First Aid Journal January-June 1940 by Museum of the Order of St John

FIRST AID Editor:

No . S47.-VoL. X LV I. NOTICE

GEORGE

READERS.

THIS

NUMBER.

S.].A. B. O verseas ... St. Andrew's Ambula nce Assoc iation Working in Harmoll), ... First Aid Pointers S.J.A. B. Headquarters and Distri ct R eports Letters to the Editor Priory for Wales London Stretcher Bearers' Competition Drill for Application of Th o mas Splint Railway Ambulance News Reviews Our Nurses' Pages Principles of Artificial R espiration in First Aid Poisons

137 138 138 138 139 1-1 0 H1 H~

14 3 1H HS 1-1 6

147 H8

QUERIES AND ANSWERS TO CORRESPONDENTS : -

Plugging Wounds .. . Examination Howler Foreign Bod y Embedded in Eye Treatment ot Protruding Eyeball Silvester Method of Artificial Respira tion Barrel Bandage for Fractured Jaw ... Treatment of Fractured Leg Treatment of Fractured Femur Simple Fractures of Femur and Patella Humour in First Aid Sling for Dislocated Shoulder Position of Foot with Dislocated Hip Asphyxia and Burns on Abdomen St. John Sling with Bleedin g Palm Time Rattles On .. . Treatment of Crushed Hand Treatment of Fractured Finger Li fting Patient by Looped Bandages .. . Treatment of Shell Sh oc k .,.

Entered a t ] [ Stationers' Hall

PRICE THI{EEPENCE [3/6 PI!R A NNU M , P OST F REI!

EDITORIAL.

EOITORI A L ; -

\ .

CRAFT.

JANUARY, 1940.

F IRST AID is published on the 20th of ea ch month The Annual Subscription is 3S. 6d . post free; dngle 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 wdcomes suggestions for Practical Papers. All Reports, &c., should be addressed to the E diw r at the address below, and should reach him before the 12th of each month, and must be accompanied (not necessarily tor tJublicat ionj by the name and address of the Correspondent. Subscriptions, Advertisements and other business Communic tt ions connected with FI.RST AID should be forwarded to the Publishe rs. DALE, REYNOLDS & Co., LTD. , 46, CAN N ON STREET, LONDON, E. C.4. Tel(graphic Address-" T wenty·four, London." T ellpholle- City 37 IO.

CONTENTS

150 150 150 150 150

150 152 152 15 2 152 152 152 15 2

15-+ 15-+ 15-+ 1S-+ 15-+ 1S I

TH E St. J oh n Ambulance Bri g ad e O ve rs eas is one branch of th e Ord e r o f St. John with which we a t bo rn e a re not vcry conversant. It was , th e re fore, w it b g reat interest that we read the annu a l repo rt fo r the year ended Decem ber 31 st, 1938, an d noted tha t the mem bership is growing rap idl y . S. J. A. B. OV ERS EAS .

Colonel James L. S leeman (Chief Commissioner) states that m uch prog ress has been made, particularly in those parts of the Empire where the Brigade O verseas has but recently been established or has hitherto not been in ex istence. 'I'here was a net increase of j 13 Divis ions durin g the year under rev iew. Six ty-seven am bulance and 55 nursin g di v is io ns were formed, whilst six ambulance an d th ree nurs ing divisions were disbanded. Personnel increased by 5,533 an d at December 31st , 1938 the stren g th was 15,7 44 men (511 divisions) and 5,87 2 nurs es (26 5 di visions) a grand total of .21, 6 l6 and 77 6 div isions. I n addition to adult perso n nel the Cadet Branch of the Bri g ade O verseas n ow numbers 2,496 boys and 1,698 g irl s, an increase of nearly 500 over 1937. The di v isi o ns i ncreased by 33; the total now being 233. During 1938 no less th a n 240 Se rv ice l\l edals were awarded; and 49 Grand Prior's Cade t Badges, which brings the total of su ch ba dg es awa rded to Cadets Overseas to 10 5. O ver 600 Se rvice Chevrons to adult members and 292 Cadet Proficiency Badges were also iss ued. Du ri ng the year permission was given to issu e Cadet effic iency stripes locall y . Also included in the report a re pa rti cu lars of tours carried out by the Hon. Mrs. Co pla ndGriffiths (now Lad y Supt. in Chief of Nursi ng

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Divisions of the Brigade Overseas) and by the Chief Commissioner. Reference is made to the resignation of Mrs. Lancelot Dent who for seventeen yea rs, from 1921 to 1938, occupied the position of Lady Supt.-inChief. Reports from the Dominions are also incorporated and make very interest in g reading.

First Aid Pointers.

Recently, Dr. Constance Roberts aave an interestin lY lectu re on " \Var an d Nerves," to mer~ bers of the ?\ obel ~ Ardee r Factory Section. Following t.he lectur~, Dr. R oberts presented the 15 year Vol~nta:y MedIcal ServIce Medal for long and efficient servIce m the St. Andrew's Ambu lance Corps to l\lr. Peter McClusk~}'. Dr. Roberts cong-ratu lated the recipient on his long serVIce and the award of the medal. It is interesting to note that ~1 r. McCluskey is the first member of the Section to qualify for this medal, and all members are proud of this dist inction. The ann.ual exam inati on of the Gleneagles Station Amlast month. Owing to the exceptIOnally la rge class, Drs. \V. G. Bissett, D . B. L ow and John]. Simpson, all of Perth, conducted the tests. Dr.. 1. T. Gunn was the lecturer, and the members, numbermg about 80, were well up to the previous hiah standard of efficiency. ~ The Section is ca rrying on with practical instruction during the remainder of the winter. ~ulance SectIOn was held

The annual competition for the M'Adam Cup confined to. fir~t and second yea r pupils of the Dunbar L. N.'E. R. and DIstn~t Ambu la.nce Corps. has resulted in 10h n Armstrong becommg the \~IOner, .t he runner-up being A. S. Robertso~ . The cup a~d pnzes, g Ive n by Mr. ]. B. John stone, president of the sectIOn, were handed ove r by Mr. William Anthony.

Working in Harmony.

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Publishers, FIRST AID, 46, Cannon St .. London I:.C.

No. I (Prince of Wales's) District County Surgeon Capt. Russell V. Steele has been appoi nted Acting Assistant Commissioner of the Central Area, whilst Corps Surgeon Basil L. Steele has been promoted County Surgeon of the Central Area.

On December 19th, the Rev. :'Ilorris, Rural Dean of St. l\1arylebone, dedicated the new ambulance of the 58/ 5 (Western Postal and St. :'Ilarylebone) Di\' ision, which had been presented by Mr. H . F . Paul. . Supt. vV. V. M. Allen was in charge of the parade, aSSIsted by Amb. O fficer Dare Those taking part in the cer emony included Mrs. H . F. Paul (wife of d<1nor) and Mrs. L yon (daughter), the :\layor and Mayoress (Alderman and 1\1rs. D ouglas W aite), :\lr. W. L. Davies (Divisio na l President), Alderman Stiles All e n (vice-P resident), Dr. H. L. Bulman (tl1. O. H.), J\lr. W. F. Bridger (Di\'. Supt. W. D. P. 0.), representatives of the B. R. C. S. an d Church Arm y, and a continge nt of stretcher bearers from the Council posts. After the dedication, the :'Ilayor expressed thanks to I\lr. and til rs. Paul and l\1rs. Lyon for t heir great assistance to the first aid m ovement. Th e ambulance will be a great asset to the division in its work, especially should air attacks become p re\·alent.

Th e headquarters of t he No . 13+ (Greenford and Northolt) Division are no\\" at the S cout Hut , Greenford l\lethodist Church, Ruislip Road, Greenford.

No II District HA;\I PSHIRE. Maj or A. Tennyson-Smith, ]\,1. D ., C.l\1., County Com missioner for H ampsh ire, is justly proud of t he increase in the persunnel under his comma nd. On October 1s t, 1939, the total person nel was 1,43 2 men, 1,077 nurses and 567 cadets, a gra nd total of 3,OY7 . This is a n increase of 94 5 since January 1st, 1939, a truly remarkable figure. 'A'e are pleased to note that the Brigade is once again established in the Isle of Wight, there being three divisions with a personnel of 75. The re markable point in l\lajor Tennyson-Smith's report is the percentage of members engaged on National Service. Over 300 members are of military age, 79 reser"ists under R.N.A.S.B.R. or M.H.R., 56 members have enlisted, 785 men are on A. R.P . work, 48 nurses are mobile V.A.D.'s, and 580 nurses are in the C. N. R. or on A. R. P. duties. Of the total personnel, 75 per cent. of all avai lable members are on Nation a l Service.

. Mrs. M. Y. Simpson, wife of County Officer M. Y. SlInpson, presented awards at the ann ual presentation to s uccessful st udents of the Clara Vale Colre I r), A m b u Iance . . . D IVlSlon and first aid class. At the annual meetin ""a of the North R'd' I mg C ounty S.].A.A., the County Secretary, Mr. George RI chardson, r epo rt ed that during the yea r ended September 30th, 1939, 3,189 people attended classes orga ni sed by the Ce nt re.

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Headquarters and District Reports.

- W. B. P ATON, Manitoba Di~trict, in Canadian Firsl Aid

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St. John Ambulance Brigade

For simple cuts or little scratches Treat with antiseptic patches But don't fo r &;et to wash o ut clean; Infect ion's sting is sharp and keen. If bright red spurting blood you see, It means a punctured artery; No single moment you must waste, The patient's life d epen ds on haste. Twist a bandage tight and so und 1m med iatel y above the wound, Then sterile bandage good and tight Ri ght on the wound, and you've don e right If you suspec t a broken bone Lea ve your pati ent quite alone Until some well placed splints will prove The broken bone ends do not move. Bandage tight an ankle sprain To stop the swelling and the pain Th en fomentations, quiet and rest; This simple treatment is the best. \\'ith dislocations let me point You cann ot tinker with a joint. Let the doctor fix the thing-, But meanwhil e hold it with a sling. Strains and. wrenches ca use you pain But heat wIll make you ri ght again. If injury appears seve re And doctor's a id is not quite ncar, Trea t for s hock without delay And do it in this simple way: Loosen clC'thing, if it's tight, Keep the patient warm and quiet, Stimulate with coffee, tea, Except there's bleeding inwa rdly. For poisons you sho uld make this note: Quickl y give an antidote; If anti~ote is no t in s ight, You stIli will be within your rig-ht T o g ive him milk, d e mulcent drinks Make him vom it ere he sinks. ' In cases where the breathing stops Plac e man on stomach; get on top; Comm ence resuscitation then Continue till he breathes aaa:n '" .

St. Andrew's Ambulance Association.

AT the three Finchley first aid station s members of the B: R. C. S. and S.1.~. B. are working together, and a very hl~h degree of effiCIen cy and keenness is shown. This is eVlde~ced by the excellent attendances at the lectures on first aid, h.om~ nursing and a nti-g as, and by the results ot ~he examInatIOns. Many of the ca ndida tes numberinO" lust over 170, obtained 100 per cent. marks. ' h Both the B. R. C. S. and the S.]. A. 8. ha ve e nroll ed many new members. The B.R.C.S. No. 11 Middlesex has grown to such an extent Ihat its membership has far exc.eeded 100 an~ another D etac hment has been formed' while the 193 (Frtern Barnet) Di vis ion S 1 A B h ' practicall y 100 ll1em bers . ' .. . ., as now

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No. ill District. "

As a tribut e to the marked interest H. R. H. the Du chess of Gloucester (Deputy Commandant-in- Chief of 1 ursing Corps and Divisions) has taken during- recent months in the

:-york of the orthampton County of tht: Brigade, the folio\\"1Il~ l.etter, Signed by Dr. .Leslie W. Dryland, County CommISSioner, and the :'IlarchlOness of Exeter County President of 1 ursing Divisions, has been forwarded to Her Royal Highness's lady-in-waiting: " On behalf of all the members of the St. John Ambulan ~e Bri&;ade in Northamptonshire, ,,,ill you kindly cOt1\'ey their ,:ery grateful thanks to Her Royal Highness for the g reat lIlterest she has taken in their "'ar " 'ork in this county. " Her Roy~1 H.i gh~ess's recent tours to first aid pos'ts have been an IOsplratIOn to all those who ba\'e had the privilege of meeting her. \V e can assure Her Royal Highness that the result of her visits will be reOected in t he in creased eJ1iciency and enthusiasm of the Briaade personnel who man these important posts. \Ye ma/' add that the members were. delighted ~o see Her Royal Highness wearing on each occasion the untform of Oeputv Command a nt-inChie~,of ~ursing Co;ps and Di\·isions. - Yours sinc~re.ly, (SIgned) LeslIe \1,7. Dryland, County COmlTIlSSIOner ; 1\1 yra Exeter, County President of Nursing Divisions."

LEICESTER.-On December 11th H. R. H. the Duchess of Gloucester paid a \'isit to Leicester to inspect St. John U nits and A. R. P. first aid posts and depots. The Duchess, wearing the Brigade uniform, and accompanied by Lady Zia \\'ernher, Lady County President, first went to Cossington-street post where she ,,'as received by the Lord Mayor and Lady 1\1ayore~s A Guard ot Honour was composed of Brigade members. Presentations were made to Her Royal Highness including the Town Clerk (l\lr. L. i\1cE\'oy), the County Commissioner of Leicestershire (Mr. G. F. Browne), the Lady County Superintendent (l\liss G. E. Partridge). During her stay at Cossington-street, the Duchess invested liss Lilian Broadhead with the Serving SiSler i\ledal of the Order. Leaving Cossington-streeet Her Royal Highness visited Belgrave House and later had tea with the Mayor and :\layoress, in the luseum Buildings, before leaving the City with Lady Zia. During her visit the Duchess witnessed a demonstration of "action stations" and was shown the complete operation of a first aid post by Dr. E. K. Macdonald (111. O. H.)

:\'ORTHA;\IPTON. - On December 11th Corps Sergeant I\lajor G. Hines completed his half century of service with the Brigade. He joined the Northampton Corps on December 12th, 1889, being promoted to Sergeant on January 3rd, 1899. He sen'ed with the Territoria l Army from August 4th, 1914 to April 25th, 1919. For his services to first aid he was admitted to the Order as a Serving Brother; he is also the holder of the Service Medal with 6 bars. Su c h a length of continued sen'ice would be hard to beat and we co ngratul ate Sergt. -:'I1ajor Hines on his long and efficient service to mankind,

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No. IV District LA 'CAS HIRE. BLACKBURN.-On December 9th, the Bishop of Blackburn (Dr. P. M. Herbert) presented lon g service and other awa rds to members of the Blackburn Corps. Th e work of the Brigade, said the Bishop, though no doubt taken for g ranted, was appreciated by the community fu r t he service and help that it represented. Th e l\Iayor (Councillor E. Porter) who presided, said the \'0 1u n ta ry servi ce of am bu lance workers was to many peopl e amazing. Both as a private citizen and as Mayor he sincerely va lu ed the work of the Brigade. Asst. Commiss ion er Dr. Clegg presented a history of The Order to the Bi shop, and suggested that the Brigad e should start a fu nd with the object of having a part of the ne\\' cathedral dedicated to the Order of St. John. In repl y the Bishop welcomed Dr. Clegg's suggestion. Thanks to the Mayor were expressed by Corps Surgeo n Clarke and Alderman W. Kenyon, J. P. Among the awards presented were third service bars to Ambulance Sisters !'I1rs.]. A. Brown and Miss A. Thompson ; second service bar to Corps Officer R. H. Harrison; firs t service bar to Di v. Supt. R. Mercer; and a service medal to Corps Sergeant-l\Iajor F . Baxendale. Corps Supt. J . W. \~/a lmsley in his report, stated that since September, 1938, the Corps had been responsible for the training of 1,323 men and women in first aid, home nursing- and air raid precautio,ns, apart from the instru ct ion given to membcrs of the Corps.

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president) . T he inspection of the parade was car ried ou t by Colonel Baker. The a wards gained by the nurses were presented by the l\I ayor and, su bsequently, the Mayoress handed o\'er those ga ined by the me n . Incl uded in the presentations were: Vice-president's ba.dge and. warrant, Col. G. C. K. Clowes; "Tedder" cu p, MISS E. L1I1der ; " Copeman" cup, Mr. R. Guthrie; B. R . C. Bl.ood Transfu.sion Society'S bron ze meda l, Girl Cadet Supt. MISS L. Rob1l1son; warrants to Cadet Officer A. Piper promoted to Cadet S upt., and to Private R . Dewing promoted to Cadet Officer. Medals (proficiency), Miss A. Butch er, l\lr. F. Ward, l\Iiss]. T aylor, and Cadet R. Spalding. Shields, Boy Cadet A. Self, Girl Cadet J, West. Col. Baker congratulated the parade on its sl1lartness and efficiency. The Mayor said that during the past year the Gra , d Prior's Cadet Badge had been gained by Girl Cadet J o)'ce Taylor, t he first ot its kind to be gained in Becc1es. Dr. Wood-Hill proposed a vote of thanks and referred to the ambu lance run by the Division. He in vited th e public to visit the first a id hut.

Letters to the Editor. \Ve are in no way responsible for the opi nions expressed, or the statements made, by Correspondents.-EDITOR.

No. VI District

VERSES

SLEEKBURN Dn'ISION. -To ce lebrate the 25th anniversary of the formation of thc Division, a supper was held recentl y. Supt. R. G . A. Bullen\'ell presi ded, being s upported by County Olncer G. R. Curry, Div. Surgeo ns J . Brown, B. B. :\fable and Div. Surgeon Lowry (Ca m bo is Di visi on). . The chairman referred to the progress of the Division , ",hlCh to-day was stronge r than ever, and welcomed the guests. " The Division was fo rmed in 191+," said Supt. Buller\,'el l, "and tv-n ight, 25 years late r, \\'e acrain meet in the midst of war. The Brigade is not a milita~y order. It is a ?istinct, civilian body of people who give their time to helpIng other:;. The members are always read y. Under war conditions, we ha"e more or less, been absorbed by another mo\'ement- r\. R. P. \Vhi lst, however, we are prepared to \\'ork \\'ith others, \varde ns, police office rs an d other branches of A. R. P., \\'e must still remember that we are members of the Brigade. We must not lose our identi ty." County Onlcer Curry, who presented the a\\'ards, re c~lkd the formation of th e Di"isi on. During the period of 2::> years there had been ups and d own s, but, co ntinued Mr. Curr)" if you can o\'ercome the" dO\\'l1s," you ca n man age the" ups." Referring- to A. R. P. work, apart from reserves with the Forces, the Brig-ade had been given the task of forming a n uc1e us for first ai d parties and post". J

No. X District BEcc~E~, :-Furlher evidence of th e efficiency of t he Beccles DLvIsIons was forthcoming at the a nnual presentatio n of awa rd s whi ch took place la st month . The parade, under Supt. vV. C. Watts, consisted of 111CI1, nurses, boy and g irl cadets and the bugle band . Amol1>{ those present were the Mayor and Mayoress of Becc1es (:\lr. and l\Jrs. Allden Owles), Lieut. B. Granville Baker, D. S. 0" D r. H enry vVood-Hill (divisional surgeon and Deputy Mayor), !\Ir. C. L. Hamby (divisional president) n ndCol. G. C. E. Clowes, D.S.O., O.B.E. (a new vicc-

WANTED.

DEAR SIR , Please co uld you furnish me with some lin es of poelry o n P oiso ns. I remember just these few line s : I f he snores like some old Druid Give him a dose of Candy'S Fluid. If in case of long stagnation Resort to artificial re~piration. . 1 should be very pleased to see th e remainder published. I t IS about twenty years since I saw it. -Yo urs faithfully, F. S. WI LKII\SON . [.We have looked through our files but ca nn ot find t h e remaLnder of the poem. P e rh aps one of our readers can ass ist the writer. -ED ITO R. ] BRIGADE

EFFICIENCY.

DEAR SIR, Th e decision arrived at by the Commissioners and Assistant Commissioners of the St. J ohn Ambulance Briga d e at thei~ confer~nce (page.119, December, 1939, FIR ST AID), regardil1g effiCIency of Brigade members will in my opinion p lace a handicap on th e real voluntary first aider. ' A full-time A. R.P. worker is but carrying o ut his work as an employee of a local authority and {yi ,'es nothing in time or service to the movemp.nt. ~ T.he voluntarY:' part-tim.e me.mber d oes how ever give both tIme and servIce after hIS ordlllary day's work has been completed. Therefore, to make him do six drills, as against the full-time paid worker's nil, is an injusti ce. Perhaps other members would gi\'e th eir vie ws on this suhject.- Yours faithfully, N. \VILLlAM SO N.

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AID

Priory for JOINT WAR ORGANISATION. THE Priory is represented on the] oint War Organisation of th e B r itish Red Cross Society and Order of St. ] ohn by its P r incipal Secretary, the Hon. John H. Bruce, J . P., D. L., and Mr. R. Wilson Bartlett, J . P., F.S.A.A. , the latter serving also on the Executive Committee. Brigade Units in coastal towns of Wales recently recei ved through the Priory copies of the following circular issued by the Joint War Organisation: " Relief to Persons Shipwreck ed by Enem y Action." The Red Cross and St. John War Organisation has undertaken responsibility not onl y for the care of th e sick and wounded of the fighting Services, but also for civilians injured by enemy action. Of the latter class, men of the Merchan t Service and Passengers have a claim on the funds of the War Organisation as great as that of the fighting Services. The Red Cross and St. John War Organisation has therefore been in touch with the Shipwrecked Fishermen and Mariners Royal Benevolent Society in order to see what action is appropriate. The Benevolent Society is responsible for clothino- feeding and temporarily boarding shipwrecked mariners ~fisher men and passengers where necessary: for seeing to their conveyance to hospital when necessary, a nd for providing- a warrant to their homes, either at once or on their discha ro-e from hospital. :-:. The following action is s uggested : (1) That Detachments of the Society and Divisions of the Order should get into touch with the local R ep resentatives of the Shipwrecked Fishermen and :\Iari ners Royal Benevolent Society. (2) That first aid treatment and ambulance transport from place of landing to hospital sho uld be provided at the port of disembarkation where necessary. (3) That in any case where the liaison between the local lifeboat and the corresponding Detachm ent or Division is not good, it should be improved, so that members of the Society or the Order may be available on shore whenever the lifeboat is out. The cost of any ass istan ce, up to a reasonab le amoun t, rendered by Detachments or Ui visions will be a cha rge against the funds of the Red Croc:;s and St. John vVa r Organisation. "

J oint Flag Days. - The Priory will be circularising its Units with a view to the adoption of the sug-gestion put forward by the Sub-Prior of the Order in the following circular on the subject of flag days organised o n behalf of the R ed Cross and St. John War Organisation : " It is proposed to hold two National Flag Days on the 5th J une and during October, 1940, throu g hout England and Wales. T he Lord Mayor of London, who has undertaken the task of raising money for the War Organisation, has very kindly consented to co-operate and to add the organis ing resources of the Mansion House to those of the two Bod ies, so that the appeal may have the strongest possible support and the widest possible basis. "The appeal w ill be issued by the Lord Mayor'S Flag Day Committee of which Lor d Luke is chairman, with Sir Joh n Du n can of the Order of St. John of Jerusalem and Lord Ebbish am of the British Red Cross Society as vice·

Wales.

chairmen. It will be addressed to all Lords Lieutenant of Counties, to a ll Lord Mayors and l\1ayors in England and W a les, and to all District Councils. " As the ~lag Days may adversely affect the usual Flag D ays on whIch Branches of the Society and the Order larg-ely depend, it has been decided that 50 per cent. of the net proceed~ r~ised in each area will be refunded by the \Va r OrganlsatJOn to the Branches of the Society and the Order, fo r. their local work in that area. The proceeds of ~ ll collectIO ns must, howe\"er, be forv;arded in the first IOstan ce to the Mansion House. As in the case of the proceeds of the Flag Day held on tbe 10th October last, the bas is for tbe al location of the 50 per cent. due to be refunded in each a rea will be agreed by a Repr~sentative Committee appoi nted by the Parent Bodies who will apportion the money refunded on the basis of the numerical strength as at 3 1~ t December~ 1939, represented in the Counties by the Bngade formatIons and the Branches of the two Bodies. " The Flag Day organisations of both Bodies will be used both at the Mansion House itself as well as in the Counties, Boroughs, etc., and Rural Districts. It is co nsid e red that more money will be raised both for the Central FUlld and for the local organisations by oro-anising this combined effort. . ~ , " It is obvious that, in addition to the welfare of the sick and wounded, the security of our Association and Brig-ade finances ~'ill depend on the success of these Joint Flag days, and I therefore earnestly request all supporters of the work of the Order of St. John to do their utmost to ensure a resounding success by e"ery means in their power. " I suggest tbat Chairmen and Secretaries of Association Centres, County Commissioners, and Assistant County Commissioners, and Omcers in charge of Units get ir,to to uch \Nith Mayors and Civic Heads within their areas. They can offer the co-operation of their Organisation and encourage their members to assist in the collection." HOSPITAL LIBRARY SERVICES. In the report of the Cardiff City Librarian, 1\1r. Harry Farr, appreciative reference is made to the sen'ices of nursing members of the Brigade who continued throug-hout another year to attend the hospitals on one afternoon a week to give vol un tary assistance to the members of the City Librarian 's Staff responsible for the maintenance of adequate library services for the patients. The stock of books provided by the City Council is supplemented by a regular supply of magazines collected by the staff at Priory House, which are greatly app reciated by those unable to enjoy more constant reading. The following extracts from the report are of interest : " Llandough HospitaL-During 1939, the work of the H ospital Library Service at Llandough Hospital has been carried on steadily, with the exception of the e\'acuation period. \Ve have -been fortunate in retaining the help of the voluntary helpers from the St. John Ambulance and the Red Cross Society, who have been with us from the beginning and have not yet been called away to any war work. . . . 11,181 books were issued during 1939." "Cardiff R oyal Infirmary.-The Hospital Library is now in the fou rth year of its existence. It is very well used by sisters, nurses, doctors and patients. . . . The issue shows an increase of 1,806 on last year: 1937- 13,676 ; and 1938-9, 15,482 The British Red Cross Society and the Order of St. J ohn still continue to help us in spite of the increased demands lipan them," I

FIRST IC City Lodge Hospital. -The pop ularity of the book sen'ice can be judged by the increase in the number of books issued for this year-10,8-+2 volumes against last year's flgure of 9,017, d espite the evac uation of patients . . . . An electric lift, rece ntly in stal led , has helped somewhat in the means of transport around the hospital, for the trolley is of use only on the g round Aoor. A liH;5e basket is our indispensable ally for upp er wards. \V e are fortunate in o ur four helpers , two of whom are sent from the R ed Cross Society on Tuesd ay and two from the Order of St. J oh n on Friday. They are most faithful, and it is a great help in having the sam e persons each w eek."

- - - .-- .----

London Stretcher Bearers' Competition. TH E L ond on R egional D efence is running a competitlOl1 on the basis of preliminary tests in each Borough to select the best party, to be followed by a group co ntest and, lastly, a fi nal competition. Certain results have been sent in in cluding the following : DEPTFORD.-Six teams competed before Capl. A. C. White Knox, lIl. C., M . B, who set and judged the tests of the Deptford Borou~h Competitions; he \\'as assisted by Supt. W. H. Webb a nd officers of the i\o. 16 (Xew Cross) Division, S.J.A. B. The case was t hat of a goal keeper who had been charged some what violently against a goal post. The injuries were: shock, fra ctu red right collar bone, fractured ri~h t shoulder blade, fractured 8th and 9th ribs, and the patient was coughing blood, had bitten his tongue, had a left" black eye," and also a sprained left ankle. In the time given for the test the teams had to do qu ick work, but all did exceptionally well. l\falpas-road (Leader, Mr. ~lelo y) gained first place, followed by Kender-street and Griffin-street.

HARRow.-The Harrow C.D.C. fi nal was held on December 16th, when one team from each of the siN. Stretcher Bearer D epots competed. The judges were Dr. Alice Burn, Div. Supt. H. V. Shrosbree, and ~l ess rs. A. J. Wood and H. E. Salisbury of S ].A.B. :\Ir. Geo rge Kirkham (Camden S .JA. B.) was com petition and organ ising sec retary. The teams were required to deal with a warden whose ri ~ht leg hal been severed; a man who had a fractured thigh and co ncussion; a boy who had a lacerated wound on the left temple, and a woman who became ve ry hysterical after having been burned. Five minutes from time a gas wa rning was given, and the teams had to d on respirators, also protect the patients similarly from the effects of phosgene. The cup was presented by the Chairman of the Council Councillor A. J. Lambert, who congratulated the teams o~ a fine performan ce, and also praised the spirit of the stretcher bearers in the Harrow dist r ict. He was supported by the members of the Council, Dr. E . Caryl Thomas (:Y1. O. H.) and District Office r F . Claridge (S.]. A. B.). The result was: 1, CH , Granada Cinema, 182t ; 2, C:8, Rayner's Hotel, 180 ; 3, C16, Stanmore, 158; 4, C23, Pinner, 150; 5, CiS, Ruffell's, 149 ; 6, C20, Priestmead, 132. ST. PANcRAs.-The Borough cvmpetltlOns, held on D ece mber 13th, pro ved very interesting and instructive. Dr. N. Corbet Fletcher was the judg-e, assisted by officers of the S. J A. B., there being eight teams.

FIRST

AID The scene of the co 111 petition represented a ga rage on which an H . E . ha d exploded, causing iniury to five patients. Th e call was se nt to stretcher bearers who had to proceed to the ce ne of action i'lvoiding certain roads which ha d been de clared" blocked." Spec ial marks we re given for quickness in arnvlng. Afer ten minutes another" red" wa rn ing Wi'lS g ive n, this being a hint for speed. Five minutes later the test ,\'as stopped o n the theory that raiders were then overhead. The injuries were : '0 . patient, chest wound. not bleeding, no pulse, not breathin~; Xo. 2 patient, simple fractures tibia and clavicle ; ~o. 3 patient, compound fracture femur and arterial h::.emorrhage ; ~o. + patient, wound forearm venous h::.emorrhage, not serious; 1\0. 5 patient, hysteria. There were also individual and vi,'a "oce tests. Inverness-street party (Leader \V . A. Richards) gained first place, foll o wed by Bartholomew-road party, and .-\Jd. \\ m. Ellis rarty. The marking sheet for the mClin scene hein g somewhat of a no vel nature, is ~in! n here\\' ith : R espi ra tor at the alert, A" p o\'('r but not fastened Correct fastening- of whipcord and correct position \Vaterbottle on ri g ht s ide and co ntain!' \yater Individual pouch on left side, fastened down Check on contents of the pouch Check on contents of th e party haversack ... ... Smartn ess of men and attitude whilst being inspected A 11 owance for speed y arrival ... ... ... Smartn ess in alighting- and unloa ding Instru ct ion by No.1 to dri ve r re parking his ca r Clear orders to lOS . 2 and 4 <'is to action. .. Taking No.3 with him to the incident Prom pt return to 1\0. 3 fo r other bearers... If message left for dri ve r to act upon on return Check on return of stores to cars Correct number of blankets an d stretchers Correctly packed individual have rsacks Correctly packed party haversack R et urn of waterbott1es

3 2

4 2 -+

5 5 10 -+ 2 2 2 2 2 -+

5 5

Co\'er ing by blankets and one folded und e r man 5 Early loading on to stretcher .. 1 Care in loadin g and with the fracture .3 Care in loading into ambu la nce 5 Labellin g- case with " T" a nd time 5 :'lI a r king forehead of "ictim \\'ith " T" 3 Tell dri"er what case i and to go to hospital 3 .) Extra marks if driver as k ed if he knows W3':\ ote. -D ri\'ers of ambulance will state what they "'ere tol d. :\0 . 2 J eDGE. Treatment of Forearm case. Examination of the \\'oun d and noting "enous haem... De cisi on that no foreign body in \l,"ound ... Tactful handling of the patient to console De cision that shock is not marked Firmly bandage \vound \\'ith dressing Large a rm sling O ffer patient drink of \vater CO\'er to keep warm Eliminate other inju ri es by question to man Deci de to assist to sitting ambulance Instruction to dri\'er re type of ca e Ins tru ction to driver re de tination Treatment of Hysteria. F irmness with out force or harshness Ask if bystander near (yes) Explain to bystander what is required Get bystander to take man to F. A Post Treatment of Tibia and Clavicle.

AID Coyer to keep "'arm Offer patient drink of water Treat cla\'ic1e with suitable pad, sling and bandage round bod\" Extra marks i{ no unneces an work don~' Instruction to dri\"er re injury" and di po al

S -'

SOCTfH.. ATE.-:'II embers of the 'outhgate Corporation ha\'e presented a siher trophy to be held by the winning team of the Local Stretcher Bearers competition. On December 9th one team from each of four depots (after eliminating contests) "ied for the honour of holdinl:; the trophy and to represent the Borough in the further competitions. Dr . Simpson, Barter, Gilchri t and Griffiths were the judges. ~h . .-\. E . Gooday (.-\mbulance Transport Officer) was responsible for the arrangement . T he men four patients sufiering from numerous inju ri es, including fractured humeru with se,'ere arterial haemorrhage, fractu r ed cla':icle, abdominal wound, se\'ere wounds. The :'Ilayor (Cr. Robert Grant, J. P.) presided oyer the proceedings, supported by the ~layoress (~lrs. Robert Grant), ,,'ho distributed the awards, Cr. Geo. Pe,erett (chairman, Public Health Committee), Cr. A. R . .-\bercromby (chairman, Ci"il Defence Committee), Cr. R. B. Dearle (Deputy Chief Warden), Cr. \'. J. Westlake, Dr. Louisa Westlake. and Dr. Clunie Han'ey (:'II.O.H.). The \\'inning team ""as -+7, BO\\'es Road, followed by Bowes Road Swimming Bath, Groyeland _ and Barrowell Green. It is interesting to note that Stretcher Party Derots in Southgate are manned alma t entirely by members of thf' X o. 118 ( outhgate) Di\'ision, S.]. .-\. B.

.3 2

5 3 .3 -+ 2 '2 .3 '2 :2 2

5 5

If time not wasted on the hysteria case \\'arn man not to move arm or leg Tactfu l handling of patient to console Decision that shock is not markeJ Treat the tibia first Eliminate h::.emo rrha ge by inspecting .-\pply one splint and essential bandages

- -- . -

.----

The annual ball and "bist drive arranged b, the Hebden Brid~e Corps, S.J ..-\.B., took place on F~iday , J anuary 5th, and pro\'ed a great success.

'2 5

Details of th e treatment of patients. 1 O. 1 JU DGE . Prompt action of leader in setting- men to '\'0rk ... ~otin g the hcemor rhage in femur case and quick action Putting two m en to this case... ... ... Putting- one man to forearm case .. . Early de cision t hat the chest cast: is dead .. . Tact in getting rid of the hysteria case \Varning tibia case to remain still Putting driver of car to work on tibia

DRILL

10tll1 g absence of pulse and breathing Cover over and leave for present

...

Treatment of the Femur case. Prompt call fo r the R. S. D. men (near by) Ask them to raise the weight carefully ... As soon as r aised high enou~h h c£morrhage is arterial.

announce that

Prompt application of digital pressure Prompt application of tourniquet ... Judge to check posirion of the pad; if correct Early. covering of the wound by dressing.. . Care 111 removal from the baulk Application of one splint and so~~ bandaR~s

A.PPLlCATIO:\

THO ~L-\S

PLI :\ T.

(To be read in conjunction wi th Appendix IlI-" First .-\id to the Iniured," S.J.A.A.)

(a) Proceeds direct to patient (w ith No. 3) and covers him " 'ith blanket.

( c)

Threads ring of splint oyer boot and up limb un til it is against buttock.

(e)

the

Ties middle sling and slings under a nkle and calf; also narroW bandage just below knee. (g)

+ 2 3 3 5

] ~dge to decide whether the few bandages wou ld sat is facton1y hold the fractu re. T ime is more important tha n book style.

Tightens Spanish windlass.

(j) Ties narrow bandage around splint and stretcher handle .

Bearer :\0. -+.

Bearer X o. 3.

Bearer X o. 2.

Bearer 0f o. 1.

Examination of the Ch est case. N ot~ that wound is not bleeding (can ask 7'e this)

FOR

Prf'pares stretcher \\·it h X o. -+.

See l\ o. 1.

(d) Prepare "clo\'e hitch" bandage and places it in position over ankle, fastening extension hands to notched bar.

(b) Applies manual extension.

(t) :\pplies Gooel- splinting, ties sl ing'S under thigh and also reta inin g bandages.

(d) Rem oves one hand at a time to allow passage of splint and" clove hitch" bandage a nd supports end of splint.

(i) (h) Places pad in ring of splint.

(a)

.-\ssists :\ o. -+ in fixing splint to suspension bar.

'0.

(b) Steadies and supports limb aboye and below seat of fracture keeping knee ~light1)" hent.

(h) Springs tirrup onto splint and ties retaining bandage: fits suspen ion bar and fixes plint thereto.

"'1 B . - Th e 1etters .In parent h ese \'ndl'cate sequence of (01Iflll enCeme71t of the \'arious details. n.

FIRST

144

FIRST

AID

Railway A mbulance News. Great Western. The presentation of the" Athlone" Bowl to 1'.lr. G. S. Hodder, divisional ambulance secretary of the Bristol B. Division, was made by l\Jr. R. G. Pole, Div. Supt. at a luncheon held recently at Bristol. The trophy was given by the Rt. Han. the Earl of Athlone in the year 1927, with the object of encouraging recruits to the Great Western Railway ambulan ce movement, and is awarded to the Division gaining the highest numcer of re.:ruits in proportion to the adult staff. It has this year been won by the Bristol B. Division with the excellent percentage of 4'28. In presenting the Bowl, Mr. Pole congratulated the divisional secreta ry, class secretaries and members of the divisional committee on havlOg achieved this result j and his remarks on the good work done in the Bristol Division were endorsed by l'vlr. R. G. Barefoot, district goods manager, 1\1 r. H. A. Alexander, divisional engineer, and i\1r. W. F. Wills, secretary of the Bristol A. Division. Mr. Hodder, in reply, expressed his appreciation of the assistance given to the movement by the divisional officers. The trophy has in past years, been won on five occasions by the Swindon Division, twice by the London A., Central Wales and Exeter Divisions respectively, and has no\v, for the first time, found its way to Bristol. BRISTOL.-The Mead Hall, Bristol, was the scene of the annual concert and the presentation of awards, arranged by the Bristol ambulance classes. 1'.1r. R. G. Barefoot, district goods manager, presided, supported by !\Ir. H. A. Alexander, div. engineer, and 1\1r. R. G. Pole, Div. Supt. and ;'I[r. C. L. Simpson, Div. Loco. Supt. The Bristol men's class is the largest station class on the Great Western Railway system, and of the 223 members who took the examination, 218 passed, twenty-four of this number being recruits. The chairman congratulated the members, and said that the possibility of "black-out" eventualities rendered first aid knowledge of more importance than ever. A report of the class work was presented by the secretary, Mr. E. E. Jakeway, and for the women's class by Miss W. U. Smith. Mr. Jakeway said he was proud of the fact that no fewer than 2-1-1 first aid gold efficiency awards had been gained hy members of his class. The distribution of the examination awards and a number of g-old medals was made by Mrs. Alexander. NE\vTON ABBOT.-The awards to the Newton Abhot Class were presented by Mr. R. W. Higgins, Div. Traffic Supt. (Exeter), on Saturday, Decemher 9th. The chairman (Mr. A. W. H . Christison, Div. Loco. Supt.) congratulated the class on their past work, and hoped all members would do their best to keep the movement alive during the preser.t time. He stressed the importance of the knowledge of first aid amongst the staff. The secretary, Ir. F. Northcott, in his annual report, stated a total of 108 took the examination, and that 100 per cent. passed, Mr. Higgins, in presenting the awards, was very pleased to see so many new members, and he hoped all present would do their best to keep the movement alive and encourage their fellow workmates to take a course of first aid.

AID

- - - - -------------------------------------------

During the past five years the Exeter Division had won the "Athlone" Bowl twice, been placed second twice, and on one occasion was fourth. This was a very creditable perforrnance and reRected the great amount of work and time g-iven by the class secretarips and their helpE rs . lessrs . S. Lewis and H. Warren proposed a vote of thanks to 1\lr. Higgins and local officers, and Messrs. B. Cooper and T. Bearne proposed and seconded a vote of thanks to the chairman, 1\lr. A. W. H. Christison. Those present included Mr. Johnson (station-master), Mr. Smith (goods agtnt), and Mr. largetts (district inspector ).

London and

~orth

Eastern.

The Special Ambulanoe Committee's Annual Report of the ambulance activities on the London and North Eastern Railway during the year ended September 30th, 1939, is a record of further steady progress. The number of ambulance classes increased from 361 in 1938 to 418 in 1939 and there was a corresponding- rise in the number of members enrolling. The total staff employed by the Company in 1939 was 170,271 and of these 8,023 Rained ambulance awards. This compares with a staff of 177,236 and 7,225 awards in 1938. One hundred and eighty gold medals and 107 gold bars were earned by railway ambulance men, making a total of 1,589 gold medals and 1,200 gold bars since the inception of these awards. Competitions were again an important feature of railway ambulance work and during the past year 182 teams entered competitions held under the auspices of the L. N. E. R. The Special Ambulance Committee appreciate the fact that railwaymen trained in first aid, have rendered valuable assistance in providing trained personnel for the Company's A. R. P. schemes, and in view of the urgent importance of such knowledge under present conditions, it is desirable that a progressingly increasing number of the staff should identity themselves with the ambulance movement.

Southern. MERITORIOUS FIRST AID CERTIFICATES.-At a recent meeting of the Southern Railway Centre Committee, the following members were granted certificates : Police Constable R. Barton, Portsmouth, and Fireman A. S. Garrett, Eastleigh. These men rendered first aid to Foreman Shunter Turton, who was knocked down by an engine and received serious injuries. Lengthman W . E. Coster, Virginia \Vater. This man was on the spot when a colleague came into contact with the live and r u nning rails. After removing patient from contact and applying artificial respiration, he efficiently treated burns which were present. Porters W. Lemon and W. Sisley, of Havant. On the occasion of a train collision these two men rendered first aid to two lady passengers. One lady had deep sralp wo und down right side of face, lacerated right leg, bru ised left leg and suffered severe shock. The other passe nger received injuries to the legs and shock.

The hospital officials, to which the patients were taken, congratulated the men on the efficient work performed and stated that, without doubt, Porter Sisley had saved the life of the more seriously injured patient. Lengthman J. Hyland and Sub-Ganger E. Smith, of Selhurst. Hyland, with the assistance of Smith, 'was instrumental in removing- a colleague from the live rail when the latter's shovel came into contact with the rail, causing- a short circuit. Artificial respiration was performed and burns treated. Relayers F. Denman and W. Downs, of Burgess Hill. These men found a labourer lying on the conductor rail. Relayer Downs performed artificial respiration for 20 minutes and Relayer Denman continued the application for a further 25 minutes before breathing was restored. Meanwhile a doctor had been sent for and he ordered the patient's removal to hospital. DIVISIONAL COMPETITIONS.-The Centre Committee have decided that the annual divisional competitions ::.hall be cancelled for the period of the war. It is hoped, however, that members of the first aid movement will not allow their interest to wane and neglect their practice, but will make every endeavour to maintain their efficiency in this important work by regular attendance at classes.

Reviews. FIRST

AID

FOR

EVERYBODY.

By A. J. B. Goldsmith, 1\1. B., F.R.C.S. London: Faber & Faber.

Pn'ce as. 6d. net. When we revievved this book in our February, 1936, issue, we expressed the opinion that readers of FIRST AID would enjoy reading this ne\\' manual which adheres more or less strictly to the now generally accepted principles of first aid, if only because it sets these out in a somewhat different manner to that of the official textbooks of the several teaching orga nisations. On that occasion we made comments on certain of the instructions in the book j and we might repeat them now if space permitted. \Ve content ourselves in again stating that Schafer's method of artificial respiration as described therein is not as Schater taught, the flexed upper limbs of the operator and the folded coat u ndt::r chEst and abdomen of the patient being errors which, in examination, would jeopardise tile chances of success of the candidate for an official certificate.

1 45

To this end the manual deals with the organisation of the A. R. P., medical service, the transport of injured persons, the treatment of wounds and other injuries, the action of war gases, and the management of sick room and of patient including those suffering from infectious disease. The sections on first aid and nursing recall the series of articles on those subjects which Major Beggs contributed to FI RST AID from Octoher 19?7 to Septem ber 1928. The popularity of these articles confirm us in the belief that the manual in its present and extended scale, will prove most acceptable to those for whom it has been compiled. Copies are obtainable from 1\1essrs. H. K. Lewis, of London, and from Messrs. Heywood Ltd., of Manchester.

BAILLlERE'S

URSES CO:\lPLETE DICTIONARY.

l'.IEDICAL

Revised by l\larg-aret Hitch, S. R. N., in collaboration with Charles F. Marshall, T\1. D. , ;\1. Sc., F. R. C. S. London:

Baillihe, Tindall & Cox. P1'l'ce ']s. n et.

After an inten'al of less than two years the need ha s arisen for a further (and eighth) edition of this most excellent Nurses' Dictionary, which consists of a dictionary proper of medical terms arranged in alphabetical sequence and accompanied in each instance by hints as to correct pronunciation o'f terms and also of twenty appendices. Of the latter t,,·o are new and deal with blood transfusion and an outline of first aid, as is befittin g in a wa rtime edition. Incidentally, the de cription gi,'en of Schafer's method of artificial respiration is not as Schafer tau g ht and req u i res correction in certain particulars. The present issue, like its predecessors, is easily carried in the pocket and so can be studied at odd moments. It is comprehensive, correct and concise j and it is printed in clear type 011 excellt!nt paper. Indeed it presents a compendium of information which callnot but be helpful to those ,,,ho study its pages. In these circumstances we once ag ain commend wh ole heartedly this dictionary to all our readers , and especially to those who are serving as auxiliary nurs es in hospi~al s and at first aid posts. They will find that it is the latest and most up-to-date work of reference compiled fo r th ei r instruction and assistance.

------.--. ------FouND.-l'.ledallion TO. 287,103 in the neighbourhood of East Ham. Owner can obtain same from :\liss J. F. \AToolford, 1S, Tyrone-road, East Ham, London, E.6 .

Price 1 s. net.

For the ten months ending October 31st, 1939, the classes under Bournemouth Centre, S.].A.A., ha\'e resulted in 1000 first aid, 276 home nursing, 45 preliminary fi~st aid and 18 preliminary home nursing certificates being obtained During a similar period in 1938 tbe total awards ",ere 248.

This is a useful manual which has been compiled for the benefit of A. R. P. personnel by the author, who is Medical Officer of Health of Middleton . It is presented in the form of question and answer; and it will serve to refresh the memories of am bulance workers on points forgotten since they took their courses of instruction. Further, it is of handy size, can be car ried in the pocket and studied at odd moments.

The finals of the first ~' ear competitions organised by the Yorkshire Collieries Ambulance League were decided on December 16th. Dinnington with 239 points won the "Lane Fox" shield, and R. Ransley (~ew Stubbin) the " Embleton" cup in the individual section. l\lajor H. J. Humphreys, Divisional Inspector of 1\1ines for Yorkshire presented the awards.

PRACTICE IN FIRST AID A 0 NURSING FOR NATIONAL SERVlCE. Compiled by Major S. T. Beggs, M.D., D.P.H.

•

FIRST

AID

14·7

Our Nurses' Pages. COM PILED

1\'0.

BY AN

DISTRICT, S.J.A.B. AND BALHA:ll NURSING Dl\·ISION. - -The Rev. H. A. Eyton-Jones, Vicar of St. Alban's, Streat.ham Park, has been appointed Vice-President and Chaplam of this Division. He has a very good knowledg-e of the work of a Nursing Division for before coming- to Streatham about a year ago , he was Vice-President at Brighton, an enthusiastic centre of the St. John Ambulance Brigade. j

S TREATIIA~r

No.2 DISTRICT, S.J.A. B. ~llI.TON NuRSING DI\'ISION .-Officers and members of this Division met at a tea at Kimbell's Cafe on Satu rday, December 16th, the guest of honour being Dr, Frances ~l. Norway, who has resigned fr<?m the pos ition of D ivisional Sura-eon on leaving the City of Portsmouth. ~On behalf of the Division, Lady Div . . Supt. Miss 1\1. Olding-, presented the docto r with a table cigarette li.g~~er, thanking her for all the wo rk she had done for the VlvlslOn and hoped that she would be spared for many years to use their gift. Dr. ;\'orway responded, and handed Miss Olding a cheque for divisional funds. Flowers were presented to Lady Corps Supt. 1\1rs. Fulljames, 1\1. B. E., Lady Ambulance Officel' Mrs. A. Clarke, and the Divisional President, Mrs. L. Nellthorp. l\1rs. Clarke, on behalf of the members, asked Miss Olding to accept a bouquet of pink carnations and white heather.

1\'0. -+ DISTRICT, S.].A.B.

SEFTON llRSING DJ\'ISION.-Tbis Division held a special e\ ening at Brigade Headquarters, l ; pper Duke Street, on December 15th, in honour of Miss B. A. Pearce \\'ho has been promoted to Corps rank, thus necessitating her relinquishing- her position as Lady Di\·. Supt. which she has held since 1929. Miss Pearce joined Lhe Sefton Nursing Di"ision in 1914, and worked' hard at the Myrtle SLreet " A " Military IIospital during the last war. On behalf of the mt>mbers of the Division, Lady Corps SupL. Dr. fargaret Joyce handed Miss Pearce a travelling \\'ritin~ case. Medallions were prespnted to the newer Ambulance Sisters of the Division by County Surgeon W. Murray Cairns. There were also present on this occasion Lady Corps Officers Miss M. Bellasis and Miss Craig, Div. Surgeon Duval, and Dr. and Mrs. Howard. All spoke very highly of the work done by Miss Pearce, and the new Lady Div. Surt., Miss E. L. Harwood, was asked to carryon the fine traditions of the Sefton Jurs ing Division. There 'were qbout 30 Ambulance Sisters present, and the cake cut in honour of the evening was made and given by them. :\TORTHERN IRELAND DISTRICT, S.J.A.B. LURGAN NURSING Dn'ISfON,-The annual inspection of the Lurgan Nursing Division took pla\.e at the; A. R. p, HalI , Lurgan, last month,

AMBULANCE

SI STER.

The inspection was carried out by A:sistant Commissioner J. Harris Rea, who was accom pal11ed by County Officer A. S. Ring-er-Hewett. There were on parade 32 officers and members ~n charge of Lady Di v. Surgeon Evelyn Russell and Lady Div, Supt. Mrs. 1\1. D. Ringer-Hewett, assisted by Lady Ambulance Officer l\liss 1\1. Caulfield. The members acquitted themselves with the. highest efficiency in squad drill, stretcher work and bandaging. The Inspecting Officer co ng-ratulated the 0!11cers and members on the splendid ""ork they had done III Lurga~ since the formation of the Division, and said he was partic ularly pleased to note that many of their members were now enrolled in the Civil Nursing- Resen'e and A.R.P. IN SPECTION AT CLACTON. Viscountess Byng of Vimy paid a visit of in.sp·e ction to the Clacton branch of the British Red Cross Society, Essex 86, on Saturday, December 16th, at their headquarters at the Middlesex Hospital, Clacton-on· Sea, and was mu ch impressed with the excellence of their'>' ork The officers of the detach ment present were Commandant Mrs. A. G. Kirkness, Hon. Commandant 1\1rs. E. Cowan, Asst. Commandant l\1rs. D. Moss, Quartermaster Miss E. Webb, and Asst. Quartermaster l\ lrs. B. A. Coles. Miss Bowdler, l\latron of the Middlesex Hospital, and Mr. ]. T. [iller, A. R. P. Officer of Clacton, also at tended. Lady Byng was recei\'ed with a guard of honou r cf Red Cross nurses, a nd fo r abo ut an hour watched them at work, attending to the supposed victims of an ai.r .rai.d who w~l~e suffering- from fractured limbs and other IIlJun es: A vlslL was a lso paid to the Cleansing Station, where patIents were supposed to be gas casualties. Lady Byng, who was presented with a lo\'ely.b.ouquet, spoke of her deep interest in the work of the BrItIsh R~d Cross Society, which she described as exce llent. She saId how favourably impressed she was by the smartness and efficiency of the detachment. Before leaving Lady Byng was entertainecl Lo tea by the Matron of the hospital.

D ean Road First Aid Station, Scarborough. This Station held a party on December 29th, given b y Commandant Mrs. Norman Shaw, S.R.N., R.F.N., S.C. 1. The cake illustrated above, was decorated with the Borough Arms, the Order of St. J ohn Cr~ss, and the British. Re~ Cross Badge. At the base can be seen nurses and st retcher bearers at work. 1r. T. G. vVdley (of l\1essrs. \\ IlJe) , Scarborough) who desig-ned the cake is a mem ber of the B, R. C. S. TRAINING SCHOOL FOR WAR-Tll\IE NURSES. Special intensive tr<lining courses have been st~rted for war-time nurses in Oxfordshire, although those takll1g them are not necessarily resident in the c?unty. . . The originator of the scheme IS M.rs. Be\.k~lth-Sn;lth of Stratton Audl ey Manor, the wife of Bng. BeckWIth-SmIth. She po inted o ut to the St. J ohn Ambulance. Brigade an~ the British R ed Cross Society tha t in war· tIme the ordll1ary courses of lectures were not, in her op inion, s uffi cient, and that an intensive co urse would be more val uable. Both o rganisations gave their approval to the scheme, and Mrs. Beckwith-Smi th took o','e r, at her own expense, Ru t land House, Bicester, which she equipped as a training school for nurses. There is a fortnight's course of traini ng in home nursing and first aid, at the end of which an examination is held. Al;out 60 women ha ve passed through the school so far~ ~nd there have been no failures, which speaks well for the tUitIOn, and the keen ness of the students. App lications from all parts of the cou ntry have been received from women between the ages of 18 and 40. If accepted they pay a fee which cove rs the ex~enses. ~fter. wa rds, some go as probationer nurses to varIO US hOS I?ltals, a nd others enrol as auxiliary nurses and do a speCIal 50 hours' course. lf a sufficienl number of women were interested, ot her t raining- centres would be opened in various parts of the l·ountry.

