F i r s t Aid, and w h ich is outside the scope of p ra ctical first aid. S o w h y w o rry ab ou t sp lit seco n d s— esp e cially w hen w e rem em b er th at the le n g th of th e jo u rn e y in a circu it of the circu latio n depends on the part of the body w h ich is b e in g supplied w ith blood. In m y lectu res I a lw a y s state th at the circu latio n can be com pleted in th irty seco n d s.— N. C o r b e t

F le t c h e r . E xam in ation H ow ler. D .S . (E a st L o n d o n ).— In a recen t exa m in atio n the doctor ask ed a ca n d id ate w h ich w as the m ost im p ortan t principle in the p ra ctice of first aid. F rom his look of surprise w e g a th e re d that he did not an ticip ate the a n sw er w hich w as g iv e n in all serio u sn ess— “ To remove the patient

from the accident ; or, ij this is not possible, to remove the accident Jrom the patient / ” A fte rw a rd s w e told the ca n d id ate th at his a n s w e r w as g o o d en o u g h for F ir s t

A id ! G ood !

N ext, p lease ! !— N .C .F .

T rea tm en t o f Tetan u s. R .P . (D u b lin ).— I read w ith in terest yo u r rep ly to the query w h ich w a s d ealt w ith un der the h e ad in g Use of Petrol for Wounds in the M ay issue of F ir s t Aid. N o w I a s k if you w ill please sa y if there is a n y sp ecial treatm en t for w ou n d s (w h ich are lik e ly to be infected w ith tetanu s as from a farm in strum en t) beyond the o rd in ary treatm ent of a w ound and g e t tin g the patient to hosp ital a s soon a s possible. A lso , h o w soon does an injection h ave to be g iv e n to be of a n y use ? F ro m the first aid point of view no action is to be tak en beyond th at laid dow n in the T e x tb o o k un der the treatm ent of w ou n d s. A lso the question of the treatm en t of tetan u s is beyon d the scope of first a id .— N .C .F .

A ctio n o f S m e llin g Salts w ith H ead In ju ries. P. N. (N ew castle). — I shall be g ra te fu l if you w ill tell us w h y the T e x tb o o k in R u le 7 , p. 45 tells us not to app ly s m e llin g salts in cases of head in ju ry. A lso, how do s m e llin g s a lts a c t ? Y o u r kin d a n sw ers w ill be appreciated. T h e T e x tb o o k tells us to w ith old the use of sm e llin g salts in the treatm en t of head in ju ry (1) becau se haem orrhage of th e brain m a y be present or th re a te n in g and (2) because s tim u latio n o f the brain by sm e llin g salts m a y a g g r a v a te or even p recip ita te this g r a v e co m p licatio n .

A I D S m e llin g salts stim u late the resp irato ry cen tre of the brain th ro u g h the nerves of sm ell. — N .C .F .

G a s C on tam in ated W ound. F .W . (B in g le y ).— In the M a y issue of F ir s t Aid you an sw ered , under the above h ead in g, a q u ery w ith refer ence to the treatm en t of a lacerated w ou nd w ith in w hich there w as a patch of liquid m ustard g a s the size of a florin ; and you stated th at a n ti-g a s ointm ent (N o. 5 ) w as to be applied. A s H om e G u ard in struction s a re th at w e should not use a n ti-g a s ointm ent on a w ound, I sh a ll be g ra te fu l for your fu rth er com m ents or in structions. In the M in istry of H e alth C ircu la r E .M .S . l 296 w e are rem inded th at a t n ig h t it w ill not u su a lly be possible to see if the w ou n ds of ca su alties are also ga s-co n ta m in ated and th at the respon sibility for proper cle a n sin g of the w ounds w ill then devolve on the H o sp ita l R ecep tion StaffF u rth er, w hen patient has reached hospital, the treatm ent recom m ended in the C ircu la r, is to rem ove the a n ti-g a s oint m ent w ith eth er and then to irrig a te the w ou nds w ith certain specified so lu tio n s.— N .C .F .

Som e Strange C o m p la in ts. B .T . (B ir m in g h a m ).— A lad y told her n eig h b o u r recen tly that the doctor had declared that her husban d w a s suffer in g from “ h a iry s lip p e rs,” a com p lain t m ore fa m ilia r to us (I hope only by nam e) as erysipelas. “ S crew m attics ” is com m on a m o n g the fo lk of m y acq u a in tan ce. A n o th er sufferer cam e d o lefu lly from his d o cto r’s s u rg e ry lo tell all and su n d ry : “ The doctor says I'm suffering Jrom general ability." If he tru ly reported the d o cto r’s d ia g n o sis his w a s a m ost excep tio n al ca se ! “ H a rico t v e in s ” I h a ve often heard of, and “ cisterns ” w h ich I kn o w to be re a lly cysts, in all parts of the body. “ T u b e rg a lo s h e s ” I h ave m et rep eatedly, and m ore th an once h a ve been told of people w hom their doctors h ave told th at they w ill suffer from “ g a s tric stom ach s ” until they g e t n ew teeth and are thus able to “ m assacre ” their food properly. So, as first aiders w e g o o ur rounds w ith sym p ath etic faces, th o u g h w e m ay often h a ve am used m inds as w ell. G ood!

N ext, p le a s e ! !— N .C .F .

F irst A id T extb ooks. P .F . (C h else a ).— M y friends and I read w ith g r e a t interest yo u r spirited rep ly to the query w h ich w a s published un der the above h e a d in g in the Jun e issue of F i r s t Aid ; and w e a s k you to a ccep t o ur best th an k s. If w e tell tru th , w e w ere b e g in n in g to lose faith in these gu id e s to la y person s w ho desire to help th eir s ic k or injured n eigh b o u rs. N ow yo u r rep ly has restored our confidence. P lease accep t m y th a n k s for yo u r th a n k s .— N .C .F .

T reatm en t o f F ra ctu red H um erus. D .M . (B e d m in ste r).— R e cen tly a t D iv isio n a l P ra ctice I g a v e m em bers a fractured h u m erus (close to shoulder). O n e m em ber applied a broad b a n d a g e round the lim b, crossed it un dern eath and then round the body. A n other applied b a n d a g e s tra ig h t round lim b and body, both ty in g un der arm p it. E a ch used a sm all arm s lin g . T re a tm e n t in T e x tb o o k is broad b a n d a g e round lim b and body, the border level w ith top of shoulder. P lease tell us if there is an y a d v a n ta g e in cro ssin g u n der arm . T h a n k in g you for yo u r ru lin g . T h e re is no a d v a n ta g e in cro s s in g th e b a n d a g e u n d er n eath the arm . O n the co n trary there is g r a v e risk of con v e rtin g a sim ple into a com pound and/or com p licated fractu re of hu m erus. So m y a d vice is th at you s tick to the m ethod laid dow n in T e x tb o o k .— N .C .F .

A C a s e for D iscu ssio n . O . M. (E a stern C o u n ty ).— A s an old first a id er I w ou ld be g r a te fu l for yo u r opinion on the fo llo w in g rem a rk a b le ca se :—

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O P H T H A L M O -A N T IP E O L i s a sem i-flu id o in tm e n t, m o re c o n v e n ie n t th an th e o rd in a ry A n tip e o l o in tm e n t fo r o cu la r in fe ctio n s and le sio n s. E y e s affected b y sm o k e an d d u s t are so o th e d a lm o st im m ed iately b y the a p p lic a tio n o f O p h th a lm o -A n tip e o l, and the a n tiv iru s p r e v e n ts g e rm s fr o m d e v e lo p in g .

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THIS

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d it o r ia l—

Pro fessio n al S ta tu s of the N urse

R ecen t A d van ces in F irst A id W o r k in W a r T h e H om e G uard and F irst Aid

Prin ciples of F irst A id ...

S .J .A .B . H ead q u arters and D istrict R eports

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R a ilw a y A m b u lan ce N ew s

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T re a tm e n t of S h o ck

S u r g ic a l S p irits for W o u n d s

C o n cealed H aem orrh age

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h o s p it a l a u t h o r it ie s fro m r e d u c i n g w o r k i n g h o u r s to the le v e l g e n e r a l l y c o n s id e r e d to be d e s ir a b le , th e re h a s r e c e n tly been a s u b s t a n tia l im p r o v e m e n t in the st a ffin g p o s i t i o n . ” H a p p i l y , w o m e n are still c o m i n g n o b l y to the fro n t, an d th ere is no p o s s ib i li t y th a t th e s h o r t a g e w h i c h m a r k e d the p o s it io n s o m e tim e b a c k w ill recur.

Recent Advances in First Aid Work in War. B y S I R H E N R Y L. M A R T Y N , K . C .V .O ., F .R .C .S . (C a su a lty S ta ff O fficer, G A rea, D evon C .C .)

( Concluded from page y .) O n e of the m ost in gen io u s ap p lian ces yet devised for b u rn s of the han ds, w h ich are so com m on a m o n g airm en, is the F irs t A id S ta n n ard silk fab ric g lo v e , a p air of w h ich is n ow carried in every R A F F irst A id P a ck . T h e g lo v e is m ade of tra n sp a ren t p liable silk fabric w ith plen ty of room w ith in it for m ovem ent, and is filled w ith a definite w eig h ed q u an tity of sulp hon am ide pow der, p opu larly kn o w n as M and B. T h e g lo v e is shaped lik e a d riv in g g lo v e and has com p artm en ts fo r th e thum b, in d ex -fin g er and a sin g le sp ace for the three rem a in in g fin g ers, the w hole b e in g con tain ed in a sealed cellop han e envelope. A t the w rist is fastened a ro ller b a n d a g e , to the end of w h ich is fixed a piece of a d h esive plaster. A l l th a t is n ecessa ry for the injured pilot to do is to pull the rip-cord of the cellop han e envelope, hold the g lo v e d o w n w ard s and to slip th e burnt hand into it. T h e b a n d a g e is w hipped round th e g lo v e at the w rist and fastened o ff by the a d h esive tap e round the forearm . T h e hand is then raised and the pow der contained in the g lo v e is sh a ken all o ver the burnt a rea. T h e b a n d a g e a t the w rist p revents escap e of the pow der, co n tact w ith air and con tam in atio n of the w ou nd, and yet the injured hand can still be used for such w o rk a s is essen tial to g e t the plane safe ly b a c k to base. It w ou ld be difficult to find a m ore sim p le, effective and v a lu a b le m ethod of first aid or one w h ich provides a m ore cla ssica l exa m p le of an a b b reviated m ethod w ith elim in ation of all th a t is n on -essential. I h ave a lw a y s found that, if the in terest and im a g in a tion of ca s u a lty personnel can be a ctiv e ly aro u sed by accoun ts of real in ciden ts a s those in w h ich th ey them selves m ay be called upon a t a n y tim e to ta k e part, th eir tra in in g becom es m ore vivid and less m ech an ical. In th is connection th e record s of the C o co an u t G ro ve d isaste r in A m erica w h ich h a ve ju s t becom e a v a ila b le are of co n sid era b le interest. T h e C o co a n u t G rove is described a s a typ ica l Boston n ig h t club, a lo w -ceilin g ed b u ild in g of one storey decorated w ith m a sses of in lla m m a b le m a terial. O n the n ig h t of S a tu rd a y , N o vem ber 2 8 th, 1 9 4 2 , the b u ild in g c a u g h t fire h a v in g w ith in it at the tim e a b ou t a th o u san d people, a lth o n g h the n orm al ca p a city w as only six h u ndred. A p an ic ru sh w a s m ade for the s w in g doors of the m ain en tra n ce, w h ich jan ib ed , and behind them w ere found piled the bodies of som e 200 victim s. O n e e m e rg e n cy e x it only ap p ea rs to h a ve been open, and, in a ll, 491 persons lost their lives.

Curiously enough, both the large hospitals in the vicinity

A I D had team s of research w o rk e rs e n g a g e d in a stu d y of the problem s a sso ciated w ith the treatm en t and m a n a gem en t of burns. T h e tra g e d y therefore provided the o p portu n ity for the reco rd in g of m uch va lu a b le in form ation , from w h ich the fo llo w in g brief excerp ts m a y serve to rein force m y re m a rk s upon sym ptom s a m o n g victim s w ith w h ich ca s u a lty p erson nel m ay exp ect to be faced. O ne hundred and eigh ty-o n e liv in g patients w ere tak en to ho sp ital; m ost of the e a rly fata lities w ere due to asp h y x ia, m an y of them s h o w in g the cherry red colouration of carbon m onoxide p oison ing. T h e m a jority of the liv in g victim s w ere in a state of violent excitem en t, som e of them a ctu a lly m a n ia ca l, as the result of pain, fear and h ysteria ; so ak ed in w ater, extre m e ly cold, and m an y in g r e a t a g o n y , the e arly use of m orphia and in tensive treatm en t of s h o ck w as of p aram ou nt im p ortan ce. M any of them suffered from g r e a t d ifficulty in b rea th in g , due to the spasm and s w e llin g of the a ir p assa g es re su ltin g from the in halation of flam e and hot g a s e s , and for som e of them u rg e n t trach eo to m y w as n ecessary a s soon a s they reached hospital. O f the 39 patients tak en to one hospital only 3 w ere com p letely free from resp irato ry com plication s, and these three w ere the only ones w h o had had the presence of mind to cover their m ouths and noses d u rin g the fire w ith either pieces of w et cloth or fra g m e n ts of clo th in g. T h e g re a t m ajority of patients w h o died in hospital did so as the result of lu n g com plication s. T h e use by the enem y of phosphorus has created new conditions, of w hich c a su a lty personnel m ust h ave full k n o w le d g e . P h osphorus m ay be used either m ixed w ith som e stick y base such a s rubber, fra g m e n ts of w h ich , dissem in ated w id ely by the explosion , adhere to w h atever they strik e and th ere ig n ite, or it m ay be em ployed in solution in som e h ig h ly in flam m able fluid such a s petrol or benzine, w hich itself is ign ited as soon a s the phosphorus w ith in it is e x posed to air. In the first in stance, it is the scattered p articles of phosphorus w hich cau se the fires and burns of casu alties, and in the second in stan ce the phosphorus a cts solely a s an ig n itin g a g e n t to the in flam m able fluid in w h ich it is d is solved. O b vio u sly the la tte r m ethod requires m uch less phosphorus. N ow phosphorus is obtained as to 90 per cent, of the to tal w orld sup ply from N orth A frica and the W e st In dies, both of w hich sources are con trolled by the A llies. G erm an y and Jap an betw een them control the re m a in in g 10 per cent, to the e xten t of ab ou t 5 per cent. each. U n fo rtu n ately for o ur enem ies, phosph orus is essential for a g ric u ltu re as a fertiliser, and they are therefore faced w ith the choice betw een b ig g e r and better phosphorus bom bs or b ig g e r and better potatoes. T h e q u a n tity of phosphorus w h ich th ey can spare for bo m b in g is therefore lim ited, and their predilection up to now h a s been for the less e x tra v a g a n t type of bomb. W e are therefore lik e ly to be faced w ith burns due to flam in g liquid ra th er than to a ctu a l fra g m e n ts of phosphorus, w h ich are defin itely m ore difficult to deal w ith. In an y case, how ever, in w h ich phosphorus has been used, treatm en t a s re g a rd s first aid in the field rem ain s the sam e. C o ver the part a t once w ith a clean d ressin g soaked in w ater, and keep this co n sta n tly w et, a llo w in g thereby no possible ch an ce of som e m in ute fra g m e n t of a ctu al phos phorus b ecom in g d ry and a g a in b u rstin g into flam e. T h e case should be m ark ed w ith a P and rem oved a t once to F irst A id Post or H osp ital. O n no a cco u n t m ust a n y oily or g r e a s y d ressin g s be applied, sin ce these are so lven ts of phosphorus and m ay rea d ily cau se p o iso n in g by a llo w in g the absorption of the poison. T h e problem for those w o r k in g in the F irst A id P o st is less easy, e sp ecially w h ere fra g m e n ts of phosphorus are ad-

F I R S T herent to the burnt a rea. T h e ir presence can be a t once detected if the burn be exam in ed in a d a rk room , w hen the g lo w g iv en off by the m ost m inute fra g m e n ts can a t once be detected ; m oreover, as the part becom es d ry w h ite fum es can be seen ris in g from them a few seconds before they a g a in burst into flam e. T h e part should be th o ro u g h ly flooded w ith , or a c tu a lly im m ersed in, a solution of b icarb o n ate of soda in the stre n g th of tw o tablespoon fu ls to a pint of w ater. E x a m i nation in the d a rk should be m ade and a n y obvious p articles p icked off w ith forceps. N o w sw a b the burnt a re a w ith a one per cent, solution of copper sulp hate, w h ich co ats an y re m a in in g fra g m e n t w ith a d a rk deposit and w ill render both detection and rem oval w ith forceps or g a u z e easier. O n ce a g a in the part should be im m ersed in the b ica r bonate of soda solution, sm all burns for £-hour, la r g e or deeper burns for as lo n g as tw o hours. If im m ersion is im possible, the sterile d ressin g should be kep t co n stan tly soaked in the solution. F in a lly , re-exam in e the part in the d a rk fo r an y p hos phorescence, if an y s ig n s of su ch rem ains retain the patient at the Post, d ressin g him hourly w ith d ressin g s so ak ed in the b icarbo n ate solution. If all is cle ar the w ound m a y be dressed as an o rd in ary burn, but since no oils or g re a s y a pp licatio n s m ay be used, a w et d ressin g so ak ed in a w ea k e r solution of b icarb o n ate— a teaspoonful to the p in t— w ill prove m ost so o th in g.

The Home Guard and First Aid. I n defence of the H .G . m edical service, I feel a fu rth er reply to Mr. W o o d is w arra n ted . H e states th at w e do not con stitu te m edical units attach ed to b a tta lion s since a m edical un it is com posed of non -com batan ts ! A p p aren tly, then, if w e are trained to ca rry arm s in an e m erge n cy or in defen ce of our w ounded (the M .O .’s even did this in the la st w ar), it m atters not how m uch m edical respo n sibility w e hold w e are not classified a s a m edical unit ? T h e point he fails to un derstan d is, th at this tra in in g en ables us to be called to arm s at a m o m en t’s notice. B ut w h ile w e w e a r our b rassard and are a c tin g in our m edical ca p a city, w e are covered by the G en ev a C on vention , and should not ca rry arm s. A t an y rate, w e w ou ld then forfeit a n y rig h t to protection. H om e G u ard m em bers do not w a rra n t an entirely nonco m b atan t unit. M an y H .G . ru les differ from those of the re g u la r services for obvious reason s. M y statem en t th at we w ere “ R .A .M .C . of th e s e r v ic e ” w as a sim ile, a s Mr. W o o d k n o w s full w ell. B u t w e ce rtain ly h ave a g re a te r respo n sibility in relation to th e H .G . than the C. D . S ., and h ave to be prepared for a m uch w id er p ractice of m edical w o rk on their b eh alf— or w e are w a s tin g o ur tim e ! T h e re are several sections of R .A .M .C . tra in in g w h ich w e are supposed to follow , apart from the collection and initial treatm en t of w ounded. If w e are to split hairs over the w o rd in g of a d escrip tive sim ile, I could a s k him if he kn o w s the com position of a F ield A m bulance, for w hich he claim s the C. D. are o rg an ised . M otor a m b u la n ces w ith th eir trained personnel form but a sm a ll part, and the supply of these form s the p rin ciple role of the C .D . in relation to the H .G . T ru e , I k n o w they are prepared and w illin g to help in other sp heres if n ecessary, but I rep eat that, often, this is fa r from p racticable. A t the present tim e, m an y of us in the fly-bom b areas are re ce iv in g in tensive tra in in g in L ig h t R escu e in order to a ssist the C. D ., w h o are m uch o verw o rk ed . B u t w e do not claim to be th e L ig h t R escu e Service, a lth o u g h w e are proud to h elp : and exp erien ce has show n th at w e are w elco m ed by the C .D .

R I D F in a lly , I can n o t d en y M r. W o o d s statem en t of fact th at w e are S. B ’s. — I h a ve said so m yself. B u t I in sist that o ur respon sibilities, from a m edical stan dp oin t, fa r e x ceed those of the S .B . in re g u la r service. It could h a rd ly be o th erw ise w ith o ur sm a ll p ersonnel, and the g r e a t la c k of M .O ’s. a v a ila b le . A nd I w ould lik e to see th at fa ct r e c o g nised. H e s u g g e s ts w e be proud of o ur statu s, but if he un derstood the service, he w ou ld rea lise th at a h ig h e r statu s w ou ld co n sid erab ly help our am bition . T h a t is — not person al reco gn ition , but a ch an ce to fu rth er develop w h a t w e co n sid er a vita l service, and one of w h ich w e are ju stly proud. D

ia g n o sis.

A lth o u g h the stan d ard of th eoretica l k n o w le d g e and p ra ctical treatm en t is g e n e ra lly fa irly h ig h in the H .G ., I find there is often a ten dency to n e g le ct tra in in g in d ia g n o sis. W h ile w ou n ds received in b attle m a y be g e n e ra lly obvious, th ey seldom sh o w the full exten t of in ju ry , and m ere treatm en t of the w ound is not e n o u g h , h o w ev er exp ertly carried out. U n le ss w e can s w iftly d ia g n o se for com p lication s, g e n era l condition of p atien t, e tc ., o ur la b ou r and ca re m ay be w asted, to the detrim en t of the patient. In a n y case, w e m ust be prepared for civil in ju ries if w e are to ca rry cn the go o d w o rk a fter the w ar. T h e old-fashioned system , used by som e units for tra in in g p ractice, of s ta g in g a c a su a lty , w ith his in ju ries c le a rly defined on a card, is useless and out of date. I, p erson ally, favo u r the C ard T e s t system as used in F irs t A id C o m p eti tions. T h is ensures not only g o o d tra in in g in d ia g n o sis, routin e exa m in atio n and treatm en t, but also enables the in stru cto r to see w hen his men h a ve fu lly m astered the re c o g nition of all s ig n s and sym pto m s re la tin g to a n y specified injury. It creates in itiative, develops self-confidence, and in creases o bservation . O n e of m y ow n team s entered a rep resen tative com petition, b e in g held in con nection w ith ch a rity , w ith o u t p revio u sly h a v in g trained a lo n g these lines. T h e resu lt w as failu re because, a lth o u g h treatm en t w a s 100 per ce n t., th ey had not satisfied th e ju d g e th at th ey w ere au fait w ith d ia g n o sis. Y o u see, a lth o u g h th ey d ia gn o se d co rrectly, it could e asily h a ve been g u e s s w o r k . N eedless to say, this has been rectified. C. W .

(S e rg t.), Sch ool H o u se, N oel-road, W . 3.

Spreadbury

Principles of First Aid. Don't assume a man is dead— it m a y be sh o ck or dope. Ju st fo rg e t th e ” l i f e ” and co n cen tra te upon the “ h o p e .” Move him from the danger spot, and g e t it done w ith speed. IJ there's hcemorrhage severe, th at h as the g re a te s t need. Give him air and keep him warm and see that he gets rest. If the skin is broken, then it m ust be q u ic k ly dressed. Treat aJracture on the spot— un less th e re ’s other d a n g er. Poisons mUst be neutralised— or else it ’s “ e xit, s t r a n g e r .” Transport— th a t’s im p ortan t, try to th in k of a ll th e s n a g s . Clothing— th in k of “ c o u p o n s ” w h en y o u ’re c u ttin g up his “ b a g s .”

Stimulants— n ow

w a tch yo u r step — a ll h ot sw eet d rin k s are rig h t. L et the doctor— if h e w an ts to — g e t the p atien t tig h t.

remember that yourjob is just First Aid. Leave the rest to doctor (if h e ’s lu ck y ), he g e ts paid.

F in a lly ,

and D o n ’t fo rg e t two golden rules— just g e t ’em fixed lik e ro ck . O n e is get the doctor— n u m ber tw o is treat for shock.

J. W.

cott

F I R S T

A I D

County o f N ortham pton.

St. John Ambulance Brigade HEADQUARTERS

AND

D IST R IC T R E P O R T S.

C ounty o f Bristol. B r i s t o l No. 3 C o r p s. — O n J u 1y 2 9 th, 3 team s com peted fo r the “ D ” D ivisio n team cup, g iv en by D iv . Sup t. 1. M arsto n of P atch w ay . D r. L a w re n c e Sm ith , M .B ., C h .B ., w a s th e ju d g e, and all th e tea m s put up a splendid show , only 6 m a rk s sep arated them . T h e visitors included Corps S u p t. E . C . B a k e r and C orps O fficers W . D . B o w se r and W . G C arter. T h e D ivisio n el V ic e President, M r. C. K n ap p , presented th e cu p to th e w in n in g team .

C ounty o f H am p sh ire. Southam pton. — D r. R . M. W a rre ll set F o llan d D ivisio n an in te re stin g test for th eir h a lf-y ea rly contest for the F ollan d C u p . T h e “ in cid en t” w as a plan e crash re a listica lly s ta g ed by M r. W a trid g e , D ivisio n President. T h e w in n in g team w as M essrs. L y e (cap t.), W . R u tter, W . G u y and W . E n glifield . R u n n ers-u p w ere C o rpl. C . B ro w n e (ca p t.), N. B ath , C o rpl. F . H ird, w ho w orked w ith one m an short. D r. W a rrell a fte rw a rd s com m ended the team s on their h ig h stan d ard of efficiency. M r. H . P. F o llan d , P residen t, presented the cup and prizes. D iv. S u p t. B. V . Stanfield presented M r. F ollan d w ith a to b acco pouch a s a to ken of app reciatio n of his w o rk and in terest in the D ivisio n .

C ounty o f L ancashire. Irla m and C a d ish e a d .— T h e C h ap ter-G en eral of the O rd er of St. John has a w a rd e d service m ed als to the follo w in g m em bers of this D ivisio n for 15 y e a rs ’ con tin uous and efficient service :— Sup t. H . W esto n , A m b u la n ce O fficer T . H azleh u rst, S e rg e a n t E M ason, S e rg e a n t T . W ilto n , C o rpo ral R . W . M e ak in and P riva te H. R . Sellon , and also to S e rg e a n t W . S te w a rt (tran sferred to L a n ca s h ire Steel Corporation D ivisio n ). T h e se m em bers w ere a m o n g the o rig in a l 16 m en w ho founded th e D ivisio n in 1 9 2 9 . O ve r 20 of its m em bers are n ow in the F o rces ; one of them (P riv a te H arold R osbottom ) b e in g a p riso n er-o f-w ar in G erm an y. T h e Irlam and C ad ish ead D ivisio n h a s a record of ser vice of w h ich it is ju s tly proud.

C ounty o f L eicester. S ile b y .— An o u tsta n d in g event in the h isto ry of the S ile b y D ivision , to o k p lace on W ed n esd ay, July 1 9 th, w hen fo u r of its m em bers w ere presented w ith lo n g service m edals. T h e m e e tin g w a s presided over by the R ev. C. C. H a r court, P resident of the S ileb y D ivision , and the a w a rd s w ere m ade by C o m m issio n er G . F. B row n e, w ho sp ok e of the w o r k of the D ivisio n and the p ro gress m ade d u r in g the past years. C o m m issio n er B row n e a lso m ade p articu iar m ention of the y o u n g m em bers of the D ivisio n and of go o d p ro gress. H e added th at th ey, one d ay, m ig h t even receive sim ilar a w a rd s. T h o s e re ce iv in g a w a rd s w ere D r. J. S. G ra y , D iv isio n a l S u rg e o n and S e rg t. C y ril W h ittin g to n , m edal and ribbon for 15 y ears s e r v ic e ; Sup t. J. W . M arston and A m b u lan ce O fficer W . E. H a rrim an , b a r to m edal for 20 y ea rs service. C o u n ty O fficer L ee of L eicester, sp o k e w ords of en co u ra g e m e n t, and outlined the n ew m ethod of tra in in g to be adopted for the co m in g w in ter. O th ers presen t w ere V iceP resid e n t E. H . Severn and C o u n ty S e cre ta ry M iss W a rd .

A sp ecial presen tation of the fifth b a r to h er S .J .A .B . L o n g S erv ice M edal took place a t the hom e of M rs. M aud Sp en cer, 2 3 , T u rn e r-stre et, N o rtham p ton. O w in g to illness she w as un able to attend at the A m b u la n ce h ead qu arters for the p resen tation. C o u n ty C om m ission er E ric H . S h a w paid tribute to the lo n g and efficient service of M rs. S p en cer co ve rin g a period of 40 years. D istrict Supt. M rs. H a rv e y R eeves, C o u n ty S u p t. M rs. I. J en n in gs, and D iv isio n a l Sup t. M iss E. C o w ley a lso con g ra tu la te d M rs. S p en cer on her record.

C ounty o f Sussex. B rig h to n .-— R e a listica lly s ta g e d in ciden ts tested m em bers of the B rig h to n C orps w hen th ey com peted for the “ P eter S tu tta fo rd ” trop hy and the “ G e o r g e ” C u p a t the R o y a l P avilion on July 2 0 th. B rig h to n N u rsin g C a d e ts w on the “ P eter S tu tta fo rd ” trophy, w ith P a tch a m 2 nd, R oedean 3 rd, and Preston 4th. T h e “ G e o r g e ” C u p w a s w on by B rig h to n A m b u lan ce C adets. F o r the purpose of the team test it w a s im a g in ed th at the occu p ier of a sm a ll house had ju s t fallen d o w n stairs, and com p etitors w ere required to deal w ith the “ in ju ries” sustain ed. T h e treatm en t of com m on accid en ts on the sp orts field tested in d ivid u a l m em bers of the team s. T h e contest w a s ju d g ed by C o n n ty O fficer F . A. T ro tt, a ssisted by D iv. Sup t. W . E . Jupp, and a ll a rra n g e m en ts w ere carried out by M r. R. G . W in d er. D r. E. H . S tu tta ford, C orps S u rg e o n and S u p t., presided.

E ast R id in g o f Y orkshire. H u ll. — M iss M abel A bbott, S .N .R ., and M rs. W in ifred M a cD o n ald , h ave recen tly each been presented w ith one of the h ig h est honours w h ich can be conferred upon w om en. B oth h ave been a dvan ced to the ra n k of S e rv in g S ister of the O rd er of St. John. M iss A bbot is perhaps one of the best k n o w n figu res in the S .J .A .B . in H u ll. Sh e h as 30 y e a rs ’ o u tsta n d in g service to her credit, and to-day, as Sup erin ten den t of the H u m ber N u rs in g D ivisio n , H u ll C orps, co n tin u es to g iv e of her best and to a ct as a sh in in g exa m p le to all w ho serve w ith her.

W est R id in g o f Y orkshire. B r a d f o r d . — O n F rid a y , J u ly 2 1 st, the M a n n in g h a m N u rsin g C ad et D ivisio n held an enrolem ent service a t their H ead q u arters, W o o d lan d S treet. M rs. G eld ard , L a d y D is trict O fficer, con ducted the cerem o n y in a cco rd an ce w ith the new C ad et M anual. M rs. F ord, C o u n ty C ad et O fficer, w h o h ad exam in ed the tw o C ad et O fficers, M rs. A. C la u g h to n and M iss E . M. T o w n , presented the C a d ets w ith their p relim in ary F irst A id Certificates. K e ig h le y . — A w ell-deserved ho n o ur in reco gn ition of e n e rg e tic w o rk for the S .J .A .B . is the prom otion to the g r a d e of O fficer of the O rd e r of St. John of Jerusalem of C o rp s O fficer W . H . S m ith , of K e ig h le y , w hich has ju s t been an n oun ced. A s M r. Sm ith passed a co u rse of first aid in 1 9 0 2 , he has n ow 42 y e a rs ’ service in the K e ig h le y C o rp s to his credit. M r. S m ith has been em ployed for 44 y ears by th e K e ig h le y C o rpo ratio n , and has attended several thousand ca ses of in ju ry, m o stly in V ic to ria P a rk , w h ere he w a s em ployed a s ga rd en er. H e attended a course of in struction in w a r g a s e s in 1936 and qualified as an in structo r in the su b je c t, and g a v e a la rg e n u m ber of lectu res in the K e ig h le y d istrict. H e w as the officer in c h a rg e of the N orthern area c o n tin g e n t from the W e s t R id in g a t m a n y n otable events.

F I R 8 T A nother a m b u la n c e h o n o u r h a s been conferred upon D r . P r e n t i c e , of K e i g h l e y , w h o h a s b e e n p r o m o t e d t o t h e r a n k of C o u n ty S u r g e o n for th e N o r th e r n a r e a of th e W e s t R id in g .

The Work of a Field Ambulance. I t w o u ld a p p e a r a t first g l a n c e t h a t t h e w o r k of a F ield A m b u la n c e , co n s ists o n th e w hole, of th e collection a n d e v a c u a t i o n of w o u n d e d . T h i s is n o t e n t i r e l y c o r r e c t . A f ie ld a m b u l a n c e i s r e a l l y a n e x t r e m e l y m o b i l e h o s p i t a l eq u ip p ed for a n y e m e rg e n c y . I t is d iv id e d in to t w o p a r t s , th e a d v a n c e d r e s s i n g s t a ti o n a n d th e m a in d re ss in g sta tio n . T h e w o r k o f t h e A. D . S . is to p o s itio n itself b e h i n d t h e f r o n t lin e a n d co lle c t w o u n d e d fro m th e re g im e n ta l aid p ost, a n d b r in g th e m b a c k to th e A . D . S . f o r s u c h t r e a t m e n t a s is p o s s i b l e a t t h i s s t a g e —m o r p h in e , s u l p h o n a m i d e a n d p l a s m a , etc. T h e patients a re t h e n e v a c u a te d to th e M . D .S . w h e r e th e y a r e g iv e n a m o r e th o ro u g h ex am in atio n . T h e M . D . S . c o n s ists of a h i g h l y t r a i n e d b o d y of m e n w h o s e j o b i t is t o d o a l i t t l e m o r e f o r t h e w o u n d e d t h a n c a n b e d o n e a t t h e A. D . S . I t is d iv id e d in to f o u r p a r t s : r e c e p tion, p re o p e ra tio n , th e a tr e n u r s i n g a n d e v a c u a tio n . Of c o u rse , in a d d itio n , th e r e a r e th e a d m i n i s t r a t i v e d e p a r t m e n t s , o f fic e s , q u a r t e r m a s t e r ’s s t o r e , d i s p e n s a r y a n d c o o k s , e t c . T h e s y s t e m w o r k s a s f o l l o w s : T h e p a t i e n t s a r e b r o u g h t in t o r e c e p t i o n a n d e x a m i n e d b y a M e d i c a l O f f i c e r , a n d if a b l e t o d r i n k , g i v e n h o t s w e e t t e a a n d a c i g a r e t t e a t t h e M . O . ’s d iscretio n . C a se s for o p e ra tio n a r e s e n t to p re op. a n d finally o p e r a t e d on. T h e p r e o p . d e p a r t m e n t is u s u a l l y s t a f f e d b y a field t r a n s f u s i o n u n i t w h i c h c o n s i s t s of a M . O . , t w o o r d e r l i e s a n d a d r iv e r w ith a th r e e to n lorry . T h i s b r a n c h of t h e R .A . M .C . c a r r ie s th e v ital p l a s m a a n d p u r e b loo d to th e M .D .S . T h e o p e r a t i n g d e p a r t m e n t is u s u a l l y s t a f f e d b y a field s u r g i c a l u n it, c o n s is tin g of a s u r g i c a l sp e c ia list, a n a n a e s th e tist, a c o rp o ra l ( o p e r a tin g r o o m a s s is ta n t, first c la s s) a n d tw o o p e r a tin g ro o m orderlies, w ith a lo rry a n d d riv er. T h is u n it carrie s th e m o st m o d e rn th e a tre e q u ip m e n t, in c lu d in g a portab le g en erato r. I n d e e d i t m i g h t b e s a i d t h a t m a n y of o u r s m a l l e r h o s p i t a l s i n c i v i l l ife w o u l d b e g r e e n w i t h e n v y a t s u c h a lay o u t. A fte r o p e r a tio n , p a tie n ts a r e p u t in a p o st op. w a r d staffed by M D .S . o rd erlies w h o a r e h ig h ly tra in e d a n d ex p erien ced in n u r s in g . T h e y n u m b e r a b o u t 16 m e n . P atien ts are k ept u n t i l fit f o r e v a c u a t i o n t o a C . C . S . w h i c h m a y b e a s l o n g a s 10 d a y s o r a f o r tn ig h t. O n e m a y t r u e l y s a y t h a t a m a n ’s life m a y b e d e c id e d in th e M. D .S . If h e d i e s i t is a m i s f o r t u n e . I f h e l i v e s , h e is n o t l i k e l y t o d i e a f t e r e v a c u a t i o n . S o m u c h f o r t h e w o r k o f a field a m b u l a n c e i n a n a c t i o n — n o w w e w ill l o o k a t t h e le s s e x c i t i n g s i d e of its w o r k . T h e r e c o m e s a t i m e w h e n a field a m b u l a n c e is r e q u i r e d t o re ceiv e a n d n u r s e s ic k only. O n s u c h o c c a s i o n s t h e r e is n o F .T . U . o r F .S . U a tta c h e d . T h e u s u a l h o l d i n g c a p a c ity a i m e d a t is 200. All t y p e s of c a s e s , i n c l u d i n g b a t t l e c a s u a ltie s , m a y b e a d m i t t e d . F a c ilitie s for m icro sco p ic d i a g n o s is of m a la r ia , u r e th r itis a n d o t h e r d is e a s e s a r e a v a ila b le in th e la b o r a to ry . T h e h o s p i t a l , a s i t is n o w c a l l e d is d i v i d e d i n t o t h r e e w i n g s a n d is s t a f f e d b y t w o c o m p a n i e s — t h e r e m a i n i n g c o m p a n y s t a n d i n g b y t o f o r m a n A. D . S . if n e c e s s a r y . W i n g I receives m a la r ia a n d in fectio u s d ise a se s . W in g I I , sk in s, V. D. a n d g a stro -e n te ritis. W i n g I I I receives m i n o r s u r g i c a l , i n c l u d i n g s e p tic c o n d i t i o n s s u c h a s b oils. N o t all c a s e s a r e k e p t u n til t h e y a r e c u r e d . I f t h e r e is a b ig influ x of sick, a n e v a c u a tio n m a y t a k e p lace, a n d th o se w e o a r e n o t l i k e l y t o b e fit f o r a f e w w e e k s a r e s e n t o f f t o t h e C .C . S.

R I D T h e w h o l e of t h i s w o r k is c a r r i e d o u t b y o r d e r l i e s a n d M e d ic a l O fficers of th e R .A . M .C . I t is t r u e t o s a y t h a t l i t t l e is h e a r d b y t h e p u b l i c o f t h e field a m b u l a n c e s . T h is m a y be d u e to th e fact t h a t th e y d o n o t c a rry a n y N u r s in g S is te rs or Q . A . I . M . N . S . , to g i v e t h e m t h e i r full title. H o w e v e r , t h e w o r k o f a f ield a m b u l a n c e m i g h t m e a n t h a t th e t r a i n i n g a n d e x p e r ie n c e ot a N u r s i n g S i s t e r w o u ld n o t b e u s e d t o f u l l a d v a n t a g e , a n d o n s o m e o c c a s i o n s it is t o o d a n g e r o u s to e m p lo y w o m e n . I a m very p ro u d to s ta te th a t o n e m e e ts m a n y m e m b e r s o f t h e S . J . A . B . i n t h e field a m b u l a n c e s , a n d I a m s u r e t h a t e a c h o n e h a s i t s q u o t a o f B. R C S . p e r s o n n e l t o o . M a n y of t h e S . J . A . B m e m b e r s w e r e M i l i t a r y H o s p i t a l R e s e r v i s t s , a b r a n c h of t h e A r m y w h i c h h a s r e c e i v e d l i t t l e m e n tio n .— J. R . C a r r (F ie ld A m b u la n c e , R .A .M .C .).

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T h e C e n t r e S e c r e t a r y ’s r e p o r t f o r t h e y e a r e n d e d J u n e 3 0 th , 1944, s t a te s t h a t 142 c la s s e s w e r e c o n d u c te d in th e A r e a d u r i n g t h e 1943-44 sessio n . T h e n u m b e r of s t u d e n t s w h o w e r e s u c c e ss fu l in p a s s i n g th e e x a m i n a t i o n a r e a s fo llo w s : C e rtific a te s, 255 ; V o u c h e r s , 142 ; M e d a llio n s , 196 ; L a b e ls, 1 ,7 0 0 ; T o ta l, 2,293. S in c e th e la s t h alf y e a rly r e p o rt th e d ig n ity of S e r v in g B r o th e r h a s b e e n b e s to w e d u p o n M r. F. C. S te a d , Y o r k a n d M r. J D. D obson, W eeto n . D u r in g th e y e a r 43 m ed als, tw e n ty 20 y e a rs b a rs, fo u r 2 5 y e a r s b a r s , five 3 0 y e a r s b a r s , t h r e e 35 y e a r s b a r s a n d 1 forty y e a rs bar, h av e been ap p roved.

T h e N o r t h E a s t e r n A r e a F i n a l C o m p e t i t i o n w a s h e l d in t h e R a i l w a y I n s t i t u t e , Y o r k , o n S a t u r d a y , J u l y 8t h , b e f o r e a la rg e au d ien ce. T h e scene w a s a w a y sid e sta tio n d e m o lish e d by a P -p la n e, a n d w a s very realistically s ta g e d by M r. N . W e e k s, th e w o rk s m a n a g e r, Y ork. D r . R . A. D e n c h s e t th e test a n d ab ly ju d g e d th e co m p etitio n , th e to tal m a r k s o b t a i n a b l e b e i n g 180 . O w i n g to th e J o h n L lo v d W h a r t o n S h ield b e in g d a m a g e d d u r i n g th e a i r r a id o n Y o r k in A pril, 1942, a s u b s t i t u t e sh ield w a s k in d ly p ro v id ed by M r. W e e k s , a n d th is w a s p r e s e n te d to th e w in n in g te a m b y M r. C. M. J e n k m Jo n e s, D iv isio n al G e n e ra l M a n a g e r , Y o rk . T h e result w a s as f o l l o w s :— 1, T y n e D o c k , 1 5 9 m a r k s ; 2, Y o r k C a r r i a g e a n d W a g o n N o 1, 1 4 3 ; 3, W e s t H a r t l e p o o l , 1 3 8 ; 4, H u l l S t a t i o n , 1 2 6 ; 5, D a r l i n g t o n Y a r d m a s t e r s , 1 0 2 ; 6 , L e e d s L a d i e s , 9 9 . D u r i n g th e c o u rse of h is r e m a r k s , M r. J e n k in J o n e s s a id he w a s very p leased to w elco m e a la d ie s’ te a m to th is c o m petition.

L O N D O N , M ID L A N D & SC O T T ISH M r. R o b e rt M a rsh a ll h a s b e e n a p p o in te d g e n e ra l se c re ta ry o f t h e S t . A n d r e w ’s A m b u l a n c e A s s o c i a t i o n . M r. M a rs h a ll r e c e n t l y r e t i r e d f r o m t h e p o s i t i o n of d i s t r i c t g o o d s a n d p a s s e n g e r m a n a g e r f o r t h e A y r s h i r e d i s t r i c t of t h e L. M .& S . R . Co. M r. J a m e s H . H . H e n d e r s o n , th e p re se n t se cre ta ry , w h o re tire s a t h is o w n re q u e st, h a s b een w ith th e A sso ciatio n for 43 y ears. M r. H e n d e r s o n w ill n o t fin a lly b r e a k h is c o n n ectio n w ith th e A sso ciatio n u n til th e a n n u a l m e e tin g , w h ic h w ill p ro b a b ly be h e ld in S e p t e m b e r .

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C o m m issio n er, S .J.A .B ., P ly m o u th , S o u th -W e st D evon, a n d E a s t C o r n w a l l D i s t r i c t , p r e s e n t e d first a i d a w a r d s to m e m b e r s of t h e S o u t h e r n R a i l w a y a m b u l a n c e c l a s s a t C a l s t o c k , a n d c o n g r a tu la te d th e re cip ien ts on th e ir success. M r. H . G. S to c k b r id g e (class se c re ta ry ) w e lc o m e d th e C o m m is s io n e r , a n d s p o k e o n th e w o r k of t h e A s so c ia tio n a n d B rig ad e. A w a r d s : 1st y e a r certificates, 3 ; 2 n d y e a r v o u c h e rs, 4 ; 3 rd y e a r m e d a llio n s, 5 ; o v er 3 y e a rs labels, 6.

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T h e in te r e s tin g rep ly to m y le tte r a n d th e c o rre sp o n d e n c e it h a s p r o d u c e d , c o m p e l s m e to c l e a r u p s o m e m i s c o n c e p t io n s th a t h a v e arisen . I n t h e first p la c e , I m u s t e m p h a s i s e t h e lin e of d e m a r c a ti o n t h a t d i s t i n g u i s h e s t h e first a i d e r f r o m t h e d o c t o r . The m o r e o n e l e a r n s of first a id , t h e less o n e d e s ire s to e n c r o a c h o n t h e p r e s e r v e s of t h e “ s e n io r s e r v ic e .” I n r e f e r r in g to th e “ e le m e n ta r y ” first a id certificate, I w a s n o t t h i n k i n g of t h e c e r t i f i c a t e a w a r d e d t o j u v e n i l e s , b u t t o t h e s t a n d a r d e x a m i n a t i o n h e l d a f t e r a c o u r s e of ( u s u a l l y ) six le c tu r e s g i v e n b y a B r i g a d e s u r g e o n o r o t h e r q u alified m edical m an. I t is n o t d o i n g j u s t i c e e i t h e r t o t h e l e c t u r e r o r to th e s t u d e n t to h a v e th e m c r a m in to s u c h a s h o r t c o u rse th e th e o r y a n d p ra c tic e of first aid . E v e r y o n e is f a m i l i a r w ith th e p e r s o n w h o p o s s e s s e s a first a id c e rtific a te b u t w h o sh o u ld n ev er be allo w ed n e a r a real accid en t. If t h e t r a i n i n g is s p r e a d o v e r a l o n g e r p e rio d , a n d th e c o n s e q u e n t e x a m i n a t i o n m a d e m o r e difficult, t h e r e s u l t w ill b e a m o r e efficien t first a id er. A s s u g g e s t e d by L io n e l C ole, a n a t o m y a n d p h y s io lo g y a r e s u b j e c t s of g r e a t i n t e r e s t to first a i d e r s a n d c o u ld b e i n c o r p o r a te d w ith o t h e r a s p e c t s of t h e s u b je c t t h a t a r e n o w b u t lig h tly to u c h e d upon. A n o t h e r f o r m of i n s t r u c t i o n t h a t h a s b e e n n e g l e c t e d in t h e p a s t i s t h e f i lm . T h e o n l y i n s t r u c t i o n a l f ilm I h a v e s e e n o f t h i s n a t u r e , h a s b e e n a n o f fic ia l C i v i l D e f e n c e o n e , b u t it w a s a p o o r a ffa ir. I fail to s e e w h a t h a r m c a n c o m e f ro m e n d e a v o u r i n g to r a i s e th e s t a n d a r d of b o th p r a c tic e a n d th e o r y , in a su b je c t in w h ic h n o tw o cases a r e e x a c tly alike. T o do th a t, a better t e x t b o o k is a s i n e q u a n o n . So, please, no m o re red h e r rin g s a c r o s s t h e t r a i l i n t h e f o r m of s n a k e - b i t e s !— Y o u r s f a i t h f u l l y , “ V. P .” D

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I r e a d w i t h i n t e r e s t , L i o n e l C o l e ’s l e t t e r i n t h e J u l y i s s u e of F i r s t A i d . W a r w i c k & T u n s t a l l ’s 1 9 4 1 e d i t i o n ( A d v a n c e d A m b u la n c e H a n d b o o k ) se e m s to su p p ly th e v ery th in g he needs. T h e r e is n o lim it to t h e a c q u i r e m e n t of p e r s o n a l k n o w l e d g e , b u t is it a p p r e c i a t e d , e n c o u r a g e d o r d i s c o u r a g e d in t h e S . J . A . B . , t h a t is t h e r e a l q u e r y ? I, l ik e y o u r c o r r e s p o n d e n t , h o l d L . C . C . T e a c h e r ’s a n d L . A . A . S . ( D i s t i n c t i o n ) F i r s t A id C e rtific a te s, & c., &c. I h av e b een e m p lo y ed a s p a n e l in s tr u c to r to s tr e tc h e r p a rtie s, w a r d e n s a n d H . R e sc u e S q u a d s , w ith c r e d it to m y s e lf a n d c la s se s , in o p e n c o m p e ti tio n w i t h v a r i o u s A. R . P. i n s t r u c t o r s ( a n d f o rg iv e t h e e g o t i s m ) h a v e b e a t e n th e m all in p r a c tic a l r e s u lts . W h a t h a s h ap p e n e d ? I a m unem ployed. M y classes h a v e t o l d m e t h e r e a s o n is I k n o w too m u c h , a n d b e s i d e s I a m o nly a tw e n ty y e a r P riv a te .— Y o u r s sincerely, B a s il

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Reviews. E f fic ie n c y i n F i r s t A i d . 4 t h E d i t i o n .