PRESENTATION TO B. R. C. S. NURSES. The Duchess of Northumberland, President of the Surrey Branch of the British Red Cross Society, recently presented special Service Crosses to three R ed C:r?SS nurses at the Victoria Hospital, Kingston. The r eCIpi ents were Commandant Vera Cave, Nurse Isabel Mary Ju ett a nd Nurse Florence Edith Walker, all of the Surrey 92 Detachment. While on night duty at their post, a passenger from the station dashed in to tell them that a man had fallen on to the li ne between Malden and Norbiton. The nurses went by car to the tracks ide embankment, climbed over spiked railinas to the lines, and fi nally found the injured passeng-er after ~ long search in the darkness. Th e injured man, Mr. C. O'Leary of Paddington, was g iven first aid treatment and hauled on a stretcher over the railings to a wa itin g ambulance, At the hospital he was found to be seriously injured .

Binding Copies of FIRST AID. KEEP your Copies of FIRST AID clean and tidyhave them bound. Send your copies for the last Volume (July, 1938, to June, 1939) and we will return sa~he bound in an attractive case of leather clot h , WIt the title of the publication in gold letters on the front and side and the eight pointed cross on front, for 6s., post free. . Complete V vlumes can be supplIed at 9s., post free. Binding Cases only, 2s , 9d. post free.

Principles of Artificial Respiration in First Aid. * By ESTHER 1\1. KlI.LICK, [\1. Sc., 1\1. B. Leeds, 1. R. C. P. E. 1\1. COWELL, D.S.O., "1\1.0. Lond., F.R.C.S., D.L. AND G. P. CROWDE ', D.Sc.Lond., l\1.R.C.P, (From tIle f- ondon SclLooloj ll.ygiene and Tropical M edicille). J IOWADAYS asphyxia, due to the inhalation o! carbon mono ox ide, or electric shock, has hecome ~elatl\'ely common, while drowning is no less rare than It was., . Cfl:bonmonoxide poisoning whether accide.nta.l .or sUlcl?al IS an emergency which n:ay ~o nfr.ont. any I~dlvldual ; ~ll1ce .as .a rule artificial respiratIOn IS ImmedIately reqUIred It IS essential that sound practical instruction in its technique should be part of the education of the cit i ze~ .. The need for this instruction is emphasised by the statIstIcs for d~aths from asphyxia in England and \Vales issued by the ReglstraGeneral. These figures of course do not re\'eal the n~mber of cases of asphyxia which are successfully resuscItated . They are however enough to show that th.e . de?ths fro.m aspbyxia due to carbon monoxide and electnClty IS steadIly increasing.

PIIYSIOLOGIl'AL PRINCIPLES.

In comparing the efficiency of different manualll1etho~s of artificial respiration too much stress has oft~n .been laId on the volume of \'entilation produced. ThIS IS clearly important, but it is only a m.ea?s to an end. In a pers.on apparently dead from asphYX IatIOn, whether due to dro'>' ning, electric ~hock, poisoning or any other cause, .the urgent · t <Yet a sufficient supply of oxygen to the VItal centres nee d IS 0 h . • d tl 'ell of the brain before irreparable damage IS one.to 1e nen e c . s. This in volves at least two other factors besldes the ventIlation of the lungs with fresh air-namely, the passage of oxycren across the alveolar membrane into the blood, a.nd the ~irculation of this oxygenated blood through the. braIn. The ventilation of the lungs, therefore, must b~ car~ led out in such a wa\' that the fresh air penetrates. fight .111 to .the alveoli. For -this to occur, the volume of air passII1g JIl~O l he lun gs with each respiration must he above a certain

* Extract of an article reprinted by the courtesy of Th(' Lance!.

FIRST

minimal ··alue. This minimum will '.-aryaccording to the build and lung-volume of the indi·, idual, but it may sa ely be assumed that a ':olume per brea~h of -r00-500 c.cm. will sa i iy the \"a t majcri'Y of people. The-:rst criterion 0: an efficient method of artificial re-~ira ion is then that it hf'uld produce a volume of \·er.tilation per breath 0; at :ea -C0500 c.cm. In some types of asph.-sia, surh as that due 0 carbon monoxide, it is de-irable to increase the pressure of oX:'gen in the lung al\-eoli abo\'e the nurma] le\-el, so to hasten the remo':al of the noxious substance from the blood. It is then an ad';antage to be able to produce a degree of ventilation consicerabh- above the minimum. The second essen'tial factor is the circulation of -he blood. The mo\-ement utilised in performing artificial respiration should therefore be such as to increa e the circulation of the blood. The next consideration is the passa~e of oxyg-en from the blood to the tissues. The ease \l,-ith which .he blood gi\-es up its oxygen depends in the first place on the di Fference bet'.\-een tr..e pressure of ox) gen in the blood and in the tissues; after a period of asphyxia this difference is likely to be con iderable, since the oxvg-en pre ure in the tissues must be low as a result of the continuous con umption of oxygen. The dissociation of oxygen from hcemoglobin depends , among other thing-, on the temperature an:! blood carbon-dioxide content. :\lo-t forms of asphvxia are associated with the lowering of the body temperatur~, which retards the dissociation of oxygen from the blood. Further, when artificial re piration is''performed, it is guite possible to reduce the carbon dioxide in the blood below its normal limits. This happens the more ea ih- becau e the unconscious individual, with his muscles rel~xed and his body temperature low, is producing less carbon dioxide than usual. If the carbon dioxide in the blood is thus reduced, the di~ so.ciation of oxygen from the blood is seriously hindered. \\ e may therefore add to our critE'ria of efficient artificial respiration that the method must be such as to consen-e body warmth, and that it must not so o\"er-\-entilate the lungs that too much carbon dioxide is remo\·ed. The body temperature is normally maintained b. a balance between the heat produced by metabolism and the heat lost fron: the. bo~y ~n. ,'arious ways. During asphyxia heat productIOn IS tbmlnlshed, as a result of cessation of movement in the unconscious patient, and also because lack of oxygen modifies the metabolic processes. Heat loss, however, continues and may e\'en be increased, as, for example, by. evaporation from. the wet skin and clothing after ImmerSIOn Ir: \\'ater. It IS, therefore, of great import~nce to prevent tillS loss of heat as far as possible by a'-oidmg undue exposure and by the use of additional cOllerin!:;s, such a.s .coats or blankets; in addition, any available source of additIOnal heat should be utilised. . The second main purpose of artificial respiration is to mduce natural breath in!:; to commence once more. To achieve this it is, of course, necessary to get oxygenated blood circulating th rough the nerve cent;es that control natural breathing, but it must also be remembe red that the nat.ur~l chemical stimulus to respiration is carbon dioxide. ThiS IS another reason for a voiding- over-ventilation of the l~ng.s, f~r if the degree of ventilation is such that carb;n diOXide IS removed fast.er than it is produced in the body, then the most potent stimulus to natural breathing is being taken away. . Breathing is regulated through the respiratory centre and the. r:erves connected with it. In certa in conditions, such as Il1Jury to the skull or nervous diseases iike infantile para.lysi.s or diphtheritic paralysis, the nervous control of respiration breaks down, and breathing becomes ve ry weak or c~as:s al.together. The prompt application of artificial respiratIOn In such a case may keep the patient al ive until the nervous s>'stem recovers sufficiently for the nor mal control of b~eathlO~ to be resumed . These patien ts a re u sually treated In hospital, but the respintto r y para l sis may be

AID

FIRST

rapid in onset and so constitute an emergency requiring Dr (aid treatment. L7E'\ERAL TRE.-\T~[E:\T.

_\5 has already been mencioned i is \-ery important to keep the patient as warm as possible. a'ld to a\-oid undue exposure, no~ only to aid hremoglobin di-sociation, but al-o to combat shock. hoc' rna,' be associattd direct"with the asphyxia. but the patie~t mar ha,-e _u-tained other injuries which aggra\'a e it. The-e may need rir t aid trea ment, but a phyxia i- the primary emerg-ency. Con idera ion hould al 0 be given to the po ilion of the patient: where the ground is sloping the patient hould be placed wi h hi head lowe t, ince this as ists the circulation of the blood to the brain, and in ca_es of drowning it help. to drain the 'i\ater :rom the lungs. .-\n exception to this rule is that the head hould he higher than the feet \\-hen the patient has a fracture of the base of the skull, a it is then desirable to decrease the upply or blood (0 the head. If the urface of the ground is rough, the patient sh~JUld be placed on a coat or rug (0 pre,-ent his skin from abrasion caused by the movements of artificial respiration. Oxygen and carbon dioxide mixture are of great value in resuscitation. In asphyxia due to carbon monoxide, it is e sential to raise the oxygen tension in the lung and blood to iree the blood of carbon monoxide as rapidly as possible. Hill and Flack (1908) sU!:{l{ested the inhalation of carbon diox.ide in such ca es to increase the pulmonar) Yentilation, and later Henderson and Hag-gard (1920, 1922) ad\-ised a mixture of carbon dioxide and oxygen in re u citation. The carbon dioxide increa es the \-olume of breathing; the high proportion of oxygen in the mixture, to!:{ether with the increased breathing, raise the tension of oxygen in the lung and in the blood, and the elimination of carbon monoxide is thus considerably ha tened. A mixture of 7 per cent. carbon dioxide with 93 per cent. oxygen is now \-ery generally used in carbon monoxide a phyxia, ,,-ith excellent re ults. It may be administered through a ma k while artificial respiration is being applied. Inhalation of thi mixture may be useful in other cases where respiration has failed, for'the carbon dioxide stimulates the respiratory centre to initiate spontaneous breathing.

Poison s. ~ A POISO:>; is a substance which when introduced into the system in harmful quantities injures the health or destroys life. Poison ma~ be administered (a) accidentally, or (b) with . Intent LO commit suicide or murder. Accidental poisoning may be suspected when the symptom~ ~ome on suddenly soon after taking food, drink, or medlclOe. If the cause be poisonous food, several persons may be affected at the same time, with similar symptoms. Suicid~1 poisons may be suspected when a bottle, glass, c;:up, or synnge, from which the poison has been taken, is round near the patient. Always saYe any bottle, g lass, vomit stained cloth es remains of food (especial ly t inned food), ~ri ne or fceces, i~ cases of suspected poisoning.

_ * Ex,tract from the Man ual. of Instructio n for t be R oyal ;\ aval Sick Berth Staff, repnnted by pe r mission of t he Controller of H. M. Stationery Office. Copies of the Ma n ua l ca.n be had of H. M. Stationer y Office, Ad ast ra l Ho u se, K m gsway, Lon don, W,c'2, or any bra nch, price -t/Sd. post free.

GE,\ERAL TREAT:UE,\T

or FOl-

"IXC

1. Remo\"t~ as much as

0s-ible 0t the F ..,isnn irL m the system. T~i- can' e done b\ ; . \tl The t0mach Tu' :-\,"hen \"ou are sure the tu e IS in thE' stomach. pinch it ~uSt belo~ he 'unnel, till the latter with warm \yat rand rai -e it after unpinchin o . the tubel. 0 that the wa er. w- into the st0mach. '\'he~ {he funnel i- nea.rly empty. quiLkiy im'ert it oyer a uc -et. ard the water and st mach contene will 0W out y -iph,-.nagE'. .-1 !~('tl.L S t, cjJ l;; . stOI/l!z~" ,'on:olls 'or [iit' Jf,'d,,',1: O,Fi,10 Sri'.

AID

Every Nurse and Every First Aid W orker must have ;]

MEDICAL DICTION ARY

......

(b) Emetics (agents which cause \·omiting).-These can only be u ed if the patient i- consciou- and -an -walJ-,,\". and must nc'Lrr be' Ils=-d In a (IlSe' ~ - pvlSO'!llIg f. ' .' «(. .. s;·~,c. The chid emetics are ; -

BAILLIERE'S NU RSES DICTIONARY

1. Tickling the bac - of the throat with the finger or a feather. 2. L ne table po niul of mustard in a tumller full o tepid water. :. Two table poonfuJ- of common salt in a tum ler full of tepid water. -t. Ipecacuanha '\'ine, -t to 6 drachm- in ,yater. .). opper ulphate, 5 to 10 grain- in water. "'0. Tartar Emetic, 1 to 2 grains in water. I. Apomorphine, 1 15 grain gi,-en by hyp0dermi(" injection. nJy (0 be gi,-en by a :\Iedical fficer. (c) Purgari,·es.-These act too -lowly for the trea(menc of acute poi oning, but are used in ca es of food poisoning. a tor Oil, 1 ounce, i the best. 2..--\dminister the Pr.)per .--\ntidote -.--\ntidotes a t either by com'erting the poi on into an in oluble or harmle compound, or by neutrali ing it~ effect in the body 3. Treat the Sperial ymptoms.-For collapse giYe til1lulant and apply warmth. Alcohol,! oz.: Ether, 1 dram; or _--\romatic pirit of _--\mmonia, 1 dram, may be gi\'en in water, and hot trong c ffee or bed tl"a by the mouth or rectum, Prepare a hypodermic yringe, tbe hypodermic tablet case. and s me sterile \,-ater. For failing respiration p rform artificial re piration. For pain apply hot fomentation around the throat or o,-er the stomach. For inAammation of the mucou membranes g-iH' demulcents or soothing- substances a milk, white of 'egg Inixed with water, barley water, oli\-e oil.

is the best book 011 the mar et. It does not merely define \'rords, t explains them.

P01S0:\S. According to its main ellect on the body apison classified as ; orrosiye. Irritant. .--\ l\erve Poison (:\arcotic or Irritant). orrosi\-e poisons are tho e which soften and de troy (he parts with ,'\'hich they omE' in contact. They affect the mucous membrane of the mouth, ce ophag-us and tomach, and usually stain the lips and clothing. The 010 t important a re ; CLASSIFICATlO:--'

1. Tlte Strong Acids Common ~ame S ulphuric Acid Oil of Vitriol

Official Name

Nitric Acid

Aqua Fortis Spirits of Salts H ydrochloric Acid { Muriatic .--\cid Acetic .-\cid Oxalic Acid Phe n ol (Acid Carbolic Liq. B. P.)

Carbolic Acid

How Recogni ed Stains the skin brown or black Stains the skin yello,,'

IN ADDITION

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Stains the skin white mells like vinegar Stains the skin white Resem bl es E pso m Salts in appearance Stains the skin white, has a distinctive smell

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FIRST

15 0

Queries and Ansvvers to Correspondents. Queries will be dealt with under the following rules :L-Letters containing Queries must be marked on the top ldt-hand corner of the envelope" Query," and addressed to FIRST AID, 46, Cannon-street, London, E. C. 4. 2.---\11 Queries must be written on one side of paper only. 3.-AIl 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.-The Textbook to which reference may be made in this column is the 39th (1937) Edition ot the S.].:L-1... :'Ilanual of First ..\id to the Injured. PLCGGI~G

"'Ot;~DS.

S. B. (\\'althamstow).-I should esteem the favour of your answer to the following question : Is it ad\'isable to plug open wounds of the chest or throat \\ here air is bei'ng admitted? If so, please what is the correct method of [-lugging? Is there any possibility of the plugging being sucked into the body cavities? Plug~ing ,...·ounds belongs to " the duties and responsibilities of a doctor" (Principle :\0. 13, p. 26 of Textbook), and, in mr opinion, should in no circumstances be actempted by first aiders. In the case of a wound in the neck involving the trachea it will suffice to dress the wound, to keep the patient's chin depressed, and so to pre\'ent gaping of the \\'ound.-:\. CORBET FLETCHER. EX.-UIl~ATIO:\

HO\\·LER.

D. K. (St. Albans).-Recently I \\'as conducting an examination for a local .-\. R. P. class in first aid, and on putting the following question to a candidate :-" Houl do J'ou know when a patient is in an epileptic fit?" I was astonished to recei\'e this reply :-" IVhen pahe7l 1 g ets violent and chases you round the house.' .' " One gets used to strange answers; but that reply was a new one to me and worthy of a place in your long list of "Examination Howlers." Good! ~ext, please! !-N.C.F. FOREIGK BODY E:-'IBEDDED IN EVE.

S. B. (Walthamstow).-Also \\·hat is the treatment of a foreign body embedded in the eye and protruding some distance outside of the eyeball? In these cases I presume that it would be inadvisable to apply a pad over the eye as this might press the forei~n body further into the eye. How woulJ you prevent the patient from blinking the eye and so di turbing the foreign body by the u yper eyelid? . Provid~d that ~he pad is soft and hgh~ly applted I Jail to ~ee what harm

that the bandage is you could do if you earned out the InstructIOns of the Textbook (p. 184) with reference to foreign body in eyeball, even \."hen a portion of theJoreign b~dy is not.completely embedded . It is extremely unltkely that In such cIrcumstances the patient will blink his eyes and aggravate the original inju ry. If, however, he should blink, then the pain in the eye aided by the pad and bandage will have a restraining inAuence.-N.C.F.

FIRS T

AID

TREAnlE~T OF PROTRCDl~G EYEBALL. .B. (\\'althamsto",-).-\\'hat ",'ould the treatment be of a patient ""hose eyeball is protruding? hould a warm aline compre be applied similar to that used for abdominal mjur:' with protrusion of intestine :' I trust that you will excuse me sending this lengthy list of queries; but they ha\'e all occurred to me during discussions on first aid in wartime. :'Ileanwhile I thank YOU for \'our \'alued ad\'ice and for the information g.ained from your replies each month.

NEW BOOK 6s. NET Postage 6d .

• • 256 PA GES

290

SILYESTER :\lETHon OF .-1..RTIFICIAL RESPIRATI01\'.

ILLUSTRATIONS

W. B. (Stockport).- What actually is the meaning of the word "upwards" in Syh'ester's method of arti(Jeial respiration? The Textbook says "grasp the forearms below elbows, draw arms up""ards, outwards and towards you." :'Ill' reading is that the forearms are raised at right angles to the body and then the arm with the elbo\\' touching the floor is taken out\'.'ards and to\\'ards you ,,'ith a sweepiIlg mo\·ement. .--inother point is the "'ord "ele\·ated." "'ould you say that a person lying down, ,,'ith arms abo\'e his head, had his upper Ii m bs ele\'ated ? Both these points ha\'e caused much discussiun in our Division. So ",'e look forward to your ruling on the matter. Both go together and centre round the word " upwards. "

BARREL BANDAGE FOR FRACTURED JA\\. ] . V. (Hampstead). -Refer ring to your reply on the Barrel Ban dage published in November, 1939, issue of FIRST AID, I have come across a publication bear ing the tit le Knots, Ties and Splices, by Comma nder ]. I r ving. Chapter X I V of this book d eals with the employment of strops and slings when ha ndling heavy packages, casks,

JUST OUT

SPARKLET RESUSCITATOR

If I ""ere a fir t aider and had to treat a patient whose eyeball was protruding-, I would protect the eyeball \,.ith a clean dry dres ing, soft pad of cotton wool and light bandage. Saline solution hould not be applied to the eye, It irecommended for protruding intestines for the special purpose of keeping the bowel warm and moist. Incidentally, in the rush of an air raid or other war emergency, what chance would you ha\'eof obtaining warm saline olution ?-:\.C.F.

The term" up\\'ards" signifies a \'ertical mo\'ement in relation to the ground and in this instance means raising the patient's elbows from off his chest. It is an interesting fact that ne\'er once have I seen this method of artificial respiration performed correctly in a first aid examination and that on several occasions, when opportunityoffered, 1 ha\'e found that the demonstrator ""as at fault in his instructions! Perhaps the instructions of the Textbook (in par 3, a on p. 149) are not as clear as they should be ; and, if I had my way, I \'.'ould alter the e instructions to read "draw the upper limbs (not arms !) in a sweeping mo\'ement upwards, then out\ya rds and finally towards you; and end this mO\'ement by making the patient's elbows touch the ground above his head." In this \\'ar only, can you put the patient on the stretch and so cause enlargement of the chest cavity which is the essential reqUirement of Silvester's l\lethod. Incidentally, if your" patient" is conscious he will raise himself on his heels to minimise the muscular strain associated with this stretching of his body. I do not know where the term" ele\'ated" (to which you refer) occurs in the Textbook; but in the anatomical sense, I would say that, if a patient is lying- on the ground with his upper limbs raised above his head, the limbs are elevated above the bod\'. Finally note the correct spelling of" ilvester. " - l . C. F.

A ID

By LO IS OAKES, S.R.N., D. N. Nurs ' ng Editor of .. 1\ u rs ing Illust rated ...

Innumerable cases> of death from GAS POISONING. SHOCK, DROWNING, etc.. could have been prevented by prompt use of the SPARKLET RESUSCITATOR. SPECIAL.

WORK S

AMBULA N CE

O U T FI T

85·

Write for leaflet on the "Prompt First Aid Treatment of Asphyx 'a and Other Respiratory Failure Emergencies" and booklet describing this and other resuscitation ourfts to Sole Makers:

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FIRST etc. On p. 105, after describing methods of slinging casks where the head of the cask is closed or the cask is empty, it goes on to say: ., With a full, unclosed cask other means must be employed and it must be slung' on end.' To sling a cask on end the sling is made round the cask as shewn in Fig. 213. This type of sling may also well provide a ready means of hoisting an injured man up from a depth where other appliances are not available. " This, to my mind, rather confirms the use of the term" barrel" in the handage and supports what you wrote about it in your reply. T trust that you will find t his information cf interest. Thank you for your interesting- and informatiye letter which is much appreciated.-N. C. F.

TREADIENT OF FRACTURED LEG.

R.P. (Romford).-The Textbook in Rule 4-, p. 66, tells us to place the lim b in as natural position as possible. Please state if this Rule applies when the leg is badly twisted or bent. Yes, provided that, as is laid down in the same Rule, this is done (1) with great care, (2) without using force , and (3) without letting go until the limb is splinted.-X. C. F.

TREATMENT OF FRACTURED FEMuR.

R.C. (Chadwell Heath}. - With reference to F:g. 48, p. 88, I maintain that in the case of a woman with large hips the splint would touch the hips but stand well away from the legs , and that padding is practically impossible to overcome this inequality. Please state ho\\" we should treat such a case. Given plenty of cotto n woo! or similar material, I fail to see why it would be impossible to overcome the inequality named. -N .C.F.

SI.\IPLE FRA CTURES OF FEMUR AND PATELLA.

E. D. (Bristol).-At a recent practice our demonstrator gave my First Aid Party (of which J am Leader) a " case" in \"hich the patient had to be treated for simple fractures of right femur and left patella. Remembering that this was a practice-room case and that the Textbook had, therefore, to be followed as closely as possible, 1 first.of all treated the fractured patella, omitting only elevatIOn of head and shoulders and of limb. I then a~plied extension to the right leg; and, bearing in mind Rule 5 (a) on p. 67, I bandaged the riO'ht foot and ankle to its fellow. Splints and bandag-es being at my command, I next splinted the right lower limb an d bandag-ed both limbs as for fractured femur. My demonstrator informed me that my treatment was incorrect and that, despite the fractured rig-ht femur, the left leg should have been elevated. Had this been an actual case my treatment may have been somewhat different, but this was a case calling for purely Textbook treatment. . . Perhaps you would be good enough to clarify the polOt?

On the whole I consider that your treatment was ~o.rrect because the fractured femur, as the more serious

Injury, demanded priority in treatment. At the same time 1 strong-ly disapprove your discrimination between" practice ro::>m" and" actual" cases. All cases should be treated as in actual circumstances, - N.C,f.

AID

FIRST

AID

153

HUMOUR IN FIRST AlD.

T. T. (BristoJ).-At a" test" examination recently, the doctor asked one bright youth how he would deal with a lady whose clothes ,vere on fire. He greatly surprised the ~lass by his ~eady reply: " Cm-ejul1y remove the bll1-mn£ garments. vVe all endorsed the doctor's comment: " You 'luould, oj course, ha'l)e a screen for the sake oj modesty!" Good!

~ext,

please! !-:-\.C.F.

SUNG FOR DISLOCATED SIIOULDER.

A.S. (l\Ianchester).-The Textbook names no definite sling for use with dislocated shoulder and simply tells us to support the limb in the most comfortable position (p. 96). So I shall be glad of your ruling with reference to the two following suggestions-(1} either put up as for fracture of clavicle but omit pad in axilla, or (2) tie the arm to the side with a broad bandage and support the limb in a small armsling.

Beitel" Ptif fol' 1;/'.1 Qid Aten

The Textbook specifies the indications for the small armsling-namely, all fractures of humerus and with shoulder bandage, and for the St. John sling-namely, all fractures of clavicle and scapula and with arterial bleeding from the palm of the hand. It follows, therefore, that the Textbook intends you to apply the large armsling with all other injuries of the upper limb. Consequently, the best way to treat a dislocated shoulder is usually to insert a large soft pad bet ween limb and trunk with or without a broad bandage tied round limb and trunk (this being omitted if it increases the pain) and finally to support the limb in a large armsling.-N.C.F.

All over the British Isles, \~orks' Managers, Factory Managers, Colliery Managers and all large and small industrial concerns are now busily seeking the assistance of fuUy-trained First-Aid men in order to maintain .the efficiency of their work-people. Special departments are being organized in most Factories, Shipyards, Collieries, \\7orkshops, etc., where injuries cannot only receive first-aid treatment, but upon being discharged by the surgeons can receive massage treatment and so decrease the rehabilitation period.

POSITION OF FOOT WITH DISLOCATED HIP.

A. H. (Woodhouse). -Please put an end to an argument by telling us how the foot lies with dislocation of the hip. Does it lie on its outer side as when the femur is fractured or not? The position of the foot varies with that of the dislocated 11ead of the femur. In the commonest \'ariet), of dislocation of hip (which fortunately is a very rare accident) the limb is shortened, the knee slightly flexed, and the toes of the foot turned-slightly but definitely-inwards toward the other foot.-N.C.F.

ASPH"XIA AND BURNS

.\BDO~IEN.

]. H. (Blackpool).-If a patient was suffering from asphyxia due to acid fumes, and from extensive acid burns on the abdomen and front of thighs and also a fractured humerus in middle ot the shaft, which method of artificial respiration would it be possible to use? An argument arose in ou;- practice concerning this. Some members advocated turning patient on his face and giving Schafer's method, whilst others said they would immobilise the hum erus and give Silvester's method. Your opinion on this problem would be greatly appreciated. Which calls loudest for treatment-the asphyxia or the injuries? The answer is obvious; and consequently you would concentrate on the treatment of the asphyxia . In other words, having protected the burned parts and the fracture as best you may in the circumstances, you would turn the patient on his face and commence Schafer's method of artificial respiration at the first possible moment. The fractured humerus-splinted or unsplinted-is an absolute contraindictive to the performance of Silvester's method.-N.C.F,

ow is your opportunity of becoming trained for the great "'ork which lies ahead in this vast fieldevery man and woman skilled in the art of scientific 1assage and Manipulative Therapy will be a national asset.

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JOHN SLING WITH BLEEDING PALM.

C.H. (Kettering).-At a recent outdoor test we had to treat a case of palmar hremorrhage (arterial). The hand affected was clenched over a pad, and firmly bound in the manner advised in the Black Book. The upper limb was then placed in a St. John Sling; but this provision was condemned by the doctor although the supposed palmar arter ial hremorrhage was not accompanied by any other injury. In recommending a St. John sling to increase Al:'xion, is the Rule in the B lack Book correct or not? \Nould such Aexion actua ll y increase the hand's blood content? The St. John sling is used in cases of bleeding from the palmar arches to keep the layer of fibrous tissue in the palm relaxed and so to render the pressure of the pad more effective in controlling the bleeding. Consequently, I stand by the instructions of the Textbook on this point and advise you to do the same. -N. C. F. TIME RATTLES

ON.

G C. (Surbiton).-Herewith a news cutting taken from a recent issue of a Wellingborough paper : " Two keen nursing sisters, wanting to carry out temperature and pulse tests in their home, looked for a watch. As one could not be found they used an al a rm clock. Does the story ring true? Well, it is." Do you agree? . Good!

AID

~ ext,

please! !-N. C. F.

TREATMENT OF

CRUSHED

HAND.

G.c. (Surbiton). - At a recent practice a friend of mine w a s told to do up a crushed hand. This he did in the correct manner, but was asked by the doctor if he h a d examined the hand to find out if the tendons were injured, as if they were it would not be possible to do hand up in the ordinary way. \Vould you please advise me as to the correct treatment of such a case? Many thanks in anti.:ipation. Personally, I cannot see how the fact, that the tendons may be injured, affects the first aid treatment of a crushed hand; and I certainly think that first aiders ought not to be expected t~ diagnose such complication. So my advice is that you slick to the treatment of crushed hand as laid down in the Textbook.-N.C.F.

FIRST L IFTING PATIENT BY LOOPED BANDAGES.

C H. (Llanelly).-l believe that this method of liftin g a patient orig in ated at the Llanelly G. W. R. cla ss, and was first demonstrated at an Ambu lance Competiti on held at Tumble Counci l School in the year 1923. However, we have found difficulty in placing the bandages under the shoulder blades and buttocks without jerking, and I wou ld esteem it a favour if you would kindly advise if you agree with the following. Place centre of broad bandage over splin t, place over this the end of a full length bandagf', pass both bandages under natural hollows of the body, and work into position as far as possible, now li ft patient sufficient by the two ends of t h e full length bandage to allow the looped bandage to be placed into position. Your historical note is interesting. At first sight I thought that your date was wrong and that we had used this form of improvised stretcher long ere 1923 . Reference to the Textbook, however, proves that this method of improvising a stretcher was introduced with the 38th Edition (1928) . How true it is that memory as to facts often pla)'s us false ! Your suggest ion is ingenious and is permissible when adopted by a team of expert nrst aiders, but it has the disadvantag-e that it might cause unnecessary and harmful movements at the hands of less experienced first aiders.N.C.F.

J.S. (Swindon). - An aerial attack might be expected to produce several cases of hysteria of the more advanced type better known as shell shock. We have discussed the question of shell shock which we believe can be very severe amongst men as well as amongst women. A number of such cases would no doubt hamper a first aider if a number of bad casualties needed attention. As ambulance men how best can we deal with these cases. No general rules can be laid down for these cases. The first aider, therefore, must apply the Textbook instructions and modify these, when necessary, in accordance with the Principles of First Aid by the proper use of his qualifications as a first aider.-N.C. F.

Make Money as a Masseur

TREATMENT OF FRACTURED

FINGER.

The Textbook (p. ~7) lays it down that a splint requires length, firm?ess and ":'Idth . Consequently, your candidate ;"as correct m suggestl!1g treatment on the lines laid down l!1 the Textbook for crushed hand, especially as the ordinary pencil is not wide enough properly to control a fractured finger. Had the examiner said that no apparatus other than a pencil was available he would have made his point and tested the ingenuity of your candidate.-N . C. F.

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V. P. (Bradford) .-At a first aid examination last month one canrlidate was asked to t reat a fractured finger. She treated it with a splint as for crushed hand. The s~rgeon-examiner objected to this, saying that he wished her to use her ingenuity and to fix it with a pencil. A fortnight later we had another examination with another examiner. This doctor objected to the pencil and wanted the fractured finger treated as for ::rushed hand. Both examiners have had long experience as lect~re rs and exa~ine r s for the Association . Wi)) you kmdly state which method is correct?

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THIS

NUMBER.

EDITORIAL : -

The First Million Correct Diagnosis St. John Ambulance Association St. Andrew's Ambulance Association S.]. A. B. Headquarters and District R eports Priory for Wales The Hospi tallers' Club ... Railway Ambulance News Poison in Verse Poisons Letters to the Editor First Aid Competition \"'ork Liston Splints ... A. R. P. Topics Our urses' Pages 1\1 isuse of the Red Cross Em blem

Li,

15 159 159

160 161 162 163 164 165 166 166 166

167 168 170

QUERIES AND ANSWERS TO CORRESPONDENTS : -

Treatm(:nt of Bleeding Tongue Examination Howler Treatment of Fractu re During Insensibility Treatment of Fractured Femur O nset of Concussion The Story of a Skeleton Humour in A.R.P. Spats in Treatment of Fractured Leg Treatment of Fractured Femur Treatment of Bleeding from Iouth .. . Treatment of Head Injuries Colou r of Face with Fractured Skull ... Treatment of Fractured Jaw Transport of Pati ent with Head lnjurie

Ene.rod a t ] [ Stationers' Halt

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EDITORIAL.

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CRAFT.

READERS.

F IRS T A ID i published on the 20th of each month. The Annual Subscription is 38. 6 d. post free; ·ingle copies 3d. Its aim and object being the advancement of Ambulan~e Work in all its branches, the Editor invites Reade rs to send Mucles and Reports on subjects pertaining to the Movement and also welcomes suggestions for Practi cal Papers. All Reports, &c., should be addressed to the Editor at the addre ss below and should reach him before the 12th of each month, and must be 'accompanied (not necessarily jor tJuhii(ati01t) by the nam e and address of the Correspondent. Subscriptions Advertisements and other business Communications connected with :r:1'RST AID should be forwarded to the Publishers. DALE, REYNOLDS & Co., LTD., 46, CANNON STREET, LONDON, E.C·4·

CONTENTS

FE B RUARY, 1940.

No . 548 .-VoL. X LV I. NOTICE

GEORGE

CO. LTD.

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members oj tke medi· ca l pro,ession and •

Editor:

JOHN FENTON, M.B., B.Ch., B.A.O., D.P.".

RAPID HEALING

_ _ _ _ _ _•

FIRST AID

AID

17 2 172 172 172

172

172 172 172 174 174 174 1,4

174 174

O:\' January 50th it was announced that the Lord ,\Iayor's Fund for ~Ir LLlOX. the Red Cross and St John had passed the fi rst mill ion-pou nd mark This, as the Duke of Gloucester wrote in his congratulatory letter, is but a milestone on a long and uphill road. During the Great \\T ar of 191-1--1 9 1 ' a sum of £20,000,000 was raised by public ub cription to support the humanitarian \york of the Red Cro s and St. John \Var Organisation. Can we say that the need is less to-day than it was then '; To provide comforts for the sick and wounJed, to forward parcels to prisoners of war, and to carry out other such duties can only be undertaken by an organ isation that is well established and has experience behind it. Such an organisation is that of the Red Cross and St. John \\T ar Organisation. It is a tribute to the generosity of the general public that such an organisation can be maintained on an entirely voluntary basis. No TO\'ernment grant is given or expected; but the generous response from all parts of the British Empire is a monument to kindliness and noble thought for these of the Fighting Forces, ,,,ho so willingly offer their lives. \Ve, at home, who assist in (he ld.-a-week fund, the collection of tin-foil and in other branches, must see that there is no slacking on our part. This fund is of the greatest importance to the welfare of our Forces. \Ve must not let it dowIl. In fact, we, as mem bers of the great first aid a rmy, must be the backbone of the fund. It may not be possible for us all to gi"e in actual cas?; but we can gi ve our time and devote our ener~les to the cause of collecti ng donations and the Itke. ,\Ve can interest others in subscribing where, perhaps, the real objects of the fund has not been clearly understood. THE

FIR T

FIRST

Correct Diagnosis. By N. CORBET FLETCHER,

,\1.,\.,

M.B., l\I.R.C.S.

PROFICIENCY in first aid (which is the state of being skilled in first Rid) depends on COIIIIJIOnSellse, /"llowledgc and exper! ('nee, the essential factors on which the principles of first aid are hased. Further, it must be realised that knowledge and experience are best acquired by the consistent and repeated study of a well-chosen text book, the reg-ular and assiduous atte ndance at all demonstrations, the gradual building up of a pocket note-book, and the fearless and trequent submis~ion to the test examination. By these methods, one may acquire proficiency in the theory of the subject; but to be proficient is not necessarily to be efficient. On the contrary, efficiency (which is the power to produce the resul t intended and is judged by the results obtained) depends in actual practice of first aid on the co mbination of correct diagnosis and treatment. Diagnosis (which signifies a knowing between and is the distinguishing of a condition or disease by symptoms) requires the same three primary factors, com11lonsense, knowledge and experience, and rests partly on the ques[ion . ings of the patient and friends (history, symptoms) and partly on t he results of examination (signs). Since, however, these are always more or less superficial, it follows that correct diagnosis (however useful it may be for correct treatment) is not essential to first aid, and that an approximate diagnosis is equally serviceable, if it ensures treatment, which will accomplish the objects of first aid and give the required results, viz., preservation of life and prevention of aggravation of injury or condition. Further, though this combination may not always be attained and correct treatment may follow incorrect conclusions, yet the converse is opposed to first principles, and is not permissible under any circumstances. Commonsense teaches a man to he observant and to make full use of his faculties of sight, hearing, touch, smell and taste, on which depends his power of appreciating signs and symptoms. In sudden emergencies, the method of approach of those who would help is instructive, the more ignorant the would-be assistant the more precipitous his advance and his desire to do something at all costs for good or ill. On the other hand the expert first aider, as he approaches, keeps his eyes open and his ears alert so that, when he is beside his patienl he knows the colour of his face, the character of the breathing, may have heard the snap of the fracture, and noted signs of bleeding or of poisoning. Next, since he realises the value of history as an aid to diagnosis, he is saved by his commonsense from volleying questions at a semi-conscious patient and turns rather to the friends and bystanders, from whom he learns by tactful and pertinent questions the story of what actually happened previous to his arrival, the sequence of events, and the possible contributory causes, which will serve as the foundation of his diagnosis. Further, knowledge makes him resourceful and enables him to carry in his mind pictures of the various conditions a nd diseases, which in an emergency may require active Or preventive treatm e nt; and his experience has long since taught him thClt successful diagnosis depends on the wise appreciation of the relati ve value of s igns and of the history of symptoms, which vary in importance with varying circumstances and persons. Symptoms (for example, pain, ~ough, headache, &c.) are effects and indicate the existence of someth!ng else, viz., a cause, which may be one of many, a.nd .be1l1g de~endent .on. t~e s~nses, they va ry greatly in slgnlFi~ance w~th the 1I1~lvlduahty of the patient. Thus, a hysterical patIent deSCribe loquaciously a pain, which a stolid person will either ignore or depreciate. Sign s (e.g.,

FIRST

AID swelling, deformity, etc. ) are the positive evidence of a cause, present themselves for objective examination, and are of real value as aids to diagnosis. As the outcome, therefore, of his preliminary observations and of his skillul enquiries of patients and friends, the expert is now armed with certain facts, either signs or symptoms, which wilt serve as indications of the possibilities in di ag nosis. He is not, however, justified in arriving at any decision until, ha"ing followed up these facts, he has confirmed them by examination. So in dealing with his patient he will carefully survey the surroundings and look for anything which will give him his first real hint and answer his first thought-is this disease, accident, or both? Then, having excluded any disease or injury, which evolves an immediate danger to life and which would call for prompt and decisive action (such as severe bleeding, obstruction to breathing, severe shock, acute poisoning, etc.) he may proceed wilh his examination. Further, having at this stage converted some of the possibilities in diagnosis into probabilities, he will now begin to differentiate between these, and so he will by a process of elimination gradually decide upon the most probable cause or causes. If there has been an accident, he will remember the possibilities of wounds, fractures, dislocations and, starting with the part indicated by pain or some other symptom, he will carefully examine the head, trunk and limbs. If the condition is apparently the result of disease, he will rapidly examine the various systems- circulatory, respiratory and nervous; and he will commence with the one to which his attention is directed by some outstanding symptom (e.g., pallor, cough, vomiting, etc.). Then keeping in mind the leading signs of the various diseases (with which knowledge and experience have made him thoroughly conversant) he will refrain from a positive di ag nosis until he has collected, as the result of his systematic examination, all Ihe available signs, and until he has convinced himself that these can be brought into agreement with those signs which he gathered during his preliminary observations. In other words, he will, as he proceeds in his reasoning, test his conclusions as carefully as he will test and verify the results of the various stages of the treatment which will follow. Finally, the expert first aider-remembering that successful and correct conclusions depend upon (1) the avoidance of undue precipitance and (2) the careful balancing of the signs, with the history and symptoms-will survey all the facts which have prespnted themselves or been discovered by himself, and, after turning these over in his mind, he may reasonably expect that his commonsense, knowledge and experience will enable him to arrive at a correct diagnosis. In conclusion, an actual case (which is described in full in my Efficiency £n F£rst A £d) may be quoted and used to demonstrate how these principles may be applied in practice, as follows : « A young }inman u 'as seen to ju mp from 117'S slaf1"ona1Y ('nl(ine and landing on his jeel to jall on tlze l;l'ottnd, wlze1'e lze lay with his hands p1'essed against h£s t pmples moaning' .!V!y head.l my llead.l' "

J. PRELIMINARY OSSERVATIONS. -As he approaches, tile lirst aider notes these important signs, viz., the early adult age, the prone position of the patient, and the leading symptoms-partial insensibility and headpain or headache. The semi-conscious condition of the patient precludes direct questioning; and his companions, when asked for a possible cause, can give no reason for the patient'S apparently deliberate action in jumping from his engine. On these facts, the first aider, concluding that there must be some disturbance or affection of the brain or some injury to the skull and/or brain, or possibly both brain affection and injury possesses a foundation for his diagnosis. II.

POSSIBILITIES

DIACNOSIS. - Disturbance

affection of bn'l in-Hysteria, Syncope, Epilepsy, Apoplexy and Injuries of skull and / or brain. Having satisfied himself that the patient'S breathing and pulse are satisfactory, and tha t there is no cause for immediate action, the firsl aider proceeds to examine the Nervous System to which the partial inse nsibility directs his attention. Finding that there is no wound of the scalp or evidence of injury to the scalp vault or base, he concludes that the co ndition is probably due to dise ase and not injur y. Further he notes (t) that there are no co nvulsions, (2) thal all the limbs are equally limp and present no signs of fracture or suggestion of paralysis, and (3) that the pupils are equal but react very sluggishly. At this stage of his examination, the first aider noti ces that the moanings have ceased and that the insensibility is more pronoun ced; and, moreover, the fa ce, by alterations in its appearance, colour and folds, gives no positive indi cat ions of brain mishief-on which facts he feels justified in eliminating Hys te ria , Syncope, Concussion and Fractured Base. Next. he examines the Respiratory System and notes (1) that there is no sign of obstruction of the air passages, (2) that the breathing is slow and regular, (3) t!-Jat the odour of the breath gives no hint suggestive of Alcoholism or of Poisoning. III. PROBABILITIES OF DIAGNOSIS.-Epilepsy, Apoplexy, Compression. Still puzzled as to the exact diagnosis, and remem bering the age of the patient and his deliberate act of jumping from his engine, the First aider next considers Epilepsy, ::ind learns from the patient's companions (1) that they ha ve never heard of previous seizures, and (2) that they noticed no convulsions or premonilory cry. Further, he has not iced during his examination an absence of that passive resistance to the n ecessa ry movements which is often met with in epileptic attacks. Considering all these facts, he now r evises some of his signs, and notes that the right leg appears somewhat more limp than its fellow . Further, remembering th e way in which the patient fell and the absence in the history of a blow to the head, he is no w convinced that Compression may be excluded, and that, in spite of the patient's age, the most prohahle diag-nosis is Apoplexy. IV . TilE DIAGNOSIs-Apoplexy - is based up on the sudden attack of insensibility (which from partial berame complete), the subsequent alteration of the pupil and character of the pulse, and the sug~estion of the onset of paralysis of the riVht lower limb. Further, he appreciates that the deliberate act of jumring from the engine was an expression of the dizz iness which hera lded the Apoplexy, and that it was the last conscious and voluntary action of the pRtient. LESSONS LEARN ED FROM THE CASE. 1. It is not always possible to make a diagnosis on the spot. 2. A diagnosis is formed by a process of elimination after balancing the history and all the signs and symptoms. 3. The signs of Apoplexy are often delayed, and 1he clinical picture may not pres ent itself for some time.

The Whitwick Colliery ambulance and res cue teams celebrated their successes during the past year with a dinner at the Grand Hotel, Leicester, on January, 10th. Trophies won were :-Leicestershire and South Derbyshire Collieries Rescue Cup, Leicestershire and South Derbyshire Collieries Ambulance Challenge Shield, and runners-up trophy in this competition, Donisthorpe St. John Ambulance Challenge Cup. W. Belcher won the individual prize in the Snibson Colliery competition,

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St. John Ambulance Association . BRISToL. - The annual report for the year ended September 30th, 1939, reveals that 204 first aid and home nurs.ing c l a~ses were held. composed of Schools, City and Man.ne, Police, Port of Bflstol Authority, A. R. P. Casualty SerVIce, etc . The number of people gaining awards wpre 4,310, which included 3,301 fir~t aid certifiL.ates, 425 home nursing certificates, 169 preliminary certificates, 386 medalI ions, etc., and 29 Mercantile Marine certificates. Altogether 6,388 attended the classes, but al l did not take the examination. The annul stretcher competitions were held as usual and were a great success. Fifty-one teams competed for the six trophies. Since the last report the Centre has lost through death County Officer A Cotton and Mr. E. L. G. North. Recently a further loss has been recorded by the death of !\Ir. R. E. Bush, D. L., J. P., Knight of Grace, who was a vice-president.

WISBECH.-At the annual meeting of the Wisbech Cmtre the Secretary, Mr. A. R. O. Osborne, announced that a considerable number of classes had been held and some 260 passes gained. The Secretary also announced that a cup had recently been presented to the Centre by '\Irs. J. A. de Rothschild, and it would be competed for by the ladies' teams in similar circumstances to those obtaining for the" Elgood " cup. A sub-committee was appointed to go into the matter of competitions in view of the expense incurred.

St. Andrew's Ambulance Association. NEAHLY 100 awards were presented to members of the Arbroath 0 and A Joint Line Section. Service medals were handed over to Mrs. George B. Crook (formerly Jessie Ross) and Mr. Peter D. Duncan, each of whom has 15 years' service. Provost Sir William Chapel presided, and amongst those present were Dr. and 1\1rs. Laing, 1\1r. and 1\1rs. Francis \Vebster, 1\1rs. G. Rutherford Thomson, and 1\1r. J. B. Edmonds, hon. secretary. 1\1 r. James Law, on behalf of the class, presented Dr. Laing with a volume on radiology in recognition of his services as lecturer. Dr. Laing, in making acknowledgment, made an appeal for blood donors in connection with the blood transfusion service. Mr. William r\icoll, on behalf of the class, presented gifts to 1r. Peter Duncan and 1\lr. George Lockhart. for their services to the week-day classes throughout the sesSIOn.

The Dalkeith and District Ambulance Section of the L. N. E. R. was recently examined by Dr. Black, Port Seton, and Dr. Wright. Portobello. There were 35 first-year students and ten seco nd-year, all of whom passed.

At the ..veekl), meeting of Forfar Seclion 102. women students were presented with certificates and medalliOns. Of these 76 were first-year students, 23 second-year, 1 third-year and 2 fourth-year. Presentations were made by Mrs. ]. E~en Cable, who was introduced by 1\1r. J. Stewart, secr~~~ry. Mr. D. Gray, Commandant, presided.

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St. John Ambulance Brigade HEADQUARTERS AND DISTRICT REPORTS.

No. I (Prince of Wales's) District 58 5 (WESTERN }iOSTAL DISTRICT AND ST. l\lARYLEBO IE) DI\·ISION. -The Portman Rooms, Baker-street, \V.1, was chosen as the venue for the diyisional dance by the members of this Division, on Friday, January 26th. Despite the inclemency of the weather and the difficulties of transport, some 300 members and their friends were to be seen enjoying the dancing. :'Ilr. T. Rodley performing the duties of M. C. The usual popular items, together with several new novelty danceq, were introduced and the company were very appreciative of the efforts made to make the evening :"ucct:ssful. Supt. W. V. l\1. Allen and Mrs. Allen welcomed the guests, who included Dr. R. Cove-Smith and 1\1rs. CoveSmith, Dr. H. A. Bulman (Medical Officer of Health, St. :'Ifarylebone), Drs. \Vallis, McGregor, Boyd and Fuller, with Councillor Miss Joan Marsh and lr. B. S. Hill-Wood among the company. A number of novelties, which had beeIl presented by tradespeople in the district, were distributed during the evening as prizes for the various competitions and were keenly sought for. It is interesting to note that this Di\'ision, with a melnbership of 286, must be one of the largest in the country. Some 30 members are serving in H.M. Forces a nd most of the remainder are actively engaged in A. R. P. duties in St. Marylebone and other London Boroughs.

Heston Senior Schools' Stretcher Party and Am bulance Depot (p resent clay staff) are to be the first local section of the A. R. P. to enrol e1l masse in the St. John Ambulance Bri!{ade. This tollows a suggestion put forward by Mr. A .. J. Attrill, c1erk-in-charge at the depot, and endorsed by D~v: .Supt. J. E. Taylor, of No. SS (Southall- orwood) DlvlslOn. Supt. Taylor, in the absence of Dr. Anderson, 1\1. O. H., presided at ~he gala Christn:as te.a, held at the depot, and expressed hIS pleasure at bemg WIth the personnel. Amb. Officer J. F. Paynter thanked the personnel for the ~o-operation and esp~rit de corps which had made it po~sl.ble for then: ~o achieve sufficient proficiency under his training to be ell.gIble for membership of the Brigade. He also made mention of the valuable assistance rendered by Ptes. S. J. Earp and A. E. Allen. . Mr. Paynter was the recipient of a presentation silver cigarette c~se inscribed "With appreciation and thanks. Heston SenIOr Schools' A.R.P. December, 1939."

Noll District Berkshire County has established an office and Rest Room at Reading. Last month the opening- ceremony was performed by The Lady Forester. . County Commissioner C. Poole said the premises had been taken over for three special reasons: (1) As a county headquarters olToce; (2) as headq uarters for the woollen cor:n!orts scheme; (3) as a rest room for trained nurses, Bnl1sh Red Cross Society and V.A.D.'s stationed in the town and quartered in billets, and others. Throu.ghout the county, he continued, the British Red Cross SocIety were copinR in a wonderful way with the supply of comforts, etc., for the sick and wounded and the S'. John f\ mbulance Brigade were launching ~ scheme

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AID whereby everyone throughout the county could supply comforts, etc., for mem bers of H. 1. Forces- at home and abroad-allocated and earmarked for each. The Lady Forester, in a charming speech, emphasised the need of the office and rest room for the nurses, and, after expressing The Lady ~lay Abel Smith's regret at being unable to be present, she formally declared the building open. CHELTENHA~1.-At the annual meeting of the Cheltenham Friendly Societies Division Supt. L. 1\1. Starr presided, and there ,"vas a good attendance of mem bers. The Secretary, Amb. Officer Skinner, reported that the strength of the Division was 93 officers and men, an increase of 35 over the previous year. It was recorded that three senior officers had been on the Divisional Roll since its inception 31 years ago. One of these, Corps Officer W. H. Ball, had been promoted Officer of The Order, a well-merited award. The members had attended 520 first aid cases and carried out 214 public duties. ' In connection with Ambulance Headquarters, 1,171 removals and 92 driving duties (366 hours actual drivin()' ti me) had been performed. ,., The officer') and members had spent considerable time in training classes in first aid for the local A. R. P. authori ties, with excellent results. Seven men were on active service, and others would follow shortly. A committee was formed to keep in contact with those in the Forces, and it was unanimously agreed to send them gifts of cigarettes and chocolates periodically. At the conclusion, Corps Officer H. G. Ballinger proposed a vote of thanks to the Superintendent and Secretar\' for their val uabl e services during the past year.

LVMINGTON.-At the annual inspection of the Lymington Corps, held on January 14th, County Commis:"joner .\lajor A. Tenn yson-Smith announced that :'Ilr. C. G. DowningFullerton, hon-treasurer of the Lymington and District Hospital, had ~enerously given a new ambulance to the Brigade. On parade were Corps Supt. R. \V. Reid, in charge, Lady Corps Supl. Miss Alexander, Lady Supt. 1\ 1iss D. Hilditch, Lady Cadet Supt. ;\lrs. H. L. Hoare. Also present were County Officer Capt. J. A. Coghlan and Corps Surgeon G. H. Pitt.

No. V District Dr. B. Hart, Corps Surgeon of Markham l\lain Corps, has been appointed County Surgeon of \\!. R. of Yorkshire (South Eastern Area) in place of Dr. Dufty, who has resigned on leaving the district. DONcAsTER.-Speaking at the annual dinner or the Doncaster Corps, held on January 13th, Major H. J. Humphrys, H.1\1. Divisional Inspector of lines, paid tribute to the work don e by men and women of the Brigade. It was, he said, one of the privileges of his position to have witnessed many deeds of heroism in the mines. The President of the Doncaster Corps, Mr. R. H. Hepworth, spoke of the increased strength of the Corps and the much extended sphere of activity. The Mayor.of Docaster, Mr. H. F. He~viside, responded to a toast submItted by Corps Surgeon Ham.

The chairm an referred to the medical side of the work, staling that on the outbreak of war Dr. Harmens took over Addlestone District and Dr. 1\1cQuade, Chertsey. Supt. R. J. Gristock's report ,vas read by Sergt. Hampshire. Early in Janu::try a ection was formed at the .\irscrew \\'o rks and, in :'Ilarch, another at "'oodham. Instruction had been given to \\'a rdens. At the outbreak of war the whole Division reported for duty. He extended thanks to Drs. Vaile, ;\lcQuade, Harmens and l\lcMurdo for their sen'ices, and also to Officers of the Division. Dr. Vaile expressed thanks to Supt. Gristock for his untiring work he had done for the BriRade. The Hon. Secretary (Sergt. W. Hooks) reported that personnel had increased in addition to members of the Airscrew and \\'oodham Sections. Dr. Harmens mentioned tha t many people had asked him about a division in Addlestone, but that the matter be left over until the end of the war. Dr. ~1cPherson said he very much appreciated the work and co-operation of the Di\'ision in connection \yith A. R. P. It had been difficult to get them all together at times but he appreciated what had been done. THANNl 'GTON. -At the annual dinner of the Thannington Divi ion welcome ""as extended to Dr. \\'. G. E\'ans pI. O. H.), who had been appointed as a new Surgeon to the Division. 1\1r. R. T. Sayer, president, presided o\-er the function, being supported by officers of the Di\·is ion. Corps Supt. F. A. Hawksworth proposed "The Thannington Di\'ision," to which Supt. H. Lye replied, tracing the history of the Dh'ision since its inception some five years a~o. RAMSGATE. - The annual mEeting of t he Ramsgate Town Division was held on January 30th, Corps Treasurer J. J\1. West presiding. The Di\'ision requires a new ambulance and the Transport Committee are dealin~ with the matter. Corps Transport Officer Bailey made an appeal to persons owing money for removals of patients to remit as soon as possible. The Secretary (Sergt. R. Smith) reported that 787 removals were Carried out and 250 casualies treated. lileage was 1,480, whilst 568 cases were treated at the Sands Hut. Twenty-eight public duties were undertaken. Corps Supt. Dawson said that the work of the past 12 months showed a steady increase both in membership and activities. In co-operation ""ith the Ramsgate S. R. Division duties had been undertaken at Jackey Bakers, Ellington Park and the Harbour. The Di\'is ion was greatly indebted to their two surgeons, Dr. Quinn and Dr. l\IcShane, and also to their old friends Amb~ Officer Benton, Transport Officer Hammond and Corps Officer Kingdon. . The Boy Cadet Division was in process of formatIOn, and all looked forward to the time when the members would be seen in uniform. Supt. Dawson also paid tribute to the transport and to the work of T '0 Bailey, Cpl. Packman and Pte. Thomas. Special thanks were due to Sgt. Smith, who had so excellently carried out the work of secretary. Pte. Norris, who had undertaken the charge of the Cadet Division. referred to the work of the members who had assisted the senior division .

- - - - ._ . - - No. VIII (Duke of Connaught's) District CHERTSEY AND AOOLESTONE DI\'ISION. - Di\'. SurO't'on J. D. Vaile presided at the annual meeting, supported by Dr. ,,\!. Harmens (President), Dr. C. A. McPhe rson (Medical Officer), a nd others,

Members of Whitegate Tenni Clu b raised £12 for the St. John Ambulance Brigade by a dance in the Town Hall Ballroom, held on January 30th. O\'er 300 people attended despite the severe weather.

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Priory for Wales. i\10NTHLY lEETlt-:GS AT CARDIFF. " First Aid to the Injured," the official Textbook of the St. J ohn Ambulance Association, \"as described as a 1939 "Best-seller" at a meeting of the Ambulance Committee of the Priory, at which Capt. J. ;\1 cLeod Carey presided on J anuary ~Oth, when it was reported that 1,577 classes helJ under the Priory for Wales had been examined during 1939, an increase of 550 on the 1938 total. The wider diffusion of first aid knowledge stimulated under Air Raid Precautions can be appreciated by one and all as a diversion of energy and money necessitated by A. R. P., which has a definite and far-reaching "alue in civilian life. Heavy demands are made upon the sen'ices of the BI igade Surgeons and other mem bers of the Medical Profession identified with Association work; and in these days when the general demand is for paid service, it is refreshing to find the spirit of volu ntaryism still acti\'ating St. John personnel. I n recognition of long periods of gratuitous sen'ice as lecturers, three Divisior:al Surgeons were appointed Honorary Life Members of the Priory, viz., Dr. \\T. Bathgate, Cardiff; Dr. S. K. Chopra, Brynmawr; and Dr. T. \\'. David, eath. Ambulance Committee agreed to encourage l urs ing Divisions of the Brigade to organise among their membership and friends working parties affiliated to the \Vomen's Voluntary Services for the knitting of comforts. 'Cnits in Glamorgan will be co-operating with the County \\'elfare and Comforts Association, of which the Earl of Plymouth, P. C., is Chairman. The Brigade is to be urged also to participate in the Tinfoil Collection on behalf of the Joint War Fund. In connection with the Joint War Organisation, Commissioners were asked to consult respecti\'e B. R.C.S. representatives of their counties with a \'iew to the formation of Joint County Committees to deal with the local administr~ tion of some of the war acti vities, e. g., the proposed organIsation of County Packing Centres under the Prisoners of \Var Department of the 'Var Organisasion, which has b~en authorised to pack and despatch parcels of food, clothIng and other comforts to British Prisoners of \\'ar in enemy territory. An increase was reported of .),685 cases and 38,762 miles on the services rendered last year by the Priory ambulances over 1938, the 21 Stations haying dealt with 22,446 removals in 1939, in\'ol\'ing a total milage of 351,156: One new station was opened last year at Abercarn, ser\'lng the residents of Abercarn under contract with the Abercarn Urban District Council, and, as part of the co-ordinated system of ambulance transport, backs up the next neighbou~ing station at Cross Keys, which is supported by local coll~ery companies and employees. While the cars in the colItery districts are intended primarily to sen'e under ~ont.ract tl:e needs of the employers and employees, .the ser\'1ce IS anulable to the general public on terms whIch compare fa"ourably with those of ambulance sen'ices in other parts of the co un try. . CI' f f Dr. D. Rocyn Jones, C.~.E., J.P., Sur?'eon-1l1- 1 I.e or "Vales, presiding at a meetlnR of the Pnory CouncIl on January 30th, referrt'd with regret to the death of 1\1r. Lemuel Jones, J.P., Aberavon, Port Talbot, a Commander of the Order and Chapter member. ~Ithou~h 83 year of aO'e, 1\1r. Jones had relinquished actIve Bngade office as A~sistant Commissioner for the Abera\'on ~ounty Area as recently as 1939 ; and he had attended meetIngs of Amh.ulance Committee and Council with commendabl~ .re&,ulanty until his health "'as impaired as a result of 1l1Junes su~ tained in a road accident two years ago.

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C."'RDIFF CENTRE BR1GADE HEADQUARTERS. The l\1archioness of Bute, D. B. E., performed the opening ceremony of a permanent headquarters for the Brigade Units in the Cardin' and Di!:>trict Corps, in the grounds of Cardiff Castle, on Sunday, February 4th. Her Ladyship said that the work of the Brigade had always been arduous and far-reaching, but now the demands had multiplIed a hundred-fold. Tne generosity of Lord and Lady Bute in placing adequate and well-equipped accommodation at the disposal of the Centre had solved a dilTiculty which had perplexed the Officprs for many years, said the Centre Chairman, Alderman G. F. Evans, J. P., in presiding; and he welcomed this great benefit to a work of increasing practical and social il11 portance. The Commissioner for Cardiff, Dr. Edgar Llewellyn, stated that the occasion marked the fulfilment of the ambilion he had worked for during his 20 years' connection with the Centre. Despile the difficulties of the past twelve months great progress has been made, the Corps membership having reached a total of -+11 by the formation of three new Divisions during the year. The Hon. J. H. Bruce (Principal Secretary and Commissioner for \Vales) paid tribute to the great help given to the Order by Lady Bute, 'Nho had placed the Banqueting Hall and other rooms of the Castle at the disposal of the Centre for its meetings. REPORT OF BARR\: AND DISTRICT CORPS. In submitting a report for 1939 on the Barry and District Corps, which has a total personnel of 302, Asst. Commissioner F. R. Hortop reveals tbat the number of treatments recorded was 5,5-+3, which includes 2,058 cases at the seaside first aid station at the Island during the summer months. In addition, at the Creche, Barry Island, 1,163 lost children were cared for by Ambulance Sisters and restored to their parents. The ~ledical Comforts Depot conlinues to sen'e a real need, 199 surgical articles having been loaned out to sick and needy persons, in 1Il0st cases free of charge. Practically all the Illembers are carrying out A. R. P. duties; the majority of the officers are holdin~ important positions in first aid posts and first aid parties. A. R. P. classes have been well attended and practically every member of the Corps has qualified in this subject. Three Sen'ice :'ledals of the Order on completion of 15 years' efficient service, 1 medal bar for 20 years and two bars for 25 years' efficiency have been awarded to members during- the year. Grateful appreciation is recorded to the Medical Oi1icers of the Ambulance and Nursing DiviSIons who, in spite of the extremely busy times have de\'oted Illuch personal attention to the work of the Brigade. ..1.NGLESEY CENTRE REPORT. The following report has been received at Priory House frO'll Sir Henry 1ulleneux Grayson, Bart., K.B.E., as Commissioner for Ang-lesey : The past year was one of much activity and the majority of the members are now fully trained in anti-gas measures. The members have, as usual, attended at galherings in various parts of the County and carried out other public duties and the Division was pleased to again render transport service to ~he Irish Pil!Srims passing through the port on their journey to and from Lourdes This dut y is alway done during the late hours of the night or early hours of the morning- and earns the gratitude of the organisers and the Pilg-rims alike. , H~~The greatest work was that entailed in giving practicai First Aid Instruction to classes of' the various bran.ches of Lhe A. R, p, organisation in Holyhead.

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The Holyhead Nursing Division was formed d ur ing the year, and after receiving first aid lectures, practical instr uction and hospital training, nineteen members qualified as auxiliary nur~esJ the Nursing Division being registered lered on June 10th and approved by the Priory. Two nlt'lllbers of this Di"ision attended the Nation~1 Service Rally in Hyde Park on July 2nd. The Centre was represented by twenty members at the Royal Review at Cardiff on July 15th, and County Officer C. R. Hollyoake, ex-Supt. Robert Griffin and Ambulance Officer J. F. Jones were the recipients of the Priory Vote of Thanks from H. R. H. the Duchess of Kent during the ceremony. At the outbreak of war the members put in some hard work in sand-bagging- the First Aid Post and assisting the A. R. P. Medical Officer in training stretcher bearers, ambulance attendants and ambulance drivers, and in recruiting and training- additional personnel for hospital and Fi rst Aid Posts. Nurses and ambulance men were on duty during the arrival of evacuated children, and also absisted in the fitting and distribution of civilian respirators, and help and advice was g-iven to the general pub lic in every possible way. Members are now in charge of First Aid Posts and Depots, and take an active part in A. R. P. exercises. A ne\" mol or ambulance for the Holyhead Division was dedicated in February, and the outstanding debt on the ambulance has been wiped off during the year. In 1939 one hundred and six patients were conveyed a total distance of 3,000 miles. A special duty befell the members during the month of September, when the submarine" Thetis" was salved, and during the removal of the bodies and at the subsequent funerals members of both the Ambulance and Nursing Di\'isions were on duty. On December 14th the Nursinl{ Division was inspected at Ravens Point, Trearddur Bay, by the Commissioner for Anglesey, this being the hrst occasion the ladies had been inspected in their uniforms. In accordance with a suggestion from the Priory, a Joint Committee has been formed to co-ordinate the activities of the Order with those of the British Red Cross duringthe continuation of the war. This Committee meets under the presidency of Sir Richard Williams-Bulkeley, Lord Lieutenant, with Sir Henry M. Grayson, Commissioner for Anglesey, as chairman, and Colonel T. R. Newton, County Director of the British Red l-ross, as vice-chairman. One of the first duties of this Committee was to org-anise a collection in the County for the Lord Mayor'S Fund. A letter of thanks and appreriation has been received from him acknowledging the donation made. I have pleasure in recording the great interest and support shown by the officers and all the members of the DivisiolJ, who are fully prepared to meet any emergencies which may arise during the coming months.

The Hospitallers' Club. TtlE Committee has decided to hold the annual general meeting of the Club at the Bonnington Hotel, on Sat urday, February 24th, at 3 p. m. Following the meeting tea will be served. A questionnaire is to be sent to all members regarding further meetings. tlIanyare now with the Forces, but it is felt that members should not lose touch with each other. It is hoped that as many members as possible will aLtend.

Railway Ambulance News. Great Western. RETIREMENT OE MR. YV. G. CHAPMAN.-The retirement of Mr. W. G. Chapman from the service of the 0r~at Western Railway on January 25th, severs .an assoCl~tlOn with the G. W. R. ambulance movement which has. eXisted for over 30 years. From the year 1909 untIl 1929 Mr. Chapman was Centre Secretary ?f that large Centre, and was responsible for the sett1l1g up of n~e divisional organisation in 1913. In the early,Years of hiS secretaryship he toured the Great Western Ral:wB:Y system each SprinO' with the late Dr. J. M. Carve~l. (ad)udlcato~) to conduct the annual preliminary competltlOns.:'lt varIOUS . t He reorganised the ambulance competitIOns on the POIl1 s. . I f th G W R and introduced four· man teams 111 p ace a e p;evi~u~' five-man teams, a change ultimately n:a.de by other ral'1 wa)' s and in the Inter-Railway .competItIOns. . . f fiMr.t Chapman held strong views as to the dlssemlllatlOn 0 rs aid knowledge over the system generally, rather than the fostering of a few expert exponents of ambulance wor~. J:Ie also stressed the voluntary side of the movement as belllg Its most valuable feature, 1 [VIr. Chapman was a member of the G. W. R. Centra t\mbulance Committee until his retirement, and was also for ~any years a railway representative on the Headq.uart~rs Committee of the Order of St. John. He was admitted to the Order as a Serving- Brother in 1921, and promoted to. t.he 1931. He . was for many . years f Offic er in gra de o ' a famlltar figure at local presentatic'ls and SOCIal meetlllgs 111 connecti'on with the movement throug~out the Great Western of ambulance _ .. . gold . R al'1 way, and at annual gatherIngs medallists, until his official duties prevented partiCipatiOn In of ambulance workers t Ilese procee d 'nO's I ,.., . Among all ranks . ' h' n the Great Western Railway, hiS sound lud~ment, IS ~enial and kindly person.ality mB:de hi;n ~any .frIends, who will affectionately wish hIlT] happllless 111 hiS retirement. SWANSEA.-A combined presentation of awards. t~ bers of the Swansea Central, Riven;:ide, and ladles ~:~es were held at the Welfare Institute: A ~ar~e gathe;in was presided over by 1r. y..,T. DaVIS, Dls~nct ~oo s M~nager "\vho congratulated the members on thelr.con~lIlued , and made a special appeal for recrUits III the progress, d' , 1 . h had coming session. He referred to the la les team w l]C . competed at Padding-ton last spring. Th~ rresentatIOns Mr. were ma d e by Dr.L, Vv . Hefferman (ladles class). 11' ] A Reynolds (certificates, vouchers and meda IOns to n~en"s classf's), and Mr. F. W. Smith (label awards), ~nd a number of O'old medals and bars for 15 a.nd 2~ years efficienc were I:>presented by Mr. Davis. SpeCial ~n~utes were y 1\1 W . J . Smith on his recent admlsSlOn pa 'd 1 to 11 r. 1 to A the G Order of St. ] ohn as Serving Brother, and ~o r. . . Lon who had been awarded a second certl.ficate by the Comg~any for exceptionally efficient first aid rendered. Presentations were made, on behalf of the class, to Dr. Hefferman and Dr. ]. Shibko by the Divisional Secretary, Mr. J. Long. . "1 enta SimI ar pres h f d C ounci'11 or W . J . Webber , in mak1l10' . t 0 1\1 r. C . H . Bevan a nd Inspector G. John, re erre tlOns t tof Mr. Bevan's instructorship of the class for over a quar er 0 a century. D Shibko to Mr. Evans, A g-ift was also presented by r. secretary. DOLGELLEY.-At the" Golden Lion" Hotel, Dolgelley,

AID members of the DolgeJley and Penmaenpool ambulance classes were entertained to dinner by Sir Robert Vaughan, K. B. E., and Lady Vaughan. Among the company,Present were Mr. A, V. R. Brown, Div. Supt. ; :'1r. DaVIS Blee, District Goods IVIanager ; 1\1 r. J. A. Denney o i\,'. Engineer; Mr. ]. R. Morris, former Div. Supt., and Mr. Anstey. Mr. Brown, who presided, said the class was representative of all departments. He was pleased to see that three members had qualified for their 15 year gold medal this year. Other speeches were made by th: C?mpany's Officers, and the examination awards were dlstnbuted by Sir Robert Vaughan, CHALFORD AND STROUD DISTRICT.-The annual smoking concert of the Chalford and Stroud district am bulance class, held on January 16th, was presided over by tIlr. G. E. Howell, Station Master. Among the large company present were Mr. S. G. Hearn, Div. Supt.; Ir. L. ]. A. Callaway, District Goods Manager, and other officials.. . Mr. A. J. Webb, class secretary, present1l1g hl.s .n;port of progress, thanked Mr. \V. E: ]. Perks; DIVISional Secretary and all concerned for their ready aSSIstance, and paid special tribute to 1\1r. V. H. O. Harris, who had a~ted as instructor to the class for nineteen years and had Just gained his gold bar for 30 years' efficiency, . Mr. Hearn, referring to the prog,:,ess achieved by the joint classes, spoke of the real service rendered b!, the Company's ambulance men in cases o! person~l aCCl?ent, when they were frequently able to tu;n mto a m1l10r mishap an injury which might have been senous. Other tributes were paid by :\1r. L. J. A. Callaway, 1\1r. F. L. Daniels, a manufacturer of the town; and 1\1r. H: C. Potter, Head Postmaster, who spoke of the happy relatIOnship existing between the Stroud G. W. R. staff and the G. P. O. staff. Toasts were drunk to members of. the s~aft on active service. Mr. Hearn distributed awards, 1I1cludlng a number of efficiency medals and bars.

southern. As announced in our January issue the District C~m petitions of the Southern Railway will not take place dunng hostilities. T Similarly, in view of the altered condition~ pre\'al mg conse uent upon decentralisation of the staff, It has been d 'd ~ that the" Sir Herbert \Valker" trophy for the be~t d~sCtlri~t results shall not be considered for awarding untIl normal conditions are resumed The following members of the Southern Railway staff h ve b admitted as Serving Brothers of the Order of St. ah n. .eAenBrazier o . , motorman, ' Strawberry Hill; \V. ]. Lyons, J trimmer, C.M.E. Dept., Selhurst. On Tuesday January 23rd, the London Bridge station I ' which comprises the staff of the three ambulance c ~ss'l t fons held its first presentation of London term 111 a s a I. ' h' f tllr E Card station awards under the chalrmans Ip 0 " t d by' tlfr P d B'd e He was suppore .' master, Lon on a;; 6i~. Supt. ; Dr. Mailer, Asst. !edical Nunn, ~°Frdo~ ~;zzeII, Welfare Officer; Miss \~. Gr~ndley, Officer, . . Offi cer ., 1\1r . H .•. A. Turpin , StatIOn laster, A t t Welfare ss. 0 . M Barrow Am bulance District Secretary, Cannon Street, r. , and others. ho resented the awards, expressed Mr. Nunn, w P . d H ave some encouragpleasure at the su~cesses att~I~:ti'ng ~l~ class as a whoie ing advice and, In congra u

FIRST remarked how essential it was that they sho uld continue to take an interest in this important work. Mr. Barrow, who had kindly undertaken the duties of class secretary, referred in general term s to the advantages gained by a knowledge of fi rst aid, and impressed on the staff the need for wearing the ambulance badge. Mr. Uzzell also took the opportunity of co ng ratulating the new candidates on their success. By their efforts they were now qualified members of the old est Order of Chivalry. He thanked I\lr. Card for the zeal displayed and who, by exam ple, had himself qualified as a first-year candidate. Mr. Turner stressed the need for taking a refresher cou rse each year and keeping u p t heir knowledge byattending classes for practice from time to time.

london and North Eastern. NORTH EASTERN AREA. M r. S. Cooper, Centre Secretary, has issued his report for the half-year ending December 31st, 1939. For the 1939/40 session 230 classes have commenced at the following districts: Darlington, 33; Hull, 40; Leeds, 20; Middlesbrough, 34; Newcastle, 57 ; York, 46. The corresponding figures for 1938/ 39 were 182 classes. Textbooks have been issued to the number of 4,480, which indicates that the membership has been maintained. Examinations have been held atBlaydon, Blyth, North Blyth, Castleford, Heaton Junction, Hull Central (4), Hull Royal Station Hotel, Leeds Ladies, York Ladies (2), York C. & W. (12), York Male Clerical (3), York Goods Male Clerical (2), Tweedmouth (2) and Re-examination at Blyth. The Divisional General Manager's appeal to the staff to take a course in first aid received the splendid response of 3,902, and this figure, coupled with the 4,162 successful students last session, would suggest that between 7,000 and 8,000 students will require to be examined during the current session. It is of interest to note that in York alone 18 examinations were arranged between November 24th and December 28th last, at which 430 students wen' examined. We are pleased to note that it has heen decided to hold the District and" Wharton" Shield Competitions, although the Group Competition, Inter-Railway and El1gland v. Scotland Competitions have been cancelled for the duration of the war. The President of the Centre, Mr. C. M. Jenkins Jones, has expressed the wish that every endeavour should be made to encourage teams to participate. Since the last report, 34 Long Service Gold Medals, fifteen 20 years' bars, two 25 years' bars, and two 30 years' bars have been granted. YORK.-A pleasing- ceremony took place at the Carriage and Wagon Works, York, on January 16th, when the Works Manager, Mr. N. H. Brown, presented Long Service Awards to members of his staff. The presentations were made in the particular shop in which the recipients were employed, and in his usual pleasing manner Mr. Brown expressed his congratulations and took the opportunity of making a strong appeal to those who had not already done so to take a course in first aid during the present session, and thus be in the happy position of being- able to render assistance to their fellowmen in case of need. The awards were as follows :-Long Service Gold Medals: Messrs. A. Adkin and H. Oldfield; 20 years' Gold Bar: Messrs. A Hutchinson and H. Clegg; 25 years' Gold Bar: A. B. Chambers. Since the inception of Gold Medal Awards in 1930, it is

FIRS T

AID gratifying to nol e that the following a ward s have been g.ai ned by e mplo yees at the York Carriage and Wagon Works : 15 years' Long Service Gold Medal, 21 ; 20 years' Gold Bar, H; 25 years' Gold Bar, 10; 30 years' Gold Bar, 5 ; 35 years' Gold Bar, 3.

Poison s. * ( ConcLztded from page 149.)

IN our last issue a reader enquired about some verses on Poisons. At the time we were unable to trace the actual verses required, but further search was successful. They were published in the October (1922) issue of FIRST AID, and for the benefit of the enquirer and others we are reprinting them. We should like to thank all those readers who so kindly sent along copies of the poem. One reader, Mr. R. Smith, of Salisbury-avenue, Ramsgate, advises us that he has a number of printed cards of this poem, price 1d. each, the proceeds being in aid of the Local Boy Cadet Division. Another reader suggests that "lung" stagnation would be better than "long" stagnation; whilst yet another reader is of the opinion that ,; burning" \-vould be better than " staining" when referring to corrosives. Send for the doctor, name the drug suspected, Keep every cup where poison is detected. In every case, whate"er the poison be, You may give water, milk, raw eggs or tea. Oils may be given, but two exceptions lie, In phosphorus poisoning and in Spanish Fly. In every case where staining is not found, To give emetics is both safe and sound. To mix at once, be quick and don't get flustered, Two tablespoollfuls of salt and one of mustard. If stains are present, then proceed with care, And of emetics most of all beware. The poison known to make the patient placid, For alkaline corrosives, give an acid. An acid swallowed, reverse the matter, And give an alkaline to kill the latter. The acid antidotes in household use, Are table vinegar and lemon juice. What alkalies to give need no revealing, Take whitewash, chalk, or plaster from the ceiling. In opium poisoning, he snores like some old Druid, Give him a teaspoonful of Condy's Fluid*. In carbolic acid poisoning, to make the patient easier, Give him two teaspoonfuls of sulphate of magnesia. In strychnine, opi um or where there's long stagnation, Resort to artificial respiration.

* In half a tumbler of water. ---. _ .---Councillor J. W . Cockroft (President) presided at the quarterly meeting of the Todmorden Centre, S.J .A.A. , at which reports of a very satisfacto ry nature were presented by the various officials. At the fina l competition of the the West Riding Constabulary for the" Cunliffe" Shield Tadcaster Division, with 193t marks, gained first place with Harrogate (190) the runners-up. Sergt. Carter, of Harrogate, won the individual contest,

P er ch loride of mercury tablets, or in strong solution Zinc Chloride

Raw white of eggs mixed with water, flour and water or barley water. Washing soda in water, raw white of egg. Strong tea. Com mon salt dissolved in water.

Sil ver Nitrate

2. 1 he Strong Alkalies.

Poison s in Verse.

AID

Official Name Ammonia

Common

ame

Spirit of Hartshorn Liquour Potassre Caustic Potash Sodium Hydroxide Caustic Soda

How Recognised Gives off a pungent odour (These feel soapy . when rubbed between the fingers Characteristic smell

Disinfecting Fluid Caustic Soda is used by the engineers on board ship, and also to remove grease stains from the decks. It is a solid supplied in tins, and is dissolved in water before use.

3. The Corrosive Salts of Metals. Common Name Corrosive Sublimate

Official Name Perchloride of Mercury (in strong solution only) Zinc Chloride Silver Nitrate

Lunar Caustic

Stains the skin black

GENERAL TREAHlENT OF CORROSIVE POISONING. 1. iVeVel' use the stomach syphon, nor give emeNcs. 2. Give the antidote as quickly as possible, followed by demulcents. 3. Treat the shock and pain. 4. Remember that tracheotomy may be necessary.

Carbolic acid

Ammo nia Liquor potassre Ca ustic soda Disinfecting fluid

SPECIAL ANTIDOTES. Antidotes Lime water, Liquor CaIcis Saccharatus, chalk, whiting, or { soap dissolved in at least one pint of water. Chalk or whiting dissolved in water, Liquor Calcis Saccharatus. Do not give soda, potaslt, ammon/'a, or magnesia. Ma<Ynesium sulphate (Epsom s~lts) t oz. in half a pint of water. {

Arsenic Zinc Antimony Lead

Phosphorus Copper

GENERAL SYMPTOMS OF CORROSIVE POISONING.

Poison

1. Salts of Metals.

How Recognised

Immediate onset of intense burning pain in the mouth, ~sophagus, and stomacb, retc.hi.ng and vomiLing, the vomit being blood-stained and contall1lng shreds of mucous r:n~m brane swellin<Y of the tongue and mucous mem brane lIning the m'outh, ex~essive flow of saliva, shock. . The patient may die from shock, suffocatIOn, or perforation of the stomach.

Sulphuric acid Nitric acid Hydrochloric acid Acetic acid Oxalic acid

Irritant poisons are those which cause inflammation of the mucous membrane of the stomach and intestines. The most important are : -

Vinegar, orange or lemon juice dilute acetic acid, citric acid, tartaric acid. Oil, butter. On no account give water.

* Extract from the Manual of Instruction .fo~ the Royal Naval Sick Berth Staff, reprinted by p~rmlsslOn of the Controller of H. M. Stationery Office. _ COPIeS of the Manual can be had of H. M. Stationery Office, Adastra! Hou~e, Kingsway, London, W.C.2, or any branch, pnce 4j;,d. post free ..

In the torm of Sheep washes, rat pastes, weed killers, fly papers, dyes; in stuffing animals, and as a spray on fruit trees. Zinc sulphate or white vitriol. Tartrated antimony or tartar emetic. Lead acetate or sugar of lead; lead carbonate, or white lead, lead su bacetate or Goulard extract which forms the ordinary lead lotion. Rat paste. BI ue vitriol or copper suI phate. (J sed in agriculture for pests and fungus diseases.

Iodine and Idoform Mercury

Perchloride of mercury in dilute solutions. 2. Organic Drugs. Cantharides Liquor Epispasticus, or Spanish Fly. Turpentine Croton Oil 3. Poisonolts Foods. Fuods may be poisonous owing to (a) the presence of disease producing bacteria, or (b) from the m,ixture of sorr;e chemical poison with the food, or (c) the pOIson may be In the food itself, e.g., certain kinds of fish, and poisonous fungi which closely resemble mushrooms. Harmful bacteria are most commonly found in pork and meat pies, sausages, ice cream, and shell fish, but vegetables may also be affected. GE 'ERAL SnlPTO~lS OF IRRITANT POISONING. The symptoms do not usually come on f.or some h~urs after the poison has been taken. Nausea, :all1tness, c~l~cky pains in the stomach, violent and persIstent VOITIltll1g, diarrhcea and shock are the usual symptoms. GENERAL TREATMENT OF IRRITANT POISONING. 1. Emetics, or the stomach syphon are used if the

vomiting has not been very free. 2. Give a purgative-castor oil 1 oz. Most of the poison may have passed into the intestines before the symptoms occur. 3. Gi"e the antidote. 4. Relieve the pain by hot fomentations. 5. Treat the shock Poison Arsenic

SPECIAL ANTIDOTES. Antidote Dilute H ounces of Tinct. Ferri Perchlor with 2 ounces of water and add to it ounce of washing soda in 5 ounces of water, mix and administer. vVashing soda or strong tea. Strong- tea or coffee. Ra w white of egg. Sulphate of magnesium 1 ounce. Demulcents, no fats or ods.

Zinc Sulphate Antimony Mercury Lead Cantharides

FIRST

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rlvot'd oils or jats, gi\'e copper su lphate 3 grains in water, followed by magsulphate i ounce. Sulphate of magnesium, 1 ounce, demul, Turpentine cents . Demulcent drinks . Copper *Spirit of camphor, to minims in milk or Croton Oil on sugar. Castor oil 1 ounce Food poisoning Iodine, Iodoform Starch and water, or soda bicarb. i oz. in water. *Tinct. Belladonna minims 20 in water. Fungi * Only to be giyen by a Medical Officer.

Phosphorus

-------. -- .------

Letters to the Editor. \Ve are in no way responsible for the opinions expressed, or the statements made, by Correspondents.-EDITOR. BRIGADE

EFFICIENCY.

DEAR SIR,I fully endorse all that N. Williamson has written regarding drills for efficiency of Brigade members. In our nursing di\'ision several of the members are engaged as factory nurses and, as the firms are doing work of national importance, kmg hours haye to be ~orked. Olher members are also doing work which necessitates long hours. Th~se, however, find time to do some voluntary L-\.. R. P. dutIes where members who are doinO' full time A. R. P. ,:"ork in most cases only do 8 hours' dut)~ .1 thtnk all members (other than those called up in the SerVIces) should do at least six drills. A really keen man or womell will not find it any hardship to do one drill in even' 8 weeks.-Yours truly, _ (L.A.O.) F. M. GIBBS. 41, \Vaxlaw Crescent, Southall, Middlesex. DEAR SIR,As I have always taken a keen inlerest in the work of the S.J.A, B. (alth6ugh only an Associate Member), I feel that I am better able to give my views on N. Williamson's letter rega~~ing Brigade Efficiency, than a Brigade member :"hose positIOn must hamper outspoken comment. vVhile I?- no way ~ttempting to dictate to Commissioners, I would like to pOtnt out an instance of facts. I know a Lady Ambulance Officer (a Serving Sister of the Order) also with ~,n unbrol~en :,ecord of 2S years' efficiency, who will be non-efficient f~r 1939 only because she has p ut in 4 out ?f 12 necessary drIlls. In the meantime she has been lecturmg throughout that same year to un certificated classes (W. V. S. and A. R, P.) and has also organised and acted as Clas~ Secreta.r~ and Demonstrator for Doctors' Courses for Certificate, gl\'tng her a total of 84 attendances at these in the S2 weeks. Surely if she were inefficient the strength of the classes wo.uld not have been maintained, nor wou ld candidates wnt~ . t~ her ~xpressing their thanks for her clear and exphcIt tnstructIOn. Also, \~ould not the position of the paid A. R. P . worker be v~ry different. if there were no volunteer lecturers, especially those wIth years of practical knowledae behind them. ,., Perhaps these matters rest with individual Superintenden ts and so they get passed over. -You rs etc. , S, Burnaby Gardens, Chiswick, W.4.

(MISS)

P. C. COLES.

(P. C. C. Ch is wick)

FIRST

AID

First Aid Co.npetition Work. ALTHOUGH the ational Competitions ha\'e been cancelled for this year, the ad\'ent of A. R. P . first aid personnel has opened up a new sphere in the competition ,,'orld. ,-\.. R . P . Handbook 10 . 10 gives the official blessing of such e\'ents, and already numerous competitions have been held, whilst others haye been arr anged . Unfort u nately, the uninitiated competitor and judge fails to realise that although compf'titions are for practical experience of cases, there is, nevertheless, a big differ ence between competition work and the attendance at the act ua l case. For this reason, therefore, we have been able to persuade one of the leading judges in the land to compile a book dealing with the subject in all its phases. Captain A. C. White Knox, 1.e., l\l.B., Ch.B., the author, is well-known in first aid circles, and his knowledge of competition work is par excellence. The book, " First Aid Competition \Vork," deals with the histo ry and objects of competitions, and also with training, the judge, the test, the competito r and marking sheets. . ~n a straig.htforward manner the author gives hints on trall1ll1g, choosll1g the team, methods of training, and also advice to the competition judge. Preparation of marking sheets and the patient are dealt with, the subject of faked injuries being \'ery lucid . Then ad\'ice is given on "The Team at \Vork" and "The Judge at \-Vork." This book is no",' in course of preparation and will be published on February 29th at the low cost' uf 1 -, post free . Readers are advised to forward their orders nOLU and so make su.r~ of their copy. The book will not only ~ssist the competitIOn man or woman, but also every first aider in their work. Orders, together with remittances, should be sent to Dale, Reynolds & Co. Ltd., 46, Cannon-street, London, E.C.4.

Liston Splints. By e.-\.PT, A. C. WHITE KNOX,

i\I.C.,

i\I.B., CH . B.

also packed in screw-topped glass jars each holding 2 ozs. of the ointment. Sup[Jlies of Ointment f\o, 1 (bleach ointment), whetber now forming- part of the issues for bulk resen'e or the product of local purcha e, will be used to form the initial equipment of first aid and light re cue panies, mobIle fir~t aid units, and wardens' boxts and boxes at first aid points; while the Ointment ~o. 2 may be distributed, in the ealed cylinders of 63 x 2 oz. jar~, to first aid posts and cIa s 1 hospitals, and the balance retained in bulk resen·e. For the ha\'er~ack of a first aid party 8-2 ozs. jar should be distributed and for eacb mobile unit 2-1--2 0/.. jars.

A .R.P . Topics. A 'Tl-GAS OINTMENT,

This will, in future, be in the fl)rm of Anti-Gas Ointment, No.2. The nature and characteristics of No.2 arc as fullo\ys ; It l'onsists of a \'anishing cream base containing ch loramine T. (the actual formula is not available at present) and is effective against both mustard gas and lewisite, Speedy application is essential and this is e\"t:'n more important in the case of lewisite contamination than for mustard gas. In the case of lewisite contamination, immediate app lication is necessary to ensure complete neutralisation of the effects, but later application \\'ill still mitigate the se\'erity of any burn which may de\'elop later. The ointment should'be applied to the contaminated area in small quantities and thoroughly rubbed in until it \·anisbes. It should be rubbed in for at least one minute . It is possible to use No. 2 Ointment as a proph) lactic against the vapour of mustard gas or lewisite (i.e. it can be applied to the skin before exposure to blister gas vapour occurs), but it has some irritant eA'ect if repeatedly applied, especially on areas cO\'ered by clothing. It should, therefore, only be used in this manner by someone whe "!lOUIS that he is about to enter an area where he will be exposed to mustard gas or lewisite \·apour. Since the ointment is made with a yanishing cream ha!"e containing water, it tends to dry out during storage, so that the containers used for it must be airtight and should not be opened until required for use. It ",ill be stored in hermetically sealed conlainers and

1111lI11111111111111I1111111111111111I111I11lI1I111I1I111111 ( C

AID

GOOD ' ESS GASEOl;S.

If you get a choking feeling and smell of musty bay

You can bet your bottom dollar phosgene's on the way; But the smell of bleachin!S pO\\'der will ineyitably mean, That the enemy you are meeting is a gas we call chlorine. \\'hen your eyes begin atwisting with tears you cannot see, It's not mother peeling onions, but a dose of C.A.P. But if you can smell onions, the \yarning you must heed, For Jerry's sending mustard and a bath is \\ bat YOU need. If the smell resembles pear drop, then you'd better not delay, It's not father sucking toffee, it's that awful K. S. K. If you get a horrible feeling as if dead you'd rather be It's the surest way of telling D. :\. , D. ;\1, and D . e. If you catch a pungent odour as you're going home to tea , You can safely put your shirt on they're using B. B. C. .-\od, lastly, while geraniums look 10\'ely in a bed, If it's lewisite you're smelling, then cheer up, you'll soon be dead.-From the .Yorlh Slu'elds E1 e71illg .\-t'7US l

a rCa ~S~1I1 1 l1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

I I NVAL I D

Whatever the Chassis use Carters' Ambulance Fittings.

F V R.N I TU R. E

• .. _ By Appointment.

SectIOnal Catalogue 7A, which is free for tbe ask, ing, describes this Patent Stretcher Elevating Gear, which is a triumph in compactness and scientific design,and the whole range of Ambulance Furniture and Flttmgs,

WRITE FOR IT.

The most up ~ to-date and scientif ic in th e w orld .

MA y ~rst aid~rs have been asking recently why some of the long thigh splll1ts have a double notch and a big hole at one end and two small holes at the other. . S uch splints are "long Liston" thigh splints which were commonly used some thirty years ago in the treatment of fractured thigh with extension; and the etceteras haye been copied by the makers e\'er since. T.he re a r~ still occasions when the" long Liston" may be satlsfactonly used, though the" Thomas" splint has now mostly replaced them. . The splints were used as follows ; -The limb was placed ll1 as natllral a pos ition as possible and the" 10nO' L iston" placed on .the. outer s id e with the larger opening over the outer projectIng ankle-bone (really the lower e nd of th e fibula). The spli nt was well pad ded at this poi n t . It was then fixed by a fig ure-of-eight bandage roun d the a n k le, foot and ro ~ nd the two notches at the end of the splint. ExtenSIOn was then made by pull ing on the foot and p ush ing- with the splint from the other end. This extension was maintained by a narrow bandage placed with its centre between the legs and the two ends passed through the two small holes at the top end of the splint and tied tiO' h tlv. . An in ner splint was then applied and faste~ed - in the ord1l1ary way, finishing u p by ty ing the two limbs together.

THE NEW "PORTLAND" GEAR This new pa tent Ambulance Gear offers many un ique adva ntages whether the Ambulance is carry ing two stretcher cases or only a single case. A self-con tained unit, it can be placed in almost an y vehicle, and it makes the loading of either top or bottom the si m plest possible matte r. The " PORT LA ND" Gear s hould be specified f or a n y new mbula nce and it A 125, 127, 129, provides an ideal Great Portland Street, me thod of modLondon, W.I. ernising vehicles Telephone-Langham 1040. al ready in use. fdegrams-"Bathchair, Wesdo, London.'

This illustration shows the clear gangway for loading the lower stretcher when only one Cil.se is beinR carried.

mlllllllllllllllllllllllllllllllllllllllllllllllllllllil1I11111 11111 1 1111111 11111111111111~\11111 1111111I1111I1I1IIIII IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII!11111111111111111111111111111111111111111111111111111111111111111'1/111111111

r68

FIRST

Our Nurses' Pages. CO"lPILED BY AN AMBULA TCE S I STER.

AID a nd d es ired to extend th eir interest in fi rst a id a nd h ome nursing, be nce t he fo rm ation of t he Di vis ion. T he Divis iona l H ea dq uarters a re at the Manse rg h W oodh a ll Clu b, Hill-road, N. VV. 8. All enq ui ries conce rnin g t he Di vis ion s hould be a d d r essed to Mrs. Al len, a t 181, Mdrylebo ne-roa d , N . VV . 1.

FIRST

AID

EQUIP YOURSELF FOR WAR EM ERG ENel ES-1lI Essential

V.A . D. CLUB AND THE VVAR. Desiring to be true to the ideals of its fo und ers, this club, which is situated at 28, Cavendish Sq uare, L ond on, VV.1, is making a special contrib ution to t he comfort a nd assistance of women engaged in war wo rk. Th e first move was made in July last, when cards wer e iss ued to its members entitling them to recommend for tempo rary membership any relati\'e or friend who had to be in Lo ndon for V. A. D. training or Civil Defence work of any kind . A cer tain number have already taken advantage of this privi lege, and as women's work extends into fresh chan nels, no do u bt more and more of these temporary members will show their appreciation 01 the club's hospitality. Under the shock of the outbreak of war, the club staggered, but was not defeated. Several important members of the staff had been quietly t raining in Civil Defence organisations and Red Cross units. and were calJed to their posts. Others had to evacuate their' families to safer quarters away from London. Bya miracle of adaptio n a nd rea r rangement, Mrs. Wybergh How and a faithful few kept the club • open, and those members who crept courageo usly to its doors found its quiet comfort unimpaired. Now it has recovered much of its usual air, although uniforms of g reater variety than of old are seen in its rooms, a certain amount of black paper and thick curtains advertise the black-out, and the menus are shorter and simpler , though the food is as good as ever. The Committee is anxious to extend the scope of its usefulness to V. A. D. 's and war wo r kers coming- to town. Besides the temporary membership already mentioned, it has been decided to allow any who avail themselves of this to stay for short periods at reduced terms. It is part icularly hoped that nurses coming to London from the D ominions or Colonies, who have to wait for the post for w h ic h they have offered their services, may avail themselves of this hospitality. The Committee asks all V.A.D. members to bear in mind that the club was founded and has been carried on for more ~han nineteen years for their especial benefit, and to make lt known to those for whom it will esteem it a privilege to provide a place of refuge and refreshment. Its situation at the corner of Cavendish Square close to Oxford Circus with its network of tubes and buses, is one of the most con~ venient in London, not to mention the near ne ighbo u rhood of VVest End stores, and several first class cinemas and other places of entertainment.

No.1 DISTRICT, S .l.A.B. In response to requests from ladies in St. J oh n's VVood district, a new Nursing Division has been formed a nd was registe~ed at Brigade Headquarters on Jan ua ry' 16th, as o. 11:> (St. John's VVood) Nu rsing Division, with a n initial membe~ship of 20. The fou nd er, an d present m em be r-incharge IS Mrs. M ..M . .AlI en, wife of S u pt. All en of No. 58/ 5 (VVestern Postal Dlstnct and St. Ma rylebo ne) D ivisio n. Dr. R. H. Boyd, t~e. ~ell known Harl ey Street s urgeon, has agreed to act as Dlvls l.onal S urgeon; whi le Mrs. Hugh Paul h?-s accepted the P.resldency. of the Division, with Lady JosephIne Hartley and SIr J ohn F Itzgerald as vice- Presid ents. Judging from the keenness displayed, the s uccess of the new Division is assured, and a large member:>hip is expected. ~ost of the members have been e ngaged at t he Co un ci l First Aid Posts in St. Marylebone since the beginni ng of t he war,

knowledge to treat successfu lly, ALL possible injuries,

THE

NORTHERN AREA . No. 46 (ENF£ELD) NURSING D n'IS [OI" . -The twe n ty-fi rst a nn ive rsary of t he fo rm ation of th is Di vis ion, the old est N u rs in g Divis ion in E n fiel d a n d D ist r ict , occu rs in Apr il , a nd refer e nce was made to t h is fact at the Annua l Ge nera l Mee ti n g, which was h eld in the T udQr Room (by kin d pe r mission of M r. D ud ley L eggatt), on Monday evening, J an uary 22nd. T he P resident, Cr. Derek Parke r-Bowles, took the chair. An important incident in the proceed ings was the fo rm a l prese n tation to him of the silver badge of ofllce, by Lad y D iv. S upt. Mrs. Phyper s, on behalf of all the members . Satisfactory reports on the wo rk of the Di\"ision fo r the past year wer e given by the Secretary, l\Iiss D . Clark, on the Medical Comforts Depot by the Storekeeper, M rs. E. Pegg, a n d 0 11 the Auxiliary Reserves by Miss E. G. Fiske. Th e financial statement was read by the Treasurer, Miss C. A. Pritchard . In her annual report Lady Supt. l\Irs. Phype rs stated t hat the membership had ulcreasE'd and that numerous classes had been held in first aid (lecturer. Dr. J . G. B . B rass), home nursing (lect urer, Nursing Officer M. Oates, S. R. N.), and anti-gas (by herself) . The attendance had been good, with a high percentage of passes in examinations. Some h u ndreds of hours had been voluntaril} worked by the membe rs in teaching bandaging at Council classes. Besides the fully-trained officers and ambulance sisters, the re were also probationers, honorary members an d a u xilia ry reserves attached to the Division, all of whom were r epr esented at that meeting . Practically all these were engaged at the present time on full or part-rime work at first aid posts or on hospital duty. H av ing had to vacate their old headquarters at the Y. M.C.A., they had been fortunate in securing accommod ation at Lancaster Hall, Si lver-street. She tendered grateful thanks to the Div. S u rgeon, Dr. Brass, the officers and all associated \-vith the Division for the loyal way in which they had given their support. Cr. Bowles expressed his great pleasure in being the Presid ent of such a flourishing Division.

No.5 DIS'rR ICT, S.lA. B. BARNSLEY NURSING DIVISION.-Among the entrants at a recent home nursing examination for t he prelimi nary certificate was a nine-year-old Barnsley gi rl , Irene S emley, d a ughter of S u pt. J . W . Sem ley, of the Barnsley Ambula nce Divis ion, and she has been informed that she has been awarded the cer tificate fur having passed the test. I t is believed that she is one of the youngest fi rst-aid worke rs ever to have ga ined this award . S he has bee n attached to t he N u rsi n g Division fo r ahout 18 month, a nd gained he r preli mi na ry first aid cert ificate some mo n ths ago.

No . 8 DISTRICT, S .J. A. B. BOROUGH OF H YTHE NURSING DIVISION.-A year of l11 u.ch activity, w h ich has bee n increased by t he wa r , was reViewe d at the a n n ua l ge neral meeting of t he D ivis ion. Th ere we re 22 members pr ese n t o n th is occasion, at w h ich D r. VVeave r , Acting Office r-in-Charge, presided .

16 9

HOUSEHOLD PHYSICIAN Descri bes in SI MPLE LANGUAG E such necess ary infor mation with helpfu l plates and di agrams.

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WAR EMERCENCIES :Gas Warfare First Aid Bandages Splints Burns Scalds Hcemorrhage Fainting

PEACE TIME SUBJECTS:-Influenza,Colds,etc. Measles, Mumps Catarrh Corns and Warts Physical Culture What to Do in Emergencies Treatment for all Skin Diseases The Lungs, Pleurisy Hygiene, Anatomy, Pharmacy The Principles of Nursing The Eye, the Ear The Throat, the Nose The Chest, the Heart The Stomach, the Liver The Teeth, the Muscles Infant Welfare Hom<Epathy, Neurasthenia 375 Prescriptions, etc., etc.

T,V hat

case

oj:

Bodily Injury, Burns and S c a ld s , Clothing Alight. Foreign Bodies in Eyes, Ea rs, N ose, Throat. Machinery ACCidents, Elect riCity Accidents. Drown i ng , Suffocation , B l ee ding, Poison, ~ro~en Bones, Fractures , Dislocat i o ns, Sprains, Fainting, Concussion, Etc.

THE YOUNG WIFE will find just the information she rpquires. MOTHERS who wish their daughters to develop naturally will find exactly the teaching they need. WOMEN OVER 40 will find their difficulties regarding health frankly discussed. BEAUTY CULTURE-Complexion Diets, Wrinkle Cures, Care of the H ands, Mouth, Eyes, Hair, Recipes, etc. PRESCRIPTIONS -375 proved remedies. There are hundreds of subjects. The muscles, teeth, digestion, hair, food "alues, Jujitsu, Ph renology. How to diagnose diseases !ro~ appearance of head, face, neck, tongue, throat, chest, perspiratIOn, etc.

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17 0

FIRST

The Annual Rcpurt stated that first aid and home nursing lectures and examinations were held between January and June, 1939. Twenty candidat!:'s were successful in passing bJth examinations, and they formeo the nucleus .of the Borough of Hythe Nursing Di\' ision which was regIstered at Brigade Headquarters on 1'I 1a)' 23rd. Officers for the Division were elected, and !\Irs. Weaver, Lady Cadet Officer, Folkestone J ursin~ Division, who had trained the Hythe classes in practical Erst aid and home nursing, was asked to take charge of the new Division. She accepted, and asked that Mrs. Pearson he appointed Lady .'\m oulance Ol1icer. Miss O. G. Fisher became Divisional Secretarv, Miss K. M. Minter, Div. Treasurer, and Mi ss L. E. East, Div. Storekeeper. Furty-three drills and practices had been held, and were well attendt!d, and six short talks on anti-gas had been given by Ambulance Officer G. Huntley (Folkestone Corps). Lectures given by Dr. ]. Comyn had been greatly appreciated, also the demonqrations by the Hythe Ambulance Division. These had proved very helpful to all who had attended them. Public duties had been undertaken nightly at the cinema, and help had been given at the Hythe Venetian Fete, the Cheerful Sparrows Fete, and with the evacu8.tion of children. One member had enrolled in the Civil lursing Reserve Mobile Unit, and had almost completed her hospital training. On the outbreak of war, all members rallied to A.R.P. work at the First Aid Posts. Ten members together with the Hythe Ambulance Division under the direction of Dr. and 1\1rs. Burchall, are entirely carrying out the work of the Pal marsh H al l First Aid Post. Sixteen members and A. R. P. Reserves are helping under Dr. Comyn alld Nurse Denniston at the Pa\·ilion First Aid Post on the sea front. Here again, thanks to those in charge, extra practices have been held weekly. All members have been keen on their work, and have turned out at all A. R . P. practices and been at their posts when actual air raid warnings have been sounded. Altogether 665 hours had been spent in public duties between ~1ay 23rd and December 31st. The Divisio.n had made great strides although it had no equipment or financial backing, but thanks to generous help from various people and the support of the members, it was now on a firm footing.

No.9 DISTRICT, S.J.A.B. LrSKEARD NURSING DIVISION.-Mrs. H. 1. Young, Lady Divisional President, on behalf of the Committee and members, presented the Div. Secretary, Miss G. M. Trethewey, with cutlery on thl:! occasion of her marria~e to M r. J. James. She thanked Miss Trethewey for her many years' loyal service to the Division, and wished her much happiness in her married life. The Lady Divisional Superintendent of this Division, Mrs. H. F. E. Thomas, S. R. N., has been elected to the panel of examiners of the St. ] ohn Ambulance Association for home nursing.

)JORTHERN IRELAND DISTRICT, S.J.A.B. COLERAIN~ NURSING DIVISION.-About 600 people attended a guest tea, concert and dance held at the Town Hall, on January 25th, in aid of the funds of the Division and those of the Ambulance Division. IV1r. W. R. Johnson presided and the tea was in charge of Mrs. R. F M'Cartney, Mrs. W. Currie and other ladies. For the dancing Mr. ]. F. Hunter acted as M.C. The proceeds amounted to over £60 .

FIRS T

AID PRESENTATION l)f FIRST : \ID CERTIFICATES TO SOUTH :\FRI CAN LADIES.-There was a happy gathering on Th u rsday morning, January 25th, at South Africa House, London, when the Union High Commissioner presented Red Cross certificates to sixteen South African ladies who had successfully passed the examination in first aid, held at CharingCross Hospital. Manyof these ladies will now take a course in home nursing. In a few cordial words, the High Commissioner congratulated all concerneJ. The examiner said that never in his experience had he met a better qualified group, and t hat was high praise indeed. Morning tea was sen'ed to the company, which included Mrs. Waterscn and the members of her Volt.:ntary Services working party, and a number of guests.

Misuse of th e Red Cross Emblem. SOME concern has been caused recently by the misuse of the red cross as an em blem. The use of the red cross is strictly governed by international conventions, and it is essential that the regulations made under them should be properly observed in order that the red cross emblem may retain its full significaace. Vehicles used as ambulances cannot properly bear the red cross emblem unless they are solely, or exclusively, enga~ed in the transport of \'ictims of enemy action. Thus a municipal ambulance removing civilians injured by an enemy air raid may properly bear the red cross emblem, but a municipal (or any other) ambulance removing injured civilians, soldiers, or anyone else whose injuries were not caused through enemy action may not properly bear the red cross emblem. Similarly, a red c ross flag can be flown only on a hospital, and should not be flown from the administrative offices of an organisation concerned in hospital work.

It is estimated that the British Red Cross will benefit by more than £30,000 from the sweepstake on the Irish Red Cross Steeplechase in Dublin. The annual meeting of the Oundle Division, S.J.A. B., was presided over by Div. Surgeon A. F. ElIiott. Personnel had increased to 26 ; 63 cases attended, also 6 road accidents. Brig.-General F. H. Willan, C.M.G., D.S.O., has presented a new ambulance, which will take four stretcher or nine sitting cases, to the Winchester Division, B. R. C. S. 3

•

A.ID

17 1

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For more than 50 years Alexander Clark have supplied Presentation Gihs and Com petition Prizes to Fi rst Aid Societies throughout the emire W o rld . . . . . surely convincing testimony to their values and service. Write, 'phone or call for illustrated Catalogues.

The staff of the Hope-street F.A. P. Todmorden, were entertained to luncheon by Dr. and Mrs. Clegg. M r. T. Lowe presented Mrs. Clegg with a cut-glass bowl from the members . Many of the men and n u rses attached to the Birken heac.: Corps, S.] .A. B., have volunteered for part-time d u ties at the first aid posts and depots under the supervision of the Medical Officer of Health for Birkenhead. A scheme is now being prepared as the result of which in the event of a n air raid all the members of the Corps will report to the first aid post or depot nearest to their homes.

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FIRST

I7 2

Queries and Ansvvers to Correspondents. Queries will he 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 FIRST AID, 46, Cannon-street, London, E.C.4. 2.-AII Queries must be written on one side of paper only.