By N. C o rb et F letcher, M .A ., M .B ., M .R .C .S . L o n d o n : J o h n B a le M edical P u b lic a tio n s L td . P r i c e i s . j d . ; p o s ta g e 2 \d .

T h e i s s u e o f t h e f o u r t h e d i t i o n is c l e a r e v i d e n c e o f t h e c o n tin u e d d e m a n d for th is boo k , w h ich w a s w ritte n w ith a v ie w to a s s i s t i n g t h o s e s t u d e n t s of first a i d w h o d e s i r e d to m a k e th e m s e lv e s p roficient in th e ir w o r k . A lth o u g h co m p i l e d o n t h e b a s i s of p e a c e t i m e a c c i d e n t s a n d m i s h a p s , i t fits in e x tr e m e ly w ell w ith w a r tim e c o n d itio n s. T h o s e of u s w h o h a v e h a d i n t e n s i v e e x p e r i e n c e of th e effects of h i g h e x p lo s iv e s a n d t h e r e s u l t i n g c a s u a l t i e s , r e a lis e th e g r e a t d ifficulty w h ic h e x is ts in m a k i n g a n a c c u r a t e d ia g n o s is , a n d w e h a v e h a d to le a r n to a r riv e a t a q u ic k c o n c lu s io n a s to in ju rie s w h ic h a r e p r e s e n t a n d still active. T h e s e c t i o n s o f t h e b o o k w h i c h d e a l w i t h e f f i c i e n c y in d i a g n o s is a n d in t r e a t m e n t w ill b e fo u n d of g r e a t v a lu e to t h o s e e n g a g e d i n t h e v a r i o u s b r a n c h e s of C i v i l D e f e n c e , a n d i n p a r t i c u l a r , is r e c o m m e n d e d t o t h o s e w h o a r e e m p l o y e d a s I n s t r u c t o r s in F i r s t A id .— E . T . M i l b u r n . ( S ta ff O fficer i/c C a s u a l t y S e rv ic e s.)

Irritant Spectacle Frames. By W IL L IA M

NORTH.

t w o y e a r s a g o I w a s a s k e d b y a c o lle a g u e to d r e s s a s m a l l s o r e p a t c h a b o v e o n e of h is e a r s , w h e r e t h e b r o a d e n d o f t h e s i d e - p i e c e of h i s “ t o r t o i s e s h e l l ” f r a m e d s p e c t a c l e s touched. I ap p lied lint a n d s tr a p p in g , a n d a s h e a p p a r e n tly h a d n o f u r t h e r t r o u b l e w i t h it, I d i s m i s s e d t h e m a t t e r f r o m m y m ind. R e c e n tly h o w e v e r, fro m A pril, 1943, o n w a r d s , a se ries of le tte r s h a v e a p p e a r e d in a m e d ic a l j o u r n a l (th e B . M . J . ) in w h i c h t h e q u e s t i o n o f a n e w k i n d of a l l e r g y h a s b e e n r a i s e d . O n e l e t t e r m e n t i o n e d t h a t o n e c a s e of s p e c t a c l e d e r m a t i t i s w a s t r e a t e d in L iv e rp o o l in 1927, th e e a r lie s t r e c o rd e d in th is c o u n try . A b o u t th is ti m e a n a r tic le a p p e a r e d in a n A m e r ic a n jo u rn a l d e s c rib in g th e co n d itio n a n d sh o w in g h o w a n o u t line in f la m m a tio n w a s p ro d u c e d o n th e a r m by b i n d in g th e f r a m e s o n t o t h e p a t i e n t ’s a r m . S in c e 1927 th e L iv e rp o o l p a tie n t h a s b een s u p e rs e n sitiv e to a n y th in g w ith b la c k or b ro w n d y e — e .g ., gloves o r c lo th in g . T h i s l e d m e t o w o n d e r if m y p a t i e n t o f t w o y e a r s a g o h a d b een a m ild sufferer fro m th is c o m p la in t ; w h ic h m a d e m e feel ju s tif ie d in d r a w i n g t h e a t t e n t i o n of o t h e r first a i d e r s to th e p o ssib ility of b e i n g a p p r o a c h e d to t r e a t a n a p p a r e n t l y triv ia l s k in u p s e t in th e r e g io n c o n ta c te d by th e s e sy n th e tic sp ectacle fram es. T h e v ictim m a y d e fe r se e in g a d o c to r a b o u t th e tro u b le u n til it h a s b e c o m e c o n s id e ra b ly w o rse . W e m a y b e a b l e t o a p p l y t h e p r o v e r b i a l s t i t c h i n t i m e if w e co m e u p o n su c h a case. I t a p p e a rs fro m th e co rre sp o n d e n c e on th e su b ject th a t a n e w t y p e of p l a s t i c , o r a n e w i n g r e d i e n t i n t h e m a n u f a c t u r i n g p r o c e s s is t h e c a u s e of t h e tr o u b le , p o s s ib ly in s o m e c a s e s , b r o u g h t a b o u t by w a r co n d itio n s. T h e s ig n s a n d s y m p to m s v a ry in d e g r e e w ith th e i n d i v i d u a l ; t h e y v a r y f r o m a s l i g h t r e a c t i o n of r e d d e n i n g of th e sk in , w h e re th e fra m e to u c h e s , a n d s lig h t itc h in g , to a s e rio u s d i s c h a r g e of c o n s id e ra b le v o lu m e a n d in t r a c t a b l e itch in g . T h e a r e a s in v o lv e d , all c o r re s p o n d e x a c tly w ith th o se to u c h e d by th e sp e ctacle fram e. F i r s t a id t r e a t m e n t of c o u rse , a n d in d e e d th e sole t r e a t m e n t u s u a l l y n e e d e d , if t h e p a t i e n t is s e e n e a r l y e n o u g h , is to re m o v e th e cau se. If th e offen d in g fra m e s a re to b e c o n tin u e d in u se , c o v e r in g t h e p a r t s of th e f r a m e in c o n ta c t w ith t h e s k i n w i t h a b i n d i n g of fine d a r n i n g s ilk w ill d o th e tr ic k . T h e c o n d itio n th e n im p ro v e s rapidly. Som e

F I R S T

Why

do you use

because it has proved to be a m ost effective antiseptic. W hat is its pharm acological action ? Medical science cannot agree on the answer, any more th an it can explain precisely why rheum atism should often respond to treatm ent w ith iodine. W e know th at life cannot exist w ith ou t io d in e ; but w hy ? This problem is y e t to be solved. R IM A R IL Y

Io d in e 2 o

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W hile iodine keeps so m any secrets, it discloses others. I f you think a better know ledge o f th is fascinating elem ent w ould help you in your work, the IODINE EDUCATIONAL BUREAU will alw ays be happy to answer your ques tions. This service is free to any mem ber o f the nursing profession or first aid worker.

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R I D a n d a s a r e s u l t o f t h e c o n f l i c t i n g o p i n i o n s o f m a n y of o u r m e m b e r s a s r e g a r d s th e g e n e r a l p rin cip le s a n d d e t a i l s to b e f o llo w e d in t h e first a i d t r e a t m e n t of f r a c t u r e d p e l v i s , w e s h o u l d e s t e e m it a g r e a t f a v o u r if y o u w o u ld e n lig h te n us. T h e c o n f u s i o n a p p e a r s to b e t h e r e s u l t of a p p a r e n t l y d if fe r e n t a d v i c e a n d d i a g r a m s g i v e n in t w o of t h e m o s t r e l i a b l e f i r s t a i d t r e a t i s e s , w h e r e a s t h e F i r s t A i d to th e I n ju r e d d o e s n o t g o in to su ffic ie n t d e ta il to so lv e o u r d ifficulties. W o u l d y o u t h e r e f o r e l e t u s k n o w :— 1. W h i c h p a r t o f t h e p e h i s is m o s t p r o n e t o frac tu re ? 2. H o w w o u l d y o u a d v i s e t h e a p p l i c a t i o n of t h e b r o a d b a n d a g e f o r : —• F r a c t u r e of, o r , l a t e r a l t o , t h e s a c r u m o r c o c c y x ? F ra c tu re in th e p u b ic re g io n ? F ra c tu re b e tw e e n th e tw o re g io n s, eith e r u n ila te ra l o r bilateral ? It is b e c a u s e th is p a r t i c u l a r l y s e rio u s c o n d itio n m a y o c c u r a t a n y t i m e a s a r e s u l t of w a r i n j u r y t h a t w e w o u l d lik e to feel c e r t a i n t h a t o u r t r e a t m e n t m a y be o f t h e b e s t. M e a n w h ile w e t h a n k y o u in a n tic ip a tio n of y o u r k in d reply.

Queries and Answers toCorrespondents Q u e r i e s w i l l b e d e a l t w i t h u n d e r t h e f o l l o w i n g r u l e s :— 1 .— L e tte r s c o n ta in in g Q u e r ie s m u s t b e m a r k e d o n th e top l e f t - h a n d c o r n e r of t h e e n v e l o p e “ Q u e r y , ’’ a n d a d d r e s s e d t o F irst A id , 4 6 , C a n n o n - s t r e e t , L o n d o n , E . C . 4 . 2 . — A ll Q u e r i e s m u s t b e w r i t t e n o n o n e s id e of p a p e r o nly. 3 . — A ll Q u e r i e s m u s t b e a c c o m p a n i e d b y a “ Q u e r y C o u p o n ” c u t f r o m t h e c u r r e n t i s s u e of t h e J o u r n a l , o r , i n c a s e of Q u e r i e s f ro m a b r o a d , fro m a r e c e n t issue. 4 . — T h e T e x tb o o k to w h ic h re fe re n c e m a y b e m a d e in th is c o l u m n is t h e 3 9 t h ( 1 9 3 7 ) E d i t i o n o f t h e S . J . A . A . M a n u a l of F i r s t A i d t o t h e I n j u r e d .

C om pound Fracture of Leg. jtf.S . ( B r i s t o l ) .— A t a r e c e n t d e m o n s t r a t i o n w e h a d to t r e a t a p a tie n t s u ffe rin g fro m c o m p o u n d f ra c tu r e of leg , f r a g m e n t s p r o t r u d i n g a n d c o m p lic a te d by b r i g h t re d blood ' s p u r iin g fro m th e w o u n d . W e ap p lied d ig ita l c o m p re ss io n to th e fe m o ra l a r te ry , c o v e re d th e w o u n d w ith a g a u z e d r e s s in g , tre a te d for s h o c k a n d th e n s p lin te d th e le g in th e u s u a l w a y . T h e J u d g e told us, w e sh o u ld h a v e a rre s te d th e h a e m o rrh a g e w ith a p a d over th e w o u n d a n d a tig h t !' bandage. W e h av e alw a y s u n d ersto o d th a t w e sh o u ld not a p p l y a t i g h t b a n d a g e t o a w o u n d w h e n t h e b o n e is p ro tru d in g . Y o u r k in d r u l i n g w ill b e m u c h v a lu e d . O n y o u r s t a t e m e n t of f a c t s , y o u r t r e a t m e n t w a s c o r r e c t b e c a u s e i n R u l e 1 0 o n p. 1 1 0 o f t h e T e x t b o o k y o u a r e t o l d n o t t o a p p l y a t i g h t b a n d a g e o v e r t h e d r e s s i n g if a f r a c t u r e is p re se n t o r su sp ected . Y o u sh o u ld , h o w ev er, h a v e released y o u r i n d i r e c t p r e s s u r e a t i n t e r v a l s of t w e n t y m i n u t e s , to a s c e r t a i n if t h e b l e e d i n g h a d c e a s e d , a s l a i d d o w n i n R u l e 11. — N

C o rb e t

F le t c h e r .

Exam ination How ler. D .S . (E a s t L o n d o n ).— In a recen t e x a m in a tio n a can d id ate w a s a s k e d h o w h e w o u ld tr e a t a p a tie n t su fferin g from s n a k e bite. S h e electrified th e s u r g e o n e x a m i n e r by r e p l y i n g : “ I f th e w o u n d i s d e e p , a p p ly a l i g a t u r e b e tw e e n th e w o u n d a n d th e h e a r t ; b u t , ip i t i s s u p e r jic ia l, a p p ly l i g a t u r e b e tw e e n th e h e a r t a n d th e w o u n d ! "

Good !

N e x t , p l e a s e ! !— N . C . F .

Treatm ent of C a m p h o r Poisoning. N . P . (C a rd iff).— R e c e n tly I h a d to t r e a t a ch ild w h o h a d sw a llo w e d a s m a ll lu m p of c a m p h o r ; a n d I w a s a t a lo ss b e c a u s e t h e T e x t b o o k is sile n t c o n c e r n i n g t h is p oison. I n t h e s e c i r c u m s t a n c e s , I a s k y o u p le a s e to tell m e t h e s i g n s , s y m p t o m s a n d t r e a t m e n t of C a m p h o r P o iso n in g . I T h e T e x t b o o k is n o t s ile n t a b o u t C a m p h o r P o i s o n i n g s i n c e i t t e l l s y o u t o t r e a t a n y c a s e of p o i s o n i n g ( i n w h i c h t h e p a t i e n t ’s m o u t h is n o t b u r n e d ) a s f o r N o n C o r r o s i v e P o i s o n in g . H a d y o u b e e n c o n t e n t t o s a y t h a t t h i s p o i s o n is n o t specifically n a m e d in th e T e x tb o o k , I co u ld h a v e a g r e e d w ith you. T h e l e a d i n g s i g n s a n d s y m p t o m s of C a m p h o r P o i s o n i n g a r e a p e c u lia r o d o u r of b r e a t h , g id d in e s s , n o ise s in e a rs, c o n v u ls io n s (esp e c ia lly in c h ild re n ), cold c l a m m y s k in , w e a k a n d r a p i d p u lse , a n d d ifficulty in b r e a t h i n g . S u c h cases fre q u e n tly g iv e rise to a l a r m i n g s y m p to m s b u t a r e ra re ly fatal. — N .C .F .

Fracture of Pelvis. J .V . (B in g le y ).— T h e adv ice w h ic h y o u g iv e in F i r s t A id is c l o s e l y f o l l o w e d b y t h e B i n g l e y D i v i s i o n S . J . A . B . ;

( 1 ) I t is e x t r e m e l y u n l i k e l y t h a t a n y f i r s t a i d e r w o u l d b e a b le to d e te r m in e th e e x a c t lo c a tio n of a f r a c tu r e in v o lv in g t h e pelvis, p a r t i c u l a r l y u n d e r a i r - r a i d c o n d itio n s . Indeed, a n e x a c t d i a g n o s i s m u s t w a i t o n t h e r e s u l t s of X - r a y e x a m i n a tion. In th e s e c ir c u m s ta n c e s y o u r tr e a tm e n t of th e f ra c tu r e d pelv is w o u ld b e t h e s a m e ; a n d y o u c a n c o n fid e n tly follow th e i n s t r u c t i o n s of t h e T e x t b o o k (p. 87 ). (2) Y o u s h o u l d f o l l o w t h e i n s t r u c t i o n s i n R u l e 2 o n p. 8 7 o f T e x t b o o k a n d t i e t h e k n o t i n t h e m i d d l e l i n e o n t h e f r o n t of t h e b o d y fo r all v a r i e t i e s of f r a c t u r e d p e lv is .— N .C . F .

Three-H anded Seat. F . A . ( B e n t l e y . ) — I n t h e f o r m a t i o n of t h e t h r e e - h a n d e d s e a t t h e T e x t b o o k te lls u s t h a t , to s u p p o r t t h e left l o w e r lim b, th e b e a r e r on th e r i g h t (or so u n d ) sid e m u s t g r a s p h is left w r i s t w i t h h is r i g h t h a n d a n d a ls o t h a t w e m u s t s u b s t i t u t e t h e w o r d s ‘ ' r i g h t ” a n d ‘ ‘ left ” w h e n w e h a v e to s u p p o r t t h e r i g h t lo w e r lim b . P l e a s e t e l l m e if t h i s m e a n s th a t th e b e a re r o n th e so u n d side m u s t a lw a y s g r a s p h is left w r is t o r t h a t h e m u s t g r a s p h is r i g h t w r is t to s u p p o r t a n i n ju r e d r i g h t lo w e r lim b . T h e T e x t b o o k s p e c i f i c a l l y t e l l s y o u t h a t if t h e l e f t l e g is i n j u r e d t h e b e a r e r o n t h e s o u n d s i d e g r a s p s t h e l o w e r e n d of h i s l e f t f o r e a r m ; a n d t h a t if t h e r i g h t l e g is i n j u r e d h e g r a s p s t h e l o w e r e n d of h i s r i g h t f o r e a r m — t h i s b e i n g t h e e x p l a n a tio n of t h e T e x t b o o k 's i n s t r u c t i o n to s u b s t i t u t e “ r i g h t ” fo r left a n d “ le ft ” f o r r i g h t . I n c i d e n t a l l y y o u f o r g e t t h a t t h e w r i s t is t h e h e e l o f t h e h a n d a n d y o u m i s q u o t e t h e T e x t b o o k w h e n y o u s p e a k of “ w r i s t ” for “ lo w e r e n d of f o r e a r m .” — N .C .F .

Com press for Fractured Patella. B.

M . ( M a n c h e s t e r ) . — P l e a s e t e l l u s if t h e c o l d c o m p r e s s r e c o m m e n d e d i n R u l e 7 o n p. 91 o f t h e T e x t b o o k , i n t r e a t m e n t of f r a c t u r e d k n e e c a p , is to b e a p p l i e d o v e r t h e p a t i e n t ’s t r o u s e r o r if t h e t r o u s e r s h o u l d b e r o l l e d a b o v e k n e e jo in t for th e p u rp o se .

I n t h e t r e a t m e n t of t h i s f r a c t u r e n o i n s t r u c t i o n s a r e g i v e n to ex p o se th e p a rt ; a n d w ith sim p le fra c tu re s w e sh o u ld n o t e x p ect a n y su c h in stru c tio n s. C o n seq u en tly , w h ile I q u e s tio n t h e effects, I t a k e it a s s t r i c t l y “ t r u e to b o o k ” to a p p l y t h e cold d r e s s i n g o v e r t h e t r o u s e r . — N . C . F .

Treatm ent of Shock. L . E . ( C o r n w a l l ) . — I s h a l l b e g l a d if y o u w i l l k i n d l y t e l l m e w h e t h e r o r n o t h e p r o m o ti o n of c ir c u la tio n a s t a u g h t by t h e R . L . S . S . w o u l d b e b e n e f i c i a l i n t h e t r e a t m e n t of o r d in a ry c a s e s of sh o c k . T h e firm u p w a r d s t r o k e s o n t h e l i m b s g i v e s a f e e l i n g of c o n f i d e n c e a n d h a s a

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R I D Jo h n T e x tb o o k teaches. R e c e n t l y , t a k i n g a s q u a d of H o m e G u a r d s u n d e r t h e i r M e d ic a l O fficer, I g a v e th e t i m i n g a s t a u g h t in th e “ R .A .M .C . T r a i n i n g 1 9 3 5 ,” c h a p t e r 3 7 , i n s t r u c t i o n 6 7 7 , e x p i r a t i o n 1. 2. 3. ; i n s p i r a t i o n 1. 2. I w a s th a n k e d by th e M .O . for g iv in g th e correct tim in g . C a n b o t h of t h e s e i n s t r u c t i o n s b e c o r re c t ? I t is a ll r a t h e r c o n f u s i n g . 1 h a v e also seen H o w a r d ’s m e t h o d g i v e n a s e x p i r a t i o n 1. 2. 3. ; i n s p i r a t i o n 1. 2. 3. ; a n d a g a i n i n “ W e l c o m e ’s N u r s e s ’ D i a r y ” a s e x p i r a t i o n 1. 2. 3. ; i n s p i r a t i o n 1. 2. W h atev er m e t h o d of a r tif ic ia l r e s p i r a t i o n is b e i n g e m p l o y e d o n a n o r m a l a d u l t , I c a n n o t s e e h o w t h e t i m i n g c a n differ. T h a n k y o u a n d p lease fo rg iv e m e for t a k i n g y o u r v a lu ab le tim e.

s t i m u l a t i n g effect o n t h e c i r c u l a t i o n ; a n d it s e e m s to m e t h a t i t w o u l d b e a g r e a t h e l p i n t r e a t m e n t o f c a s e s ol s h o c k , e s p e c i a l l y n o w t h a t t o o m u c h a r t i f i c i a l h e a t is n o t recom m ended. I t is c o r r e c t t h a t f r ic tio n of t h e l i m b s h a s a b e n e f ic ia l e f f e c t ; b u t it c a n n o t b e a d e q u a t e l y p e r f o r m e d o v e r th e c lo th ing. F u r t h e r , i t is n o t a d v i s a b l e t o r e m o v e c l o t h i n g f o r t h i s p u r p o s e , a s t h e r e b y th e s h o c k w ill b e i n c r e a s e d . In th ese c i r c u m s t a n c e s it is b e t t e r in t h e t r e a t m e n t of s h o c k f r o m c a u s e s o th e r t h a n d r o w n in g , to re stric t tr e a tm e n t to th e m e t h o d s d e s c r i b e d i n C h a p t e r I V of t h e T e x t b o o k . — N . C . F .

Surgical Spirit for W ounds. N .O . ( L iv e rp o o l).— T h e a p p lic a tio n of s u r g ic a l sp irit in th e t r e a t m e n t of w o u n d s , a p p e a r s to s o m e of u s to in c r e a s e t h e s h o c k a l r e a d y p r e s e n t, by its s t i n g i n g effects. So w e w o n d e r w h y B r ig a d e R e g u la tio n s re c o m m e n d th is a n tis e p tic fo r t h e t r e a t m e n t of w o u n d s ; a n d w e w e lc o m e y o u r co m m en ts. I f s u r g i c a l s p i r i t is u s e d p r o p e r l y — t h a t is p a i n t e d o n c e o v e r th e w o u n d a n d s u r r o u n d i n g s k i n — it w ill n o t c a u s e or a g g ra v a te shock. T h e first s u g g e s t i o n t h a t s u r g i c a l s p irit is t h e id e a l e m e r g e n c y a n t i s e p t i c w a s m a d e by t h e 19 3 7 C o n fe re n c e of B r i g a d e S u r g e o n s . — N . C . F .

Concealed Haem orrhage. H . C . ( H u l l ) . — I n a re c e n t e x a m i n a t i o n I w a s a s k e d to e x p la in co n c e a le d h a e m o rrh a g e . A lth o u g h I g a v e th e sig n s a n d s y m p t o m s of i n t e r n a l h a e m o r r h a g e , m y a n s w e r s w e re n o t a c c e p t e d , s o I w o n d e r if y o u w i l l b e g o o d e n o u g h t o g iv e m e th e a n s w e r to th is q u e s tio n . T h e w o r d i n g of t h e q u e s t i o n w a s d e c i d e d l y v a g u e . To “ e x p la in co n c e a le d h a e m o r rh a g e ,” you sh o u ld h a v e sa id th a t th e te r m covers b le e d in g fro m bloodvessels a n d o r g a n s w ith in t h e c lo s e d c a v i t i e s of t h e s k u l l , c h e s t a n d a b d o m e n . — N . C . F .

C ru s h In ju ry . D . W . ( D o r c h e s t e r ) . — I s i t c o r r e c t , w h e n a l i m b is c r u s h e d , to p u t a to u rn iq u e t im m e d ia te ly ab o v e th e cru sh e d a re a before re le a se a n d sh o u ld th is be loosened g r a d u a lly a fter re le a se ? Y o u r k i n d a n s w e r w ill be a p p r e c ia te d . I n s o m e c irc u m s ta n c e s , a t ig h t c o n strictio n sh o u ld be a p p l i e d i m m e d i a t e l y a b o v e t h e c r u s h e d p a r t of a l i m b b e f o r e t h e w e i g h t is r e m o v e d ; b u t t h i s s h o u l d b e d o n e o n l y o n t h e a u t h o r i t y of a d o c t o r . I m m e d i a t e l y , t h e r e f o r e , it is k n o w n t h a t t h e i r is a c r u s h i n ju ry , a d o c t o r s h o u l d b e s u m m o n e d , p a r tic u la r ly a s th e a d m i n is t r a tio n of b ic a r b o n a te of so d a s o lu tio n in la r g e q u a n titie s m a y be a d v is a b le .— N .C .F .

Fractures of Le g and Knee-cap. D .W . ( D o r c h e s te r ) .— W o u ld yo u k in d ly g iv e m e y o u r opin io n a s to t h e c o r r e c t m e t h o d of s p lin tin g , a n d t r a n s f e r r i n g t o t h e s t r e t c h e r , a c a s u a l t y w h o is s u f f e r i n g f r o m a c o m p o u n d f r a c t u r e of t h e r i g h t t i b i a a n d fib u la , a n d a f r a c t u r e of le ft p a t e l l a ? M e a n w h i l e I t h a n k y o u f o r y o u r k in d an sw er. T h i s q u e r y is s i m i l a r to m a n y o t h e r s w h i c h h a v e b e e n receiv ed a n d w h ic h r e q u ire th e e x e rc ise of “ d is c r im in a tio n ” a s t a u g h t o n p. 16 of t h e T e x t b o o k . In th is instance, th e in ju rie s to th e le g a r e th e m o re se rio u s a n d d e m a n d p re f e re n tia l t r e a t m e n t o n t h e lin e s la id d o w n in th e T e x t b o o k . In o th e r w o rd s, a fte r you h a v e tre a te d th e w o u n d (or w o u n d s) y o u sh o u ld im m o b ilis e th e fra c tu re d r i g h t le g a n d p lace a fi g u r e - o f - e i g h t b a n d a g e r o u n d t h e left k n e e b e fo re th e t w o lim b s a r e tied to g e th e r . B y so d o in g y o u p ro te c t b o th f ra c tu re d le g a n d fra c tu re d k n e e -c a p fro m fu rth e r co m p licatio n s. — N .C .F .

T im in g in Artificial Respiration. N .W . (C ro w th o rn e ).— C ould you p lease e n lig h te n m e on th e s u b j e c t of t i m i n g in a rtific ia l r e s p i r a t i o n ? I h a v e a l w a y s t a u g h t e x p i r a t i o n 1. 2 . ; i n s p i r a t i o n 1. 2. 3 . , a s t h e S t .

P e rso n a lly , I th in k t h a t yo u a r e r i g h t a n d t h a t in th e p e r fo r m a n c e of artificial re s p ira tio n , in s p ir a tio n sh o u ld be slig h tly lo n g e r th a n e x p ira tio n , o n th e g r o u n d s t h a t physical f o r c e is a p p l i e d t o p r o d u c e e x p i r a t i o n , a n d t h a t t h i s w o u l d te n d to d riv e o u t th e a ir e n t e r in g th e l u n g s . — N .C .F .

Shock and P illo w for Head. J . R . ( B r i d g f o r d ) .— A t t e n d i n g a d e m o n s tr a t i o n re c e n tly , in w h i c h t h e t e s t c a s e w a s a s i m p l e f r a c t u r e of t h e f e m u r , I n o t e d t h a t “ A ” t e a m p u t n o p i l l o w u n d e r t h e p a t i e n t ’s h e a d ; t h a t “ B ” t e a m u se d a b l a n k e t ro lle d u p ( m a k i n g a l a r g e p illow ) ; a n d t h a t “ C ” t e a m u s e d a s m a ll, so ft pillow fro m th e sim p le k it a v ailab le. T h e a d ju d ic a to r(a p a rt fro m o th e r tre a tm e n t) praised “ A ” team , d ed u cted m a rk s from “ C ” te a m an d f u rth e r , p e n a lis e d " B ” te a m , r e m a r k i n g t h a t in t r e a t in g for sh o c k , th e h e a d s h o u ld be low . I t w a s co n te n d e d , h o w ev er, t h a t th e p a tie n t sh o u ld be m a d e c o m fo rta b le b y u s e of t h e s m a ll , s o f t p illo w . W e w elco m e y o u r ru lin g . I t is q u i t e c o r re c t t h a t , c o n s e q u e n t o n t h e s h o c k a s s o c i a t e d w i t h a f r a c t u r e d f e m u r , t h e p a t i e n t ’s h e a d a n d s h o u ld e r s s h o u ld b e k e p t low . If, h o w e v e r , t h e p a t i e n t c o m p l a i n s of d i s c o m f o r t , I t h i n k t h a t t h e d i f f e r e n c e b e t w e e n t h e u s e of n o p i l l o w o r o f a s m a l l s o f t p i l l o w is s o s l i g h t t h a t t h e p o i n t i s u n i m p o r t a n t , e s p e c i a l l y if s u c h p i l l o w g i v e s c o m fort to th e p a tie n t.— N .C .F .

W eight of Stretcher. J .R . (B rid g fo rd ).— T h e R .A .M .C . M a n u a l a n d B .R .C .S . N o . 2 M a n u a l s ta te t h a t th e s t r e tc h e r w e ig h s 30 lbs., b u t t h e S . J . A . B . M a n u a l g i v e s 2 1 -2 2 lbs. a s t h e c o r r e c t w eig h t. P l e a s e t e l l u s w h i c h is t h e c o r r e c t f i g u r e . As fa r a s I k n o w , b o th fig u re s a r e correct, th e F u rle y stretch er b ein g lig h te r th a n th e A rm y s tre tc h e r.— N .C .F .

Prussic A cid. A.

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W e h a v e b een m u c h in terested N a t i o n a l i s a t i o n in t h e S t a t e m e n t w h i c h h a s b e e n o f th e p u t fo r w a r d b y the H o s p ita ls A m b u la n c e a n d W e l f a r e S e r v i c e s U n i o n in S e rv ic e s. a d v o c a c y of the N a t io n a lis a t io n o f th e A m b u l a n c e S e r v i c e s o f th i s c o u n t r y . A t th e c e n t r e , it s a y s , “ t h e , M i n i s t e r s h o u ld a p p o in t a C h ie f D ire c to r o f A m b u la n c e S e r v ic e s , and he sh o u ld o p erate su ch se rv ic e s t h r o u g h a D i r e c t o r o f A m b u l a n c e S e r v i c e s to b e a p p o i n t e d a s a n o ff ic ia l b y t h e n e w J o i n t A u t h o r i ti e s fo r t h e e f f i c i e n t m a i n t e n a n c e o f s u c h s e r v i c e s . In t h e o p e r a t i o n o f t h e s e s e r v i c e s h y g i e n i c a n d w e ll-p la n n e d and e q u ip p e d sta tio n s sh o u ld be erected. In s o m e d i s t r i c t s t o - d a y t h e o ld h o r s e a m b u la n c e s ta tio n s are b e in g u tilised . N o fa cili tie s a r e a v a i l a b l e f o r t h e p r o p e r c l e a n s i n g a n d d i s i n f e c t i n g o f t h e - v e h i c l e s ; a n d t h e q u a r t e r s f o r th e staff do not p e rm it of a d e q u a te p r e c a u tio n s b e i n g t a k e n . , A m b u l a n c e s a r e b e i n g u s e d f o r a ll t y p e s of cases, in fe ctio u s, m a tern ity, a ccid en ts, etc., a p a r t f r o m n o r m a l r e m o v a l to h o s p i t a l s a n d i n s t i tu tio n s. I f t h e p u b l i c c o u l d s e e s o m e o f th e sta tio n s fro m w h ic h a m b u la n c e s are o p e r a t in g , th e y w o u ld be d i s g u s t e d .” A s to th e s t a f f , t h i s s h o u ld be p r o p e r ly train ed , an d th ere s h o u ld be a p eriod o f th ree y e a r s ’ t r a in in g b e fo re b e c o m in g c ertifica ted . A ll e x istin g a m b u la n c e e m p lo y e e s w o u ld be g i v e n an o p p o r t u n ity o f b e i n g p la ce d on th e s t a t e r e g i s t e r ; t h e r e a f t e r s u c h r e g i s t e r w o u l d co n ta in o n ly the n a m e s o f th o se w h o h a v e q u alified by tra in in g and exam in ation . T h e type of w o rk f o r w h i c h t h e p e r s o n n e l is r e s p o n s i b l e c a n be d iv id e d in to th re e c la s s e s , g e n e r a l w o r k , in fe c t io u s d is e a s e 'c a s e s , and accid en t, in c lu d in g m a te rn ity , cases. T h e p e rso n n e l s h o u ld be so train ed th at th e y can deal w ith a n y e m e r g e n c y and be ca p a b le o f r e m o v a l o f a n y p a t i e n t t f o r it m u s t b e k e p t in m in d th a t an in a d v e rte n t s lip or m is h a p at the o u t s e t m a y c a u s e l o s s o f l i f e or, a t l e a s t , r e ta r d recovery. T h e s ta ff s h o u ld b e s m a r t, efficien t a n d t a c t f u l , a n d h a v i n g r e g a r d to t h e r i s k o f i n f e c t i o n , th e y s h o u ld be p r o v id e d w ith u n ifo rm and e v e r y fa cility for p re c a u tio n a r y m e th o d s. T h e C h ief D ir e c t o r o f A m u l a n c e S e r v i c e s s h o u ld be the in d i v i d u a l r e s p o n s i b l e to t h e M i n i s t e r a n d t h r o u g h t h e

F I R S T

M i n i s t e r to P a r l i a m e n t to e n s u r e t h a t t h i s a n c i l l a r y s e r v i c e is b e i n g p r o p e r l y a d m i n i s t e r e d a n d is f u n c t i o n i n g in e v e r y a r e a a n d r e g i o n . S p e c ia l stress m u s t b e la id u p o n th e f u l l o v v i n g p a r a g r a p h in th e U n i o n ’s s t a t e m e n t :— “ T h e p e r s o n n e l s h o u l d h a v e e v e r y e n c o u r a g e m e n t , a n d th e s e r v ic e s h o u ld h old o u t s u c h p r o s p e c t s in r e g a r d to w a g e r a t e s a n d c o n d itio n s , p ro m o tio n , s u p e ra n n u a tio n , e tc ., that it b e c o m e s to t h e m a l i f e t i m e p r o f e s s i o n , a n d in f i x i n g the w a g e rate r e c o g n itio n s h o u ld be g iv e n to t h e r e s p o n s i b l e n a t u r e o f t h e d u t i e s a n d r i s k s in v o lv e d .” T h e reco m m en d a tio n s and s u g g e s t i o n s e m b o d i e d in t h e S t a t e m e n t , t o g e t h e r w i t h t h e o p i n i o n s w i t h w h i c h it is p u n c t u a t e d , m e e t , it is p e r h a p s s c a r c e l y n e c e s s a r y to a d d , w i t h o u r u n q u a lifie d a p p r o v a l.

A.R.P. Handbook No. 10. T raining in F irst A id for C ivil D efence P urposes .

T he A m e n d e d R e p r i n t o f t h e 2 n d E d i t i o n o f t h e a b o v e h a n d b o o k a p p e a r e d i n M a r c h o f t h i s y e a r , a n d i s w o r t h y of c a r e f u l s t u d y b y a ll b r a n c h e s of t h e C ivil D e f e n c e S e rv ic e s . The b o o k e m b o d i e s all th e c h a n g e s in a d m i n i s t r a t i o n r e s u l t i n g f ro m t h e fu s io n of t h e f o r m e r R e s c u e a n d F i r s t A id P a r t ie s to fo rm th e n e w R e s c u e S ervice, a n d in clu d es m a n y a m e n d m e n t s a n d a d v a n c e s in F i r s t A id itself, m o r e e s p e c ia lly w ith r e g a r d t o t h e h a n d l i n g o f c r u s h i n j u r i e s a n d c a s e s of b l a s t syndrom e. A n i n n o v a t i o n i n t r o d u c e d i n t o t h i s r e p r i n t c o n s i s t s in m a r g in a l lines p laced a g a in s t p a r a g r a p h s c o n ta in in g a d d i tio n s a n d a m e n d m e n ts w h ich c o n sid e ra b ly facilita tes th e a p p r e c ia tio n of n e w w o r k in tro d u c e d in to th e book. I t i s i n t e r e s t i n g t o n o t e t h a t a h a n d b o o k is i n c o u r s e of p r e p a r a t i o n o n t h e s u b j e c t of F i r s t A id fo r A ir R a i d I n j u r i e s , i n w h i c h is t o b e i n c l u d e d a l l t h a t w e h a v e l e a r n e d u p o n t h e s u b j e c t i n five l o n g y e a r s o f w a r . I t is t o b e h o p e d t h a t w h e n th is b o o k a p p e a r s it w ill b e su ffic ie n tly c o m p r e h e n s iv e to b e a c c e p te d by th e e x is tin g e x a m i n i n g b o d ies g r a n t i n g certifi c a te s in F i r s t A id a s a n a u t h o r i s e d te x tb o o k , a s te p w h ic h w o u ld av o id th e m u c h d isc u sse d q u e s tio n a s to th e u r g e n t n e e d fo r m o d e r n is a tio n of th e p r e s e n t h a n d b o o k s . P a r t I o f t h e n e w r e p r i n t is d e v o t e d t o t h e g e n e r a l p u r p o s e s , o r g a n i s a t i o n , t r a i n i n g a n d e q u i p m e n t of th e R e s c u e S ervice. M u c h a n t a g o n i s m fo llo w ed th e f o r m a t i o n of th is S erv ice b y t h e c o m b i n a t i o n of t h e f o r m e r R e s c u e a n d F i r s t A id P a r t i e s , a n d i t is p o i n t e d o u t h o w v a l u a b l e i t w o u l d h a v e b e e n a n d w h a t c o n s e r v a t i o n of m a n p o w e r w o u l d h a v e r e s u l t e d if, f r o m t h e v e r y f i r s t , a l l m e m b e r s o f t h e o r i g i n a l F i r s t A id, R e s c u e a n d D e c o n t a m i n a t i o n P a r t ie s h a d b e e n a b l e t o u n d e r t a k e o n e a n o t h e r ’s d u t i e s . T h e F i r s t A id P a r t i e s a f t e r r a i d s a r e s e ld o m so h a r d p r e s s e d a s t h e R e s c u e P a r t i e s , w h o s e w o r k i n t h e r e l e a s e of tra p p e d c a s u a ltie s o ften e x te n d e d for lo n g p eriods. W here r e s c u e w o r k w a s h a n d ic a p p e d by s h o r t a g e of p e rso n n e l, F irs t A i d P a r t i e s t r a i n e d a l s o i n t h e s e d u t i e s w o u l d h a v e b e e n of th e g r e a te s t value. U n d e r th e h e a d in g of “ E x p e d ie n ts u se d to F a c ilita te T r a i n i n g ” t h e r e is l i t t l e c h a n g e d , b u t i t c a n n o t b e t o o s t r o n g l y s t r e s s e d h o w v a l u a b l e i s t h e m e t h o d d e s c r i b e d of “ f a k i n g ” c a s u a ltie s to s im u la te th e re a l th in g .

R i f t M e re ly to la b el a c a s u a lty w ith a d efin ite s t a t e m e n t a s t o t h e n a t u r e a n d e x t e n t of h is i n j u r i e s p r o v id e s n o p r a c t i c e w h a t e v e r f o r t h e p u p i l e i t h e r i n t h e e x a m i n a t i o n of t h e p a t i e n t o r t h e d i a g n o s i s of h i s in ju r y , n o r d o e s it p r e p a r e h i m in a n y w a y f o r t h e h o r r o r s w 'h i c h h e w i l l m o s t c e r t a i n l y b e c a lle d u p o n to face. E xperienced p erso n n el a re lo n g p ast th e s ta g e w h e n a labelled c a s u a lty c a n s u s ta in th e ir in terest. H o w w i d e l y t h e d e s i r e f o r m o r e r e a l i s t i c t r a i n i n g e x i s t s is m a n ife st from th e n u m e r o u s in q u iries u p o n th e su b je ct w h ich h a v e a p p e a r e d f r o m t i m e t o t i m e i n F irst A id . A careful s t u d y of t h i s c h a p t e r w ill p r o v i d e t h e i n s t r u c t o r w i t h a ll t h e s u g g e s t i o n s n e c e s s a r y , e s p e c i a l l y if i t b e c o m b i n e d w i t h t h e m a g n i f i c e n t s e r i e s o f c o l o u r e d p h o t o g r a p h s of f a k e d a n d r e a l c a s u a l t i e s r e c e n t l y i s s u e d u n d e r t h e t i t l e “ A t l a s of A i r R a i d In ju rie s.” T h e m o r e vivid a n d r e a l p r a c tic e c a s u a ltie s c a n b e m a d e t h e g r e a t e r w ill b e t h e i n t e r e s t of t h e s e n i o r m e m b e r s of t h e p a r t y a n d t h e le ss w ill b e s h o c k to t h e in e x p e r i e n c e d w h e n in a c tio n for th e first tim e . T h e y w ill v e ry so o n a p p r e c ia te t h a t , in w a r a t a n y ra te , th e y m u s t b e p r e p a r e d a n d t r a in e d , m o r e o f te n t h a n n o t, to d i s r e g a r d t h e d i c t u m of a p a s t a g e of p e a c e t h a t “ T h e first a i d e r m u s t o n n o a c c o u n t t a k e u p o n h i m s e l f t h e d u t i e s a n d r e s p o n s i b i li t e s of a d o c t o r . ” W hen h e fin d s h i m s e l f a l o n e w i t h h is first b a d c a s u a l t y t h e o d d s a r e h e w ill jo lly w ell h a v e to ! T h e chief m o d ific a tio n c o n t a i n e d in th e c h a p t e r u p o n t h e m a r k i n g of c a s u a l t i e s c o n s i s t s i n t h e i n s t r u c t i o n t h a t t h e s y m b o l X is in f u t u r e to be u s e d , n o t o n ly a s a n i n d i c a t i o n fo r t h e n e e d of p r io r ity of r e m o v a l f o r c a s e s s u c h a s w 'o u n d s of th e c h e s t a n d a b d o m e n , c a s e s of in te r n a l h a e m o r r h a g e , e t c . , b u t is n o w a l s o t o b e e m p l o y e d f o r a l l u n c o n s c i o u s p atien ts. T h e l a b e l a t t a c h e d t o s u c h c a s e s is a l s o t o b e a r u p o n t h e r e v e r s e s i d e e v e r y p o s s ib le p ie c e of i n f o r m a t i o n w h i c h m i g h t a s s i s t i n e s t a b l i s h i n g t h e i d e n t i t y of t h e c asu alty . T h e c h a p te r u p o n T r a n s p o rta tio n c o n ta in s a n ew section d e v o t e d t o a n e x p l a n a t i o n of t h e u s e o f t h e K i n g S t r e t c h e r H a r n e s s , o n e s e t of w h i c h is n o w is s u e d to a ll R e s c u e P artie s. T h e s e c t i o n u p o n l i f t i n g b y m e a n s of w e b b i n g b a n d s — o r T r i g - L i f t s — is r e p e a t e d i n t h e r e p r i n t . A lth o u g h th ese a re n o w a p a r t o f t h e s t a n d a r d e q u i p m e n t , t h e r e is s t i l l a d i s i n c l i n a t i o n t o m a k e f u ll u s e o f t h e m i n s p i t e o f t h e f a c t t h a t th e y h a v e m o re t h a n p ro v ed th e ir value. No one w ho has h a d e x p e r i e n c e of t h e i r u s e i n a c t i o n c a n h a v e t h e f a i n t e s t d o u b t a s t o t h e i r s u p e r i o r i t y o v e r a n y i m p r o v i s e d m e t h o d of lifting. T h e s ta g e h as lo n g passed w h en th ere w as a te n d e n c y to r e g a r d th e m a s u n n e c e s s a r y e q u i p m e n t w h ic h c o u ld readily be rep laced by tr ia n g u la r b a n d a g e s. T h e c h a p te r u p o n C ru sh In ju rie s h a s been com pletely r e - w r itte n in a c c o r d a n c e w i t h th e la te s t r e s e a rc h u p o n th e su b je ct. I t in c l u d e s all th e n e w w o r k u p o n k i d n e y d a m a g e , t h e u s e of l a r g e q u a n t i t i e s of fluid d u r i n g t h e p e r io d of c o m p ressio n , a n d i n s tr u c tio n s a s to th e i n f o r m a tio n to b e g iv e n u p o n th e c a s u a lty lab el. I t is t o b e n o t e d t h a t t h e u s e of a t o u r n i q u e t in t h e s e c a s e s to l i m i t t h e s p r e a d of t o x i n s h a s b een en tirely g iv en up. A new ch ap ter h a s been introduced upon th e s u b j e c t o f “ I n j u r i e s f r o m A t m o s p h e r i c B l a s t , ” w h i c h is o f s p e c i a l i m p o r t a n c e i n v i e w o f t h e n u m b e r of c r i s e s o c c u r r i n g in F l y i n g B o m b in c id e n ts . T h e s t a t e m e n t is m a ^ e t h a t c e r t a i n s i g n s a n d s y m p t o m s a re c o n s ta n t a n d m a y be read ily o b served by c a su a lty p e r so n n e l. S h o c k is p r o f o u n d a n d g e n e r a l l y a c c o m p a n i e d b y restlessness. T h e la tte r sh o u ld c o n stitu te a v a lu a b le d ia g o n i s t i c p o in t, s i n c e its a b s e n c e in t h e s h o c k of s e v e r e a i r r a i d in ju rie s w a s first n o te d b y T r u e t t a in S p a in , a n d h a s b e e n c o n s t a n t l y n o t e d a m o n g t h e c a s u a l t i e s of e a r l i e r r a i d s . T h e f o r c e of t h e p r e s s u r e w a v e m a y a t t a i n a v e l o c i t y o f 2,000 ft. p e r s e c o n d , b u t d i e s d o w n r a p i d l y b e y o n d 3 0 ft. I t p r o d u c e s t h e effe ct of a v io le n t b lo w u p o n t h e b o d y , i n j u r i n g p a r t i c u la r ly th e i n t e r n a l o r g a n s u p o n th e ex p o s e d side. H aem orr h a g e m a y be c a u s e d w ith in th e tis s u e s of th e lu n g , b u t th e

F I R S T first signs are not commonly seen for about an hour after exposure, when a dry cough followed by haemoptysis and cyanosis develops. Pain in the abdomen from injury to an abdominal organ may occur, but is very much less frequent than is the case when a man, immersed in water, is exposed to the blast of underwater explosions. Treatment consists in the customary methods for dealing with shock. Morphia should not be used except in small doses for controlling restlessness ; sm oking should be prohibited and no attempt made to carry out any form of artificial respiration. The case should be labelled with an X as one of urgent priority, In former editions of the Handbook the last chapter upon Artificial Respiration consisted only of a description of Schafer’s method, but the rocking method of Dr. F. C. Eve is now advocated as an alternative, and is fully described and illustrated.— H.M.