3.-AII Queries must be accompanied by a " Query Coupon' cut from tbe 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 39th (1937) Edition of the S.l.A.A. Manual of First Aid to the Injured. TREATMENT OF BLEEDING TONG UE. H. C. (Sutton Coldfield).-Will you please advise me what treatment should be given a person who has had an Epileptic fit and has severely bitten his tongue? ·W ould pressure on the facial artery stop the h;;:emo rrhage ? I thank you for past adVice. Tut ! Tut!! You must really pay more attention to the Textbook! !! So turn to p. 115 and harn which parts are supplied with pure blood by the facial artery; and then turn to p. 138 and learn how you should treat excessive bleeding from the tongue.-N. CORBET FLETCIIER.

EXA!'v1INATION HOWLER. 1\1. R. (Cannon-street).-In a recent examination I a s ked a candidate how she would treat a patient ,,\'110 was suffering from excessive nose bleeding. I was mu ch amused when she replied in all se riou s ness :-" I ?e'ould 11"11 patient not to 1lreatlze.l.l" Good!

ext, please! !-N . C. F.

TREATMENT OF FRACTURE DURING INSENSIBILITY. L. W. (Plaistow).-I am an Instructor at a large A. R. P. First Aid Centre, and at a recent demonstration I was asked by one of the first aiders if, in the event of an unco nscious person having a fractund limb, it would be correct to splint the limb as per Textbook or if it should be left without splints and merely immobilised. Am I correct in stating that it should be splinted because, on recovery, the patient may become violent or restless and do himself harm? The opposition by the other first aider to the application of splints was that he was told that, if the limb was splinted, the patient, on reco,'e ry, would suffer severely from cramp due to expansion of muscles which had been relaxed. While thanking you for past hints, I ask your kind ruling. Of course you are right. As the Textbook says in Rule 1 on p. 66 all fractures must be splinted on the spot, the only exception to such action being when "life is in danger from so me other cause." The muscles of the limbs no not "expand" after reco ve ry from insensibility, but only during voluntary contraction; and the splints would have been incorrectly applied if the patient, on recovery, "suffered sev~rely from cramp."-N.C. F,

AID

FIRST

•

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ONSET OF CONCUSSIOl>:. P.S. (Croydon).-The Textbook (p. 163) tells us that after head injuries Concussion comes on immediately. Our lecturer, however, stated that this is not so and that it is most frequently delayed. The statement in the Textbook that in Concussion" the patient is at once in a state of stupor" is perfectly correct. It seems to me, therefore, that you are rather at cross purposes with the Textbook and that you are incorrectly thinking of Concussion in terms of complete insensibility. If you remember that Epilepsy is the one condition named in the Textbo"k which is associated with" sudden and complete loss of co nsciousness," perhaps your difficulties will disappear. - N. C. F.

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HUMOUR IN A. R. p_ M. G. (Crayford}. - A local authority in Kent is building its new First Aid Post within 40 yards of a large munitions factory but it has chosen a safer spot for the mortuary. Good! Next, please! !-N.C.F.

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SPATS IN TREATMENT OF FRACTURED LEG. A.H . (Thornton}.-Attached please find news cutting frolll recent issue of vVest Lancashz"1'e Gazelle :" A use for spats has been found at the Front. A letter from a surgeon 'somewhere in France,' quoted by a correspondent to the B11'mz"nl[lzam Post says : " Could you enquire among your acquaintances for any old spat'> they don't want? We've worked out a method of extending fractured legs by means of spats, and would be glad of any that are going." I shall be g lad if you can tell me what possible use spats could be in such cases. I can only think of one use and that is in place of a clo.ve hitch on ankle and foot \\'hen used in conjunction with the Thomas Splint. Like you, 1 give it up !-N. C. F.

173

TRE.\TMENT OF FR ,\CTU RED FEMUR. E.II. (Ely) . - Tn the January issue of FIRST AID you replied to a query whi ch, published under the above heading, refened to the difTiculties of splinting the fractured femur of a WOIllan with large hips. So I would like to say that I once treated such a case and that I found a feather pillow most satisfactory which, of course, falls within your suggestion - " cotto n wool or similar material. "

G. P. (Kidsgrove). - Herewith the true story of a skeleton, the funny side of which may appeal to readers of FIRST AID as it did to me when first 1 heard it : The Superintendent of a Division close to here owned a skeleton which was used for demonstration purposes. On his death the skeleton was returned to his son who, having no use for same, laid it out full length in an empty chest in his garage. One day a traveller called who had previously sent some goods of inferior quality. The Superintendent's son, after telling the traveller in no uncertain manner what he thought of him, asked if he knew what happened to the last man who played such a tri : k on him. The traveller said he did not, whereupon the son lifted the chest lid remarking, "there he is," and the traveller promptly fainted. Thanks for story which is duly published, even if the son's action was a bit rough on the traveller.- .C.F.

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cerns are now busily seeking the assistance of fully· trained First- A.id men in order to maintain the efficiency of their work·people. Special departments are being organized in most Factories, Shipyards, Collieries, Workshops, etc., where injllries cannot only receive first-aid treatment, but upon being discharged by the surgel)ns can receive massag;e treatment and so decrease the lehabilitation period. SPECIALL.Y

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FIRST

174 TREAT,\ lENT OF FRACTURED

FEMl'R.

C.H. (LIanelly).-When lifting- patient .\lith fractured thig-h bone, we notice that the splint moves up and down 3 to -+ inches at the rap end, bandage B, unless we pull unreasonably tight. V.:e have tried the following which appears to nx the splint, but ask your opinion : Place bandage in position, take the upper end of the bandage in the left hand and pass it outside, unGer. inside, and over the top of the splint, hold firmly, pull on the bottom end of the bandage and tie the t,vo o\'er the splint. From your description it would seem. that you loop bandage B round the splint before tying the ends. While I can see no objection to this, I am of the opinion that the movement of the splint, to which you refer, can produce no harmful effect on the fractured femur. -N. C. F. TREATMENT OF BLEEDING FR01<1

MOUTH.

P. H. (Fin~hley).- The other night I was sent out as a patient with some others. from the First Aid Post where J am on duty, on an A. R . P. practice. Before the stretcher party arrived the warden was telling us what he would do for us. One of the cas'Jalties had a fractured lower jaw (we were all made with grease paint, etc.) and blood was coming out of his mouth, whereupon the warden informed us that he would" apply a tourniquet to the facial artery." I think that is worthy-of going into your howler column. don't you? On your statement of facts the warden llas clearly received inadequate instruction in first aid, if he imagined that pressure on the facial artery would control bleeding from within the mouth. You should refer him to p. 138 of the Textbook. - N.C. F. TRE.\T ,\ IENT OF HEAD I 'JURIES. G.C. (Chin~·ford).-In a recent discussion the question arose as to the co rrect treatment of concussion and fractured skull. The treatment of these injuries, as set out in our Textbook. appears to me, to aim at drawing the blood away from the brain by cold to the head and warmth to the lower parts. The first rule, however, instructs us to apply the General Rules for Treatment of Insensihility as far as they are applicable; and I take it that this means raise the feet and legs while keeping the head low. This would, of course, promote a better circulation of blood in the brain and seems to contradict the other part of the treatment. In these circumstances r ask for your kind ruling.

The Textbook recommends similar treatment (includina application of cold to the head) for all cases of head injuri~~ because there may he deep-seated injury which will sooner or later de,'elop into compression of the brain. The raising of the patient's lower limbs is not contradictory treatment because it limits the general circulation and so in this way promotes im ,J rovement in the patient's condition.-N.C. F. COLOUR OF FA CE WITIl FRACTU RED

SKULL.

G.C. (Chingford).-I should also appreciate your ruling on the colour of the patient's face with fractured skull. I presume that it wo uld be pale unless compression were present. In the e\'ent of a patient suffering from a

AID

~ FIRST

fractured skull and still retaining unconsciousness what \\'ould the correct position be-to lay him down or ha\'e him sit up? With a fractured skull the patient may b~ suffering frol11 concuss ion or compress ion of the brain, his face being pale or Rushed as the case may be. \Vith such injury the Textbook (p. 154) tells you to keep the patient flat on his back with his head turned to one side and to raise the head and shou lders only when the face is Aushed. The latter instruction signifies raising head and shoulders just above the level of the body and not to a sitting position.-N.C.F.

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By G. DOUGLAS DREVER. M.B.• Ch.B.

7d. each

I. FRONTVIEW. 2. BACK VIEW. 3. BONESOFTHESKULL. 4. ARTERIAL CIRCULATION AND PRESSURE POINTS 5. TYPES OF FRACTURES (Each size 10 x 7+ ins.)

6/- PER DOZ.

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I s. net; postage 2d. Obtainable of all Booksellers TREATMENT OF

FRACTURED

J AW.

S.E. (Rugeley).-The J\linistry of Health have recently issued a J\lpmorandum for the Guidance of l\ledical Officers and other Personnel at Aid Posts. Among other things mention is made of fracture of the Lower Jaw and emphasis is laid on the fact that the practice of usirlg the method of the St. John Textbook when dea ling with such cases should be avoided. It states that our method" is likely to increase the displacempnt of the fragments by its backward pull," and it is recommended that a barrel bandage be used for such cases. From enquiries I understand that this bandage was originated by Sir Harold Gillies and consists of a piece of strong two-inch bandage, four feet in length applied under the chin. The ends being tied in a half knot, the knot is then divided, and loops are passed round the forehead and back of head respectively. Completion is made by tying off at the top of the head. At the Aid Post under my charge, this bandage .vas tried for practice purposes and appeared to g ive good results. Taking into consideration that a narrow bandage is about the right width and length, we tried out with his method and we found same to be a decided improvement. In these circumstances it would be interesting to have your opinion on how far the objection raised against our own method are legitimate. To me it seems that the St. John method of treating a fractured jaw is quite satisfactory for the purposes for \vhich it was designed, namely for cases of civilian injuries. Under war conditions, however, fractures of the jaw are usually so badly complicated and comminuted that the objection raised would appear sound and justify the substitution of the barrel for the halter bandage. -N. C. F. TRANSPORT OF

PATIENT WITI-I

HEAD lNJURIES.

G.C. (Chingford).-Another problem which has just arisen is the method of carrying a patil:!nt on a stretcher with his head hanging face downwards over the edge as advocated by the E.1\1.S. for fracture of the lower jaw or severe injuries thereto. Surely this method is going to increase the injury by jolting during transport, besides being extremely awkward to handle. Thanking you for your kind answers which will settle a number of disputes here. If you will re-read the instruction in A. R. P. Handbook No. 10 (p. 20 & 21) you will appreciate that the patient is to be transported with his face downwards and with his head hanging over the head of the stretcher only when, consequent of face and lower jaw injuries, there is present a danger of the patient's tongue falling backwards and choking- him. N.C.F.

Prices for quantities on application.

LONDON: This frame has been designed especially for the purpose of securely locating and thus preventing slip of Cotton Wool Filters or other Masks when used as Resp irators in safeguarding workmen against dust arising from industrial operations . It possesses many advantages over other articles of a similar character inasmuch as : It is rustpro~f and smooth, bei ng flexible it readily conforms to contour of the face th~s 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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. . . d f R de '0 " Fir t Aid incluJin't Elemcntary Anatolll\. Th is Notebook \las originally prepared t? afford assl ranee tn (he slLu yo , c ~ f~~ blank 'page for cllC student's o\\'n notes. It is illu tra ted by reproductions of the diag ram s shown durtng the ecttl!e~. Eac aceS:l . Size 8" x 6*" (limp clotb) 28. 6d. nct 70 lllustr:ltions Pp. 10 4

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CRAFT.

1940.

THIS

NUMBER.

EDITORIAL : -

Summer Acti\·ities ... Blood and its Functions S.]. A. B. Headquarters and District Reports St. John Ambulance A.ssociation Priory for \\Tales A. R. P. Topics First Aid Competitions ... Rail~'ay Ambulance News St. A.ndre\\·'s Ambulance A.ssociation London Stretcher Parties' Competitions :'Ilarking Sheet The Hospitallers' Club ... Classification of Fractures Police Am bulance N" ews Re\'iews Our Nurses' Pages The Beg-inner ... Concussion of the Brain

177 17 " 179 1 0

1 2 1 2 1 3 1 -I 1 -I

18-1 1 "5

1 5 1 5 186 1c 8

190 190

QUERIES AND ANSWERS TO CORRESPONDENTS : -

A.ction of Smelling Salts with Head Injuries Examination H O\\'ler Sugar in Treatment of Shock Com'ulsions Limited to One Side Treatment of Gas Contafininated "Vound Humour in First Aid Bleeding from Palm of Hand Wound Infected with Blister Gas Special Bandage \vith Fractured ForE'arm Application of Bandages "'ith Fractured Leg ... Tnu port of P:l.tient ,,\lith Head Injuries

E"te,..d a t ] [ Statio,.er~ · Hall

PRICE TBRBEPENCIl [S/6 PER A:-rNUM, POST "FREE

EDITORIAL.

FII<ST AID is published on the 20th of each month . The Annual Subscription is 3s. 6d. post free; single copies 3d. I ts aim and object being tbe advancement of Ambulance 'York 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 belo\ , and should reach him before the 12th of each month, and must be accompanied (not necessarily jor {)ubhcation) by the name and address of the Correspondent. Subscriptions, A.d'·erti~ements and other business Communic:iuons connected with FIRST AID should be forwarded to the Publishers. DALE, REYNOLDS &: Co . , LTD., 46, CA:\,);O); STREET, LO:-lDO);, E. C.4.

CONTENTS

READERS.

CO. LTD.

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ASEPTIC

Editor:

JOHN FENTON, M.B., B.Ch., B.A.O., D.P.H.

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192

1n 19-1 19-1 19-f

19-1

THE advent of Summer Time, in the past, meant the cessation ACTIYITIE of classes and the commencement of summer duties, including the manning of Roadside Huts, Fir t Aid Stations at the seaside, and other outdoor activities. This year, however, \\' ill see an alteration in the usual procedure. Owing to petrol rationing, less cars \\·ill be seen on the road, and therefore the work at Roadside H titS will be lessened. The evacuation of parents and children to country and seaside districts will, howeyer, mean more voluntary seryice for first aid personnel during the bright e\'enings. Also classes in first aid, home nursing and allied subjects are to be continued during the summer months, and therefore personnel will again find much to occupy their time. The Government has urged that holidays be taken as usual this year. \'Te find that no summer lea ve has, as yet, been arranged for A. R. P. personnel, and it is therefore more than probable that first aiders will be asked to supply reliefs during the absence of the usual personnel. 'Vhat is usually the ., easy" time for first aiders mar therefore become as busy, or busier, than the" rush" period of the winter. The voluntary first aider is to-day, \yichout doubt, the grearest li\'ing example of " Service for Others." I n no other sphere of social activity is service and time given so cheerfully, so readily and so enthusiastically, and on many occasions at great inconvenience, without one thought of reward. No matter what calls are made on the voluntary personnel, we know they will be answered, and the work carried out in the high tradition of " Service to :'Ilankind." Sl".:-'DIER

FIRST

The Blood and Its Functions. By N. CORBET FLETCHER,

M.A •.

M.B., M.R.C.S.

BLOOD is the red fluid which circulates in the arteries, veins and capillaries. It performs three special duties: (1) it nourishes the body; (2) it carries away waste prod ucts and discharges them from the body thro ugh the organs of excretion ; and (3) it protects the body against invading organisms. CHIEF FUNCTIONS. Its chief duty is to afford a means of communication between the various organs and parts of the body, whereby the inter-action of the vital functions-or, in other words, the process of life-is carried on. Without this Suid medium the co-ordination of the systems in man and the higher animals could not be effected; and with its loss-and especially when this is great and also rapid-shock and possibly death may quickly supervene. In brief the blood has been aptly described as a mechanz"cal transport system, which is controlled by the nerves acting as a telephone system. In this connection research has proven that some (probably all) the internal organs pass into the blood special chemical secretions which have been called "hormones" (that is stimulants) and which act as cltemz"cal messengers to excite other organs into suitable activity. Instances of these are (1) adrenalin (secreted by small ductless g land s which cap the kidneys and are ' consequently called" supra-renal" glands) which controls bleeding and causes blood vessels to contract; (2) some substances from the thyroid g land (found in the neck over the trachea), absence of which causes in the child a form of idiocy called" cretinism" and, in the adult, a form of degeneracy known as "myxcedema" ; and (3) pituitrin (from the pituitary body situate in the base of the brain) which may cause rapid and lasting improvement in cases of profound shock. COMPOSITION OF BLOOD. Human blood has a specific gravity of 1055, a saltish taste, and an alkaline reaction. It is composed of a fluid element (plasma) which, a clear liquid, carries nourishment and waste products in solution, and in which are suspended the cell elements consisting of red and white corpuscles and blood platelets. In a cubic millimetre of human blood there are 5,000,000 red cells, 8,000 white cells, and 500,000 platelets. The quantity of blood in man averages i-12th of the total body weight. The red corp uscles consist of bi-concave discs slightly thicker at their edges, and are composed of nitrogenous matter combined with an important protein called hmmoglobin- rem arkable in that it contains iron-which takes up oxygen easily and in solid form, keeps it in loose but plentiful combination, and yields it readily when its concentration decreases. The colour appears to have no special value but to be merely incidental to its chemical composition. In short, red corpuscles are the oxygen ca1'rz"e1's and distri butors. The white corpuscles (l eucocytes), which are derived from lymph glands and spleen, vary in kind and shape, and are claSSified according to staining qualities as exhibited under the microscope. They ingest and destroy germs, and ~Iso neutralise products of inflammation whereby the body IS protected. In short, the white cells are germ hllers. The blood platelets are small circular bodies which are ?alf the size of red corpuscles, and are believed 'to have an Im~ortant part in the clotting of blood. In this process, in hlch ,. a.s we shall see, the proteins of the blood share,fibrz"n IS precIpitated from the plasma and from the clumps which form blood platelets, catches up and entangles the blood ce lls to form a clot.

INTER-ACTION OF VITAL FUNCTIONS. . In. the blood the fuel suppliej by the food through the Digestive System enlers into chemical combination with the

FIRST

AID oxygen which is derived from the lungs and in corporated in the hremoglobin of the red corpuscl es. Thereby body-heat and body-energy arc given off. The h;;emoglobin then passes into every part and organ of the body, gives up its oxyg-en where the oxygen pressure is low and removes in its stead carbonic acid to the lungs for excretion. By this means Circulation, Respiration and Digestion work together for the common good; and over each and all the Nervous System presides. Research has shown that digestion is after all not a s imple chemical process in which complicated compounds taken as food are broken up into simple combinations of carbon, oxygen, hydrogen and nitrogen; but that there are certain accessory food factors-known as vitamines-s uppli ed by food and derived directly or indirectly from plants. These circulate in the blood in very small quantities but are essentially necessary for good health. Of the vitamines the earliest recognised is "fat soluble A," which is present in butter, milk and vegetables; "water soluble B" which is found in embryos of seeds and total absence of which causes an Eastern disease called beri-beri ; and" antiscorbutic C" which, as its name signifies, is essential for prevention of another deficiency disease called scurvy, and which is supplied in large amount in fresh fruit and vegetables and in less amount in milk and meat. The blood plasma, therefore, contains many important subsLlonces essential to the inter-act ion of the ViLal Functions-proteins, salts, bicarbonate of soda, sugar, fat, vi tamines , hormones - in addition to the products of combustion -carbonic acid , water, urea, and uri c acid . The latter, by the way, are not poisonous as the advertisements of some popular remedies often state! The salts are chiefly those of sodium potassium and calcium. The bicarbonate of soda, in conjunction with a variabie content of carbonic acid, serves to maintain a constant slightly alkaline condition of the blood. RESISTANCE TO DISEASE Resistance to disease caused by germs is due to the a ction of the white co rpuscles and the formation of certain anti-bodies in the blood, which either destroy the germs or assist the white cells to do so. This resistan ce can be produced or stimulated artificially by the injection of the products of germs or their poisons (toxins) in reg ulated nonpoisonous doses. In this fight with dise ase a part is taken by the proteins of the blood plasma, which are derived from the food taken by mouth a nd simplified in structure in the process of digestion. Part of the proteins is used for feeding the tissues; yet more is present than is required for this purpose and some doubt still exists as to how the excess is utilised. It serves, however, to f01"m blood clot and also has a share in creating the antibodies by which the human body is immunised against certain diseases, especially those of infectious character. In cases of wound-shock some poison is supposed to be produced in the injured tissue and to caLIse dilatation of the smaller blood vessels to such an extent that a great part of the blood is retained within these vessels and the patient collapses as if suffering from profuse external h mmorrha ge. The condition used to be treated by injection of salt solution, the disadvantage of this being that salt consists of small molecules which pass rapidly through the vessel walls. During the Great War, therefore, Professor Bayliss instituted a more successful treatment of shock by injections of gumarabic. This substance, though inactive of itself, is made up of large molecules to which the blood vessels are impervious, and enables the solution to remain in active circulation long enough for the patient, in many instances, to recover from the shock. To sum up, it has been clearly shown in this article that the blood takes a most important share in the development of the body, in the support of life itself, in the maintenance of good health, and in the protection ag-ainst disease.

St. John Ambulance Brigade HEADQUARTERS AND DISTRICT REPORTS.

Brigade Headquarters Brigade Orders, issued 011 February 15th, 1940, set out many items which were di scussed at the recent Commissioners' Conference and reported in the December issue of FIRST AID, including the following : B.O. 701, Brigad e Efficiency (which takes effect from January 1st, 1940); B.O. 701, Omit wearing of shoulder brace of Sam Browne belt (medal ribbons only to be worn for all occasions durin g war period) ; B.O. 704, Drill Manual (revised issue deferred , st retcher dri 11 in structions to be issued in lea Set form); B. O. 70S, Replacement of Sam Browne belt; B.O. 706, Uniform on A. R. P. (members may wear uniform when on duty or overall uniform with Brigade Badge on right breast). Other orders include :-B.O. 700, Except for Surgeons, Nursing Officers, Presidents and Vice-Presidents, appointments of Officers and N.C.O.'s will be temporary durin g war; B. O. 703, "Dewar" a nd "Perrott" Shields Competitions cancelled for war period; B. O . 707, Recruitment of the R. N. A. S. B. R. ceased for period of war; B. O. 708, A waiting li st is bein g kept at Brigade H eadquarters for members who desire to volunteer for service in the R. A. M. C. Form Ref. R.A.M.C. / V. ; B.O. 709, Ambulance Drive rs and Orderlies at Home and Overseas, required by the War Organisation. Pay ranges fr0111 45/ - per week for married drivers (22/6 , sin g le driver) and all found; 40/- per week married orderlies (20/-, single) and all found, plus certain a llowances; B. O. 710, Two National Flag Days (J une 5th and one to be arranged in October) ; B.O. 711, Anti-G as Instructors (Grade 1) including Grade 1 (External), examined or re-examined during past two years have been recognised by the Home Office as qualified to give the full course, the V.A. course, and the short course, as set out in H ome Office Circular 26/ 1939, da ted March 26th, 1939. They a re not, however, to use the smelling samples or gas vans excepl under supervision; B. O. 712, Enrolment of Alien s and non-British born subjects; B. O. 713, Members prevented attending drills and practices with their di vision may, during the war period, count attendances with any registered division of the Brigade.

No. I (Prince of Wales's) District R OMFORD .- The Boroug-h of Romford Ambulance and Nursing Divisions held an Inaugural Dinner and Dance on Thursd ay, February 1st, and in spite of the weather and the black-out, a very enjoya ble evening was spent. Those present included the Commissioner and Mrs. Goodley, the Mayor and Ma yoress of Romford, and the Medical Officer of H ealth of Romford. Supt. E. Howard presided a nd was supported by L. A. O. Mrs. D. B. Howard, i/c the Nursing D ivisio n. At the co nclusion of the Dinner, and after the Toast of "The King, II Pte. R. A. Root a bly proposed the Toast of " Our Guests," making a few appropriate comments on each of the chief visitors. This Toast was replied to in well chosen words by the Mayor. The T oast to "The Divisions" was proposed by the Commissioner, who congratulated the officers in charge on ha vi ng- brought these new Division s to a strength of 66 m en and 34 women in the short time they were reg istered. Suitable replies were made by both officers, who stressed the self sacrifice of the members in providing themselves with uniforms at their own expense, and in doing their utmost to keep up the good name of the Bri gade in its " Servi ce to Humanity."

AID

179

Dancin g followed and cont inued un ti l 11 o'clock, when the gathering h ad reluctantly to dispeJ-se.

No . IT District BUCKINGIIA~ISHIRE.-The County Secretary (County Officer N. R. B. T ebbitt) issued his third County Circular last month. Practically all available personnel in the county are assisting in A. R. P. services, clinics, hospitals and the care of evacuated children and mothers. Emphasis is laid upon the collaboration with the British Red Cross Society wherever possible. It is interesting to note that a Joint Committee of B.R.C.S. and S.J.A.B. has been in existence in Bucks since 1921. Dr. E. W. H. Townsend, County Medical Officer has been appointed County Surgeon (Advisory). The circular includes reports from numerous divisions in the county which clearly show that members are upholdin g the traditions of the Brigade.

WlTNEY.-Al the annual meeting of the Witn ey Division, held on February 8th, Supt. J . C. Chesterman, who presided, referred to the importance and successs of the work carried out by the Division. He especially thanked the officers and men for their services. Having completed 37 years of ambulance work, Supt. Chesterman said that he had never regretted joining the S.J.A.B. The report of the retiring divisional secretary (!\Ir. S. Collis) showed that first aid had been rendered on 151 occasions, members had attended 46 public duties and made 304 attendances at local cinemas. Cadet Supt. S. Collis reported favourably on the Cadet Division; and Div. Treasurer W. J. Rowe on the finan cial side. The chai rm an presented lr. Collis with a mirror, subscribed for by the members, to mark his retirement from the secretaryship, a position he had held and carried out efficiently for many years. Mr. C. Hudson had succeeded Mr. Collis. Pte. R. Lawson won the "Chesterman II attendance cup, with Corpl. H. Busby runner-up. The Cadet attendance cup had been gained by Pte. D. Godfrey; Pte. R. Beale and Pte. C. Ivings being- runners-up.

No. V District BENTLEY.-At the annual dinner and dance of the Bentley Colliery Division, held on February 10th, Dr. J. Fergusson in proposing" The Am bulance Brigade," referred to the fact that whilst so many people knew all about the workin g of a motor-car or radio set few had the faintest idea where their liver was. The proposer knew of no voluntary orga nisat ion whose work was held in greater respect than the two first aid associations in this country-the St. John Ambulance Brigade and the British Red Cross. Supt. S. J . Temperley responded. In spite of members being called up the personnel had increased. He welcomed Supt. Goodall (Cadets) who had won the admiration of all i:: the cheerful way he had borne his accident. Lady Supt. Jameson said that she had never had a more loyal band of workers. Her membership had increased from 19 in 1937 to 40 in 1939. Mr. D. MacGregor, who was accompanied bi' l\Irs. IVlacGreg-or, presided and thanked by Dr. ]. T. ErsklOe and Amb. Officer W. Mayes. About 180 people attended the dinner and, at the dance which followed, some 350 were present. D ER lw.-Duri lllT the January heavy snowfall in Derbyshire the D erby S.J.A.B. received from the Medical Officer of a unit" somewhere in the county," an urgent message

FIRST

r80

for an ambulance to take a soldier, who had de\'eloped acute appendicitis, to hospitaL The ambulance set off about 1 p. m. Two miles from the unit's headquarters the ambulance men started off on foot "'ith their stretcher throuRh a long lane blocked by drifts of snow which in places were eight to ten feet in height. Soldiers and a small sno,>,--pJough pulled by two horses helped to clear a way. Eyentually the stretcher bearers arri\'ed at the unit's base, carried the sick man across an orchard and fields to the lane, and strapped stretcher and patient to the snow-plough. Drawn bv the horses, with the ~ledical Officer and ambulance m~n in attendance throughout the hazardous journey, the party finally reached the main road and the ambulance. The soldier was taken to the Derbyshire Royal Infirmary, where the operation was performed "just in time," and \vas completely successfuL The two ambulan;-e men concerned ,,'ere CorpJ. Ibbotson and Pte. Toon.

No. VI District HULL.-The Alexandra Dock Di\'ision held their annual competition for the "Dr. 'Wilson" efficiency cup at headquarters, Anlaby-road. Corps Surgeon ~. Rymer, set the test. The competitors had to render first aid in black-out conditions, using only a torch and ha\'ing no real equipment. The result was: 1, S ergeant H. Clark; 2, Pte. H. Wick; 3, Pte. H. E. Cheetham. EAST CLE\'ELM\D.-The first competition of the East Cleveland Division for the cup presented by the Skinning rove Iron Co. Ltd., was held recently. The members of the winning team were Ptes. J. Blenker (capt.), J. Bennetts, ]. F. Cuthbert and G. Beadnall. Each member will hold a sih'er cup until December 31st, and in addition, they were each presented with a silver spoon Riven by Div. Surgeon v\'. P. Dunn and his partner Dr. J. B. S. Guy. Pte. J. F. Cuthbert gained the prize for the highest individual marks. The Divisional Surgeon and Dr. Kirkpatrick judged the work. :\lr. \V. S. B. Bosanquet, :\lanaging Director, Skinningrove Iron and Steel \Vorks, presented the cups and prizes; also the awards gained by members of the ambulance and nursing divisions during 1939. Supt. J. Fawcett proposed a vote of thanks to 1\1r. Bosanquet and the judges. Lady Amb. Officer 1\1rs. Kitchener seconded the proposal. Di v. Secretary Amb. Officer ]. H. Jackson was responsible for the arrangements.

'".r.

No. X District The half-yearly officers conference of the 'orfolk County was held on Sunday, February 18th, at the Lads Club ~orwich. ' Acting County Commissioner Dr. K. F. Lund was introduced by Lord Bury (County President) and was unanimously elected to the chair. Letters of absence were read from County Commissioner Sir T. Cook, 1\1. P. and several officers. The two new Asst. County Officers, Mr. R. C. Hannant (Gorleston) and :\1r. C. B. Andrews (Fakenham) were welcomed by the chairman. I\1any questions were asked regarding members joining the R. A.:\1. C., also on A. R. P. and other matters. , Si: Basil :\1ayhew, K.B.E., Chairman of the Joint War CommlLtee gave a very interesting talk on the Committee's work. At the end of the meeting, Sir Basil was elected County vice-President.

FIRST

AID BECCLES.-At the annual meeting of the Beccles Division, a presentation was made to Supt. \\'. C. Watts, b:' Lady Supt. :\liss E. Tedder, on behalf of all members. Div. Secretary C. Bennett reported a good increase in membership; Mrs. C. Bennett (Di\·. Secretary of the I\ursing Division) stated that members had supplied two units for the Beccles F. A. p, and most of the personnel for the three mobile units. I ncreaseS in personnel were also reported by Cadet Officer R. Piper and Cadet Supt. :\liss L. ,-\. Robinson. The first Grand Prior's Badge to be a,,'arded in Suffolk had been won by Joyce Taylor.

SHERRINGHA:ll.-SUPt. S. E. Day presided at the annual meeting of the Sherringham Division, held on February 27th, when details were given of the members' war time duties in connection with ,-\. R. P. and also the lifeboat. In addition to forming three first aid parties and otht'r parties, a further call had been made upon the voluntary se:-vices of members, as the lifeboat area extending from Blakeney to Cromer ,,'as to be covered, in case of landing of ship-wrecked people.

St. John Anlbulance Association. .-\s stated in a previous issue of FIRST AID the Association has decided to recognise certain State Registered General-Trained Nurses as Examiners in Home nursing. For the period of the ,,'ar the following alterations in rules will be allo\wd :Classes of mixed seNes in Home :\ ursing as well as in First Aid. Examinations in the same subject at intervals of four clear months, e g., First Aid Certificate, "lay 6th, 19fO i Voucher, September 7th, 1940 i :'ledallion, January 8th, 1941 ; 1st Label, May 10th, 1941. After the first label a student will be unable to sit for further examinations during the same calendar year. Should an examination in Home J ursing be taken as one of the three towards the nledallion, then eight months must elapse between the two First Aid Examinations. The first Pendant may be gained four months after the date of the Home Kursing Certifi:ate provided the :'tledallion has been gained in the meantime. Thereafter Pendants can only be g-ained once in each calendar year. The changes will take effect as from October j st, 1939. The Association has also decided to accept applications for award from first aiders who have been in the habit of being re-examined at reg-ular inten-als but, having enlisted in H.M. Forces, have been prevented thereby from continuing their studies and from being re-examined. Normally, the possession of the Medallion gained as the result of examinations held in three successive calendar years, or of the Label gained in the year following the Medallion, or of two (or more) labels gained in consecutive years, will be accepted as legibility to benefit by this concession, provided that an award was gained in the calendar year immediately prior to that in which the applicant enlisted. Any person, however, who obtained a Certificate and joined the St. John Ambulance Brigade on or before December 31st, 1938, and was re-examined during 1939, is eligible to apply for a medallion for 1940 and for labels for each subsequent calendar year of service with H.M. Forces. In order to benefit by this concession persons other than those serving in a Medical Unit must pass a re-examination in First Aid within twelve months of the date of their demobilization. Applications will pot be enter~ained until after demobiliZ8.tion.

Priory for Wales.

AID

181

~ewrort

Rhondda wansea

_-\. R.

BRIGADE A. R. P. ,-\\\'ARDS ISSlJED 1)-,; \\'A LES DURING 1939. Centre

Anglesey Brecknockshire Caernar\'onshire Cardiganshire Carmarthenshire Denbighshire Flintshire GlamorganAberayon Bridgend Caerphilly Gower Llantrisant Neath Pontardawe Pontypridd l\lerionethshire 0IonmouthshireBedwellty Gwent Trevethin :\lontgomerysh ire Pemhrokeshire Radnorshire Aherdare Cardiff l\lerthyr

G. P. G.P. Certs. Vchrs.

Total

Grade I

Grade 2

A.R..P. Ceres.

A.R.P. Vchrs.

10 7

159 92

42 30 29

36 13

50 19 51

8 72

g- I 65 34 5

34 13

337 117 8f 213

4 "7 206 119 310

2 7

29 7

105 13 9 71

4 14 11

106 49 17

225 232

449

SOC)

68 222 6

172 318 161

9 3

7 1

16 4

5 8

9 25 9

f 1 3

2 1 2

77 61

Ie)

292 160 19 173 43 136

11 I

12 20 2

cl.f bll 111

150 1,402

2~~

2,041

4 Total

BRIGADE A. R. P. I/\STRC'CTIO~ DC'RI:o.:G 1939. 1t i very creditable that the Brigade in \\'ales should ha\'e continued with undiminished enerRY to instruct its personnel and a good proportion of the genpral public in .~.R.P. measures during the year 1939, \".hen monetary aS~I. tance was no longer available in meeting the cost of tralnlOg at the Home Office A.R.P. school, and the Home Office grant to,,'ards administrati\'e costs had been discontinued \\'ith consequent loss of a considerable sum incurred br the Priory in maintaining its .-\. R. P Department, responSible for the issue of the f,963 awards summarised in the table given below. Grade 1 Instructors, of \\·hom there are 810 on the Priory Reg-i ter ha \'e "'elcomed th.e announ~e~ent in a ne" Bri aade Order issued b\' the ChIef Commissioner that the P. Department of -the Home Office has now agreed that Grade 1 Instructors, including Grade 1 (Extern~1) Instructor, who ha\'e been examined or re-examined 10 anti-gas measures during the past two years, may be reco~ nised as qualified to gi\'e the full course, the voluntary aId course, and the short course in anti-gas measures as set out in H ome Office Circular 26 1939 dated :'larch 21st, 1939. The use of smelling samples and the pa sing of trainees through gas, or I' testing the fit of respirators in. a gas chamber or gas \'an II must, ho\\,e\'er, be superVised as hitherto b\' an Instructor A.R.P.S., C.AG.S., L..-\.R.P., L.A.G.C.,' or other Instructor specially apprO\'ed for this purpose. The Home Office Circular 26 1939, "'hich had the effect of limiting the powers of Grade 1 Instructors, .to gi\'e only the" Voluntary ,-\id Course" of about 2t hours mstru~= tion was estremeh' discouraaing to those who from 19.)') on,,:ards had at no 'little sacrifice of time and money qualified to instruct Bri aade membership and such members of the public as \\'er~ interested in a ubject ,,-hich they had perceived to be one of vital importance.

50 lOb 29

11/

HEADQCARTER

4 ",)

102

/0 4, Yb:

~OTE

The return alread\' recei\'ed from the majoritvof the Centres g-ive good rea o'n to expect a considerable increase in Brigade member hip as at December 31 t, 1939. ~e\y recruits continue to find in the Brigade an outlet for the desire to sen'e which has become a compelling force in the ]j\'es of most men and women to-day. In the first month of this year the following- ne,,' Cnit \~'ere regi tered :-\\,hitchurch (Cardiff Centre) .-\mbulance Di\'i ion : ~antyffyl1on, Skewen, TonHefail and Coedely \Glamorgan Centre), Pontllanfraith, :\lonmouth (:\lonmouthshire Centre) ; Rhiwbina, Ely and Fairwater (Cardiff Centre) ~ursing Di\·isions. . The recognition of certain member ot the nurslOg profession as competent to examine in Home ~ur ing will relie\'e the strain on the examining tall of medical men. The following se\'en appointments to the Panel of Home Xursing Examiners started by the Priory ha\'c been appro\'ed by :\liss L. J. Ottley. :\latron, Royal. Gwent Hospital, acting in the capacity of :\latron for_the Pnory ;:\liss E. .-\. Gra\'enor, HengoeJ; \lrs. "L rban :\larks, Swansea; :\1iss :\l abel 1. Leonard, Bargoed ; \lrs. S) bil Thomas, Llanelly : :'.lrs. :\1. Jones, Gilwern : :\liss :\1. G. James, Swansea, and :\lrs. H. \1. E.in~ , Barry. The ub-Prior, acting on behalf C'f H. R. H. the Grand Prior, has approved the award of six. en'ice :'.ledals and fo ur Ser\'ice :\ledal Bars, as under : :\ledals (15 years' efficient sen·ice). Glamorgan" Centre.-.-\mbulance Officers \Y. Jenkins and D. Will'iams, Corporal J. H. La\'is, rriYate F. Snook and J. G,,'ilym. . , ' \1 onmouthshire Centre. -Pn\·ate \\. L. Pntchard. Second Bars (20 years' senice) have been awarded to Corps Secretary .-\. J. Elkins and CC'rporal B. Hale, :\lonmouthshire Centre. Third Bars, on completion of 25 years' sen'ice ha\'e be.en received bv :\lajor .-\. W. ,-\nderson, :\1. B., Ch. B., and 01\'. Supt. J. Rossiter (:\lonmouth hire Centre). Dr. .-\nd~rson, who for the past four years has held the office of ,-\ s~stant Suraeon-in -Chi ef for 'Yales, has sen-ed the BnRade In all the ~anks open to members of the medical profession, from Di\'. Surgeon up\\'ards : and from 19.H to 191 was Secondin-Command of the UOth St. ] ohn Field .-\~bulance: . :\ progressi\'e account of th.e past .year s ,,·.ork. IS gl\'en by the Commissioner, :\1r. Damel Dantel]. P., 10 hiS .-\nnual Report, from which the follo\ying are extracts :- . . _ " Li,'e interest is shown by the general pubhc 10 tirst aid and home nursing generally, evidenced by th,e keE'n~ess of joint classes held throughout the County. Dunng ~ 9"Q ~e,,' Divisions of the Brigade \\'ere formed at Haverlord" est, t\lilford Hayen and ~e\\'port. :\ur ing members h~v.e responded readily to the call for \'L'~unteer. to the C.I'·~ l\ursing Re erve, a large numb~r hanng traIne~ or ~eIn,., due to train at the County Hospital, Ha:'erford\\ est, \\ here their a sistance has been much appreCiated. The la~ge number of members who have equipped thems.eh·es With uniform indi cates the keenness of new recrUits to the Brigade. . I bl "League competitions once agaIn proves a \'a ua, e source of enthusiasm, the I Daniel' Leagu.e Trophy bel~lg won by :\lilford Ha\'en Division. \\'hile ' E!ltot .-\lves' Poh,e Troph" was ecured b\' :'>tilf?rd Ha:'en T'l~hce. "-One cause for regret IS the dl bandment of the Fi hauard and Goodwick Cadet enit, which for many )ears functioned as one of the most active and e~ernplary .~~det Di\'isions in \\'ale , two of the members havlOt?' the dl:;tInction of being the first Cadets in Wales to gain the Grand

F IR ST

r82

Prior's Cadet Badge. The disbandment is due to the transfer from the County of the Superintendent, and the mobilisation of older Cadets in the various branches of the Defence Forces. " A Joint County Committee, formed under the Presidency of the Lord Lieutenant who is President of the Pembrokeshire Centre, is demonstrating the local activities of the Joint War Organisation of the British Red Cross Society and Order of St. John. By the end of the year a sum of over £700 was collected by the Joint Committeee to provide comforts for the soldiers and supplies for the Hospitals."

AID

FIRS T

A. R. P. Memorandum No. 12 " Protection of Wind ows in Commercial and Industrial Buildings" (5d. post free) is primarily for those in charge of buildings. Emergency Medical Services Memorandum No. 5 " Oxygen AdministraLion-Indications, Methods and Types of Apparatus" (2~d. post free) is issued by the Ministry of Health: Research has been carried out on the efficiency of the varIOUS methods of oxygen administration, and especially on the new masks devised by Boothby, Lovelace and Bulbulian (B. L. B. Inhalation Apparatus). The results of this research have been included in the Memorandum. "AIR RAID FIRST AID."

A. R. P. Topics. ARSINE GAS. There has been much talk recently on a " new" gasArseniuretted Hydrogen-which has, however, been known for many years. This is a true gas, but it should not be confused with the nose gases which are toxic smokes. It might be employed in the gas form or as a powder called Calcium Arsenide, which resembles Calcium Carbide in appearance, and which generates Arsine Gas when in contact with moisture. The following particulars should be of interest to all readers : -

Clzamcteristics.-Non-persistent; no smell-except in high concentrations when a faint smell of garlic is noted; can be detected by Detector Paper (" Type A") issued, at present, to Gas Identification Officers. Effects. -Acts on the red corpuscles of the blood; exposure in high concentration may prove fatal; low concentration breaLhed for long periods of several hours, or frequently at short intervals, may have serious results owing to the cumulative effect of the gas. Treai1~1ent. -:-Respirator will give protection against conCfmtratlOlls ltkely to be met with in this country. Patients should be stretcher cases, kept warm, given hot sweetened tea, receive medical attention as early as possible.

Limitations.-As this gas dissipates rapidly, the effectiveness against a civilian population is very low. It may, ho~ever, be used i~ large aircraft bom bs or in projector or cylinder attacks which would set up local concentrations. It could also be spread, in powder form, from projectiles, bombs or s~ray at fre9ucnt intervals (i.e., daily over a period) to obtam cumulative effect at low ce ncentration. Decontamination.-For ground contaminated with powder~d Calcium A:senide, the same principles apply as those. laId down for bltster. gas. As however, this gas is not a veSicant, protected clothing is not necessary. Respirators sqould be worn. NEW PUBLICATIONS. A. R. P. Memorandum No. 13, « Care and Repair of Resrirators "(2~d. post free) contains notes on the care of resp~rators,. together with instructions with regard to local repairs. LIttle can be done to the General Civilian Respirator, it is pointed out, except replacement of parts. The Service and Civilian Respirators may, however need minor repairs of various kinds, and scheme-making loc~l authorities are asked to appoint one or more instructors holding special or first class certificates, A. R. P. S. or C. A. G. S. to take char?,e of .a repair depot for these respirators. A list of repairs whIch c~n be done locally are set out, together with metho?s of rep~lr to the h~rne~s, rewiring connecting tube, c~langll1g conta1l1e:, chang.ll1g 1l1let valve, changing eyepiece diSCS, etc. Many illustratIOns accompany the instructions.

This is the title given to a series of 15 wall charts (type area 21 ins. by 15 ins. wide) just issued by John Bale Medical Publications Ltd., of 85, Great Titchfield-street London, W.1, price 7/6 per set, postage 6d. ' The author is Robert J. Blackham, C.B., C.M.G., C.I.E., D.S.O., K.St.J., M.D. etc., who is well known in the ambulance world in England and abroad. The first chart deals with Bombs; No. 2 deals with War Gases (recognition and treatment); and these are followed in turn by Asphyxia; Fractures, Dislocations and Sprains; Anatomical diagram of the skeleton, together with arterie~ .a.nd pre.ssu~e points; treatment of h<:emorrhage; InsenslbllLty; POISOnll1g ; Wounds, Burns, Scalds, Hernia, etc. Sheets Nos. 10 and 11 deal with the Triangular Bandage and its application in regard to slings, fractures, etc. The last four sheets deal with the Roller Bandage and its application. Instructors will find this series of charts of great service and .assista~ce in th~ir teachi?g. The text is clearly and conCisely prInted, whIlst the diagrams are clear and easily followed. The tables of pressure points, insensibility, etc., sh.o\,ld be a help t~ memorise the various conditions app!=rta1l11l1g to the subjects.

Railway Ambulance News.

Sunday, March 3rd, was the 50th anniversary of the foundation of St. John Ambulance work in Guildford. It was started by the late Dr. F. R. Russell and the late Mr. Martin Williamson, and is to-day one of the finest organisations in the town.

Members of the class have manned the first aid post which has been equipped there.

London, Mid land and Scottish. Great Western. LLANTRISANT.-At the annual distribution of awards to the Llantrisant ambulance class, Mr. Alexander presided, the awards being presented by Mr. H. J. Peacock, Divisional Superintendent. Among those present were the station master, Mr. Reeves, and the divisional ambulance secretary, Mr. B. Board. LLANDAFF.-The annual distribution of awards to the Llandaff class, was held at the first aid post at Whitchurch Mental Hospital. Mr. H. H. Phillips, Asst. Div. Supt. was in the chair, supported by Mr. H. ]. Peacock, Div. Supt., Mrs. Peacock, Dr. J. Sewart, Dr. E. H. Spickett and Mr. B. Board. The presentations were made by Mr. Peacock, and before the close of the proceedings, a demonstration in first aid was given by members of the class. CARDIFF. -A combined presentation to members of the men's and women's classes was held on February 8th, when Mr B. Gordon, station master, presided, and was supported

DERBY. -Mr. E. Pugson, Derby, L.1\J. S. Carriage and Wagon Superintendent, was presented with a fountain pen and pencil by Mr. T. Allen, on behalf of members of the Carriage and Wagon Ambulance Corps at the annual dinner of the Corps, held at the Railway Institute, Derby. Mr. Allen stated that Mr. Pugson had been President of the Corps for nearly ten years, and his work had been of great val ue. Mr. Pugson thanked members for their gift and said that he was happy to see that the Corps was in such a fine position. Competition results for last year showed a great improvement on those of 1938. In 1939,95 members presented themselves for the examination and 94 passed. Twentyfive obtained certificates, compared with 19 in 1938; ele\'en vouchers were obtained, nine medals and 50 labels. For those who were unable to attend the examination, said Mr. Pugson, the secretary had arra nged a further examination. There were 23 first year students still to be examined, and the instructors were continuing the classes on Wednesday evenings. The Corps has suffered one great loss by the death of Mr. H. Hobson. Mr. W. Sinclair, Assistant Superintendent, proposed the toast of "The Visitors," to which I\lr. H. C. Healey of Manchester, replied.

london and North Eastern.

First Aid Competitions. THE title of the book by Captain A. C. White Knox, M.C., M. B., Ch. B., has been altered to read as above. Already hundreds of copies have been distributed and many readers have expressed their pleasure on the contents. A.s the author in the Preface states: "The object of this book IS to endeavour to standardise the work of the three units in first aid competitions-the work of the competition secretary, the judge and the competitor." . This book will cert~inly guide the beginner in competitIo~ work, a nd also assist even the most experienced competItor. To members of tl:~ medical profession who are entering the sphere of competitIOns, the author gives hints on the compilation of t;Jarking sheets, faking of injuries, how to prepare for and Judge tests, and numerous items which can easily be overlooked by the unitiated. . Those w~o have actually run competitions know the pitfalls to avoid; but once again this book sets out to assist the competition secretary on whom rests the success of the venture. . The ~ost of the book is 1/-, post free. Orders, together With remittances, should be forwarded to Dale, Reynolds & Co. Ltd., 46, Cannon-street, London, E. C. 4. Special prices are available for quantities.

AID

Mr. W. G. Chapman, who as announced in the February issue, retired from the service of the Great Western Railway on January 25th. by Mr. H. H. Phillips and Mr. H. Swift, Asst. Div. Supts. ; Mr. B. Board, Div. Ambulance Secretary, and ~r .. E. Kennett, Class Secretary. Awards gained 111 examll1atlOn were presented to the men's class by Mr. H. J .. Peacock, Div. Supt., and Mr. Pace, Mineral Accounts SectIOn, Barry Docks, distributed those gained by women members. GLOUCESTER.-A presentation of long service awards was held at Gloucester recently, when Mr. S. G. Hearn, Div. Supt., and Mr. F. J. Tyley, Div. Enginer::r, presented the following awards :-35 year gold bar, Mr. G. Jackson and Mr. C. R. Bradley; Quarter Century medal, I\lr. W. C. Bishop; 20 year gold bar, Mr. E. ]. Hebditch ; 1~ year gold medal, Mr. G. W. Locke and Mr. H. L. G. MerrICk. CWMBRAN. -Awa rds gained in connecLion with the 1939 examination were distributed at a meeting of the Cwmbran class, presided over by Mr. E. F. Hall, t?e presentations being made by Mr. W. E. W. Ro~ers. StatiOn Master, wl;o congratulated the members on tl~elr 100 per cent. reco~cd 111 the examinations. The awards ll1cluded the Company s 20 year gold bar to M r. E. G. Moule. and 15 year gold medals to Messrs. A. G. Colley, O. J. Lewarne and C. W. Spiller. GUERNSEY.-The joint G. 'vV. R. and Southern Railway class established at the port has continued to progres.s a~d a 100 per cent. success was achieved at the examlI1atiOn.

The Cambridge District Officers' Shield Ambulance Competition was held on March 2nd, when six teams competed before Captain W. Goodley, O.B.E. (team) and I\lr. T. E. Walsby (individual). March "A" team again retained the championship, scoring 338 marks out of 400. Other placings were March "B," 291~; Cambridge" A," 283t; King's Lynn, 271 Cambridge" B," 225 ; Shippea Hill, 212t. ;\1r. . Sproston (captain, March" A") scored the highest individual marks. The tests were watched by a large crowd of spectators, including Mr. J. P. Allix (District Goods and Passenger Manager), Mr. A. H. Rees (District Loco. Supt.), -:\1r. E. Robinson (Dist ri ct Engineer), I\Ir. A. H. Wright (ex-Asst. District Supt.), Mr. H. C. Johnson (Asst. to the S:,~t., Liverpool Street). Mr. R. A. Taylor was the competttlOn secretary. Mr. Allix presented the shield and medals at ~he tea which followed. He congratulated the teams on their \\'ork and emphasised the importance of ambulance work. He hoped more teams would enter in tile future.. . Capt. Goodley praised the efforts of competttors, as dId also Mr. Walsby. The L. & N. E. R. Laundry, Colchester, was the venue for the Ipswich District Officers' Shield Competition, held on Saturday, February 2 4 t h . . . , Five teams competed. the Judges being Capt. \\. Goodley, O. B. E. (team) and i\Ir. -r:. E. ~Valsby (individu~l). Th e result was: 1, IpSWIch 213 marks; 2, -VVlvenhoe. 26+; 3, Harwich 245; 4, Thorpe-Ie-Soken. 228; 5, Colchester, 221. . ' Mr. G. B. Hennessey presented the shield and prIzes; I\1r. G. G. Goodings (District Goods and Passenger i\Ianager) extended tbanks to the judges and helpers. Capt. Goodley as Centre Secretary. presented ~o l\1r. P. Paveley of Colchester, a gold bar for 30 years' servIce to the am bu lance movemen t.

FIRST

St. Andrew's Ambulance Association. DUNFERMLfNE.-The members of the first aid team of Dunfermline L. N.E. R. Section were congratulated on their s uccesses of last year at a meeting held on February 17th. Mr. H. Elder, President: conveyed the Association's congratulations. Mr. R. W. Johnstone (captain) replying on behalf of ;\iessrs. R. ]. Johnstone, J. Ritchie, 'vV. De\.var and 'vV. Mills, the members of the team. The team won the Scottish L. l . E. R. eliminating competition. the Scottish L. ·.E. R. cup, the Deuchars Trophy for the best practical team in the Scottish L. N. E. R. competition, L. .E. R. International Shield, and the Fife Mathewson Cup competition. GLENEAGLEs.-Mr. David Ogilvie presided at the annual meeting of the Gleneagles Station Section, and expressed regret at losing the sen'ices of 1\1r. A. W. Panton, who had acted as class secretary to the Section since its formation eight years ago. After the meeting Dr. Priestley, Gynoch , conducted an examination. Members of this Section recently attended a meeting at the Gleneagles (Hotel) Auxiliary Hospital, when ~lr. Ferguson, medical superintendent of the hospital, instructed members as to what they would be expected to do in the event of their services being called upon. PORTOBELLo.-In Portobello Town Hall, on Februarv 25th, six teams competed for the" Graham- Yooll " Troph)T of the Portobello and District L. N. E. R. Ambulance Sections. The winners were "C" team (R. illackay, captain; F. Morrison, A. Wishart, G. Innes and T. Needham) with 169t points.