The Home Guard and First Aid. IN R E T R O S P E C T . So the end of the Home Guard is in sight ! Many of us, especially those who were luckier in the time at their dis posal, cannot help feeling some pangs of regret, despite the hard work, long hours of training after a day’s work, and, at times, almost overpowering monotony. Y e t all the time, there was the feeling that vye were doing a useful job, and that the time was not wasted. Looking back, one cannot help feeling a tw inge of pride in small incidents— unimportant perhaps, to any but our selves. I remember, for instance, the first parade, years ago, of the original recruits to the old L. D .V . Almost all, old service men— men who had done no drill, or handled arms for nearly a quarter of a century ; some 200 of them, and most with medals up from previous campaigns. All walks of life were represented, and all mixing and chatting as though life-long friends. Clerks and coal-heavers ; direc tors and dustmen ; lawyers and labourers ; doctors and draughtsmen ; all drawn by the common feeling that they must do their bit at such a critical time. And I remember the inspection by the white-haired old colonel, and the march-past, with every man automatically dropping into step, bracing shoulders, and turning with such precision, that it'seemed they had been in training since 1918. One felt proud to be among them ! T h e curious thing is, this bonhomie, good fellowship— call it what you will, has existed to the end. A good motto for the entrance to H.G. headquarters, would have been “ Abandon rank all ye who enter here ! ” As in most walks of life, the war had at least drawn men closer together ; more friends were made, and fresh interests developed. Will it continue after we are dis banded ? I wonder— and hope. Then later, when the younger men ‘j oined us, they too found new interests, and quickly fell into the scheme of things. They soon proved their worth, and we— many of us with sons am ong them— felt proud of them, too. All those who afterwards joined the regular forces, were appreciative of their initial training in the Home Guard. And to a very large number, it meant rapid promotion and commissions. But what has all this to do with first aid you may well ask ? Nothing much perhaps, except that this comradeship was even more evident in the medical sections. T he very nature of our work ensured this. And we started in the same humble w a y as the other units. While they were wielding pick-handles and broomsticks, while aw aiting the first consignment of rifles, we had to equip ourselves and train with any F.A. materials we" could rake together our selves, or make. My unit was quite proud of the resuscita

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tion tent they made ; the Thom as Splints made to exact copy of one borrowed for the purpose, and other things, especially when given considerable praise by the G .O .C . London dis trict, on the occasion of an unexpected visit. One effect of the difficulty in getting started, was to developeatthe outset, improvisation and initiative, so essential to the real first aider. How different now, with up-to-date equipment, and generous supplies of dressings, bandages, splints, etc ! The training has proved invaluable, even if we were not called out for field work. All over London during the flying bomb period, H .G . medical personnel have proved their worth, and have given valuable assistance on many occasions. And what of the future ? Many, I know, will transfer to the ranks of the Red Cross or St. John. Some are con sidering working together as private units, purely for the love of it, and willing to give help wherever needed. W h a t ever they do, their H .G . training will prove its worth. Unlike the rifle, which must necessarily be shelved at the end of hostilities, first aid goes on, with something new to learn each day, and alw ays that deep feeling of satisfaction from useful service to those in need of one’s assistance. And once its in the blood', there’s no escaping its magnetism. As this may possibly be my last column as a Home Guardsman, I want to thank all those who have followed my poor attempts to prove of interest to the H .G . first aider— and not least, my critics ! Criticism is a wonderful teacher, and I have learnt much. I make no claims to journalism, and for that, I make no apologies. Many thanks also, to all those numerous friends who have sent such kindly letters. I, like the rest, mean to carry on to the best of my ability, and perhaps we may still continue our contacts through the columns of F irst A id . C. W . S pr e a d b u r y .

St. John Ambulance Association. W isb e c h .— T h e officials of the Wisbech Centre of the S.J .A.A . who were responsible for the sta gin g of the first aid demonstrations and competitions on Sunday, August 27th, were awarded top marks for efficient organisation. T h e considerable crowd which attended saw simultane ously the contests for the cup and rose bowl presented by Mrs. E. T. R. Hall, and a series of realistic incidents and demonstrations, all showing most effectively the practical application of first aid in a variety of every-day accidents. The organisers w'ere honoured by a visit from Lady Waleran, Chief Staff Officer to the Chief of the St. John Nursing Cadets, who inspected the assembled teams at the opening of the afternoon’s activities. A team from the Wisbech Ladies’ Nursing Division won the “ H a l l ” Cup by the narrow margin of one mark, and a party of Wisbech Nursing Cadets were the winners in a close contest for the rose bowl. First aiders from all over the district took part in what was not only a most successful and entertaining effort, but also a source of valuable instruction and an excellent means of m akin g the general public more appreciative of the great w ork being done by the S.J.A .A . The “ H a l l ” Cup contest was judged by Dr. Groom, points being awarded for general efficiency. T he winners were the Wisbech Ladies’ Nursing Division No. 1 team, with 63 marks ; 2nd, the Wisbech Ladies’ Nursing Division No. 2 team, 62 marks ; highest possible, 80. The Cadets’ competition for the rose bowl was judged by Dr. Maurice Smith, assisted by Mrs. Manley. The winners were the Wisbech Nursing Cadets No. 3 team. Thanks to the two doctors were voiced by Sir Walter West," and Dr. Groom thanked Mrs. Hall for her interest in the Association and for so generously giving the cup and the rose bowl for annual competition.

F I R S T

St. John Ambulance Brigade HEADQUARTERS

AND

D IST R IC T R E P O R T S.

A I D W in n e r s : S ir S ta n le y W h i t e C u p , “ B ” D iv isio n (A ero E n g i n e s ) , W . L. K i n g ( c a p t.) , J. G a r n e r , T . L e e , A. G o u g h , W . L. T ay lo r. R u n n e r s - u p : “ A ” D iv isio n (A irfram es), W . E . D a w t r y ( c a p t . ) , T . A b r a h a m s , S . J. W i l t s h i r e , F . M o r r is , J. G. M o r t o n . I n d i v id u a l p riz e : C pl. W . L. K i n g (A ero E n g in e s ).

N o . I (P rince o f W ales’s) D istrict H eston and S ou th al l . — A n e w m o t o r a m b u l a n c e h a s b een p ro v id ed for th e H e s to n a n d S o u th a ll A m b u la n c e a n d N u r s i n g D iv isio n s. It cost ;£ 8 0 0 , ra ise d d u r in g e ig h te e n m o n th s by social fu n ctio n s, aid e d by p riv a te d o n a tio n s from s u p p o r t e r s of t h e B r i g a d e . It h a s a c c o m m o d a t i o n fo r o n e s t r e t c h e r ca s e , a s i t t i n g c a s e a n d o n e a t t e n d a n t , a n d is f i t t e d w i t h a l l m o d e r n d e v i c e s . T h e r e is a l o a d i n g - t r a y f o r t h e h a n d l i n g o f p a t i e n t s , a n d s tre tc h e r w ith p a te n t h e a d a d ju s tm e n ts for th e co n v en ien ce of t h e p a t i e n t . T h e e q u ip m e n t in c lu d e s first-aid kit, o x y g e n a p p a r a t u s a n d electric h e a te r. T h e a m b u l a n c e will b e a v a i l a b l e fo r t h e c o n v e y a n c e to a n y d i s t a n c e of s i c k p a t i e n t s , o n p r o d u c t i o n of c e r t i f i c a t e f r o m a d o c t o r o r m a t r o n of h o s p i t a l o r n u r s i n g h o m e , s t a t i n g t h e p a t i e n t is u n a b l e t o t r a v e l b y o t h e r m e a n s ; a p p l i c a t i o n s h o u l d b e m a d e to S u p t. J. E . T a y l o r , S O U 1808, T r a n s p o r t O ffice r A . H . S p e c k , 3, S u t t o n S q u a r e , H e s t o n , o r m e m b e r s of t h e D iv isio n s or S ectio n s. ■

C ounty o f Berkshire. R eading C entral N ursing D ivision . — A m b u l a n c e S i s t e r M is s S. G e o r g e of th i s D iv is io n h a s b e e n s e le c te d f o r C iv ilian R e lief W o r k o v e rse a s, a n d h a s n o w g o n e to t a k e u p h e r ap p o in tm en t. C adet N e w s . — F o r t y A m b u l a n c e C a d e t s a n d t h i r t y - e i g h N u r s i n g C a d e t s of t h e R e a d i n g C o r p s , a t t e n d e d t h e c a m p w h ic h w a s h eld a t S w allo w field fro m A u g u s t 12th to 1 9th. T h e c a m p w a s i n c h a r g e of t h e C o u n t y C o m m i s s i o n e r , M r . C. A . P o o l e a n d C o u n t y C a d e t O f f i c e r M r s . C . A. P o o l e . C a d e t S u p t. F ..G . C a rte r w a s O ffice r-in -C h arg e , a b ly a s siste d b y s ix o t h e r officers a n d m e m b e r s . A ctiv ities in c lu d e d s w i m m i n g in th e L o d d o n , a r a m b l e to W e llin g to n M o n u m e n t a n d c o m p e titio n s fo r th e c le a n e s t t e n t a n d t h e m o s t o r i g i n a l a n d u s e f u l s e t of c a m p “ g a d g e t s . ” A s p o rts m e e tin g w a s held a n d th e prizes w e re p re s e n te d to th e w i n n e r s b y M r. D a n c e (w h o k in d ly le n t th e site fo r t h e c a m p ) a t th e C a m p F ire w h ic h to o k p lace on th e last n ig h t. O b it uar y . — W e r e g r e t t o a n n o u n c e t h e d e a t h o f S u p t 1 W . J . M e r e d i t h of R e a d i n g T o w n “ A ” A m b u l a n c e D i v i s i o n s R e a d in g C orps. H e j o i n e d t h e B r i g a d e in 1 912, w a . a w a r d e d h is L o n g S e r v ic e M e d a l in 1926, a n d B a r in 1 9 3 4 r I n M a y , 1 934, h e w a s m a d e a S e r v i n g B r o t h e r of t h e O r d e of St. J o h n . T h e fu n e ra l to o k p lace o n M o n d a y , S e p te m b e r 4 th , a t the H en ley Road- C re m a to riu m , C a v e rsh a m , R e a d in g . It w a s a t t e n d e d b y t h e C o u n t y C o m m i s s i o n e r , M r . C. A . P o o l e , w h o w a s a c c o m p a n i e d b y C o u n t y O f f i c e r F . A . C. J a r v i s a n d C o r p s S u p t. J. W i n t e r b o u r n e . M a n y o t h e r officers a n d m e m b e rs w e re p resen t.

C ounty o f B ristol. B r i s t o l N o . 3 C orps ( B . A . C . ) . — T h i s C o r p s h e l d t h e i r a n n u a l co m p e titio n for th e S ir S ta n le y W h ite C u p on S a t u r d ay , A u g u s t 12th, a t C h a r b o r o g u h R o a d , F ilto n . T h e six D ivisional te a m s th a t e n te re d th e co m p etitio n w e re co m p o sed e n t i r e l y of v o l u n t e e r s f r o m t h e B r i s t o l A e r o p l a n e C o m p a n y a n d t h e y w o r t h i l y u p h e l d th e fine t r a d i t i o n o f t h e C o r p s . D r. R o b e rts a n d D r. D a t t a w e re th e ju d g e s , a n d M r. W . S ibly, v ic e -p re sid e n t of “ A ” D iv isio n , N o. 3 C o rp s, p r e se n te d th e prizes.

C ounty o f H am pshire. H o u n d an d N e tle y . — T he a n n u a l p r e s e n t a t i o n of a w a r d s to th e A m b u la n c e , N u r s i n g a n d C a d e t D iv is io n s w a s , in t h e a b s e n c e of M a j o r T . H . D e n m a n , p r e s i d e d o v e r b y R . C. M o o r m a n , V i c e - P r e s i d e n t . W . S t e p h e n C l a r k e h a n d e d to e a c h c a d e t of t h e A m b u la n c e a n d N u r s i n g D iv isio n s th e ir first a id certificate s a n d b a d g e s , c o n g r a t u l a t i n g t h e m all o n t h e i r s tu d y , e tc ., for t h e s e a w a r d s ; h e u r g e d t h e m to c o n t i n u e w i t h t h is fine w o r k . T h e fo llo w in g p assed — M iss M. B irch , M iss C. G r a n t, M iss J. H o d d e r , M iss J. C r o o k , M iss B. H o u g h t o n , M is s J. T a l b o t, M iss P. M ills. ' M e s s rs . J o h n H i l l m a n , J. L u c a s , H . L o n g w o r t h , M. E d w a r d s , P. F o y le, C. B irch , R . L u c a s , L. Ja rv is , N. W rig h t, J. R a tten b u ry . C o u n t y O ffic e r H . S. T h o m a s t h e n c a r r ie d o u t t h e e n r o l m ent cerem ony, ad d ressin g th e c a d e ts on th e g re a t o p p o r t u n i t i e s t h a t l ie a h e a d , a l s o o n t h e t r a d i t i o n s o f t h e V e n e r a b l e O r d e r of S t. J o h n . A r e a C a d e t O f f i c e r ( C o u n t y ) W . B u t t s p o k e of t h e o r g a n i s a t i o n a n d i t s c o n t r o l o f t h e c a d e t s b y t h e y o u t h i t se lf . T h e m e m b e r s of t h e A m b u l a n c e D i v i s i o n t h e n r e c e i v e d t h e i r a w a r d s of e f f i c i e n c y i n t h e f o r m of m e d a l l i o n s a n d l a b e l s , for th e year. M r . R . C. M o o r m a n p r e s e n t e d l a b e l s t o t h e f o l l o w i n g : M e s s r s . A. B r i g h t , R . B i n f i e l d , P . M o r e y , H . C. E d w a r d s , H . C. D a v i s , a n d m e d a l l i o n s t o : M e s s r s . R . W o r t , T . W . S m i t h , A. A n d e r s o n , D . F a r r . T h e o c c a s i o n c o n c l u d e d w i t h a v o t e of a p p r e c i a t i o n t o D r. L. C a rd e n for th e h e lp a n d k n o w le d g e i m p a r te d to th e c a d e ts a n d to th e o t h e r D iv isio n s , A m b u l a n c e a n d N u r s i n g .

County o f W arwick. C o v e n t r y ( C e n t r a l) C o r p s .— A fu rth er l i n k in t h e c h a in of c o - o rd in a tio n h a s b e e n f o rg e d b e tw e e n th e C o v e n try a n d W a rw ic k s h ire H o sp ita l S a tu rd a y F u n d a n d th e S .J.A .B . T h e fu n d h a s for m a n y y e a rs b een r u n n in g a v ast a m b u l a n c e fleet, b e a r i n g t h e b a n n e r of t h e B r i g a d e , . a n d s ta ffe d b y i t ’s m e m b e r s . T h e F u n d a l s o h a s i t ’s o w n N u r s i n g D ivision. R e c e n t l y , L a n h e r n e H o u s e a t D a w l i s h in S o u t h D e v o n , w h ic h h a s p rev io u sly b een a y o u n g la d ie s ’ school, h a s been a c q u ire d by th e F u n d a s a C o n v a le scen t H o m e , a n d th e C h a p e l in t h e g r o u n d s w ill, a f t e r d e d i c a t i o n , b e k n o w n a s t h e C h a p e l of S t. J o h n . T h e b u i l d i n g a n d i t ’s c o n t e n t s h a v e b e e n p r e s e n t e d b y M r s . D o r o t h y M . M a r c h , of C o v e n tr y , w ife o f C o r p s S u p t . L . T . M a r c h , of t h e W a r w i c k s h i r e C e n t r a l (C oventry) C orps. T h e C h a p e l is t o b e d e d i c a t e d t o t h e C o v e n t r y m e m b e r s of t h e B r i g a d e w h o m a d e t h e s u p r e m e sacrifice, a n d to th e m e m b e r s t h a t se rv e d in th e H o s p it a l a n d t h e C i t y d u r i n g t h e h e a v y a i r r a i d s o n C o v e n t r y of 1 9 4 0 a n d 1941. _

County o f W orcester. T ip t o n . — T h e M .E .C . s p o r ts p av ilio n a t T o ll E n d , T i p to n w a s o n S u n d a y , A u g u s t 20th, th e sc e n e of a realistic d e m o n s t r a t i o n b y m e m b e r s of t h e A m b u l a n c e , N u r s i n g a n d C a d e t D i v i s i o n s of t h e T i p t o n a n d D i s t r i c t C o r p s . T h e initial p h a s e s h o w e d th e disc o v ery a n d “ a t t e n t i o n - o n - th e - s p o t” w o r k of th e a m b u l a n c e m e n , a n d t h r o u g h o u t th e d e m o n s tr a tio n a r u n n i n g c o m m e n t a r y w a s g iv e n by D r. T . W . K e m p . T h e su p p o sitio n w a s th a t th e w a r h a d ended, a n d th a t h e r e w a s o n e of t h e v o l u n t e e r S t. J o h n u n i t s a t w o r k in a v illa g e in d e v a s ta te d E u r o p e w h e r e n o p r o p e r m e d ic a l se rv ic e w a s in b e i n g .

F I R S T T h e d e m o n s t r a t i o n w a s t h e f i n a l i t e m o n t h e o c c a s i o n of th e p r e s e n ta tio n of c o rp s tro p h ie s. B re n d a L a d y H ic k m a n th e n p re se n te d th e tro p h ie s an d certificates to th e seniors, a n d L a d y D ia n a H a m ilto n R ussell to th e ca d e ts.

R I D

Some Psychological Aspects of Ambulance Work. B y F.

Reviews. ifp -T o - D a te T r a in in g .

B y L t . - C o m m a n d e r F . A. M . E d e n , L o n d o n : J o r d a n & S o n s L td . P r i c e 3 s. ; by

R. N. p o st 2S.

M .B .E .

[T h ese n o tes a re m a in ly b ased on lec tu re s g iv en by D r . K e n n e t h R o d g e r , M . D . ( P y c h i a t r i s t ) , w h o is a D i v i s i o n a l S u r g e o n of t h e S . J . A . B . ]

T he f i r s t a s p e c t t o b e c o n s i d e r e d is t h e a m b u l a n c e w o r k e r

T h i s little b o o k h a s b e e n c o m p ile d to su p p ly its r e a d e r s w i t h p r a c t i c a l h i n t s o n t h e b e s t w a y t o g i v e c o u r s e s of i n s t r u c tio n to c la s se s c o m m i t t e d to th e ir c h a r g e . D iv id ed into e i g h t s e c t i o n s it d e a l s w i t h t h e c o n d u c t of l e c t u r e s , d e m o n s t r a t i o n s , p r a c t i c e s a n d e x e r c is e s , w h i l e it m a k e s H elpful s u g g e s t i o n s w i t h r e f e r e n c e to t h e m a n a g e m e n t of d is p la y s , t r a i n i n g a n d e x a m i n a t i o n s ; a n d it e n d s w i t h s o m e a d v ic e to th e in s tru c to rs co n cern ed . T h e b o o k is w r i t t e n i n s i m p l e l a n g u a g e ; a n d it s h o u l d s a t i s f y t h e n e e d s o f i n s t r u c t o r s w h o realise t h a t th e ir m e th o d s a r e n o t a lto g e th e r sa tisfacto ry . C a s u a lty W o r k F o r A d v a n c e d F i r s t A i d S tu d e n ts .

B y A. W . M ac Q u arrie, M .B .C h .B . E d i n b u r g h : E . & S. L i v i n g sto n e L td . P r i c e 4 s. 6 d . ; by p o s t 4 s . g d .

T h i s b o o k is i n t e n d e d f o r t h o s e w h o h a v e a l r e a d y q u a l i f i e d in first a id ; a n d its t e a c h i n g is i n t e n d e d to be s u p p l e m e n t a r y to t h a t a lr e a d y received, b e in g b a s e d u p o n th e s a m e p rin cip le s. In o th er w ords, a lth o u g h th e m eth o d s a re so m e t i m e s d i f f e r e n t f r o m t h o s e t a u g h t i n t h e o f fi c i a l t e x t b o o k s of firs t a i d , t h e e x p e r i e n c e d s t u d e n t w i l l r e c o g n i s e t h a t t h e b a s ic p r i n c i p l e s 'g o v e r n i n g t h e a p p l i c a t i o n of t h e m e t h o d s a r e th e sa m e. T h e b o o k s t r e s s e s t h e i m p o r t a n c e of i m m e d i a t e c o n t r o l of h a e m o r r h a g e , i m m o b i l i s a t i o n of b a d l y d a m a g e d t i s s u e s a n d r a p i d i t y of t r a n s p o r t t o h o s p i t a l ; a n d it s h o u l d p r o v e m o s t u s e f u l t o t h o s e f o r w h o m it is i n t e n d e d .

Southern Railway. T hames

W . A U S T IN ,

V alley.— T h e

4 t h a n n u a l p r e s e n t a t i o n of a w a r d s of t h e S . J . A . A . , T h a m e s V a l l e y c l a s s , t o o k p l a c e a t S t r a w b e r r y H ill s t a ti o n o n W e d n e s d a y n i g h t , A u g u s t 30th, w h e n M r. H a m m o n d (d ep u ty c h a ir m a n ) presided. O f th e 77 m e m b e r s w h o s a t fo r e x a m i n a t i o n , 73 w e r e successful. T h e a w a r d s w e r e 56 lab el c a r d s , 3 silv e r m e d a l s , 3 b ro n z e m e d a ls , 8 m e d a llio n s, a n d 8 certificates. M r . B r a z i e r s p o k e of t h e g o o d w o r k d o n e b y t h e r a i l w a y f i rs t a i d c l a s s e s , r e m a r k i n g t h a t t h e S o u t h e r n h a d h a d t h e i r s h a r e of “ b u z z b o m b s . ” T w o 30 y e a r s ’ c ertific ate s a n d o n e g o ld m e d a l a n d tw o s i l v e r m e d a l s h a v e n o t y e t b e e n r e c e i v e d f r o m h e a d , office. M r . S h a r p e , of t h e S t . J o h n B r i g a d e a t K i n g s t o n , s p o k e of t h e w a y t h e c l a s s h a d b e e n i n s t r u c t e d a n d of t h e a w a r d s p r e s e n t e d a n d p r o p o s e d a v o t e of t h a n k s t o M r s . B r a z i e r f o r presen tin g th e a w ard s. ' A v o te of t h a n k s w a s a ls o a c c o r d e d M r . H . H a m m o n d fo r h is u n t i r i n g effo rts a s c la s s le a d e r , a n d to M r. S. W . S m ith , for h is h a r d w o r k a s cla ss se c re ta ry .

N ew A mbulance . — A l a r g e c r o w d a s s e m b l e d a t t h e S p o r t s G r o u n d , S t e y n i n g , o n W e d n e s d a y , S e p t e m b e r 6t h , f o r t h e p r e s e n t a t i o n a n d d e d i c a t i o n of a n e w a m b u l a n c e t o t h e S te y n in g D iv isio n of th e S .J .A .B . M e m b e r s of t h e D iv is io n ( u n d e r S u p t . H o l l o w a y ) w e r e f o r m e d in t o t h r e e s id e s of a s q u a r e fo r t h e c e r e m o n y , t o g e t h e r w i t h officers a n d o t h e r r a n k s fro m B r ig h to n , H en field , H o r s h a m , S o u th w ic k , L an cin g , W o rth in g an d S horeham .

h i m s e l f in r e l a t i o n to h is s t u d i e s . A d v a n c e d first a id e r s a r e n o t in fr e q u e n tly te m p t e d to delve in to m ed ical te x tb o o k s w h ic h c o n ta in k n o w le d g e b e y o n d t h e s c o p e o r n e e d s of first a i d w o r k . I t is w is e to esch ew su c h e x tra n e o u s studies, w h ich m ig h t o nly fo g th e m i n d w i t h i n f o r m a t i o n t h a t is u s e l e s s t o t h e a m b u l a n c e w orker. F a r b e t t e r to c o n c e n t r a t e w ith in th e co n fin es of th e o f f i c i a l s y l l a b u s , a n d t o k n o w t h o r o u g h l y t h e c o n t e n t s of t h e o f fic ia l fir^ t a i d t e x t b o o k s . S o u n d first a id k n o w l e d g e , w ell a n d t r u ly g r a s p e d , w ill n e v e r fail in a n e m e r g e n c y .

T he P atient . T h e p a t i e n t is, o f c o u r s e , t h e r e a l l y i m p o r t a n t p e r s o n . H e is a l r e a d y su ffic ie n tly w o r r i e d b y m a n y p r o b l e m s r u n n i n g t h r o u g h h i s m i n d c o n s e q u e n t u p o n h i s m i s h a p w i t h o u t being f u r t h e r w o r r i e d b y f u s s y b y s t a n d e r s o r i n c o m p e t e n t f i rs t a id ers. H e is w o r r y i n g , m a y b e , a b o u t h i s j o b , h o w l o n g h e w i l l b e a w a y f r o m h i s w o r k , h o w m u c h i t is a l l g o i n g t o c o s t , w h o is g o i n g t o l o o k a f t e r t h e f a m i l y , a n d m a n y o t h e r s i m i l a r p e rso n a l p ro b lem s. I t i s t h e f i r s t a i d e r ’s t a s k t o r e - a s s u r e t h e p a t i e n t , t o m a k e h i m feel t h a t t h i n g s a r e n o t so b a d a f t e r all. T h e best w a y t o d o t h i s is t o l e t h i m s e e t h a t y o u k n o w y o u r j o b , a n d t h a t m e a n s k n o w in g it. H a v e it a l l a t y o u r f i n g e r t i p s . Let th e re .b e no fu m b lin g . Y o u r p erso n al co m p e te n c y co u n ts far m o re w ith th e p a tie n t th a n you p ro b ab ly realise a t th e tim e : a g r a t e f u l p a t i e n t m a y s u b s e q u e n t l y a s s u r e y o u of t h i s f a c t .

T he C rowd . A c r o w d is a l m o s t i n e v i t a b l e . E ven th o u g h you b ro k e y o u r f e m u r in t h e m i d d l e of t h e S a h a r a a f e w h e l p l e s s g a p i n g b y s ta n d e rs w o u ld su re ly be th e re before th e v u ltu re s. I t is u s e l e s s t o a p p e a l t o t h e c r o w d c o l l e c t i v e l y . For e x a m p l e , if y o u s a y “ T h e p a t i e n t n e e d s m o r e a i r ” t h e e n t i r e c r o w d w ill a g e e e w i t h y o u a n d w ill tell e a c h o t h e r t h e p a t i e n t n e e d s m o r e a i r , b u t i t is d o u b t f u l w h e t h e r a n y o n e w i l l m o v e . T h e a p p ro a c h sh o u ld be to indiv id u als, w h ic h m e a n s m ak in g a “ snap ” ju d g em en t. Q u ic k ly select o n e or tw o of th e m o r e c a p a b le lo o k in g b y s ta n d e rs , a n d a d o p t th e p r i n c i p l e o f o n e m a n o n e jo b . D e ta il o n e to k e e p th e c r o w d b a c k , a n o th e r to tele p h o n e for th e m o to r a m b u la n c e , a n o th e r to f e tc h s o m e b l a n k e t s , o r a h o t d r i n k , o r s o m e ice, o r w h a t e v e r j ’o u n e e d . A v oid a s k i n g o n e p e r s o n to d o m o r e t h a n o n e t h i n g a t a tim e , o t h e r w i s e y o u w ill b e u n a b l e to re ly u p o n a n y t h i n g b e in g d o n e sa tisfacto rily .

T he H osp ita l . F i r s t a id e r s a r e s o m e ti m e s t a u g h t to e n q u ir e , o n a r riv a l a t h o s p i t a l w ith a p a t i e n t , w h e t h e r t h e y c a n b e of a n y f u r t h e r a s sis ta n c e , a n d s o m e tim e s th e o ffer— b e in g m is in te r p re te d — is m e t w i t h u n j u s t i f i a b l e r u d e n e s s . D octors a n d nu rses are d o i n g th e job fo r w h ic h t h e y h a v e b e e n sp e c ia lly t r a in e d , a n d s o m e few a r e e a s ily i r r i t a t e d b y first a i d e r s ’ a t t e m p t s to b e h e l p f u l t o t h e m ; b u t i n e x t e n u a t i o n l e t it b e r e m e m b e r e d th a t a d o c to r or n u rse w o u ld not n ecessa rily m eet w ith m u c h c o u r t e s y if t h e y o f f e r e d t o a s s i s t a t a t r a d e s m a n ’s j o b . T h e a m b u l a n c e w o r k e r ’s t a s k e n d s w h e n t h e p a t i e n t

F I R S T

a r r i v e s a t t h e h o s p i t a l , a n d th e w is e first a i d e r w ill d e p a r t b e fo re th e s is te r in c h a r g e h a s o c c a s io n to “ b r i s t l e ” ! T w o m o re po in ts. N e i t h e r t h e d o c t o r n o r t h e s i s t e r in c h a r g e a r e n o r m a l ly in te r e s te d in h o w y o u f o u n d t h e p a tie n t, o r in w h a t c o n d itio n th e p a t i e n t th e n w a s . W h a t does i n t e r e s t t h e d o c t o r o r t h e s i s t e r is t h e p a t i e n t ’s c o n d i t i o n w h e n t h e y f irs t s e e t h e p a t i e n t , a n d of t h a t t h e y a r e s k ille d j u d g e s . S e c o n d ly , y o u h a v e m a d e a d i a g n o s i s s u ffic ie n t fo r first a id p u r p o s e s , b u t b e e p y o u r d ia g n o s is to y o u r s e lf . T h e do cto r p r e f e r s t o m a k e h i s o w n d e c i s i o n a s t o w h a t is w r o n g w i t h t h e p a t i e n t ; h e c e r t a i n l y w ill n o t a p p r e c i a t e y o u r h e l p in t h a t directio n . G i v e w h a t e v e r i n f o r m a t i o n y o u a r e a s k e d fo r — a n d be tactfu l 1

Massage. M assage i s t h e s c i e n t i f i c m a n i p u l a t i o n of t h e s o f t t i s s u e s of t h e bod y for th e ra p e u tic p u rp o ses. T h e ra p e u tic m ean s an a g e n t of h e a lin g . M a s s a g e sh o u ld n ot be a s so c ia te d w ith r u b b i n g a n d o t h e r r a t h e r c r u d e m e t h o d s , b u t a s a sc ien tific s y s t e m of m o v e m e n t s so d e s i g n e d a n d a r r a n g e d to h a v e s p e c ia l effe cts in m e d i c a l a n d s u r g i c a l c o n d itio n s . A fam ous S w e d e of t h e 1 9 t h c e n t u r y , P r o f e s s o r P e t e r L i n g , p e r f e c t e d m a s s a g e a n d m e d i c a l g y m n a s t i c s , t h a t is w h y i t is c a l l e d S w ed ish m a s sa g e . I b e lie v e t h a t in t h e n e a r f u t u r e m a s s a g e w ill b e in c lu d e d i n t h e c u r r i c u l u m of f i r s t a i d t r a i n i n g . T h e re a so n for th is is : S c i e n t i f i c a l l y a d m i n i s t e r e d m a s s a g e h a s w o n d e r f u l b e n e ficial r e s u l t s u p o n t h e w h o l e b o d y . T h e m ed ical profession of to -d a y re a lise s this. O n P r o f . L i n g ’s f o u n d a t i o n o u r o w n m ed ical m e n h a v e b u ilt u p a v alu ab le a d ju n c t^ to th e p ra c tic e of m e d i c i n e . T h e y call u p o n t h e m a s s e u r o r m a s s e u s e t o h e l p i n p r e v e n t i o n , r e l i e f a n d c u r e of m a n y a i l m e n t s a n d d eform ities. M a s s a g e d eals d irectly w ith th e m u s c u la r sy stem , th e v is c e r a l s y s t e m , t h e c i r c u l a t o r y s y s t e m , a n d in g e n e r a l w ith t h o s e tis s u e s w h ic h a r e k n o w n a s soft tiss u e s. T h e term m a s s a g e m e a n s to k n e a d . M a s s a g e h a s a l s o a d e e p effe c t u p o n th e nervous system . T h e e f f e c t s of m a s s a g e u p o n t h e b o d y a r e m a n y a n d varied. It a id s m u sc le d ev elo p m en t by i m p r o v i n g t h e c i r c u l a t i o n a n d n u t r i t i o n of t h e b l o o d a n d l y m p h in t h e m u s c le s , l e a d s to i m p r o v e d c i r c u l a t i o n a n d n u t r i t i o n of t h e u n d e r l y i n g b o n e s . B o n e d e v e l o p m e n t is t h u s in d ire c tly in flu e n c e d by m a s s a g e . I t a i d s t h e c i r c u l a t i o n of th e blood by d ire c t p r e s s u re a n d by s tim u l a t i n g th e nerves. T h e s t i m u l a t i n g m o v e m e n t s i n c r e a s e t h e a c tiv ity of t h e m u sc le s, vessels a n d g la n d s , w h ic h a r e co n tro lle d by th e stim u la te d nerves. T h e s o o t h i n g m o v e m e n ts relieve p a in a n d n e r v o u s i r r i t a b i l i t y . T h e a c t i v i t y of t h e l y m p h a t i c s y s t e m is q u i c k e n e d . L y m p a ti c d u c t s a n d g l a n d s a r e s t i m u l a t e d by direct p ressu re. A b s o r p t i o n is p r o m o t e d b y p r e s s u r e o n t h e t i s s u e s , t h e r e b y g e t t i n g r i d of h a r m f u l w a s t e f r o m t h e b o d y m o r e q u ic k ly a n d easily. T h e lu n g s, k idneys a n d sk in are a i d e d i n e l i m i n a t i o n of w a s t e p r o d u c t s b y i m p r o v e d c i r c u l a tio n of blo o d a n d ly m p h . T h e s tim u la tio n of th e re n a l p le x u s in a b d o m in a l m a s s a g e d irectly in c re a s e s k id n e y activity. M o v e m e n t s of t h e b o w e l s i s p r o m o t e d b y e x c i t i n g t h e r e f l e x a c t i o n of t h e n e r v e s c o n t r o l l i n g t h e m o v e m e n t s of t h e s t o m a c h a n d i n t e s t i n e s , a n d b y i n c r e a s i n g t h e a m o u n t of b i l e g i v e n o u t b y all t h e d i g e s ti v e ju ic e s . I t s t r e n g t h e n s t h e w a l l s of th e a b d o m e n a n d intestin es. I t im p ro v e s c ir c u la tio n in th e a l i m e n t a r y t r a c t w h i c h a i d s d i g e s t i o n a n d a b s o r p t i o n of d i g e s t e d food s u b s t a n c e s . A q u a lifie d m a s s e u r o r m a s s e u s e m u s t h a v e t r a i n i n g in a n a to m y , physiology, b a n d a g in g , p ractical a n d th eo retical m a s s a g e , a lso re m e d ia l exercises. A s t u d y of m e d i c a l g y m n a s t i c s a n d m e d i c a l e l e c t r i c i t y is v e r y u s e f u l a s c o m b i n e d t r e a t m e n t is o fte n o r d e r e d b y t h e d o c to r . A first a id a t t e n d a n t w o u ld m a k e a g o o d m a s s e u r for th is r e a s o n , a s y m p a th e ti c d isp o sitio n , ta c t a n d d e p e n d a b ility a r e very im p o r ta n t factors. — G e o r g e H o l m b e r g h in F ir s t A i d A tte n d a n t, B .C .

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ASTHMA, BRONCHITIS C atarrh, Hay Fever, and o th er Respiratory sufferers should communicate with British Medica Laboratories, Ltd., for particulars of the most efficacious rdmedy known to medical science. Send stamp to D epartm ent Z.A.3.

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W i t h M e tal sockets fo r jo in tin g . 2 pieces : 2 5/8ths. in. x 3/l6ths. In. x 15 In. 2 pieces : 2 5/8ths. in. x 3 / lit h s . In . x I 3 J In. I p ie c e : 2 5/8ths. i n. x 3 /l6 ths. in . x 7 J In. I p iece : 2 S/8ths. in. x 3/l6ths. In . x 6 in. 2 W e b b in g S tra p s w it h m e ta l b uckles : 18 In. x I In. 2 W e b b in g S tra p s w ith m e ta l b uckles : 27 In. x I t in. 3 sockets.

LTD.

MANUFACTURERS

LO N DO N

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TRANSVERSE GROOVE OF SPLINT

i , B y th is In v e n tio n S p lin ts m ade In any c o n v e n ie n t lengths m ake rigid co n n e c tio n s by m eans o f In cu rv e d o p p o site edges o f th e m e ta l so c k e ts o r sleeves firm ly engaging w it h tra n sve rse g ro o v e s In the surfaces o f th e S p lin ts w h e n pressed hom e In to t h « socket. U n lik e th e o r d in a r y so c k e tte d S p lin t, th is ty p e Is rig id ly co u p led to g e th e r and held against r e la tiv e d isp lace m e n t b u t can be disengaged by p u llin g a p a rt w ith su fficien t force. N . B . —T o e n su re p e rfe ct lo c k in g It Is Im p e ra tiv e th a t th e S p lin t should be c o r re c t ly In se rte d Mn th e s o c k e t, i.e ., B Y M A K I N G C E R T A IN T H A T T H E IN C U R V E D ED GE OF M ETAL SO C K ET E N G A G E S W I T H T H E T R A N S V E R S E G R O O V E O F T H E S P L IN T . P r ic e : C o m p le te w ith tw o pairs o f straps - - 4/- p er set. W it h o u t stra p s 3/- p e r set.

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I f you are prepared to stu d y f o r an hour or tw o each day you can become an expert practitioner in Swedish Massage and play y o u r part in the service o f the N ation and enjoy the status, remuneration and com forts o f the professional worker. I f you are interested in First A i d you w ill readily understand the value o f Massage. D o c to r s, N u rsin g H o m es, H yd ros, etc., are all in need o f the trained masseur. PLAN

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Queries and Answers toCorrespondents Q u e r i e s w i l l b e d e a l t w i t h u n d e r t h e f o l l o w i n g r u l e s :— 1.— L e tte r s c o n ta in in g Q u e r ie s m u s t b e m a r k e d o n th e top l e f t - h a n d c o r n e r of t h e e n v e lo p e “ Q u e r y , ” a n d a d d r e s s e d t o F irst A id , 4 6 , C a n n o n - s t r e e t , L o n d o n , E . C . 4 . 2 . — A ll Q u e r i e s m u s t b e w r i t t e n o n o n e s i d e of p a p e r o n ly . 3 . — A ll Q u e r i e s m u s t b e a c c o m p a n i e d b y a “ Q u e r y C o u p o n ” c u t f r o m t h e ' c u r r e n t i s s u e o f t h e J o u r n a l , o r , i n c a s e of Q u e rie s fro m a b ro a d , fro m a re c e n t issue. 4 .— T h e T e x tb o o k to w h ic h refe re n c e m a y b e m a d e in th is c o l u m n i s t h e 3 9 t h ( 1 9 3 7 ) E d i t i o n of t h e S . J . A . A . M a n u a l of F i r s t A id to t h e I n j u r e d .

Treatm ent of Fractured Leg. W . R . ( B r i s t o l ) . — A t a r e c e n t a n n u a l r e - e x a m i n a t i o n , o n e of o u r m e m b e r s h a d to t r e a t p a t i e n t f o r f r a c t u r e of t h e l e g (unaided). T h e fiv e b a n d a g e s w e re a p p lie d (1) c o m m e n c in g w ith sp lin ts a n d fig u re-o f-eig h t ro u n d feet a n d a n k l e s , a n d ( 2 ) p r o c e e d i n g a c c o r d i n g t o T e x t b o o k , v i z ., A B C D E. A n u m b e r o f u s a g r e e d t h a t t h i s is i n s t r i c t a c c o r d a n c e w i t h i n s t r u c t i o n s o n p. 9 2 o f t h e T e x t b o o k . The e x a m i n e r , h o w e v e r , w a s of t h e o p i n i o n t h a t s i x b a n d a g e s s h o u l d b e u s e d , viz., first, e x te n s io n a n d b a n d a g e r o u n d f e e t a n d a n k l e s , t h e n p r o c e e d i n g w i t h A B C D a n d E in o rd e r, r o u n d b o t h lim b s of c o u rse , in e a c h in s ta n c e . W h i c h m e t h o d is c o r r e c t ? M a n y t h a n k s for y o u r k in d ru lin g . T h e r u l i n g of y o u r s u r g e o n - e x a m i n e r w a s s t r i c t l y i n a c c o r d a n c e w i t h t h e i n s t r u c t i o n s o n p. 92 of t h e T e x t b o o k . If y o u r e - r e a d th e s e , y o u w ill find t h a t “ w h e n s i n g l e h a n d e d ” y o u a r e t o fix a n k l e s a n d f e e t w i t h f i g u r e - o f - e i g h t b a n d a g e a t t h e o u t s e t of y o u r t r e a t m e n t a n d t h e n t o a p p l y B a n d a g e s A B C D a n d E to k e e p th e s p lin t in p o sitio n . I n sh o rt, six b a n d a g e s a re to be used. Y o u r m e t h o d is i n c o r r e c t , b e c a u s e if y o u u s e f iv e b a n d a g e s ( o n e o f w h i c h is t h e e x t r a f i g u r e - o f - e i g h t a p p l i e d a t o u t s e t r o u n d a n k l e s a n d f e e t ) t h e l o w e r e n d of t h e s p l i n t w i l l be u n c o n t r o l l e d . — N. C orbet F letcher .

Exa m in a tion How ler. M .R . (C an n o n S t.).— D u r in g a recen t e x a m in a tio n , I a sk e d o n e c a n d i d a t e w h a t w a s t h e m o s t i m p o r t a n t p r i n c i p le in th e t r e a t m e n t of b u r n s a n d sc ald s. S h e replied— “ To e x c lu d e a i r f r o m th e s e i n j u r i e s ! " I a g re e d ; a n d then en q u ired h o w th is sh o u ld be done. Y ou m ay im ag in e m y s u r p r i s e , w h e n s h e e j a c u l a t e d “ C lo s e a l l d o o r s a n d w in d o w s ! ! ” Good!

N e x c , p l e a s e ! !— N . C . F .

Tre a tm e n t of Nose Bleeding. P .M . ( P a d d i n g t o n ) . — R e c e n t l y I h e a r d it s t a te d t h a t a n elderly p a tie n t, w h e n su fferin g fro m p ro fu se b leed in g f ro m t h e n o se , s h o u ld b e p la c e d in a r e c u m b e n t p o sitio n. A s I q u e s t io n t h e w i s d o m of s u c h a c t i o n , I w e l c o m e y o u r k in d ru lin g . I f a p a t i e n t , b e h e e l d e r l y o r y o u n g , a s s u m e s ( o r is p la c e d in) r e c o m b e n t p o sitio n , th e u s u a l r e s u lt is t h a t th e b lo o d p a sse s b a c k w a r d s in to th e t h r o a t a a d c a u s e s p a rtia l o b s t r u c t i o n t o t h e b r e a t h i n g , e s p e c i a l l y w h e n t h e b l o o d is c lotting. C o n s e q u e n tly th e p a tie n t sits u p c o u g h in g a n d sp lu tterin g . In o th e r w o rd s s ta n d by th e in stru c tio n s on p. 1 3 8 o f t h e T e x t b o o k . — N . C . F .

Tre a tm e n t of O p iu m Poisoning. L . M . ( S y d e n h a m ) . — W h i l e r e a d i n g t h r o u g h C h a p t e r X I V of th e T e x tb o o k recen tly , I n o te d w ith su rp rise th a t u n d e r t r e a t m e n t of o p i u m p o i s o n i n g , R u l e 2 t e l l s u s “ a f t e r t h e

R I D e m e t i c h a s a c t e d t o g i v e t e n g r a i n s of p e r m a n g a n a t e of p o tassiu m .” I f t h i s is c o r r e c t w h y a r e t h e t w o t a b l e s p o o n f u l s o f C o n d y ’s f l u id t o b e a d m i n i s t e r e d “ i n h a l f a p i n t of w a t e r , p r e f e r a b l y w a r m ? ” In m y p erp lex ity I a s k y o u r k i n d aid. If y o u d e le te t h e se m i- c o lo n , w h i c h h a s a c c i d e n t a l l y s l i p p e d i n t o R u l e 2, t h e i n s t r u c t i o n w i l l b e c o m e c l e a r . In o t h e r w o r d s , b o t h r e m e d i e s a r e t o b e g i v e n “ i n h a l f a p i n t of w a te r, prefe rab ly w a r m .” — N .C .F .