London Stretcher Parties' Competition. THE final competition of the London Civil Defence Regional Stretcher Parties, was held at the Horticultural Hall, 'vVestminster, on February 28th. Tine teams, winners of the Borough and Group eliminating rounds, competed for the shield and medals presented by Col. G . S. Wallace (Regional Inspector Stretcher Parties) and Mrs. Wallace. In addition to first aid tests, there were sections for gas, dress and equipment, inspection of cars. There were no first aid indi vid ual tests. The judges were: Major-General Barrow (City of London) chief judge; Drs. McMillan (Woolwich), Williams (Barking) and Stansfield (Kensington) team first aid, with Capt. W. Goodley (Commissioner, S.J .A. B.) adjudicating on the stretcher work. Other judges were Capt. Ebbutt (Croydon) Dr. Davies and Mr. Naldreth (Regional Amhulance O~cer). Col. Wallace ~as the Competition Officer, being assisted by Mr. P. Hudls. Stewards were supplied by the va ri ous boroughs. The first aid work was not of the high standard usually expected at competition finals held in London, but it must be remembered that for many competitors, this competition was the first in which they had participated. As further competitions are held, and it is hoped to make this event a half yearly one, the work should improve. During the afternoon, Sir Ernest Gowers (Regional Inspector) and other officials were present and witnessed the teams at work. At the conclusion of the tests Sir Ernest inspected the com petitors. ' The honour of holding the shield for the first s ix months

AID

FIRST

was gained by the Greenwich team, being followed by Ruislip and orthwood and St. Pancras. Other teams, not in order of merit, were vVestminster, Holborn, Battersea, Walthamstow, Malden and Coombe, and Penge. Lady Gowers handed the shield and medals to the winning team.

Marking Sheet. CARD.-Your patient was working outside cleaning a window when he slipped and fell to the pavement. He is lying doubled up over a packing case when you are called to attend him. There is first aid material in the building. Time allowed 15 minutes. Warning at 10 minutes. SETTING.-First aid haversack and stretcher. Four blankets. Buffet with bottles, hot and cold water, tea cup, teaspoon, a glass. Room with fire in building. Despatch one man for first aid kit Hasten to scene of accident Keep back any cr owd and call to patient LO lie still Use encouraging words and tell him you are first aiders Does the patient respond intelligently (yes) Appreciate he is conscious Is there any obvious h<£ morrage (no) Enquire if he has any pain (yes, he complains of his back and right leg) Detail member to steady right leg Place rug on ground With great care lift patient and lay him on his back.. Is the face pale (very pale) Keep his head low and to one side Keep him well wrapped up with other rugs Examine back for signs of injury .. Find irregularity, swelling and pain oyer left scapula Find irregularity, swelling and pain left lower ribs . .. Examine right leg, find swelling, irregularity and deformity over middle tibia Examination shows no other injury Careful examination for shock Find beads of cold sweat on forehead Skin cold and clammy on examination And becoming colder Pulse rapid and feeble Breathing shallow... Faintness and thirst Loosen clothing about neck, chest and waist Apply smelling salts to llotrils Support left arm in large arm sling or in coaL Tie ankles and feet and knees together Decide remove patient to warmth of room Loading Stretcher.. . Carrying stretcher... Fill bottles hot water and place to body, legs and feet Get strong tea with plenty of sugar and give freely ... Remove temporary treatment, support arm and leg ... Broad bandages round chest ... ... ... Broad bandage under armpit and opposite shoulder, and tie in armpit Support limb in St. John sling Apply splints inner and outer sides leg ... ... Secure splints by bandages above and below fracture Above knee and round both ankles and feet Broad bandage round both knees '" ... Detail message giving diagnosis to doctor by 'phone.. . Send call for ambulance ... ... '" Obtain name and address of patient and notify relati ves Frequent examination of pulse and temperature of skin Advise he remains in warmth until condition improves Method of co nducting case

2 2 4 4 2 2 2

2 2 4 4 10

Total

150

2 "1-

2 4 2 2 4 4 3 3 3 6 2 2 2 22 2 2 2 2 4 4 4 -+ 4 3 4 2

-+ -+ -+ 2 2 2 2

The Hospitallers' Club. THE annual general meeting was held on Saturday, February 24th, :\Ir. G. C. Green (Prf'sident) being in the chai r supported by the Vice-President (:\Ir. J. Kemp, now Sergeant Major in the R.A.M.C.), the Treasurer (Mr. F. E. Stallard) and the Secretary (Mr. A .. E. T~rtle). . . There were many interesting dIscusSIons on the actIvIty of the Club during wartime and the following resolutions were unanimously accepted : That the present officers of the Club, including members of the Committee, should continue for a further term of office. That the Club should carryon during wartime and that further mt!etings should be arranged by the Committee and announced later. That subscriptions sho uld be continued as before. . The Secretary in his annual report referred to curtailment of the Club's meetings. Membership was now 114. The Treasurer submitted a satisfacto ry financial statement, whilst the Auditors congratulated Mr. Stallard on his well-kept books. The President expressed thanks to the officers and members for their support during a very trying time. Further meetings would be held and speak~rs arranged. It bad been decided not to hold the annual dlOner. Letters were read from numerous members, who were unable to be present including one from Capt. Calvin Lines . The Club's Remembrance \.vas read by Mr. S. B. Piers. Particulars of the Club can be obtained from the Secretary, at 36, Noel-road, Islington, London, .1.

Classification of Fractures. FRACTURES are breaks in the structure of bones produced by violence Moreover, to settle all doubts, a broken bone is a fractu~ed bone, and vice versa. It is surprising how often one still hears the remark-" Oh, yes, he fractured his leg, but it is not broken," All fractures are divided into two main classes: (1) according to the condition of the tissue adjacent to the bone, and (2) according to the injury of the bone itself. In the first group we haye s£mple fractures, which form the commonest variety. I n these cases the bone is broken into two pieces, with or without much laceration of the surrounding parts, although there is no wound leading from the fracture through the skin. The term "Simple" does not mean" of no ' importance," but rather that this fracture is "\lot compound." Next we have compoltnd jractures. In these the skin is injured, and a wound leads from the outer air to the broken bone, the fragments of which may even protrude through the skin, . The fact that a fracture is compound renders It very much more serious, even though there is little splintering of the bone or laceration of the soft tissues. Special dangers are present with compound f~actu.res. The bleeding is apt to be much greater than WIth SImple fractures; the union of the bone is much delayed; and a somewhat lengthy illness is the result. The ~reatest da.nger,. however is that the wound may become Infected WIth VIrulent mic;o-organisms, which may cause supperation, erysipelas! or blood poisoning, with the ultim ate result that amputatIOn of the limb may become necessary. For theSe re~sons the greatest care is necessary in handling a fractured 11mb ; and

AID

18 5

steps must be taken to ensure that a simple fracture is not converted into a compound and 'or complicated one. The third variety in the first group, comphcated fractures, are those in which, in addition to the actual fracture, some other serious injury is produced. Thus with fractured ribs the broken ends of the bone pierce the lungs or other internal organ; and with a fractured limb injury to a joint or main artery, nerve or vein may be associated with the broken bone. In the second group, we have z'17lpacted fractures, in which one end of the broken bone is driven into the other end; cOlllmz'nufed fractures, in which the bone is broken into two or more pieces, or even splintered; and, lastly, greenstick jractures. I n the last named, the bone is partly bent and partly broken; and the periosteum, the tough membrane surrounding the bone, is not torn. This variety often occurs in children, whose bones contain more fibrous materi a l and less bone earth than tbose of older individuals.

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Police Ambulance News. ill ETROPOLIT AN. On Sunday , February 25th, ten teams (six regular, three vVar R eserve and one Special Constabulary) of " 1\1 " Division competed for the "Dalton-~latthew" First Aid Cup. The judges were Dr. Norman \V. Hammer (team) and Mr. G. E. Craft, Editor of FIRST AID (indi\·idual). In the team test members were called to a man who had arterial h remo rrhage from palm of hand, fractured scapula and pelvis; whilst in the individual test injuries were concussion and fractured ribs, fractured jaw and burst varicose vein, and a question on hremorrhage from an internal organ. . . There was a good gat hering of spectators ,.1I1cl udmg Deputy Asst. Commisssioner D al~o n, Supt. Bnggs, S.D Inspectors Gillies, Southern and FllOt, }1aJor Rogers (Chief Staff Inspector 1\let. Specials), Commandant ~latthews , Dr. 1\1. Scott, and other officials. Supt. Briggs, " ,hose eners)' and enthusiasm for first aid is ,,'ell known in the l\letropolitan Area, announced the result as follows: 1, Deptford Regulars, 250 marks; 2, Special Constabulary, 219t ; 3, Rotherhithe Regulars, 219. Best \Var Reserve team, Deptford. 199. l\1rs. 0I at th e ws presented the trophy and individual awards. 1\1r. Dalton expressed his pleasure at being present. He knew of no other Di\'ision where \Var Reserves had taken part in a competition . . l\Ir. l\latthews said that to Supt. Bnggs was due t~e credit for 90 per ~ent. of first aid in "l\I" Division; and hiS policy of continuing wi th this important work was a good one. . h . The judges addressed the competitors, expressIng t elr appreciation of the work done.

The Ambulance and Nursing Divisions, S.].A. B., ..at Henfield held a successful whist drive and dance on st. Valentine's Day. A men's detachment of the British Red Cross Society is beina formed at Hammersmith. Particulars can be obtained from Commandant D. R. Healey, Red Cross Hut, Brook Green-road, London, W.6.

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Reviews. A POCKET MEDICAL DICTIONERY. By Lois Oakes S.R . N. & T . B. D avie, B.A., M.D. Edinburgh: E. & S. Livingstone. Pn'ce JS. 6d. __ by post, 7S. 3d. This di ct ionary was first puhlished in March, 1933, as a book of reference for medical students, especially during the first year or two of their studies. That a fourth edition is now called for is evidence that the book has proved both popular and useful and that it appeals to a wider circle of students than that for which it was first compil ed. Most of the common terms, de6nitions a nd tables connected with medicine an d s urgery will be found in the dictionary, the whole subject matter of which has been carefully revised for this issue. This has involved the deletion of certain obsolete terms and the insertion of many new ones. Amo ng the many useful appendices there is now one which deals with 6rst aid. Incidentall y, it is news to us that reduction of a dislocated jaw comes within the scope of 6rst aid! In short, readers of FIRST AID and especially those working in hospitals and first aid posts with find much useful knowledge in this most interesting and instructive pocket dictionary. CASSELL'S MODERN DICTIONARY OF NURSING AND MEDICAL TERMS. Edited by Elizabeth M. Day, S. R. N. London: Cassell & Co., Ltd. P1'ice JS. n et. This dictionary, which has just been published, includes most of the terms and technica l words likely to be met with by a nurse in the daily round of hospital and private practice. These a re accompanied by explanations, descriptions and numerous figures, whereby the usefulness of the dictionary is considerably increased. At the end there in an appendix, in which various practical and useful data is suppl ied, such as weights and measures, tables of g rowth, and essential facts connected with the blood, the urine (including tests for abnormalties), the infectious diseases , and the common causes of poisoning, and so on. Though primarily intended for those preparing for the diplomas in nursing and t he certificate for sister tutor, the dictionary will prove interesting and instructive to individuals engaged in vario us activities which are connected with the health services and other d epartments of public administration. A

CATECHISM

OF AIR RAID (Parts 1 a nd 2).

PRECAUTIONS.

By Norman Hammer, B.Sc., M.R.C.S., Major R. A.M .C. T. (Retd .). London: J ohn Bale, Sons & Staples, Ltd. P1'ice (each part) IS . __ by post, IS. 2d. This book of questions ar:d a nswers in A. R. P., which was published originally in Septem ber, 1935, and has had a most s.uccessful career, was found to require co nsiderable additIOns and alte rations to bring- it up-to-date and in lin e with

FIRST

AID

recent advances, especially in connection with the organisation and training of tbe A. R. P. services. Consequently, Major HammEr decided that it would be more convenient if tbis, the 5th edition, were published in two Parts, each being approximately of the same size as the original issue. By this means he has retained the old form of the book, which slips easily into pocket or satchel; and he has avoided its conversion into a more bulky and expensive volume. Part 1 is concerned principally with the g eneral and first aid aspects of gas, whereas Part 2 presents in simple fashion the main points connected with the practical aspects of the subject and will be most useful to those engaged in A. R. P. first aid and casualty services and also for A. R. P. Wardens . The book does not pretend to be a Textbook, but is rath er a vade-mecum for the first line workers who seek practical instruction and not scientific education. In short, it is simply a catechism of questions and answers and covers the various points as they may arise in teaching, in practi cal training or in act ual circumstances. For this reason it will continue to enjoy a ready sale among all who are interested in A.R.P.

HOME

ou r knowledge of First Aid, and your interest in such useful, humanitarian work, will enable you to master qUickly and thoroughly the principles and practice of SWEDISH MASSAGE as taught by the Northern Institute since 1924. The demand for Massage Operators is still, and will be always, greater than the supply, and there are jobs waiting for NORTHERNtrained students-in Municipal Hospitals, Institutions, Naval and Military Hospital s, in the field of Sport, and in profitable private practice.

NURSING FOR EVERYBODY. By Doris Webb. London: Faber & Faber, Ltd.

Learn Massage-the Profession

Przce 2S. 6d. net. This book r epresen ts an attempt to explain methods of nursing in every-day and easily understood language in the hope that it will enable women, without any previous training in nursing, to make their sick folk more comfortable. I t is based on a long experience of Di st rict Nursing, and it is esse ntiall y practical, more especially in that it lays a definite line of di stinction between the cases with whi c h an amateur nurse can deal an d (hose which must be left to the professional nurse. Th e book ends with a most useful chapter on Diet and Im'alid Cookery.

Prospects 1111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111

"Northern" Students write:I can personally recommend the Course to any student of First Aid, or any person interested in Physiology or Anatomy.-T. A. jones, Hanley. -

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Lady Limerick, President of the County of London Branch, B.R.C.S., accompanie d by Mrs. Prenti ce (County Secretary), in spected the Streatham Baths First Aid Post which is staffed by members of the .local detac hment under Commandant Clapton.

At the annual mef'ting of the Mellows Nursing Division, S.J.A.B., held on February 27t h, reference was made to the vis it of H. R. H. the Du chess of Gloucester when Mrs. Clapham and Mrs. Toulmin a nd th eir reserve officers, Mrs. Mellows and Miss M. Crick were presented.

Have secured a good position

as Trainer.

private practice is also growing.-j. Gibb , Edinburgh . It is my opinion that if more First Aiders took the Course they would be better able to do their work . -W. H. Hall, Doncaster. I recently secured a post at Southend-on-Sea, and lowe my success to your instruction.-j. Collings, Salford. Next week I start as Trainer to a football team, and it will mean my getting to know a great many people.-j. Pritchard, Maston. As a First Aider I recommend others to pluck up courage and take the Course which I confidently recommend to any member of the St. John Ambu-

lance Brigade.-T. Brown, Keswick.

~IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII111111111111111111111 1 11111111111

Send off this COUPON to-night Congratulations and all best wishes to Sergt.-Major Frank Wrigglesworth who, on Saturday, March 2nd, married Miss Mabel May at the Fulham Parish Church. Mr. Wrigglesworth is the eldest son of Mr. H. J. \\'rigglesworth, who is well known as the Asst. Secretary of the St. John Ambulance Bri g ade and Asst. Commissioner, No. 8 District, and Mrs. Wrigg lesworth. Ma ny congratulatory messages w~re received at the rece ption from friends of the St. John Ambulance Brigade.

The Institute's 0 I P L 0 M A The Diploma of the NORTHERN Institute is only awarded to students whose work in the Final Exam ination merits the necessary percentage of marks . As a result, it has come to be recognised as valuab le proof that the holder of a " Northern" Diploma is fully qualified to practice.

WRI TE

(Reg'd.)

for this

BOOKLET To-day

The Course set by the NORTHERN Institute is intensely interesting, instructive . and thoroughly up-to-date, and is fully explained in th e booklet , .. The Power in Your Hands. " Write for your copy to-day. It may prove you r first ~eal. step towards assuring your future and enJoYing a pleasant an d profitable career.

• THE NORTHERN INSTITUTE OF MASSAGE,

The NORTHERN INSTITUTE OF MASSAGE Established 1924

A Nort he rn train ing is you r passport to Prosper ity. NORTHERN students LEARN and EARN. Some are making as much as £. 15 a week , (l nd man y who previously worked in dead-end jobs are now forging ahead in their new career, bringing help and healing to sufferers, and being well paid for their work. You can do the same. Th e NORTHERN have trained a large num be r of First Aid worke rs who are now earning comfortable incomes in their congenial occupations as Massage Ope rators. Not only thiS, but the Course itself has received the recommendation of the Editor of FIRST AID.

6 JOHN DALTON ST., MANCHESTER, 2

Please send me a copy of " The Powe r in Your Hands," free, and without obligation Signature . ........... .... ............. ..................... . .... . Address .... ........ ..... ............. .... ...................................... .

6 JOHN DALTON St., MANCHESTER, 2 F.A.

FIRST

188

Our Nurses' Pages. COl\1PILED BY AN AMB U LAN C E SISTER. UNI FORMS, ST. JOliN AMB ULANCE BRI GA DE. New Dress Reg ul a tions ha ve bee n issu ed by the Ch ief Commissioner. Those concernin g the uniforms of Divi s iona l Offi cers and members bein g as under :Shoulder Cape for Nurs ing Officers.- R egulation thin black wooll en materi a l; 11 inches from neckband to base; neckband 1 in ch dee p ; ~. inch white piping inset round tile bottom a nd t he fronts, allowing 2t inch border at bottom a nd front a ng le t urn, but narrowing to inches at neckline; 2 in ch opening- in bottom hem at centre back; fa s ten ed by hook at neck ba nd in front. Corridor Cape for Offi cers and Members for Duty in W a r Establishments.- Circ ul a r cape, 30 inches in length, of da rk g rey appro ved woollen materia l; lined scarlet flannel; step and fall coll a r; straps to cross over in front and fasten at back. Ambulan ce Sis ters' Caps.-The e mbroidered cross, s imil a r to t ha t on the apron bib, will in future be substituted for the cross on black bac kground now in use.

Costum es, Coats and Dresses. - Costume skirts a nd offduty dresses to be 14 inches off the g- round. Dresses a nd overalls to meas ure 13 inches off the g round; apron s to be H inches off th e g round; coats to be 12 in ches off the g round . O ve rcoats to have gathers at back converted into tw o pleats 6t inches apart under the belt, forming a wide box pleat. Dresses to h a ve pocket in rig ht-h a nd skirt s eam , a nd t wo s mall patch pockets, one eith er sid e of the bodi cewa tch pocket 3;t inches by 2f inch es wide; pe ncil pooket Sl inches d eep by in ches wid e. Dress skirt to be gored instead of ga th ed into wai stb a nd, but to r e main full at bottom. Apron skirt to have shaped pan el in front and t he hip and back fulness to be made by gores and gathers. Skirt to overl a p inc hes the whole leng th of the back openin g . No pock ets in apron.

O ff-duty Dress, V.A. D. 's.- R egul ation light g- rey thin woolle n dr ess; pla in s kirt; s titched panel front and back with pleats at base, to reach within 14 in ches of the ground; bodice with box plea t down front fas tened with fi ve regulation bu ttons No. H ; m ode ra te coat s lee ve ; hi g h colla r band of bla .::k ma te ria l (sam e texture as grey) piped whit£' cord ; black shoulder stra ps 2;t in ches a t ba se. rounded e nd s fast ened r egul a tion button No. t 4 ; dart from shoulder sea m to bodice front and dart at wais t on either s ide box pleat. V.A.D. train ed nurses to have off-duty dress as a bove, but with sh ould er straps and belt of same grey mate ri a l, and both shoulder s traps and belt to be piped with white cord . V.A.D . clerks ma y wear on duty regulation jacket, skirt and blou se, or the nursing members' dress with black tie, grey petersham belt, 2J inches wide, and white collar and cuffs , as an alternative to the white overall. I:J"O. S DISTRICT, S.lA.B. HEELEY NURSING DrvISION.-To celebrate the 21 st birthday of this Division, about 160 people attecded a tea a nd social evening following the Annual Ge neral Meeting- of the Am bulance and Nurs ing Divisions held on February 10th . A cake weighin g about 28 lbs, decorated with 21 candles, the bad g e of the St. John Ambulance Brigad e, a nd a doll dressed as a member of th e Division, ha.d been made by Ambulance Si ster Mrs. Puttrell and Mr. Puttrell.

FIRST

AID To mark the occasion, an inscribed wristlet watch was presented to Lady Div. Supt. Mrs. A. M. Duke, and awards were presented to each member of the Division. During the evening, A. R. P. certificates were handed to m e mbers who had gained them. The celebration had been postponed from last Septem ber owing to the war. No. 10 DISTRICT, S.J.A. B. MARCH NURSING DIVISION.-A very successful year's work was reported at the annual general meeting held at the new headquarters, the Guildhall, March, on Monday, February 4th. The chair was taken by the Div!. Surgeon, J. A. Hislop, and he was supported by Lady Supt. Miss E. M. Lefe vre, Mrs. Heaton (Div. Secretary), Mrs. H. M. Shepperson (Div. Treasurer), and Miss J . Dunham (Social Secretary). In his opening remarks, the Chairman said that, although they were in their new headquarters, he thought that the building was still too small, and he looked forward to the time when the ambulance movement in March would have its own headquarters worthy of the Brigade. The Secretary reported that last Decem ber the Division was 26 strong, but this year they had more than doubled their numbers . They now had S4 members on the register. Owing to this expansion, some promotions had been necessary, and Mrs. Bidwell and Mrs. Heaton had been appointed Lady Ambulance Officers. Mrs. E. E. Truman, who had been an honorary member since the formation of the Division, had been appointed Lady Divl. President. They were sorry to record the death of one of their honorary mem bers, Mrs. Warnett. During the spring, a series of leclures in A. R. P. had been given by Miss Lefevre; 8S ladies attended, S2 of 'w hom took the examination and were successful. All members of the Division were volunteers for the W. V.S., and, with some of the Amhulance Division, were manning the first aid post in March. Continuous duties had been undertaken at the post since Septe mber 2nd. Members also assisted with e vacu ees. The Balance Sheet presented by the treasurer showed a balance in hand of £22 8s. 1d. Miss Dunham presented a report of the work of the social committee, and stated that the amount raised by bazaars, whist drives, etc., amounted to £36 Os. 9t d. The Superintendent addressed the meeting, and said that, owing to the war, they had had to redouble their efforts. She was very proud that all m e m bers had done their best and were carrying- on. Their work was appreciated by the people of March, which fact was a great encouragement to them all. Dr. Hislop said that he was very pleased that his appeal for recruits had bee n so successful; but th ey still needed more members. Much credit was due to those who took duty at the first aid post, especially as they all had other calls on their time, their families, business, etc. Besides this. the ordinary work of the Division had to be carried on. He thought that it would not be out of place to thank those who were never there, the husbands who were left at home by their wives, and the wives who were left at home by their husbands. The chairman specially thanked all those who had undertaken duty at the first aid post over Christmas, and the townspeople who had seen that there was plenty of Christmas fare for the A. R. P. workers. Emphasing the work of the Brigade as voluntary, he pointed out that though they were very grateful for the support given them by the townspeople, they could do with much more help.

No. 124 (STAFFORDSHIRE) DETACHMENT, B. R.C.S. This detachment, which was formed just over six months

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BLACK'S

DICTIONARY ASHDOWN'S COMPLETE ByMEDICAL JOHN D. COMRIE., M.A., B.Se., M.D., F.R.C.P. (Edin.l SYSTEM OF NURSINC Latest (15th) Edition, containing 500 Illustrations in the Te'xt, 8 Full Plates in Colour, 10 in Black-and-White.

By A. MILLICENT ASHDOW'N, S.R.N. Certificated King's College Hosp i tal and Royal London Ophthalmic HosP ital .: Examiner in Nurses' Practica' Work to Charlng Cro ss Ho splta', Essex Co ~ nty Coun~ 1f and Wellhous e Hospital. Barnet ; Formerly Ex min er for the General N urSin g COU~CI! . London County Counci'. Middlesex County Council , etc. , and Lecture r at King s College Hospita' .

Completely NEW, Revised & Enlarged Edition Special Subscribers ' Edition, containing 374 Photographs Diagrams, Charts and Illustrations. 4 Colour Plates. 65 Full-page Black·and-White Plates ~

NEW SECTION ON CHEMICAL WARFARE Treatment and Prevention of Gas Casualties

(I) Tear Gases or Lachrymators (2) Sneezing Gases or Sturnutators (3) Lung Irritants or Pulmonary Gases (4) B lis t e r i n g Gases or Vesicant Agents Every F'RST AID worker wi II appreci ate the importance of this entirely new section .

TI-IlS well-known standard work, the accepted textbook for nurses, has been entirely revised and re-set in the new edition here offered, in orde r to bring it up to date and to in clude man y new treatments and additions. Th e illustrations have also been renew ed, with a large number of additional photographs. Specially writ ten for the qualified nurse and for those in tra ining , it m eets the standard of profession a l requirements and covers th e entire ran g e of nursing. Every FIRST AID worker and every nurse should own a copy of this authoritative, comprehensive and up to date work.

DON'T MISS THIS OPPORTUNITY-SEND TO-DAY! Just sign and post the form below and we will send yo~ this book. carriage paid, to examine for four days free . You may either re.tu r n it to us within five days to end the matter, or you may keep It on the very easy terms outlined. ............ -.................................................. -_ ........... . .......................................................................H

Please send me, carriage paid, for fOUl days' FR EE E xam in at ion, " AS HDOWN 'S' COMPLE TE SYSTRM OF N U R~ ] NG ( e w Edition) " comple te in one volum e. ] t is und ers tond th a t I may retu rn the wor k on th e fifth d ay a fter I ro ceiv e ll a nd that th e re t he mat t-r enns. If } k~e p it [ w,lI se nd yo u o n the fifth day a Fi rst P ay ment o f 1/6, and, be~m l1l ng thirt y da ys a fter. fo ~r furth e r monthl y pa ym en ts of 45. each, th us completing the purchase prt ce, Price for Cash on the Fifth Day , 166 .

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Diseases of Bicarbonate the Abdomen of Soda Abscess Bites Absinthism Black-death Absorption Black-water Acetic Acid Fever Acidity Bl indness Aconite Bone Disease Poisoning Brain Acromegaly Break-bone Addiso"s Fever DIsease Disorders Acne of Breath Adhesion Bronchitis, Air Pa , sages etc . Alcohol Capi lIaries Alkali Catalepsy Amputation Cataract Ammonia Catarrh An;emia Diseases of

I A~~~.thetics, Chicke~~~~t Bacilli Backache Bacteria Baldness Balsams Bandages Barley Water Baths Bell 's Paralysis

Ch ilblain Chills and Colds , Chloroform Chocolate Clubfoot Colic Constipation Contagion Croup Cysts, etc.

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absolu te necessity to every FIRST AID worker and nurse, whether beginner or experienced . Full information is given on the treatment required in cases of accidents and emergencies of every description. " Black's Medical D ictionary» is actually more than a dictionary. To quote the words of the author: "In articles dealing with methods of treatment which are likely to be used by Nu rses, full details have been given and special care has been taken to explain such details, where necessary, by clear illustrations ." Tbis statement just referred to gives the key to (h.e methods used in "Black's "- defir 1tions consist actually of brief articles on each subject, and are not ordinary " dict ionary" definitions. "BLACK'S :-'lEDICAL DICTIO TAR Y" is the work of one of tbe most learned men in the Profession - John D . Comrie, M.A., B.Sc., M.D ., F.R.C.P.Edin., one of the best known lecturers and au thors in Ihe country. The book is practical and accurate in every sense of th e words. A valuable 16 page supplement on the Treatment of Air-Raid Casualties is included in this latest Edition. Jus t s ign and post th e form bel ow andwe ". ilI send ~uu this book , carriag e paid, to tXa mlDe for four da}s free. YOll may either return it 10 us "ith ln Ihe days to end the matter, or you may keep It 011 tbe ,ery easy te rm s outlined .

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FIRST ago, has attained a gratifying- measure of efficiency in this short time. Its first inspection was carried out by Lady Dorothy l\1eynell, County President, on February 20th. She was accompanied by Miss Harri so n, O. B. E., Staffordshire Vice-President. The detachment was under the command of Mrs. F. T. Sudlow, Commandant. Th e re were also present Dr. Murray, Medical Officer; Mrs. Wood, Masseuse; Mrs. ]. 1\1. Mason, Asst. Commandant; Mrs. Ogilvie, Lady Supt. ; Miss Bagguley an d Miss Newbold, Quartermasters; and 36 members. The detachment was inspected on parade and, afterwards, at first aid work. Addressing the members, Lady Dorothy Meynell congrat ulated them on their efficiency and upon the invaluable service they were rendering to the community. Although the part they were called upon to play differed from that in the last war, when nursing members of the Society were with Voluntary Aid Detachments under the War Office, their work in nursin g civilian casualties was just as important and valuable to the co untry. Further, in taking up this work, they were learning- something that would be useful after the war as well as now. Lady Dorothy Meynell presented fi rst aid and home nursing certificatee to those who had won them, also Civ il Nursing Reserve Badges.

No. 92 (LINCOLN) DETACHMENT, B.R.e.S. Mrs. H. A, BelI has resigned her position as Commandant of this detachment, and her place has been taken by Miss Platt, on the recommendation of Mrs. Bell.

The Beginner. THE ent husias tic beginner in a mbulance work often presents a curious psychological aspect to the eye of the person who chances to be practically ignorant to medical knowledge. As soon as the first certificate of proficiency has been obtained, the owner is usually burning to put his newly acquired skill to a practical use. This desire is fanned by a diligent perusal of accidents reported in the daily press j the paper is put down with a sigh and" I wish I had been there! " Like a carrion crow he scents trouble from afar and speeds up to the scene of an accident. It may be serious or it may be but a slight injury. Nevertheless he sets his mouth and does his best. How ca refully he tries to give the finishing touch to the reef-knot, only to find he has made a " granny"! How keenly he feels the disgrace; anyone co uld tie a " granny." For a time he revels in (imaginary) gore, and walks abo ut looking for broken limbs on which to try his skill. .

The exponent of first aid in the initial stage of his career, IS usually a small perambulating hospital ready to open ".shop" anywhere. He certainly seems t~ gloat over his ~nend:s fractured radius or his wife's fractured jaw. Yet his l~tentl~ns are good, a nd the services he renders, compensate ?l~ patIent for the unprofessional delight he displays over the Injury. After a little experience, he soon discards his amateur display of feelings, and he may then be r eckoned as a u~eful membe.r of society, and in r.o small way, a benefactor to humalllty.

FIRST AID

AID

In the presence

Concussion of the Brain. THE degree of unconsciousness in Concussion of the Brain depends largely upon the severity of the injury. In mild cases, unconsciousness is slight, lasting only a few seconds and amounting only to a feeling of bewilderment or mental confusion. Nevertheless, very grave after-effects may follow, and these may be aggravated by the failure to take the necessary precautions to prevent them. In severe cases, unconsciousness is more marked, and the brain is more or less disturbed, jarred and, possibly, torn. The actual damage to the brain and its membranes (that is, its covering) may only be congestion, an abnormal accumulation of blood in some part or parts. On the other hand, portions of the brain substance, varying in size from minute points to patches an inch or more in diameter, may be disintegrated. The brain is a semi-fluid mass enclosed within an unyielding bony box- t he cranium, which may be fractured by a blow. When this happens, further complications and greater danger of injury to the soft brain follows. We aTe not, however, engaged with this complication, but on with Concussion, which may occur with or without fracture of the skull. We can compare the brain to a jelly which, if disturbed by a tap or blow on the vessel containing it, will be observed to shake. If greater violence be applied to the vessel, then a rupture (or tear) of part of the jelly may occur. Similarly, if a direct injury be appled to the skull, as by a blow or fall on the head, tho::: brain substance may be merely jarred or may be ruptured in some parts, according to the severity of the blow. If the injury is indirect, as ' by falling heavily on the feet, the whole brain will be jarred more or less ao-ainst the unyielding bony substance, and according t~ the heavinsss of the jar, the resultant effects will vary. What should be done in these injuries ? It has been discovered that when head injuries are complicated by free bleeding from wounds of the scalp, less reaction follows. In all cases of Concussion-severe or otherwise there should be cornplete, perfect rest immediately after tl;e injury. In mild cases this is very often difficult to obtain, because the patient resents having- to rest when he does not feel really ill. It should, however, be insisted upon that patient mu st rest. The patient should be kept recumbent and all excitement should be avoided; the room should be kept cool and darkened. Little else can he done except by the doctor, whose services should be obtained at the earliest opportunity.

of blood

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When considering Trophies, remember it is only by dealing direct with the Actual Manufacturers that intermediate profits are eliminated and lowest prices obtained. It is this serv ice that has made Alexander Clark Official Silversmiths to leading First Aid Societies th roughout the World, for more than half a centu ry. Apart from Cups and Medals. Alexander Clark always have an enormous range of util ity Prizes and Gifts su itable for Ambulance Competition Prizes.

A concert to provide funds for the Berkhamsted Division was organised by Mr. F. O'Dwyer and held on February 24th.

Catalogues- and Wholesale Terms allowed bona-fide First Aid Societies, gladly sent upon request.

At the annual meeting of th e Melksham Division, S.J.A. B., Mr. Percy Hughes was presented with his badge of office as Divisional President. The Director-Genera l of Medical Supplies in France has as ked the Red Cross and St. John War Organisation to supply 125 fully equipped ambulances for use in FTance. A grant of £40,000 to cover the purchase of 75 has been made and it is hoped that individual firms and cities would provide the remaining SO. The cost of a complete ambulance is £550.

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FIRST

Queries and Ansvvers to Correspondents. Queries will be dealt with under the following rules ;1.-Letters containing Queries must be markt-d on the top ldt-hand corner of the envelope" Query," and addressed to FIRST AID, 46, Cannon-street, London, E. C. 4.

AID

FIRS T

.AID

193

The Textbook teaches that, when convulsions are present, as in Hysteria, Epilepsy, and so on, they practically always involve the muscles of the body and limbs and are general. I t sees fit, however, to hint at a certain rare condition of which I have only seen two examples. This, known as Jacksonian Epilepsy, results from old standing injury to the brain, and is characterised by attacks of convulsions (or rather twitchings) limited to one side of the body or to a definite reg-ion or limb. There may be no loss of consciousness throughout the attacks, which last for variable periods. As the cause of this rare condition is known to be a lesion of the brain, you can treat as laid down on p. 164 of the Textbook-if you are certain of your diagnosis. -N. C. F.

2.-AIl Queries must be written on one side of paper only.

3.-All 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.-The Textbook to which reference may be made in this column is the 39th (1937) Edition ot the S.l.A.A. Manual of First Aid to the Injured. ACTION OF SMELLING SALTS WITH HEAD INJURIES. S. W. (Manchester) -Please tell me (1) what would be the effect of applying smelling salts to the nose in cases of head injury, as contraindicated in Rule 7 on p. 45 of the Textbook? Also please say (2) how smelling salts act. (1) The Textbook tells you to withhold smelling salts in your treatment of head injury because ha-morrhage of the brain may be present or threatening, and because stimulation of the brain with smelling salts may aggravate or even precipitate this grave complication . (2) Smellin g salts stimulate the respiratory centre of the brain through the nerves of smell.-N. CORBET FLETCHER. EXAMINATION HOWLER. M. R. (Cannon-street). -In a recent examination I asked a candidate to tell me what is asphyxia; and I was much amused when he replied :-" AsjJhY:X1,a is an)1 fixed part oj tile body!" So please accept this as my further contribution to your never-ending collection of " Howlers." Good! Next, please! !- N.C.F.

TREATMENT OF GAS CONTAMINATED WOUND. H.C. (Reading).-I would be pleased if you would kindly settle a difference of opinion concerning the treatment of a wound which is known to be contaminated with blister gas. To mention a possible injury-if a person was struck in the leg with a splinter from a gas shell (or bomb) it is likely that h::emorrhage, a fracture, and gas (liquid) contamination may be present together with a piece of the contaminated shell or bomb in the wound. Would you please teIl me the correct treatment (i) in the street immediately after the injury had occurred; (ii) in the street, if delay in calling a First Aid Party had been occasioned, and (iii) at the First Aid Post on receipt of the patient? (1) To be effective, liquid mustard gas on skin or wound must be treated by mopping, use of solvent and application of bleach ointment within five minutes. I fear, therefore, that during an air raid you are not likely to be called to such a case within that period. (2) If there is marked delay in reaching the patient, you should not attempt treatment but should rather facilitate his removal to hospital and transfer to the charge of the medical staff. (3) First Aid Posts are intended to relieve congestion at hospitals by intercepting lightly injured casualties, especially walking wounded cases. Your patient with lacerated and contaminated wounds, therefore, should be removed to hospital without further delay. -N. C. F. HUMOUR IN FIRST Am. S.C. (Bourne). ----'- At a recent examination the doctor asked a candidate what she would give a patient who had fainted. I would g~ve hz'm some brandy," replied the andidate ; and when the doctor asked what she would do if no brandy was available, she added-" Oh I would promise him some. " I send this story because it seems worthy of a place in your library of '( Examination Howlers." II

SUGAR IN TREATMENT OF SHOCK. P. W. (Old Trafford). - Please tell me why sugar is specially mentioned in Rule 2 on page 45 of the Textbook under the treatment of shock. The outstanding feature of shock is the tendency of the body temperature to drop below normal. Sugar (which is a carbohydrate) is easily dissolved and rapidly absorbed into the system, where it undergoes chemical changes and produces body heat. Consequently, with all cases of shock it is good practice, as the Textbook tells you in Rule 3, p. to give' freely hot strong tea or coffee with plenty of sugar," except when patient is unconscious or injury to internal organ is present.-N.C.F.

45,

CONVULSIONS LIMITED TO ONE SIDE. S. W . (Manchester). - The Textbook, on p. 160, tells us that convulsions may be general (by which I take it that they affect the whole of the body) or limited to one side of the body. Please tell me the conditions in which there are convulsions affecting one side of the body only.

Alas, ! The story is a chestnut and figured long years ago in this column as a Howler." Consequently it cannot do so again. Nevertheless, the younger generation of first aiders wiIl probably say ., Good.' Next, please. "-N. C. F. I.

BLEEDING FROM PALM OF HAND. A.C. (Sale). - Tbe Textbook on p. 122 gives full treatment of a wound of the palm or hand accompanied by arterial bleeding when a foreign body is not present. WiIl you kindly describe the correct treatment (including armsling to be employed) wIlen a foreign body is present or suspected in the wound? If there is an injurious foreign body present or s uspected in a wound of the palm of the hand accompanied by arterial bleeding you must modify your treatment of the same as laid down in Rule 10 on p. 110 of the Textbook.

BeHer pa'l fol' 1i,',1 f/id Aten A 11 over th~ British Isles, Works' M~nagers,. Factory M~nagers, Colliery M~nager~ and ~ll larg~ and small industnal concerns are now buslly seekmg the asslstance of fully-tratned Fast-Ald men 1n order to maintain the . efficiency of their work-people. Special departments are being organized in most Factories, Shipyards, Collieries, Workshops, etc., wh~re injuries cannot only receive first-aid treatment, but upon being discharged by the surgeons can receIve massage treatment and so decrease the rehabilitation period.

SPECIALLY TRAINED Research has shown that the convalescent period is reduced by as much as 80 per cent. where adequate follow-up therapy is employed, and first-aid men are being specially trained by the S.M.A.E. (Swedish Massage and Electrical) Institute to fulfil these requ irements. Now is your opportunity of becoming trained for the great work which lies ahead in this vast fieldevery man and woman skilled in the art of scientific Massage and Manipulative Therapy will be a national asset.

T REMENDOUS OPPORTUNITIES Your knowledge of first-aid will be ten times more valuable if you can wear the badg e of the S.M.A.E. Institute-the badge of qualification. Tremendous opportunities lie before you in this greatly extending field which is now open to you without having to leave your present work until you qualify as an expert and can command an expert's pay. For over 20 years the S.M.A.E. (Swedish Massage and Electrical) Institute has been teaching scientific massage and numbers among its graduates some of the most successful fiLL _I N__ A ND POST T HIS COUPON . . . t h e rea1m 0 f Massage. ____ _______ ____ and highly pald men an d women 1n

COUPON To The Secretary, The SMAE Institute, Leatherhead, Surrey. Please send me without obligation, a copy of your free Booklet " Manipulative Ther apy as a Profession."

NOTHING TO LOSE The very moderate tuition fees, which c~n be paid by easy .inst~lments, includes all necessary text books, charts, dtagrams and examlllatton fees, and remember that with the S.M.A.E. Institute you have nothing to lose, as it guarantees to coach you until successful at the examination a~d your Diploma secured, or return your fees tn full.

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FI LL IN T H E C O UPON FO R T HI S FR EE BOOK

FIRST

194

AID

WOUND INFECTED WITH BLISTER GAS.

G . B. (Stratford).-I have yet to find published the treatment of a wound caused by a fragment of a blister gas bomb casing. Would the use of Eusol serve the double purpose in this case of neutralising the gas in the wound and also of acting as an antisepti c? Your opinion on this matter will be greatly appreciated.

SPECIAL BANDAGE FOR

FRACTURED

FOREARM.

W.H. (Netherfield ).-Th ere is a query in our class concern· ing special bandage u sed in treating a fractured forearm. Some state that the bandage is a simple figureof-eight commencing around fingers, as done in fracture involving elbow joint. Others state that it goes round the wrist over back of hand towards fine-ers, etc. But, according to diagram on page 85 of Textbook, I believe that I am applying cor rectly with bandage facing first aider, wrapped once round wrist, underneath towards little finger, over fingers (once or twice) and back towards thumb, round wrist again and tie on the splint. As this matter has caused a littl e controversy, would you kindly describe in detail how this bandage should be applied? This is a freak bandage for which the one a nd only advantage is that it serves the purpo se of two bandages. Rumour has it that many examiners are not interested and that they are ready to accept three bandages in the treatment of fractured forea rm , as in the pre-1937 days of the Textbook. It is applied as follows : The patient's u pper limb being flexed at the elbow and the palm of his hand being t urn ed towards his body, a narrow bandage is placed between his forearm and body with a short end which just covers the front splint. The long end is then bro ught" from without in " (and over the splint) wrapped firmly twice round the lower end of the foreann immediately above the wrist passed as figure-of-eight round the hand and then brought back w ith a sloping turn to the lower end of forearm where the two ends are tied off on the front splint. It is noteworthy t hat, t hough in this instance the tria ngular is used as a roller bandage the gold en rule of bandaging" from within out" has been broken.-N.C.F. ApPLICATION OF BANDAGES WITIl FRACTURED LEG.

II. F. (Tyldesley).-Will you please g ive me yo ur opinion on the treatment of a fract ured leg when no splint is available? The Textbook (page 92) states: ' I When no splint is available the feet, an kles, knees a nd thighs

As the T exLbook is silent on this point first aiders can please themselves and no examiner can expect or demand a figure-oF-eight bandage round ankles and feet in the circumstances na med-even though thereby an f'xtra bandage is saved. My own view, however, is that the figure-of-eight g ives better support than two bandages and that fo r this reason it should be used whenever possible. In other words, the decision depends on the actual position of the lower fragment which, in certain cases, can be better secured by two bandages than by a figure-of-e ight an d vice vena. - N.C. F. TRANSPORT OF PATIENT WITII HEAD INJURIES.

R.G. (Stockport). -I am a member of the Casualty Service A. R. P. and a discussion has arisen among our members as to the correct position of carrying a man on the stretcher with the bottom part of his lower jaw blown away during an air raid. Some say we should place the patient on the stretcher face downwards and with his face over t h e end of the stretcher. Others say that he shou ld be seated with his head bent slightly forwards. Your ruling on this point \vill be much appreciated. The suggestion that such a patient should be removed seated does not conform to the Textbook instruction concernin g the t reatment of Shock which, in such circumstances, would be very marked. Should, therefore, there be pressing danger of the patient's tongue falling backwards and choking him, then it will be wise to follow the instructions of A.R.P. H an dbook No. 10 (pp. 20 and 21) and to remove the patient with his face downwards and with his head hanging over the end of the stretcher.-N.C.F.

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AID

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s hould be tied together." Does this mean two bandages for the feet and ankles, or are we supposed to lake our pattern from the treatment with splints and use only one bandage "round a nkl es and feet as a figur'e-ofeigh t" (page 92, rule 4). My fe ll ow first aiders are divided o n this point, one s ide saying that as the figure-oF-eight bandage is used ruund the ankles an d feet in a ll other instances (including roller ban d aging) we should use it here. They also say that the figure-oF-eight is firmer and g ives more s upport. The other side say that, if it is a compound fracture with the bone protruding, the bandage round the a nkl e would secure the injured leg witho ut applying extension. while the bandage round the feet would prevent the foot on the injured side falling outwards. They also say that if the book meant a figu re-of-eight to be used it would say so, as it does in other bandages. Before I close I should like to say how m u ch we look forward to I I Queries and Answers" each month a nd to thank YOll for the many helrful suggestio ns we have d erived from this section of FIRST AID.

In other words, you wou ld treat as laid down on p. 122 except yo u would not lel lhe patient g rasp th e pad and you would control the bleeding by keeping lhe tourniquet applied to the radial and ulnar arteries, Such treatment, of co urse, includes the raising of the hand in a St. John Sling. This done, you would regard the case as urge nt and remove lhe patient without delay to doctor or hospita l for imm ediate medical attention. . C. F.

When blister gas gets into a wound, it sh ould not be treated by first aid personnel who , after protecting wound , should arrange for the immediate transfe r of the patient to doctor and hospital. Liquid gas on t h e skin is treated by mopping, use of a solvent (paraffin Or petrol) and bleach ointment, such treatment being contraind icated in the case of a wound infected by blister gas. Bleach ointment is used because the chlorine is quickly and readily liberated, qualities which are not present with Eusol, although the latter is a combination of boric acid and chlorid e of lime.N.C.F.

FIRST

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Editor

NOTICE

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TO READERS.

EDITORIAL.

FIRST AID is published on the 20th of each month. The Annual Subscription is 3s. 6d. 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 12th of each month, and must be accompanied (not neassarily +or pUD/itation) by the name and address of the Correspondent. Subscriptions, Adyertisements and other business Comm~nications connected with FIRST AID should be forwarded to the Pubhshers. DALE, REYNOLDS & Co., LTD., 46, CANNON STREET, LONDON, E.C.4. Telegraphic Address-" Twenty -jour, London." Tel,phone-CitY37 Io .

CONTENTS

THIS

NUMBER.

EDITORIAL : -

Increasing Personn el Insensibility ... Nursing Exhibition Death of Sir Aylmer Hunter-Weston S.]. A. B. Headquarters and District Reports St. Andrew's Ambulance Association The Order of St. John .. . Priory for Wales Railway Ambulance News The Hospitallers' Club ... S.J.A.B. Overseas Durham, Cleveland and Westm0r1and Districts Ambulance League Our Nurses' Pages Reviews Fevers A.R.P. Topics

197 198 199 199 200 201 201 202 203 204 204

204 205

206 208 210

QUERIES AND ANSWERS TO CORRESPONDENTS : -

Sling with Compound Fracture of Arm Examination Howler Causation of Air Hunger Indications for Silvester's Method Jugular Vein Roller Bandage for Fingers Pin in Tongue During Insensibility Bleeding from Scalp and Fractured Thigh Method of Artificial Respiration Humour in First Aid Treatment of Hysteria or Shock Treatment of Scalded Throat Sites of Splints with Fractured Arm.. .

212 212 212 212 212 212 212 212 214 214

214 214

214

ALTHOUGH the annual reports of the voluntary first aid organisations have not yet been issued for the year 19.39, it is a definite fact that membership has greatly increased in the British Red Cross Society, the St. John Ambulance Brigade and the St. Andrew's Ambulance Association. Civil Defence has been the direct cause of enlisting the sympathy of hundreds of men and women to the voluntary ambulance movement , which movement is, as has been described on many occasions, the greatest voluntary effort for the benefit of mankind. Will this increase have a lasting effect? This is a question that has been asked; but it is impossible to give a definite answer. Many of the new members have undertaken this work as their voluntary war effort, and it is to be expected that at the conclusion of hostilities these members will gracefully retire after having, as one might say, served their purpose. Others will certainly be permanent mem bers and will continue to give active assistance for many years. During the past few years, especially since the Home Office instituted Air Raid Precautions instruction, first aid personnel has shown a large increase over each preceding year; but at the same time members were called upon to cover a considerable amount of increased duties, consequently the new members were all the more welcome . At the present time it would not be possible to estimate how many new members will be permanent, or how many will be of the" here to-day and gone to-morrow" type. It is, however, safe to state that the training given to all new members will prove of the greatest importance in the life of INCREASING PERSO NEL.

FIRST the general public. To-day the percentage of persons with first aid knowledge is higher than at any other time in the history of our country. This in itself is but one asset that Civil Defence can claim.

I nsensibi lity. THERE are three degrees of Insensibility : (1) Sleep (which is natural) ; (2) Stupor (which is partial), and (3) Coma (which is complete). Insensibility, or lack of -onsciousness, occurs by reason of a suspension, in part or in whole, of the normal working of the Cerebra-Spinal Nervous System. This consists of the Brain, the Spinal Cord, and the Nerves which lead between these and all parts of the body. The nerves of the Cerebro-Spinal (or Voluntary) Nervous System are of two types: motor ne1'Ves, carrying- orders f1'0112 the brain, causing groups of muscles to contract and thereby giving- movement to the limbs, etc. ; sensory nerves, which carry to the brain from all parts of the body, sensations or impressions, such as pain, heat, cold. The Brain, we are tola, is the seat of the intellect, the emotions, and the will. It is localised as to its functions. One area is called the motor a1'ea, where orders are given for movement, another the sensorya1'ea, which receives sensations or impressions, whilst other areas are specialised and defined, more or less accurately, for specific duties-such as speech, reception of visual impressions, thought, and so on. In the condition of Insensibility the sensory and motor functions of the brain may be wholly or partially suspended, while the intellectual and emotional functions may be quite suspended. This suspension may be temporary, as in sleep; but the livin g and efficient conscious self is slight and can be pierced by stimuli carried to the brain (e.g. by touch, light, sound), or can be dissolved by chemical processes. What is the cause of sleep? The activity of the brain is dulled by an accumulation in the blood of certain toxins or poisons called fatique-toxins. When this accumulation has reached a certain concentration, it causes changes in substances, microscopically found in nerve and brain cells. These are called Nissl's Spindles, and become smaller and thinner when we g-et tired. It has been found that these spindles are restored to their full size and activity after refreshing- sleep. So we sleep because fatigue toxins make our Nissl spindles small. During sleep the fatique-toxins are got rid of and our spindles are restored. Insensibility, however, may be of a deeper nature than natural sleep, as in stupor, which is an abnormal and patholog-ical condition, and during which the veil between consciousness and the outside world is thicker, less readily pierced and less readily dissolved. This veil may be even more opaque. Ko stimulus can pierce it ; and resolution from within is slow and difficult. This deg-ree of insensibility is known as Coma. In sleep a light touch, a soft sound, a bright light, may be enough to arouse the person. In stuP01', from which, as good first aiders, we know that a person" may be aroused with some difficulty," the reflex response of the pupils to light and the touch reflex in the eyeball can still be elicited. The sensory nerves will still carry sensations, and the motor response may still be called forth as a result of these sensory im pressions. I n coma the subject responds to no external stimuli; the veil cannot be pierced from without but may be dissolved from within slowly and with difficulty.

FIRST

AID THE CAUSES OF INSENSIBILITY.

In the state of consciousness the brain must be uninjured and intact; the blood must circulate; the blood must contain oxygen; and the blood must be free from such toxins as affect brain activity. Otherwise insensibility will result. We will consider some of the chief causes ot insensibility as seen by the first aider. Asphyxia.-According to the St. John textbook" continuous want of pure air produces a condition known as Asphyxia, which will cause loss of consciousness (Insensibility)." Why does the continued absence of fresh air cause such a condition? The reasons are (a) that the brain, like every other tissue and organ must have oxygen carried to it by the blood, and in asphyxia the blood contains no such oxygen; and (b) that the brain will cease to function if the blood in its cells is full of poison. In cases of asphyxia this poison is carbon dioxide (C02), which acts on the brain in the same manner as a strong- fatigue-toxin. When blood is preve nted fram getting its full supply of oxygen, it lacks oxygen (02) and becomes full of carbon dioxide (C02) ; and the essential factor in all cases of asphyxia is that the blood cannot obtain the necessary oxyg-en. The primary object in the treatment of the cond ition is to ensure that clean oxygen- bearing air gets into the lungs, from whence the blood will carry the oxygen to the brain tissue. INSENSIBILITY WITH CONVULSIONS PRESENT.

Epileps)! may be of the usual constitutional type due to an "uncontrolled discharge of spontaneous cerebral motor activity." This excessive stimulation of motor cells causes the characteristic alternate contraction and relaxation of muscles. At the same time with this excessive activity of the motor cells of the brain, we get a proportionate cessation of activity in other brain cells which results in sudden and complete insensibility. Epilepsy may, however, be of the rare condition known as "Jacksonian" which results from an old standing injury to the brain. In such conditions some part of the motor area is subjected to irritation such as by resolving blood clot, by fibrous tissue clue to scar formation, or by callus after fracture of the vault. Infantile Convulsions are due to the fact that the brain is affected by circulating toxins. Stimulation of the motor area, causing movements of the limbs, etc, is followed by a dulling of all brain functions. The toxic poisoning may be due to (a) onset of fever and especially of some acute infectious disease; (b) faulty digestion and assimilation of food material; (c) to g-erms, as at the onset of an illness, or (d) to the brealdng down of gum substance in the process of teething. Poz'sons.-Corroslve poisons may cause insensibility as part of the general co llapse; whilst in cases of irritant poisoning it may be caused by the onset of collapse or as thE' result of accumulation in the blood of poisonous substances derived from foodstuffs containing ptomaines-products of decomposition. Narcotic poisons act directly on the brain cells. The blood carries the poison from the small intestine to the brain which is put out of action. Some narcotic raisons dull the brain at once, thus causing- sleep, followed by stupor and later coma. Others first stimulate the brain excessively and produce delirium, thereby causing the overworked brain cells to becolne tired and cease to function. Thus coma intervenes. Others again, act on the motor parts of the cerebro-spinal nervous system and produce convulsions, co nsequently the patient dies either through coma or through asphyxia which results from the tonic contraction of the muscles of respiration. INSENSIBILITY WITII NO CONVULSIONS PRESENT.