Transport of Fractured Th ig h . L . B . ( S y d n e y , N . S . W . ) . — T h e d e m o n s t r a t o r of o u r a m b u la n c e c l a s s h a s l a id it d o w n t h a t c a s e s of f r a c t u r e d t h i g h o u g h t to b e r e m o v e d in t h e s a m e w a y a s th e T e x t b o o k te lls u s to r e m o v e c a s e s of f r a c t u r e d s p in e . A s s o m e of u s d o n o t c o n s id e r th e s u g g e s t i o n c o rre c t, w e d ecid ed to w r ite to yo u a n d to a s k y o u r k in d h e lp o n th e point. T h e m e t h o d of r e m o v a l r e c o m m e n d e d in t h e T e x t b o o k f o r c a s e s o f f r a c t u r e d s p i n e t a k e s a n u n u s u a l a m o u n t of t i m e , r e q u ire s e x t r a b e a r e r s a n d e q u i p m e n t ; a n d it h a s b ee n e v o l v e d b e c a u s e o f t h e g r a v e r i s k of i n j u r y t o t h e s p i n a l c o r d d u r in g liftin g a n d tran sp o rt. C o n s e q u e n t l y it is n o t in d ic a te d for a p a tie n t su f f e rin g fro m f r a c tu r e d t h i g h , chiefly b e c a u s e it w o u l d u n n e c e s s a r i l y d e l a y h i s r e m o v a l t o h o s p i t a l a n d b e c a u se s u c h p a tie n t c a n be q u ic k ly a n d safely c a rrie d on a s tre tc h e r in th e u su a l w a y .— N .C .F . ^

Hand Splint. C .G . ( T e d d in g to n ) .— I h a v e in v e n te d a special h a n d sp lin t w h ic h c a n be u se d for v a rio u s in ju rie s b u t m o stly for p a t i e n t s w h o a r e s u f f e r i n g f r o m D u p u y t r e n ’s C o n t r a c tio n of f in g e rs . M y d o c to r h a s u s e d it o n o n e of h is p a t i e n t s a n d h a s a p p r o v e d i t, a s a l s o h a v e t h e s u r g e o n s of th e S e a m e n s ’ H o s p ita l. C a n y o u p l e a s e tell m e h o w I c a n g e t t h i s a p p r o v e d a n d m a d e u niversally available ? F i r s t a i d is c o n c e r n e d w i t h s i m p l e a p p a r a t u s w h i c h c a n b e u se d for m a n y p u rp o se s a n d n o t w ith ap p lia n c e s w h ic h a r e lim ite d to sp ecial p u rp o se s . W e c a n only s u g g e s t t h a t y o u m a k e c o n t a c t w ith a firm w h ic h m a n u f a c t u r e s s u r g ic a l a p p lia n c e s ; a n d to th is e n d y o u co u ld c o n s u lt y o u r o w n do cto r.— E d it o r .

Treatm ent of Fractured Spine. W . M . ( N e w p o r t ) . — L a s t n i g h t a m e m b e r of o u r R e s c u e P a r t y t r e a t e d a s u p p o s e d c a s u a l t y s u f f e r i n g f r o m f r a c t u r e of sp in e in th e l u m b a r r e g io n , a s laid d o w n in th e T e x t book. O u r in stru c to r, ho w ev er, sa id th a t th e m e th o d w a s w r o n g a n d t h a t all s p in a l c a s e s a r e n o w t r e a t e d a n d rem o v ed on th e ir b ack s. As I d isa g re e , I sh a ll w elco m e y o u r co m m en ts. T h e facts b e in g a s sta te d , y o u r in s tru c to r erre d w h e n he s a i d t h a t t h e m e t h o d l a i d d o w n i n t h e T e x t b o o k is w r o n g , a s e x p e r i e n c e h a s s h o w n t h a t t h e f a c e - d o w n w a r d s p o s i t i o n is b e s t fo r a f ra c tu r e of sp in e in lu m b a r r e g io n . U n d e r a i r r a i d c o n d i t i o n s , h o w e v e r , it is n o t p o s s i b l e t o m a k e a n a c c u r a t e d i a g n o s i s jor t o m a n i p u l a t e t h e s t r e t c h e r i n th e lim ite d sp a c e availab le. F u r t h e r , m y p e r s o n a l o p i n i o n is t h a t s u c h p a tie n ts s h o u ld be r e m o v e d in th e p o sitio n in w h ic h th ey a re fo u n d .— N .C .F .

Treatm ent of A rteria l Haem orrhage. E . W . ( W i l le n h a l l ) .— A t a r e c e n t d e m o n s tr a t i o n w e h a d to tr e a t a p a tie n t su fferin g fro m a rte ria l h aem o rrh a g e. A f t e r w a r d s w e w e r e a s k e d if w e w o u l d g i v e p a t i e n t a n y th in g to d rin k . W h e n w e sa id th a t w e w o u ld , w e w ere to ld th a t a n y d rin k s w o u ld do m o re h a r m th a n good. Y o u r k i n d r u l i n g w ill b e m u c h v a lu e d . A rte ria l b le e d i n g w ill a l w a y s g iv e rise to a g r e a t e r o r l e s s d e g r e e o f s h o c k c o n s e q u e n t o n l o s s o f b o d y fluid . F u r t h e r , t h e T e x t b o o k i n R u l e 2, o n p. 4 5 , t e l l s u s t h a t , if t h e p a t i e n t is a b l e t o s w a l l o w , a n d t h a t p r o v i d e d t h a t a n i n j u r y to a n i n t e r n a l o r g a n is n o t p r e s e n t o r s u s p e c te d , liq u id s s h o u l d b e fre e ly g iv e n . I n o t h e r w o r d s , it is d e f i n i t e l y

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per doz., postage 7 d .; 30s. per 24, postage 9 d .; £3 per SO; £5 16s. per 100. Obtainable o f a ll Booksellers.

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Tunstall Bandage W inder each 6/6 Splinter Forceps, pair 3/6 St. John’s Pattern T ourniquet I/9 each Solid Steel Scalpels 4/6 each N.P. Scissors from 5/- pair A rtery Forceps, N.P. 6/- pair Fitted Pouches and Haversacks always in stock. Let us quote for your First Aid requirem ents. 45,

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b y J O H N F E N T O N , m.b., B.ch., b . a .o ., d .p . h . a n d L . A . H . S N O W B A L L , m .r.c .p., F.R.c.s.(Ed.) P R I C E : 8d . p o s t fre e (7s. 6d . p e r dozen ) F O R C IV IL D E F E N C E SER V IC E S , E T C ., T R A I N IN G

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- F I R S T - A I D “ It doesn’t h u rt in the least ’’— Iglodine can be applied to an open wound w ith o u t' pain! This safe, but powerful antiseptic cleanses and heals cuts, wounds, bruises, scalds and burns. '

PROFESSIONAL SAMPLE SE N T O N REQU EST

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COX, j 7- 8, H e n rie tta S tre e t, L o n d o n , W . C . 2. j Please send me . . . ."H andbook of First Aid & Bandaging I *Male & (or) Female Atlas * Delete if not required For which I e n c lo s e ................. J

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T h e P A IN L E S S A ntiseptic U sed by F acto ries, H o sp ita ls, A m b u l a n c e s a n d A .R .P . A u t h o r i t i e s t h r o u g h o u t G r e a t B ritain .

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W . C . 2.

F I R S T g o o d f i rs t a i d t o a d m i n i s t e r d r i n k s a s s o o n a s t h e h a e m o r r h a g e h a s b een co n tro lle d a n d t h e w o u n d d re ss e d , e x cep t w h e n i n j u r y t o i n t e r n a l o r g a n is p r e s e n t o r s u s p e c t e d . — N . C . F .

Treatm ent of Shock. A.YV. ( H a v a n t ) . — W h i l e o n a c t i v e s e r v i c e I h a d t o t r e a t s i x t e e n c a s u a l t i e s w h o w e r e p i c k e d u p o u t of t h e w a t e r b y m y ship. I w a s th e only S ic k B e rth R a t i n g a b o a r d ; a n d tw o h o u r s e la p s e d before 1 co u ld g e t m e d ic a l a s s is t a n c e fo r m y p a t i e n t s w h o w e r e su f f e rin g chiefly fro m f ra c tu r e s , b r u i s i n g a n d w o u n d s w ith little h a e m o r rh a g e , a n d a ls o f ro m a g r e a t d e a l of sh o c k . T o all I g a v e a t o t of r u m f o l l o w e d b y h o t s w e e t t e a . M y chief w o rry , h o w e v e r, w a s a b o u t o n e p a tie n t w h o w a s m o re sh o c k e d th a n th e re st a n d w h o , afte r h a v i n g h a d h i s t o t of r u m , c o m p l a i n e d of a s e v e r e p a i n in h is side. O n e x a m in a tio n I found a lo n g w h ite s w e l l i n g o v e r t h e left k i d n e y , a b o u t f o u r i n c h e s l o n g a n d of t h e w i d t h e q u a l t o a g o l f b a l l . A s I c o u l d t h i n k of no in ju ry t h a t w o u ld p ro d u c e th is s w e llin g , 1 h a d to c o n t e n t m y se lf w ith a p p ly in g w a r m t h a n d a d m in is te r in g m o r p h i a w h ic h r e g u l a t i o n s a llo w u s to g iv e. C a n y o u f r o m m y d e s c r i p t i o n t e l l m e ( 1 ) if m y t r e a t m e n t of m y p a t i e n t s w a s c o r r e c t a n d ( 2 ) o f f e r a n y s u g g e s t i o n a s to t h e c a u s e a n d t r e a t m e n t of t h e s w e l l in g ? M e a n w h ile I te n d e r m y b est t h a n k s for y o u r replies. O n th e fa c ts a s s ta te d , n o a u th o r ity could possibly ta k e e x c e p t i o n t o y o u r t r e a t m e n t of p a t i e n t s s u f f e r i n g f r o m s h o c k c o n s e q u e n t o n in ju rie s s u s t a i n e d a n d on im m e r s i o n in th e sea. W i t h r e fe re n c e to y o u r s e c o n d q u e r y I w o u ld n o t lik e t o e x p r e s s a n o p i n i o n o n t h e n a t u r e of t h e s w e l l i n g w i t h o u t e x a m i n a t i o n . — N . C. F .

Bites ot A nim als. P. M . ( C h e l s e a ) . — 1 w a s t o l d r e c e n t l y t h a t t h e b i t e s of a n i m a l s m a y be a c c o m p a n ie d b y little or no b le e d in g . T h is s t a t e m e n t s u r p r i s e d m e ; a n d 1 w r i t e t o a s k if i t is t r u e . B ite s of a n i m a l s u s u a l l y c a u s e l a c e r a t e d w o u n d s w h i c h b leed less v ig o r o u s ly a n d c e a s e to b le ed m o r e q u ic k ly t h a n d o i n c i s e d w o u n d s , a s t h e T e x t b o o k (p. 1 0 4 ) d e f i n i t e l y t e a c h e s y o u .— N .C .F .

A I D In ju ry s u s ta in e d by a D ia b e tic p a tie n t m ay , a s th e re su lt of s h o c k , p r o d u c e a l o w e r i n g of t h e b l o o d s u g a r . Shock, t h e r e f o r e , m a y h a v e t h e s a m e e f fe c t a s o v e r d o s a g e w i t h in s u lin , by l o w e r i n g th e blo o d s u g a r . H e n c e , in b o th c o n d itio n s, s u g a r m a y b e n e c e s s a ry .— N .C .F .

Treatm ent of C rush Injuries. D . H . ( S o u t h b o u r n e ) . — I n t h e t r e a t m e n t of c r u s h i n j u r i e s , A . R . P . H a n d b o o k N o . 10 ( 1 9 4 4 ) t e l l s u s t o a d m i n i s t e r p l e n t y of f l u i d if o n l y o n e l i m b is a f f e c t e d . P l e a s e te l l us th e re a so n for th e s e in stru ctio n s. F r e e a d m i n i s t r a t i o n of f l u i d s is r e c o m m e n d e d i n t h e h o p e ( 1 ) t h a t th e s e w ill d ilu te th e p o is o n s fo u n d w i t h i n th e b o d y c o n s e q u e n t o n d e s t r u c t i o n of t h e t i s s u e s , a r i d ( 2 ) t h a t t h e c i r c u l a t i o n m a y b e r e s t o r e d in th e v e in s w h i c h c o lla p s e a s th e r e s u l t of s h o c k . — N . C . F .

C a rry in g Stretcher. R .B . ( P r e s t o n ) .— T h e T e x t b o o k i n s t r u c t s u s to c a r r y a s t r e t c h e r w i t h t h e p a t i e n t f e e t f irs t, a s a g e n e r a l r u l e . W e h a v e b e e n d o i n g d u t y a t a local h o s p ita l r e c e iv in g a rm y casu alties, a n d th e h o sp ital a u th o ritie s in sist th a t p a t i e n t s b e c a r r i e d h e a d f i rs t . A l s o , s o m e of o u r m e n h a v e b een on s im ila r d u ty a t a n e a r by M ilitary H o s p ita l, w h e r e t h e r u l e is h e a d f i rs t . I s t h e r e s o m e r u l e f o r c a r r y i n g a p a t i e n t h e a d firs t w h e n in sid e h o sp ita l ? M e a n w h i l e , I t h a n k y o u in a n t i c i p a t i o n of y o u r k i n d r e p l y . I t is a g e n e r a l l y a c c e p t e d r u l e t h a t t h e p a t i e n t is c a r r i e d feet first on t h e s t r e t c h e r , a s e x p e r i e n c e h a s s h o w n t h a t th is m e t h o d is m o r e c o n v e n i e n t f o r b e a r e r s a n d s t r e t c h e r . I t is i n t e r e s t i n g t o n o t e , h o w e v e r , t h a t o n p. 2 8 of A . R . P . H a n d book N o . j o ( 1 9 4 4 ) it is s t a t e d t h a t “ a s a r u l e it d o e s n o t m a t t e r w h e t h e r a c a s u a l t y is c a r r i e d h e a d - f i r s t o r f e e t - f i r s t . ” F u r t h e r , t h e m e t h o d o f te n a d o p t e d in h o s p i t a l s h a s b e e n m o d ifie d to a v o id t u r n i n g t h e s t r e t c h e r a f t e r a r r i v a l in th e w a r d , a s w h e n c a r r i e d h e a d - f i r s t t h e p a t i e n t is i n c o r r e c t p o s i t i o n a t t h e f o o t of t h e b e d . — N . C . F . ,

Brigade and Fixe G u a rd D uty. J .M . ( E d g b a s t o n ) . — A re m e m b e r s of t h e S t. J o h n A m b u la n c e B r i g a d e e x e m p t f r o m f ire g u a r d d u t y p r o v i d i n g t h a t t h e y do a t le a st 48 h o u r s p e r m o n th on tr a n s p o r t d u ty or hospital d u ty ? A s t h i s q u e s t io n is c a u s i n g s o m e a r g u m e n t a m o n g us, w e lo o k fo rw a r d to h a v in g y o u r v iew s on th e subject. W e a r e officially i n f o r m e d t h a t in th e c i r c u m s t a n c e s n a m e d , m e m b e r s of t h e B r i g a d e a r e n o t e x e m p t f r o m fire g u a r d d u t y . — E ditor .

Q U E R Y To

A I D ’'

R E P L IE S

C O U P O N .

b e c u t o u t a n d e n c lo s e d w ith

a ll Q u e r ie s .

Sept., 1944.

D O L T O N ’S R E L IA B L E FOR

D iabetic C o m a. R . C . ( M ilf o rd H a v e n ) . — A s m e m b e r s of t h e A . R . P . o r g a n i s a t i o n , w e a r e e x p e c t e d t o b e a b l e t o d e a l w i t h c a s e s of s u d d e n illn ess c a u s e d by D iab etes. A .R . P . H andbook N o . i o (2 n d ed itio n , 1942) on p a g e 2 1 , p a r a . 4, u n d e r a c h a p t e r d e a l i n g w i t h “ D i s p o s a l of P a t i e n t s , ” w e a r e to ld “ o n n o a c c o u n t g iv e such p atien ts s u g a r or sw eeten ed d rin k s .” A n a m e n d e d r e p r i n t of t h i s m a n u a l d a t e d M a r c h , 1 9 4 4 , h a s b e e n i s s u e d ; a n d o n p a g e 20 w e a r e t o l d t h a t “ if t h e p a t i e n t i s u n i n j u r e d a n d s t i l l c o n s c i o u s h e s h o u l d be g iv e n a s u g a re d d rin k , e tc .” Is th e re n o t so m e co n fu sio n h e re w ith th e tr e a tm e n t of I n s u l i n C o m a ? M a n y t h a n k s for th e g r e a t h elp w h ic h you h av e b e e n t h r o u g h y o u r a n s w e r s to c o r r e s p o n d e n ts , in d e a l in g w ith “ k n o tty o n e s ” fro m classes.

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FourthEdition. P r ic e I s . 3d. post 2.\d. P r o b l e m s In S t u d y , T r e a t m e n t a n d E x a m i n a t i o n s o lv e d / o r S e n i o r S t u d e n t s.

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‘ ‘ T h is book g ives a clea rer in sig h t into the m ethods a n d d ifficu ltie s o/ emergency trea tm e n t by laym en th a n the o fficia l Textb ook i t s e l f ”— L a n c e t .

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A d v e r t i s e m e n t s w i t h re m i tt a n c e s h o u l d b e se n t t o First A id , 46, C a n n o n S tre e t, L o n d o n , E . C 4. 3d . p e r w o r d , m i n i m u m 4/ 6. 20 0 C o n c e r t T i c k e t s 5/6. M e m o s , R u b b e r S t a m p s , R oll T i c k e t s , S a m p l e s - T i C E S , 1 1, O a k l a n d s G r o v e , L o n d o n , W . l 2

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F IR S T -A ID C O M P E T IT IO N T R A IN IN G . H E b est g u id e for c o m p etito rs. B ased on a c tu a l ex p eri ence. l i d . P o s t f r e e ( 8/ - d o z e n ) F o u n t a i n P r e s s , 4 6 , C h a n c e r y L a n e , L o n d o n , W . C . 2.

LEG TROUBLES Try Germolene yourself— and you will be convinced INFLAMMATION of its power to soothe and RASHES, SPO T S relieve skin complaints. Under the healing hand BURNS, CUTS of Germolene many skin afflictions vanish in a few days — or even hours. But Germolene’s most wonderful victories are recorded in letters like the following:

“ I h a v e been troubled w ith bad legs f o r y ea rs . . .

I R S T A ID C O M P E T IT IO N S are w on by good coach ing. A ny F irs t A id er (eith er sex) m a y co ach a n y a m b itio u s t e a m — m ale, fem ale, o r m ix e d — to e a rly success. C o m p e titio n ex p erien ce n o t n e c e ssa ry w ith n e w G uide ( a d a p ta b le to a n y tex t-b o o k ). F o r particulars, send stam ped e n v e l o p e t o : — R . J e f f e r y , 5, A v e n u e G a r d e n s , L o n d o n . W .3

O IS O N S C H A R T — H a n d y Q u ick R eference— T re a tm e n t a n d R e m e d ie s for 30 d iffe ren t p o iso n s. H a w k i n s , l i d . P o s t f r e e ( 8/ - d o z e n ) . F o u n t a i n P re s s , 46, C h a n c e r y L a n e , L o n d o n , W . C . 2. IN S T IT U T E

C E R T IF IC A T E S

D IPL O M A S.

E M B E R S H I P o f t h e a b o v e I n s t i t u t e is o p e n t o p e r s o n s h o l d i n g a n y re c o g n iz e d h i g h g r a d e C e rtific ate. W rite for in te r e s tin g p a r tic u la rs to B C M /C h a m b e rs , London* W . C . 1, o r 6 7 , L o r d S t . , L i v e r p o o l , 2.

A B Y T E D D Y B E A R S w ith m o v eab le h ead s, attractiv ely boxed. C u t o u t re a d y to m a k e , w ith stuffing, g la s s eyes, a n d i n s t r u c t i o n s ; 3 6 / - doz. in c h T a x . R ussell In m a n , 5 , . R o u n d h a y T e e . , L e e d s , 7. ■

67.

A N T E D , C a d e t O f f i c e r ’s U n i f o r m i n g o o d c o n d i t i o n . H e i g h t 5 ft. 1 0 i n . M e d iu m build. H . P. M ason, H a ls b u ry R o a d E a st, N o rth o lt P a r k , G re e n fo rd , M iddx.

‘ R ESU LTS HAVE BEEN W ON DERFU L’ I a p p lied G erm olene three an d som etim es fo u r times a day. T h e results have been w onderful. I am sure i t w a s only G erm olen e that g o t me on my f e e t again. N o praise is too high f o r y o u r w onderful o in tm en t; it is w orth more than I can say about it. Y o u m ay pu blish tlus letter as y o u w ish.” ( S i g n e d ) C . A . B . (M r s .) , S h ifn a l, S a lo p .

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FIRST AID Journal Jx»r flje Ambulance atib pursing J^ertricesr N o . 6 0 4 , V ol. LI.]

OCTOBER.

1944.

U P -T O -D A T E TR A IN IN G Lectures, Demonstrations and Exercises

r I

By Lt.-Commander F. A. M. EDEN, R N. A NEW

I ^

BOOK

Planning and Delivering Better Lectures • Practical Lessons and Drill • Displays • , Staging Demonstrations • Exercises • by post 2s. 2d. Tactical Training • Examinations • The Instructor

J O R D A N & S O N S , L IM IT E D , 116 C H A N C E R Y - L A N E , L O N D O N , W .C .2 .

BIOLOGICAL M B f c PREPARATIONS A N T I P E O L

8KSRB O I N T M E N T

O n e o r o t h e r o r all o f th e t h r e e races o f g e r m s , S t re p to c o c c i , S tap h ylo co cci a n d B p y o c y a n e u s a r e f o u n d in e v e r y sk in in f e c tio n c o m m o n t o th is c o u n t r y , a n d A N T I P E O L O I N T M E N T c o n t a i n s t h e antibodies (an tiv iru s ) o f thes e g e r m s . H e a l i n g is e x p e d ite d by th e p r o v e d in g r e d i e n t s o f the o i n t m e n t , a n d s< ptic d e v e l o p m e n t is s t o p p e d o r p r e v e n t e d b y its a n t i v i r u s sterile vaccine filtrates . A N T I P E O L O I N T M E N T is u n s u r p a s s e d f o r B U R N S a n d S C A L D S , f o r it is m i c r o b ic id e a n d n o n - a d h e siv e , a n d d r e s s i n g s d o n o t r e q u i r e t o be c h a n g e d ev e r y day . W O U N D S , B U R N S , etc., W I L L N O T T U R N S E P T I C if t r e a t e d w i t h A N T I P E O L O I N T M E N T .

O P H T H A L M O - A N T I P E O L i s a se mi-fluid o i n t m e n t , m o r e c o n v e n i e n t t h a n t h e o r d i n a r y A n t i p e o l o i n t m e n t f o r o c u l a r in fectio ns a n d lesio ns. E y e s affected b y s m o k e a n d d u s t a r e s o o t h e d a l m o s t im m ed iately b y the ap p lic a tio n o f O p h t h a l m o - A n t i p e o l , a n d th e a n t i v i r u s p r e v e n t s g e r m s f r o m d e v e lo p in g .

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T h e C o u n c il fo r the p r o v is io n of R e s t - B r e a k H o u s e s for N u rse s a n d M i d w i v e s is a r e p r e s e n t a t i v e a nd n o n -p ro fit-m a k in g so ciety r e c e n t l y e s t a b l i s h e d w i t h t h e o f fic ia l a p p r o v a l o f th e M in ister o f H e a lth and the M in tste r of L a b o u r and N a t i o n a l S e r v i c e in o r d e r to a d m i n i s t e r a g i f t b y th e B r i t i s h W a r R e l i e f S o c i e t y o f t h e U n i t e d S t a t e s o f A m e r i c a for the p r o v isio n o f a re st-b re a k h o u s e for th e n a tio n ’s n u rs e s a n d m id w iv e s . P rem ise s h a v e been taken at B u x to n . T h e h o u s e is o p e n t h r o u g h o u t the y e a r , and th e c h a r g e s w ill be tw o g u in e a s a w e e k for q u alified n u rse s a n d m id w iv e s a n d £ \ 5 s. a w e e k f o r s t u d e n t n u r s e s a n d p u p i l m id w ives. W i t h t h e r e tu r n o f e n e r g y ( c o m m e n t s a c o n t e m p o ra ry ), “ w a lk s an d e x p e d itio n s can be p l a n n e d in t h e b e a u t i f u l s u r r o u n d i n g c o u n t r y , w h ile , fo r th o s e w h o h a v e h a d their fill'o f w a l k i n g w h i l e o n d u t y a n d o n l y c r a v e to b e l e f t in p e a c e , t h e r e a r e b o o k s , k e e n i n v i g o r a t i n g a i r , a n d th e fr ie n d ly a tm o s p h e r e of the n e i g h b o u r i n g h ills. R e c r e a t i o n s a r e s t i l l a v a i l a b l e in t h e t o w n w h i c h e n d e a v o u r s to m a i n t a i n u n d e r d i f f i c u l t w a r - t i m e c o n d i t i o n s , t h e title o f b e i n g a B r i t i s h s p a . A c c o m m o d a t i o n is in s i n g l e a n d d o u b l e r o o m s a n d th e w i s h e s o f v i s i t o r s w i l l b e m e t a s f a r a s p o s s i b l e in th is r e s p e c t.” T h e M i n i s t e r o f H e a l t h in a c i r c u l a r s t a t e s t h a t h e a p p r e c i a t e s t h a t s h o r t a g e o f s t a f f at th e p r e s e n t t i m e m a y m a k e it i m p r a c t i c a b l e to g r a n t r e l i e f f o r r e s t b r e a k s in a l l c a s e s w h e r e it m i g h t be c o n s id e re d d e sira b le , b u t h e h o p e s n e v e rth e le s s th a t g o v e r n in g b od ies of h o s p ita ls a n d o th er au th o rities c o n c e r n e d w ith th e h e a lth a n d w e lfa re se r v ic e s w ill d o a l l t h a t is p o s s i b l e to r e l e a s e n u r s e s , i n c l u d i n g t h o s e e m p l o y e d in t h e p u b l i c h e a l t h s e r v i c e s , a n d m i d w i v e s w h o a r e in n e e d o f a r e s t b r e a k a n d w h o w i s h to m a k e u s e o f t h e f a c i l i t i e s o f fe r e d u n d e r t h a t schem e. R e s t b re ak s s h o u ld not be c o n fu sed w ith o rd in a ry h o lid a y s or c o n v a le sce n c e , and n u rse s or m i d w i v e s w h o a r e ill o r in n e e d o f m e d i c a l o r n u r s i n g c a r e a r e n o t e l i g i b l e to m a k e u s e o f t h e fa cilities p ro v id e d . T h e re st-b re a k h o u s e at B u x t o n w a s o p e n e d a t t h e b e g i n n i n g o f A u g u s t , a n d f u ll pa rticu la rs a n d fo rm s o f a p p lic a tio n can be o b ta in e d fr o m the S e c r e t a r y , W a r - t i m e R e s t B r e a k s for N u r s e s , R o o m 179 , 5 th F l o o r , W i n d s o r H o u s e ,

Rest Houses for Nurses.

F I R S T

Victoria Street, S . W . l . W hen one considers the fatiguing nature of the work of the nurse, it may be lealised what a boon houses such as this we are dealing with have upon the profession. Many nurses, owing to the strain of long hours, broken sleep and heavy duties are sadly in need of some form of a rest holiday, which may in many cases avert breakdown. These breaks have been described as “ recuperative rest ” and “ diversional therapy.” “ They are not holidays; neither are they con valescence after illness. They represent the ‘ stitch in time ’ and they are proving the proof of this adage all over the country.”

Lectures Delivered to Advanced Casualty Service Personnel in the 6th Year of War. By S I R H E N R Y L. M A R T Y N , K . C . V . O . , F .R .C .S . L a d i e s a n d G e n t l e m e n , — For live long years of war you have attended course after course of First Aid Lectures until 1 am sure that you know every word of the Standard Text Books by heart. In some areas you have been encouraged to extend your knowledge of the fringes of Medicine and Surgery, but in others you have been rigidly confined within the strict limits of First Aid teaching under the wholly mistaken im pression that to advance beyond those boundaries was to encroach within the sacred province of the Doctor. I have watched with great interest the results of both methods of training as carried out by different local authori ties, and I remain a keen exponent of the theory that the more people can be taught about a subject which interests them the more efficient they become, even though the chances of applying their knowledge may be limited in extent. For instance, one very large local authority, almost from the beginning of the war, instituted frequent lectures for their whole time casualty personnel upon medical and surgical subjects, most of which were far beyond the bounds of first aid. T h ey learned the elements of bacteriology, physiology and anatomy, of minor surgery, simple medicine, and the principles of nursing, with the result that they maintained a very great interest in their work and have avoided the “ browning off,” which is so common a complaint among those whose training has been strictly confined to a weary reiteration of the Textbooks. This brings me to an aspect of the matter which 1 should like you all to consider very carefully. No system of State Medicine can ever do all that could be done to improve the health of the nation as a whole save with the collaboration of the people themselves. However extensive be the institution of clinics of every sort, available to everyone from the cradle to the grave, success will not be complete until the people can be induced to make use of them, taught to detect the early signs of disease, and taught, above all, to seek help while those signs are still early. W hat an infinity of suffering could be prevented if the public as a whole could be trained simply to observe and to recognise the beginnings of disease. No longer would the Out-Patient Departments of our Hospitals see patients seek ing advice for the first time with cancer already completely

A I D inoperable, or children already in an advanced stage of tuberculosis or rickets. In this sixth year of war we see the end in sight, but for the vast multitude of you trained people there should be no “ Cease fire” for the rest of your lives, Y o u have been taught to observe, to k e e p j o u r heads and to act ; in short, you are disciplined trained individuals. Y o u will always be of help to your fellow beings in dealing with minor injuries and accidents, but, what is infinitely more important, you should prepare yourselves to go out into the post-war world as a vast force capable of instilling into others the elements of first aid in disease as a whole, as active participants in the fight to improve the health of your fellow men. It is upon this point of view that I propose to base this short course of lectures, endeavouring to extend your know ledge of some of the things which you have learned in first aid in the hope that, when air raids have ceased to trouble us, your training may be of practical value in a wider sphere. A very great deal that you have learned has perforce been without any solid foundation behind it. For instance, you have been told that when a wound occurs your first duty is to protect it from further contamination after stopping any haemorrhage. Few of you, however, would be able to give any information concerning the bacteria which might infect it, in spite of the fact that they are, to all intents and purposes, ubiquitous, and the cause of the greater number of illnesses to which human flesh is heir.

V arious T ypes of B acteria . A, Staphylococci. B, Streptococci. C, Pneumococci. D, Tuberculosis. E, Typhoid. F, Tetanus. G, Cholera. Bacteria are infinitely minute plants, each consisting of a single cell and multiplying by the simple division of one cell into two. T he cells thus formed may separate or may remain joined until long chains of bacteria result. Some bacteria are surrounded by a gelatinous capsule and some are provided with whip-like extensions, by the movements of which mobility is obtained. There are three great groups of organisms :— ( 1) The Cocci, which are minute spherical bodies arranged in various forms. T he Staphylococci exist in clusters, occur extensively on the skin, and are the common cause of boils. T he Streptococci occur in chains of various lengths. T hey are the cause of the more severe types of spreading infections in wounds ;

F I R S T otherforms cause erysipelas, septic infections of the throat and scarlet fever. The Diplococi occur in pairs, the best known being the Pneumococcus, which gives rise to pneumonia. (2) Bacilli, which are rod shaped, Among these are the bacteria of typhoid fever, tetanus or lockjaw, anthrax and tuberculosis. (3) The Spirillae, which are shaped like corkscrews, one type of which is the cause of cholera. Many bacilli are capable of forming what are known as spores. These are rounded bodies which develop either at one end or at the centre of the rod, and appear to be a rest ing stage in the life of the plant when conditions for develop ment are unfavourable. Most bacteria can be killed by exposing them to a temperature even as low as 60 degs. C. for half an hour, but spores are highly resistant and may not even be killed by prolonged boiling or immersion in an antiseptic, such as 1 in 20 carbolic, for several days. They will resist drying for almost indefinite periods, and, in the case of tetanus, can remain as spores in the soil until accidentally introduced into a wound when they once again resume active growth and give rise to the dreaded lockjaw. It is for this reason that soldiers, who may be wounded when on highly cultivated agricultural land where tetanus contamination most frequently exists, are protected, before proceeding on active service, by the injection of either tetanus toxoid or anti-tetanic serum, which enables the body to resist invasion by this terrible disease. As it would have been obviously impossible to protect in this way the entire civilian population, all of whom have been liable to injury in air raids, every individual who has been so wounded has receivrd similar injections immediately on admission to First Aid Post or hospital. Every year some lives are needlessly lost am ong our agricultural workers by the neglect of some accidental, and often quite minor, wound which has become contaminated by soil or manure. Any such wounds should be cleansed with more than ordinary care, and in many cases it may be advisable to send the man to hospital in order that he may be protected by an injection of serum.

(T o be continued .)

Reviews. F ir s t A i d in

W ar.

Revised Edition.

By F. A. Hawks-

R I D

St. John Ambulance Brigade HEADQUARTERS

AND

D IST R IC T

R EPO RTS.

N o . I (P rince o f W ales’s) D istrict T w ickenham .— On Monday, September 25th, a very pleasing ceremony was performed at Y o r k House, by His Worship the Mayor of Twickenham. Members of No. 84 (Twickenham) Division were paraded for the presentation of “ The Meritorious Certificate” to Ambulance Officer W. Chandler. After inspection and congratulatory speeches, the parade was dismissed, and the presentation ceremony proceeded under the chairmanship of the Divisional President Councillor C. W. Beckett, J.P. After speeches of welcome, the Mayor replied, stating his pleasure in being given the opportunity of making the presentation, and reminding those present of the wonderful work A/O Chandler had done while serving as Staff Casualty Officer for the Borough. He then read the citation and pre sented “ The Meritorious Certificate ” to A/O Chandler, who made a modest reply, thanking the Mayor. Dr. Maddison, the M .O .H . then rose to his feet stating that now A/O Chandler had received his award, he would like to state exactly what had been done. He went on to state that A/O Chandler was on duty when a “ Doodle B u g ” dropped close by, the blast picking him up and throwing him some distance through a door way, the door, fortunately preceding him, and then on to his back on a lot of rubble, with such force that any ordinary man would have been knocked out, but not so with A/O Chandler, who immediately picked himself up, enquired after his staff, and finding them alright, immediately proceeded to the incident and commenced to help relieve the suffering of the casualties. It was by his efforts that one girl was re covered from the debris and, thank God, was quite alright to-day. He continued to work for three hours, then return ing to the depot, and was noticed to be grey and obviously ill, with signs of cerebral haemorrhage. He was sent to hospital at once, where the haemorrhage was confirmed and a fractured spine also found to be present. It was obvious that A/O Chandler had worked to relieve the suffering of others while he himself must have been in terrible pain. This was typical of members of the Order of St. John. A further presentation was made to Ex. Sergt. Crump (who had been Divisional Treasurer for a considerable time) by D/O Hipkins.

worth.

County o f Berkshire.

This useful little book, which was first published in November, 1941, pursues its successful career and continues to give good service to Civil Defence personnel as a practical addition to their knowledge of the ways in which they can best deal with the victims of air raids. Far from seeking to supersede the official textbooks it presupposes that those who follow its instructions and suggestions will have carefully studied their chosen textbooks before they seek in its pages further knowledge which will supplement the textbooks in the light of experience of air raids during the present war. Copies may be obtained from the author at 14, Yorkroad, Tunbridge Wells, price 1/4, by post 1/7 (lots of one dozen post free).

R eading .— T he Reading Southern Division of the S .J .A .B . in conjunction with the R eading Southern Railw ay Ambulance Class, held their annual presentation of awards and social at the Ambulance Hall, Chatham Street, on Thursday, September 7th. Mr. VV. Gard the new Stationmaster of the Southern R ailw ay at Reading, presided. The County Commissioner, Mr. C. A. Poole, presented the Brigade awards ; the Southern Railw ay presentation being made by Mr. A. Barrow, District Secretary. D uring the evening a fine programme of entertainmen was given.

Ambulance S e c r e t a r y . — Private A. E. Allen, of 17, Elton-road, Kingswood, has been appointed Divisional Secre tary of 7 Division, Bristol 1 No. 3 Corps, St. John Ambulance Association. He has been an active member of the branch since 1939 and holds the appointment of Band Secretary to the St. John Ambulance Brigade Band.

R eading S o u th N u rsin g D ivisio n .— On Wednesday, September 13th, at Palmer Hall, West Street, the annual inspection of the Division was carried out by the County Commissioner Mr. C. A. Poole, who was accompanied by the County Supt., the Hon. Mrs. Leslie Gam age. Ambulance Officer Mrs. Thom as (Officer-in-Charge) was congratulated by the Commissioner on the smartness of

F I R S T

th e D ivision, a n d on th e w a y th e a c c o u n ts a n d B rig a d e F o rm s w e re kept. M r. Poole g a v e a sh o r t ta lk , a fte r w h ic h h e g a v e e a c h m e m b e r a te s t in b a n d a g i n g , etc.

W a l l i n g f o r d . — T he a n n u a l i n s p e c t io n of t h e A m b u lan ce, N u r s i n g a n d N u r s in g C a d e t D iv isio n s, to o k p lace a t t h e F i r s t A id P o s t o n S u n d a y , S e p t e m b e r 1 0 th . T h e C ounty C o m m i s s i o n e r , M r . C. A . P o o l e , c a r r i e d o u t t h e i n s p e c t i o n , a n d b o th h e a n d th e C o u n ty S u p t. (th e H o n . M rs. L eslie G a m a g e ) e x p r e s s e d t h e i r s a t i s f a c t i o n a t t h e d i s p l a y of f irs t a id a n d h o m e n u r s i n g g i v e n b y all t h r e e u n its . The Com m i s s i o n e r , w i t h m e m b e r s of t h e C o u n t y a n d C o r p s S ta ffs w e r e a f te r w a r d s e n t e r ta in e d to tea.

C o u n ty

of B u c k in g h a m sh ire .

T h i s D i v i s i o n h e ld its first a n n u a l i n s p e c tio n sin c e 1939, a t G r e e n la n d s , on S e p te m b e r 10th, w h e n th e o p p o r t u n i t y w a s t a k e n o f p r e s e n t i n g w a r r a n t s a n d b a d g e s of o f fic e t o V i s c o u n t H a m b l e d o n w h o h a s a c c e p t e d t h e office of P r e s i d e n t o f t h e H e n l e y A m b u l a n c e D i v i s i o n , a n d t o M r . E . S. M a k o w e r a n d S i r F e l i x B r u n n e r , w h o h a v e t a k e n o ffice a s v ice-P resid en ts. A fter s e v e ra l c o n g r a tu la to r y sp e e c h e s h a d been m a d e , L o rd H a m b le d o n g a v e a s tir r in g a d d r e s s to th e D ivision, c o n c l u d i n g b y w i s h i n g t h e B r i g a d e s u c c e s s in all its a c tiv itie s a n d e x p r e s s in g th e h o p e t h a t h e w o u ld b e p riv ileg e d to r e m a in th e ir P r e s id e n t for a v e ry lo n g tim e. A fter in s p e c tin g a p a r a d e , h is lo r d s h ip p re s e n te d c e rtific a te s to S g t. B a r l o w a n d P te. T h w a i t e s , w h ic h h a d b e e n a w a r d e d t h e m o n p a s s i n g a n i n s t r u c t o r ’s e x a m i n a t i o n . A t o u r of th e b e a u tifu l g r o u n d s co n c lu d e d a n i n te r e s tin g cerem ony. H

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o f C a m b rid g e .

T h e th ird a n n u a l g e n e r a l m e e tin g w a s held at t h e i r h e a d q u a r t e r s o n M o n d a y , S e p t e m b e r 25th. D i v . S u p t . A n d e r s o n r e p o r t e d t h a t t h e m e m b e r s h i p of th e D iv isio n h a d b e e n m a i n t a i n e d a t a p p r o x i m a t e l y 36 m e m bers. T h e E ff ic ie n c y C u p h a d a g a i n b e e n w o n b y Cpl. S c a r l e t t w ith a v e ry h i g h p e r c e n t a g e a n d h e w a s clo sely fo llo w ed b y P ie . C h a m b e r l a i n a n d P te . V o g e l. I n t h e c o m p e t i t i v e field t h e D i v i s i o n h a d r e t a i n e d t h e S av iile P e c k S h ield a n d also s e c u re d th e R a ilw a y O r p h a n a g e C u p ; in e a c h c a s e t h e w i n n i n g t e a m w a s le d b y Cpl. S c a r lett. S g t. T h u r lb o r n w a s c o n g r a tu la te d on his c o n s iste n t effo rts t h r o u g h o u t , h is t e a m b e i n g a clo se r u n n e r u p in e a c h instance. A t th e a n n u a l in sp e c tio n held d u r i n g M ay, th e C o u n ty C o m m i s s i o n e r h a d e x p r e s s e d h is p l e a s u r e a t t h e i r efficiency an d sm artn ess. A t th e r e - e x a m in a ti o n , all m e m b e r s a t t e n d in g had passed. At th e L a y I n s tr u c to r s C e rtific ate E x a m ., h e h im se lf, a n d C pl. S c a r le tt, w e r e b o th su c c e ss fu l. T h e S e c r e ta r y , A m b u l a n c e O fficer R . N . F a r d e ll, th e n p re se n te d th e receipts a n d p a y m e n ts acco u n t, a n d p o in ted out th a t th e ir in c o m e h a d b een a g a i n la r g e ly d u e to d a n c e s ru n by th e D ivision. C o rp s S u p t. D ic k e r a d d re sse d th e m e e tin g , a n d sta te d t h a t h e w a s v e ry p le a s e d to b e a b le to c o n firm t h a t in h is o p in io n t h e e fficien c y of t h e D iv is io n h a d b e e n m a i n t a i n e d . H e t r u s t e d t h a t th e y w o u ld c o n tin u e w ith th e ir efforts a n d h o p ed th a t one d ay h e w o u ld h a v e th e p le a su re a n d h o n o u r of a c c o m p a n y i n g a P y e t e a m t o L o n d o n f o r t h e f i n a l s of th e n a tio n a l c o m p e titio n s. A m b u l a n c e O fficer N o r to n s t a te d t h a t it w a s t h e d e s ire of th e O ffice rs t h a t a sp e c ia l effort s h o u ld b e m a d e s h o r tly to i n c r e a s e t h e m e m b e r s h i p of t h e D iv is io n . Each m em ber w o u ld be a s k e d to s e c u re o n e n e w m e m b e r. T h e p r e s e n t a t i o n of t h e E f f i c i e n c y C u p a n d M e d a l l i o n s P y e . —

t h e n to o k place.

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County o f H am p sh ire. I sle of W ight A rea . J . S . W hite S ection , C owes D ivision . — T h e a n n u a l W o r k s C o m p e titio n for th e “ M i l n e ” C u p , to o k p lace a t C o w e s on S e p te m b e r 16th, b e i n g w o n b y S o m e r to n B r a n c h . A d e m o n s t r a t i o n of f i r s t a i d w a s g i v e n b y a w o r k ’s l a d i e s ’ team . A t th is p a r a d e th e c u p a n d p rizes w e r e p r e s e n te d by M r s . M i l n e , w i f e of t h e P r e s i d e n t . C o u n t y O fficer H . B a k e r , p r e s e n t e d A m b u l a n c e O f f i c e r W . T u f f t w i t h a 15 y e a r s ’ l o n g s e r v ic e m e d a l , t h e first in t h e I s le of W i g h t . T h e J . S . W h i t e S e c t i o n is d o i n g r e m a r k a b l y w e l l . F o r m e d in 1943, it h a s o v e r 4 0 m e m b e r s ; 25 u n i f o r m e d m e m b e r s d o local to w n d u ty , a n d h a v e d o n e g o o d w o r k a t w o rk s accid en ts.

C ounty o f N ortham pton. N orthampton . — A t t h e w e e k l y d r i l l o f t h e H e a d q u a r t e r s D ivision, N o r t h a m p t o n C o rp s, h e ld S e p te m b e r 18th, th e fo llo w in g a w a r d s w e re p re se n te d by C o rp s S u rg e o n D r. J a m e s O r r :— A m b u l a n c e O ffice r H . B la n d , 4 th b a r ; C a d e t S u p t. H . Y o r k , s e rv ic e m e d a l r ib b o n ; S e r g t . A. G e o g e ( b a n d m a s t e r ) , 1st b a r ; P riv a te R. T y le r, 5 th b a r ; P riv a te s F. N o rto n , E. D e a r , A. F a r m e r , H . R o b e r t s o n , s e r v i c e m e d a l r i b b o n ; P riv a te R . B a te s, 1st b ar. P r i v a te F a r m e r w a s o n leav e, h e h a s b e e n s e r v in g in th e R . N . S . B . sin c e 1939, h a v i n g t a k e n p a r t in t h e l a n d i n g s a t M a d a g a s c a r , N o r t h A frica a n d Italy . P riv a te s R o b e rts o n a n d B a te s a re b o th a t p re se n t on a c tiv e service. D r. O r r c o n g r a tu la te d th e recip ien ts on th e ir lo n g a n d e f f i c i e n t s e r v i c e i n t h e B r i g a d e , r e m i n d i n g t h e m of t h e g r e a t t r a d i t i o n s of t h e O r d e r of S t . J o h n a n d t h a t t h e y w e r e a l w a y s a t t h e s e r v ic e of t h e n a t i o n , b o t h in p e a c e a n d w a r . D i v . S u p t . H . I. E d w a r d s t h a n k e d t h e C o r p s S u r g e o n for a tte n d i n g th e p a r a d e a n d p r e s e n tin g th e a w a r d s . He t h a n k e d t h e m e n o n b e h a lf of a ll r a n k s f o r t h e i r s e rv ic e to t h e D iv is io n , p o i n t i n g o u t t h e r e c o r d of P te . R . T y le r , w h o in s p i t e o f a g e , o v e r 6 0 y e a r s , a n d w h o is n o w l i v i n g f o u r m i l e s f ro m h e a d q u a r t e r s , p u t in 42 d rills la s t y e a r. D u rin g th e w in te r m o n th s a n d th e b la c k o u t p r e v a ilin g , h e w a s only a b s e n t on tw o drill n ig h ts . I n a d d i t i o n t o h i s S . J . A. B. d u t i e s h e is a l s o M e d i c a l O r d e r l y t o t h e H o m e G u a r d . S urely a g r e a t e x a m p le to th e y o u n g e r m e m b e r s of th e D ivision.

County o f Sussex. G e n . S ir Clive L id d e ll, K . C . B . , t h e C h ie f C o m m is s io n e r , a n d L a d y L o u is M o u n tb a tte n , S u p t.-in -C h ief, paid a m o st c o m p r e h e n s iv e v isit to S u s s e x on S a t., 7 th a n d S u n ., S th O ctober. V isits w e re m a d e on th e S a t u r d a y to th e Q u e e n V ic to r ia H o s p ita l a t E a s t G rin s te a d ; th e R e st H o m e on th e H a s tin g s f r o n t r u n b y m e m b e r s of t h e l o c a l B . R . C . S . a n d S . J . A . B . , f o l l o w e d b y a n i n s p e c t i o n of E a s t S u s s e x u n i t s of t h e B r i g a d e ; t h e n o n to a H o v e F i r s t A id P o s t ; a n d fin ally to t h e r e c e n tly op en ed C a d e t C lu b a t C hichester. O n th e S u n d a y , th e K in g . E d w a r d V I I S a n ito riu m a t M i d h u r s t w a s v isited , fo llo w ed b y a n in s p e c tio n of W e s t S u ss e x u n its a t th e P avilion, B o g n o r R e g is ; th e n th e J .W .O . P r i s o n e r of W a r F o o d P a r c e l s p a c k i n g s t a t i o n a n d W o r k i n g P a r t y ’s D e p o t a t H o v e , e n d i n g t h e t o u r w i t h a v i s i t t o t h e J .W .O . H o sp ita l S to re s D ep o t a t H a y w a r d s H e a th . T h e C hief C o m m is s io n e r a n d th e S u p t.-in -C h ie f w e re a c c o m p a n ie d th r o u g h o u t by C o u n ty C o m m is sio n e r D a v id B ryce, O .S t .J ., J . P . , L a d y B e ssb o ro u g h , J .P ., C o u n ty P re sid e n t, a n d C o u n ty S u p t. M iss H u b b a r d , S .S .S t.J .

E ast R id in g o f Y orkshire. H umberside C orp s . — T h e f i r s t a r e a c o m p e t i t i o n b e t w e e n D iv isio n s in th e H u m b e r s i d e C o rp s, w a s h e ld a t t h e B r o u g h

F I R S T a n d D istrict D ivisional h e a d q u a rte rs on S a tu rd a y , S e p te m ber 16th, a t w h ic h a te a m te s t w a s se t a n d ju d g e d by D r. j . M . H e r m o n of H e s s l e , a n d t h e i n d i v i d u a l t e s t b y D r . D . F e r g u s o n Y u i l l e of H u l l . T h e re su lt w a s a n n o u n c e d by D r . C . T h o m p s o n , C o r p s S u r g e o n , a s f o l l o w s :— B la c k b u rn A ircraft N o. 1 A m b u la n c e D iv isio n , 103 ; B r o u g h a n d D i s t r i c t N u r s i n g D i v i s i o n , 91. D r . H e r m o n in h is s u m m i n g u p r e f e r r e d to t h e f a c t t h a t it w a s a n e w e x p e r ie n c e fo r th e s e D iv is io n s a n d e x p r e s s e d h is belief in th e u tility o f c o m p e titio n s fo r t r a i n i n g . The a w a r d w a s p re se n te d to th e w in n in g te a m by M rs. H a r ris o n , a B r i g a d e O f f i c e r of m a n y y e a r s s t a n d i n g . S u i t a b l e v o te s of t h a n k s w e r e m o v e d b y m e m b e r s of t h e C o rp s S taff. T e a w a s p r o v i d e d u n d e r t h e s u p e r v i s i o n of C o rp s O ffice r M iss E . G . M o o re, a n d b r o u g h t w h a t w a s d e s c rib e d b y D r . H e r m o n a s “ a n ice, h o m e l y a f t e r n o o n ” to a close.

R J .P . S ir J O H N L U M S D E N , K . B . E . , M . D . ( L ate C ommissioner of the B rigade in E ire ) W e a r e s u r e t h a t m a n y of o u r r e a d e r s , p a r t i c u l a r l y t h e o ld e r o n e s, a n d th o s e r e s i d e n t in t h e E m e r a l d Isle , w ill s h a r e w ith u s t h e d e e p r e g r e t w e f e e l a t t h e p a s s i n g of t h a t g r e a t w o r k e r f o r s u f f e r i n g h u m a n i t y , b y v i r tu e of a c tiv itie s in c o n n e c t i o n w i t h t h e B r i t i s h R e d C r o s s S o c i e t y a n d t h e O r d e r of S t. J o h n of J e r u s a l e m , S i r J o h n L u m s d e n , K . B . E . , M . D . I n h i s l a t t e r y e a r s , S i r J o h n w a s c h a i r m a n of t h e J o i n t C o m m i t t e e in E ir e , of t h e s e b o d ie s . H e w a s b o r n on N o v e m b e r 14th, 1869, a t D r o g h e d a , a n d i n 1 8 9 5 w a s a p p o i n t e d m e d i c a l o f f i c e r t o G u i n n e s s ’s b r e w e r y in D u b l i n , a n d s o o n a f t e r h e o r g a n i s e d a m e d ic a l se rv ic e fo r t h e w o r k m e n a n d th e i r fam ilie s. I n 1 9 0 3 h e f o r m e d t h e f i r s t D i v i s i o n of t h e S t . J o h n A m b u l a n c e B r i g a d e in t h e S o u t h of I r e l a n d . H e Was a w a r d e d t h e s i l v e r l i f e - s a v i n g m e d a l o f t h e O r d e r of S t . J o h n a n d t h e B r i t i s h R e d C r o s s S o c i e t y ’s m e d a l f o r s p e c i a l s e r v i c e s a t t h e t i m e of t h e E a s t e r w e e k r e b e l l i o n i n D u b l i n in 1 9 1 6 . S ir J o h n held m a n y h ig h a p p o in tm e n ts a n d w a s a D e p u ty L i e u t e n a n t of t h e C ity of D u b l i n a n d a G o v e r n o r of t h ^ R o tu n d a H o sp ita l. H e w a s th e a u t h o r of tw o s m a ll b o o k s, “ H i n t s o n I n f a n t F e e d i n g ” a n d “ D i e t a r y S tu d ie s in D u b lin . ” H e also c o n trib u te d p a p e rs on pro fessio n al su b je c ts to m e d ical jo u rn als. H e w a s m a d e a K n i g h t o f J u s t i c e o f t h e O r d e r of S t. J o h n of J e r u s a l e m in 1915, a n d h is lo ss w ill b e g r e a t l y felt b y m a n y c o l l e a g u e s a n d th o s e w h o m h e h a d b e f rie n d e d .

Museum of Hygiene. M any o f o u r r e a d e r s m a y n o t k n o w t h a t t h e I n s t i t u t e of H y g i e n e m a i n t a i n s a p e r m a n e n t h e a l t h e x h ib itio n a t 28, P o r t l a n d P la c e , L o n d o n , W . l , w h i c h is o p e n to t h e p u b lic daily fro m 9-30 a .m . to 5 p .m . ( S a tu r d a y s to 1 p .m .) . C e rtifie d a r tic le s a n d p r o d u c t s , w h i c h a r e in g e n e r a l c o n s u m p tio n , o r u se , m a y b e se e n a n d d e m o n s t r a t e d in th e m u s e u m , w h i c h is d iv id e d in to s ix s e c tio n s , viz : F o o d s ; B e v e r a g e s ; M edical, D e n ta l a n d T o i l e t ; D o m e s tic H y g ie n e ; H y g ie n ic A ppliances ; a n d C lo th in g . A r ra n g e m e n ts c a n be m a d e to receive p a rtie s a n d individuals, w h o a re c o n d u c te d ro u n d , a n d e x p e rt in fo rm a t i o n is g i v e n g r a t u i t i o u s l y b y t h e d e m o n s t r a t o r s , u p o n t h e m e r i t s a n d c h a r a c t e r i s t i c s of e a c h e x h i b i t . F u rth e r p articu la r s m a y be o b ta in e d u p o n a p p lic a tio n to th e S e c r e ta r y .

R I D

Railway Ambulance News. L .P .T .B . (M et. L ine). C hiswick and A cton W orks ( 8 9 / 4 and 1 2 5 / 2 N ) . A t a m e e t i n g of th e a b o v e D iv isio n s , P r e s i d e n t a n d C h a i r m a n A. J . W e b b , E s q . , c a l l e d u p o n C o r p s S u p t . J . A . G r a v e s t o c k t o p r e s e n t A m b u l a n c e O f f i c e r s ’ W a r r a n t s t o L . K. S p e n c e r a n d W . A. B e s t , a n d t h a t o f D i v i s i o n a l S e c r e t a r y t o H . J. W a lf o r d . T h e C o rp s S u p t. p a id a tr ib u te to th e O fficers a n d D ivision, w is h in g th e m every su c c e ss for th e fu tu re , a n d e x p r e s s i n g , f r o m h is k n o w l e d g e of t h e O f fic e rs a n d S e c r e t a r y , c o n f id e n c e t h a t t h e y w o u l d n o t fail. T h e C h a ir m a n th e n p erfo rm e d a very p le a s in g cere m o n y i n p r e s e n t i n g a w a r d s t o t h e m e m b e r s of t h e t e a m r e p r e s e n t i n g 8 9 / 4 D i v i s i o n , w h o w e r e t h e w i n n e r s of t h e C l a r k e ’s S hield. P r e s e n t a t i o n of a n n u a l a w a r d s b y t h e C o r p s S u p t . fo llo w e d , a n d t h e r e c ip ie n ts c o n g r a t u l a t e d . T h e P a r a d e w a s t h e n d i s m i s s e d to e n a b l e all to sit in c o m f o r t to lis te n to s o m e v e r y fine s p e e c h e s . T h e n e w 12 5/2 N u r s i n g D iv isio n w a s w e lc o m e d , a n d p l e a s u r e e x p r e s s e d a t s e e i n g s o m a n y n u r s e s a l r e a d y in u niform .

SO U TH ER N T hree B ridges . — D r . S i d n e y M a t t h e w s p r e s i d e d a t t h e a n n u a l p r e s e n t a t i o n of a w a r d s o f t h e T h r e e B r i d g e s c l a s s held a t th e In stitu te , T h re e B rid g e s on W e d n e s d a y , S e p te m b e r 2 0 t h , s u p p o r t e d b y M r . E. U z z e l l , W e l f a r e O f f i c e r , D r . R. M a tth e w s , C lass L e c tu re r, M iss B. B lo u n t, C o u n ty D i r e c t o r , S u s s e x R e d C r o s s , M r. A. G o d d a r d , D i s t r i c t S e c r e t a r y , M r . F . A. T r o t t , A m b u l a n c e I n s p e c t o r , a n d M r . J e n n in g s, C lass S ecretary . M r . U z z e ll s p o k e of t h e e x c e l l e n t w o r k p e r f o r m e d b y R a ilw a y A m b u lan ce m en d u rin g th e w ar. T h e y h a d set a n e x a m p l e e q u a l l e d b y f e w o t h e r o r g a n i s a t i o n s , in r e n d e r i n g se rv ic e to o th e r s , a n d h e c o m m e n d e d t h e T h r e e B r i d g e s m e m b e r s fo r s t a y i n g t h e c o u r s e t h r o u g h difficult tim e s. I n a d d i t i o n to t h e m a n y a w a r d s p r e s e n t e d , M r. U z ze ll h a n d e d D r . R . M a t t h e w s a s e t o f m e d i c a l b o o k s o n b e h a l f of t h e c la s s, a s a t o k e n of th e ir a p p r e c ia tio n fo r h is s e rv ic e s to t h e c l a s s ; h e a ls o h a n d e d M r . J e n n i n g s t h e c e r tif ic a te of h is a p p o i n t m e n t t o S e r v i n g B r o t h e r o f t h e O r d e r of S t . J o h n . T h e e v e n t w a s fo llo w e d b y a S o c ia l, w h i c h w a s w ell sup p o rted . B asingstoke . — A n i n t e r e s t i n g e v e n i n g w a s h e l d a t t h e C a th o lic H a l l , B a s i n g s t o k e , o n th e o c c a s io n of a n A m b u l a n c e C la s s ev en t, th is b e in g a “ B r a in s T r u s t ” c o m p o s e d of D r. J . A. W h i t e , D r . J . V . E l l i s , D r . A . M a c L e a n , D r . E . W a l k e r , a n d D r . J . C l e m e n t s , w i t h M r . F . A. T r o t t a s Q u e s t i o n M aster. Q u e s t i o n s w e r e d e a lt w i t h o n first a id , c o m m o n a i l m e n t s , a n d h e a l t h , w h i c h c r e a t e d s o m u c h i n t e r e s t , t h a t it w a s s u g g e s te d a fu rth e r “ B ra in s T r u s t ” be held o n T u e s d a y , N o v e m b e r 4 t h , a t w h i c h a r e c o r d a t t e n d a n c e of t h e s t a f f is expecte'd. M r. J. F r a n c i s p ro p o s e d a v o te of t h a n k s to D o c to r s a n d Q u e s tio n M a s te r for g iv in g th e cla ss s u c h a n ex c e lle n t e v e n i n g ’s i n s t r u c t i o n i n a m o s t e n t e r t a i n i n g w a y . C hard J unction .— A l a r g e a n d e n t h u s i a s t i c n u m b e r of first a i d e r s b e l o n g i n g to th e a b o v e A m b u l a n c e C la s s, m e t a t th e W ilts U n ite d C a n te e n o n W e d n e s d a y , S e p te m b e r 27th, o n th e o c c a s io n of th e a n n u a l p r e s e n t a tio n of a w a r d s . T h e c h a ir w a s t a k e n by th e S ta tio n M a s te r , M r. F . S nell, s u p p o r te d b y M r. W h ite , A s s is ta n t M a n a g e r of t h e W i lts

F I R S T

U n i t e d D a i r i e s , a n d D r . D a n i e l s ( l e c t u r e r of t h e c l a s s ) . M r. W . J. R o o k s ( D is tric t S e c retary ) o u tlin e d th e w o r k d u r in g th e p a s t s e s s io n a n d t h a n k e d all w h o h a d h e lp e d to m a k e th e class su c h a success. P a r t i c u l a r t h a n k s w e r e p a id to th e u n t i r i n g efforts of th e C l a s s S e c r e t a r y ( M r . F . I. S. B ily a r d ) . T h e p r e s e n ta tio n s to a b o u t 30 su c c e ss fu l c a n d id a te s w e re m a d e b y M r . W h i t e a n d t h e r e c i p i e n t s of 14 a n d 2 1 - y e a r l o n g service m e d a ls receiv ed loud a p p la u s e . A fter th e p r e s e n ta tio n s, th e c o m p a n y , w h ic h in c lu d e d w ives a n d ch ild ren , e n jo y e d a so c ial e v e n in g , m u s ic b e i n g p ro v id e d b y a local dance band. * I t is c o n f id e n tly e x p e c t e d t h a t t h e c o m i n g s e s s io n will be even m o re successful th a n th e past.

Letters to the Editor. W e a r e in no w a y resp o n sib le for th e o p in io n s ex p re sse d , or tjie s t a t e m e n t s m a d e , by C o r r e s p o n d e n t s . — E ditor . N A T IO N A L IS A T IO N

THE

AM BULANCE

R I D

D e a th o f Col. C h a rle s J. T r im b le , C.B., L.R.C.P. J ust a s w e w e r e p r e p a r i n g f o r t h i s n u m b e r o f F . A . f o r t h e P r e s s , w e r e c e i v e d n e w s of t h e p a s s i n g o f t h a t G r a n d O l d M a n of t h e B r i g a d e , C o l o n e l C h a r l e s J o s e p h T r i m b l e , C . B . , C . M . G . , V . D . , T . D . , L . R . C . P . , K n i g h t of G r a c e , I n s p e c t i n g O ffice r of N o. I V D is tr ic t, a n d f o rm e r ly C o m m is s io n e r of t h a t D istrict. O n M a r c h 16th, 1944, C olonel T r im b le a tt a in e d th e r i p e a g e o f 88, a n d w a s s t i l l o n t h e a c t i v e l i s t o f t h e B r i g a d e a t t h e t i m e of h i s d e c e a s e . T h e v a s t a m o u n t of w o r k w h i c h t h i s d i s t i n g u i s h e d a n d p o p u l a r s u r g e o n did , n o t o n ly fo r t h e B r i g a d e a n d its m e m b e r s , b u t a l s o f o r s u f f e r i n g h u m a n i t y , w ill live l o n g in t h e m e m o r y of t h o s e w h o k n e w a n d l o v e d h i m a n d o f t h o s e w h o se rv ed u n d e r him .

ASTHMA, BRONCHITIS

S E R V IC E S . D

e a r

Catarrh, Hay Fever, and o th er Respiratory sufferers should communicate with British Medica Laboratories, Ltd., for particulars of the most efficacious rem edy known to medical science. Send stamp to D epartm ent Z.A.3.

,—

H a v i n g b e e n a r e g u l a r r e a d e r o f F irst A id f o r o v e r th ir ty y e a rs, I re a d w ith th e g r e a te s t in te r e s t y o u r e d ito ria l in t h e S e p t e m b e r is s u e , u n d e r t h e a b o v e h e a d i n g . B e in g a t r a n s p o r t S u p t. 1 k n o w o n ly to o w ell w h a t a d e p l o r a b l e a m b u l a n c e se rv ic e is o ffered to t h e c o m m u n i t y th r o u g h o u t th e c o u n try . E a c h a n d every to w n a n d county s e e m t o h a v e t h e i r o w n i d e a s of t h i s s e r v i c e , b u t f r o m m y e x p e r ie n c e n o o n e trie s to d o a n y t h i n g to im p ro v e th e service. E i t h e r f r o m i g n o r a n c e o r a p a t h y t h e a m b u l a n c e s e r v ic e s of th is c o u n try , a s a w h o le, a r e a d is g ra c e , a n d for th is re a so n , s ir , k n o w i n g y o u r p a p e r to be s o w id e ly r e a d , I h o p e it will a r o u s e s o m e in t e r e s t in th e m a t t e r . I f o n l y y o u c a n b r i n g b e f o r e t h e p u b l i c a t r u e p i c t u r e of t h e s t a t e of a f f a i r s , I a m s u r e y o u w i l l b e d o i n g o n e o f t h e g r e a t e s t s e rv ic e s to th e people, a n d h e l p i n g to b r i n g a b o u t a m u c h needed r e f o r m . W i s h in g y o u r efforts every s u c c e s s .— Y o u r s faithfully, F.

H olden ( T r a n s p o r t S u p t . ) .

M anufacturers o f Ethical

B R IT IS H

M edical Products

M E D IC A

L A B O R A T O R IE S

H e a th c o te R o a d , B o s c o m b e , B o u rn e m o u th .

T H E ST. JO H N

AM BU LAN CE

C O RBET

FLETC H ER,

sh o u ld b e in t h e

• D A LE,

O n l l w y n . — T h e O n l l w y n S t . J o h n ’s A m b u l a n c e D i v i s i o n c o m p e t e d in s t r e n g t h o n S e p t e m b e r 1 6 th , a t N e a t h , in th e g r o u p C o rp s co m p e titio n s for th e N e a th C o u n ty A rea. C o m p e titio n r e c o r d s w e r e su r e ly b r o k e n w h e n all th e tr o p h ie s w e r e w o n by th e a b o v e D ivision, t o g e t h e r w ith tw o se c o n d prizes a n d o n e th ird . T h e w i n n e r s w e r e a s f o l l o w s :— T h e s e n io r “ A ” t e a m , c a p t a i n e d by A m b u l a n c e O fficer J a m e s L. L e w is, w o n th e silv e r c u p a n d £ 2 . T h e second prize of £ \ w a s a ls o w o n b y th e “ B ” te a m , c a p ta in e d by S e r g e a n t E . C. T h o m a s . T h e se n io r N u r s in g te a m , c a p ta in e d by D iv isio n al S u p t. L e t ty M. W illia m s , w o n t h e first prize, w h ic h w a s a silv er cup and £ 2 . T h e Boy C a d e t “ A ” te a m c a p ta in e d by C o rp o ra l J u lia n J o h n w o n th e c h a lle n g e sh ie ld a n d j £ l . T h e se c o n d prize of 10/- w a s a ls o w o n b y t h e C a d e t “ B ” t e a m , c a p t a i n e d by C a d e t G r a h a m C u rtis. T h e G irl N u r s in g “ A ” te a m , c a p ta in e d b y C a d e t J e a n Je n k in s, w o n th e D . M. E v a n s B evan c h a lle n g e cu p a n d £ i . T h e th ir d p rize w a s a ls o w o n by th e “ B ” te a m . T h e D iv is io n h a s a w a r t i m e r e c o r d in p u b lic d u t y , civil d e fe n c e , a n d c o m p e t i t i o n w o r k of w h ic h it m a y w ell be proud.

O .B .E .,

M .A .,

M ovem ent M .B .,

M .R .C .S .

” A s a w o r k o f r e f e r e n c e , t h e b o o k w ill b e e x t r e m e l y u se fu l an d lib r a r y o f a ll a m b u la n c e w o r k e r s . ” —

P r ic e 3s. 6 d .,

Priory for Wales.

A S S O C IA T IO N

I t s H i s t o r y a n d I t s P a r t in t h e A m b u l a n c e By N .

LTD .

( Telegrams “ Universal")

REYN O LD S

CO.

First Aid.

p o st fre e 4 s.

L T D . , 46, C a n n o n S t . , L o n d o n , E C .4 .

“ G A S — A S y n o p sis o f D e fe n c e A g a in s t ’ Essential Facts W ithout Padding. B y J o h n F e n t o n , m . b ., b . ch ., b . a . o ., d . p . h Price ls. Id . post free. Dale, Reynolds & Co. Ltd., 46, Cannon Street, London, E.C.4.

ST R E T C H E R

E X E R C ISE S

for the St. John A m bulance Brigade. P rice 4d. post free. Dale, Reynolds & Co. Ltd ., 46, Cannon St., E.C .4

IN S T IT U T E

C E R T IF IC A T E S

D IPL O M A S.

^ ^ E M B E R S H I P of t h e a b o v e I n s t i t u t e is o p e n to p e r s o n s I * h o l d i n g a n y re c o g n iz e d h i g h g r a d e C e rtific ate. W rite for in te re s tin g p a rtic u la rs to B C M /C h a m b e rs , L o n d o n W . C . l , o r 6 7 , L o r d S t . , L i v e r p o o l , 2.

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CELLON SERVICE FO R

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S K L E N P L A B A N D A G E H eadaches resulting from overw ork and fatigue respond readily to trea tm en t w ith ‘ A n a d in .’ A balanced com bination o f aspirin, phenacetin and caffeine, this p r ep ara tion acts rap id ly and effectively and m a y be recom m ended w ith confidence. T h e constituents of ‘ A n a d in ’ are care fully standardised. I t is not habitforming and there are no harm ful or unpleasant after-effects.

ANADIN A N A D IN

LIM IT ED ,

C H E N IE S

LONDON.

W .C .I

R E M O V E R

(n o n -in fla m a b le )

A so lu tio n fo r d isso lv in g the adhesive o f p lastic bandages, e nab lin g easy rem oval o f the p laster and su b seq ue nt cleansing o f the adhesive rem ain in g on the skin . A lso in valuab le fo r cleansing th e skin p r io r to applying the, bandage. F u r th e r in fo rm a tio n , s a m p le s and

Tablets ST R E E T ,

S T I C

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K IN G S T O N - O N - T H A M E S K IN G S T O N 1234 (S lin e s )

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CVS—34

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ADAM, ROUILLY & CO., Human Osteology, Anatomy, etc., 18 FITZROY STREET, FITZROY SQUARE, LONDON, W .l TELEPH O N E

TH E

M U S E U M 2703.

W O M A N

W A R -W O R K ER

FIR S T A ID PRESSURE P O IN T , S K E L E T O N , CIRCULATION CHART (Arteries Coloured)

M i n o r gastric d is o r d e r s , to which th ro u g h

D ev e lo p e d f o r Civil D e f e n c e , F irst A i d C o u r se s, etc. 2/3 rd n a t u r a l size. O n m u s l i n , w ith ro lle rs - - - - 10/ - p o s t free.

women

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EMERGENCY TREATMENT O F S K IN I N J U R I E S

digestiem. its

Be prepared for an emergency and keep Cuticura Brand O int m ent in your First Aid Kit. It 1 rings instant soothing relief to cuts, burns, skin lacerations— prevents spread of infection, quickly heals. Obtainable at all Chemists and Stores, f?

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p l e a s a n t,

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flav ou r

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a n y te n d e n c y to c o n s t i p a t i o n .

—BiSoDoL—

fiiticu ra

B IS O D O L

LIM IT ED .

C H E N IE S

STREET.

L O N D O N , W .C .I

BRAND

V 'O IN T M E N T

“SANOID” RESPIRATOR FRAME R e g is te re d D e s ig n

FOR

D IV IS IO N S

OF TH E

St. John Ambulance Brigade

No.

Price of F ilte r Masks (R e s p ira to r R efills) on A pplication

806838

P R IC E

7d.

each

6/- PER D O Z .

c a n be O B T A I N E D f r o m T h is fram e has been designed esp ecially fo r the purpo se o f secu rely lo catin g and thu s preve n tin g slip o f C o tto n W o o l F ilte rs o r o th e r Masks w hen used as R e sp ira to rs in safeguarding w o rkm e n against dust arisin g from In d u stria l o p era tio n s. It possesses many advantages o v e r o th e r a rticle s of a sim ila r ch aracte r Inasm uch as : It is ru s tp ro o f and sm ooth, being fle xib le It re a d ily conform s to c o n to u r o f the face thus e n su rin g c o rre ct po sitio n in g of the Mask. It Is lig h t, easy to adjust, and the lo w e r p o rtio n fits com fo rtab ly u n d e r the chin thus an ch o rin g both fram e and filter.

HO BSO N & SO N S (L O N D O N )

LTD .

UNIFORM CLOTHING & EQUIPMENT MANUFACTURERS.

154-164, T O O L E Y LO N DO N

STREET,

B R ID G E , S .E .i.

Sole Manufacturers I ’P h o n e : H o p 2476 (4 llnei)

’G ra m s: ’ Hobton, Bofoh, L o n d o n .

GUXSON, GERRARD & CO. LTD. First

Aid

Specialists

OLDBURY,

BIRMINGHAM

F I R S T

R I D

P A T E N T

“ PORTLAND AMBULANCE

CEAR

The Gear Illustrated (A.B.C.D.) carr'es tw o stretch ers on one side of Ambulance, leaving oth er side clear for sitting patients. UP AND DOW N action Is quick easy for loading o r unloading. A.

S h o w s t h e t w o s t r e t c h e r s in p o sitio n *

S h o w s t h e t o p s t r e t c h e r lo w e r e d r e a d y f o r l o a d in g .

I l lu s t r a t e s t h e s a m e G e a r w it h th e t o p s t r e t c h e r fr a m e h in g e d dow n fo r u s e w h e n o n l y o n e s t r e t c h e r c a s e is c a r r ie d .

O .

S h o w s t h e s a m e p o s itio n a s in “ C o n ly w it h c u s h io n s a n d b a c k r e s t fitt e d fo r c o n v a le s c e n t c a s e s .

W h ere Ambulances are required to carry four beds two Gears are fitted, one on EITHER. SIDE, and th e same advantages apply as described above. Full catalogue o f Ambulance Equipment No. 7A w ill be sent

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O U can m a k e M a s s a g e a sp a re tim e or w h o le tim e o ccu p atio n . T h e t r a i n e d M a s s e u r is o f i n e s t i m a b l e v a lu e to F i r s t A id o r g a n i z a t i o n s , N u r s i n g H o m e s , H y d r o s , S p o r ts a n d A th le tic C lu b s, P h y sic a l C u ltu r is ts , etc. T rain w ith th e S M A E In stitu te a n d re m e m b e r you h av e N O T H IN G

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F I R B T

Queries and Answers toCorrespondents Queries will be dealt with under the following rules :—

1. — Letters

containing Queries must be marked on the top left-hand corner of the envelope “ Query,” and addressed to F i r s t A i d , 46, Cannon-street, London, E .C . 4.

2.— All 3. — All

Queries must be written on one side of paper only.

Queries must be accompanied by a “ Query Coupon ” cut from the current issue of the Journal, or, in case of Queries from abroad, from a recent issue. 4. — T he Textb ook to which reference may be made in this column is the 39th ( 1937) Edition of the S.J.A.A . Manual of First Aid to the Injured.

Thanks to the Doctor. W e feel sure that every one of our readers will join us in tendering the heartiest thanks to Dr. N. Corbet Fletcher, O . B . E . , M.A., for his .great kindness in solving all the problems submitted by our numerous readers during the past 29 years, despite the fact that this often means burning midnight oil after a hard d ay’s work. Since the present Editor has been in control, the Doctor has never kept a reader waiting for a reply to a query. This is adequate evidence that his heart is in the great work of assisting others in difficulty and in encouraging all first aiders to be sure that the methods of assisting unfortunate people, when in pain, are correct. With this number the Doctor commences the thirtieth year of this meritorious work. Our heart goes out to him in praise of what he has done in the past, and we are sure all our readers will join us in saying “ T h a n k Y o u Doctor ” for past kindnesses, and in expressing the hope that N .C .F . will be seen under replies to queries in this Journal, for many years to come.— E ditor . Fracture of C e rv ic a l Spine. M.N. (Chelsea).— Please settle the following problem which has puzzled us and given rise to much discussion in our first aid circle :— With a fracture of the spine in the cervical region which is accompanied by loss of power and of sensation below the seat of fracture, would there be paralysis of the chest muscles resulting in asphyxia ? If the fracture is below the fourth cervical vertebra, the muscles of the chest wall would be paralysed, but asphyxia would not result because the diaphragm is not involved. If, however, the fracture is above the fourth cervical vertebra and if the spinal cord is completely crushed, asphyxia would result because paralysis would affect the muscles of the chest wall and the diaphragm. Such cases are almost invariably fatal.— N. C orbet F letcher . Exam ination How ler. G.G. (Wiakato, N .Z .) .— In a recent examination, the doctor asked one candidate what he would do if he came across a patient suffering from a burst varicose vein. He was taken aback when the candidate replied :— “ I w o u l d do n o t h in g b e c a u s e th e tr e a tm e n t o f a b u r s t v a r ic o s e v e in is th e d o c to r 's j o b ! ”

Now we wonder what you would have said if you had been the examiner. Good !

Next, please ! !— N .C .F .

Sal A m m o n ia c for Burns. A .H . (Twickenham). — I shall be grateful for any informa tion which you can give me on the use of sal ammoniac in the treatment of burns caused by caustic.

R I D Personally, I have never heard of ammonium chloride (the old name of which was sal ammoniac) being used in the treatment of burns. Nevertheless, it is an alkali and so could safely be substituted for bicarbonate of soda if the latter is not available.— N .C .F . T im e Factor in Poisoning. N.R. (Finchley).— In its instructions on the treatment of poisoning, the Textbook omits altogether, the question of time. Suppose that a person had ptomaine poisoning and did not discover it until hours afterwards, as occurred in a actual case, is it of any use to administer an emetic ? Your kind explanation of this omission will be apprecia ted. You forget that first aid is “ the immediate, temporary and efficient assistance rendered by doctor or trained lay person in cases of accident and s u d d e n illness.” Consequently, the time factor as you call it, does not come within the scope of first aid. In the instance quoted by you, the administration of an emetic would, of course, be an error ; and in any case it would be a meddlesome act for any first aider to attempt actively to treat such a patient. — N .C .F . Crushed Ribs and Broken C lavicle. B.M. (Uxbridge).— At a meeting of our first aid class, I told a squad to treat a patient suffering from crushed ribs and fractured clavicle. They placed a large dressing on the ribs and held it in position by a loosely tied triangular bandage. They then treated the fractured clavicle by placing in position a long splint which extended from armpit to ankle, and fixed the arm proper to the splint, the inside of which they padded at its head. My observation was that both fractures should have been treated on the lines laid down in the Black Book as two separate injuries, the ribs being firmly bandaged and the clavicle being padded and supported in arm sling. As we differ on this point your expert opinion will be welcome. Y o u r problem is decidedly vague, because you do not make it clear what you mean by “ crushed ribs ” especially whether or no the fractured ribs are compound and/or complicated. In these circumstances, I deal with your problem on the assumption that it refers to simple fractures of several ribs and of clavicle. With this combination of injuries, shock would probably be severe. So I would keep patient recum bent, and apply firmly a couple of broad triangular bandages to support the ribs. This done, I would control the fractured clavicle by placing the upper limb alongside the body, flex it to a right angle at the elbow, place hand on chest wall, and fix the limb by a broad triangular bandage round elbow, hand and chest. T he suggestion of your squad that a long splint be used to control the fractured clavicle is ingenious. T o me, how ever, its use is unnecessary, a waste of time, and would in volve delay in removing patient from the place of accident to hospital.— N.C. F. Hand Splint. B .P. (Lewisham).— A correspondent in a query which was published under the above title in the September issue of F i r s t A i d , refers to a condition of the hand which he calls Dupuytren’s Contraction. As we have never heard of it, we shall greatly appreciate an explanation of what it is and what happens to the hand. ' Dupuytren’s Contraction is a condition, in which, as the result of thickening and contraction of the palmar fascia, one or more fingers may become flexed at the joint between the

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— A Synopsis o f W a r -t im e Training b y J O H N F E N T O N , m.b., B.c h., b . a .o ., d .p .h . a n d L . A . H . S N O W B A L L , m .r.c .p., p.R.c.s.(Ed.) P R I C E : 8d . p o s t f ree (7s. 6d . p e r dozen ) F O R C IV IL D E F E N C E SER V IC E S , E T C ., T R A I N IN G Published by Dale, Reynolds & C o ., Ltd., 46, Cannon Street, London, E.C.4 .

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IG L O D IN E - F I R S T - A I D “ It doesn’t h u rt in the least ” — Iglodine can be applied to an open wound w ith o u t pain. This safe, but powerful antiseptic cleanses and heals cuts, wounds, bruises, scalds and burns.

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F I R S T first a n d s e c o n d p h a l a n g e s a n d m a y e v e n t u a l l y b e d r a w n im m o v a b ly in to th e p alm . N o w f o r g e t a b o u t t h e c o n d i t i o n w h i c h is b e y o n d t h e s c o p e of firs t a i d . — N . C . F .

P rio rity in Transport. C . M . ( B e v e r l e y ) . — -1 s h o u l d b e v e r y m u c h o b l i g e d if y o u w o u ld let m e h a v e y o u r o b s e rv a tio n s on th e fo llo w in g c a s e :— M y t e a m w a s t a k i n g p a r t in a c o m p e t i t i o n in w h ic h th ere w ere three casualties. O n e, a sm a ll boy w ith g ra z e d k n e e a n d h a n d ; tw o, a m a n — u n c o n sc io u s w ith p ale face, no a p p a r e n t h e a d in ju ry a n d no fra c tu re d s k u ll— h e w a s s u ffe rin g only from s lig h t c o n c u s sio n a n d a b r o k e n c o lla r b o n e a n d c o m p o u n d f r a c t u r e of left le g —b l e e d i n g s t o p p e d ; a n d t h r e e , a p a t i e n t w h o h a d c o m p l i c a t e d f r a c t u r e s of r i b s a n d w a s c o u g h i n g b l o o d a n d a lso h a d f r a c tu r e d w rist. A fter w e h a d a tte n d e d to th e in ju ries, th e D o c to r a s k e d w h ic h p a tie n t w o u ld be tre a te d a s p rio rity a n d t a k e n t o h o s p i t a l first. I ch o se th e m a n w ith th e in te r n a l h a e m o r rh a g e ( c o m p o u n d f ra c tu r e d ribs) ; a n d so did th r e e o th e r te a m s . T h e w i n n i n g t e a m ( q u i t e bya cc id e n t) ch o se th e u n c o n sc io u s m a n a n d th u s w o n th e c o m p e t i t i o n , a s a g o o d n u m b e r of p o i n t s w e r e a w a r d e d for p ic k in g th e r ig h t case. T h e L eader afterw ard s s t a t e d to m e t h a t h e d id n o t k n o w w h y h e p ic k e d th is u n c o n sc io u s p atien t. I t w a s j u s t by' a c c i d e n t , a n d o n t h i n k i n g it o v e r h e re a lis e d h e s h o u ld h a v e t a k e n th e o ther. W e c a n n o t f in d o u t t h e D o c t o r ’s r e a s o n f o r g i v i n g p r i r o i t y t o t h e u n c o n s c i o u s p a t i e n t , a n d s o a s k if y o u c a n th ro w a n y lig h t on th e m a tte r p lease a s w e h a v e a lw a y s u n d e r s t o o d t h a t i n t e r n a l h a i m o r r h a g e is g i v e n p r i o r i t y . M a y I a l s o a d d h o w m u c h I e n j o y y 'o u r a n s w e r s t o c o r r e s p o n d e n t s i n F i r s t A id ? I t is n o t p o s s i b l e f o r m e t o k n o w w h a t w a s i n t h e m i n d of y o u r s u r g e o n - j u d g e . 1 do, h o w ev er, k n o w th a t concussion is o f t e n f o l l o w e d b y c o m p i e s s i o n of t h e b r a i n a n d t h a t t h e c a s e of c o m p o u n d f r a c t u r e o f r i b s w o u l d i n a l l p r o b a b i l i t y s u f f e r 'n o f u r t h e r c o m p l i c a t i o n b y a s h o r t d e la y in r e m o v a l to hospital. Bv th e w ay , you d o n o t s a y w h a t p re v e n te d b o th th ese c a s u a l t i e s b e i n g r e m o v e d i n t h e s a m e a m b u l a n c e ! !— N . C . F .

A I D Use of Petrol for Wounds. H . H . ( A P O . , B L A ). — B e i n g a first a i d e r in a m o t o r t r a n s p o r t u n i t o n a c tiv e se rv ic e , I a m v e ry i n t e r e s t e d in y o u r a n s w e r s to q u e r ie s w h ic h w e r e p u b lis h e d u n d e r th e a b o v e h e a d i n g i n t h e M a y a n d J u l y i s s u e s o f F irst A id . R e c e n tly , I a t t e n d e d to a m a n w h o h a d sp ilt p etrol o n h i s b r e e c h e s ; a n d it h a d s o a k e d t h r o u g h t o h i s l e g . A r e d d e n i n g a n d s o r e n e s s ' of t h e s k i n h a d r e s u l t e d , s im ila r to a b u r n . T h e so re n e s s w a s relieved by a dry d ressing. As you say t h a t you w o u ld n o t h e s ita te to use w a r tim e p etro l in a n e m e rg e n c y , I w o u ld a p p re c ia te a n y f u r t h e r c o m m e n t s t h a t y o u m a y b e k in d e n o u g h to m a k e a s to th e s u ita b ility ot w a r ti m e p e tro l a s a n a n tis e p tic , b e a r i n g i n m i n d t h i s c a s e , a n d if m y t r e a t m e n t w a s c o rre c t o r not. I w ill g r e a t l y a p p r e c i a t e y o u r e x p e r t in fo rm a tio n . I n t h e e n i a r g e n c y t r e a t m e n t of w o u n d s t h e u s e of c e r t a i n a n tis e p tic s (e .g ., a lco h o l, p etro l a n d tin c tu r e of iodine) m a y g i v e r is e to i r r i t a t i o n u n le s s th e a n t i s e p ti c se le c te d is p a in te d o v e r th e w o u n d a n d s u r r o u n d i n g s k i n a n d a llo w e d to d ry before th e d re s s in g s a r e applied. T h i s is j u s t w h a t h a p p e n e d to y o u r p a tie n t, th e p etro l b e in g k e p t in p r o l o n g e d c o n ta c t w ith th e sk in by th e so a k e d tro u ser. C on seq u en tly your t r e a t m e n t w a s c o rre c t, in t h a t yo u a p p lie d a d r y d r e s s i n g a n d , a s I p re su m e , re m o v e d th e tro u s e r u n til th e petrol h a d evaporated. I n c id e n ta lly , in m y a n s w e r in t h e J u l y iss u e , I s t a te d t h a t I w o u ld u s e w a r t im e p e tro l in a n e m e r g e n c y “ s h o u ld no o t h e r m e t h o d of t r e a t m e n t b e a v a i l a b l e . ” — N . C . F .

Treatm ent of O p iu m Poisoning. P .M . ( P o r ts m o u th ) . — In y o u r rep ly to a q u e ry w h ic h w a s p u b lis h e d u n d e r th e a b o v e h e a d i n g in th e S e p te m b e r i s s u e o f F irst A id y o u a r e c r e d i t e d w i t h s t a t i n g t h a t t h e T e x t b o o k o n p. 1 7 4 t e l l s u s t o a d m i n i s t e r t e n g r a i n s of p o tassiu m p e r m a n g a n a te or tw o t a b l e s p o o n f u l s of C o n d y ’s f l u i d i n h a l f a p i n t o f w a t e r , p r e f e r a b l y w a r m . I a s s u m e t h a t t h i s w a s a p r i n t e r ’s e r r o r f o r “ o n e p i n t ” ; a n d I t h a n k you for th e g r e a t help w h ic h y o u r a n s w e rs to o u r q u e r i e s affo rd to u s a ll in o u r difficulties. Y o u r a s s u m p t i o n is c o r r e c t ; a n d y o u r l e t t e r is a p p r e c i a te d .— N .C . F.

C a rry in g Stretcher.

Treatm ent of Fractured Spine. E.

N. ( B u s h e y ).— In r e g a r d to th e q u e ry w h ic h w a s a n s w e re d u n d e r t h e a b o v e h e a d i n g i n J h e S e p t e m b e r i s s u e of F ir st A id , I w o u ld lik e to p o in t o u t t h a t th e i n s t r u c t o r d o u b tle ss h a d in m in d th e in stru c tio n s issu ed by th e E m e r g e n c y M e d ic a l S e r v ic e s in a C i r c u l a r [ E M S 30/165] d a t e d M a y 2 2 n d , 1944. T h e i n s t r u c t i o n s f o r r e m o v a l of t h e p a t i e n t f r o m t h e i n c i d e n t , a s s u m i n g n o d o c t o r is a v a i l a b l e , s t a t e i n p a r a g r a p h (4 ) :— “ I n a f r a c t u r e of th e s p i n a l c o l u m n a t a n y level t h e p a t i e n t m u s t b e t r a n s p o r t e d o n h i s b a ck . I f h e is f o u n d in s o m e o t h e r p o sitio n h e m u s t b e v e ry c a re fu lly t u r n e d o v e r ‘ i n o n e p i e c e ’ b y t w o o r m o r e b e a r e r s , f o u r if p o ssib le .” T h e E M S in stru ctio n s quoted above are based on a m e m o r a n d u m p re p a re d by th e N erv e In ju rie s C o m m itte e of t h e M e d ic a l R e s e a r c h C o u n c il.

W h ile t h a n k i n g yo u for y o u r le tter, I a g a i n re p e a t th a t th e in s tr u c to r e rre d w h e n h e s a id t h a t th e m e th o d laid d o w n in th e T e x t b o o k w a s w r o n g . I n b rief, t h e p o in t p r e s e n t s a d i f f e r e n c e of o p i n i o n b e t w e e n t h e e x p e r t s w h o l a y d o w n i n s tr u c tio n s for St. J o h n p e r s o n n e l a n d th o s e w h o d o th e s a m e for th e E m e r g e n c y M e d ical S erv ices ; a n d , a s w e b o th k n o w , t h e e x p e r t s d o d i f f e r ! !— N . C . F .

M .D . ( E a s te rn C o u n tie s ).— A n in c id e n t w a s recalled to m y m in d w h e n I r e a d y o u r re p ly to th e q u e r y w h ic h w a s p u b lis h e d u n d e r th e a b o v e h e a d i n g in th e S e p te m b e r i s s u e o f F irst A id a b o u t w h e e l i n g p a t i e n t s o n s t r e t c h e r s i n a n d o u t of w a r d s ; a n d i t t a k e s m e b a c k 5 0 y e a r s w hen I w as a g a y yo u n g house surgeon. I a s k e d th e s is te r of a s u r g i c a l w a r d w h y p a tie n ts w ere w h eeled o u t a lw a y s h e a d f irs t. “ B e c a u s e ,” said s h e “ th e y a r e w h e e le d o u t feet first o n ly w h e n th e y a r e d e a d ! ” T h e s u rg e o n , h o w ev er, am plified th is s o m e w h a t su p e rstitio u s re a so n by a d d in g th a t “ th e clerk p u s h i n g t h e w h e e l e d s t r e t c h e r c o u l d w a t c h t h e f a c e of th e p a tie n t b e tte r fro m th e feet e n d ! ” A las ! I co u ld n e v e r c o n v in c e m y se lf t h a t th is r e a s o n w a s a d e q u a t e l y c o rre c t or tru e. Good !

N e x t , p l e a s e ! 1— N . C . F .

“

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O ct., 1944.

MANUALS OF FIRST AID By

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O IS O N S C H A R T — H a n d y Q u ick R eference— T re a tm e n t a n d R e m e d ie s for 30 d ifferen t poisons. H a w k in s , l i d P o s t f r e e (8/ - d o z e n ) . F o u n t a i n P re ss , 46, C h a n c e r y L a n e L o n d o n , W . C . 2.

A N T E D , all sizes se c o n d h a n d C a d e t T u n i c S h irts a n y offers. C a d e t Sw pt. T a r l i n g , P a r k R o a d C r o m e r . ____________________________________________________________

A N T E D , s e c o n d h a n d g r e a t c o a t , S t. J o h n N u r s i n g S ister. R e c e n t m o d e l, g o o d c o n d itio n , b u s t 36 in ., l e n g t h 46 in. A pproval, W a d e , M o u n tp le a sa n t, R ipon.

A R S T A I R S ” In v alid C h a ir, u n u se d . £ ,T 1 0 s . S. B u l t , 2 6 , C a n n i n g R o a d , C r o y d o n , S u r r e y . __________

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B A B Y B E A R (Jo in ted G g la s s eyes, s tu ffin g a n d A ttra c tiv e ly B o xed . 36/- doz. 5, R o u n d h a y T e r r a c e , L e e d s ,

H e a d ) R e a d y to m a k e w ith i n s t r u c t i o n s . A s s o r t e d Colours. Inc. T a x . G. R u ssell In m a n , 7 . _________________

FO R Y O U R W IN T E R PRO G R A M M E. C I R S T A I D C o m p etitio n a n d P ra c tic e T e sts. B o o k conI t a i n i n g s i x t e a m t e s t s , s i x i n d i v i d u a l , s i x o r a l , p r i c e 2/-, p o s t a g e I d . C o m p ile d by D iv is io n a l S u p e r i n te n d e n t . F r o m : R o b in s o n , B C M / F i r s t A id, L o n d o n , W . C . l .

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LEG TROUBLES Try G erm olene y o u rse lf— and you w ill be convinced INFLAMMATION o f its power to soothe and RASHES, SPO T S relieve skin com plaints. U nder the healing hand BU RN S, CUTS o f G erm olene m any skin afflictions vanish in a few days — or even hours. But G erm olene’s m ost w onderful victories are recorded in letters like the fo llow in g: ‘ RESU LTS HAVE BEEN W ONDERFUL’ “ I h a v e been troubled w ith bad legs f o r y ea rs . . .