Inj~tries to the H ead.-These cause insensibility by dis-

turbance of brain function either by shaking the brain on its

cushion of cerebra-spinal fluid within the brain-box (concussion of brain), or by pressure in the brain by blood clot, depressed fracture, or new growth (compression of brain). Fainting, Slwck, Collapse. - In these conditions the brain does not receive an adequate supply of blood. Consequently oxygen requirements are not available, and cerebral amemia results. Apoplexy.- This is caused by a sudden eruption of blood from a burst blood vessel plus direct pressure on the surface of the brain by the outpoured blood. The motor area is especially affected owing to the course of the meningeal artery-the blood vessel which is most often to blame. The paralysis is due to the motor area of the brain bein cr so markedly affected. h Sunstroke and Heatstroke.- Insensibility is caused by the congestive stagnation of the blood in the brain and cordquite the reverse to that which happens in shock. Blood vessels in the brain and cord become engorged with blood; carbon dioxide is not carried away, and no oxygen is available. TREATMENT OF' INSENSIBILITY.

First, attention must be given to the breathing. If absent, artificial respiration must be carried out without delay. If breathing is present, the position of the patient is most important-o n his back, head turned to one side, and head and shoulders raised or lowered according to whether the head requires more (pale fa ce) or less blood (flushed face) . All tight clothing about chest, neck and waist must be loosened to allow free mo ve ments of the respiration, and to prevent pressure on the air channel and on the blood vessels in the neck. In all cases ensure an abundance of fresh air. This done, patient must be warmly wrapped between blankets. Special measures indicated by the condition which caused the insensibility should then be put into operation; and, after having treated the cause, we must remove the patient to she I ter as soon as possible in a recum bent position and on a stretcher. Whilst the patient is insensible, we must give nothing by the mouth to eat or drink. It is well to remember that the upper part of the throat conveys both food and air. The air passage divides at level of the" Adams Apple," the food and the fluid being- prevented from" straying into the wrong path" by the epiglottis, which, when a person is insensible, does not function. Unless it is unavoidable, we must not leave our patient except if there is present a competent person who can take charge of the case. Later, when consciousness has fully returned, and not before, we may give sips of cold water; and if the pulse is feeble, we may administer hot and strong tea or coffee in sips. These will act as stimulants and increase the force of the heart's action. Sh ould, however, bleeding externally or internally be present or suspected, this stimulation must be withheld. Lastly, if the patient wishes La go to sleep he should be encouraged to do so, except in cases of h yp notic poisoning. It is quite unnecessary to emphasise the importance of obtainin1{ medical assistance at the very first opportunity. As good first aiders we should have sent a message to the doctor at the very outset of our treatment.

In accordance with a custom established some 15 years ago, members of the Nottingham Divisions, S.J.A.B., paraded for Service at the Canaan Street Chapel on Palm Sunday. Corps Officer F. Carrier was in charge of the parade, which numbered about 100.

AID

199

NurSing Exhibition. THE 30th annual Hospitals, Nursing, Midwifery and Public Health Exhibition and Conference was held at the lew Horti~ultural Hall, London, on April8th to 12th, and praved of great lOterest not only to the strictly professional nurse but also to membe~s of th; B. R. C;. S., St. John and other organisations. ThiS year s SpeCial Feature was on Wartime NursinO' First was displayed eight models wearing the correct unifor;;~ of v~riow~ nursin~ services. Then came a panorama displaymgYlctures and transparencies tracing the com plete chain of. medical and nursing responsibility, from the Maginot LlOe t? a Home Ho~pita1. Facing this was displayed ten war dl~e.ases (frost bite, t re?ch fever, &c.), accompanied by an exhibit on the ProphylaXIS of War Wounds and Diseases, arranged by Messrs. Parke, D avis & Co. l\lessrs. Coxeter & Co., and their allied firms, furnished an instru ctive show of various forms of amesthetic apparatus and a fine range of apparatus for the use of oxygen. Messrs. Sparklets Ltd., displayed apparatus for the employment of Carbon Dioxide ( C02 ) for the resuscitation of asphyxiated patients. . There was also an interesting display of newer antiseptiCS and Capt. W. Goodley (Commissioner No.1 District, S.l.A. B.) loaned some first aid eq uipment and also prepared copies of the actual devices employed with Field Ambulances in France for keeping the wounded warm, and preventing shock. During each day of the Exhibition, members of the S.J.A.B. and B.R.C.S., gave demonstrations on various treatments, which included artificial respiration, scalds and burns, Thomas Splint Drill, fractured spine, etc. In addition, th ere was the usual display made by manufacturers, in the Main Hall. Messrs. Reckitt & Sons of Hull, displayed their modern gt:rmicide "Dettol," also " Dettolin " (mouth wash) and other specialities; The Herts Pharmaceuticals Ltd., Welwyn Garden City, presented surgical adhesive plasters (" Handyplast," "Leukoplast" and" Crepoplast ") ; l\lessrs. VI. H. Bailey & Son Ltd., 45, Oxford Street, W.1, displ ayed numerous medical and nursing instruments; whilst on the stand at Messrs. Edward Taylor Ltd., 22, Ely Place, E. C.t, was shown" Flexoplast " dressings of various kinds. Book publishers were well represented by Bailliere, Tindall & Cox, H . K. Lewis & Co. Ltd., and Faber & Faber, Ltd., all of whom had an interesting display of textbooks appertaining to the nursing and allied professions.

Death of Sir Aylmer Hunter-Weston. VVE regret to record the death of Lt.-General Sir Aylmer Hunter-\Veston, who died as the result of a fall from a turret at his house, Hun terston, \Vest Kilbride, on March 18th. Sir Aylmer will be remembered by all who attended the numerous competitions organised by the St. John Ambu la nce Association as a man who was wholeheartedly an enthusiastic member of the Order of St. John. Meetings under his chairmanship were far from dreary; and his ready wit, his booming voice will be missed from such functions. He was an inspiring leader of men, and his magnificent career in the army, where he was affectionately known as Hunter-Bunter, gave full rein to his personality, self-confidence and optimistic outlook up on life. To readers of this Journal, however, he will ever be remembered for the interest taken in humanitarian work, especially with the Order of St. John. He was appointed a Knight of Justice of the Order in 1884 and a Bailiff Grand Cross in 1925. He was appointed Chancellor of the Order in 1924, a position he held until 1938, when, having resigned his seat in the House of Commons, be went to live in Scotland.

200

FIRST

St. John Ambulance Brigade HEADQUARTERS AND DISTRICT REPORTS. No. I (Prince of Wales's) District Owing to Asst. Commissioner Dr. F. E. Bendix being seconded for work of national importance, District Officer C. J. Fitch has been appointed temporary Assistant Commissioner in charge of Eastern Area. No. 146 (L.M.S. R. CAMDEN) DIVISION.-A most successful evening was enjoyed by about fifty members and friends on Saturday, April 6th, when the Division held its first annual dinner at the Strand Corner House. Amb. Officer G. Kirkham (Officer-in-charge) was in the chair, being supported by District Officer T. McBride and Mrs. McBride. The members were complimented on their smart appearance by District Officer McBride, who also congratulated the Division on the sterling work performed since its inception in May last. Following the dinner a visit was paid to the Hippodrome Theatre lo witness a performance of " Black Magic." No. 58/5 (Western Postal and St. Marylebone) District. This Division claims to be the largest DivisionintheBritish Empire. According to the annual report the membership at December 31st, 1939, was 281 all ranks of whom 120 are in full uniform and 35 are serving with the Forces. Cases treated numbered 1505, of which 22 were taken to hospital or escorted home; 522 public duties were performed; 51 drills held; 13 first aid and 2 home nursing courses were run, which resulted in 915 certificates being awarded. In addition many short courses were held for the benefit of A. R. P. Wardens. Owing to hostilities the competition for Div. Surgeon M. M. Scott's trophy and the annual divisional dinner and dance was not held. The Division continues to be in complete co-operation with the Borough of St. Marylebone A.R.P. scheme. Div. Supt. W. V. M. Allen, who has been awarded the Service Medal of The Order, was appointed Commandant. Large numbers of the public were posted to Depots and First Aid Posts in addition to divisional members and A.R.P. Auxiliary Reserves. An extensive A. R. P. and first aid training was necessary and resulted in 220 certificates being obtained. No. 144 (Highbury) Division. The social club connected with this Division has started a fund for sending comforts and gifts to members serving with the Forces. Recently the G'esters Concert Party, recruited from the ., G" Division of the Metropolitan Police, came to its aid and provided a grand variety entertainmet, as a result of which it is expected that about £10 will be added to the Fund.

No. m District. NORTHAMPTON.-The annual report of the Northampton Corps for 1939 was submitted at a meeting held recently. The Corps, which consists of the following DivisionsNorthampton Headquarters, Daventry, Earls Barton, Weedon, Towcester, Northampton Kingsley Park W. M. Club, and Northampton Electric Light and Power Co.-has now a personnel of 369, an increase of 102 since December 1938. During the yea r the Brackley Division was transferred to the O xford Corps.

AID First aid had been rendered to 5,040 cases, an increase of 1,537, whilst the motor transport work had been especially heavy. Altogether 2,796 cases had been removed, 304 accidents altended and nearly 24,000 miles covered. Increased long-distance removal~ had been undertaken by the Northampton ambulances-London, 12; Redbourne, 2; Oxford, 4; Shrewsbury, Fareham (Hants.), GorIestone, Birmingham, &c. The extra calls on the transport services meant increased duties for members and it is pleasing to report that since the outbreak of war, additional driver and attendants with an officer in charge have been on night duty voluntarily at Headquarters. WHITTLESEY.-Mr. T. Searle, J. P. (President), presided at the annual meeting- of the Whittlesey Division supported by Div. Surgeon A. Bernard, Supt. G. W. Foster and Corpl. J. Elding (Div. Secretary). The ambulance had answered 138 calls, covering a distance of 4,329 miles, all members had passed the examination and 4 had joined the Forces. Supt. Foster thanked the President for the interest he had always ~hown, and Dr. Bernard for the work and time he had given.

No. IV District LIVERPOOL.-Mr. S. Bowman (President) presided at the annual presentation of awards to members of the B.A.T. Division, supported by County Surgeon Murray Cairn s, Div. Surgeon J. W. Flood, Vice-President G. L. Grant, Corps Supt. W. E. Searl, Corps Officer E. M. Moore, and others, including the management of the B.A.T. Co., Commercial-road. The chairman paid tribute to the members for their unstinted services to the cause of humanity and the traditions they had upheld since the formation of the Division in 1922. He gave a resum e of the Divisio n's activities during the past 17 ~years From the year 1922 to 1939 the Division attended 20,943 public duties and had treated 5,490 cases. The County Surgeon presented a vice-president's badge and warrant to Mr. G. L. Grant, who said how much he appreciated the honour and assured the members of his fullest support. A vote of thanks to Dr. Murray Cairns was proposed by Dr. Flood and seconded by Dr. H. H. Evers. Corps Supt. Searle also paid tribute to the efficiency of the B.A. T. Division. Mrs. S. Bowman presented thirty female awards, whilst Mr. Bowman presented 22 certificates, 22 vouchers and 11 labels to members of the Division. The presentations were followed by a supper and social items.

No. VI District MALTON.-Miss Hall presented certificates and other awards to members of the Malton and Norton Division at a meeting held recently. Amb. Officer E. Shaw presided, and said that the total membership, including reserves, was 58. There were 14 members serving with the Military Hospital Reserve. Last year the Division conveyed 109 patients by motor ambulance (mileage, 2,035), and .dealt with 16 road accidents (mileage, 135). Sergt. W. Hollingsworth thanked Miss HaIl, who is a home nursing officer. She was presented with a chromium plated dish by Mr. W. F. Brander. ACOMB.-A whist drive was held last month in aid of funds for the Acomb Division, and it is hoped to hold similar functions each week.

_ _ _ _ _ _ _ _ _ _._ _ _ __ :F=-==I -= R~S~ T_ A I D . DARLINGToN.-The Darlington Friendly Societies' DiviSlOn recently held a supper and dance. During the eveningthe" J. H. Taylor" Efficiency Trophy, given by Councillor J. H. Taylor, M. C., F. R. C. V. S . (PreSident), and awarded to the most efficient member each year, was presented to Corpl. W. Hodge by Mrs. F. Hope Wilson wife of the Div. Vice-President. ' Points are awarded for efficiency in first aid anti-o-as precautions, also public duties are taken into' accou"'nt. Corpl. Hodge had the splendid record of 222 public duties during 1939. . Co~ncillor Taylor presided at the function, whilst Supt. T. Robms, M. M., moved a vote of thanks to the Divisional President and Mrs. Taylor for their continued interest. Div. Vice-President J. Burnside supported the motion.

No. VIII (Duke of Connaught's) District ESHER.-The Esher Division, which was formed in the summer of 1938, is now firmly established, thanks fo the support of public-spirited members. Activities include assistance in t he training of A. R. P. personnel a nd other useful work is being undertaken in spite of the fact that the superintendent and some of the members are now in the Forces or otherwise engaged in work of national importance. SNOWDOWN COLLIER Y.-The annual meeting of the Snowdon CoIliery Di vision was held on 1\1 arch 22nd when Mr. W. Ackroyd presided. The Secretary's (Corpl. E. Dudley) report stated that mem bershi p was 24 ; six mem bers were in the R. N. S. B. and one in the Army. Sixty- nine cases of accident or sickness received attention, 18 patients remo ved to hospital and home (mileage 128), 18 road duties undertaken. Public duties involved 86 men; transport 20; and road service, 42. Eighteen members were enrolled under th e Eastry R. D. C. A. R. P. Scheme. Various first aid and home nursing awards were distributed by Mr. W. Ackroyd.

No. IX District Lt. -Col. VV. Blackwood, County Commissioner for Cornwall, in his annual report states that there are now 26 ambulance, 17 nursing, 12 boy and 5 gi rl cadet divisions in the county with a personnel of 134 officers and 1,228 other ranks. This is an increase of eight divisions and 359 members. First aid was rendered on 22,206 occasions; cases transported by the 17 ambulances totalled 3,780 with a mileage of 59,823. Members of the Nursing Divisions accompanied the ambulances on 340 occasions. Road accidents numbered 249, and to deal with such cases 16 roadside first aid boxes were established and 26 roadside first aid posts. Since the outbreak of war, 115 members ha\'e joined lhe Forces and a large number were engaged in civil defence. Miss Helen GryIls, Lad y County Supt., reported an increase of six Nursing Divisions and 189 personnel. The nursing cadets continued to make satisfactory progress.

PLYMOUTII.-Great satisfaction was given to members of the Millbay Railway Division by the announcement that their superintendent, Mr. J. A. Hott, has been promoted to Officer (Brother) of the Order of St. John. Supt. 1I0tt has 45 years' service to his credit, and was for many years an active member of the Great Western Railway Ambulance Centre.

201

----------------------~~ Northern Ireland (Ulster) District. ~rofessor . Gregg Wilson,

O. B. E., D. Sc.,

has been

ar:pOl~ted Act1l1g Commissioner of the Northern Ireland

Distnct, for the period of the war. During the y~ar 1939, the Brigade in this district had a wond~rful expansIOn-from 34 to 63 divisions. The memb.ershlp ro~e from 846 to 2,077 (1,190 members are in possesSlOn of Bng-ade uni~orm).. Members of Nursing Divisions s~e?t 20,4~6 hours II1 vanous hospitals in training for the Civil Nursm g Reserve, &c. The Chief Commissioner, Sir John Duncan commenting upon the past year's work, wrote as follows :--.:' I must con gratulate you on the remarkable results achieved. I can tell you that no other district or county has been able t" show such a large number of new divisions. Will you please c.onvey to all members o~ Northern Ireland my high appreciab.on of the fine work which they have carried out in the past difficult year." I

St. Andrew's Ambulance Association. D AL~E[TH.-:c:x. Provost Doughty presided at the annual presentatiOn of pnzes of the Dalkeith District Ambulance Association. Mrs. Leonard Tod, Lasswade, presented the awards. . Best. Practical Work, Miss J. Steele. "Mrs. Doughty's" Pnze, MISS J . Hamilton. "Spalding" Trophy, 1, Walter Dickson's team' 2 'vV Steele's team. Association Prizes, first year, Miss Pri'ngl~ and John Parks; second year, 1\1 iss E. Wilson and Alex Prentice.

KlRKCALDy.-Fourteen teams competed for the" Nairn " c.up at Kir~caldy on Saturday, l\larch 23rd, in the competitwn orgaI11sed by the Kirkcaldy Branch of the S.A.A.A. The wi?ners we~e !?ysartCo-operative team with 175 points, BalgoI11e and Dlstnct No. 1 came second with 174 points, an.d Dunfermline third with 160 points. The captain's pnze was awarded to R. Johnston, Dunfermline.

LEITIJ.-The presentation of 89 certificates, 21 medallions, and four re-examination vouchers were made to members of the first aid class ot the Leith District, L. N. E. R. Section, S. A. A. A. Corps. This section has run classes each year since 190-+, and the class now concluded was the largest held durin g that period. Thirteen lectures were given, and as many nights were put in at practical wark. The presentations were made by Mrs. Walker, wife of the honorary surgeon. Commandant 'vV. P. Leslie, on behalf of the members, presented a gift to Dr. Angus 'vValker in recognition of his valuable services as lecturer.

-------.--. ------The Order of St. John. THE Secretary-General, Major-General Sir Percival S. Wilkinson, has advised members that, owing to the war and the co nsequent dislocation of the activities of The Order, the Grand Prior has decided, as regards this year, to cancel the Di\'ine Service held annually in the Priory Church on S t . John's Day, together with the Annual General Assembly which usually follows it. The annual report will, as usual, be sent to all members of The Order.

FIRST

202

Priory for Wales. The membership of the Brigade in Wales shows an increase at the 31st December, 1939, of 1,640 on the previous year, to a total of 14,434, comprising 7,742 men, 2,029 women, 3,270 boys and 1,393 girls. While 2 Ambulance, 2 Nursing and 1 Cadet Ambulance Divisions were disbanded during the year, 45 new Divisions were formed, bringing the establishment up to 273 Ambulance, 104 Nursing, 149 Cadet Ambulance and 66 Cadet Nursing Divisions. The summary of duties recorded, which can never be regarded as a complete statement as so many services go unrecorded, indicate that the Brigade in Wales attended 70,428 cases during the twelve months. The needs for ambulance transport are to a great extent covered in South Wales by the Priory's officially recognised Service, but 14 Divisions are operating ambulances on a voluntary basis, which dealt with a total of 6,360 removals, involving a total mileage of 36,072. The Brigade maintains 13 Roadside First Aid Huts with regular patrol duty j and is responsible also for 76 First Aid Cabinets or Boxes and 38 First Aid Posts. Instruction in anti-gas has been carried out to a considerable extent, no fewer than 4,963 A. R. P. awards having been gained in 1939. The Association Department increased by almost 75 per cent. on previous years' records. First aid and home nursing classes, held under the Priory for Wales, were attended by 32,313 students in 1939, of whom 27,594 qualified for awards of the St. John Ambulance Association. The continually increasing services of the day and night Transport Service operated by full-time drivers and attendants are shown in the figures for the following 21 stations, which are 3,685 cases and 38,762 miles more than the 1938 totals : Abercarn (From October 5th) Aberdare Ammanford (Accident) Ammanford Bryn Cardiff Clydach Coedely Crosskeys Cwmllynfell

Cases

Mileage

836

2,058 362 2,141 586 2,518 955 1,308 518 1,352

11,734 9,170 25,971 10,752 27,892 12,204 22,238 9,614 28,882

FIR ,S T

AID Cymmer Gowerton Gwaun-cae-Gurwen Kenfig Hill Llanbradach Llanelly Pen coed Pontardulais Pontypridd Trimsaran Tumble

753 1,628 686 464 865 803 1,248 572 997 1,817

21,618 9,719 25,685 14,802 8,788 6,290 18,251 20,904 11,993 22,816 31,597

Totals

22,446

35l,756

776

WREXHAM AMBULANCE DEDlCATION An important part of the activities of the Wrexham Division, Denbighshire, is the Ambulance Service, which has just been extended by the purchase of a third car, which was dedicated on March 10th by the Rev. T . Jones, vicar of Berse, Hon. Chaplain to the Division, who was assisted in the religious service by the Rev. Ezekiel Williams, representing the Noncomformist Churches. The Assistant County Commissioner, Mr. G. T. Guest, after welcoming Sir Alfred McAlpine, who has been appointed President of the Division in succession to the late Lieut.-Colonel J. E. H. Davies, D.S.O., M.R.C.S., said the work of the Division was increasing year by year, and the number of cases carried in 1939 was 1,400. All the am bulance work was done voluntarily by a rota of members, who were continuously on duty throughout the day. A tribute was paid by Sir Alfred McAlpine to the efficiency of the members and particularly to the coolness and courage with which they did their work and said the public scarcely realised the debt they owed to this wonderful service. The Mayor, Councillor John Davies, in presenting warrants of appointment as Divisional Superintendent to Capt. R. H. Guest Williams and Ambulance Officer to Mr. George Peters, Rossett Division, said the people of Wrexham responded to no appeal for support with more enthusiasm than they did on the St. John Ambulance Flag Day.

Lady Helen Seymour, president of the B. R. C. S. in Warwickshire, opened a new Red Cross first-aid post at Knowle on April 4th. The posts consists of a receiving room for casualties, a waiting room and surgery.

Railway Ambulance News. Great Western. PANTYFFYNNON.-At the annual presentation of awards to the Pantyffynnon class Mr. D . T. Evans, Station Master presided, and was supported by Mr. H. Williams, Div: Supt., who paid high tribute to Dr. McMillan for his <;ervices as instructor to the class. Medallion and label awards, as well as a number of gold efficiency medals were presented by Mr. Williams, and the vouchers and certificates gained in the last examination were distributed by Mrs. Williams. The instructor and secretary of the class, Mr. R. T. Jones, was complimented on its efficiency. BUILTH WELLs.-The L1anelwedd Arms Hotel was the sce ne of the an nual dinner of the Builth Wells class on March 8th, when Mr. Frank L. Morris, J. P., Chairman of the Builth \Vells Urban Council, presiJed, and was supported by Mr. T. C. Sellars, District Traffic Manager; Mr. C. A. Neale. Divisional Engineer j Mr. W. H. Glasscodine Station Master j Mr:. F. Rowlands, class secretary, and other railway officials. The examination awards and four Rold medals for 15 years' efficiency were presented by Messrs. Sellars and Neale, who congratulated the recipients. BRISTOL.-The Secretary of the G. W. R. Filton class, Mr. R. G. Hunt, gained the silver challenge cup at the competitio n held by the Bristol North Division of the S.l.A. B., obtaining premier position out of 48 competitors. Mr. Hunt has been promoted from Corporal to Sergeant in the Bristol Corps. WEDNESBURY. - The newly-formed \Nednesbury class held its first presentation of certificate and label awards recently, when Mr. F. \N. Davies, chief clerk, presided, and expressed his pleasure at the 100 per cent. examination s ucceeses achieved. In appreciation of his services as lecturer, Dr. Shaw was presented with a combined cigarette case and lighter on behalf of the class GLoUCEsTER.-At the annual smoking concert of the Gloucester Ambulance Corps, held on March 9th, the City Member, Mr. H. Leslie Boyce, paid tribute to the good work of the Corps . Mr. S. G. Hearn, Div. Supt., presided, and was supported by officers of the Company. Mr. 'N. C. Drinkwater, honorary secretary of the Corps, was presented with the" S. Morris" cup on the vote of his fellow members. as the member having done most to further the Movement -luring the past year.

london, Mid land and Scottish.

Wrexham Ambulance and Cadet Units with the new Ambulance dedicated on March 10th, 1940.

ACCRINGTON.-Awards and prizes were presented to nembers on March 20th, by Mr. G. B. Brinnand, stationmaster at Blackburn and formerly of Accrington. The winner of the "Hayhurst" Cup was J . Allan, C. & W. Dept., with J. Kendal, Loco. Dept., 2nd, J. Birtwistle, Loco. Dept., 3rd, and F. Atherton, Goods Dept., 4th. Long service medals and gold bars were presented to J. Swarbrick, 35 years, H. Eccles, 30 years, T. E. Sutton, 2S years, and H. C. Hamer, 15 years. . .Mr. ]. H. Unsworth, stationmaster at Accrington, preSIded.

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.GLAS GOw.-On March 31st, Mr. William Scott, Asst. StatIOnmaster, Central Station, presented gold medals to seve? me.mbers of the Glasgow Central Stat.ion Ambulance SectIOn, 10 recognition of 10nO' service. . !hose rece.iving the awa~ds were: Charles Sandilands, W1lham WalkInshaw, John Davidson Harry Hemming Claud Pullin, 'Walter Bruce, and Charl;s Mathew. ' Mr. William Orr, Asst. Hon. Secretary, presided at the ceremon y. STIRLING.-Five teams competed on March 31st for the " rl.\1 ~n grange "C up at t h e annual contest held by the 'Stirling SectIOn of th.e ~. M. S. Am bulance Brigade. The adjudicators were D. J. W. Cowie, oral, and Dr. A. J. Shedden, practical and transport, and the trophy was awarded to. the team captained by R. Sinclair, the other members belOg G. Henderson, Miss Syme and J. Strang. J. Mitchell's team was second and D. Stalker's team third.

Southern. ASHFORD.-The annual competition for the cup presented by Mr. R. E. L. Maunsell was held on larch 9th. Seven teams competed and 11r. J. T. Heneker, class secretary, announced that Mr. G. H. Morse's team had been placed first, followed by H. Coombe's team. Dr. J. N. Robins adjudicated, being assisttd by Mr. E. A. Richards and Mr. F. A. Trott. The cup, prizes and the annual class awards were presented by Mrs. Slade. Messrs. G. Fuggle and R. H. Baldock received 30-year certificates. Mr. E. Uzzell (Welfare Officer), who presided, congratulated the competitors and members of the class on their excellent work and referred to the valuable support which Mr. R. E. L. Maunsell always accorded them. He applauded the efforts of the staff at Ashford in connection with the Company's A. R. P. scheme. Mr. Maunsell remarked that the cup had now been competed for over a period af 24 years, and expressed the hope that it would long continue to serve the purpose intended when it was first presented. He proposed thanks to Mr. Uzzell. To be a Welfare Officer of the Southern Railway in times like the present was no soft job. PooLE. - The annual dinner of the Poole and Distri ct ambulance class, was held on March 13th, Mr. A. Holdaway (station master) presiding. Mr. C. N. Anderson (Asst. Div. Supt.) distributing the awards in the regretted absence of Mr. E. Hight (Div. Supt.) congratulated all concerned that they were giving the class the same support as before the war, despite the many more demands on their time. Mr. F. Bryant proposed" The Medical Officers" and was glad that Dr. Hindmarsh, lecturer, was able to be present. He also welcomed Dr. R. J. 11aule Horne, 11edical Officer of Poole. Dr. Hindmarsh and Dr. ;\laule Horne suitably replied. Mr. 'vV. Stempt in proposing" The Visitors" welcomed their Welfare Officer, Mr. E. Uzzell, who in response, said the work of the Order of St. John was dear to them all. He congratulated the mem bers on their work, and stressed the importance of ambulance work. He mentioned tr at the 1,000th accident case had that day been dealt with at the \Vaterloo first aid post. RAMSGATE.-Members of the Southern Railway Centre at Ramsgate, participated in the "Spooner" Cup competition held on March 6th. Mr. C. Silk was placed first, the runner-up being lYlr. S. Redwood.

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In the absence of Mrs. Spooner, the cu p and other prizes were presented by Dr. Gordon, who remarked upon the good wor k of the first aid~rs, and paid tri bute to the efforts of the new members. He added that he was always ready to do what he could to ass ist the Rams g-ate class. Votes of tnan ks were accorded Dr. Gordon and all those who had helped to make the competition a success. Previous to the competiti on, the annual class examination was held, when 45 members presented themselves to the examiner, Dr. Paterson of Margate. HONOUR.'-Mr. E. ]. Prew (District Ambulance Secretary for No. 1 b District) has been promoted to Officer (Brother) of the Order of St. John. Sin ce his appointment as Serving Brother in 1922, Mr. Prew has co ntinued to act as District Secretary to a very large area on the Southern Railway, and has been responsible for the recruitment of a number of men into the movement. His spare time is devoted to the training of recr uits at the 12 classes in his district, and he is ever ready in the promulg-ation of the First Aid Movement. Mr. Prew is also District Officer in t he No.8 District of the S. J. A. B., and is in charg-e of the Addiscom be, Surrey, Division.

The Hospitallers' Club. ON Friday, April 12th, the Club held its first social meeting of the year at the Bonnington Hotel, London. There was no speaker present but members were called upon to give a short 'talk on " I was there when " and some very interesting- and amusing experiences were related. The next meeting will be held on Friday, May 17th, at 6 p. m . Members are requested to book the date and to support the function as far as is possible.

S.J.A.8. Overseas. CEYLON P<?LlCE CORPS.-The annual report for the year ended September 30th, 1939, sets out increased activities of this Corps, which was formed in the year 1912. Commencing with 132, the Corps now has 2,331 members. Every policeman who has a sufficient knowledge of English is required to obtain a first aid certificate. 423 members hold the Service Medal, 24 the second bar, and one the third bar. Every Station in the Island is equipped with the necessary first aid. materi.als j sp~cial attention is paid to teaching members to Improvise applIances from material:; found at or near the scene of the accident. . Members have gain:d 1,7:8 Royal Life Saving Society certificates and awards, IOcludlng one award of merit (Silver Medal), one teacher's and thirty-one instructor's certificates. The report sets out instances where efficient treatment was given by members, which prove the value of first aid training. Mr. D. B. Ranasinghe, who is in the service of the Medical Department, has been admitted to the Order as a Serving Brother. Tribute is paid to the work of Medical Officers, especially to Dr. F. S. Wickremasinghe (Police Surgeon,

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Colom bo), who, in addition to lecturing at courses for 171 first year members, put 600 members through refresher courses and re-examined 905 men. As in past years, Captain W. T. Brindley, assisted by Mr. C. Weeraswriya, has been responsible for the organisation of Training-. Thanks are expressed to them and to Dr. S. T. Gunasekera, Director of Medical and Sanitary Services, who is also the Acting Asst. Commissioner, Ceylon, and to Medical Officers in the Provinces. TRANSVAAL. -Lt. -Col. G. E. Peacock, Com missioner in his annual report for the year ended September 30th: 1939, states that 18 new adult and cadet Divisions were formed and 831 new members enrolled. From 12 divisions in 1933 there are now 68 : and personnel has increased from 304 in 1933 to 2,056 in 1939. During 1939 the increase in personnel was nearly 500. In addition to many calls for staff for training purposes, members undertook an increased number of public duties, Mem bers of Nursing Divisions continued to show l,een interest in hospital training j whilst instruction in A. R. P. continues among all members, nearly 200 having enrolled for practical courses. Close co-operation between officers and members of the two Railway Sub-Districts continues j and the standard of efficiency of all members is well maintained. The Commissioner closes his report with thanks to the Department of Defence and to tbe Municipalities of various cities, to the University of the Witwatersrand, and to others for the inter~st, assistance and facilities accorded.

DurhalTI_ Cleveland and Westmorland Districts Ambulance league. Ar the final competitions of the above League, held last month at Durham, the view was expressed by Mr. Will Lawther, a Durham Miners' Association Agent and President of the M ineworkers' Federation of Gt. Britain, that the time was ripe for the Miners' Welfare Movement to organise a national first aid competition. The judges at the finals were: Drs. Whitley (]esJ11ond), Brown (Bedlington), O'Kelly (Bolden), and Woodward (Sunderland). Mr. Geo. Watkin, J.P., the secretary, was responsible for the excellent arrangements. The results were :-Seniors: •• Donald Bain" Shield and gold medals, Bowburn Colliery j Committee Cup (runners-up), North Skelton ., A" j .. Heath" Cup (best stretcher work), Blackhall; "Dillon" Cup (best team from the Seaham district), Blackhall. Juniors: "Elizabeth Bain " Shield, Medomsley. The trophies and prizes were distributed by Mr. Lawther, who, in addition to the above statement referred to the indebtedness of all the community to the me~ with a high degree of first aid. Mr. M. J. Charlton, H. M. Divisional Mines Inspector and Chairman of the League, presided.

The Harborough Division, S.J .A. B., held its annual dinner on April 2nd. Supt. C. H. Maycock announced that 367 removals were carried out last year. 3'

•

The first round of the Yorks hire Collieries Ambulance League took place at 11 centres on Saturday, April 6th. The semi-finals will be held on May 4th and the final on May 25th.

Our Nurses' Pages.

AID c1usion, he appealed for la dies in the audience to take up this work. District Officer McBride expressed thanks to the Mayor and Mayoress, to the Committee of the Club and to the audience for their support. ' -'

COMPILED BY AN AMBULANCE SISTER. It is infere:;ting to note that H. R. H. the Duchess of Kent has passeJ the S .J.A.A. first aid examination, and so joins H. M. the Queen and T. R . H. the Princess Royal and the Duchess of Gloucester in ability LO give practical assistance to the injured. Her Majesty, Commandant-in-Chief of Nursing- Corps and Divisions of the St. John Ambulance Brigade, has done a considerable amount of first aid training. The Princess Royal passed through her no vitiate as a nurse before her marriage; while the Duchess of Gloucester served in the nursing ranks of the B.R.C.S. during the Great War. H. R. H . Princess Arthur of Connaug-ht is a fully train ed nurse. For years she has given her services voluntarily to a London hospita l, and is now Matron of a hospital for the wounded. No. 1 DISTRICT, S.] .A. B. ED GWARE AND MILL HILL N URSING DIVISlON-The first social and dance org-anised by No. 101 (Edgware and Mill Hill) Nursing Division was held at St. Alphage H a ll, on Saturday, March 23rd. Mr. W . ]. MorRan acted as M. C., and the music was provided by Ron Scarlett and his band . The proceeds were in aid of the uniform and equipment fund of the Division. Spot dance prizes and a novel ty prize were kindly distributed by Mrs. Evershed. The Division was grateful for a donation of £2 and a box of chocolates from County Councillor Mrs. Grey-Skinn er.

No . 62 (HAGGERSTON) NURSIN G D[VISTON.-This Division held a concert and presentation of awards 0n April 1st, at the Hackney Working Men's Club. The Committee of the Club kindlyarrang-ed the func t ion, the proceeds bein g handed over to the Division towards its funds. Among those present were the Mayor and Mayoress of Shoreditch (Councillor T. J. Sillitoe and Mrs. Sillitoe), District Officer T. McBride and Mrs. Mc Bride, Mrs. A . M. Craft (Div. Vice-President), Lady Amb. Officer Mrs. Kempsell (Officer-in-Charge), and officers and m e mbers of the Division. Owing to indisposi t ion, Mrs. A. Granard (Div. President) was unable to be present. District Officer T. McBride presided at the presentation ceremony. Lady Ambulance Officer Mrs. Kempsell reported on the past year's work, and referred to the loss they had s ustained by the tra nsfer of Lady Supt. Mrs. Milburn to a nother Division. The strenRth of the Division was 27, an increase of 9 ; 35 drills had been held, and 33 duties covered, duri:: g which 302 cases had been attended. Nearly all the members were engaged in full-time or part-time A. R. P. work. Mrs. Kempsell paid tribute to the support given by the memhers whereby, in spite of the black-out, it had been possible to hold weekly meeting-so The Mayoress kindly presented the awards, whilst the Mayor presented a replica of the" Mrs. Milburn" cup to A. / S. Mrs. Jagger. The Mayor said that he was delig-hted to do anything he could for the St. John Ambulance Brigade. The general public did not realise the vast work undertaken by the Brigade in a voluntary capacity. :Y1embers received no pay for their services, and even had to buy their own uniforms! Should an emergency arise, he knew that the members would be ready and waiting to give assistance. In con-

No.3 DISTRICT (EASTERN) S.J.A. B. Lady Zia Wernher, Lady County President for Leicester, reports that the resident scho ol which she opened at Dingley Hall, Market Harboroug-h, at the beg-inning of March, to provide an intensive course of t raining in first aid and home nursing- is proving a great success. It is one of two schools set up under the auspices of the S . John Am bulance Brigade to enable nursing- certificates to be obtained quickly, the other being- und er the supervision of Mrs. Beckwith-Smith at Rutland House, Bicester. Lectures in first aid are g-iven by a doctor, and those in home nursing by a State-reg-istered nurse. Students pay an inclusive fee of £3 for the two weeks' course.

No.5 DISTRICT, S.J.A.B. The posthumous honour of the insignia of Serving- Sister of the Order of St. John has been conferred on Mrs. Martha Astin, West Hill, Hebden Bridge. who died early in March. She had been a leading figure in the ambulance movement for over 20 years.

NO.6 DISTRICT, S.J.A.B. H ULL CORPS -The" Lady Atki nson" Cup competition was held at the St. J ohn Headquarters, Anlaby Road . The entrants must only be first year members of the Brig-ade ; there was a record entry of 36. The winner of the cup and the Lady Atkinson prize was Mrs. Fairclough, Y. P. 1. Nursing Division. Miss P. Anson, Thornton-Varley Nursing- Division, was second, and Miss 'W oods, Peel House Nursing- Division. third. Lad y Corps Supt. Mrs. Howell presented the cup and prizes in the absence of Lady Atkinson.

No. 9 DISTRICT, S.J. A. B. NEW NURSING DIVISION AT PLYMOUTH.-Yet another Nursing Division of the Brig-ade has heen formE'd in Plymouth, the Chief CommissiOlJer having provisionally sanctioned the registration of the Plymouth Post Office Nursing- Divi sion. It is composed exclusively of women in the Post Office service, and Dr. Donald Cameron is their Divisional Surgeon. ~ F or several years the male staff of the Post Office have had their own ambulance Division, which also shares fully in the voluntary public ambulance service of Plymouth and District. VVEYMOUTH NURSING DIVISION.-The annual general meeting and presentation of awards of the above Division, was held at the Headquarters, Westway Road, on March 21st. Div. Surgeon Cooper, presided, supported by Lady County Supt. Mrs. Cooper, l\l rs. Davison (vice-President) Lady Div. Supt. Mrs. Bartlett, Nursing Officer Ch?ules an.d others. The Div. Pres ident, Mrs. Shewell and VIce-PreSIdent l\lrs. Biles. were unable to attend owing- to ilIness. The Divisional Secretary reported that the Division now numbered 51, an in crease of 27 on 1938, and the Auxiliary Reserve had 10 members. The total numher of cases treated was 1,190, including those attended at the First Aid.

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Hut on the sands; and 325 lost children had been restored to their parents. The number of public duties performed was 699 , and hospital duties 207 (representing 621 hours). The Division had two Grade I and one Grade II A. R. P. Instructors, and 14 members held A. R. P. certificates. The Division had ag-ain been successful in winning- the County Competition, and came third in District Finals. The following- awards were gained during the year, and were presented by Mrs. CO(lper and Mrs. Davison :-33 pendants, 23 labels, 10 medallions, 10 N.C. R. badges, 33 first aid certificates, 27 home nursing- certificates, and 16 A. R. P. certificates. These do not include awards gained by examinees following classes organised for national service. The most important events of the year were the opening of their new HE'adquarters, the visit to the town of H. M. the King-, and the County Inspection. A beautiful silver cup had been presented to the Division by Mr. Watson in memory of his wife who had been a member of the Division. Since September 1st members had staffed the local First Aid Post and had assisted with the evacuees. Lady Cadet SupL Mrs. Day read a report of the Cadet Nursing Division. There were 21 cadets and 10 probationers, and the two outstanding events of the year had been the winning of the County Competition for the cc Martvn" CuP, and the qualifying of 8 members for the Grand Prior's Badg-e. Lady Div. Supt. Mrs , Bartlett thanked all their supporters for attending, and the officers and members for their work and loyalty throughout the year. Clocks suitably inscribed were presented to two members who were being- married at Easter. The Weymouth Nursing Division regrets to announce the death of one of its keen members. Miss Edna Jackson died on Feb ruary 2Rth at the early age of 22 . Members attended the ~uneral in uniform. Lady C(lunty Supt. Mrs. Cooper was also present. The Aag at the Headquarters was nown at half-mast. Miss Jackson was one of the team who won the County Competition in 1939.

No. 10 DISTRICT, S.J .A. B. BECCLES N URSING DrvIsroN.-At the close of a nursing class at Blyburgate Hall First Aid Post, on Tuesday, March 19th, Lady Div. Supt. Miss E. Tedder presented an eightday clock. subscribed by members of the Nursing Division, to Miss Ethel Tilmouth to mark the occasion of her marriage to Mr. E. Charlish, which was to take place two days later. Miss Tilmouth has been a member of the Nursing Division for the past seven years.

ORTHERN IRELAND DISTRICT, S.J.A. B. COOKSTOWN NURSING DIVISlON.-Thirty members of this Division in uniform, were insrected on Thursday, March 21st, by Mrs. Wallace, Lady District Supt. This was followed hy a competition in bandaging, adjudicated bv Mrs. Robert Allen. The winners were :-1, Miss V. Haug-hey; 2, Mrs. Stevenson (London) ; 3, Mrs. Boyd; 4, Mrs. John G1as~ow. Mrs. Wallace praised the Division for its efficiency and keenness.

FIRS T

AID Friday evenings from 7 p. m. Further particu lars can be obtained from the Commandant, Mrs. Angel, 113, Bu sh ey Road, Raynes Park, S. W.20 (telephone LIB 3265).

WEDNESBURY AND DARLASTON DETACHMENT, B. R. C. S -Lady Dorothy Meynell distrihuted home nursing. first aid. and anti -g-as certificates to memhers of this recently formed Staffordshire detachment at Wednesbury Town -Hall on Saturday, March 16th. After doing so, she said that it may well be that that feeling of uncertainty and possible boredom of waiting and marking time is part of the enemy's attack on our home front, but it was for the members to keep up the public morale on the home froni and not to be discourag-ed. The detachments of the Red Cross and the Order of St. John were part of the civil defence. In this time of waiting she would advise them to make the g-reatest possible efforts to advance their training, so that when the occasion arose, they would be able to render as efficient and skilled service as was possible. Lady Dorothy MeyneIl added that there were 38 detachments in Staffordshire, and last year they more than doubled their personnel. Up to the end of the year, 164 depots in the county distributed 47,000 hospital benefits and parcels for prisoners of war.

FUTURE SUCCESS de mands that

you

sen d

fo r

T HIS Reviews. ROLLER

AND

TRIANGULAR BANDAGING ILLUSTRATED.

By Mary Farnworth, S. R. N.

F REE

....

BOOK

London: Faber & Faber, Ltd.

Price 3s. 6d. net, This handy book, which consists of 144 pages, presents useful and accurate descriptions of the correct methods of applying the raIler and triangular bandages. It is illustrated by 160 excellent diagrams, these being placed in sequence at the end of each chapter. It has been completed to assist those who, having learned the rudiments of bandaging, desire to become more proficient in this art, but find frequent attendance at practice classes difficult or impossible. The first two chapters deal with general principles and methods of bandaging. The following two chapters describe the use of the roller bandage for the limbs, for the trunk, and for the head and neck. Next comes a chapter on the triangular bandage, while the closing chapters, which sets forth details of certain special bandages, has been added to make the book useful for those working in hospi tals.

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In aid of the funds of the Fenton and Glebe Colliery Division, S.J.A. B., a dance was beld at the Fenton Town Hall, which was attended by over 400 persons. 3

NEW B. R.C.S. DETACHMENT.-A women's detachment of the B. R. C. S. has been formed in the Raynes Park and Merton area. New members will be welcomed at St. Saviour's Hall, Grand Drive, Raynes Park, S. W. 20, on

YOUR

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Over £340 has been subscribed towards the newambuance of the Redruth Motor Ambulance Fund. Over 2,000 donations were received, including £50 from the Cam borneRedruth Urban District Council.

6 JOHN DALTON ST., MANCHESTER

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20 7

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208

Fevers.

!II

A FEVER is a rise in the temrerature of the body, accompanied by a general disturbance of hea!th. Some fevers are infectious, that IS, they may be conveyed from one person to another... .. All the infectious fevers met with 10 the Bntlsh Isles are acute conditions. . Several are accompanied by a rash, which usually appears after a certain interval from the commencement of the illness.

AID

In dealing with infectious diseases, the following terms are employed : Endemic Fevers are those which are constantly present in a district or country. Epidemic Fevers are those which occur occasionally in a district or country, a large number of persons being attacked at one time. Incubation Period.-This is the time which elapses between the date of infection and the appearance of the first symptom. During this period .the germs of t~e dise~se are multiplying in the body. It IS short for Dlphthena, Influenza, Erysipelas, and Scarlet Fever, and longer (between 2 and 3 weeks) for other infections. <Juarantine Period. -This is the time during which certain restrictions are imposed on the movements of persons who ha ve been exposed to infectious disease. Isolation Period.- This is the time during which a patient suffering from an infectious disease, or a "carrier," is isolated from others. A Carrier is a person who, without symptoms of a disease, harbours and spreads the germs of it. A Contact is a person who is known to have been sufficiently near an infectious disease to run the risk of contracting it. In describing the rash which accompanies infectious fevers, the following terms are used : A Papula or pimple is a small red solid elevation of the skin. A Macule is a small spot of congested skin. It is larger and flatter than a papule.

* Extract from the Manual of Instruction for the Royal Naval Sick Berth Staff, reprinted by permission of the Controller of H. M. Stationery Office. Copies of the Manual can be had of H. M. Stationery Office, Adastral House, Kingsway, London, W.C.2, or any branc.h, price 4/Sd. post free _

-------- -------

A Vesicle is a small collection of serum under the epidermis. A Bulla or bleb is a large vesicle. A Pustule is a small collection of pus under the epidermis. . A Scab is an irregular mass of dned serum or pus. To remember the day on which the rash appears, the following" tip" may be used : Learn this sentence :-" Very sick people must take no exercz'se," and apply it thus : Tip.

INFECTIOUS FEVIIRS.

(1) Those Accompanied by a Rash. Chicken Pox or Varicella. Scarlet Fever. Small Pox. Measles or Morbilli. German Measles or Rubella. Typhus Fever. . Enteric or Typhoid Fever, and ParatyphOId Fever. Cerebro-Spinal Meningitis. (2) Those not Accompanied by a Rash. Mumps. Whooping Cough. Diphtheria. Influenza. Encephalitis Lethargi~a. Polio-myelitis. (3) Those of Tropical Origin. Undulant or Mediterranean Fever. Cholera. Malaria. Dysentery. Plague. Yellow Fever. Dp.ngue. Sleeping Sickness. Sandfly Fever.

- - - - -- - - - -

1. Very 2. Sick 3. People 4. Must 5. Take 6. No 7. Exercise

Disease. Varicella. Scarlet Fever. Small Pox. Measles. TyphUS Fever. (No disease) Enteric Fever.

FIRST

AID

EQUIP YOURSELF FOR WAR EMERGENCIES--. Essential

knowledge to treat successfully, ALL possible injuries,

THE

HOUSEHOLD PHYSICIAN

Dayan which Rash usually appears. 1st day of Illness. 2nd 3rd 4th 5th

Describes in SIMPLE LANGUAGE such necessary information with helpful plates and diagrams.

AND FOR MORE PEACEFUL TIMES

7th

INFECTION is spread in several ways : 1. Contact, directly with the patient, or indirectly with anything used or touched by him. Food or Drink infected by a case or carrier. 3. Body excretions, urine, freces, disharges from the skin, nose, ears, etc. 4. Air, infected by couRhing, sneezing, or dried body excretions. 5. Insects, flies, lice, mosquitoes. In all cases of infectious disease, the breath, sweat, skin, hair, urine, freces, discharges from wounds, or abscesses and secretions from the mouth, eyes, ears, nose and lung~ should be regarded as possible means of spreading infection.

The COMPLAINTS OF MEN, WOMEN AND CHILDREN, Their

DISINFECTION. Disinfection is a process for killing germs. The masking of smell by deodorants is insufficient, and only gives a false sense of security. . Disinfection is carried out by heat, by chemicals, and by fresh air and sunlight. Heat scrubbinawith soap and hot water, followed by h exposure to sun and air, are by far the best disinfectants for general use. . Liquid disinfectants are far more effectIve than powders and ·Rases. All disinfectants must be allowed to act for a certain length of time. 1. Moist Heat is the most effective. (a) Boiling in water for twenty minutes is a si~I?le a~d efficient method. Surgical instruments are sterIlIsed 10 this way. . . . Remember that linen stamed With albumInous matter such as blood should be soaked in cold water before boiling, otherwise the stain will be fixed. In certain infective cases (e.g., Typhoid), the water used for this purpose must itself be boiled before being thrown away. (b) Steam disinfection under pressure. ~h.is is carried out in a special apparatus known as a steam dzsmjecfor. 2. Soap and Water. The disinfecting value of a thorough scrub with soap and water is often forgotten. It should al ways supplement the other forms of disinfection, and in many cases can replace them. 3. Chemicals. The efficiency of chemi::als as disinfectants depends upon their streng.th, the ~uration .of th:ir application, and their thorough mlxture wlth the 10fectlve material.

with

Cause, Treatment

complete

instructions

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The 500 illustrations and full-page Plates makes the reading matter more easily understood.

ACCIDENTS A few of the Subjects treated:

WAR EMERCENCIES :Gas Warfare First Aid Bandages Splints Burns Scalds Hcemorrhage Fainting

PEACE TIME SUBJECTS:Influenza, Colds,etc. Measles, Mumps Catarrh Corns and Warts Physical Culture What to Do in Emergencies Treatment for all Skin Diseases The Lungs, Pleurisy Hygiene, Anatomy, Pharmacy The Principles of Nursing The~ Eye, the Ear The Throat, the Nose The Chest, the Heart The l Stomach, the Liver The Teeth, the '. Muscles I nfant Welfare ' Homcepathy, Neurasthenia 375 Prescriptions, etc., etc.

What

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Bodily Inj ury, Burns and Scalds, Clothing Alight. Foreign Bodies in Eyes, Ears, Nose, Throat. Machin ery Accidents, Electricity Accidents. Drowning, Suffocation, Bleeding, Poison, Broken Bones, Fractures, Dislocations, Sprains, Fainting, Concussion, Etc.

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find

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BEAUTY CULTURE- Complexion Diets, Wrinkle Cures, Care of the Hands, Mouth, Eyes, Hair, Recipes, etc. PRESCRIPTIONS-375 proved remedies. There arE' hundreds of subjects. The muscles, teeth, digestion, hair, food values, Jujitsu, Phrenology. How to diagnose diseases from appearance of head, face, neck, tongue, throat, chest, perspiration, etc.

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210

FIRST

(a) Chlorinated Lime (Bleaching- Powder). Thirty grains added to 100 gallons of water, mixed, and allowed to act for 20 minutes is required for drinking- water. Stabilized 1ixture is Chloride of Lime, containing 20 per cent. quicklime, and is used for the same purpose. (b) Quic:klime. (c) Disinfecting Fluid. T!1i.s is a. coal-tar prepa~ation, and is in use for general dlsiOfectlng purposes 10 the Navy. It mixes well with both salt and fresh water, and can be used in various strengths frolll 1 ounce to 5 ounces to the gallon. (d) Formalin is a liquid, and can be used either as a spray (6 oz. to the gallon), or a gas (formaldehyde) can be generated from it, by means of chlorinated lime (witho1lt the use of heat). Formaldehyde is generated by mixing 2 Ibs. of chlorinated lime with 2 pints of formalin, which produ:::es sufficient gas to disinfect 2,000 cubic feet. (e) Carbolic Acid. Where other means are not available, a solution of 1 in 20 carbolic may be added to sputum, urine and fceces, and allowed to act for two hours. (j) Perchloride of l\lercury. This is sometimes used for wasl:ing down walls, floors, etc. It is a very powerful disinfectant, and a solution of 1 in 500 will destroy spore in one hour. It is very poisonous and will corrode metals. With albuminous matter, such as f;:eces and sputum, it forms an insoluble compound, and should therefore not be used as a disinfectant for anything containing organic matter. (g) Deodorising Fluid (a compound of zinc and magnesia) may be used to mask offensive smells, but is not to be regarded as a disinfectant. 4. Fresh Air and Sunlight are valuable disinfectants, and should always be used in conjunction with other methods. l\Iany germs are actually kilJed by free exposure to sunlight, while the beneficial effect of fresh air in blowing away the germs in the atmosphere of a room is very important.

How TO DISINFECT A ROOM. 1. Burn everything of little value. Mattresses, bedding, etc., properly wrapped in a sheet damped with disinfectant, should be taken to the disinfector. Draw the furniture well away from the walls, open drawers and cupboards, and hang up all clothing. 2. Measure the cubic capacity of the compartment to be disinfected, and prepare the necessary amount of formalin and chlorinated lime (1 lb. of lime and 1 pint of formalin for every 1,000 cubic feet). 3. Seal all cracks and openings by pasting paper over them. 4. Distribute the buckets containing formalin about the room and drop the packages of lime into them, beginning with that farthest from the door. 5. Leave the room at once, close the door, seal up its margin and the keyhole. 6. Keep the rOOm closed for six hours, then open up all means of ventilation and allow as much air as possible to circulate for 24 hours. . 7. Scrub the Aoor well with soap and water, and wipe down all furniture with 5 per cent. disinfectant Auid. Sometimes re-papering or re-painting is carried out as well.

Does your colleague read PIRST AID, if not, send us his address and we will post him a copy,

FIRST AID

AID

A.R.P. Topics. BASIC TRAINING IN AIR RAID PRECAUTIONS.