I a p p lied G erm olene three an d som etim es fo u r tim es a day. T h e results have been w onderful. I am sure i t w as only G erm olen e tha t g o t me on m y fe e t again. N o pra ise is w o high f o r y o u r w ond erfu l o in tm en t; it is w orth m ore than I can say about it. Y o u m ay pu blish this letter as y o u w ish .” ( S i g n e d ) C . A . B. { M r s .). S h ifn a l, S a lo p .

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A C U T S R H IN IT IS • C H R O N IC R H IN IT IS • C A T A R R H S IN U S IT IS • A S T H M A • H A Y

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BIOLOGICAL M B I 3 PREPARATIONS A N T I P E O L

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O n e o r o t h e r o r all o f th e t h r e e races o f g e r m s , S t re p to c o c c i , S taph y lo co cci a n d B. p y o c y a n e u s a r e f o u n d in e v e r y sk i n in f e c tio n c o m m o n t o t h is c o u n t r y , a n d A N T I P E O L O I N T M E N T c o n t a i n s th e antibodies (an tiv iru s ) o f thes e g e r m s . H e a l i n g is e x p e d ite d b y th e p r o v e d i n g r e d i e n t s o f th e o i n t m e n t , a n d septic d e v e l o p m e n t is s t o p p e d o r p r e v e n t e d by its a n t i v i r u s sterile vaccine filtrates. A N T I P E O L O I N T M E N T is u n s u r p a s s e d f o r B U R N S a n d S C A L D S , f o r it is m i c r o b ic id e a n d n o n - a d h e s i v e , a n d d r e s s i n g s d o n o t r e q u i r e t o be c h a n g e d ev e r y day. W O U N D S , B U R N S , e t c , W I L L N O T T U R N S E P T I C i f t r e a t e d w i t h A N T I P E O L O I N T M E N T .

O P H T H A L M O - A N T I P E O L i s a sem i-fluid o i n t m e n t , m o r e c o n v e n i e n t t h a n th e o r d i n a r y A n t i p e o l o i n t m e n t f o r o c u l a r in fection s a n d les ions . E y e s affected b y s m o k e a n d d u s t a r e s o o t h e d a l m o s t im m ediately b y th e ap p lic a tio n o f O p h t h a l m o - A n t i p e o l , a n d the a n t i v i r u s p r e v e n t s g e r m s f r o m d e v e lo p in g .

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...

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1944 .

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T r e a t m e n t of N o s e B l e e d i n g

T r e a t m e n t of F r a c t u r e d . A r m a t E l b o w

A rtificial R e s p i r a t io n w ith F r a c t u r e d R ib s

M r. R obert F. B a rc la y , c h a ir m a n o f the R o y a l H o s pital fo r S i c k C h ild r e n , G l a s g o w , and form er c h a irm a n of the S c o t tis h b ra n c h o f the B ritis h H o s p ita ls A s s o c ia tio n , h as a d d re ss e d the R o y a l P h ilo s o p h ic a l S o c ie ty on “ O u r V o lu n t a r y H o s p itals— T h e ir F u tu re or F a t e .” H e recalled th at in 1942 t h e M i n i s t e r o f H e a l t h f o r E n g l a n d a n d th e S e c r e t a r y o f S t a t e f o r S c o t l a n d o u t l i n e d a s c h e m e fo r t h e c o - o r d i n a t i o n a n d c o - o p e r a t i o n o n a “ r e g io n a l and p a r tn e r s h ip ” b asis o f v o lu n ta r y and l o c a l a u t h o r i t y h o s p i t a l s , a n d s t a t e d t h a t it w a s t h e d e s i r e a n d i n t e n t i o n o f t h e G o v e r n m e n t to s a f e g u a r d and p r e se rv e the v o lu n t a r y h o s p ita ls . The B r i t i s h H o s p i t a l s A s s o c i a t i o n , r e p r e s e n t i n g a ll v o l u n t a r y h o s p i t a l s in G r e a t B r i t a i n , i n t i m a t e d th a t s u c h a jo in t effo rt on a “ r e g io n a l a n d p a r t n ersh ip b a s is w o u ld r e c e iv e their c o rd ia l s u p p o r t, p ro v id e d su ita b le and s a tis fa cto ry a rr a n g e m e n ts w ere m a de on tw o vital m a tte rs— a d m in istratio n and fin a n ce. T h e S e c r e ta ry o f S ta te for S c o tla n d a s k e d th e S c o t t i s h b r a n c h o f t h e B r i t i s h H o s p i t a l s A s s o c i a t i o n to p r e p a r e a n d s u b m i t to h i m a s t a t e m en t s e t t in g forth a s c h e m e fo r the c o -o rd in a tio n a n d co -o p e ratio n b y v o lu n ta ry and local a u th o rity h o s p ita ls on su c h a b asis. A m o n g the m atters p o i n t e d o u t in t h e s c h e m e w e r e t h a t t h e p a r t n e r s h i p m u s t b e a real p a r t n e r s h i p ; t h a t a d m i n i s t r a t io n a n d c o n t r o l m u s t n o t r e s t w i t h o n e p a r t n e r b u t m u s t b e v e s t e d in r e g i o n a l c o u n c i l s , w i t h e q u a l representation o f both p artn ers and so m e rep re sen ta tio n of o th e r in terests— the u n iv e r s itie s , the m e d i c a l p r o f e s s i o n , e t c . — -that v o l u n t a r y h o s p i t a l s c o u ld not a g r e e on b e i n g c o n t r o lle d b y local a u th o rities o r b e in g d e p e n d e n t on th em for fin an cial s u p p o r t ; th a t on th e m a tter of fin a n ce , if t h e G o v e r n m e n t i m p o s e d a c o m p u l s o r y l e v y on e v e r y o n e w h ic h w o u ld p r o v id e free o f a n y o th er c h a r g e a ll h e a l t h s e r v i c e s o f e v e r y k i n d t h a t a n y o n e m ig h t req u ire, i n c lu d in g h o s p ita l trea tm en t, a ll i n c e n t i v e to t h e g e n e r a l p u b l i c to s u p p o r t h o s p i t a l s a n d to c o n t r i b u t e v o l u n t a r i l y t h e r e t o w o u l d a u t o m a t i c a l l y c e a s e , a n d if b y t h i s G o v e r n m en t a ctio n th e r e v e n u e s o f v o lu n t a r y h o s p ita ls w e r e a d v e r s e l y e f fe c t e d o r d e s t r o y e d , it w o u l d

F uture of V oluntary H ospitals.

F I R S T

obviously be essential, if the voluntary hospitals were to continue, that the financial loss sustained by them through said action should be made good by State grants out of the funds ingathered by them. In the 1944 White Paper dealing with the proposed National Health Service, it was stated that “ the voluntary hospital movement repre sented the oldest established hospital system in the country. It is not merely that the best of the voluntary hospitals have in a degree unsurpassed developed specialist and general hospital resources which they will be able to at once make available, while most of the rest of the voluntary hospitals have experience and an existing organisation which it will be obviously sensible to enlist. It is certainly not the wish of the Government to destroy or diminish a system which is so well rooted in the goodwill of its supporters.” After a careful study of the W hite Paper the considered verdict of the voluntary hospitals of Great Britain was that “ it is of vital importance that the full implications of the administrative structure pro posed in the W hite Paper should be realised not only by Parliament but by the community which it is the privilege of the voluntary hospitals to serve. Indeed, if it were the intention of the Government to destroy the voluntary hospitals, no surer method could have been devised than an administrative structure as set out in the W hite Paper, which places them in a position of com plete subservience to local authorities and gives them no effective voice in the planning of the hospital service nationally or locally.” W ere the question asked as to the continuance of the volun tary system, it is not easy to give an answer. According to Mr. Barclay, certain conditions are absolutely necessary, but space does not permit of our detailing them, and we must leave interested readers to have recourse to the text in his speech.

St. Andrew’s Ambulance Association. D u r i n g t h e p a s t y e a r t h e M o t o r A m b u l a n c e S e r v i c e s of t h e S . A . A. A. t h r o u g h o u t S c o t l a n d a n s w e r e d 5 8 , 8 5 4 c a l l s f o r a s s i s t a n c e i n c a s e s of a c c i d e n t a n d i l l n e s s . T h e n u m b e r of p a t i e n t s c o n v e y e d d u r i n g t h e A s s o c i a t i o n ’s l o n g h i s t o r y n o w r e a c h e s t h e f i g u r e of 1 , 2 1 6 , 4 3 0 . T h e s e f a c t s w e r e c o m m e n t e d o n b y t h e D u k e of B u c c le u c h , p r e s id e n t of th e A sso ciatio n , w h e n h e sp o k e re c e n tly a t th e a n n u a l g e n e r a l m e e t i n g in G la s g o w . N e a r ly 9 ,0 0 0 p u p ils, h e sa id , h a d receiv ed c e rtific a te s in t h e v a r i o u s b r a n c h e s of a m b u l a n c e w o r k . A t t h e c l o s e of t h e m e e t i n g t h e D u k e w a s r e - e l e c t e d p r e s i d e n t of t h e A s s o c ia tio n . L a t e r a t a b l e t w a s u n v e i l e d in t h e e n t r a n c e h a ll of th e A s s o c i a t i o n b u i l d i n g in m e m o r y of t h e l a t e M r. A lle n H a n n a h , L arb ert. M r. H a n n a h s e r v e d t h e A s s o c i a t i o n in a v o l u n t a r y c a p a c ity for 39 y ears. H e d i e d in J u l y of la s t y e a r , a f t e r f o u r y e a r s ’ s e r v ic e a s t r a n s p o r t officer in t h e S o u t h H i g h l a n d area.

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L. M A R T Y N , K .C .V .O ., F .R .C .S .

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• U nder s u i t a b l e c o n d i t i o n s , b a c t e r i a m u l t i p l y a t a n a m a z i n g speed. A ll o f t h e m r e q u i r e s u i t a b l e f o o d , t o g e t h e r w i t h a c e r ta in a m o u n t of m o is tu r e a n d th e c o rre c t t e m p e r a t u r e for th e ir g ro w th . M o st species need o x y g e n , b u t c e r ta in fo rm s f lo u ris h o n ly in t h e a b s e n c e of a ir. A m o n g th e la tte r a re th e h i g h l y d a n g e r o u s t y p e s w h i c h g i v e rise^ t o t h e d r e a d e d g a s g a n g r e n e w h ic h o c c u r r e d so e x te n s iv e ly in th e la s t w a r , a n d h a s a p p e a r e d , t h o u g h to a less e x te n t, in th is. L ig h t, e s p e c i a l l y d i r e c t s u n l i g h t , is h a r m f u l t o m o s t b a c t e r i a , a n d t h e b a c i l l u s of t u b e r c u l o s i s is s o o n k i l l e d b y e x p o s u r e t o s t r o n g su n lig h t. I w a n t y o u to t h i n k of t h e s e p o in ts , n o t a s m e r e u n i n t e r e s t i n g f a c t s , b u t a s r e a s o n s f o r t h e m a n y f o r m s of t r e a t m e n t u s e d in m e d i c i n e a n d s u r g e r y . F o r i n s ta n c e , all c a s e s of t u b e r c u l o s i s a r e n u r s e d a s f a r a s p o s s ib le o u t of d o o rs, a n d all s e p tic in fe c tio n s d o b e t t e r in w ell lig h te d a n d f u l l y v e n t i l a t e d w a r d s , w h e r e w o u n d s a r e f r e q u e n t l y left e x p o s e d to th e s u n l i g h t u n d e r th e lig h t e s t p o ssib le co v e rin g . B a c te ria a r e e x a m in e d a n d stu d ie d u n d e r very h ig h p o w e r m icroscopes, b u t even by th is m e a n s th e y w o u ld be q u i t e in v is ib le , s in c e t h e i r b o d ie s a r e t r a n s p a r e n t , w e r e it n o t t h a t , h a v i n g b e e n fixed a n d d r ie d u p o n a m ic r o s c o p e slide, th e y c a n be s ta in e d by v a rio u s dyes, su c h a s m e th y le n e b lu e , g e n t i a n v iolet, e tc ., a n d so r e n d e r e d visible. T h e r e s t i l l r e m a i n , h o w e v e r , w h a t is p r o b a b l y a l a r g e n u m b e r of o r g a n i s m s to o s m a ll to b e v isib le to o u r m o s t p o w erfu l m icroscopes. W e c a n p ro v e th e ir e x is te n c e by o th e r m eth o d s, b u t th u s far th e y re m a in ultra-m icro sco p ic. I t is p o ss ib le t h a t t h e o r g a n i s m c a u s i n g t r u e in flu e n z a m a y e v e n tu a lly b e id en tifie d a m o n g th is class. I n m o s t c a s e s m i c r o s c o p i c e x a m i n a t i o n a l o n e is n o t su fficien t to id e n tify all th e d iffe ren t b a c t e r i a p r e s e n t in a s p e c i m e n , p e r h a p s of p u s f r o m a w o u n d , a n d i t is n e c e s s a r y to g r o w th e m o n a s u ita b le food m e d i u m k n o w n a s ' a cu ltu re. M a n y f o r m s of m e d i a a r e u s e d , t h e c o m m o n e s t is a g a r a g a r , w h i c h is a g e l a t i n o u s s u b s t a n c e o b t a i n e d f r o m a Ja p an ese seaw eed. T h e m e d i u m se le c te d is s te rilis e d a n d , w h ile h o t, p o u r e d in to a g l a s s te s t tu b e. I n t h i s i t is allo w e d to cool w h ile th e tu b e r e s ts a t a n a n g le , so t h a t w h e n solidified th e a g a r f o r m s a s m o o t h s l o p in g su r f a c e . I f it b e t h e d i s c h a r g e f r o m a w o u n d w h i c h is t o b e e x a m i n e d , a s t e r i l e l o o p of p l a t i n u m w i r e is d i p p e d i n t o it, w i p e d l i g h t l y o v e r t h e s u r f a c e o f t h e m e d i u m , t h e m o u t h of th e tu b e p lu g g e d w ith sterile w ool a n d th e w h o le th e n p l a c e d i n a n i n c u b a t o r a t a c o n s t a n t t e m p e r a t u r e f o r 24 hours. M a n y of y o u m a y h a v e h a d a s w a b t a k e n f r o m y o u r t h r o a t if a t s o m e t i m e y o u h a v e b e e n s u s p e c t e d of s u f f e r i n g from d ip h th e ria . E x a c tly sim ila r steps a re ta k e n , a n d th e s w a b c a r r y i n g t h e m o i s t u r e f r o m t h e t h r o a t is w i p e d o v e r th e m e d iu m a s d escribed. W h e n p l a c e d in t h e i n c u b a t o r n o t h i n g w h a t e v e r c a n be se e n on th e s m o o th s u r f a c e in th e tu b e , b u t w h e n e x a m in e d n e x t d a y i t is f o u n d t o b e c o v e r e d w i t h t h o u s a n d s o f m i n u t e r a i s e d d o t s , e a c h a p p e a r i n g l i k e a g l i s t e n i n g d r o p of d e w . S o m e a r e w h ite a n d o p a q u e , o th e r s yellow , o th e r s t r a n s p a r e n t l i k e w h i t e o f e g g , b u t e a c h d r o p c o n s i s t i n g of m illio n s u p o n m illio n s of b a c t e r i a w h i c h h a v e g r o w n f ro m th o s e d e p o s ite d u p o n th e s u r f a c e of t h e m e d iu m 24 h o u r s before.

F I R S T O n e o f e a c h o f t h e d i f f e r e n t k i n d s of d o t s i s n o w p i c k e d off w ith a p l a t i n u m lo o p a n d e x a m i n e d o n a m ic r o s c o p e slide a f te r s t a in i n g , a n d t h u s a n e x a c t d e t e r m i n a t i o n c a n be m a d e of a l l t h e v a r i o u s k i n d s o f b a c t e r i a p r e s e n t i n t h e o rig in a l sp e cim en . 1 h a v e o f t e n b e e n a s k e d w h y it is t h a t , o n c e a w o u n d h a s b e c o m e i n f e c t e d , it is s o d i f f i c u l t t o g e t i t c l e a n . A m o m e n t ’s c o n s i d e r a t i o n o f t h i s d e s c r i p t i o n of h o w r a p i d l y b a c t e r i a g r o w a n d m u l t i p ly will a ffo r d a r e a d y a n s w e r . N o a n tis e p tic h a s y et b e e n in v e n te d w h ic h c a n be a p p lie d to a w o u n d i n s u f f i c i e n t s t r e n g t h t o k i l l t h e b a c t e r i a in it w i t h o u t h a r m i n g th e liv in g tissu es, even c o n s ta n t m e c h a n ic a l s c ru b b in g w ill n o t r e m o v e t h e m all, a n d n o w t h a t y o u a p p r e c i a t e t h a t o n e s i n g l e b a c illu s c a n m u l t i p ly in to m illio n s in th e c o u r s e of a f e w h o u r s , y o u w i l l r e a d i l y u n d e r s t a n d h o w v e r y m u c h e a s i e r it is t o p r e v e n t b a c t e r i a g e t t i n g i n t o a w o u n d a t a l l , a s is d o n e b y a s e p t i c m e t h o d s i n o p e r a t i o n s , t h a n t o h a v e t o c l e a n s e a w o u n d o n c e it h a s b e c o m e infected . U n f o r t u n a t e l y , in w a r , t h e w o u n d s a r e a l r e a d y g r o s s l y in f e c te d by f r a g m e n t s of c l o t h i n g a n d d i r ty s k i n , e tc ., d r iv e n in b y t h e p r o j e c t i l e . I n t h e field w e c a n o n l y p r o t e c t t h e m f r o m - f u r t h e r c o n t a m i n a t i o n , l e a v i n g t h e s u r g e o n in h o s p i t a l to d e a l w ith th e c r u s h e d a n d in fe cted tis s u e s by c u t t i n g o u t t h e e n t i r e w o u n d , o r , if t h i s b e i m p o s s i b l e , b y r e m o v i n g a l l th e in fe cted a n d d e v ita lise d p a r t s w h ic h c a n be r e a c h e d . O n c e th is h a s been done, tr e a tm e n t by m o d e rn m e th o d s w ith th e s u lp h o n a m id e s , p en icillin , e tc ., c a n b e re lied u p o n to d e s tro y s u c h infection a s re m a in s . B a c te ria exist a lm o st ev ery w h ere, on o u r sk in (h o w e v e r c le a n ) , in o u r m o u t h s , t h r o a t s a n d i n t e s t i n e s , in t h e a i r w e b r e a t h e a n d in t h e w a t e r w e d r i n k . A lth o u g h a very la rg e p ro p o rtio n a re h a rm le ss, w e n ev e rth e le ss co n sta n tly h a r b o u r i n o u r b o d i e s b a c t e r i a c a p a b l e of p r o d u c i n g d i s e a s e , a n d even d e a th , giv en su ita b le co n d itio n s a n d c irc u m sta n c e s. L e t us ta k e a n exam ple. T h e c o m m o n cold c a n b e c a u s e d by se v era l different ty p es ot b a c te ria , a n d a n e x a m i n a t i o n of a s w a b f r o m t h e n o s e a n d t h r o a t of a n y o n e of u s w i l l r e v e a l q u a n t i t i e s of t h e s e o r g a n i s m s . W e do not, h o w ev er, all of u s su ffe r f ro m c o n s t a n t c o ld s a ll t h e y e a r r o u n d for several reasons. I n t h e f i r s t p l a c e , t h e h u m a n b o d y is p r o v i d e d w i t h h i g h ly c o m p le x m a c h in e r y , d e s ig n e d to p re v e n t th e b a c te r ia w h ic h s u r r o u n d u s f ro m a c tu a lly in f e c tin g us. T h is m a c h i n e r y w e m a y call, in p o p u l a r l a n g u a g e , a n i n d i v i d u a l ’s r e s i s t a n c e . I t m a y b e lo w e r e d by a n y c o n d itio n w h ic h im p a ir s his g e n e r a l h e a l t h — o v er f a tig u e , cold a n d w et, c h r o n ic illness, a lc o h o lis m , o v e r c r o w d e d a n d ill-v e n tila te d h o u s e s , etc. It m a y b e s im ila rly im p a ire d by local c o n d itio n s, su c h a s th e p r e s e n c e of i n f e c t e d t o n s i l s a n d a d e n o i d s i n c h i l d r e n , o r t h e f a i l u r e o n t h e p a r t of t h e i n d i v i d u a l t o b r e a t h e t h r o u g h t h e n o s e r a t h e r t h a n t h e m o u t h , s i n c e t h e f o r m e r is n o t o n l y a n o r g a n o f s m e l l b u t is a l s o d e s i g n e d t o w a r m a n d f i lt e r t h e a i r o n its w a y in to th e l u n g s . M a n y p eo p le s e e m to t h i n k t h a t u n le s s t h e i r liv in g r o o m s a r e m a i n t a i n e d i n a c h r o n i c s t a t e of f u g g t h e y w i l l i n e v i t a b l y c a t c h cold. O b v i o u s l y i n s u c h r o o m s t h e c o n c e n t r a t i o n of b a c t e r i a is f a r h i g h e r t h a n i n w e l l v e n t i l a t e d s u r r o u n d i n g s , e s p e c i a l l y if t h e a t m o s p h e r e b e d u s t y . A p a r t f r o m <• t h e q u e s t i o n o f r e s i s t a n c e , t h e a c t u a l v i r u le n c e of b a c t e r i a v a r ie s , t h e r e b e i n g a n i n c r e a s e in t h e i r i n f e c t i v e p o w e r s a t c e r t a i n s e a s o n s of t h e y e a r , a n d a p p a r e n tly in c e r ta in y ears. A t t h e s e t i m e s w e s a y t h a t t h e r e is a n “ e p i d e m i c of c o l d s — o r i n f l u e n z a , ” b u t w e k n o w n o t h i n g o f t h e c a u s e of t h e s e v a r i a t i o n s . I t is a t th e s e t i m e s e s p e c ia lly t h a t a n i n d i v id u a l s u ffe r i n g f r o m a n a c t i v e c o l d is m o s t l i k e l y t o s p r e a d h i s i n f e c t i o n , s i n c e h e is c o n s t a n t l y s p r a y i n g f r o m h i s m o u t h a n d n o s e m i n u t e d r o p l e t s of m o i s t u r e , e a c h c o n t a i n i n g t h o u s a n d s of bacteria. T h e s e a r e d i s s e m in a te d u p to s ix feet in th e c o u r s e of o r d i n a r y s p e e c h a n d to a still g r e a t e r d i s t a n c e w h e n c o u g h in g or sn e ezin g . E m p l o y e r s of l a b o u r a r e b e g i n n i n g

to r e a lis e t h a t t h e p r e s e n c e of s u c h i n d i v i d u a l s in a h i g h l y infective sta te , e v e n fro m so m in o r a c o m p la in t a s a c o m m o n c o ld , m a y p r o v e v e ry c o s tly in s u b s e q u e n t e p i d e m i c s w h i c h th ey m a y o rg in a te . S om e in terestin g resea rch w o rk h a s recently been done u p o n t h e r e l a t i o n s h i p of d u s t , p r e s u m a b l y c o n t a i n i n g d r i e d b a c te ria , to th e c o m m o n r e s p ir a to ry infectio n s. F o r t h e p u r p o s e of t h e e x p e r i m e n t t h e A r m y M e d i c a l A u th o ritie s selected tw o la r g e t r a in in g c e n tre s, e a c h c o n s is t i n g of a c o m p l e t e b a r r a c k a n d e a c h c o n t a i n i n g 1 ,3 0 0 to 1,700 m en . A ll t h e f l o o r s i n U n i t A w e r e o i l e d e v e r y f o u r w e e k s by a special te c h n iq u e in v e n te d b y v a n d e n E n d e , th o s e in U n i t B w e r e left u n t r e a t e d . A r e c o r d of all u p p e r r e s p ir a to r y in fe c tio n s w e r e k e p t in b o th u n its f ro m D e c e m b e r, 1942, to M a rc h , 1943. T h e result w as strik in g . T h e a v e ra g e w eekly re sp ira t o r y i n f e c t i o n r a t e i n U n i t A, i n w h i c h t h e f l o o r s w e r e o i l e d , w a s 7 p e r 1 ,0 0 0 ; in U n i t B it w a s 38 p e r 1 ,0 0 0 , m o r e t h a n 5 tim es as g re a t. S im ila r e x p e rim e n ts h av e been u n d e rta k e n i n s e v e r a l h o s p i t a l s w i t h a v i e w t o l i m i t i n g t h e s p r e a d of o th e r in fe c tio n s k n o w n to b e d u s t b o rn e , a n d t h e r e s u l t s so fa r r e p o rte d a p p e a r to b e p r o m is in g . T h e r e is n o q u e s t i o n b u t t h a t t h e s p r e a d o f e p i d e m i c s , s u c h a s i n f l u e n z a , is l a r g e l y d e p e n d e n t u p o n t h e f a i l u r e o f t h e v i c t i m t o r e a l i s e t h a t h e is h i g h l y i n f e c t i o u s t o o t h e r s . O n ly too often o n e h e a r s a n in d iv id u a l b o a s t i n g t h a t h e carrie d on w o rk th r o u g h o u t a n a tta c k entirely re g a rd le s s of t h e n u m b e r of h is fe llo w w o r k e r s w h o m h e h a s p u t o u t of a c tio n .

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Dried Plasma Sheets in Treatment of Burns and War Wounds. T h e u r g e n t n e e d fo r a n id e al c o a g u l u m h a s b e en s tr e s s e d m a n y tim es. It sh o u ld be d u r a b le , n o n c o n tr a c tile , p liable, no n to x ic, n o n ir rita n t, b a c te ric id a l, pain less, a n d sh o u ld c o n t a i n fibrin. T h e a u th o r p roposes a n e w d re ss in g w h ich a p p e a r s to m e e t th e s e d e m a n d s . P l a s m a s h e e ts w e re p r e p a r e d in th e f o llo w in g m a n n e r : T o 20 cc. of s t e r i l e w a t e r in a P e t r i d i s h 1 S to 2 g m . of d r i e d p l a s m a a r e a d d e d a n d d i s s o l v e d , a n d t h e n 0 ‘ 2 g m . of s u l fa n ila m id e p o w d e r a re ad d ed . T h i s p r e p a r a t i o n is d r i e d i n a n o v e n a t 1 4 0 d e g s . C. u n t i l a f i lm s h e e t f o r m s , u s u a l l y in IS to 20 m in u te s . I t is t h e n a l l o w e d t o c o o l a n d is a p p l i e d d ire c tly to th e b u rn . T h e p la s m a sh e e t c a n be m a d e q u ic k ly by h e a tin g th e p re p a ra tio n over a B u n se n b u rn e r u n til th e sh e et se p a ra te s itself f r o m t h e d is h . T h i s r e q u i r e s le s s t h a n 5 m i n u t e s . The p l a s m a s h e e t is a p p l i e d t o t h e b u r n e d a r e a a f t e r d e b r i d e m e n t . P l a s m a l o s s is i m m e d i a t e l y s t o p p e d . W ith in a few m in u te s th e p l a s m a s h e e t b e c o m e s a d h e r e n t , a n d in a few h o u r s s t r a n d s of f i b r i n c a n b e s e e n s e c u r i n g t h e p l a s m a s h e e t t o t h e b u r n a l m o s t a s if t h e b u r n w e r e “ f i b r i n h u n g r y . ” No dress in g n eed be applied. T h e p la s m a sh eets can be preserved f o r a p e r i o d of w e e k s b y k e e p i n g t h e m m o i s t e n e d w i t h w a t e r in a r e f r ig e r a to r . T h e a u th o r sta te s th a t a d ried p la s m a sh e e t o v erco m es m o s t of, t h e o b j e c t i o n s t o o r d i n a r y c o a g u l u m s . P l a s m a loss is s t o p p e d i m m e d i a t e l y . D re ssin g s m ay be used b u t a re not essential. H i s e x p e r i e n c e i n a li m i t e d n u m b e r o f c a s e s w a s g r a t i f y i n g . — P o ll o c k , B ., L i e u t . C o m m a n d e r : U n ite d S ta te s N a v a l M e d ic a l B u lle t in .

F ound . — A m i n i a t u r e m e d a l l i o n b e l o n g i n g t o H a r r y W i l d 2 3 4 4 0 0 , in L a i n d o n . W ill th e o w n e r ap p ly to C h a rle s L y n c h , “ M ib e c im ,” A rnold A v en u e, L a in d a n , E sse x .

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C ounty o f Bristol. B r i s t o l No. 3 C o r p s — T h e f i n a l f o r t h e “ D ” D i v i s i o n In d iv id u a l T r o p h y w a s held a t P a tc h w a y on O c to b e r 28th. T h e j u d g e w a s C o rp s O fficer W . R e e d , w h o s e t a v ery c o m p r e h e n s i v e t e s t e m p l o y i n g t h e u s e of p l a s t i c w o u n d s f o r t h e first t i m e in t h i s c o m p e t i t i o n . T h e effects w e r e v e r y r e a listic , b o t h f r o m a p o i n t of i n t e r e s t a n d r e a c t i o n o n t h e c o m p e t i t o r s . A m o n g th e v isito rs w e r e C o rp s O fficer a n d M rs. W . D . B ow ser. T h e w in n e r w a s Pte. D . R o b e rts o n , w h o a lso h a d th e h i g h e s t p o in ts in th e e l i m i n a t i n g co n te s t. M rs. B o w ser p re s e n te d th e t r o p h y to t h e w in n e r , a n d a ls o a silv er m e d a l g i v e n b y A m b u l a n c e O f fic e r O . A llen. P te. D . C o u s in s w a s re sp o n s ib le for th e r e fre s h m e n ts, w h ic h w e r e g r e a t l y a p p r e c ia te d , a n d D iv. S u p t. M a r s t o n t h a n k e d e v e ry o n e w h o h a d h e lp e d to m a k e th e c o m p e titio n su ch a success.

C l e e t h o r p e s . — T h e a n n u a l i n s p e c t io n of t h e C l e e th o r p e s a n d D istric t A m b u la n c e , N u r s in g a n d C a d e t D ivisions and th e H u m b e r s to n a n d N e w W a l t h a m N u r s in g D iv isio n of th e S .J .A .B . w a s h eld on O c to b e r 20th. T h e i n s p e c t i n g officer w a s t h e A s s i s t a n t C o m m i s s i o n e r f o r N o r t h L i n c o l n s h i r e , D r . M . C. L a v i n , w h o w a s a c c o m p a n ie d by M rs. L av in . D r. L a v in in sp e cted th e p e rso n n e l, e x p re ss e d his s a t is f a c t i o n a n d t h a n k e d t h e m f o r t h e i r s e r v i c e 's t o f i r s t a i d d u r i n g th e p a s t year. T w o f a k e c a s u a l t i e s h a d b e e n p r e p a r e d by D ist. O fficer P a d d i s o n a n d th e y w e r e t r e a t e d by t w o s q u a d s of t h e p e r s o n nel on p a ra d e . S ervice b ars, m e d a l rib b o n s, a n d service c h e v ro n s w ere p r e s e n t e d t o v a r i o u s m e m b e r s of t h e A m b u l a n c e D i v i s i o n b y D r. L avin. S e rv ic e m e d a l rib b o n s d u e to m e m b e r s n o w on a c t i v e s e r v i c e w e r e p r e s e n t e d t o e i t h e r t h e w i f e o r p a r e n t s of th e s e rv in g m a n . D r . L y n c h (M e d ic a l O f fic e r,o f H e a l t h for C le e th o rp e s ) a ls o e x p r e s s e d t h a n k s to th e D iv is io n a n d s a i d t h a t in h is o p i n i o n , m e m b e r s of t h e S . J . A . B . w e r e t h e b a c k b o n e o f t h e ci v i l d e f e n c e s e r v i c e s . H e specially a p p r e c ia te d th e fact t h a t C lee th o rp es D iv isio n h a d a s tr o n g C a d e t D iv isio n w h ic h w o u ld su p p ly m e m b e r s to th e a d u lt D iv isio n la te r on.

C ounty o f H ertford. W are .— A G r a n d P r i o r c e r e m o n y w a s h e l d i n t h e P r i o r y , W a r e , on S a tu r d a y , O c to b e r 28th. T h e C h a irm a n , H . L a n g le y Jo n e s, E s q ., C o u n ty C o m m is s io n e r, introducecj the C o u n t e s s of L y t t o n , w h o p r e s e n t e d G r a n d P r i o r B a d g e s t o e i g h t m e m b e r s of t h e W a r e C a d e t D i v i s i o n , t h e f i r s t A m b u l a n c e C a d e t s of t h e c o u n t y of H e r t f o r d s h i r e to g a i n th is co v eted a w a rd . T h e recipients w ere R. D avy, D. S h a rp , R. S am p fo rd , G . H o c k le y , H . L a v e r, J. C h a p m a n , A W h y b r e w ’ a n d M. H u ttlesto n e. L a d y L y tto n th e n g a v e a n in te re stin g ta lk on th e O rd e r of S t. J o h n . A W h i t e C ro ss d e m o n s tr a t i o n w a s g iv e n b y th e c ad ets. T h e C o u n ty C o m m is sio n e r th en th a n k e d L a d y L y tto n fo r m a k i n g t h e p r e s e n t a t i o n s a n d all th o s e w h o h e l p e d to m a k e th e cerem o n y su ch a success. S u p t. T . H . B u rg e ss replied. C / S u p t . H . B e a u m o n t - S m i t h , p r e s e n te d to th e C o u n ty C o m m is s io n e r , a c h a l l e n g e sh ie ld for c o m p e titio n in b a d g e s u b j e c t s a m o n g all A m b u l a n c e C a d e t D iv is io n s in t h e c o u n ty . T h e w h o le c o m p a n y w e re served w ith tea by th e k in d n e s s of W a r e D ivision.

C ounty o f L ancashire. I rlam and C a d ish ea d . — T h i s D i v i s i o n s u f f e r e d a g r e a t l o s s 'o n O c t o b e r 1 Sth, b y th e d e a t h of A m b u la n c e - O f f ic e r T . H a z l e h u r s t , o n e of t h e k e e n e s t O f f i c e r s i n t h e D i s t r i c t . H e w a s o n e o t t h e f o u n d e r m e m b e r s o n t h e f o r m a t i o n of th e D i v i s i o n in 1 929, a n d h is e n e r g y a n d a b i l i t y to a p p l y first a id w a s so o n noted. H e w a s a p p o i n t e d D iv . S t o r e k e e p e r in O c t o b e r , 1929, a n d t h i s w a s r a p i d l y f o llo w e d by p r o m o t i o n to C o r p o r a l in M a r c h , 1930, to S e r g e a n t in O c to b e r , 1930, a n d t o A m b u l a n c e O f f i c e r a n d D i v . S e c r e t a r y i n M a r c h , 1 93S . H e w a s a w a r d e d t h e B r i g a d e S e r v i c e M e d a l in J u l y of t h i s year. O n t h e o u t b r e a k of w a r h e t h r e w h i s e n e r g i e s i n t o t h e o r g a n i s i n g a n d t r a i n i n g of f i r s t a i d p a r t i e s f o r t h e l o c a l C iv il D e f e n c e A u t h o r i ty , a n d t h e efficienc y of t h o s e p a r t i e s tes tifie d to h is g o o d w o rk . H e w a s m u c h e ste e m e d a n d resp ec te d by all w h o k n e w h im . H i s f u n e r a l w a s a t t e n d e d b y s ix officers a n d 22 r a n k a n d file o f t h e I r l a m a n d C a d i s h e a d D i v i s i o n a n d t h e L a n c a s h i r e S t e e l C o r p n . D i v i s i o n , a s w e l l a s by' r e p r e s e n t a t i v e s of t h e I r la m U r b a n D is tric t C o u n c il.

County o f N ottin gh am . S o m e 500 m e m b e r s of th e S . J . A . B . in N o tts , o n O c t o b e r 2 7 th , e a c h r e c e iv e d a h a n d s h a k e a n d a w o r d of g r e e t i n g f ro m th e ir S u p t.-in -C h ief, L a d y L o u is M o u n tb a tte n , w h e n sh e a d d r e s s e d th e m a t N o t tin g h a m C o u n c il H o u s e . T h e B r ig a d e , sa id L a d y L o u is, w a s d o in g m a g n ific e n t w o r k , b o t h a t h o m e a n d in t h e a t r e s of w a r o v e r s e a s . She h a d r e c e n t l y h a d t h e o p p o r t u n i t y of s e e i n g t h e w a y t h e y w e r e d o i n g t h e i r jo b in E u ro p e . A d d r e s s i n g h e r s e lf e s p e c ia lly to t h e b o y a n d g i r l c a d e ts , L a d y L o u is r e m i n d e d t h e m t h a t it w a s t h e y w h o w o u l d c a r r y o n t h e g r e a t t r a d i t i o n s of t h e o l d e s t o r d e r o f c h i v a l r y i n t h e w orld. T h e r e w a s a t r e m e n d o u s t a s k a h e a d of t h e m a f t e r t h e w 'a r , a s t h e w o r k o f t h e B r i g a d e w o u l d b e e x t e n d e d w h e r e v e r it w a s n eed ed . C o u n t y C o m m i s s i o n e r D r . S. J. W . D o n a l d p r e s id e d , a n d a v o t e of t h a n k s t o L a d y L o u i s w a s m o v e d b y A m b u l a n c e S i s t e r M rs . W o o t t o n a n d s e c o n d e d b y P te . A llen. E a r l i e r in t h e e v e n i n g , L a d y L o u is v is ite d t h e j o i n t R e d C r o s s a n d St. J o h n Y o u t h C e n tr e a t E d g a r - r i s e a n d s a w cad ets a t w ork.

County o f Surrey. C h e r t se y . — “ I am p a r t i c u l a r l y p r o u d of t h e w a y t h e S u r r e y m e m b e r s h a v e r e s p o n d e d t o t h e c a l l of d u t y d u r i n g th e w a r y ears. In th is a r e a you h a v e g iv e n a n especially g o o d a c c o u n t of y o u r s e l v e s , ” C o u n t y C o m m i s s i o n e r W . G . P a p e , O . B . F.., t o l d a p a r a d e o f t h e S t . J o h n A m b u l a n c e B r i g a d e o n Y V e y m a n n ’s s p o r t s g r o u n d . It w a s th e o ccasio n of t h e a n n u a l p a r a d e , a n d u n i t s w e r e d r a w n f r o m C h e r t s e y , W e y b r id g e , A d d le sto n e a n d VVoodham a re a s .

C o m m i s s i o n e r P a p e w e n t o n : “ I c a n n o t tell y o u t h e p l e a s u r e it is t o c o m e a n d s e e y o u a l l a g a i n . I co n g ratu late y ou all on y o u r a p p e a r a n c e th is a f te rn o o n . I co u ld n o t help m a k in g c o m p a riso n s b e tw e e n m y la s t in sp e c tio n a n d to d a y ’s. I t h o u g h t t h a t t h e r e w a s e v e n a g r e a t e r s e n s e of c o m ra d e s h ip a n d h ig h sp irit p re s e n t th is a fte rn o o n th a n b e fo re .” T h e C o m m i s s i o n e r a ls o told th e c a d e ts : “ Y o u y o u n g p e o p l e m u s t g o f o r w a r d t o fill o u r p l a c e s . As tim e g o es on w e o ld e r p e o p le w ill w a t c h y o u t a k e o v e r th e p a r a d e . ” The s p e a k e r p r o p h e s i e d a b i g i n c r e a s e in t h e B r i g a d e a f t e r t h e w a r a s w ell a s a n in c r e a s e in th e i r d u tie s. T h e i n s p e c t i n g p a r t y w a s m a d e u p of t h e C o m m i s s i o n e r ,

F I R S T A s s is ta n t C o m m is s io n e r J. P. F la v in , O .S t .J ., C o u n ty C a d e t O ffice r W . H . H a r r i s , M . B . E . , D is t. O ffic e r C a p t. E llis, D r . V a ile a n d D r . H a r m e n s ( D i v . S u r g e o n s ) , a n d M r. E. G. Izod ( P r e s id e n t, A d d le s to n e D ivision). T w o am b u lan ces w e re also inspected. T h e p a r a d e , w h ic h n u m b e r e d 170, w a s a r r a n g e d by D iv. S u p t. R . J. G r is lo c k . I n c h a r g e of t h e d if fe r e n t d e t a c h m e n t s w e r e S u p t . J. T h o m p s o n ( W e y b r i d g e ) , S u p t . J. B all, ( A d d le s to n e ) , S u p t . D C o u g h l i n ( A irs c re w ). The c a d e ts w e r e u n d e r C a d e t O fficer B a tt.

County o f W arw ick. W v k e n . — O n T u e s d a y , O c t o b e r 2 4 t h , t h e m e m b e r s of th e W y k e n a n d D istric t A m b u la n c e a n d N u r s in g D ivisions, e n t e r t a i n e d a p a r t y of 60 w o u n d e d s o ld ie r s f r o m lo c a l m i l i ta r y h o sp ita ls , to ^ S h o w fo llo w ed by S u p p e r , a t th e N e w H i p p o d r o m e T h e a t r e , C o v e n try .

T h e S h o w w a s “ G a n g w a y ,” a n d th e p rincipal S ta rs, T e d R a y a n d Jill M a n n e r s , a u t o g r a p h e d th e p r o g r a m m e s a n d sp o k e w ith th e boys w h ilst th ey w ere h a v in g S u p p er. O n l e a v i n g t h e t h e a t r e , e a c h m a n w a s g i v e n a p a r c e l of fru it a n d c ig arettes. T h e a r r a n g e m e n t s fo r t h is e v e n t w e r e w ell c a r r ie d o u t b y t h e D i v i s i o n a l S e c r e t a r y , S g t . W . J . W a k e l i n a n d S g t . A. H ip w ell.

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Railway Ambulance News. L O N D O N , M ID L A N D & SC O T T ISH H o r w ic h . — T h e H o rw ich L .M .S . R a ilw a y A m b u lan ce C o rp s held th e ir se co n d a n n u a l in te r -d e p a r tm e n ta l c o m p e ti tio n a t th e R a ilw a y M e c h a n ic s’ In s titu te a n d T e c h n ic a l C o lleg e recently. T h e com petition w a s ju d g e d by D r. H . L e s l i e of A d l i n g t o n ( s t r e t c h e r ) , D i v . S u p t . T . D a v e n p o r t of B olton (in d iv id u al in ju ries), a n d C o rp s S e c re ta ry H . K. B a rl o w of B o lto n ( q u e s tio n s ) . T h e co m p e titio n w a s w o n by th e In sp e c tio n D e p a r tm e n t l a d i e s ’ t e a m , v i z ., M i s s e s I . M i l n e r , E . F o l e y , V . F l a t t e r s a n d E . S h o w ell, w ith 254 o u t of a p o ssib le 290 m a r k s . O th er te a m s co m p e tin g w e r e : M a c h in e sh o p (day tu rn ), 243 m a r k s ; c h a in s m ith y , 229 ; b oiler sho p , 227 ; m a c h in e s h o p (n ig h t tu r n ) , 2 2 2 £ ; a n d e r e c t i n g s h o p , 194. A p a rt fro m th e w in n in g te a m s , prizes w e re a lso g iv e n to th e tw o b e s t c o m p e tito r s in th e in d iv id u a l a n d q u e s tio n r o o m s . T h e s e p riz e s w e r e w o n by M r. S. L a t h a m , 38 m a r k s ; a n d M r . J . E . H e s t e r , 37 £ . A f te r t e a a t t h e L . M . S . C a fe, M r . M . G . B u rro w 's, A s s is ta n t W o r k s S u p t ., p re sid e d fo r th e d is t r i b u t i o n of th e c u p a n d p rizes w h ic h w e r e h a n d e d to t h e s u c c e ss fu l c o m p e t i to rs by M rs. B u rro w s.

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At a re c e n t m e e tin g of th e H a r r o g a t e N u r s in g D ivision, R o b in a , V is c o u n te s s M o u n tg a r r e t, k in d ly h a n d e d t h e w a r r a n t s a n d t h e b a d g e s of o ffice t o t h e n e w P r e s i d e n t , M r s . C. W o o d h e a d a n d t o t h e V i c e - P r e s i d e n t , M rs. G. R a e.

T o n b r i d g e . — O n t h e o c c a s i o n of t h e i n a u g u r a t i o n of t h e T o n b r i d g e A m b u l a n c e c la s se s o n O c t o b e r 12th, D r . L . S co tt, L e c tu re r , p re s e n te d th e a,w ard s g a in e d d u r i n g th e p a s t se ssio n a n d s u ita b ly c o n g r a tu la te d e a c h m e m b e r . M r . F . A. T r o t t , r e p r e s e n t i n g M r . E . U z z e l l , W e l f a r e O fficer a n d C e n tr e S e c r e ta r y , r e fe rr e d to th e e x c e lle n t s p irit p r e v a i l i n g a m o n g s t first a i d e r s t h r o u g h o u t th e line, in r e n d e r i n g s e r v ic e to o t h e r s , a n d s a i d m u c h c o u ld b e e x p e c t e d of t h e T o n b r i d g e c l a s s , w 'h o w e r e f o r t u n a t e i n h a v i n g a n e n t h u s i a s t i c C la s s S e c r e t a r y in M r. S. F rie n d . M r. G. W h i t e , D i s t r i c t S e c r e t a r y , t h a n k e d all m e m b e r s f o r m a i n t a i n i n g t h e c l a s s d u r i n g t h e d i f f i c u l t d a y s of t h e w a r , a n d c o n g ra tu la te d th e m on th e ir success.

H a rro g a te .—

T h e L a d y S u p t . ( M i s s A. M . P a l e y ) a s k e d t h e P r e s i d e n t to p r e s e n t th e se rv ice a w a r d s a n d strip e s. A m o n g th e recip ien ts w e re D ivisional S u p t. (s u p e r n u m e r a ry a tta c h e d ) W in te r flo o d (20 y e a rs ) a n d A m b u l a n c e O fficer A th e r to n (2 0 y e a r s ) . T w o y e a rs a g o , M iss W in te rflo o d h a d th e h o n o u r t o b e p r o m o t e d t o t h e r a n k of S e r v i n g S i s t e r . C e rtific a te s for H y g i e n e w e r e p r e s e n t e d to fifteen m e m b e r s . T h e T r e a s u r e r ( M i s s J. S h a w ) o n b e h a l f o f t h e o f fi c e r s a n d m e m b e r s of t h e D i v i s i o n , h a n d e d a c h e q u e t o L a d y M o u n tg a rre t a s a d o n atio n to w a rd s h er w o rk for th e St Jo h n H o sp ita l a t Je ru sa le m . ---------------------- •

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O b i t u a r y . — I t is w i t h r e g r e t w e h a v e t o a n n o u n c e t h e d e a t h of P o r t e r W . R e lf, M a i d s t o n e E a s t , w h o w a s s u c c e s s ful in p a s s i n g 36 c o n s e c u t i v e first a i d e x a m i n a t i o n s d u r i n g his service w ith th e S o u th e r n — a re c o rd h eld by few . M r. R e lf m is s e d h is 3 7 th a w a r d t h r o u g h illn ess, a n d his d e m i s e m e a n s a g r e a t lo s s to t h e a m b u l a n c e m o v e m e n t in th e M a id sto n e district.

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A s h f o r d . — F i v e a m b u l a n c e t e a m s , c o n s i s t i n g of o ld a n d y o u n g m e m b e r s of t h e m o v e m e n t , c o m p e t e d fo r t h e “ M a u n sell ” c u p a t A s h fo r d W o r k s o n S a t u r d a y , O c t o b e r 1 4 th , a n d a v ery k e e n a n d i n t e r e s t i n g c o m p e titio n r e s u lte d a s fo llo w s : 1, M r . J . W i l l i a m s o n ’s t e a m , 1 6 2 p o i n t s ; 2, M r . G . M o r s e ’s t e a m , 1 3 6 i ; 3, M r . C . E l f o r d ’s t e a m , 1 2 5 ; 4, M r . S . K n i g h t ’s t e a m , 121 ; 5, M r . F . B o u g h t o n ’s t e a m - 1 1 8 - L M r. M . S. H a t c h e l l , W o r k s M a n a g e r , p r e s i d e d a t t h e p r e s e n t a t i o n in t h e a b s e n c e of M r. O . V . B u lle id , C h ie f M e c h a n i c a l E n g i n e e r , w’h o r e g r e t t e d i n a b i l i t y t o b e p r e s e n t . M r. H a tc h e ll sa id th e c u p w a s p re s e n te d by M r. R . E. L. M a u n s e l l in 1 916, w i t h a v ie w t o e n c o u r a g i n g first a id in A s h f o r d W o r k s , a n d t h e r e w 'a s n o d o u b t i t a t t a i n e d i t s o b j e c t , as sh o w n by th e e n th u s ia sm th a t day. F o r th e co n tin u ed s u p p o r t in th e first a id m o v e m e n t h e e x p r e s s e d t h a n k s , a n d a ls o a p p r e c ia tio n of t h e e x c e lle n t s e rv ic e s r e n d e r e d b y first a i d e r s i n c o n n e c t i o n w 'i th e n e m y a c t i o n . M rs. M a u n s e ll p r e s e n te d th e c u p a n d prizes, a n d sa id h o w p l e a s e d s h e w a s t o a c c e p t t h e i n v i t a t i o n t o d o so . She w as p resen ted w ith a b o u q u e t by A nne S p ratfo rd .

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M r. E . U z z e ll, W e l f a r e O ffice r a n d C e n t r e S e c r e ta r y , on b e h a lf of th e G e n e r a l M a n a g e r , c o n g r a tu la t e d th e c o m p e t i t o r s o n t h e i r fine w o r k a n d t h a n k e d a ll c o n c e r n e d f o r t h e i r i n t e r e s t in first a id . H e s t a te d e v e ry o n e w a s h a p p y to be a s s o c i a t e d i n p e r p e t u a t i n g t h e m e m o r y of t h e i r f r i e n d M r . M a u n sell, w h o , w h e n he g a v e th e c u p n early 30 y ears a g o , co u ld not h a v e visu a lised w h a t w o n d e rfu l w o r k th a t cu p w o u ld be th e m e a n s of e n c o u r a g i n g . M r; U z ze ll e x p r e s s e d th e h o p e t h a t th e g o o d w o r k w o u ld c o n tin u e to flourish a t A sh fo rd , w h ic h w a s th e in cep tio n p o in t for a m b u la n c e w o rk on th e S o u th e rn R a ilw a y . H e th a n k e d M r. J. T . H e n n e k e r f o r h is lively e n t h u s i a s m a s C la s s S e c r e t a r y , a ls o M r. G. W h i t e fo r h is h e lp in first a i d a n d A . R . P . w o r k . T h e c a p t a i n of t h e w i n n i n g t e a m , M r . J . W i l l i a m s o n , t h a n k e d M r . F . A. T r o t t a n d M r . C . M e r r e t t , W e l f a r e D e p a r t m e n t, l o r j u d g i n g t h e test. M r. T r o t t s u ita b ly replied, s a y i n g it w a s a p riv ile g e a n d p le a s u r e to j u d g e s u c h a c o m p e ti tio n , a n d g a v e th e c o m p e tito rs s o m e u se fu l h in ts fro m his o w n v a lu a b le co m p e titio n experience. M r. M e rre tt a lso r e p lie d , r e m a r k i n g o n t h e k e e n n e s s of a ll t h e c o m p e t i t o r s . T h a n k s w e re e x p re ss e d to M r. H a tc h e ll for p re sid in g by M r . P . G o o d f e llo w , A s s t. W o r k s M a n a g e r , w h o s t a t e d it w a s h is p l e a s u r e to d o a n y t h i n g to e n c o u r a g e first aid .

d r i n k i n g a l a r g e c u p o f t e a o r co f fe e a n d w a r n e d n o t t o o v e r e x e r t th e m s e lv e s d u r i n g th e n e x t 24 h o u r s o r so. To e l i m i n a t e u n d e s i r a b l e e f f e c t s i n t h e r e c i p i e n t it w a s e s s e n t i a l th a t perfect c le a n lin e s s sh o u ld be m a in ta in e d a n d t h a t th e p a tie n t sh o u ld be c o m p o s e d a n d confident. U n t i l f i f t e e n y e a r s a g o t h e o n l y o r t h o d o x u s e of b l o o d t r a n s f u s io n h a d b e e n to r e p la c e lost blood, b u t to - d a y it h a d m a n y o th e r uses. O n e w a s in t h e t r e a t m e n t of “ s h o c k , ” a c o n d i t i o n f r e q u e n tl y s e e n in t h e s e v io le n t d a y s . O n ly th e c l e a r p a r t of t h e b l o o d f r e e d f r o m t h e r e d c e l l s w a s n e e d e d . O n e f o r m of t h i s — p l a s m a — c o u l d b e d r i e d , s t o r e d , a n d t h e n reconstituted m a n y m o n th s afte rw a rd s by a d d in g w ater, and t h e v a l u e of s u c h d r ie d p l a s m a in m o d e r n w a r f a r e w a s obvious. In o r d in a ry p ractice, blood tra n s fu s io n , by su p p ly i n g m i s s i n g f a c t o r s i n t h e r e c i p i e n t ’s b l o o d , c o u l d c u r e c e r t a i n blo o d d is e a s e s a n d r a i s e r e s i s t a n c e to in fe c tio n . In surgery, m a n y p a tie n ts w h o fo rm erly w ould h av e been considered as in o p e r a b le c a n b e so im p ro v e d in th e ir c o n d itio n b y t r a n s f u s i o n , t h a t m u c h of t h e r i s k w a s r e m o v e d . In th e m a te rn ity d e p a rtm e n t, tra n sfu sio n h a d sim ila r app licatio n s. D r. K n o tt a d d e d t h a t in n o n e of t h e s e a n d o t h e r s p h e r e s h a d f in a lity been reached.

Blood Transfusion in Practice.

Centralisation of the Ambulance Services.

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( S u m m a r y of a L e c t u r e d e l i v e r e d a t t h e R o y a l I n s t i t u t e of P u b l i c H e a l t h a n d H y g i e n e , 2 0 , P o r t l a n d P l a c e , W . l , o n W e d n e s d a y , N o v e m b e r 1st, 1944. S. E r n e s t D o re, M .A ., M . D . , F . R .C . P . , in th e C h a ir .)

D r. F rank A. K nott , w h o is D i r e c t o r o f t h e B a c t e r i o l o g i c a l D e p a r t m e n t a n d B l o o d T r a n s f u s i o n D e p o t , G u y ’s H o s p i t a l , c o m m e n c e d b y t r a c i n g th e h i s t o r y of v e r y e a r l y a t t e m p t s a n d f a i l u r e s a t b lo o d t r a n s f u s i o n w h e n l a c k of k n o w l e d g e m a d e t h e p r o c e d u r e so r i s k y t h a t u l t i m a t e l y it w a s officially f o r b idden. R e v o lu tio n a ry c h a n g e s to o k place w h e n , sh o rtly b e f o re t h e o u t b r e a k of t h e first w o r l d w a r , t h e n a t u r e of th e v a r i o u s b lo o d g r o u p s w a s d is c o v e r e d , m a k i n g it p o s s ib le a c c u r a t e l y t o m a t c h a p a t i e n t ’s b l o o d w i t h t h a t o f t h e p r o posed don o r. It w a s fu rth e r found th a t so d iu m c itrate ad d ed t o b l o o d w h e n d r a w n p r e v e n t e d i t f r o m c l o t t i n g a n d m a d e it q u i t e e a s y to h a n d l e a n d s to r e , b u t d id n o t d e t r a c t f ro m its value w h en transfused. A t t h e b e g i n n i n g of t h e p r e s e n t w a r w h o l e b lo o d o r its c o m p o n e n t s , s u c h a s c e l l s a n d p l a s m a , c o u l d b e s t o r e d in q u a n tity for lo n g periods, tra n s p o rte d e n o rm o u s d istan c es, a n d m a d e a v a ila b le to th o s e d e a lin g w ith c a s u a ltie s r ig h t u p a t th e fig h tin g fro n ts o r on th e sp o t d u r in g th e w o rst a tta c k s u p o n civilian e s ta b lis h m e n ts . T h e differen t p h a s e s of th is c o n tin u o u s d e v e lo p m e n t o i b lo o d t r a n s f u s i o n a s a s a f e a n d e s s e n t i a l p a r t of m o d e r n m e d i c i n e , f o r m a p e r f e c t e x a m p l e of t h e v a l u e to t h e p u b lic of s y s t e m a t i c sc ien tific r e s e a rc h . A f t e r p o i n t i n g o u t t h a t if u n s u i t a b l e b l o o d w a s t r a n s f u s e d in to a p a tie n t, violent a n d even fatal re s u lts m ig h t en su e, D r . K n o t t s a i d t h a t it w a s f o r t u n a t e t h a t n e a r l y h a lf t h e p e o p l e i n G r e a t B r i t a i n b e l o n g e d t o g r o u p O , a n y m e m b e r of w h i c h c o u ld a c t a s a d o n o r to a n y m e m b e r of t h e f o u r g r o u p s O , A, B, a n d A B . G ro u p O persons w ere therefore k n o w n a s “ u n i v e r s a l d o n e r s , ” a n d it w a s f r o m t h e m t h a t m o s t of th e sto re d blood w a s o b ta in e d . B lo o d f ro m m e m b e r s of th e o t h e r g r o u p s c o u l d o n l y b e u s e d a f t e r t h e p a t i e n t ’s g r o u p h a d been d eterm in ed . G r o u p O blood could be u se d im m e d ia te ly f o r a n y o n e , a a d its g r e a t v a l u e in e m e r g e n c i e s w a s o b v io u s . D r . K n o t t s t a t e d t h a t t h e effect o n d o n o r s w a s n e g l i g i b l e — t h e y w e r e s i m p l y a d v i s e d t o r e s t f o r 20 m i n u t e s w h i l e

In a r e c e n t i s s u e w e d i r e c t e d a t t e n t i o n t o t h e s t a t e m e n t i s s u e d b y t h e A m b u l a n c e S e r v ic e s G u ild of t h e H o s p i t a l a n d W e l f a r e S erv ices U n io n . T h is s ta te m e n t h a s been su b m itte d to th e M i n i s t e r of H e a l t h w h o h a s i n f o r m e d t h e U n i o n a s f o l l o w s : “ A t th is s ta g e he do es not th in k he can do m o re t h a n s a y t h a t h e f u l l y a g r e e s w i t h t h e L e m o n 's v i e w t h a t t h e w i d e d i f f e r e n c e s in t h e o r g a n i s a t i o n a n d e f f i c i e n c y of A m b u l a n c e S e r v ic e s b e f o re t h e w a r left m u c h to be d e s i r e d , a n d t h a t t h e r e is a d e f i n i t e n e e d f o r t h e e s t a b l i s h m e n t t h r o u g h o u t th e c o u n t r y of a d e q u a t e a n d efficient A m b u la n c e S ervices, a s fa r a s possible o n u n ifo rm lin e s .” W e a r e g r a te fu l for th is positive s ta te m e n t by th e M i n i s t e r of H e a l t h . I t is c l e a r t h a t t h e A m b u l a n c e S e r v i c e s m u s t of n ecessity fo rm a n in te g r a l p a r t of th e n e w H e a l th S ervice pro p o sals. T h e h i g h e s t d e g r e e of e fficien c y m u s t be m a i n t a i n e d , a n d t h i s im p l i e s t h a t a ll p e r s o n n e l m u s t b e fully tr a in e d a n d certificated. T h e “ L a n c e t ” a ls o m a d e re fe re n c e to th e p r o p o s a ls su b m itte d by th e U n io n a n d co n clu d ed by e x p re ssin g th e c o n s i d e r e d o p i n i o n t h a t “ t h e U n i o n is u n d o u b t e d l y w i s e i n m a k i n g its voice h e a r d a s e a r ly a s p o s s ib le .” W e u n d e r s t a n d t h a t to a n y i n t e r e s t e d p e r s o n s a c o p y of t h e s t a t e m e n t a n d p r o p o s a ls w ill b e su p p lie d , u p o n a p p l i c a tio n to th e G e n e r a l S e c r e ta r y , A m b u l a n c e S e rv ic e s G u ild , 3 8, A r g y l e S q u a r e , L o n d o n , W . C . l .

B y C o l. R. J. B L A C K H A M , C .B., C .M .G ., C .I.E ., D.S.O., M .D .

A IR R A ID F IR S TA ID A Series of 15 Charts covering all the dudes of a First Aid Worker, giving full instructions as to Air Raid effects and precau tions, recognition and treatment of injuries. Th e Ideal W a ll C hari. S i z e 2 2 \ i n . x 1 4 | i n . , h a s b e e n p r e p a r e d fo r u s e in A i r R a id S h e lte r s , R e d C r o s s a n d S t. J o h n ’s A m b u l a n c e S t a t i o n s a n d C l a s s e s , a n d a l l p l a c e s w h e r e F i r s t A i d a n d N u r s i n g a r e r e q u i r e d . P r i c e 7s. 6d. P o s t a g e 6d.

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Queries and Answers toCorrespondents Q u e r i e s w i l l b e d e a l t w i t h u n d e r t h e f o l l o w i n g r u l e s :— 1 .— L e t te r s c o n t a i n i n g Q u e r ie s m u s t b e m a r k e d o n th e top l e f t - h a n d c o r n e r of t h e e n v e l o p e “ Q u e r y , ’’ a n d a d d r e s s e d t o F ir s t Aid, 4 6 , C a n n o n - s t r e e t , L o n d o n , E .C . 4 . 2 . — All Q u e r i e s m u s t b e w r i t t e n o n o n e s i d e of p a p e r o n l y . 3 . — All Q u e r i e s m u s t b e a c c o m p a n i e d b y a “ Q u e r y C o u p o n ” c u t f r o m t h e c u r r e n t i s s u e of t h e J o u r n a l , o r , i n c a s e of Q u e r ie s f ro m a b r o a d , fro m a re c e n t issue. 4 . — T h e T e x t b o o k to w h i c h r e f e r e n c e m a y be m a d e in th is c o l u m n is t h e 3 9 t h ( 1 9 3 7 ) E d i t i o n of t h e S . J . A . A . M a n u a l of F i r s t A id to t h e I n j u r e d .

Sw elling of Tissues of Throat. T . VV. ( L e i g h t o n B u z z a r d ) . — I s h a l l b e g r e a t l y o b l i g e d if y o u w i l l e n l i g h t e n m e w i t h r e g a r d t o t h e t r e a t m e n t of S w e l l i n g of T i s s u e s o f T h r o a t c a u s e d b y s w a l l o w i n g b o ilin g w a te r o r te a a n d corrosives. I n y o u r W h y a n d W h e r e fo r e in F i r s t A i d , i n r e p l y t o t h e q u e s t i o n w h y a p a t i e n t is p l a c e d b e f o r e t h e fire, y o u w r i t e :—• “ C o ld affects local i n f la m m a t i o n h a r m f u l l y b e c a u s e , i n s t e a d of c a u s i n g d i l a t a t i o n of t h e v e s s e ls a s h e a t d o e s , it t e n d s t o c o n s t r i c t t h e m . C old air, th erefo re, irrita te s th e re sp ira to ry p a ssa g e s, c a u s in g c o u g h in g a n d s o i n c r e a s i n g t h e s w e l l i n g of t h e t i s s u e s o f t h e t h r o a t . ” O n t h e o t h e r h a n d , th e T e x t b o o k tells u s to g iv e ice to s u c k o r cold w a t e r to d r i n k w h e n w e h a v e to tr e a t su ch cases. M y d i f f i c u l t y , t h e r e f o r e , is t h a t c o l d a i r h a s a h a r m f u l effect a n d y e t w e a r e a l l o w e d to g i v e co ld w a te r to d rin k . Y o u r k i n d e x p l a n a t i o n w ill b e a p p r e ciated. I t is a f a c t e s t a b l i s h e d b y e x p e r i e n c e t h a t , w h e n t h e r e is i r r i t a t i o n a t t h e b a c k of t h e t h r o a t , c o l d a i r m a y p r o d u c e a s p a s m o d i c c o u g h w h e r e a s s i p s of c o l d w a t e r w i l l r e l i e v e th e c o u g h . I n t h i s i n s t a n c e t h e e x p l a n a t i o n is t h a t t h e s p a s m o d i c c o u g h t h r o w s a l l t h e m u s c l e s of b r e a t h i n g i n t o v io le n t a c tiv ity a n d so in c r e a s e s th e local c o n g e s t i o n .— N .

C o rb e t

F le t c h e r .

Exam ination How ler. G .G . (V V iakats, N . Z . ) — I n a re c e n t e x a m i n a t i o n th e d o c to r a sk e d a c a n d id a te h o w h e w o u ld im p ro v ise a stretch er. H e w a s n o t p leased w h e n th e la tte r rep lied : “ T a ke a r u g ( o r m a t) a n d tw o o r th r e e n a i ls a n d f i x w a lk in g s tic k s ."

Good !

A I D W i t h re fe re n c e to y o u r q u e ry , I c a n n o t im p ro v e on y o u r s o l u t i o n of t h e p r o b l e m . I n d e e d , i t is t h e o n e a n d only so lu tio n . O f c o u r s e , y o u e m p h a s i s e d t h a t t h e firm p i l l o w , f o l d e d c o a t o r o t h e r s u c h p a d d i n g m u s t fill t h e g a p a c c u r a te ly , lest a s im p le be t u r n e d in to a c o m p o u n d a n d / o r c o m p lic a te d frac tu re. — N .C .F .

Treatm ent of Fractured Spine. B .T . (C a tfo rd ). — I n o tic e t h a t in y o u r a n s w e r to th e q u e ry , w h ic h w a s p u b lis h e d u n d e r t h e a b o v e h e a d i n g in th e S e p t e m b e r i s s u e o f F irst A id , y o u s t a t e t h a t y o u r p e r s o n a l o p i n i o n is t h a t “ s u c h p a t i e n t s s h o u l d b e r e m o v e d in t h e p o s itio n in w h i c h th e y a r e f o u n d . ” I t m a y , th e r e fo r e , be ot in te r e s t to first a id e rs g e n e r a l l y , t o h e a r of a c a s e w h i c h o n c e o c c u r r e d a t a local in c id e n t d u r i n g h e a v y b o m b i n g . T h is w as an eld e rly m a n w h o m I fo u n d b u rie d u p to h is a r m s in a tre n c h w h e re he h a d been w o rk in g a n d w ith a p a v in g sto n e r e s tin g o n h is c h e s t a n d lo w e r lim b s. H e w as co n scio u s th o u g h d a z e d ; a n d w h ile h e w a s ab le to m ove h is a r m s free ly , h e c o m p l a i n e d t h a t h i s l e g s w e r e co ld a n d t h a t t h e y h a d n o f e e lin g in t h e m . S u s p e c t i n g a f r a c tu r e of sp in e in t h e l u m b a r re g io n , 1 a t o n c e called th e s t r e t c h e r p a r ty to h im ; a n d , h a v i n g re m o v e d th e p a v in g stone, w e tra n s p o rte d h im on a s t r e t c h e r in t h e s i t t i n g p o s i t i o n i n w h i c h h e h a d o r i g i n a l l y b e e n f o u n d , a f t e r a d o c t o r h a d g i v e n h i m a n i n j e c t i o n of m o rp h ia . I w e n t w ith h i m in th e a m b u l a n c e a n d a s s is te d to m a i n t a i n h im in a s i l t i n g p o sitio n u n til o u r a r r i v a l a t h o s p i t a l w h e r e h e w a s p l a c e d o n a b e d in th e sam e m an n er by th e i n s t r u c t i o n of t h e h o s p i t a l au th o ritie s . T h e x -ra y p h o to g r a p h s s h o w e d perfect a lig n m e n t of t h e l u m b a r r e g i o n t h o u g h t h e t h i r d l u m b a r v e r t e b r a w as crushed. T h e p o o r old c h a p d ie d t w o m o n t h s la t e r f r o m s e p tic in f e c tio n c o n s e q u e n t o n c r u s h i n g of t h e r i g h t leg a t th e a n k le jo in t, w h ic h th e ho sp ital d o cto rs d is cov ered on his a d m iss io n . A t th e incid en t, w h ile I w as c o n c e n tr a tin g on th e sp in a l in ju ry , n o o n e else h a d n o tice d th e i n ju r y to th e le g in th e h u s tle for a p rio rity case. T h e c a s e illu s tr a te s th e differen ce b e tw e e n th e o ry a n d practice, sin c e th e m issed in ju ry w a s n o t m a d e w o rse d u r i n g r e m o v a l to h o sp ita l. N e v e rth e le s s, w h a t a pity ! Y e s ; t h e u n e x p e c t e d u s u a l l y h a p p e n s ! ! M y m o t t o is a lw a y s to play for sa fety ! ! ! S o I e n tire ly a g r e e w ith y o u t h a t it is s a f e a n d s o u n d a d v i c e t o “ r e m o v e s u c h p a t i e n t s i n t h e p o s i t i o n in w h i c h t h e y a r e f o u n d . ” Y o u r k in d N .C .F .

i t to tw o

N e x t , p l e a s e ! !— N . C . F .

Treatm ent of Fractured Leg. B .H . ( R .A .F . C a m p ) .— As a v a ria tio n fro m n u r s in g d u tie s , I w a s r e c e n t l y a s k e d to g i v e t h e S h o r t C o u r s e of F i r s t L e c tu re s to p ro sp e c tiv e R .A .F . s e rg e a n ts . W h en d eal i n g w i t h f r a c t u r e s of t h e l o w e r lim b , I to ld t h e m to u s e t h e g o o d l e g a s a s p l i n t a n d t i e b o t h l e g s t o g e t h e r in t h e u s u a l places. O n e m e m b e r of t h e c l a s s , w h o a s s u r e d m e t h a t h e w a s se rio u s, a s k e d m e h o w I w ould deal w ith a bow legged m an. I s u g g e s t e d t h a t t h e c h a n c e s of m e e t in g le g s so b o w -le g g e d t h a t th e y co u ld n o t be tre a te d in th is w a y w e r e m o s t r e m o te , a n d a d d e d t h a t a ro lle d c o a t o r pillow b e tw e e n th e le g s w o u ld g iv e th e n e c e s s a ry co n tro l. H e t o l d m e t h a t h e w a s o n e of t h e s e “ r a r e o n e s ,” sto o d up, a n d so h e w a s ! ! I n t h e s e c i r c u m s t a n c e s , I w e l c o m e y o u r o p i n i o n of m y su g g e s te d tre a tm e n t an d a n y oth er reco m m en d atio n w h i c h y o u m a y s s e fit t o m a k e .

letter a n d

report are m u ch a p p re c ia te d .—

Treatm ent of Burns and Scalds. E.

F. ( W a lw o r th ) . — In th e E x a m in a ti o n H o w le r of th e S e p t e m b e r i s s u e o f F irst A id , I s u g g e s t t h a t o n e m a y f i n d m o r e i n t e r e s t t h a n a t f i rs t a p p e a r s . I n p r a c t i c a l f i rs t a id , o n e g e n e r a l l y d o e s t h e t h i n g w h i c h lies n e a r e s t. N a t u r a l l y t h e a c t i o n of c lo s in g d o o r s o r w i n d o w s w o u ld o n ly t a k e a m a t t e r of s e c o n d s , t h e r e b y p r e v e n t i n g a p o ssib le d r a u g h t , in w h ic h n o p a tie n t m u s t be placed . S h o c k is p r e v e n t e d , b e c a u s e t h e p r e v e n t i o n is c o m m e n c e d rig h t aw ay. I t h i n k t h a t w e m u s t g i v e t h a t s t u d e n t full m arks. Good!

N ex t, p le a s e !

!— N . C . F .

Sal A m m o n ia c for Burns. K .L .

( M u n d e s l e y ) .— T h e re fe re n c e to S al A m m o n i a c w h ic h o c c u r r e d in t h e Q u e r y C o l u m n of t h e O c t o b e r i s s u e of F i r s t A id u n d e r th e a b o v e h e a d i n g m a d e m e w o n d e r h o w m a n y m e m b e r s of t h e S . J . A . B . k n e w t h e d e r i v a t i o n of t h e w o r d . B efore a n d d u r in g th e g r e a t L ib y a n a d v a n c e f r o m E l- A l a m e i n , m e n t i o n w a s m a d e of t h e O a s i s of S iw a , 300 m iles W . S . W . fro m C a iro . T h e o a s i s is

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m in o r injuries. M ade in England by T . J. Sm ith & N ephew L td ., Hull.

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F I R S T described by H ero d o tu s, th e G re e k H isto rian , w ho v isite d it 450 y e a r s b e fo re C h ris t. H e s a y s t h a t “ it w as th e s e a t o f th e T e m p le o f th e G o d A m m o n — t h e E g y p t i a n A m o n R a — a n d it w a s t h e r e t h a t S a l A m m o n i a c ( o r ( A m m o n iu m C h lo rid e) w a s m a n u f a c tu re d fro m c a m e ls ’ u rin e .” I t is t h e s o u r c e o f a m m o n i a , t h e c h i e f i n g r e d i e n t of sa l volatile, a n d s m e ll in g sa lts. So w h e n w e u se sal v o la tile w e m a y r e m e m b e r t h a t w e a r e in d e b te d to th e E g y p tia n s , w h o w o r s h ip p e d th e S u n G od u n d e r the n a m e o f A m o n R a , a t l e a s t f o r t h e n a m e of a m m o n i a , if n o t f o r t h e k n o w l e d g e of i t s m a n u f a c t u r e . H e r o d o t u s a ls o m e n t i o n s t h a t h e w a s to ld by th e C h i e f P r i e s t of t h e E g y p t i a n T e m p l e t h a t t h e p r i e s t s — w h o w e r e th e m e d ic a l m e n of th o s e t im e s — h a d k e p t a r e c o r d of t h e h e i g h t , w e i g h t a n d a g e o f a l l t h e i r p r i e s t s , a n d t h a t th e a v e r a g e a g e a t d e a th w a s 70 y ears. T h is r e c o r d h a d b e e n k e p t f o r 2,000 y e a r s , s o t h a t w e m a y s a y t h a t f o r n e a r l y 4 ,4 0 0 y e a r s t h e a v e r a g e a g e of m a n h a s n o t v aried , a n d a g r e e s w ith th e “ th re e sc o re y e a rs a n d te n ” of th e P s a lm is t !

R I D a b i d e b y t h e i n s t r u c t i o n s u n t i l m o r e is k n o w n a n d t h e p o i n t officially c la rifie d . So there we will leave th e c o n u n d r u m !— N . C . F .

Treatm ent of Nose Bleeding. N . O . ( E d m o n t o n ) . — T h e T e x t b o o k t e l l s u s i n R u l e 1, p. 1 3 8 , t h a t , w h e n w e h a v e to tr e a t a n y o n e s u f f e rin g fro m n o se b le e d in g , w e s h o u ld r a is e o u r p a t i e n t 's h a n d s ^ a b o v e his head. S e v e r a l of u s r e c e n t l y d i s c u s s e d t h e o b je c t of so d o in g ; a n d , a s w e could n o t solve th e p ro b le m s a tis f a c t o r i l y , w e d e c i d e d t o p a s s it t o y o u . M eanw hile, p lease acce p t o u r th a n k s . R a is in g th e h a n d s ab o v e th e h e a d lo w ers th e p re ss u re w i t h i n t h e c h e s t c a v i t y a n d p r o m o t e s t h e r e t u r n of b l o o d t o t h e h e a r t , b e c a u s e it i n c r e a s e s t h e s i z e a n d c a p a c i t y o f t h e c h e s t a n d s o c a u s e s d i l a t a t i o n of t h e s u p e r i o r a n d i n f e r i o r v ena; ca v a i a t th e ir e n tr y to th e r i g h t a u ric le . C onse q u e n tly , r a i s i n g th e p a t i e n t 's h a n d s a b o v e th e h e a d is a n e s s e n t i a l s t e p i n t h e s u c c e s s f u l t r e a t m e n t of n o s e b l e e d i n g .

— N .C .F . Y o u r l e t t e r is m u c h a p p r e c i a t e d ; a n d w e a r e a l l g r a t e ful for th e in te r e s tin g in f o rm a tio n w h ic h y o u h a v e su p p lie d . I n c i d e n t a l l y , t h e B r it is h M e d ic a l J o u r n a l of O c t o b e r 28th c o n ta in s a refe re n c e to A m m o n iu m C h lo rid e, w h ich a p p a r e n t l y is i s s u e d t o f i r m s f o r t r e a t i n g b u r n s c a u s e d b y soda-ash. F u r t h e r , it s t a t e s t h a t if t h e b o t t l e is l a b e l l e d “ 55 p e r c e n t , s o l u t i o n ” i t is t o b e u s e d u n d i l u t e d t o d r e n c h th e affe cted tiss u e , a n d m a y be fo llo w ed b y b a t h i n g or ir rig a tio n w ith n o rm a l sa lin e o r plain w a te r .— N .C .F .

H u m o u r in Hospital. P .R .

( B e c c l e s ) . —-I h a v e r e a d w i t h g r e a t i n t e r e s t y o u r a n s w e r s t o q u e r i e s i n F irst A id f o r s o m e t i m e , and I recall a n in c id e n t w h ich o c c u rre d last y e a r w h e n I w a s e m p lo y e d a s F i r s t A id A t t e n d a n t on a G o v e r n m e n t S ite. 1 w a s c a l l e d u p o n t o r e n d e r f i rs t a i d t o a m a n w h o h a d received a d eep cu t w h ile w o r k in g on a pond. A s I t h o u g h t o f t h e p o s s i b i l i t y of t e t a n i c i n f e c t i o n , 1 t o o k h i m t o h o s p i t a l , w h e r e it w a s d e c i d e d t o i n j e c t a n ti-te ta n ic se ru m . T h e S is te r s a id s h e w a s g o i n g to in ject A . T . S . , to w h i c h t h e p a t i e n t r e p l i e d : “ N o , y o u d o n 't ! I 'm a r e s p e c ta b le m a r r ie d m a n , a n d w i l l h a v e n o t h in g to do w it h th e A . T . S . ! ! ” T h is incident caused so m e a m u s e m e n t, an d 1 pass th e sto ry to you. M e a n w h ile , I t h a n k y o u for th e help d e r iv e d f r o m y o u r a n s w e r s in F ir s t A m . Good !

N e x t, p le a s e ! !— N .C . F.

Treatm ent of C ru sh In ju rie s. H .M . (O rp in g to n ).— M ay 1 s u g g e s t th a t your correspondent h a s m i s q u o t e d t h e t r e a t m e n t f o r c r u s h in j u r i e s in h is q u e r y w h i c h w a s p u b l i s h e d u n d e r t h e a b o v e h e a d i n g in t h e S e p t e m b e r i s s u e of F irst A id ? A . P . P . H andbook H o . i o , S e c o n d E d i t i o n ( R e p r i n t e d 1 9 4 4 ) , s t a t e s “ if n o D o c t o r i s p r e s e n t a n d o n l y a l i m b is i n v o l v e d , ” a n d t h e n g o e s o n to t h e a d m i n i s t r a t i o n of flu id s , i n t e n d i n g t o m a k e i t c l e a r t h a t t h e t r e a t m e n t is q u i t e d i f f e r e n t b e t w e e n t h e c a s u a l t y s u f f e r i n g f r o m c r u s h i n g of th e tru n k a n d t h e c a s u a l t y h a v i n g c r u s h i n g w h i c h o n ly i n v o l v e s t h e lim b s . T h e m i s q u o t a t i o n , n a m e l y , “ if o n l y o n e l i m b is a f f e c t e d , ” t h e r e f o r e s u g g e s t s t h a t t h e r e is a d if fe r e n c e in t r e a t m e n t b e t w e e n t h e c r u s h i n g of one l i m b a n d t h e c r u s h i n g o f tw o o r m o r e l i m b s , w h i c h of c o u r s e , is n o t t h e c a s e . T h e f a c t t h a t t h e w o r d s “ o n l y a l i m b is i n v o l v e d ” a r e in ita lic s s e e m s to s u p p o r t y o u r s u g g e s t i o n . N ev erth eless, a s l o n g a s t h e i n s t r u c t i o n r e l a t e s t o “ a ” l i m b , it is b e t t e r t o

Treatm ent of Fractured A r m at Elbow . N .P . ( F in c h le y ).— I n th e t r e a t m e n t of a fra c tu re d a r m in volving th e elbow a n d w ith m a rk e d sw e llin g on o u ter s i d e of t h i s j o i n t , s h o u l d w e ( w h e n a p p l y i n g t h e a n g u l a r sp lin t in p o sitio n ) tie t h e k n o ts o n th e sp lin t o r o n th e f r o n t of t h e a r m a n d f o r e a r m ? A c c o r d in g to th e T e x t b o o k t h e k n o t s s h o u ld b e tied on th e sp lin t ; b u t th is w ould give th e do cto r m o re t r o u b l e w h e n h e t a k e s of f t h e s p l i n t a n d w o u l d c a u s e u n n e c e s s a r y m o v e m e n t of t h e l i m b d u r i n g t r e a t m e n t a n d afterw ard s. W e w e lc o m e y o u r k in d ru lin g . N o w h e re does th e T e x tb o o k te a c h th a t k n o ts m u s t in v a ria b ly b e tied on th e sp lin t. F o r in sta n c e w ith cru sh ed h a n d it g i v e s i n s t r u c t i o n s t o t i e o f f t h e b a n d a g e s o n t h e b a c k o r o u t e r s i d e of t h e f o r e a r m . S im ila rly w ith fra c tu re d a r m in v o lv in g t h e e lb o w j o in t ( w ith g r e a t e r s w e l l in g on o u t e r side), th e k n o t s m u s t be tied o n th e o u t e r sid e of t h e lim b , in w h ic h positio n th e y c a n be tied easily a n d w ith o u t u n d u e m a p ip u la t i o n a n d s i m i l a r l y b e u n t i e d w h e n t h e d o c t o r t a k e s c h a r g e of th e p atien t. I n d e e d , it i s g o o d f i rs t a i d t o c o n s i d e r t h e c o m f o rt a n d c o n v e n i e n c e of p a t i e n t a n d d o c t o r . — N . C . F .

Artificial Respiration w ith Fractured Ribs. A .M . (H a c k n e y ). — R e c e n tly w e w ere d isc u ssin g a m o n g o u r s e l v e s t h e t r e a t m e n t of a n a s p h y x i a t e d p e r s o n w h o w a s a l s o k n o w n t o b e s u f f e r i n g f r o m f r a c t u r e s of s e v e r a l r i b s . A s w'e c o u l d n o t a g r e e , w e a s k y o u t o b e k i n d e n o u g h t o tell u s w h ic h m e t h o d of a rtific ia l r e s p i r a t i o n y o u w o u ld use w ith th is c o m b in a tio n . O f c o u r s e y o u r e a l i s e t h a t t h e d i a g n o s i s of f r a c t u r e d r i b s i n a n a s p h y x i a t e d p e r s o n is a m o s t d i f f i c u l t p r o p o s i t i o n ! B e t h a t a s i t m a y , I c o n s i d e r t h a t S c h a f e r ’s m e t h o d is t h e r i g h t o n e i n t h e t r e a t m e n t of a s p h y x i a a c c o m p a n i e d b y f r a c t u r e d r i b s , b e c a u s e p r e s s u r e is e x e r t e d o n t h e l o i n s a n d n o t o n t h e ribs. O n t h e o t h e r h a n d , S i l v e s t e r ’s m e t h o d r e s u l t s i n a b i g pull o n t h e rib s w ith c o n s e q u e n t r i s k of s im p le b e i n g c o n v e r te d in to c o m p o u n d a n d / o r c o m p l i c a t e d f r a c t u r e s of ribs. — N .C .F .

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FIRST AID ®l)e JruWpmfenf Journal for r^eAmbulance anb pursing Jlmneesf DECEMBER,

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by p ost 2s. 2d.

J O R D A N & S O N S , L IM IT E D , 116 C H A N C E R Y L A N E , L O N D O N , W .C .2 .

BIOLOGICAL M B f c PREPARATIONS A N T I P E O L

CUTANEOUS VACCINE

O I N T M E N T

O n e o r o t h e r o r all o f th e t h r e e races o f g e r m s , S t re p to c o c c i , S tap h y lo co cci a n d B. p y o cy an eu s a r e f o u n d in e v e r y sk i n in f e c tio n c o m m o n t o this c o u n t r y , a n d A N T I P E O L O I N T M E N T c o n t a i n s the antibodies ( a n tiv ir u s ) o f th ese g e r m s . H e a l i n g is e x p e d i t e d b y the p r o v e d in g r e d i e n t s o f th e o i n t m e n t , a n d sep tic d e v e l o p m e n t is s t o p p e d o r p r e v e n t e d by its a n t i v i r u s sterile vaccin e filtrates. A N T I P E O L O I N T M E N T is u n s u r p a s s e d f o r B U R N S a n d S C A L D S , f o r it is m i c r o b ic id e a n d n o n - a d h e s i v e , a n d d r e s s i n g s d o n o t r e q u i r e t o be c h a n g e d ev ery day. W O U N D S , B U R N S , e t c , W I L L N O T T U R N S E P T I C i f t r e a t e d w i t h A N T I P E O L O I N T M E N T .

O P H T H A L M O - A N T I P E O L i s a se mi-fluid o i n t m e n t , m o r e c o n v e n i e n t t h a n the o r d i n a r y A n t i p e o l o i n t m e n t f o r o c u l a r in fection s a n d lesions. E y e s affected by s m o k e a n d d u s t a r e s o o t h e d a l m o s t im m ediately b y the ap p lic a tio n o f O p h t h a l m o - A n t i p e o l , a n d the a n t i v i r u s p r e v e n t s g e r m s f r o m dev elo p in g .

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M E D IC O - B IO L O G IC A L L A B O R A T O R IE S

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Subscriptions, Adver tisem en ts an d other business Com m unications connected with F I R S T A I D should be forwarded to the Publishers. D A L E , R E Y N O L D S & C o . , L t d ., 46, Cannon Street , L ondon, E . C . 4. Telegraphic A d d ress — “ T w enty -fou r, London Ttlephone — C ity 3710 .

TH IS

NUM BER.

E ditorial — Ambulance and Nursing Cadets Lectures Delivered to Advanced Casualty Service Personnel in the 6th Y ear of W ar

The Army Blood Transfusion Service

62 63 63 65

Letters to the Editor

Red Cross and St. John S .J.A.B . Headquarters and District Reports

...

Lady Louis Mountbatten Sees Fine W ork of Red Cross and St. John...

T he Correlation of Medical Science and Physical Education Q ueries and A nswers Tp C orrespondents : Fractures of L e g and Patella Examination Howler Fractures of Clavicle and Humerus ... Sal Ammoniac for Burns Effects of Antidotes Diagnosis of Apoplexy Schafer or Silvester Status of Brigade Officer

Bleeding from Tooth Socket F akin g of Injuries Use of Thomas Splint Use of Tourniquet...

67 70 70 70 70 70 70 70

...

1944 .

T E n te r ed a t 1 LS ta tio n e r s ' H a lt }

P R IC E

TH REEPENCB

[4/- P h r Annum, P o s t F r e e

EDITORIAL.

F .R .S .A .

The

C O N TEN TS

F .R .S a n .l.,

70 72 72 72 72

Y o u t i i is a t t h e p r o w . B ald heads and flo w in g b ea rd s d o not c o m m a n d t h e r e s p e c t th e ) ' d i d , an d th e y are no lo n g e r re g a rd e d as the a ttrib u te s o f w is d o m and c a p a b i l i t y n o r a r e t h e y th e r e c i p i e n t s o f v e n e r a t i o n . O u r sires a n d g r a n d s ir e s a n d g r e a t g r a n d s ir e s h a v e n o t c o n t r i b u t e d to th e w e l f a r e o f h u m a n i t y , a n d th e p r e s e n t c o n d i t i o n o f th e w o r l d is l a r g e l y t h e r e s u l t of a p a th y and u n w is d o m . H o w y o u t h w ill s h a p e r e m a i n s to b e s e e n , b u t it c a n n o t l e a v e t h e w o r l d in a w o r se m u d d le than th a t w h ic h n o w ex ists. E v e r y t h i n g p o i n t s to b e t t e r m e n t . W e a r e le d to th e se reflection s b y the recen t c e r e m o n y o f e n r o l m e n t a t B e d f o r d fo r A m b u l a n c e a n d N u r s i n g C a d e t s o f the S t. J oh n A m b u l a n c e B r i g a d e ( B e d fo r d T o w n D ivisio n s). T h e u n i t s w h i c h t o o k p a r t in th e parade w ere : B ed ford T o w n A m b u la n c e and N u r s in g D iv isio n s and C ad ets D iv isio n s ; T h e A m b u la n c e a n d N u r s i n g a n d C a d e t D i v i s i o n s fro m L o n d o n R o a d , S t . C u t h b e r t ’s , a n d G r e a t B a r f o r d ; K e m p sto n A m b u la n c e C ad et D iv isio n ; B e d fo rd s h i r e 502 B . R . C . S . Y o u t h D e t a c h m e n t ; B e d f o r d sh ire 4 B . R . C . S . C a d e t D e ta c h m e n t. In h i s a d d ress , th e V i c a r , th e R e v . A . S t . G . C o lth u r s t, s a i d “ t h e r e a r e s o m e o r g a n i s a t i o n s — f i n e in t h e m s e l v e s — w h o r e g a r d it a s t h e i r s o l e d u t y to s e r v e t h e i r f e l l o w - m e n , a n d f o r t h e m it d o e s n o t m a t t e r w h a t s o r t o f a h a ll t h e y u s e f o r t h e i r i n i t i a t i o n c e r e m o n y ; b u t S t . J o h n ’s A m b u l a n c e B r i g a d e C a d e ts fo llo w the trad itio n o f the a n c ie n t K n i g h t s o f S t . J o h n , a n d in r e m e m b e r i n g h i s o r d e r o f d e d ic a tio n , y o u h a v e d is c o v e r e d th e se c re t o f the sp irit of se rv ic e . Y o u k e e p the s p r in g s o f se rv ice a l w a y s g r e e n , fo r th o se y o u s e r v e , w h a t e v e r their r a c e , n a t i o n o r c l a s s , a r e b r o t h e r s a n d s i s t e r s in d is tre s s .” H e p o i n t e d o u t t h a t t h e r e c o r d o f th e K n i g h t s o f S t . J o h n f r o m t h e 12 th c e n t u r y to t h e present d a y h as been m a g n ificen t. It is t h e r e c o r d o f t h e o l d e s t o r d e r o f c h i v a l r y in t h e w o r l d . He then d re w from the s to ry o f the G o o d S a m a r it a n s o m e p o in ts o f v a lu e to S t . J o h n C a d e ts . The S a m a r it a n w a s , he sa id , r e a d y fo r the e m e r g e n c y , b e c a u s e he had d o n e h is t r a in in g an d k n e w w h a t to d o , a n d w a s n o t a f r a i d to p u t a ll h i s o w n p r o p e r t y

A m bulance andN ursing C adets.

F I R S T

at the disposal of the stranger ; he was very thorough in all he did. There were, he added, three qualities of a good cadet : Alertness to the good, generosity in action, thoroughness in execu tion. It is upon the cadets that the future of the Service depends. The youth of to-day become the men and women of to-morrow, and upon them rests that possible betterment for which the whole world is waiting.

L e c tu re s D e liv e re d to A d v a n c e d C a s u a l t y S e r v i c e P e r s o n n e l in t h e 6 th By S IR

HENRY

Y ear of W a r. L.

M A R T Y N , K .C .V .O ., F .R .C .S .