This isAirRaid Precautions Training l\lanual No.1 (8d. post free), and has recently been issued by the A. R. P. D~part ment of the Ministry of Home Secunty. A new senes of trainin<Y manuals has been designed in order to further the practic~l training of personnel on an u~iform ba~i7 in accordance with the requirements of war-tItTle conditIOns. The manuals are to be read as supplementary to the general series of Handbooks and Memoranda which deal in detail with the different aspects of the work. The manual is divided into five chapters: General Organisation of Civil Defence; Incendiary Bomb Control; Notes on Elementary Protection Against High Explosive Bombs; War Gases and Personal Protection Against Gas; Notes on the Elements of First Aid. These are followed by Notes on Improvised Splints and three append~x~s-1, Ty~es of Instructors qualified to conduct Part 1, IndiVidual Traming . 2 Notes for Instructors, which set out subjects, official refe;en~es and length of lecture; 3, a list of Official Publications. The Chapter on First Aid is divided into 8 sections dealing with Introductory, Shock, H<emorrhage, Fractures and Dislocations, Insensibility, Burns and Scalds, Gas Casualties, and, laslly, General Survey.

If you would be sure of life-long grateful remembrance, let your Gift be one of thoroughbred quality. Welbeck Plate suggests itself, for it fulfils every demand of even the most fastidious, and every piece is guaranteed for 35 years' hard wear.

For more than 50 years Alexander Clark have supplied Presentation Gifts and Competition Prizes to First Aid Societies throughout the entire World . . . . . surely convincing testi· many to their values and service. Write, 'phone or call for illustrated \ Catalogues.

Wholesale Discounts to bona·fide First Aid Organisations.

\ Cambridge

MANUAL FOR OFFICERS RESPONSIBLE FOR A. R. P. TRAINING.

This is A. R. P. Training Manual No.2 (price 7d. post free), and, like No.1 referred to above, has been issued by the A. R. P. Department of the Ministry of Home Security. The manual has been prepared as a guide to the drawing up of a Training Plan, from the newly enrolled to those with several years' service. To meet their varying needs, the Plan has been divided into a number of stages; although the sequence is designed to cover a complete scheme of training, beginning with the needs of a new recruit, any stage can be used by itself or the sequence can be made to start at any stage. The Syllabuses and Instructions in this Manual supercede the relevant parts of all previous A. R. P. literatUl published befoce January 1st, 1940.

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The most up-to-date and scientific in the world. 250 A. R. P. QUESTIONS ANSWERED." This is a book recently issued by Messrs. Jordan & Sons, Ltd., 116, Chancery-lane, London, W.C.2 (price 1/-, by post 1/2), com piled for the assistance of those engaged in A. R. P. work. It is a concise course covering H. E. Bombs, Incendiary Bombs, War Gases and First Aid. Those under<Yoing their first instruction will find the book, which is in a~handy pocket size, valuable as an aid to crystallising the principal points in the lecture courses; the experienced personnel will find it useful as a refresher course. The book, which we can fully recommend to our readers, will certainly assist the instructor and pupil to answer questions at lectures or in the examination room. rc

Alderman A. H. Carter, af Tydd, performed his first public duty as the new Sheriff of the County, when, on April 1st, he presented first aid awards to local members of the St. John Ambulance. Div. Surgeon H. L. Groom received a certificate of honorary life membership of the S.J.A.A.

THE NEW "PORTLAND" GEAR This new patent Ambulance Gear offers many unique advantages whether the Ambulance is carrying two stretcher cases or only a single case. A self-contained unit, it can be placed in almost any vehicle, and it makes the loading of either top or bottom the simplest possible matter. The " PORTLAND" Gear should be specified for an y new Ambulance and it 125, 127, 129, provides an ideal Great Portland Street, method of modLondon, W.I. ernising vehicles Telephone-Langham 1040. already in use. fdegrams-"Bathchair, Wesdo, London.'

This illustration shows the clear gangway for loadingl the lower stretcher when only one Cflse Is being curied' -L

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FIRST

Queries and Ans\Ners to Correspondents. Queries will be dealt with under the following rules ;i.-Letters containing Queries must be marked on the top ldt-hand corner of the envelope" Query," and addressed to FIRST AID, 46, 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" 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 39th (1937) Edition ot the S.J.A.A. Manual of First Aid to the Injured. SUNG WITH COMPOUND FRACTURE OF ARM. F. H. (Plymouth).-We ask if you will please settle a sporting argument which has arisen in our Division, and we agree to abide by YOLlr decision. If we have to treat a compound fracture of humerus in the upper third, which armsling should be used after we have dressed the wound. One side suggests a broad bandage tied firmly, but not tightly, round the body and a small armsling. The other side suggests use of large armsling. The first side is correct in suggesting a small armsling.-N. CORBET FLETCHER. EXAMINATION HOWLER. D. S. (East London). -In a recent examination the doctor asked one of the members of our class where he would expect to find bright red blood. He burst out laughing when the member replied in all seriousness;-" On an arteria l road! " Good!

Next, please!! "-N.C.F.

CAUSATION OF AIR HUNGER. P.N. (Gorleston).-I shall be much obliged if you will explain why patients may suffer from air hunger as the result of internal hcemorrhage (Textbook, p. 136). We have discussed this point among ourselves and cannot agree on satisfactory explanation. Air hunger may also be described as "oxygen starvation." It is net confined to cases of internal bleeding; and it occurs whe:1 there is rapid and severe loss of blood, whether external (and seen) or internal (and concealed). It results from the loss of fluid, and especially of the red blood corpuscles, consequent on which the latter cannot carryon their function of absorbing oxygen from the small air cells of the lungs and carrying it to the tissues of the body.N.C.F. INDICATIONS FOR SILVESTER'S METHOD. O. T. (Wellington, New Zealand}.-The Textbook (p. 149) tells us that Silvester's Method of artificial respiration "is to be used only when it is impossible to turn patien.: on to his face." Will you please tell me in what circumstances it is impossible to turn patient on to his face?

FIRST

AID Silvester's Method was brought back into the body of the Textbook on account of several well authenticated cases (reported from both mines and quarries) in which men had been trapped by falls in such a position that Schafer's Method could not be used. Consequently, the Revision Committee rightly decided, even though such cases might be few and far between, the Textbook ought to teach a method which could be done with the patient lying on his back-N.C.F.

ESSENTIAL NEW

AID

TO ALL FIRST AlDERS

EDITION

1940 BAILLt"ERE'S

COMPLETE

MEDICAL

DICTIONARY

JUGULAR VEIN. L. G. (Penzance).-Would you please let me know if the so-called "jugular vein" is a vein or an artery? A vein. The four pulmonary veins are the only veins which carry arterial blood.-N.C. F.

488 PAGES WITH 144 PAGES OF APPENDICES FULLY ILLUSTRATED

ROLLER BANDAGE FOR FINGERS. A. T. (Saddleworth).-Our members are taking the Home Nursing Course and are puzzled about the bandaging of the fingers, because they have been shown two methods. The first demonstrator has told the class to pass the bandage round the wrist and then to start at the little finger; whereas the second told the members to pass the bandage round wrist, then to start at the third finger, next to proceed to the second and first finger and finally to return to the little finger. In these circumstances we ask your kind help. The first method is correct in view of the bracketted instructions on p. 261 of the Textbook, which read "taking the fingers in order from the little finger side."-N.C.F.

CERTIFICATED ST. BARTHOLOMEW'S HOSPITAL LONDON SISTER TUTOR DIPLOMA. KING'S COLLEGE FOR WOMEN' UNIVERSITY OF LONDON . SISTER TUTOR. ST. BARTHOLO~ MEW'S HOSPITAL, LONDON

PIN IN TONGUE DURING INSENSIBILITY. H.H. (Nelson).-Sometime ago I attended an A.R.P. lecture at which . the instructor told us to put a pin through the tongue of an insensible person to prevent it from falling back and choking him. Neither the Textbook nor any St. John lecturer has ever mentioned such a procedure. This has caused some controversy as a number of us think it is unnecessary and far too drastic. It appears that the pin itself would be a great danger in many ways. For the benefit of all first aiders will you please say if it is ever necessary, or advisable, to resort to such a method. Thanking you in anticipation of your reply. If you keep the unconscious patient's head well turned to one side, as the Textbook suggests in Rule 1, p. 154, you will guard against any possibility of his tongue falling backwards. By so doing you will obviate any need to adopt such a drastic procedure as piercing the tongue. Personally, I have never found any need to hang on to the patient's tongue, even when doing Silvester's Method of artificial respiration, much less to stick a pin through his tongue. So forget the instructions of the demonstrator and treat insensible patients as laid down in the Textbook. -N. C. F. BLEEDING FROM SCALP AND FRACTURED THIGH. J. R. (By Cummock, Ayrshire}.-If we had to treat a patient who lying on his face, is found to be suffering from fractured thigh and is also bleeding freely from wounds of upper lip and scalp, what ought we to do? Some members of our class say that we ought to turn the patient on his back before commencing treatment, whereas others claim that we should control the bleeding before we turn the patient. As this point has caused some controversy we ask you kindly to tell us how we should act Since (1) the bleeding is " free" (2) the wounds are easily accessible, and (3) it would be wrong to turn the

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The Dictionary explains not merely defines. Is comprehensive, correct and concise. No other book contains so much practical information. Latest and most up-to-date work of reference compiled . CONTENTS INCLUDE: FIRST AID Treatment of Shock; Hremorrhage; Bu rns and Scalds; Fractu res; Dislocations and other su bjects. POISONING. BANDAGING-Complete 12 page (7 Plates) AppendiX. WAR GASES - Description and Treatment.

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FIRST

214

patient without some preliminary preparat~ons! I agree with those members of your class who mamtam that the wounds of upper lip and scalp should receive immediate attention as patient lies on his face.-N.C.F. METHOD OF ARTIFICIAL RESPIRATION.

S. L. (West vVickham).-In the current issue of Armchair SC£ence is an article on Electric Shock which describes a method of artificial respiration as under : " An object such as a rolled up coat is placed under the back between the shoulder blades so as to raise the shoulders some inches from the ground. The shoulders are then seized and then pushed forcibly back to the ground. The action is repeated every four or five seconds . . . . ". . . . A movement of the lips or larynx indicates the return of normal respiration and calls for the immediate cessation of artificial respiration. I t is as harmful to continue artificial respiration after this takes place as to give it for too short a period." The Textbook, on page 148 however, says : "vVhen natural breathing begins, regulate the movements of ar tificial respiration to correspond with it." As I am unable to reconcile these two statements, insofar as the cessation of artificial respiration is concerned, I s hould appreciate your g-uidance. The statement in t}1e article suggests that those doing artificial respiration might not correctly time the movements with the efforts at breathing made by the patient. If this happens, then harm might result. In other words, the article and the Textbook are teaching the same lesson, namely that Nature's efforts to restart breathing are much more efficacious than all artificial attempts thereat. Incidentally this is a new method of artificial respiration to me; and I would put my trust in the Schafer method, which has proved so successful in cases of Electric Shock.N.C.F. HUMOUR IN FIRST AID.

S.G. (Bourne).- There was a house on fire in a small town. St. John men were called out for ambulance duty and a fellow member helped to rescue a female patient to a safety zone. He then realised that his patient was not breathing and asked the N. C. O. in charge of the party what he should do. "Give her artificial respiration)) was th e reply, on hearing which the angry husband roared-" Artificial respiration be d--d I Give her the real thing and I will pay for it! ! We have heard this one also before, and have told it in this column in the distant past 1 ~evertheless we say "Good 1 Next, please."-N.C.F. TREATMENT OF

AID

FIRST

I•

TREATMENT OF SCALDED THROAT.

H.A. (Marylebone).-The Textbook (p. 158) tells us that in treatment of scalded throat we should apply a hot compress frequently and give ice to suck. On the other hand the Royal Naval Sick Berth Manual (p. 120) for the same condition tells us to apply a cold compress. Please explain the rcason for this difference in treatment. Heat and cold, though diametrically opposite in their action, often produce the same results-the former by causing dilatation and the latter by causing contraction of the blood vessels. So in usual practice you can make your own choice, although in first aid the patient's feeling and response to treatment controls the situation.-N. C. F.

21 5

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SITES OF SPLINTS WITH FRACTURED ARM.

F. H. (Chapeltown). - At a recent meeting of our ambulance class a point arose which brought about a difference of opinion with reference to the correct treatment of fracture of arm near the middle of its shaft, owing to men who had been attending different classes previously. I should be pleased if you would give your definition of the point in question. The one party argued that of the three splints used in this particular case, a small one is placed in front of the muscle of the arm, a longer one from the shoulder to the elbow on the outer side and the remaining one on the back. According to the Textbook the splints should all be of the same length (as no mention of any difference is made). Then after the forearm has been placed across the chest the side of the muscle becomes the front then, as in Rule 3 on p. 83, it says" On the front, back and outer side of the arm in its present position.)) Please say which exactly is the position of theJront splint. To me it is evident that the difference of opinion arises not from the fact that some of you have attended different classes previously, but from the fact that some of you are behind the times and are quoting- the illstructions of the 38th Edition of the Textbook. In this issue the wording of Rule 3 on p. 69 was such that the front splint rested on the biceps muscle and was of necessity smaller and shorter than its fellows, though the Textbook did not say so. In the current (or 39th) Edition the wording of Rule 3 on p. 83 was altered by the addition of the words" in its present position." Consequently, the anatomical position of the limb (as described in the Frontispiece) no longer operates in this connection and the front splint is placed on the front of the upper limb as it lies flexed at right angles across the chest and supported in a small arm-sling. The results of these words added to Rule 3 are that three equal sized splints can be used to-day to control this fracture and that the Revision Committee have cleverly corrected its error in the 38th Edition.-N.C. F.

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HYS T ERIA OR S H OCK.

G. L. (Leeds). - In a recent discussion re Hysteria and" Shell Shock," we considered the t reatment of hysterical patients (male and female) during an air raId. We agreed that in these cases intense fear was the cause, and because of this should require sympathetic handling. The Tex tbook ruling of avoiding sympathy with the patient under the circumstances is hard to understane If such patients do not come under the hysterical condition mentioned in the book, but under a " shell shock" condition, what should be the treatment? You are mixing- up causes and trying to put the blame on the Textbook. So if during an air raid you have to treat a patient suffering from Hysteria, you should treat this condition as laid down in the Textbook. If, however the patient is suffering from Shock you should treat as for' this condition.-N.C. F.

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THIS

NUMBER.

A. R. P. First Aid. . A. R. P. First Aid Services A. R. P. Topics S.J.A. B. Headquarters and District Rerorts A Few Don'ts in First Aid Railway Ambulance ews Our Nurses' Pages St. Andrew's Ambulance Associrltion Special Bandages Another Reason Why... National Blood Transfusion Council of New Zealand Police Ambulance News Fevers Marking Sheet

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227 228 230

QUERIES AND ANSWERS TO CORRESPONDENTS : -

Artificial Respi ration with Fractured Ribs Examination Howler Treatment of Fractures of Thigh and Leg Action of Sympathetic Nervous System Treatment of Patitlnt with Multiple Injuries Treatment of Corrosive Poisoning Signs and Symptoms of Syncope Treatment of Scalded Thigh Sling- for Fractured Fingers and Palmar Bleeding ... Treatment of Fractured Kneecap Action of Strychnine Four-footed First Aider

EICtend at ] [ StatioICers' Hall

PRICE THREEPENCE [S{6 PBR ANNUM, POST FREE

EDITORI~~L.

FIRST AID is published on the 20th of each month. The Annual Subscription is 3S. 6d. post free ; ~ingle 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 add ress below, and should reach him before the 12th of each month, and must be accompanied (not necessarily "'or -bublication) by the name and address of the Correspondent. Subscriptions, Aclv.ertisements and other business Communications connected with FIRST AID should be forwarded to the Publishers.

CONTENTS

:\1 A Y, 1940.

EDITORIAL : -

NOTES

ANATOMICAL

VENO

GEORGE

CO. LTD.

LONDON,

ALLMAN'S

THE

NOTICE

I twill

assist them in their general work, as well as in

_ _ _ _ _ _ _.

No. 551.-VOL. XLVI.

TRAINING,

CAPTAIN A. C. WHITE KNOX, LC., 1.B., Ch.B. Lecturer and Examiner, The St. rohn Ambulance Association. Assistant Commissioner, The St. John Ambulance Brigade.

Editor:

The JUDGE, The TEST, The COMPETITOR,

ties bring quick healing without scar8.

septics. This is appreBOVE are the three reasons whyGermo- ciated most in dealing with children. lene Ointment has been Many medical authoriuniversally accepted as the finest skin healer ties use and recommend Germolene Ointmentobtainable. I ts unique , Aseptic' action offers countless homes have benefited by its effecyou the undoubted adtiveness. A trial tin vantage of PAIN-FREE will convince healing - doing away with the FREE you. Take adThe manufacturers vantage of our smarting associ~ will be de.ighted to send a trial sample, offer NOW! ated with Anti- tree of charge, to

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received many letters regarding A.R.P. First Aid Services, we asked a special correspondent to investigate in the London area and to give his findings without fear or favour. The result is published in this Issue. There can be no doubt that there are many matters which require urgent attention. These are by no means one-sided. The authorities and the personnel each have to contribute to settlement of such matters, which would make for a better and more efficient service. The call to-day is for volunteers for stretcher bearers and first aid person nel ; and whilst members of the voluntary ambulance organisations are ever willing to give their time to the \York, they cannot be expected to go on doing so indefinitely. Most members have given voluntary service over a number of years, and it is quite time that such services were fully recognised. Stretcher bearers and first aiders can not be become trained in a few days. It has been said that it takes two years to become a stretcher bearer! Further, most members have their livelihood to earn, and this must take precedence over other work. There is one matter which only mem bers of the voluntary organisations can settle-that is, the "feeling" which exists between them at certain posts. The headquarters of the British Red Cross Society and the St. John Am bulance Brigade have set an example to their rank and file that during wartime they should work in harmony. But, unfortunately, the example has not extended to all. For the smooth working of the services, we a ppeal to mem bers of both organ isations to "bury the hatchet" for the duration. Only by complete harmony can the service function at its best. HAVING

A.R.P. FIRST AID.

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A. R. P. First Aid Ser\tices. By OUR SPECIAL CORRESPONDEKT. AT the time of writin cr (and I hope at the time of publication) this article there hav: been no air raids involving the civilian population, and it is intere~t~ng in tbe light of :ecen.t developments, to consider the posltlOn of the first alder 10 A R. P. Services. . . The Editor of FIRST AID asked me to investigate this important matter and I have recently disc.ussed admi~is trative social and training problems wIth responsIble oITicial~, medical officers and personnel of first aid, stretcher and ambulance posts in several of the London borou~hs. The first question that arises is-" Is all well ,,,,nh first aid in A. R. P. ?" Reluctantly I am compelled to the fact that it is not; and I propose to analyse the present state of affairs in the hope that my criticisms will pro\'e of con.structive value and not in any way detract from the magntficent work that has already been done by all concerned. The outbreak of war found some boroughs much more prepared than others and there was, undoubtedly, a scramble to establish a First Aid Service. The backbone of all po~ts was composed of members of the organised first aid bodies, who did yeoman service in training their less experienced colleagues, and for the first two or three months preparations continued with feverish haste. Enthusiasm was kept at high pitch by the expectation of air raids, by social fu~ctio~s and the like. l\Ioreover, the status of the first alder 10 common with the other A. R. P. workers ranked very high in the eyes of the publtc ; and altogether life, although earnest and hard was, neverthelc!ss, full and pleasant. Slowly and insidiously, however, a change gradually appeared, due to a combination of facts, the main one being boredom arising from repetition of the same routine. At the same time the general pu blic, forgetting the efforts of the early months, began to look upon first aid posts a~ places where people were paid for lolling about all day doing nothing more strenuous than playing darts and drawing their pay. Stretcher-bearers have told me that they are almost ashamed to be seen wearing the A. R. P. badge, because of the remarks passed by neighbours who look upon them as idlers drawing nearly three pounds per week, whereas soldiers risk their lives for two shillings a day. The logic of this form of reasoning is absurd, because the stretcher-bearer is just as much a cog in the war defensive scheme as the highly-paid munition worker. Many first aiders voluntarily gave up stl!ady jobs at the outbreak of war to do their bit-jobs that they have now lost for ever. Can we honestly say that three pounds a week, less deductions, is an adequate living wage for a married man and family with the cost of living at its present level and ever increasing-? There is no doubt that lack of recognition of the full-time first aider is undermining his morale. Then again, the 6rst aider has his own problems from within. The beginner has now become the expert; he can recite his textbook from the beginning to the end; he has practiced every conceivable form of bandaging or splinting. In an effort to introduce fresh enthusiasm, doctors in charge of posts and depots have wandered from the path of orthodoxy and lectured on subjects only very remotely connected wit:, first aid subjects. One doctor proudly told me that he had been lecturing on embryology (which is the study of the development of a living being, from the moment of conception to birth). Nurses have been instructing female personnel in the mysteries of midwifery while a doctor friend of mine is at present busily engaged in teaching his post the various diseases of the heart! These well meaning efforts are extremely commendable, even if the choice of subjects leave something to be desired. Some medical officers of

AID health have arranged with the local evening institutes to hold day classes, in which many of the popular night school subjects are taught, in the posts or depots, so that personnel are immediately to hand should the emergency arise. There are 'additional internal problems which beset the first aiders, and although many are being cleared up, there still remains a number which are a great source of exasperation and annoyance. Perhaps the most important of these is the question of control and command . In the early days, I remember seeing four sets of orders, each s igned by four different persons, posted up on a notice board, and the pathetic part of the whole business was that each order contradicted the other and the personnel were in a very worried state wondering exactly who was in charge. From December last, the problem was partially solved by making the medical officer in charge of each post directly responsible for the conduct of his post and its equipment-a scheme which probably works well in many cases. Unfortunately, other persons arpeared on the scene in the form of liaison officers and matrons, who in many cases have harassed personnel ""ith so many minor pin-pricks and orders that one is tempted still, to "vonder who is actually in command. It would seem that it is high time the position of these officials be cleared up. Their job is, or should be, an intermed iary bel ween the responsi ble officers and the medical officer of health, who is usually the head of all First Aid Services; but it appears that many are acting as administrative officers. l\lany trained nurses and skilled first aiders, who are only too ready to obey the instructions of their own medical officer, have resigned rather than take ridiculous orders from those who know less about first aid and administration than the people they presume to supervise. Meddlesome interference has done much to decrease the efficiency of first aid posts, and I am afraid that it has become a very real menace. Another very important factor arises from my investigation. I am of the opinion that there are many persons attached to posts who are not beint; honest to themselves or to the general public. Some are unfitted either temperamentally or physically for the work under real conditions, son Ie cannot acquire the necessary knowledge or dexterity, notwithstanding months of training, and then others openly state that they look upon their posts not as a public duty but as a job of work-to be thrown up shou ld air raids actually occur. Fortunately, these are in the minority-but they do exist and unfortunately tend to bring discredit upon their more conscientious colleagues. The time is undoubtedly ripe for a rigid weeding out of personnel, especially as in many cases the efficiency of a post has been gauged by numbers ratba than by actual knowledge. I, myself, would much prefer to have two intelligent and dextrous a8sistants instead of a number of inefficient passengers who will probably do more harm than g-ood. The organisation and housing of the different posts varies considerably in the numerous boroughs. I was distressed to find that conditions v.' ere so bad in some places that they were undermining both the health and morale of the personnel. The chief trouble was putrid ventilation due to the inahility to open windows as the result of sandbaggingand the blackout, aggravated by the fact that the rooms have been in continuous me since last September by day and by night. In other pl8.ces, the buildings were cold, damp and draughty. The shift I felt most sorry for, was that of the night shift. I n some posts, bedo and blankets were provided, and the personnel encouraged to rest while still being on the alert. In the majority of cases however, the re verse was the state of affa irs, and it was pathetic to see some of the women sitting on hard chairs waiting for the moming-, when there was no earthly reason why they should n ot be resting. This seems all the more difficult to understand in view of the fact that IT'atrons have been appointed to supervise female staff and therefore, presumably their welfare. In most places I found that the personnel were becom-

FIRST ing most apprehensive about the tendency to economise in paid workers. They fee l that if their positions are insecure, it would be difficult for them to concentrate wholeheartedly and exclusively upon their duties because they should naturally be on the look-out for a position in another sphere. This factor is undoubtedly proving extremely unsettling; and it must be admitted that as a result of resignations, the calling up of the younger members for military service, and the genera l discontent and uncertainty, the efficiency of the First Aid Services is probably not at such a high le\'el as it was three months ago. I was distressed to find that one of the causes of ineffi.ciency in some of the 6 rst aid posts was due to friction between members of the organised first aid bodies and, I further re~ret to say, that in practically every case the same organisation was at tault. It seems a great pity that the co-operation and working agreement of the heads of the B. R. C. S. and the Order of St. John does not extend to the rank and file. Cases came to my notice where local officers had deliberately enticed serving members of the opposite organisation to enter into its ranks; the inducement, in many cases, being early promotion. First aiders holding the certificate ot one of the bodies have been persuaded to attend lectures and sit for the examination of the opposite organisation, because they were informed that the certificate of the second organisation was a sure pass for ado:ittance into one of the Forces' medical services, whereas the certificate already held would not prove as acceptable to the authorities. Furthermore, I heard of lecturers actually passing ridicule on the teaching and the textbook of thf!l opposite body; to the advantage, of course, of their own. In fairness to the authorities of both org-anisations I would state that I have traced the source of these cases and I am satisfied that the trouble lies with the rank and file and not with Headquarters. I am sure that neither the B. R.C.S. nor The Order of St. John are in need of the services of " Fifth Columnists," and that the authorities deprecate such methods as described. I do not want my readers to obtain an erroneous idea of the efficiency of the First Aid Services. I could tell of numerous beginners who have become experts; I have seen certain services which are excellent; I have seen trained personnel who have reached a very hi~h standard of efficiency; I h:ave also seen the other side. On the \\'hole the services are good; but let us not pretend that efficiency is increasing with time. I have pointed out the weak spots in the present system, and the remedy in every case is obvious. Lastly, there is one pleasing feature emanatin!S from my investigation. I refer to the steadying effect exerted by members of the S.l.A.B. and B.R.C.S. (and I have been informed in Scotland by the S.A.A.A.) on the rersonnel at first aid and other posts. The organised first aid bodies are still the backbone of everything connected with first aid. On behalf of the First Aid Services I pay tribute to them.

---- ._ . - - FOUND. - Bronze medallion No. 361351. Owner can obtain same on application to lr. S. C. Robinson, 11, Clarence-road, Bickley, Bramley, Kent. The Bentinck Colliery Division, S.J.A. B., held its annual supper and presentation of awards on May 3rd, when Asst. Commissioner P. Muschamp distributed 61 awards. Supt. T. L. Moulton presided. -:>-+-<-

A two-day bazaar was organised by the Dewsbury S.lA. B. to raise funds to clear debt on their new headquarters. Mr. Basil Hughes, the Bradford Surgeon, opened the bazaar, which was held on May 3rd and 4th, and praised the work of the m~mbers.

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A.R.P. Topics. ANTI-DIM COI\IPOU '0. The ~linistry of Home Security A. R. P. Equipment Bulletin No.7 (.-\ pril 9th, 19-10), contains revised instructions for the use ot anti-dim compound, which are as follows : Clean eyepiece with cloth provided. r\pply the compound evenly with the finger. If it is too stiff to spread easily, breathe on the eyepiece to moisten it. Spread the compound lightly over the eyepiece \"ith the c1otb. Do Jlot polish. Breathe on the eyepiece until it becomes clear. These instructions replace the instructions at present printed on the out fit. It has bee n found that with the preseQt instructions users ha\'e tended to polish off most of the compound so that insuffi cient was left to give the proper effect in cold weather. In summer temperatures little difference in effect between the two procedures will be arparent. STRETCIIER BEARERS. The :'Ilinister of Health has advised I;ospitals to recruit volunteers to act as stretcher bearers in the event of air raids, or in any oth er emergency which entails the mO\'ing of large numbers of patients. illen available for this work are asked to apply, preferably in writing, to the nearest large general hospital, voluntary and municipal. They should state \"hether they could attend at night or during the day, or both. They would only be called on when their services were required, and the ,,\'ork would consist of loading and unloading ambulances at tbe hospitals and in carrying stretcher cases inside the hospitals. Suitable instruction and practice would be given to accepted volunteers. ANS\\'ERS TO QUERIES. Numerous queries on "Gas" ha\'e been recei\'ed from time to time and have been answered by Captain .:\. C. \Vhite Knox, ~l. c., i\l. B., Ch. B. For the benel1t of all readers the more important questions and answers are given below. Q. Is the period of well-being a bOlla fide symptol/l of Phosgene Poisoning ? A. I t is not a bona fide sym pton. I n phosgene poisoning there may be a delayed action in the progress of the condition characterised by a lessening of the \'arious symptoms. Q. Failing to find an I"ye-shade. (for mu tard .gas in eye), would it be \\'fong in covenng the eye wllh a ~oosely tied bandage or handkerchief, making sure that It ~ o es not put any pressure on the eye .whatsoe\· ~ r, but Just su!11cient cO\'erino- to prevent the light causLOg further pain and pre\'ent':>undue exposure until medical aid can be procured. The book states, of course. " 1\0 bandaging" ; but an examiner stated recently" Place a rad of cotton wool under the eye, or hold a pad of cotton wool to the eye." . ' . . Which is the more Ultable, bearIng- In mi nd the conditions. There is nothing about a pad undl:r the eye-shade in the Book (ct. f.{. P. No.2). A. You would be wrong in using even a loosely tied bandacre on contaminated eye. Free drainage is essential a~d cannot be ensured with bandage applied. Use a shade of brown paper or similar material. For the same reason as stated, I do not like the idea of cotton wool pad under the eye.

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St. John Ambulance Brigade HEADQUARTERS AND DISTRICT REPORTS. No. I (Prince of Wales's) District No. 83 (NORTHERN HEIGHTS) DIVISION. - This Division has lost in tragic circumstances a member who had served for ten years. 1\1r. H. C. Dunk collapsed and died whilst carrying out his duties as 'bus driver. Mr. Dunk was very popular with his colleages and had made a name for himself in the athletic world, being known as I' Atlantis," the water wonder. Two days before his death he took the artificial respiration test of the Royal Life Saving Society and, ironically enough, his badge and certificate arrived on the day he died. The Division was represented at the funeral by Div. Surgeon S. C. Pritchard , Div. Supt. John J. Ascott, T / Sgt. W. Puddefuot, and other members. A Aoral tribute draped with the Brigade colours was sent by the Division; and a message of sympathy, endorsed by the Commissioner, sent to Mrs. Dunk and family.

MITCHAM.-The annual "J. M. Davies" Challenge Cup Cadet Competition ~ras held on April 20th, at Mitcham, the judge being Dr. Mrs. Evans; timekeeper, Nursing Sister]. Reed, with Mr. F. C. Walls as the secretary. Southgate gained first place, followed by Tottenham and Edmonton second, and Mitcham third. Six teams competed. Following the competition tea was provided and the opportunity taken of presenting to Mr. H. Manning a gift on his promotion to ambulance officer.

No. n District BUCKS COUNTy.-According to the annual report there are 35 ambulance, 14 nursing, 9 cadet ambulance and 2 cadet nursing divisions, an increase of 17 units, with a net personnel increase of 376 men, 95 women, 16 boys and 28 girls, a grand total of 515. First aid was rendered to 12,412 persons; the nursing personnel attended hospitals and clinics on 1,544 occasions and undertook transport duties on over 1,500 occasions; whilst Medical Comforts Depots are maintained by two nursing divisions. The 18 motor ambulances of the Brigade conveyed 6,490 cases, travelling some 126,194 miles. Thirtyseven Roadside Cabinets are maintained by Divisions. There are 81 certificated instructors in A. R . P., and 53 full courses were held, resulting in 614 passes. Nearly 600 men and 136 women are actively engaged in A.R.P. duties. This number, allowing for 225 members serving with the Forces, represents 70 per cent. of the available personnelan excellent percentage, bearing in mind that the motor ambulance service, hospital and clinic attendances must be maintained.

CHELTENHAM.-A new ambulance division, to be known as the Cr.~ltenham Spa Ambulance Division, has been formed in Cheltenham, composed chiefly of members of First Aid Post parties. Some are old members of the Brigade who have had their enthusiasm revived by their A. R. P. duties; others are recruits who have found much appeal in ambulance work. The Division, which has been registered, has a membership of over twenty, and the following appointments have been made :-Dr. Crabtree to be Divisional Surgeon, Mr. C.

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AID G. Collins, who has been a member of the Cheltenham Town Division for many years, and was partly instrumental in the formation of the Cadet Divisions, is be the new Superintendent, Mr. W. Tabran Rees will be Ambulance Officer, and Mr. A. Bailey the Secretary.

HAMPSHIRE AND ISLE OF WIGHT COUNTY. - The Lady Louis Mountbatten has been appointed President of the County Brigade. The Dowager Lady Swaythling, the Han. Mrs. Ingham Whitaker, Mrs. Harcourt and Mrs. Lionel de Roths ch ild have been appointed County VicePresidents. A conference was held at County Headquarters, Bournemouth, to discuss in what way the services of Presidents and Vice-Presidents of Corps and Divisions could best be utilised. The Lady Superintendent-in-Chief, Mrs. St. John Atkinson, very kindly attended this conference and addressed the meeting. She spoke of the importance of the Honorary Staff and suggested that Corps and Divisions might cooperate more fully with their Presidents and Vice-Presidents. After some discussion it was decided that steps should be tah:en to bring this into effect.

SOMERSET COUNTY.-The Bath City Division has suffered a grt>at loss by the death of Amb. Officer T. ]. Dyte, its Secretary and Transport Officer. He joined the Division on February 2nd, 1916, and during his 25 years service he travelled an average of fourto five-thousand miles per annum with the ambulances, a figure that will surprise many. It was not only a voluntary service but a positive sacrifice of time and money. Having served in the R.A.F. during the Great War, he Rave valuable assistance in re-establishing the Brigade's civilian work in Bath, especially the Invalid Transport. He received the well-deserved recognition of Serving Brother of The Order. The overflowing church at his funeral testified to the affectionate regard of a much wider circle who had experienced and valued his devoted service. The Division was privileg-ed to supply the bearers consisting of six of his old friends and colleagues.

Padfield, Lady Supt. ~1iss Goodman, Supt. S. S'11ith, Corps Officer A. W. Free. The 3 years' medal of the Doncaster Mines Rescue Brigade was presented to G. Grant.

NOTTINGHAM. - JUst over a quarter of a century ago the Bulwell Division, Nottingham Corps, was formed, actually on March 15th, 1 Sl15. For 24 out of those 25 years Mr. VV. Whysall has been connected with the division. He passed his first aid examination in 1899 and his re-examination every year since, so that alto~ether he has 41 years service to his credit. Although his active participation has terminated, he is still 'Ion reserve" of the Bul well Division. The 25th anniversary was celebrated by a dinner on Saturday, April 6lh. Corps Supt. F. Wilson :'Iioulds presided, and a feature of the function was a presentation of a smoker's cabinet to the former Div. Supt, Mr. \Nhysall, and an umbrella to his wife, from some of his old colleagues. .vIr. S. Seagrave, who has been a member of this division since 1916, made the presentation. The chairman proposed the toast to the Bulwell Division. the response being given by Amb. Officer E. Perry, Acting Div. Supt., in the absence of Div. Supt. W. L. Ashmore, who is serving with H. M. Forces in Palestine. Sergt. F. Fillingham proposed the toast to the guests, Corps Officer C. E. West replying . . All arrangements were made by Amb. Officer E. Perry.

SELBY. -The Selby Division, formed last September, is now on its way to establishing itself as a worthy division, after one or two set backs. Five members have been called to the Forces, whilst the majority of other members are on local A. R. P. work. Div. Surgeon C R. Hiley recently carried out the re-examination, and expressed his satisfaction to Supt. W. H. Osborn on the knowledge of the personnel. A dance was held on April 26th in aid of divisional funds. It was a great success, some 200 persons being in attendance.

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~riends and if the Deal Corps was to be judged by the visitors

It had not much to fear from the verdict. The Rev . Peshall responded. Behind the members was the. spirit of God, of devotion, of self-sacrifice and service which nothing would ever quench, that will make them ~eally strong- and c~urageous to help all civilian population If the emergency anses.

. GUILDFORD.-According to the annual report of the

0utldf?rd Corps, 2,~20 cases were removed by ambulance,

111cludmg 337 at aCCldents and 1,134 long distance invalid transport cases. Fifty-six fire calls were answered; 116 attendances made at clinics by nurses anJ also 218 duties at the Royal Surrey C:0unty Hospital. Public duties attended, numbered 713, patients treated on public duties, 509, patients treated off duty, 80, whilst 527 medical comforts were issued . The ambulances travelled 26,020 miles.

RAMSGATE.-:\1ay ht is a notable date in the history of the Ramsgate Town Division, for it was on that day, SO yea rs ago, that the inaugural meeting, which lead to the forming of the Division, was held. Only one of the seven original members is alive to-day. He is Mr. VV. H. Underwood who resigned but seven years ago. According to lr. Underwood five members of the Royal Artillery who had some experience in stretcher work consentt>d to undergo training- in St. John work, and on February 25th, 1891, the Town Division was estaclished, with Mr. Matthews a~ ,>uperintendent and Dr. Tamplion the surgeon. The Town Hall was used for lectures and drills and various addresses were used later. Mr. Underdown, who holds the rank of Sergt.-~lajor (retired) and is a Serving Brother of The Order, was made the first corporal of the Ramsgate Division during the Boer War. The Ramsgate Division was the third to be formed in Kent, but the Nursing Division can beat this record, as it was formed in 1890.

No. VIll (Duke of Connaught's) District No. V District ASKERN MAIN.-At the annual tea, concert and distribution of awards to members of the Askern Main Corps Mr. W. LI. Jones, director and general manager, Askern Coal and Iron Co., Ltd., made presentations to Mr. Gwyn Morgan (agent), Mr. Matthew Thompson and Mr. Charles Smith, in recognition of bravery shown in rescuing an Askern miner who had been trapped by an extensive fall of roof. Mr. C. H. Liversedge, the trapped miner, was present at the function. About 200 attended the function. County Surgeon B. Hart presented the awards. Mr. Jones extended thanks to Drs. J. and D. Malloch for their services to the ambulance classes and in other respects, to Mr. Free, the corps secretary over a number of years, and all members who had given valued service to the corps. Dr. D. Malloch, proposing a vote of thanks to Dr. Hart for distributing the awards, said his appointment as County Surgeon had been followed by increased local enthusiasm in first aid. Nobody in the district had a livelier interest in ambulance service than Dr. Hart, and he asked members to be encouraged by his appointment. The awards, in addition to certificates, vouchers, medallions and labels, included a Service Medal to Pte. J. R. Heffer; Service Medal Bars to Lady Amb. Officer Mrs.

DEAL.-Sir Gerald W. Wollaston presided at the first annual dinner of the newly formed Borough of Deal Corps. The chairman proposed' I The Borough of Deal Corps." The amalgamation of the four divisions was a wise one. The Corps had recently acquired headquarters at Manor House and he was sure that this would be of great advantage to the Corps. They owed the acquisition of headquarters very largely to their energetic Superintendent, Dr. Davies. Making an appeal for continued support, Sir Gerald referred to the activities of the Joint Committee. Commissioner E. A. Richards responding to the toast, said that the work was growing steadily. Personnel in Kent increased 39 per cent. and 4,000 wad accidents were treated. Referring- to the Corps, the Commissioner paid tribute to the work being- done. Dr. Davies also replied and gave particulars of the acquisition of Manor House. The Corps was doing well and they need have no fear as to its future. Mr. Richards then presented Sergt. F. Hambrook with a 30 year Southern Railway certificate and 15 year medals to Corpi. A. Jordan and Pte. J. Hilditch. Alderman R. F. Denne (Deputy Mayor) proposed" The Visitors," and on behalf of the Mayor and Civic Authorilies, he thanked the members of the Brigade for the magnificent work they were doing-. Welcoming- the visitors by whose presence they were honoured, Ald. Denne said that a man was known by his

A Few Don'ts in First Aid. DON'T lose confidence in yourself when treating a case. Don't neglect to observe the position and surroundings of the patient. Don'c wait for appliances not readily to hand improvise. Don't delay in cases of h<emorrhage. Don't neglect to protect a wound. Don't displace clots from a woun,d. Don't carelessly handle an injured limb. Don't apply extenSIOn to a compound fracture. Don't try to reduce a dislocation. Don't expose burns to tbe air. Don't give solids or Auids by the mouth during insensibility. Don't forget to restore breathing first in drowning Don't hesitate to be firm with an hysterical patient. Don't fail to treat shock in all cases. Don't lose hope in any case. Don't give emetics in corrosi\"e poisoning Don't let a patient go to sleep in opium poisoning. Don't for<Yet to send for medical assistance early. Don't neglect to keep a watchful eye on your patient. Don't leave your patient till fully recovered or someone has taken cbarge.

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Railway Ambulance News. Great Western. At the annual smoking concert held in connection with the Swindon men's and women's classes on Apri l 19th, close upon 500 awards, including a number of g-old meda ls and hars for ambulan ce efficiency for 15 to 35 years, we. re presented. Mr. John Auld, President of the Divisiofl alld Prin cipal Assistant to the Chief Mechanical Engineer, presided , and wa s supported by the Mayor and Mayoress of Swindon, 1\1r. W. W. Wakefield, M.P., and.local officers of th e Great Western Railway. The presentatIOns were made by 1\1r. G. F. Boxall. Stores Superintendent. M'r. ~.a~{e field on behalf of the general public, thanked the DlvlslOn for ~heir excellent work, and paid tribute to the medical lecturers, Drs. Behr, McCandlish a nd Hick , and also to their indefa ti O"able divisional secretary, Mr. L. G. Bretsch, Mr. G. Cullin:g, chairman of Committee, and other officers. An excellent programme of vocal and instrumental music was contribu ted by local artistes.

The Swindon and District Ambulance League, which organisation has been run so successfully during the past three seasons decided that, owing to the many calls upon 6rst aid er's time imposed by the war-time conditions, it was not practicabl e to conduct the League as in past years. A competition on a "knockout" principle was substituted, a nd after a series of eliminating rounds the fina l match was staged at S w ind on Town Hall on April 10th. The t\VO t~ams who met in this contest were t he G. W. R. team 0. Dixon , captain) and the Cambria Bridge First Aid Post (W. Ellis, captain). The team test was a supposed accident, stag ed by the secreta ry, Mr.]. W. Sutton, presented an electrician at work upon a ladd er, electricuted before the eyes of the spectators. A blinding flash, a scream, and the patient flung headlon g t o the g round ass isted the imagination. Aft er a very close contest, the G. W. R. team were declar ed th e winners, scoring 332t marks against the First Aid Post, who scored 310. The Mayor of Swindon (Coun cillor H. R. Hustings) presented the lea g ue's trophy to the winners at the conclusion of the competition. He was supported by the League President (Mr. G. Culling, S. B.) and the Casualty Service Staff Officer for the area (Mr. B. O. D. Palmer), who complimented both teams for the efficient manner in which they dealt with the suspended respiration and injuries that looked terribly real.

london, Mid land and Scottish. The report of the ambulance work in Scotland has just been issued. There are now 81 sections and 2,168 passes were obta ined at the exam inations. Increases were shown in first and second year students. Dundee West gained first place in the Final Ambulance Compet ition, and the same team was successful in gaining the Scottish Inter-Railway Shield. The L. M. S. was well represented at competitions held by the St. Andrew's Ambula nce Association, Motherwell winning both the' " Cowan" and "President's" Cu ps competitions. Staff in Scotland have been a warded 899 Long Service

Medals and 1,137 bars, including 3 for 45 yea rs ' service. Forty-nine members of the L.M.S . R ailwa y Bri gade were awarded the Voluntary Medical Service Medal in recog nition of 15 years' efficient service in th~ St. Andrew's Amb ulance Corps. The L. M. S. amb ul ance organisation in S cotland is carried on under the auspices of the St. Andrew's Amb ulance A!>sociation, and thanks are extended to the Associatio n for the ass istance rendered.

london and North Eastern. Seven teams competed on Ap ril 24th in the Hull District alobulance competitions. Dr. C. D. ·Wilson, of pa.rl!ngton (team), and Dr. E. B. Appleby, of Newcastle (mdlvldual), were the judges. . The" Hull District Shield" was won by Dalrycoates, who will represent the District in the North Eastern Area fina l competition. Paragon No.1 gained second place a nd Dock Engineers. third. Mr. J. S . Harper, district supt .• presided at the pres~nta tion ceremony; Mrs Harper distributed the shi~ld and prizes. Others present included Mr. E. V. Taylor (vice-preSIdent), Mr. W . E. Twinham (district chairman), Mr. S. Cooper (Centre secretary), Mr. G. H. Oakes (district secretary), and others.

The Southern Scottish Area competition final was held at Glas O"ow, on April 12th, when Dunfermline won the ChallenZe Cup with 269 points. Kipps Works g-ai ned second hplace and were awarded the "Deuchars" Cup. Eight teams competed. Mr. ·William Whitelaw, former chairman of the L. N. E. R., presented (he cu p.

We offer our congratulations to Mr. Sidney Cooper, North Eastern Area Centre Ambulance Secretary, on his promotion as Officer (Brother) of the C?rder o~ St. John . . Mr. Cooper gained his 6rst certificatE. m 1908, being appointed Centre Secretary in 1934, following the death of Mr. G . Jackson.

Southern. Dr. J. R. John after being lecturer to the Bournemouth Central S. R. ambulance class for seven years, hfls joined H. M. Forces. Recently a presentation was made to him on behalf of the class by Mr. Hutton (class secretary) who asked the doctor to accept a "Swan" writing set and ex pressed the hope that he wou ld be happy in his new appointment. A handbag was a lso given to Mrs. J ohn. Dr. ] ohn thanked the class for their kind thoug h ts an? the way the members appreciated his efforts . He hoped It would not be long before he was back agai n, carrying on with the class. Mr. Shrimpton, Goods Dept., who presided, r egrette d that they had to lose such an. able lecturer as £?r. ] ohn, whose personality had broug ht m creased membership.

Owing to pressure on space many reports have had to be held over. Will readers please forward news items as early as possible.

Our Nurses' Pages. COMPILED BY AN AMBULANCE SISTER. No. 1 DISTRI CT, S.].A.B. NORTlrERN AREA. - On Sunday, April 14t h, th e Coun cil Chamber of the Town Hall, Southgate, was th e scene of a competition between the staff s of the thr ee First Aid Posts and two Mobile Units of th e Borough. The competitors were exa min ed on th eir knowl edge of various surgi cal instrurnents a nd th eir uses , and a fterw a rd s ha d to pre pare a bed to recei v~ a n acc id ent case fr om t he street, apply dressin gs, and prepa re dressi ng trays . Th e jud ges w er e th e Ma tron of th e Nor th Midd lesex H ospital and t he Medical Offi cer of H ealth fo r W ood G reen , and both wer e ve ry impressed with the work of t he tea m s. Th e r esults were as foll o ws : -1, F. A. Post No.2 (B owes Park Methodist Church Hall), 88· 5 per cent. ; 2, l\lobil e Unit No . 1 (I solation Hos pital), 80 p(! r cen t. ; 3, l\Iobil e Uni t No.2 (Gro velands ), 77 per cent. ; 4, F. A. P ost No. 1 (Keble S chool ), 70·5 per cent. ; 5, F. A. P ost No. 3 (Gro vela nd s), 66 per cen t. The winning team "V ere a ll m e mbers of the S t. J ohn Ambul a nce Brigade- Miss Say (Fin chl ey and S ou t hg-ate Nurs in g Divis ion ) a nd l\liss Brittain, ~lr s . Kni g ht, l\ li ~s Lane a nd Mrs. Wilso n (Palmers Green Nurs in g Division). The cup w a s presented to the winnin g t eam by the Mayoress of Southgate.

No. 2 DISTRICT, S .J. A. B. L Yl\IIN GTON NURSI NG DI\"]s ION. - ]n a nticipa t io n of her marriag e at Whitsun, Lady Su pt. 1\li ss D. Hildi tch , of th e L ymin g ton Nur s in~ Di vis ion, h as handed over h er cha rge to l\Iiss H a mmersley. Miss Hildi tch j oined t h e Di vis ion fif tee n years ago, an d for the pas t eig ht years ha d bee n in charge . On Tuesday. April 30 t h, t h e Hon . Mrs. Whi taker, Presiden t of the L yming ton Corps, present ed 1i ss Hild itch with a vVes tmin s ter-chim es cloc k in a wa lnut case bea rin g the S .J. A. B. bad ge o n behalf of 51 offi cers a nd m embe rs of th e Di vis ion, to m a rk th eir a pprec iat io n of her l eade r~ h ip a nd the occas ion of her m a rri age. In pay in g tr ibute to t he work she had d one while in cha rge of th e Di,·isi on , l\lrs. \Vhita k e r s pecially m entio ned her e ffor ts eig ht yea rs ago when th e Divi sion was in d a nge r of bein g dis band ed o \\"in g to its declinin g numerical streng th. Miss Hilditch th a nked the donors for their kind gift a nd Mrs. vVhita ker for h er g ra cious word s. The surviyallhroug h the period refe rred to was a ls o du e to th e co-oper a tio n of eig ht faithful m e mbe rs, she said.

BO U RNE~lOU TlI COR PS. - On April 3rd, t he L a d y Su pt.in -Chief inspected th e Nursing- Di visions of the Bourn emouth Corps at the Tow ::. Hall, Bournemouth. Sh e w a s a ccompanied by His vVorship the Mayor of Bournemouth , County Commissioner l\lajor A. T ennyson Smith , th e County S tarr, a nd Lady Croft (L ad y Presid ent of th e Nursing Division s). Th e Lad y Supt. -in-Chief expressed herself a s being extremel y pl ea sed, no t only with th e ~en e ral sm a rtn ess on pa ra de and durin g th e l\[arch P as t, but als o wi t h th e practical \Y ork perfo rm cd by tca m s fro lll th e nine U i\"is ion s of th e Corps . Three hundred and four ollice rs and m e mhers we re o n parade on this occa sion.

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~V ES~ro N - S~P~~- M A R E NURSI NG D I\·ISIO N.-A Ju mb k S~l e m a id of di VISIOn al fund s wa s held on Thursday, April 2:>th, and was well patronised. The joint effo rts of me mbers and thei r fr ien ds under th e a ble leadership of Lady S u pt. 1\1iss A. K. Lowther, toge th er with valu abl e help from officers a nd mem bers of the Am bula nce Divis ion, m et w ith g reat s uccess.

No . 6 DI STRICT, S. J A. B.

No wrON-ON-T EES N URS ING DI \· I ~ION.-An interes ti ng event . took place last mon t h w hen a presentation of an electriC coffee per colator was ma de by Lady S upt. :'I1iss D. Dunthom e (0 Div. Surgeon ]. G. H a r bi nson, to mark the occa sion of his marr iage. Th e g ift was from the officers a nd m embers of the D ivision. Both D r. and :\lrs. H arbi nson graciouslyaccf'pted the presen t a nd, in thank in g t he m embe rs the Divis ional Surgeo n com m ented on t<heir numerical s't reno,th a nd the s plend id progress t he Di\·ision had made in fIle fi rst ten m onth s of its existence.

No . 8 D ISTRICT, S.J.A. B. GUILDFORD NURSING DI\·ISION.-O\·er £4 has been handed to the funds of the newly-formed :\'ursing D ivision of th e Brigade as a result of a dance arranged by :'Il r. F. G. S k a n , h eadmaster of Lightwater Ju nior School. T he re we re about 100 people present, in.:l ud ing :\lrs. J . T . North , Lady Div. President, and Lady Supt. 1\1iss l\lapple. An appeal for recruit5 during the evening res ul ted in eigh t new members joining the Diyision. Th e D i" is ion is g reatly appreciative of the kind efforts of l\lr. Ska n on their behalf.

CHICHESTER Nr..:RSING DI\'ISIO/'\.-The first annual ge ner a l meet ing of this Division was held on Apr il 2l!lil. L a d y Bessboro ugb, Lady Div. President, was in the chair, foIl o\" in g a n inspect ion by her of the DiviSIOn. Lad y Bessbor ough said it was a remarkable achim"em ent to haye become such a thriving Division in such a s hor t t ime. They had 68 members and SO cadets. and she w as s ure ther would contin ue to succeed because their work was so vital at this time . She stressed the tremendous importance ot the coo pera tion between them and the units of the British Red Cross Societ), both bodies \\"orking closely together at H ead q uar ters , and it was a hope that had become a hobby wi th her to see th is co-operation extending to 'Vest Sussex.. So fa r the V. ~\. D . 's had not been needed, but she was a fr aid th ey wo uld be wan ted before long. ,\m ong those present on this occasion were Mrs. D en to n Ca rli sle, Vice-President; His \ Vorship the :\Iayor of Chich ester, Cr. \V. O. Stride; Div. Surgeon ~-\ . 1\1. Barton, Lad y Supt. !\Irs. Buxton Knight, District Officer W . J. B. Trolter and Supt. H . H. Bridle. l\Irs. B uxton Kn ight tba nked the Ambulance Division fo r its s u ppo rt, and t he i\Iayor proposed a vote of thanks to L ad y Bessboro ugh for presidi ng. L a dy Bess boro ug h respo nd ed, and decla red that one of t he good th ings t he \,·a r had done for he r was to gi ve her the o pportunit y of gettin g to know t he people of Chichester and vVest Su sse x mor e than had been possible before. N ORTTT Er;: N I REL. \ND D ISTl{ICT, S .] .. \ . n. B.\ LLL\I ENA X URSING O I\·ISION.- J n the BallYIllcna T own H a ll on Tue day, .\ pril 9th , Lady District Supl. :\l iss vVall ace carri ed ou t a n in s pect io n of the Ba llY l1lc ll 3 Xu rs in g

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Division and, in the course of the p~oceedings, presented first aid home nursing and A.R . P certdlcates and badges to a laro-e 'number of the members who had qua li fied. She was introduced by Lady Supt. Miss Beck and, at the close, com plimented all concerned on the high state of . 0eHiciency displaye~ in the vari~us tests. A demonstration of first aid and home nursmg banda h ing was given, and this was followed by th.e treatment of first aid to injured people, and to casualties from a gas attack, and artificial respiration. The com,mentators were Amb. Officer C. Lancashire, Lady Amb. OA1eer Mrs. ]. W. Haughton, and fr.]. B. Caldwell (local A.R.P. Officer) . 1\1 r. Caldwell and 1\1 r. T. B. Whiteside, Town Clerk, also complimented the Division on its efficiency. 1\1rs. Wallace Mr. R. A. Simpson and 1\'1r. Caldwell were judges of an interesting team work competition.