( C o n t i n u e d fr o m p a g e 5 / )

T he v a rio u s m e th o d s by w h ich ep id em ics a re sp re a d beco m e a m a t t e r of v ita l i m p o r t a n c e in w a r , a n d f e w p e o p le h a v e a n y c o n c e p t i o n of t h e v a s t o r g a n i s a t i o n w h i c h e x is ts , q u i t e a p a r t f r o m t h a t d e a l i n g w i t h t h e w o u n d e d , for t h e s o l e p u r p o s e of p r e v e n t i n g d i s e a s e a m o n g t r o o p s i n t h e f ield . I n o r d e r t h a t y o u m a y h a v e s o m e u n d e r s t a n d i n g of this, let u s c o n s id e r for a m o m e n t m e th o d s , o th e r th a n t h o s e of d i r e c t t r a n s m i s s i o n w h i c h w e d e s c r i b e d in th e la s t lectu re, by w h ic h b a c te ria c a n re a c h a n d infect th e ir victim s. I n t y p h o i d f e v e r t h e i n f e c t i n g o r g a n i s m s a r e e x c r e t e d in e n o r m o u s n u m b e r in t h e s to o ls a n d u r i n e of t h e p a t i e n t . If flie s a r e a l l o w e d a c c e s s t o t h e s e , t h e i n f e c t i o n m a y r e a d i l y b e c a r r i e d to a n y fo o d t h a t h a s b e e n le ft e x p o s e d o r to d r in k in g w ater. D y s e n t e r y , t h e c u r s e of o u r t r o o p s i n t h e E a s t , c a n sim ila rly b e c a u s e d by u s in g c o n ta m in a te d w a te r supplies. P l a g u e in th e f a r E a s t p r im a rily affects r a ts . T h e rat f l e a s s u c k t h e i n f e c t e d r a t ’s b l o o d a n d t h e n i n o c u l a t e m a n by b itin g h im . T h e first o u t b r e a k of t h e d i s e a s e a l w a y s o c c u r s in t h e a n i m a l s , a n d t h e e p i d e m i c a m o n g t h e m p r e cedes th a t a m o n g h u m a n b e in g by a b o u t tw o w eek s. In fe c te d r a t s m a y be c a r r ie d in sh ip s , a n d m a y t h u s con v ey p la g u e to o th e r c o u n trie s, se v e ra l o u tb r e a k s h a v e even o c c u r r e d in S u ffolk. M a l a r i a is s p r e a d by t h e b ite of th e a n o p h e l e s m o s q u ito , b y w h i c h t h e p a r a s i t e , it is n o t a b a c i l l u s , is c o n v e y e d t o m an. T y p h u s f e v e r , t h a t s c o u r g e o f t h e M i d d l e E a s t , is s p r e a d b y b o d y lice. T h e e x a c t n a t u r e of t h e o r g a n i s m is n o t k n o w n , b u t epidem ics a s s u m e v ast pro p o rtio n s an d have o c c a s io n e d e n o r m o u s m o r ta lity , e s p e c ia lly in S e r b i a a n d R ussia. I n p e a c e t i m e , m o d e r n s a n i t a r y s c i e n c e c a n k e e p it u n d e r c o n t r o l , b u t i n w a r , w i t h i t s a t t e n d a n t e v i l s of f a m i n e , p o v e rty a n d d irt, e p id e m ic s s p r e a d m o r e r a p id ly t h a n a n y o th e r d ise ase. P ic tu re for a m o m e n t w h a t a p ro b le m e v en th e s e few fa c ts h a v e p re s e n te d to th e A rm y M e d ical A u th o rities. In B u r m a , a n a r m y f ig h tin g in ju n g le c o u n try , w ith o n ly local w a te r su p p lie s a lm o s t in v a ria b ly c o n ta m in a te d , flie s a n d m o s q u i t o s i n a b u n d a n c e , m a l a r i a , d y s e n t e r y a n d m a n y o t h e r t r o p i c a l d i s e a s e s i n v i t i n g t h e o p p o r t u n i t y , of spread. In th e N o rth A frican c a m p a ig n a d e s e rt w ith p ra c ti c a l l y n o w a t e r s u p p l y w h a t e v e r , c l o u d s u p o n c l o u d s o f flie s,

A I D m e n living u n d e r co n d itio n s in w h ic h th e lo u se could flourish, a n d w ith e n tire ly im p ro v is e d s a n ita tio n . I n Italy, a n a r m y f ig h ti n g its w a y u p c o u n t r y t h r o u g h m a r s h y a r e a s i n w h i c h t h e m a l a r i a l m o s q u i t o f l o u r i s h e s , t h e b o d y l o u s e is f o r e v e r p r e s e n t w i t h i t s a t t e n d a n t t h r e a t o f t y p h u s , a n d flies s w a r m in c lo u d s . P i c t u r e th e s e t h i n g s a n d all t h a t th e y m e a n n o w ! L o o k a h e a d t o t h e t i m e w h e n h u n d r e d s a n d t h o u s a n d s of p r i s o n e r s of e v e r y n a t i o n o n t h e C o n t i n e n t w ill b e r e l e a s e d f r o m p r is o n c a m p s , m a n y of w h i c h , i n E a s t e r n G e r m a n y e s p e c i a l l y , a r e lo u se in fec te d a n d p r o b a b ly ty p h u s in feste d . P ic tu re th ese m e n , h a l f s t a r v e d a n d f i lt h y , m a k i n g t h e i r w a y a c r o s s a d e v a s t a t e d E u r o p e c a r r y i n g w i t h t h e m e v e r y p o s s i b i l i t y of c o n v e y in g a n d s p r e a d in g disease. R e a lis e th e s e t h i n g s a n d be forever th a n k f u l for th e M e d ic a l, S a n i t a r y a n d Q u a r a n t i n e s e rv ic e s , of w h i c h so little is h e a r d , b u t w h ic h , b e tw e e n t h e m , w ill h a v e d o n e a s m u c h to w in th e w a r a s t h e f i g h t i n g m e n th e m s e lv e s , for i t is v e r y c e r t a i n t h a t w i t h o u t s u c h s e r v i c e s n o a r m y c o u l d ex ist. “ S u p r e m a c y o v e r t h e e n e m y in t h e m a t t e r of h y g i e n e c o n t r i b u t e d m a t e r i a l l y t o t h e v i c t o r y of E l A l a m e i n in O c to b e r-N o v e m b e r, 194 2 .” S o s t a t e s a r e c e n t r e p o r t in th e B r itis h M e d ic a l J o u r n a l, a n d c e r t a i n l y a n a v e r a g e d a i l y a d m i s s i o n r a t e of s i c k a n d w o u n d e d o v e r t h e w h o l e t w o m o n t h s o f l e s s t h a n 2 p e r 1 , 0 0 0 m e n e n g a g e d is r e m a r k a b l e . Even so, a d m is s io n s w e re m o re n u m e r o u s fro m sic k n e ss th a n from w ounds. . W h a t m u s t it h a v e b e e n a m o n g t h e e n e m y w h o s e a r r a n g e m e n t s d i d n o t a p p r o a c h i n e f f i c i e n c y t h o s e of o u r o w n a r m y , a n d w h o , a t o n e t i m e h a d 4 0 t o SO p e r c e n t , of h is fro n t lin e tro o p s affected by dysen tery and d iarrh o ea . F l i e s w e r e t h e g r e a t p r o b l e m , s w a r m i n g in c l o u d s o v e r th e battle area. S p e c i a l fly c o n t r o l u n i t s , e a c h o f t w o o r t h r e e h u n d r e d m e n , w e r e f o rm e d to d e a l w ith t h e m , to r e m o v e t h e d e a d a n d c l e a r a l l r e f u s e , b o t h f r o m n o - m a n ’s lan d a n d th e w hole fo rw a rd area. F ield H y g ie n e S ectio n s w e r e held a v a ila b le a t every possible point. T yphus w as a l w a y s in t h e offing, t h o u g h it n e v e r a p p e a r e d , b u t n o c h a n c e s w e r e t a k e n , a n d e v e r y s i n g l e p r i s o n e r , m o s t of w h o m s w a r m e d w i t h lice, w a s h i m s e l f c l e a n s e d a n d h is c lo th in g d isinfected. M o b ile c l e a n s i n g t e a m s w ith all th e n e c e s sa ry m a c h in e ry , a n d m obile b a th a n d la u n d ry u n its w e r e k e p t a s n e a r a s p o ssib le to th e fa st m o v i n g tro o p s. W a t e r w a s b r o u g h t t o th e A la m e in a r e a b y specially c o n s tru c te d p ipes from A le x a n d ria , 60 m iles a w a y , a n d as th e a d v a n c e p ro c e e d e d ev e ry w ell h a d to be te s te d a n d p u r i f ied . E v e r y e m p t y food tin h a d to b e b u r i e d — t h i n k of t h e m illio n s — a n d a ll e x c r e t a b u r n t , n o t left a s a b r e e d i n g g r o u n d f o r fiie s. H o w e a s y it i s t o t e l l a n d w h a t i n f i n i t e w o r k a n d o r g a n is a tio n it e n ta ile d , a n d n o t o n ly w o r k b u t t r a i n in g . T rain in g for th e f ig h tin g m a n h im se lf to b e c o m p “ h y g ie n e c o n s c io u s,” to a p p re c ia te t h a t h o w e v e r th irs ty h e m u s t n o t d r i n k s a v e fro m p u rified w ells, h o w e v e r h u r r i e d h e m u s t n o t l e a v e e m p t y food t i n s u n d i s p o s e d o f - o r e x c r e t a e x p o s e d , a n d t h a t t h e l i v e s of h i m s e l f , h i s c o m r a d e s a n d t h e f a t e of th e A r m y itself m i g h t w ell d e p e n d o n it. A s E u r o p e is l i b e r a t e d , c o u n t r y b y c o u n t r y , a l l t h e o r g a n i s a t i o n s of G r e a t B r i t a i n w ill se n d o u t t h e i r c o m b in e d f o r c e s t o a i d i n t h e r e c o n s t r u c t i o n of t h e C o n t i n e n t . V o lu n t e e r s fo r t h is w o r k a r e a l r e a d y b e i n g c a lle d for, a n d I h a v e n o d o u b t t h a t m a n y of y o u , t r a i n e d in t h e C a s u a l t y S e r v ic e s , w ill b e a m o n g t h e i r n u m b e r . Y o u a ls o , in t h e d e v a s t a t e d a r e a s in w h i c h m o s t of y o u r w o r k w i l l lie, w i l l h a v e t o l e a r n t o b e “ h y g i e n e c o n s c i o u s ” a n d to b e a b le to in still th is t r a i n i n g , a n d , a b o v e all, th e r e a s o n s f o r it, i n t o t h e r e f u g e e s a r o u n d y o u . T h e r e is o n e o t h e r m e t h o d by w h i c h in f e c tio n s c a n be s p r e a d o f w h i c h y o u s h o u l d h a v e s o m e k n o w l e d g e , t h a t is bv th e so called “ c a r r ie r .” L e t u s t a k e a v e ry c o m m o n e x a m p l e , t h a t of t y p h o i d

F I R S T

fever. It is possible for an in dividual who at some period has suffered from an attack of this disease to retain in his body, probably in his g all bladder, active bacteria, although he him self may show no signs or symptoms whatever. The bacteria may be passed either continuously or at intervals in the stools, and thus contaminate food or water supplies or m ilk. Some cases have been known to be the cause of epidemics suddenly commencing in districts hitherto com pletely free from disease. S im ilarly, it is quite possible for one individual to carry the bacteria of scarlet fever for long periods in his throat. Epidem ics have occurred in places in which such an in d i vidual has taken up w ork in a dairy quite unaware of his condition, and, through him, the m ilk supply from that dairy has become infected and an epidemic started, which, at first, is confined to the customers from that dairy only. Diphtheria can also be spread by carriers. Such people may never even have had a recognised attack themselves, but still may carry and convey to others the active bacteria from their throats. In other cases, the bacteria may persist for long periods after an attack, and no case is discharged from hospital until at least three swabs have proved negative. The popular idea that diphtheria may arise as the result of bad smells is, of course, quite im possible. A vigorous cam paign to persuade people to allow their children to be im munised by injections against the disease is doing much to reduce this scourge. Other forms of high ly virulent streptococci capable of causing dangerous infections in wounds, puerperal fever after childbirth, erysipelas, and other sim ilar conditions can be carried in the throats of otherwise healthy individuals. Knowledge of these facts has necessitated great in crease in all possible precautions in hospitals. The throats of nurses and staff's are frequently examined ; no maternity case should ever be conducted unless everyone in the room is masked and gowned ; visitors to maternity hospitals are not encouraged for several days after labour, and are frequentfy only allowed to see the newly-born babe if masked or even through glass screens. Children’s wards especially are often closed entirely to visitors. Prejudice exists among the public against imm unisation of children against diphtheria, and is often apparent against many of the modern hospital regulations. People resent the suggestion that they may bring infection and even death to others while they themselves are quite well, and it is in the overcoming of ignorance in these matters that trained in di viduals such as yourselves should do much valuable w ork— true F irst Aid in the Post-war W orld. ( T o b e c o n t in u e d .')

A I D

S t.

J o h n A m b u la n c e

HEADQUARTERS

AND

B r ig a d e

D IST R IC T

R EPO RTS.

N o . I (P rince o f W ales’s) D istrict E r it h a n d D i s t r i c t . — Cadets of No. C 14 (E rith and D istrict) D ivision, held their third annual social and pre sentation of aw ards recently, at the M anor Road C ivic Restaurant, Erith. After the refreshments, the C hairm an, Supt. B agshaw , said it was his pleasure to welcome the company to this function. He remarked on the high standard the D ivision had reached, and how fortunate they were to have an officer with such u n tirin g energy as Cd. Supt. H . R . Collins, to whose credit the successes of the D ivision were due. H e then introduced D iv. Supt. Harbottle, and asked him to present the awards. In his rem arks, Supt. H arbottle said that to be in the w inning class meant a great deal of hard w ork and constant study, and he congratulated the w inners on their very high standard. T h e winners of the aw ards were as follows :— Senior Section : Efficiency Cup and Medal, Cd /C pl. P. B u tle r; Medal, C d./C pl. J. Squirreli. Junior Section : Efficiency Cup and M edal, Cd. Roberts ; Medal, Cd. W ilk in s. F ollo w in g the presentation a team of cadets gave a demonstration of a typical playtime accident ; this team was trained by Cpl. H . W rig ht. D u rin g the evening, the company were ably entertained, Cd. Supt. Collins fulfillin g the role of M .C. The Cadet D ivision records their appreciation of the support given to the venture by the parents and friends of the cadets. Also their thanks are due to the donors of the parcels for the raffles.

C ounty o f Berkshire. An am bulance for use in R eading and district, has been presented to the B rigade by Captain and the Hon. Mrs. Leslie G am age in memory of their parents Lord and Lady H irst and M r. and Mrs. Gamage. The Dedication Service, w hich was held at St. Peter’s Church, Earley, on November 4 th, was arranged by the V ica r (the Rev. S. C. Robinson) in conjunction with the County Com m issioner Mr. C. A. Poole and conducted by the Bishop of Reading. After the Dedication, the am bulance was accepted on behalf of the Order of St. John by Lady Louis Mountbatten, C .B .E . (Supt.-in-Chief). W o o l h a m p t o n . — A N u rsin g D ivision has now been registered at W oolhampton with twenty members.

Red Cross and St. John. R e c e n t contributions to the D uke of Gloucester’s Red Cross and St. John Fund include :— . £ 100,000. — Transferred from Penny-a-W eek Fund. £ 2,709. — M ayor of Scunthorpe’s Appeal. £ 1,500.— B ritish Charities Fund, Beira. £ 1,000 each.— 11th Armoured D ivision, B .I.A ., London Cham ber of Commerce Inc. (Dentifrice M anufacturers Section), and B ritish N urses’ Fund for In valid Prisoners of W ar. Field-M arshal S ir Philip Chetwode, chairm an of the Executive Committee Red Cross and St. John, has received a letter from Mr. G raham Ballenden, chairm an of the Council of the South African Prisoner of W a r R elatives’ Association, recording the C ouncil’s deep appreciation to the South African Red Cross Society, the Red Cross in the Unifed Kingdom , and the International Red Cross for the magnificent w ork they have done for South African prisoners of war.

W o k i n g h a m . — On November 1st, at the Am bulance Station Headquarters, W okingham , the County Com m issioner, Mr. C. A. Poole, accompanied by County Officer F. A. C. Jarvis, unveiled a scroll and presented the annual awards. T h e scroll contained the names of fifteen members of the D ivision serving in H .M . Forces. Vice-President Alderm an F. J. Barrett was presented w ith his badge of Office by the Com m issioner. T h e Edw ard Lee M em orial Challenge Cup was awarded to Pre. Cook who was also presented with a m iniature medal replica w hich he is allowed to retain. Pte. Cook, who was runner-up in 1942 and 1943, won the competition with m arks and the runner-up Cpl. J. W oodley (who was the w inner last year) obtained 75 m arks, i T h e annual awards included first aid vouchers, medal lions and labels.

F I R S T

R e a d i n g C o r p s . — On Sunday afternoon, November Slh, the annual inspection of N ursin g Cadets was held in the B ig School, R eading School, by kin d permission of the head master. The Inspecting Officer was the County Com m is sioner M r. C. A. Poole, who was accompanied by County Officer F. A. C. Ja rv is and County Cadet Officer Mrs. C. A. Poole. About 100 officers and cadets were present. The Com m issioner gave every cadet a practical test in first aid or home nursing and expressed his satisfaction with the general smartness and efficiency of the Divisions.

T h e a l e . — On November 16th, Theale Am bulance and N u rsin g Cadet D ivisions held their birthday party at the Parish Room, Theale. The party was arranged by Div. Supt. M iss Corderoy and Cadet Supt. F. C. Povey. Fiftyseven boys and g irls sat down to tea, and the visitors in cluded the President, S ir F e lix Pole. After tea, S ir F e lix Pole presented certificates gained d urin g the year. Those for the boys in cluding first aid, home nursing, home-craft and cam ping and natural history ; and for the g irls, first aid, home nursing, hygiene, cam ping and natural history. Games and entertainment concluded the party.

C ounty o f C am bridge. B o r o u g h . — The belief that the Borough D ivision has reached its lowest ebb so far as membership is concerned, was expressed at the annual meeting on Wednesday, Novem ber 22nd. More members, it was stated had gone into the Forces d u rin g the year, but it was hoped that some of the C ivil Defence and Home G uard personnel, who had been doing first aid m ight well like to carry on their w ork through the Brigade. Corps Supt. S. S. D icker, who presided, expressed the hope that next year would see a gradual rise in membership again, and extended an invitation to C ivil Defence members to join the Borough Division. Acting D ivisional Supt. C. Sargent also endorsed the invitation of the chairm an. H e reported that d rills and practices had been carried on fortnightly in spite of decreas in g attendances. H e went on to express the hope that now there had been some relaxation in other duties they would have a better muster. The report of the Borough secretary (Sergt. Burnham ) showed that the w ork and duties of members in the D ivision had been good, and he thought they were unlikely to lose any more members to the Forces. The treasurer’s report, given by Corps Officer Sizer, showed a satisfactory state of affairs, with a substantial balance in hand towards the immediate needs of the post-war period.

County o f Cheshire. M o r e t o n . — D ivisional Supt. W . E. Lew is, Moreton Am bulance D ivision, achieved one of his am bitions, when on Saturday, November 18th, a M edical Comforts Depot was form ally opened at Chadw ick St., Moreton. Mr. F. Daven port, J . P . , President of the Am bulance D ivision, performed the ceremony. There were about twenty guests present, includihg Mrs. Dorothy Barton, O .B .E ., and Mr. Tom Findley, T .C . M rs. K elsall represented the local N ursin g Association. D r. John W illia m s the W allasey Corps Supt. was unable to attend and the Corps was represented by Corps Supt. Mrs. Chesterman and Corps Officer S. Purcell. After the ceremony, the committee entertained the guests to tea at The Coach and Horses Cafe. Supt. Lew is welcomed the guests and in explaining the work and aims of the Depot, said that it would be open on Monday and Th ursday even in gs and W’ednesday afternoon, for the h irin g of sick-room requisites at a sm all weekly charge. H e thanked those who

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had helped him to b rin g the Depot into being, particularly Pte. Bulm an who had done most of the m anual work. Mr. Davenport expressed his pleasure at being asked to officiate at the opening. H e regretted that ow ing to pressure of his educational and m agisterial work, he was not able to devote more of his time to the work of the St. John Am bu lance Brigade. H e concluded his rem arks by praising the hard w ork of Supt. Lew is as chairm an of the committee, and Cpl. F. Rogers as an efficient and energetic Secretary. Other speakers were Mrs. D. Barton, Mr. Tom Findley and Mrs. Kelsall.

County o f H am pshire. H o u n d a n d N e t le y N u r s in g D i v i s i o n . — A ta meeting of the above Division, the President, Mrs. C la jre , presented proficiency awards. Mrs. Clayre was introduced by the chairm an, Mr. R. C. Moorman, who expressed the pleasure of the D ivisional members in having her with them. Aw'ards were presented to the follow ing :— Mrs. Jordan, bar ; M rs. A. Orm an, M iss Furlong, M rs G osling, M iss H ichie, Mrs. Sanger, Mrs. W heeler, M rs. Norman, Mrs. B right, medallions. F irst aid certificates were also presented to Mrs. Keogh, Mrs. R ichard, Mr. S. W . Bennett and Mr. G. Mitchell. Mrs. G osling, Supt., N ursin g D ivision, reminded all members that they must keep proficient as nurses ; she also thanked all for their interest and help. Mr. A. B right, Supt., Am bulance D ivision, spoke to all cadets as future members of the adults Division, u rg in g them to continue study of their first aid and nursing ; he also thanked Mr. F arr, Cadet Officer, for his interest and instruc tion. In closing, Mrs. Clayre and Mr. Moorman were given a hearty vote oi thanks.

Isle o f M an County. No. 1 D o u g l a s . —-The follow ing members of the above Am bulance D ivision were successful in passing the Lay In structor Exam ination in September-October last :— D ivisional Supt. Charles A. K idd, Am bulance Officer Evan R. G. Cain, Cadet Officer W illiam J. K elly, Corporal Jam es C. Caine, and Privates H enry D. Keating, D aniel K . Kneale, Samuel D. Watterson, Percy E. Hum phreys.

County o f Lancashire. T o d m o r d e n . — On Friday, November 24th, the N ursin g Cadets of the Todmorden D ivision, held an enrolment ceremony. The enrolling officer was D istrict Cadet Officer Mrs. J. C. Pitter Bayley ; also present were D istrict Officer M iss I. M. Sutcliffe, Supt. Mrs. M arshall, A cting Cadet Supt. M iss M artin and officers of the N ursing, Ambulance and Cadet D ivisions and Cadet Instructors. The ceremony was opened by a short speech from the C h air Lady, A cting Cadet Supt. M iss M artin, after which the actual ceremony took place. The SO cadets to be en rolled, gave their promise to uphold the traditions and honour of the Brigade, and Mrs. Bayley handed to each cadet in turn, her Enrolm ent Form , Cadet Rules and R e g u lations and Cadet Standing Orders. D istrict Officer M iss Sutcliffe then presented 18 first aid certificates, 8 fire fighting certificates and 17 child welfare certificates to cadets. The ceremony closed by the cadets reciting “ The Code of C h iv alry .”

L a n c a s t e r . — The Lancaster N ursin g D ivision held their annual presentation of awards and social at the Friends H a ll, Fenton Street, on W ednesday, November 29th.

T h e M a y or (Councillor D e rrick) presented L t.-Co l. W

F I R S T

George, M .C ., T .D ., J . P . , Hon. Surgeon, with his promo tion from Serving Brother to Officer. The Mayoress presented the A /L / Supt. with her 4th bar to long service medal ; Sgt. D. Cross, long service medal ; Amb. Sister Mawson, long service medal ; 2 lay instructors’ certificates ; 1 medallion ; 35 labels ; 12 home nursing certificates. A whist drive and dance followed, and was very successful.

The Army Blood Transfusion Service.* By

B r ig a d ie r

L. E. H . W h i t b y , C .V .O ., M .C ., M .D ., F .R .C . P.

the beginning of this war, a service of stored blood was organised and perfected by The Medical Research Council, the M edical Em ergency Service and the Army. It remained for the Arm y to w ork out its own particular problems of supply in the field and in fields far distant from the Home Country, under all conditions of climate and temperature. The Arm y Service has had to operate from Iceland to the Cape of Good Hope and from England to the F a r East. Improvements were soon made in the preservatives for stored blood, so that, provided accurate and constant refri geration were available, the possible storage period was lengthened from a fortnight to three weeks and, more recently, to a month. Accurate refrigeration in the field has been one of the A rm y’s chief difficulties, w hilst the keeping properties of different fluids, substances, and pieces of appa ratus, under tropical or arctic conditions, have had to be tested before one could be certain that these would stand up to field conditions. F o r these tests, the Arm y has the facili ties of various conditioning rooms at its Experim ental Station ; rooms which can imitate a tropical day or an arctic night, including even the development of intermittent hum idity equivalent to tropical rainstorms. So far, this war has produced no substitute to compare with the hum an material, but it has clearly demonstrated the virtue of human plasma, in fluid or dried form, for meet ing the fundamental requirements of the ex-sanguinated wounded man, namely, the restoration of the volume of his circulating blood. F o r him, quantity is more important than quality ; when both quantity and quality, that is plasma and blood, can be supplied, so much the better. But in certain climates, and in many situations, the quality, that is blood itself, is hard to come by. It is here that plasma, particularly the dried product, which is stable in definitely under tropical conditions, without need for refrigeration, is a vital and life saving m aterial ; it needs no more than to be dissolved in saline or water to render it fit for use. Plasm a has the advantages of req u irin g no grouping test for com patibility ; it has been the m ainstay of far flung forces. Plasm a, and all other blood substitutes, nevertheless, have their lim itations, especially when the transfusion has to be massive, as in the case of very large blood loss. T h is is because no blood substitute yet invented is possessed of oxygen carrying power. In such circum stances, all surgeons have found that a proportion of blood itself is re quired, and this our distant arm ies have obtained from troops on the spot— especially base troops. A ll such donors have to have their blood group determined with sera guaranteed to be active and potent. Before the war, such A t

* Extracts from a lecture delivered before the Royal Society of Arts at John Adam Street, Adelphi, W .C .2, on November 29th, 1944,

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testing sera had to be frozen solid to preserve their potency ; dehydration has solved the problem ; dried grouping serum requires no refrigeration and needs no more than a little water with which to reconstitute ju st before use. One is often asked why the A rm y does not undertake wholesale blood grouping of troops on enlistment, recording the group in their record books. The main objection to this is the difficulty of obtaining a high degree of accuracy in the mass, because of lack of technical s k ill and the fre quency of clerical error. It is preferable for skilled w orkers to do blood grouping in sm all batches, as and when required, otherwise 9 0 per cent, of the labour is lost. The transfusion officer needs to be a first-class doctor, in addition to being an expert in the m echanical side of the work. O nly then w ill he get the best result in the large variety of conditions that come into his hands. By adjust ing the volume and the rate of the transfusion, by em ploying numerous adventitious means he can bring his patient to the surgeon at the optimum time for operatien, m aintain the condition throughout that ordeal, and see the case through the often stormy post-operative phase. It is for these reasons, and others, that the B ritish Arm y policy of establish ing a transfusion service, with its own highly trained officers and men with sources of supply separate from general medi cal stores supply, has paid handsome dividends. In this respect, the B ritish Arm y differs from all other arm ies, allied or enemy, who have relied upon the general medical officer to do this important work, and have obtained their supplies m ainly through comm ercial firm s and ordinary supply channels. Recent surveys show that the wounded have an 8 0 -9 0 per cent, chance of life ; from 1 0 -1 5 per cent, require to be transfused ; it is indeed rem arkable what m utilated and battered bodies can nowadays be brought back to efficiency, bodies which, in former wars, would have had no chance of life at all ; even the dangerous abdom inal wound has been robbed of its high m ortality rate. T h is great im prove ment in recovery rate can be attributed to three main causes which the B ritish Arm y have exploited to the full ; they are, firstly, the b rin g in g of the surgeon to the wounded, that is the establishment of advanced su rgical centres, staffed by young but experienced surgeons, who w ork right up in the forward areas ; secondly, the m astering of infection with the modern remedies, the sulphonomide d rugs and penicillin ; and, thirdly, the Transfusion Service. The ward of a mod ern field hospital is no longer a mass of stin k and corruption, with feverish, pale wasted faces. Instead you w ill see a row of beds containiag placid rosy cheeked men, sm oking cigarettes and reading the newspaper. In this triad of modern improvements, the w o rk of the h ig h ly trained trans fusion officer is vitally important, for his w ork has to be carried out before the surgeon can even begin to repair the damage. D u rin g this w ar we have learned that a man can lose almost incredible quantities of blood, two, three or four litres, and yet can still be brought rapidly back to life, pro vided he is promptly and adequately transfused. W e have learned other things about transfusion, too, not only its benefits but also its hazards, and much of this knowledge is directly applicable to ordinary civilian work. The m ultiple transfusions w hich m any of our men have to receive may give rise to a complication not previously known. It was alw ays believed that a donor once compatible would alw ays be compatible again with the same recipient. W ith the discovery of the Rhesus factor and the im m unizing potentialities of a transfusion, this sim ple assum ption is now known to be erroneous. F or the future, this additional knowledge w ill have to be taken into account in a ll general and maternity hospitals, and, as is now well know n, it has contributed greatly to reducing the m ortality of a fatal disease of the new-born-icterus gravis neonatorium. The organisation of the A rm y Blood Transfusio n Ser vice contains a large Supply Depot at home, a Base organi

F I R S T

sation in every theatre of war, which is divided into three sections, known as the Base headquarters, the Advanced Blood B ank and the Blood Collecting Section ; the lastnumed operates only in those theatres of w ar outside the range of blood supply by a ir from the Hom e Depot. Lastly, there are the Field Transfusion Units, the smallest unit in the B ritish Arm y, which w ork with the forward surgical teams. T h is service organises the chain of supply by air, sea or road, according to circum stances, but the keys to suc cess are that every officer and man in the Service is highly trained and has a great esprit de corps , that every unit in the Service has refrigeration facilities, most of which are highly mobile, and that the blood alw ays gets there— regulations or no regulations. The Hom e Depot began with a staff of about 80, nearly all men ; it now has over 500, nearly all women. H a s the B ritish policy been worth while ? After all, we have established a special R .E .M .E . corps d urin g this w ar for the purpose of repairing tanks, guns, vehicles and other m achinery. And it takes only a few weeks to make a tank, but 19 years to make a man, with two more years to train him completely. The Transfusion Service, quite apart from the sentimental aspect of savin g lives, has saved many a pension from the State, has conserved man-power, in that it not only restores men to the fighting line, but also greatly shortens their convalescence and has been a fine moral sup port to our men go in g into action. They know that if they are wounded they have the m axim um chance of life. It is as well to remember that the whole service rests upon the support of the general public, which has been given in fu ll measure. A ll the organisation, machinery, s k ill and m aterial are useless, unless an ample supply of the essential raw m aterial— blood— is available.

L e tte rs to th e E d it o r . W e are in no way responsible for the opinions expressed, or the statements made, by Correspondents.— E d i t o r . W AR D

ear

S E R V IC E

CHEVRO N S.

,—

spot of bother is arisin g in the London area amongst the regular staff of the London Ambulance Service in refer ence to the decision of the Government as to the award of w ar service chevrons or wound stripes. The Government, for reasons best know n to themselves, decided that there should apply a most u n fair discrim ination in the issue of w ar service chevrons. F ire W atchers, Metro, police, A u xilia ry Am bulance personnel A .R .P . personnel, etc., were included in the authorisation. The re gular am bu lance service in the County of London were definitely excluded. W h y ? M iss F. H orsbrugh, M .P ., has stated— “ I thin k I should explain that these am bulance w orkers are not C iv il Defence personnel, but are the staff of the L .C .C . regu la r Service, although I know that they have given much useful assistance to the C ivil Defence Service when neces s a ry .” In reply to a question by M r. F. Messer, M .P ., in the House of Commons on November 2nd, 1944, the M inister of H ealth (M r. W illin k ) stated — “ 1 understand that any members of the staff of the London Am bulance Service who were enrolled as whole-time C ivil Defence w orkers in the earlier part of the war are entitled to war service chevrons in respect of the period they were so enrolled. For the rest, the conclusion was reached that there was no ground for dis tin g u ish in g this staff from other regular staff of Local Authorities who, although they may from time to time have assisted the C ivil Defence O rganisation, are not in fact part of that O rganisation and are, therefore, not entitled to A

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chevrons. I regret that I cannot undertake to review this decision.” The M inister of Health and M iss F. H orsbrugh are both badly informed of the facts. By the C ivil Defence (Em ploy ment) (No. 2) Order, dated September 12th, 1940, the whole of the L .C .C . Am bulance Services were definitely scheduled by the M inister of H ealth as “ whole time C ivil Defence w orkers,” and the Order continues to operate. In conse quence of the operation of the Order staff were restricted. The M inister of Hom e Security,, on May 9th, stated— “ he is advised that active members of the London Ambulance Service may be regarded as engaged in C ivil Defence duties, at any rate d u rin g air raids.” Throughout the period of the w ar and in every blitz on the great capital, the regular staff have been definitely en gaged in C ivil Defence duties. Some, alas, have given their lives, and many others have been injured. Several of the stations have been blasted. Hence the attitude of the Government is beyond under standing. W hy this discrim ination ? The w riter has been a Fire W atcher in a certain suburb of London, fortunately not seriously affected by the blitz. H e has received, w ith out asking, w ar service chevrons. The regular employee in the London Ambulance Service, definitely scheduled by Order as a whole time C ivil Defence W o rker and active in every attack, is deprived of the same. M iss H o rsbru gh adds insult to in jury by her gratuitous implementation of her defence by adm itting that “ they have given much useful assistance to C ivil Defence Services when necessary.” It is a pity M iss H orsbrugh has not personally investigated the facts.— Y o urs faithfully, G. E. E v a n s , General Secretary, H ospitals and W elfare Services Union.

Lady Louis Mountbatten Sees Fine Work of Red Cross and St. John. F o l l o w i n g on her recent visit to the Red Cross and St. John Commission and Hospitals and Casualty Services in North W est Europe, Lady Louis Mountbatten may shortly be under tak in g a sim ilar tour in In d ia and South East Asia. W hile in France, Belgium and H olland she was struck by the m agnificent w ork being accomplished for the sick and wounded and the efficiency and speed with which the casual ties are dealt. She was much impressed by the manner in which surgery, blood transfusions and the adm inistration of Penicillin were made possible at the earliest moment after the reception of the casualties from the firing line, and there is no doubt that it is this factor w hich has been so largely responsible for the low percentage of deaths. On all sides she saw the vast range of w ork undertaken by the Red Cross and St. John and heard high praise given to its members. The W ar O rganisation is, of course, operating on a wide scale in Italy and the M iddle East and a Commission is already functioning in In d ia and with the South East Asia Com m and— vast stores, as well as a number of V .A . D .’san d W elfare w orkers are already in that theatre, and more are being posted all the time. As operations in the F a r East intensify, the Red Cross and St. John w ill give the sick and wounded in that theatre of w ar their continued support and meet every'demand made upon them.

Publishers N ote .— W ill readers please note that all back num bers of “ F irst A id ” are now out of p rin t and cannot be supplied. W ill South A frican and o ther C o lo n ial readers please add to th e ir rem ittances, “ o r English equivalent.”

F I R S T

R I D

What do you know about I ODI NE? are already fam iliar w ith the use

o f tincture o f iodine as a wound dressing. D o you know some o f the other m edicinal uses for iodine ? Iodine in other forms has been used

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H O U S E

E d u c a tio n a l B I S H O P S G A T E

The Correlation of Medical Science and Physical Education. B y

B r ig a d ie r

F. D. H C H V IT T ,

c .v .o .,

m .a .,

m .d .,

f.r .c .p .

(From a Lecture delivered at the Royal Institute of Public H ealth and Hygiene, 28, Portland Place, London, W . l, on W ednesday, November 22nd. D r. Percival P. Cole, m . b . , c h . B . , f . r . c . s . , in t h e C h air.) pointing out that in Ancient Greece, intellectual, spiritual and physical culture went hand in hand, that athletics were intim ately associated with the Arts, and that the ideal of the cultured citizen-soldier-athlete died with the Greeks, D r. How itt said that since those times m any efforts had been made by many countries on a national scale to improve physical welfare, but the motive had usually been immediate and objective and often undertaken for purely m ilitary purposes. One had only to cite the instances of Rome, Germ any and Japan. In our otfn country the urge had not been lackin g, but it had usually lacked Government assistance. From time to time, isolated organisations— often voluntary— had appeared and struggled in a parochial way to promote physical fitness. They had usually lacked Government support and co-opera tion from the different sections of the community interested in the wider problems. In such circum stances their outlook tended to become narrow, their design sometimes faddish, and, like H e rric k ’s daffodils, they tended to “ haste away too soon.” D r. H ow itt urged that there was, therefore, a great A f t e r

I f you think a better know ledge o f iodine w ould help you in your w ork, the

I o d in e 20

m ycotic infections o f the skin. There are m any other uses.

B u r e a u L O N D O N

E . C . 2

need to bring together all those services without whose com bined interest, success was unattainable. H e suggested that medicine had played too much emphasis on the cure of disease and too little on preventing it ; education had placed too great an emphasis on academic and too little on physical distinction ; industry, w ith the exception of certain large and enlightened firms, had failed to appreciate that the health of its employees was an asset and that ill-health yielded a poor economic return ; and organisers of sport had been prone to cater for the expert, disregarding the needs of the less gifted exponent— hence the adulation of the professional and the tendency of people in general to spend their leisure hours in w atching contests rather than in takin g part in them. D r. How itt continued : “ Such was the position in this country before the war. Characteristically, the E ng lish m an never sees the blow'that is levelled at him until it has almost reached his nose, but at that moment he sees it more clearly than anybody else. T h e strides w hich we have made in the fields of physical development, rehabilitation and revocation, in order to meet a national emergency are very considerable, and have placed this country for the moment in a position of respect. T h is success has been achieved by the pooling of knowledee of those interested from widely different angles— in other words by team w o rk.”

O b i t u a r y . — The Ram sgate D ivision has suffered a great, lost by the passing of Am bulance Officer Benton, who for nearly 25 years was a member of this D ivision H e was laid to rest on November 29th, when many of his sorrow-ing fellow-members and friends attended the in terment as a m ark of the great respect in w hich he was held.

F I R S T

R I D

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Q u e r ie s a n d A n s w e r s to C o r r e s p o n d e n t s Queries w ill be dealt with under the follow ing rules :— 1.— Letters containing Queries must be m arked on the top left-hand corner of the envelope “ Q uery,” and addressed to F i r s t A i d , 46, Cannon-street, London, E .C .4. 2. — A ll Queries must be written on one side of paper only. 3. — A ll Queries must be accompanied by a “ Query Coupon ” cut from the current issue of the Journal, or, in case of Queries from abroad, from a recent issue. 4. — T h e Textbook to which reference m ay be made in this column is the 39th (1937) Edition of the S .J.A .A . M anual of F irs t Aid to the Injured.

F ra c tu re s of L e g and Patella. J .P . (R h o n d d a ).— Recently at our first aid class we discussed the treatment of simple fractures of the distal ends of the tibia and fibula and of the patella, the injuries being on the same lim b. As, however, we could not agree whether the lim b should be raised or not, we agreed to submit the point for your kind ruling. From the first aid point of view, the fractured leg is the more serious in ju ry and requires preferential treatment. W ith this combination of injuries, therefore, I w-ould first apply a figure-of-eight bandage to control the fractured patella and then treat the fractured leg as laid down in the Textbook. T h is done, I should raise and support the patient’s head and shoulders and raise his lower lim bs, whereby I should hope to protect the fractured leg and patella from agg ravatio n. — N . C o r b e t F l e t c h e r .

E xa m in a tio n H o w ler. M .R . (Cannon S t.).— In a recent exam ination the doctor asked one candidate what he would expect to find if he had to treat a patient suffering from compound fracture of the leg. H e burst out la u g h in g when the candidate replied— “ S u ch patients alw ays bleed from the nose I ” Good !

S .W

Next, please ! !— N .C .F .

F ra c tu re s of C la v ic le and H um e rus. . (E d g w a re ).— At a practice class we were asked to treat a patient suffering from a fractured clavicle and fractured hum erus (m idway) both in juries being on the same side. Y o u r advice as to the best method of securing the lim b would be very much appreciated.

The fractured arm is the more serious in jury and, con sequently, demands preferential treatment. F o r this reason I would control it with splints and bandages as laid down in the Textbook. T h is done, I would bandage the lim b to the trun k with two broad bandages, applying the lower one in such a m anner that it gave support to the forearm, since the fractured clavicle contraindicates the use of a sm all arm sling. By such means I should know that I had done my best to protect both fractures from aggravation whether patient was a sitting case or was so badly shocked that he required re moval on stretcher.— N .C. F.

Sal A m m o n ia c fo r B u m s. E .M . (Southgate).— Please note a m isprint in your reply to

R I D

the query published in the November issue of F i r s t A i d under the above heading. The strength of the solution of am m onium chloride should have been given as S and not 55 per cent. Many thanks for letter and correction of printer’s error. — N .C .F . Effects of Antidotes. P.S. (H o u n slo w ).— If a person who has swallowed a corro sive acid or alkali, is given an antidote, would the poison and antidote still ran k as a poisonous substance, either by assim ilation or by absorption into the blood w hile it is passing through the alim entary canal ? Y o u r reply w ill be much appreciated. N o ! The very essence of an “ antidote” is that it should form with the poison a harm less compound. — N .C .F .

D ia g n o sis of A p o p lexy . M .N . (F in ch le y).— In its description of apoplexy on p. 166, the Textbook adds a cryptic note which has alw ays puzzled me, namely “ Signs of in jury are not necessarily present.” I shall be grateful if you w ill tell me what is really meant. The sentence is incomplete ; and it should read— “ Signs of in jury to head are not necessarily present.” In other words, the diagnosis of apoplexy rests on the signs and symptoms of compression of the brain combined with the absence of history (or evidence) of in ju ry to the head.— N .C .F . Schafer or S ilvester. H .D . (Bolton).— At a recent first aid session, a discussion arose with reference to the application of Schafer and Silvester methods of artificial respiration ; and the ques tion was asked as to the earliest age at which it would be suitable to do artificial respiration on a young child. One member said 4 years, and another 5 years. A ll first aiders know, or should know, the faculties of children and we think that the pressure used in apply ing pressure in these methods would injure the child internally. So we should appreciate your ru lin g on this matter while we thank you for all the help which your answers to our queries give us. If a first aider decides that an asphyxiated child is too young to be treated by the Schafer and Silvester methods of artifi :ial respiration, what alternative treatment is there for him /her to adopt ? A ru lin g on the precise age of the patient does not solve your difficulty, especially as I see no reason why, on the score of age, these methods of artificial respiration should not be tried. I do, however, stress that the pressure on loins in the case of Schafer and the pull on upper lim bs and pressure on chest in that of Silvester must be applied w ith great dis crim ination lest further in ju ry result to the child. Incidentally, Captain Alw yn E . Biscoe of the Royal Life S aving Society writes that he can definitely confirm that Professor Schafer himself stated that his method of artificial respiration can be applied to quite young children with safety, providing that the operator applies it with gentleness and care, according to the age of the patient.— N .C .F .

Status of B rig a d e O fficer. J .H . (B righ o u se).— I shall be greatly obliged if you w ill en lighten me on the follow ing problem with reference to the status of an Officer of the B rigade :—

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A Lady Am bulance Officer has been transferred from one Corps to another. Does she become a Lady Am bulance Officer proper or is she only attached to her new Corps, as its Superintendent has stated ? By the way, in the D ivision there is one other Lady Am bulance Officer who has held office for five years, whereas the lady who has been transferred to this D ivision has been an Officer for thirteen years. Does this affect the situation ? B rigade Regulations lay it down that the number of Officers in a D ivision (apart from the Superintendent) depends on the num ber of members in the Division. In the case of N u rsin g D ivisions, R ule 39 (p. 9) states that one Lady Am bulance Officer is to be appointed for each twelve Am bu lance Sisters. If, therefore, the new D ivision has its com plement of Officers, the transferred Lady Am bulance Officer is rig htly regarded as attached to her new D ivision and is not officially appointed until a vacancy occurs. Incidentally, the num ber of years served in the Brigade as Officer does not alter the rule just quoted, because R ule 131 (p. 25) states that Officers transferred from one unit to another w ill take their seniority from the date at which the transfer is authorised.— E d i t o r .

B le e d in g fro m Tooth Socket. M .M . (Y o rk ).— A few weeks ago I was called to a friend who was bleeding freely from a tooth socket and who had had a tooth extracted some hours previously. For some reason I was not very successful in controlling the bleeding. Fortunately for me the doctor arrived soon after I did and plugged the socket. I shall be grateful if you w ill tell me how to proceed with such cases ; and I thank you in advance of your reply. Bleeding from a tooth socket often proves troublesome to control because pressure is either not applied directly over the socket or not applied continuously for a period long enough to accom plish its object. T o control such bleeding, therefore, I suggest that you take the cork of an ordinary sized medicine bottle and cut off a portion just large enough for the patient to hold it comfort ably in his mouth and without putting his jaw s on the stretch. Then with a sharp knife shape the selected portion of cork so that you convert one end into a wedge which w ill fit accurately on the plug placed over empty socket and the other end into a furrow in which the opposing teeth (or if these are absent the upper or lower jaw, as the case may be) w ill rest. Lastly, persuade the patient to bite on the cork (when placed in correct position) for at least half an hour continuously. If he does so, then the bleeding should be effectually controlled ; or if bleeding re-starts, the cork may be replaced for a further half an hour.— N .C .F .

F a k in g of In ju rie s . J .T . (M arket H arb oro ugh ).— In the November issue of F i r s t A i d , I read with interest that in the final for Bristol No. 3 Corps “ D ” D ivision Ind ivid ual Trophy, the judge set a test em ploying the use of plasticine wounds. I consider their use would be very helpful as well as realistic when organ isin g competitions, and I should be greatly obliged, therefore, if you could k in d ly give me any further inform ation with regard to them. M eanwhile I thank you in anticipation of your kind assistance. T h e only book known to me which deals with the faking of in juries for competition purposes is F ir s t A i d Competitions

A I D

which, compiled by D r. A. C. W hite K nox, is published by Messrs. Dale, Reynolds & Co., 46, Cannon-street, E .C .4.— N .C .F .

Use of T h om as Splint. W .A . (P uckeridge).— At a recent C. D. Mobile U nit Competi tion, the team of w hich I was a member was criticised by the Judge, a R .A .M .C . Captain, because we did not apply a Thom as splint to a compound fracture of the femur for the patient to travel a distance of ten miles to hospital. T h is has given rise to much discussion among ourselves and we would appreciate your ru lin g on these points. Can the Thom as splint be applied efficiently without extension of the lim b, and is this a recent advance in medical thought since the last edition of the Textbook ? We thank you for your solution to this problem and await your reply with interest. The Textbook is written for the education of individual first aiders whereas the use of the Thom as splint should be (and is) restricted to squads of first aiders trained in its application. Consequently, the instructions for its use are contained in an appendix and not in the body of the T e xt book. On the other hand, though the Textbook may provide the basis of the teaching given to C. D. personnel, the M inistry of Health has supplied and authorised the use of the Thom as splint for fractures of thigh. It would, there fore, be correct for the personnel of fixed F irst Aid Posts and Mobile L'nits to use this splint in a ll tests and actual incidents connected with the C .D . Services even though this has the effect of applying extension to a compound fracture of thigh. — N .C .F .

Use of Tourniquet. B.S. (Leeds).— In a recent lecture a doctor said that the tourniquet was a dangerous instrument. As this state ment seems contrary to facts I shall be grateful for your comments. In my lectures I say the same thing ; and I add the statement that not once in my forty years of general practice have I had occasion to use it. W ith a tourniquet, six points merit attention. T h u s (1) except as a temporary measure “ while the wound is being examined and treated,” its use is indicated only when direct pressure fails or is impossible, especially with a main artery (e.g., femoral or brachial) a foreign body in wound, or a fracture beneath the wound ; (2) its use causes pain and is a last resource in treatment, like stim ulation w ith brandy ; (3) its pad must be placed (and kept) accurately on the pres sure point ; (4) its tw isting apparatus must be arranged carefully on the side of the lim b exactly opposite to its pad; (5) its pressure must be ju st sufficient (this often varies from time to time) to stop the bleeding ; and (6) its pressure must be relaxed (and if possible, removed) at the first possible moment and certainly w ithin twenty m inutes.— N .C .F .

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