St. And rew' s Aln bu lance Association. Commandant Peter D. Duncan presided at the annual meeting of the Dundee and Arbroath Joint Line section of the S.A.A. Corps. The secretary (1\1r. ]. B. Edmonds) reported a memb~r ship of 83, an increase of 33, and mentioned that :l\~ISS Elizabeth Martin had qaalitied for the Voluntary Medical Service Medal. Office-bearers for the ensuing year were elected.

1\1r. R. Clarke (District Goods and Passenger manager) presided at the annual supper and presentation of awards to members of the Scottish Railway's Ambulance Class (St. Andrew's) held at Carlisle. :\lrs. Knight presented the awards, including the" Dr. Lediard" Cup, to Miss C. Heskett, and the "Dr. Crawford Aitken" Cup, to 1\1r. J. M. ·W ard. Commandant ]. Armstrong presented Dr. D. A. Kni(Tht with a set of coffee cups and saucers in appreciation of l~s services as lecturer, whilst Asst. Commandant W. McNarney presented !\ir. j. M. Ward with a tea service in appreciation of his work as hon. secretary, a post he had occupied for tile past len years.

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Another Reason Why.

Speci al Bandages.*

By A. C. \iVIIILST the triangular bandage is ideal for Immedia~e all.d temporary use, a more efficient method of banda~1l1g- IS required for later treatment. The ~~l1er Band.age IS t~en used, and according to the part requlrmg. att~ntlOn, specific instructions are laid down as to their appltcatlOn. In the special appendix on Ba?daging in Baillier~'s Complete Medical Dictionary, there IS an excell~nt descrlptioll of three such special bandages, and we are mdebted to the Publishers for allowing- us to print this description belo~. Incidentally for the benefit of those who do not know thiS Dictionary, we can recommend all readers to pr~cure a cOI?Y now' it is an invaluable book. Its appendices con tam infor:nation which is of service to all first aiders. 1. MANY-TAILED consists of a series of strips (4 to 6) of b:ll1dage of the required length, this i5 . su.ftlciently .long to encircle the part and overlap at least SIX Inches ~Ith each end. In making, each strip overlaps the prec~d1l1g one, and the whole are secured in the centre by a pIece of the same material. These bandages are made of any of the ordinary materials already described (open-wove cotton, calico, '" domette, etc.), and are commonly used for the abdomen a'nd chest but can be used for a limb when undue mO'Jement caus~s pain, as a dressing can be changed without disturbing the part. Advantag·es.-They are easily applied and adjusted.

Disadvantages.-Give little, if any, support, and som:times tend to become displaced; e.g., on the abdomen It tends to rise up over tbe crest of the ilium. Groin straps are to prevent this.

MANY'TAILED BANDAGE

"T" BANDAGE

GROIN STRAPS The annual competition in home nursing and first aid organised by the Dunfermline Local Committee of the S. A. A. A. were held on Saturday, April 13th. In the home nursing competition, for which four tf'ams entered, the Dunfermline Rose Bowl was won by the Dunfermline L.N.E.R. team with 170 points. Runners-up were Fife V.A. D. 58 A team with 163 points. Fifteen teams competed for the" Mathewson" Cup in the first aid competition. The trophy was won by Dunfermline L.N.E.R. No.1 with 257 points. Second place was taken by Lochgelly Co-operative team with 229 points, 1\lethil and District No.1 being third with 227 points. The arhiters were Dr. \iV. B. Ross, Tillicoultry; Dr. W. Adams, Dunfermline; and Dr. R. S. Lind, Dunfermline. Mrs. Andrew Shearer, Dunfermline, presented the trophies.

Councillor W. S. Jackson presided at a social evening held at Sholtar Colliery, when Mrs. ]. B. Adamson presented certificates to members of the Shottar Woman's Mobile Unit. A presentation was made to Dr. J. B. Adamson (hon. lecturer), on behalf of the class, by Mrs. C. R. Knaggs.

CUT I...-----±

~UTc::::::------------==::~:===:JJCUT JAW (FOVR-TAIL£D8ANOAGC)

2. FOUR-TAILED OR JAvV BANDAGE is made usually of calico and is used either as a temporary support for a fractu'red jaw or to keep a small dressing in place in that region. A strip of bandage is cut from either end lengthways to within about three .in~hes of the centre, thus making- four ends. A .short sltt m the centre supports the chin. 3. "T" BANDAGE is one used to keep in position a perineal dressing. Two pieces of bandage-calico or domette are usually used-are ;oined in a "T" shape; the cross piece is to encircle the waist, and the dressing is kept in place with the other strip, which can be split 10ngitudinal1y for some inches for convenience in tying. 'k Extract from Raillicre's Complete Medical Dictionary (Appendix XX), price 3/2 post free.

\NllITE

KKox,

M . C.,

lVI.B.,

CH.B.

I HA\' E been very much struck in recent years by the apparent difficulty of fjr~L aid students to absorb the fundamental elements of wounds and h<.emorrhage treatment; and 1 have wondered whether it was due to taults in teaclling, lack of practice in this type of work, or just the natural complication which this type of inj u ry produces. Let me try to sift the whole matter and give suggestions which may help in the improvement of the work. Blood is a liquid which occurs in vessels or tubes of various sizes in our bodies, and these tubes are found in all tissues of the body with the exception of a few like cartilage, epidermis, hair and nails. It is not an ordinary solution but is a Auid which contains soft, solid bodies suspended in it. vVhen examined under a microscope we see these bodies as blood-corpuscles of two kinds, red and white, Roating in an almost colourless Quid called blood plasma. Blooe: is the great nutrient fluid for the cells and tissues of every organ of the body, having obtained its nutrient matter from the digested food in the alimentary canal. It also carries away waste materials from all parts and this waste is afterwards removed from it by excretory organs, such as the kidneys'. Another function of the blood is to carry oxy>;en to the tissues as oxidation must go on in them continuously. The carbon dioxide produced by oxidation is taken into the blood stream to be afterwards eliminated in the lungs. One hundreu parts by weight of blood consists of 80 parts of water and 20 parts of solids. The solids consist of nitrogenous compounds-ha:moglobin (10 parts) and proteins (9 parts), with 1 part made up of smalll quantities of fats, carbohydrates, inorganic salts and urea. The hremoglobin is found in the red cells only. The proteins contain certain albumins and a substance called fibrinogen found in solution in the plasma. This tlbrinogen is important and I will refer to it again. To give an idea of the red blood cells they are only 1/ 3200 of an inch in diameter and one-fourth of this fraction in thickness. Tlwy get their colour frolll the hccmogloCin they contain and this hc.emoglobin is the oxygen carrier of the blood. Red blood cells perish after a few weeks and are replaced by new ones produced in the red marrow of certain Hat bones and in the spleen. The white blood cells are much less numerous than the red (1 white to 400 red). They vary in shape and have the power of penetrating the thin walls of the minute blood vessels into the surrounding tissue, and this they do in quantity when all injurious foreign body intrudes into the tissues, their object being to engulf and remove such harmful bodies. \iVhen blood escapes from the vessels in the body it is, at rirst, liquid, but in a few minutes it thickens or coagulates and, at the end of ten or twenty minutes, forms one mass of jelly, which will not Row. This coavulation, or clotting, is due to the ribrinogen in the plasma chang-ing into a stringy solid called fibrin. The threads of fibrin settling into a meshwork contract and entangle the blood corpuscles, so that a clot consists of fibrin and corpuscles. Fresh Ii vi ng blood then consists of Corpuscles Plasma fibrinogen \ Serum

coagulated blood, on the other hand, consists of Corpuscles \ CI t Fibrin) o. Serulll

AID T? lood .d~es not coagulate in the living vessels while they rema1l1 un1l1Jured, but it clots when it escapes or when a vessel is injured internally. Every' 100 volumes of blood can be made to yield about 60 volumes of gases. The carbonic acid (46 volumes per ~OO volu.mes in venous blood and 40 volumes per 100 volumes JJ1 arterIal blood) exists mostly in loose combination with substan~es diss~lved in the plasma. The oxygen (20 volumes per 100111 arterIal bloed and 10 volumes per 100 in venous blood) exists for the most part in loose chemical combination with the h<emoglobin of the red blood cells. We thus see ~hat bl~od is th~ real ~utrient fluid of the body and must be In cont1l1uous circulatIOn. This circulation is maintained by the heart, by alternate contraction and relaxation of its muscular walls, and I am not goin~ into ~ detail~d description of systemic and pulmonary circulatIOns which students are quite familiar ·with. I would like, ho\ve\'er, to emphasise the structure of the arteries, veins and capillaries in relation to the escape of blood. STRUCTURE OF THE ARTERIES. The wall of a large artery can be separated into three coats-a thin internal lining, a middle muscular coat, a tough outer coat of white fibrous 20nnective tissue. The large arteries contain a large proportion of elastic tissue and increase in bore when distended. vVhen elTiptv the" keen their tubular form. I J

STRUCTURE OF CAPILLARIES. In the smallest arteries the middle and outer coats gradually disappear until in the capillaries, the average diameter of which is about 1/ 3200 of an inch, there is left only the inner lining. They are thus well adapted for the transmission of the various substanres through their walls . STRUCTURE OF VEU\'S. As the capillaries pass into veins the same three coat s as are found in arteries begin to appear, but even in the large veins the walls are not as thick as those of the arteries. \Vhen an artery is cut across it remains open and keeps its form as a tube; but when a vein is cut its thin walls collapse. Veins further differ from arteries in being supplied with valves along their course which prevent reflux of blood, allowing the passage of blood towards the heart, but pre\'ent its flo,," in the opposite direction. BLOOD PRESS URE. During life the arteries are ahvays so full of blood that their walls are on the stretch. This pressure of blood on the arterial walls is callE'd blood pressure. It is shown "vhen any large artery is cut, for the blood spurts out to some distance. In the case of a large artery, if a vertical tube were placed in it the blood would rise about fi ve feet in the tube. The equal pressure of the arteries on the blood in them squeezes the blood onwards towards the capillaries. In the small arteries and capillaries there is much resistance to the blood flow owing to the great friction in these minute passages. Hence blood pressure is greatest in the arteries, less in the capillaries and least in the veins. The onward flow of blood in the veins is assisted br muscular exertion and by the movements of respiration. At each contraction of the heart a fresh quantity of blood is forced into the commencing arteries and a wa\'e of expansion passes along the art~ries, this ""ave being known as the pulse. The pulse travels along the walls of the arteries at a rate of about thirty feet per second, reaching the wrist from the aorta in about 1/ 10th of a second. There is no pulse in the capillaries or the veins.

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The whole of the b lood of the body passes through the heart, the arteries, the lungs and capillaries nearly three times per minute-once in twentr-three-and-a-half seconds. :-':.\TURAL ARREST OF H . E:"IIORRIJAGE.

The process is much the sam~ in arteries, ca~illaries and yeins, and as the arrest of artenal ha:morrhage IS most important I shall deal, mainly \l,'ith that. The temporary arrest of arterial h<t~ morrhage is brought about in three \\'ays-(1) the coagulation of the blood; (2) diminution in the force of tbe heart's action from ancemia of the cerebral centres and, therefore, coagulation is facilitated and the now of blood checked; (3) changes in and around the blood yessels. They consist of retraction of the artery within its .sl~eatl~. As a result of this retraction the rough and uneven 11l11ng IS t'xpo., ed and on this the blood coagulates g radually produces the external clot. At the same time the transverse muscular fibre causes contraction of the open mouth of the ve5sel and an internal clot de\'elops extending up"vards as far as the n\?arest open branch . This clot gradually becomes organised and the end of the cut artery become!> a firm fibrous pad. :\1an\' different methods are needed for the effective arre~t of -hccmorrbaRe, but it can be laid down as a preliminan' axiom that digital pressure O\'er the bleeding point will' alwa\s check temporarily the most furious outburst \,,·il ile mea'ns for its permant:nt stoppage are being arranged . Remember, that e\'en in a large wound it may be possihle to apply the pressure o\'er the bleeding point. Re n c illber, also, that the application of cold water, or hot \\'ater at a temperature of 130 degs. to 150 degs. Fahr., is a powerful clotting agent. The use of the firm pad and bandage on pressure points abov~ the lines of the arteries is a powerful asset in the stoppin~ of arterial h,emorrhage. I am often illl pressed by tbe futility of the type of pad u.,ed, especially the improvised pad. Usually it is much too soft. It should be of the consistency of firm rubber and, when using triangular bandages, they should be wound rl' aJly firm. :\1uch criticism bas been aimed at certain tourniquets Irltcly, especially the Sam way. Tourniquets are only required ('\11 the brachial and femoral arteries and, I agree, that the Sdll1\\'ay is mu.:h too powerful and is likely to injure the linint; of the artery where it is applied. The flat rubber strap with the sliding buckle is a great improvement o n the Sam way type . In using- "In improvised tourniquet the following points \,vill help the students . Use a flrm pad accurately applied to the pressure point. The centre of a narrow bandage is placed on the pad and tied in a sin~lc knot diametrically opposite to the pad. The t\\'is l ing stick i", then tied on with a reef knot. Gse tbe followint; technique in twistint;. Take the tw isting stick hdv..'een the first and second fingers of the right hand, place the palm of the left hand on the limb w ith the thumb extending under the knot, push the limb away with the left hand and pull with the twister making a halfturn, rc1.lx tile pull, turn the fingers, then pull and twist again. This pulling when the twist is made prevents clothing and skin being involved and gives a much tighter to urn iquet. On the other hand, tourniquets should only be tight e nou gh to stop the now of blood and not so tight as to inju re the artery, Alsc remember that in many cases the collateral circu lation is so good that you may get blood coming from the other end of the cut artery, and pressure will ha\'e to be a pr l ied t here also. Students !>hould practise assiduo u sly the application of di gital and pad and bandage pressure to the varying arteries until they can apply the pressure swiftly, smooth ly and efficiently.

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227

HI TS ON P RACTICE.

Far too littl e practise is done for wounds and h cc morrhao-e an d not enouo-h use is made of the new charts which o canhn~\\" be obtained fr0 111 the St. J oh n Association Stores. They are a great improvement oyer the ol d charts a nd in di cate more clearly the lin es of arteries and ve ins and also th e positio n of wounds -" 'ilh their associated pressur~ points . . It is a good thing to ha\'e a model dressed 111 a bathtng s uit and the demo nstrator to mark clearly the line of the \'essels with red g rease paint. Th en making a quick mark o n some par t of the body indi cati ng arterial or veno us bleedi ng , make the student app ly the immedia te press ure required. Thi s game can be played fo r hours with a dvantage, and I recommend it to stretcher party posts a nd, indeed , to a 11 as bein o ' the primary essential in first a id work Gradually on thist> practise s hou ld come the practise \\'ith bad and bandage and tourniquets, including impro\'ised and standard , so that st ud ents can get the feel of a. tourniquet. Then all students sho uld go throug-h the routine of the general treatment of a ,\'ound, including exam inatio n , ~em<:l\'a l of foreit;n bodies, clea nin g and app licatio n of antiseptics if used, a nd the detail of app lication of the antisept ic dressing which many people have never seen and more still have never applied. A know led ge of the app lication of a roller bandage is essential for this dressing and all stretcher party posts shou ld practise this. Antiseptic dressillgs can be easily impro\'ised for practise. Tbe student should also practise the application of pieces of lint, gauze, &c., taking- all the care necessary for these more exposed dressing-so Instead of t h e continuous practise which I see for fractures and which, after all, can be fix~d very s im ply and very easily and present no difficulty to the ave rage first aider, I should like to see infinitely greater pract ise on this enormously important subject of bleeding. The practise of faking- wounds is helping- cons ider ably in their treatment and I recommend it to all demonstrators.

- - - - .

- . -- - -

National Blood Transfusion Council of New Zealand. Tms Council, which is conducted under the Commandery of the Orde r of St. John in New Zealand, has recently commenced publishing a monthly Bulletin, which sets out t h e activities of the various branches, and also articles on the s ubject. Th e val u e of blood tran fusion is hecoilling more fully appreciated by the med ic<1 1 proff'ssion in New Zealand. The call s made on the \\' ell i nglon Ser\'ice has risen from 8-1in the year 1933 -I- to 300 in the year 19389. Sir R. Heaton Rhodes. K.C.V.O., K.B.E., Knigllt Commander of the Commander)" in the first Bulletin pays tribute to mem bers of the Sen' ice; whilst ~linister of H ealt h P. Fraser, in a Foreword, cong rat ul ates the Council a nd a lso emphasises the imrorlance of the \\'ork of the Co un cil , which now has th irt een new branches and a total memhersh ip which novv exceeds 1,000 donors.

Police Ambulance News. ;\IETROPOLITA T. Th e No. -+ District has given a lead to other dis t ri cts, and has clearly shown that the officers consi der first a id an essential part of thE' members' training. On A.pril Hth thirteen teams competed in the fi rst District compet iti on for the chall enge cup presented by Comman d a nt :\latth ews ("1\1" Di\,., Special Constabulary) and medals presented by Asst. Commissioner G. Abbiss. Th e competition, which was initiatE'd as the result of presentations by Supt. Briggs (":\1"), is to be an annual e\'ent. Th e judges were Dr. :-':orman Hammer (team) and :\lr. G. E. Craft (ind ividu al). both of whom paid tribute to the excellent work donE'. Supt. Brigg-s anno un ced the results as fo11o ws : Championship Cup: 1st, ":\1" Regulars. 2-+3~; 2nd, "Z" Division, 226t· Best" Special" team: "1\1" Special s (who a lso came third in the main competit ion ; runn ers-up, "P" Spec ials . Best \Var Reser\'e team: Deptford-road, ":\1" . As the competition was held at Gilmmour H ou se, Kenning-lane, the resulL was a " homely" one, Deputy .\sst. Commissioner H. G. F. Archer distributed the cups, medals and other prizes, and expressed thanks to COI1lmandant l\latthe\\'s and :'11 r. Abbiss for thei r support in presentin~ t he cup and medals. H e also referred to the support g-i\'l:~n by numeroll superintendents and commandants by their presence at the function. He hoped that next time more teams "'ould enter.

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The tlrst indi\'idual first aid competition open to members of "A" Di\'ision was held at Great Scotland Yard on April 20th, when thirteen competitors \' ied for the cup presented by P.C 216A Eagles (first aid instructor). The judges were ~Ir. G, E. Craft (practical) and S. P. S. 'Wheatley (\'i\'a yoce), whilst P. C. Eagles was re ponsible for the organisation. Chief Illspector Frith announced the result, which \"as : 1st, P . C. 38-+ Stewart; 2nd, P. C. 60-+ Parsonage; 3rd, P.C.194 Turp ; a ll members being from RochE'ster-row. Supt. Storr ier presented the cup and medals to the successfu l candidates, and expressed thanks to the judges and stewa rcl s for their assistance. Fi rst aid ,,'as most important to.day, and he congratulated P. C. Eagles and the competitors on the:r ,,'ork

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R esults of the annua l spri ng co urse ha\'e no'>\' come to hand. Sixty·three J1Rsses were obtained , which is very satisfactory hearing in mind that all members are doing voluntary duty eac h week. Th e Chief l\ledical Officer (Capt. A. C. Whi te Kn ox, 1\1. C , 1\1. B., Ch. B.) is n ow instructing members in roller bandaging, a subject h e cons id ers to be an importan t on e. The members a re fin din g the tuition \'ery interesting and instructive.

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Dowager Duchess of Norfolk, Presidf'nt of Sussex R ed C ro ss, insp ected the units of the Eastbourne Red Cross on l\lay 1st. Addressing the m embers, H er Grace said it \\' as a pleasure to see how keen a nd read)' they all were at Eastbourne.

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FIRST

Fevers.''!< CHICKEN POX OR VARICELLA.

Is an acute infectious disease characterised by a rash which appears on the first day of the illness and ~onsists of vesicles, which later dry and form scabs. The vesicles come out in crops, mostly on the trunk, face and scalp, and only a few on the limbs. General signs and symptoms are usually slight. . Mild cases of Small Pox have often been mistaken for VarIcella. Treatment. -Confinement to bed until all the vesicles have become scabs. Itching may be relieved by sponging the skin with warm 2 per cent. carbolic lotion. If there is much eruption on the scalp the hair should be cut short. SCA RLET FEVER.

Is an acute infectious disease characterised by sudden onset sore throat. and a bright red rash. The rash appears on the second day j it consists of a bright red blush and papules set very close together. It is seen first on the neck, and then spreads downwards to the chest, arms, abdomen and legs, but rarely appears on the face. The skin round the mouth is never affected. The rash seldom lasts beyond three days. The throat is congested. The tonsils are red and swollen and may be covered with yellow patches. The tongue is at first covered with a white fur, through which the red papillre show, giving it a strawberry-like appearance. Later, when the fur disappears, the tongue becomes very red and glazed. The fever varies in degree and lasts about a week. It may cause some flushing of the face, which must not be mistaken for the rash. The pulse is fast. Desquamation, or peeling of the skin, commences as the rash disappears, and is first noticed on (hose parts of the body where the rash was most marked. The last parts to peel are the palms of thf' hands, and the soles of the feet. The infection is contained chiefly in the secretions from the throat, discharges from the ears and abscesses. Treatment -The patient is put to bed and kept there till the temperature has been normal for a week, provided there are no complications. For the sore throat, fomentations and gargles, sprays or paints may be ordered. When desquamation begins, a daily hot bath may be given. Save a specimen of urine for examination each day, or as ordered, and be on the look-out for signs of complications. Complications.-The following may occur: Enlargement of glands of neck, which may break down and form abscesses. Nephritis, or inflammation of the kidney. Otitis Media. or inflammation of the middle ear. The infection spreads from the throat to the ear by the Eustachian Tube. Rheumatism or Heart Disease. S~IALL Pox OR VARIOLA. Is an acute and very infectious fever characterised by sudden onset with rigors, headachE', pain in the back and a rash which, appearingon the third day, passes through t;le stages of papules, vesicles and pustules before forming scabs. The rash appears chiefly on the forehead, scalp, hands and feet, and is always more extensive on those parts than on the trunk.

* Extract from the Manual of Instruction for the Royal Naval Sick Berth Staff, reprinted by permission of the Controller of H. M. Stationery Office. Copies of the Manua; can be had of H. M. Stationery Office, Adastral House, Kingsway, London, W.C.2, or any branch, price 4jSd. post free

AID

FIRST

AID

229

It may also appear on the mucouS membrane of the mouth, larynx, and trachea, and on the conjunctivre. At first it consists of papules, which feel like shot under the skin. On the sixth day the papules become vesicles, on the ninth pustules, and on the twelfth scabs form, which, in time, fall off, leaving pitted scars. When the papules have appeared the temperature falls, but it rises again \\ hen the pustules are forming. At present Small Pox is a mild disease in this country. but severe cases, especially in unvaccinat ed persons, are liable to occur at any time. Treatment. -The body must be sponged over twice da;]y, or warm baths g-iven if the patient is strong enough. The mouth must be kept clean and the eyes washed with boric lotion. The eruption is usually covered with some oily dressing, such as vaseline or carbolic oil. A mask may be required to cover the face, and a cradle to relieve the patient of the weight of the bed-clothes. Feeding- may be difficult if the rash involves the mouth. Complicatians.-The following sometimes occur: Laryngitis, or inflammation of the vocal chords. Bronchitis or Pneumonia. Inflammation of the eyes, sometimes resulting in blindness. Otitis Media. Septiccemia.

All c:>ver th~ British Isles, Works' M~nagers,. Factory M~nagers, Colliery Managers and all large and small

MEASLES OR MORBILLI.

mdustrlal concerns are now bustly seektng the ass1stance of fully-trained First-Aid men in order to maintain the · efficiency of their work-people . .. Sp~cial departments ar~ being or.ganized in most Factories, Shipyards, Collieries, Workshops, etc., where tnJunes cannot only rece1ve first-a1d treatment, but upon being discharged by the surgeons can receive massage treatment and so decrease the rehabilitation period.

Is one of the most easily transmitted of the communicable diseases. It is infectious before the rash appears and while catarrhal symptoms persist. The disease commences like a cold, with sneezing, running of the eyes and nose, headache, cough, and a slight fever. On the fourth day the rash appears on the forehead close to the edge of the hair and then spreads downwards to the neck, chest, abdomen and limbs. It consists of dull red papules grouped tog'ether, forming half-moon patterns, but leaving white skin between. On the mucouS membrane of the cheeks minute bluish spots, called Koplik's Spots, may be seen. . .. The rash fades in the same order as that 111 whIch It spread, leaving- more or less staining of the skin. Convalescence is rapid unless complications set in. Treatment.-The chief danger is from complications of the Respiratory system. Special attention should be pa ic1 to the cleanliness of the mouth. Sometimes a steam tent is requirej. Complications.-Bronchitis, Pneumonia, and Otitis Media, may occur.

SP ECIALLY TRAINED Research has sho.wn that the convalescent period is reduced by as much as 80 per cent. where adequate follow-up therapy 1S. employ~d, and first-aid men are being specially trained by the S.M.A.E. (Swedish Massage and Electncal) Instltute to fulfil these requirements. Now is your opportunity of becoming trained for the great work which lies ahead in this vast fieldevery man and woman skilled in the art of scientific Massage and Manipulative Therapy will be a national asset. TREMENDOUS OPPORTUNITIES . Y.our knowledge of first-aid will be ten times more valuabJe if you can wear the badge of the S.M.A.E. InstItute-the badge of qualification. Trem~ndous opportunities lie before you in this greatly extending field which is now open to you without havmg to leave your present work until you qualify as an expert and can command an expert's pay. For over 20 years the S.M.A.E. (Swedish Massage and Electrical) Institute has been teaching scientific fiLL IN AND POST THIS COUPON massage and numbers among its graduates some of the most successful --~-~------~-----and highly paid men and women in the realm of Massage.

RUBELLA OR GERMAN MEASLES.

Is characterised by a bright red papular rash, appearingon the first day, first affecting the face and in a few hours spreading to the rest of the body. Symptoms are usually mild, consisting- of slight sore throat, headache, very mild fever, anJ enlargement of the glands of the neck. The rash consists of red papules, larg-er and duller than in Scarlet Fever, smaller and brighter than in Measles, and lasts about two days. Treatment.-Confinement to bed (in a well-ventilated ward) until the temperature has been normal for a few days. ENTERIC FEVER,

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FEVERS.

Typhoid fever is caused by t~e Typhoid B~cillus. Infection is generally due to consummg food or dnnk conta~ inated by sewage, flies or " carriers," or by carelessness 111 nursing typhoid cases. Water, shell fish, raw vegatables and milk are the usual sources of infection. Paratyphoid fevers are caused by closely allied bacilli and give rise to simi lar symptoms. The disease is characterised by prolonged fever, and is often accompanied by a papular rash and enlargement of the spleen. Peyer's patches in the ileum become inflamed and ulcerated. If ulceration is extensive, th e blood vessels ma

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FIRST

be eroded, causing hremorrhage, or the walls of the intestine may be perforated, allowing escape of its contents an d setting up pentonitis. Symptoms come on gradually with loss of appetite, aeneral indisposition, and headache. There may be cough, ~nd bleeding from the nose. The skin is hot and dry, the tongue furred, except at the sides and tip, ",,,hich are clean; the abdomen is distended, and there may be either diarrhcea or constipation. The temperature rises a little higher each night durin g the first week, and then remains up with slight rem iss ions. The rash appears about the seventh day on the abdomen, back, and lower part of the chest. I t consists of fairly large, raised, rose-pink spots, which fade on pressure. They are usually scanty and come out in crops. Each spot lasts about four days and then fades. Later the patient becomes very weak, and seems too exhausted to care what becomes of him; delirium may occur. During the third week, the ulcerated tissue separates and some blood may appear in the stools. When separation is complete the temperature falls by lysis and is generally normal by the end of the fourth week. As the temperature falls the appetite improves, but convalescence is very slow, and in the fifth or sixth week relapses may occur. Death seldom results from the effects of the fever itself, but is due to some complic~tion. Complications. - Those which may occur are: In the first week, High temperature, Delirium, Exhausion ; in the second week, Pneumonia, Bronchitis, Pleurisy i in the third week, HGemorrhage, Perforation ; lat~r, Throm bosis, Relapse. Treatment of Enteric Fever.-The patient is usually nursed on a water bed. A draw sheet is essential. The body must be sponged all over, night and morning, special attention being paid to the lower part of the back and the buttocks. After thorough washing, these parts are rubbed with methylated spirit and a dusting powder used . The mouth, tongue and teeth must be frequently cleaned. At least two nurses must help to turn the patient or alter his position in bed. The bed-pan or urinal must be placed in position for him; he must be handed the feeding cup and not allowed to exert himself in any \\"ay. All excreta and soiled linen must be at once removed and disinfected. I Vasil )'Oltl' hands after t()lIciz1'ng tlte patient, the bed, the clothing, or al~)' utensil. Diarrhcca. -[}o not tire the patient by frequently lifting him to place the bed pan, but let him pass his motions on to pads of tow or cotton wool. Be caref ul to clean the buttocks afterwards. Constiration.-Is fairly common, and may be relieved by a simple enema, or half an ounce of liquid paraffin. Convalescence.-Is very slo"Y. vVhen stron g enough, the patient is allowed to sit up in bed, supported by a bedrest. There is always a danger of straining his heart by too early exercise. Feeding.-This is a very important part of the treatment. From the time e nteric fever is suspected, no solid food must be given until the temperature has been normal for at least ten day". Milk is the chief food, and about three pints are given in 24 hours. The feeds are given regularly every two hours, and consist of five ounces of milk diluted with three of water, barley water, or lime water. Peptonised milk, whey, or albumen water are used when ordinary milk does not agree with the patient. For thirst, freshly made lemonade, barley water, or cold water are given.

FIRST

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I ILLUSTRATIONS OF BANDAGING AND FIRST AID By LOIS OAKES, S.R.N ., D .N.

Prospectuses (ree on app Ii cation to

INDI\'IDUAL TEST ( 1 os. 1 and 3). -You t'vvo are entering this station at 10.5 p. m. when you are attracted by a noise on the opposite side of the road. On im'estigation you find a man lying on the ground. \Veather cold and dry. Time allowed 5 minutes.

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Re-examine bmmorrhage (controlled) Keep leg elevated ... Correctly apply two bandages for fractured jaw Does patient show signs of sickness (no) ... Colour of face (pale), pulse (rapid and weak) Breathing (shallow), skin (cold and clammy) Telephone doctor and ambulance Obtain blankets and apply Hot water bottles asked for and prepared Undo tight clothing Obtain name and address; send tactful message General efficiency ...

23 1

NEW BOOKS

Other food may be g-rad u ally added by the Medical Officer, s u ch as egg-flip, jellies, c ustard, junket, or Benger's Food. Cream, tea, butter, etc. , may be allowed. When the patient is convalescent, he is allowed boiled bread and milk, thin bread and butter, eggs (poached or boi led) ; then fish, mince, chicken, chops, etc., until he is fit to have full diet. The patient's friends frequently attempt to smuggle food into hospital for him, under the mistaken idea that he is being starved. The nurse must be on the look-out for this and report any such attempt to the Medical Officer. (To be concluded.) - - --. _ . - - -

Appreciate darkness: procure lights Speak to patient; What happened (patient mumbles and points to jaw One bearer goes for first aid kit Any visible hcemorrhage (yes, left leg) Expose wound, colour of blood (dark red) Flowing from both sides of the wound (yes) Examine leg for signs of fracture (nil) EleYate leg, apply direct digital pressure Remo ve any constrictions from limb Apply bandage below and above wound ... Antiseptic to wound and surrounding skin Cover with dressing, cotton wool, bandage firmly Appreciale cold night Rapid examination for other injuries Find irregularity, etc., jaw (no other injuries) Support for jaw Convey patient to shelter; 3-handed seat...

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Th e address of 1\1r. A. E. Turtle, secretary of the Hospitallers' Club, is now 17, Gloucester-drive, London, N.+.

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Dr. Wm. C. BentaII, O. B. E. (Assistant Surgeon-inChief, S.JA.B.), has been appointed by the l\linistry of Health to the South East Region as from April 1st, to assist the Regional Hospi ta l Officer in A. R. P. Training and Operational Work. Ten teams from Cleveland l\lines competed for the "\Vharton" Ambulance Shield and the ,\Iine Owners' Stretcher Cup on April 6th. North Skelton ;\ 1ines ;\, 257 marks, gained the Shield and mcdals, whilst the B team of (he same mines won the cup .

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E must produce more ~oods, .say G?\"ernm.ent spokesmen. In all ntal national wdustnes maximum production must be reached and maintained: W

In this effort, the First Aid Department of every Prompt and effective .FIrst A.~d ~a~ ~reatly reduce lost time through minor 1I1dustnal InJunes among skilled workers-and thus help to maintain production. v\~orks ~an play an important part.

It is for this ,:err reason that so many big engineering firms are now uSJOg T. C. P. as their standard First Aid Antiseptic. They have proyed by actual tests that the use of T. C. P. on all injuries, however slight, results in:-the practical abolz"fl"on of cases of sepsIs /

-a big reduction in the average iL"me taken for 771£nor hljllries to heal or clear up. Why. d~es T. C. P. I?ive these results? Simply because It IS a new kmd of antiseptic with special therapeutic properties. In preventing sepsis, T. C. P. has a double action. First it acts as a powerful and penetr~ti.ng germicide. Second, it actually stimulates the actIVity of the leucocyte cells in the tissues, which the~selves attack and destroy infecting germs. Then agall1, -r:. c. P. has an exceptional power of relie\'ing pain and rapidly reducing- inflammation. And because it is absolutely free from irritating or caustic action healincr is particularly c lean and rapid when T.C.P. is ~sed. 1-> If you are in charge of a First Aid or \Velfare Department, you should have the facts about T. C. P. A copy of the T. C. P. First Aid Book. and also a trial bottlc, will be sent free on request to-British Alkaloids Ltd., Dash wood House, Old Broad Street London E.C.2. ' ,

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23 2

Queries and Ans'Ners to Correspondents. 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 FIRST AID, 46, Cannon-street, London, E. C. 4. 2.-AII Queries must be written on one side of paper only.

3.-All Queries must be accompanied by a " Query Coupon" cut from tbe 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 39th (1937) Edition ot the S.].A.A. Manual of First Aid to the Injured. ARTIFICIAL RESPIRATION WITH FRACTURED RIBs. W. B. (Oeal). - vVill you please advise me on the best method of adminis tering artificial respiration in the case of a patient suffering from fractures of the ribs? Of course you realise that the diag-nosis of fractured ribs in an asphyxiated person is a most difficult proposition and that they are often missed in an emergency! Be that as it may, I consider that Schafer's method is the correct method of artificial respiration in the treatment of a patient suffering from asphyxia and fractured ribs, because pressure is exerted on the loins (namely, the space between lowest rib and crest of ilium) and not on tile ribs. On the other hand, Silvester's method results in a big pull on the ribs, with consequent risk of simple being con verted into complicated fracture of the ribs. - N. CORBET FLETCHER . EXAMINATION HOWLER. vV.S. (Birmingham). - In a recent examination I asked a car:didate the treatment of a bite by a poisonous snake; and I was vastly amused when she replied :-" Remove tlte stt'ng and apply the blue bag! " Good!

Next, please! !- N.C. F.

TREATMENT OF FRACTURES OF TIlIGH AND LEG. W.J. (Chesterfield). ·-At a recent practice at our First Aid Post a team of four of us were a sked to treat a patient whose supposed injuries were simple fractures of the thigh and of both bones of the leg. These injuries broug-ht forth four diff~rent opinions as to how they should be treated. So we welcome your kind advice. Also, can you tell me where I can purchase allY book which gives the treatment of multiple injuries, with which, I feel sure, we shall have to deal should we ever get any air raids? It is, in my opinion, essential .hat-whenever, and also as far as, p0ssible- each of several injuries should be treated separately. Such action facilitates the task of the doctor who takes over the patient from the first aider and is thereby able to examine each injury separately. With the combination of injuries named you would first control the fractured leg. This done, you would fix the fractured thig-h and complete your treatment by tying limb to limb. So you would ensure that neith<!r fracture will be converted into a compound and /or complicated one during transport.

AID With recrret I know no book which teaches the treatment of case~ with multiple injuries.-N.C.F. ACTION OF SYMPATHETIC NERVOUS SYSTEM. J.H (Beckenham).-The Black Book describes Shock as a (, sudden depression of the nervous system," etc. At another part of the book it is stated that there are two nervous systems, i.e., the Cerebro-Spinal and the Sympathetic. Text books g-enerally state that the nerve systems are the Cerebro-Spinal and the Autonomic, Hnd that the latter is divided into the Sympathetic and the Parasympathetic systems (which mo~tly work in opposition to each other). I shall much appreciate your opinion as to which of these nervous systems is mainly affected by shock as referred to in the book.

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The answer to ) our query is to be found in the last parag-raph on p. 153 of the Textbook, where you are told that the Sympathetic System" controls the involuntary muscles and reg-ulates the vital functions of the body." Shock being a condition of sudden depression of the nervous system, it follows that it is always accompanied by a more or less severe disturbance of the vital functions. Incidentally, you appear to be dehing more deeply into anatomy and physiology than is necessary for the proper practice of first aid.-N.C.F.

3/2 POST

TREATMENT OF PATIENT WITH MULTIPLE INJURIES.

"Vv'.A. (Halifax).-At a recent practice we were given the case of a goalkeeper who has been char~ed heavily against the g-oal posts and sustains the followinginjuries-complicated fractures of right ribs (patient cou~hing and spitting brig-ht red frothing blood). Simple fracture of right clavicle and scapula, black eye, bitten ton~ue and sprain of left ankle. A collection of injuries like this has naturally led to arguments. So we are asking you to give your ruling please. Of course, the ribs are the most serious injury and after this the scapula which, if left alone, may do a good deal of damage. So if the fractured scapula be treated as laid down in the Textbook (p. 82), how can the clavicle be treatc.>d. Further, if the patient be turned towards the injuries. as is taught in the Textbook (p. 80) under treatment of complicated fracture of ribs, what happens to the two fractures in the shoulder region? With a patient who is suffering from such multiple injuries shock would be very marked. You would, therefore, concentrate on the treatment (If this condition and content yourself with placing- the right upper limb in a large arm sling. The essential ohject of your treatment would be the rapid and safe transport of your patient to medical aid at the first possible moment. Incidentally your sug-g-estion that a fractured scapula can" do a lot of damage" is contrary to fact.-N. C. F. TREATMENT OF CORROSIVE POISONING. W. N. (Rossendale).-On page 171 of the Textbook it says: I I If an acid is known to be the poison, give . whitening, chalk or magnesia." Then again, further on it says, " . if it is not known whether the corrosive poison is an acid or an alkali, g-ive copious draughts of cold water, or of milk." On page 165 of the February issue of FIRST AlD, under antidotes for Oxalic acid poisoning, it says, " Do not give soda, potash, ammonia. or magnesia." Then again, lower down, for Disinfecting fluid it

233

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FIRST AID TREATMENT OF Shock; Ha:morrhage; Bu rns and Scalds; Fractures; Dislocations; and other subjects. POISONING. BANDAGING Complete 12 page (7 Plates) Section. WAR GASES Description and Treatment.

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FIRST

234

says, "O n no acco unt ~ive water:" . 1 wish yo u would kmdly elu cidate those pomts. The Textbook recognises that in an emergency, when a corros ive has been swallowed, there may be difficulty in deciding (a) what i:. the specific poison and (h) whethe~ it is a n ac id or alkali . In these circumsta nces the teaching of the Textbook is general and correct. On the other hand the Manual of Instruction for R. N. S. B. Staff which yo u q uote, ' is com piled for orderlies who a re dealing with patients in hospitals; and, since special facilities a re there ava il able, it goes into more exa~t details with reference to indi vid ua l poisons, such as oxalic acid and disinfecting Auid. You will notice, of course, that, if yo u know that Carbolic or any other disinfecting Au id of its g roup has been swallowed, there is a special line of treatment laid down on p. 173 of the Textbook.-N.C.F. SIGNS AND SYMP rOMS OF SYNCOPE.

G. W. (Manchester).-Please tell me if we are to take the signs and symptoms on page 165 of the Textbook to refer only to the condition of sy ncope or a lso to the conditions of shock and coll apse, as in the 38th Edition on page 162, where it states they a re the same? I know the 39th Edition deals specifically with shock, although the signs and symptoms of collapse are not mentioned! Syncope, Shock and Collapse are progressive degrees of depression of the nervous system. It, therefore, follows that the signs and symrtoms of Shock as given on p. 44 of the Textbook are similar to those on p. 165 for Syncope. In other words you would expect the same signs and symptoms in all three conditions . It is strange that the Textbook says nothing about the siQ;ns and symptoms of Collapse. As a fact, however, the causes, sig-ns and symptoms of this condition are the same as those of Shock, except that its muscular relaxation is more complete and the patient is usually totally unconscious.-N.C. F. TREATMENT OF

SCALDED

THIGH.

M. S. (Redland). -In treating a patient with a scalded thi~h, when medical assistance or hospital is readily available, should we place the cotton woo l and bandage over the trouser leg or next to the skin? As YOlt cannot diagnose a scald unless (and until ) you have examined the injured part, you should unbutton the trousers in the circumstances named and confirm the presence of a scald. This done, yo u should slip some cotto n wool between trousers and scald sufficient to cover scald , rebutton trousers and remove to hoo:pital.-N.C. F. SLING FOR FRACTURED FINGERS AND PALMAR

BLEEDING.

A.K. (Douglas, LO.M.).-During a discussion amongst several first aiders in this Island recently, a matter a r ose relative to the correct arm sling to be used for the support of the injured limb in an accid ent in volvin g severed palmar arches compli cated by two fractun d fingers. Other injuries received necessitated the removal of the pat ient in a sup ine position. I might add that the bleeding had be~n co ntrolled by pressure on the radial a nd uln a r arteries , the wound dressed, an d a bandage-to r etai n a dressing on the hand-applied. In the treatme nt of the fra ctured fi ngers, a padded splint had heen app lied over the r eta inin g bandage. Your valued opinion would be much app reciated as to whether, or not, the large a rm sling (used in the case of the crushed hand) sh ould be used in preference to the St. John sling laid down in the treatme nt of severed palmar arches.

FIRST AID

AID

I •

\tVith this combination of illjuries, the severed palmar arches co nst it ute the more serious co nditi on from the standpoint of first aid, and demand priority in treatment. Consequently, I would s upp ort the hand when treated in a St. J ohn sling.-N.C.F. TREATMENT OF FRACTURED

FIRST AID HANDBOOKS

GET A

KNEECAP.

P.e. (Hounslow).-Please tell me if Bandage C, which is used in the treatment of fracture of kneecap (Textbook, p. 90) is commenced on the sp lint or o\'er the in step. Bandage C is commenced over the s plint. Otherwi se diffic ulty would arise in the completion of the double figureof-eight ba ndage.-N.C.F.

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A.C. (Selby).-Pages 190-162 of the Textbook d eal with "insensib ili ty when breathing- is present an d there are convulsio ns. " The poisons mentioned o n p. 162 are prussic acid, cyan ide of potassium, an d f un g i and berries in later stages. No mention is made of strychn ine, although the s ig-ns a nd symptoms of t hi s roison are described on p. 175 among the poisons which require special treatment. Is strychnine omitted from p. 162 for some special reason, please? Strychnine is peculiar in that, circulatin g in the blood, it attacks the cells of the spinal cord and so causes the characteristic conv ul sions. There is no loss of consciou sness except when death is imminent. Indeed the patient is ge neral ly acutely conscious and suffers from great anxiety. Death usually occurs from asphyxia during a conv ul sion though it may result from coll apse between the conv ulsions. Now you know why the Textbook does not includ e strych nine among the poisons which may cause insensibility ~ ith convulsions.-N.C. F. FOUR-FOOTED FIRST AIDER.

E. H. (Wimbledon Park).-Some days ago I was thrown from my bicycle through the failure of a brake, an d my left knee was rather badly lacerated. I sat down at the side of the road and immediately ~ beautiful Labrador retriever appeared and showed the grearest concern. He licked my fa ce affectionately several times, ran around me, pawing me gently, as thoug-h to say, " P001' dea1', whe1'e is the bad place? " Finally, he sat down close beside me on the kerb (my arm round his neck) and there remained in si lent sympathy until I was wd l e nough to go on. I thanked him most g ratefu ll y, and he stood and watched me off, then trotted away round the corner as si lent ly as he h ad come. All this time he had not made a sound. He quite took my mind off the little accid ent; and I am sure no two-feoted first a ider co uld have given better" treatment for shock ! " Good! Your story reminds me of another incident in which a big retriever played his part. A small boy, running across the road, fell in front of a rapidly advancing ca r and was in danger of being run over. Before any of the onl ookers could act, the dog had dashed into the road, grabbed the child by his clo th ing, carri ed him across the road and pl aced him safe and unhurt upon the o ppos ite pavement. He then trotted down the street without furthtr delay. So, next please! !-N.C.F.

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VOL. XLVI. NOTICE

GEO RG E

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Annual Report of the S.J.A. B. A. R. P. First Aid Services A Simple Treatment of Wounds'" S. ]. A. B. Headquarters and Dist';ict Rep~;~s Railway Ambulance News Metl:od of Transporting a Pati'~~t with' 'Seve re 1ll Jury to Jaw ... ... Police Am bulance News Methods ot Sterilizing Instru mE'~'~s Fract ure of the Shaft of the Hum erus The Hospitallers' Club ... Fevers Head Injuries'i~ War ::: .. , Ne w Stores Manager a t St. Juhn'~ GatL' ._ . Ho me Service Ambu lance Committee A. R. P. Topics Ou r Nurse!;' Pages . .. St. John First Aid Courses

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FI RST AID. i~ pu.blished on the 20th of each month Th e Annual SubscClptlOn IS 4s. post free; single copies 3d. . It.s aim and object bei.ng the advancement of Ambulance Work In all Its branc~es, the ~d~tor invites Readers to send Articles and Reports on subjects pertammg to the Movement and also welcomes suggestIOns for Practical Papers. All Reports , &c., sho uld be addressed to 1he Ediror at the address below, and should reach him before the 12th of e::tch month and must be accompanied (not necessarily fvr publication) by th~ name and address of the Correspondent. Subscrif,'t ions, Advertisements and other business Communications connected With FIRST Al D shuuld be forwarded to the Publishers. DALE, REYNOLDS & Co., LTD.,

CONTENTS

CRAFT

JU NE, 1940.

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252 252 252 252 252 252 252 254 25+ 25+ 25+

SIR JOHN DUNCAN, Ch ief Commissioner, in his annual report REPO RT OF for 1939 sets out increases wb ich THE S.J.A.B. are, undoubtedly, due to the fact that the general public have now realised the importance of first al'd training. ANNUAL

The personnel of the BriO'ade . ncreased by b 1 31,563 and now numbers 1?1 '708' ,.:J ll1 E nO' I an d

Wales, Northern Ireland and Eire. Ne :u7 30~ · . . y new d lVISlons were formed brinO'inO' the b0' ranc ! b b total to 2,831 units. These increases are not confined to any particular area but in districts all over the country. Cases of accident and sudden illness which recei ved attention were 130,565 fewer than in the p~evious year, bu~ the total figure of 622,183 is sttll one which gives satisfaction to tbe members. Motor ambulances of tbe Brigade carried 101 )875 cases, travelling 1,419,501 miles. At civil hospitals, clinics and welfare centres 186,322 attendances, an increase of 150,000, were made by officers and nursing sisters. There are nO\\1 +30 roadside buts, 677 first aiel posts and 663 first aid cabi nets establisbed on main roads; and treatment was given in 21,987 ro ad acciden teases. Since the commencement of the war the activities of the Brigade have greatly increased. I n A.R.P. close co-operation with tbe Home Office has been maintained, and many members are doing part-time duty. The total of 1,606 reservists of the R. N. S. B. were mobilised on A ugust 25th, whilst l\lilitary Hospitals were mobilised on September r.\ st. The total numbe r of Brigade members mobilised in the R.A.M.C. at the end of last year was 2,+00a magnificen t effort.

23 8

FIRST

.I.ID

FIRST

----------------------------------------------

A.R.P. First Aid Services. By OUR SPECIAL CORRESPONDE!,;T. My article of last month has resulted in a large number of letters being received by the Editor and, with one exception only, they are all in full agreement with the findings of my investigation. The solitary disentient is a reader who signs himself with the not exactly original name of " First Aider." In somewhat abusive and bitter terms, he condemns the whole article, and yet the only reason he puts forward is that first aiders in A. R. P. Posts have no reason to be paid. He seriously asserts that first aiders are only paid for playing darts (how that very feeble joke irritates, apart from being in bad taste) and, by way of contrast, points out what" he " is doing voluntarily, apart from what "he" did in the last war for sixpence a day. Moreover, he questions the statement that some workers gave up a full-time job to enter A. R. P. Services, and that the position of the first aider is in no way comparable with that of the munition work. I am afraid that the opinions of "First Aider" are based on some personal factor rather than on actual fact, because I am perfectly satisfied with the correctness of my statements. My opinions are unprejudiced and the results of careful investigation. Incidentally, service in the last war was not exclusively confined to " First Aider" (who seems to be extremely desirous of resting upon his laurels). The number of ex-service men at stretcher party depots, etc., is an extremely appreciable one and, without wishing in the slightest to belittle" First Aider's" war service, I would point out to him that the present problem is that of to-day and to-morrow and not of twenty years ago. Nevertheless, there is an interesting problem arising out of the question of salary. Without entering into the relative personal dangers of the fighting forces and the A. R. P. services, the average cost of maintaining a soldier is at least half as much again as that of the full-time stretcher bearer who, apart from an overall suit, pays for his own clothing, food and fares, and has no marriage or dependent allowances "First Aider" suggests that all first aid in A. R. P. should be done by volu ntary workers. I quite agree -if there are sufficient people forthcoming who are able to devote the time to do so and still earn their livings by their ordinary daily tasks. Unfortunately, sufficient voluntary workers are not forthcoming-hence the need for the fulltime man. The remedy for the objectors to salaried fulltime A. R. P. workers is obvious. Further discussions with first aid personnel have convinced me that there will inevitably be some considerable overlapping of duties until such time as that they all have had experience under working conditions. Nevertheless, the position might be clarified. The ambulance services, stretcher parties, and first aid units will all of necessity render first aid and, in addition, air raid wardens, firemen) police, and the rescue and demolition squads will hold the first aid fort should the occasion arise. The standard of first aid in the police has become increasingly high in recent years, numerous air raid wardens are now extremely efficient, and the A. F. S. in London, which had previously learned the principles of first aid on a purely voluntary basis, is now making preparation to train its personnel in the subject as part of its routine official training. Responsible bodies and officials have repeatedly asked me where the line of demarcation between the function of the various~ ections lay. A. R. P. handbooks do not sufficiently clarify the position, but in fairness to the authorities it must be realised that first aid is everybody's concern, and that in actual practice it will so work out that the patient will be given progressive first aid until at the hospital

or first aid post final treatment will be administered according to the needs of the particular case . I have frequently been asked a n extremely important question during first aid lectures. The first aider wants to know how on earth it will be possible for them to apply slings, bandages and splints, etc., in the approved manner under working conditions. The query is a reasonable one. The extent of the first aid administered will depend upon several factors, the most important of which are-the number of patients to be treated, the amount of help available, the relative importance of the various casualties, the quantity of equipment available, the available transport facilities, and the condition of the weather and extraneous surroundings. The first aider must learn to strike a happy medium and utilise his resources to the best possible advantage. It might so happen, therefore, that we may "overdo" first aid. In competition work there is frequently only one patient and four first aiders, whereas in everyday conditions the reverse will be more likely to happen. Therefore, there may have to be an "immediate" first aid as opposed tu the" orthodox" variety, and it will consist solely of controlling haemorrhage, treating shock by urgent methods, and as far as possible controlling injuries by rapid methods, such as tying injured lower limbs together, and binding an injured upper limb to the trunk. Finally, I would like to refer again to my comments regarding friction between the rank and file in the organised first aid bodies. Cases have now come to my notice in which Medical Officers of Health of certain boroughs have asked members of both bodies to curtail their propaganda activities because of the friction that frequently ensues. In last month's issue the Editor appealed for the" hatchet to be buried-not that there should be a "hatchet" in the first place. We have now become amalgamated in the A. R. P. Services, so, without losing our individuality, let us loyally co-operate with all our colleagues. We all have much to learn from one another-and even a " granny" knot is better t han no knot at all ! )J

St. John Ambulance Brigade HEADQUARTERS AND DISTRICT REPORTS. Brigade Headquarters . District. Staff Officer J. ~annam has been appointed ASSIstant BrIgade Secretary, VIce-Asst. Commissioner H. J. Wrigglesworth transferred to Stores Manager. Mr. Hannam has passed through the ranks of the Brigade from Private to District Staff Officer with the exception of Corporal and Sergeant. He founded and was Officer-in-Charge of the Horley (Surrey) Division for seven years and, before he was promoted to the No.8 District Staff the Division had 34 fully-equipped members, two ambulances: own headquarters and a road hut. In addition the financial balance was considerable. For several months he was attached to No. 8 District Staff for A. R. P. and general duties and in March 1939 was appointed District Treasurer. ' , With on~ wh~se knowledge of Brigade work extends over. 14 years servJ.ce, mem~ers ca~ be sure that they will receive every attentlOn to theIr enqUlries. STRETCHER EXERCISES.-Instructions on Stretcher Exercises for the Brgade have now been issued in booklet form (4d. post free). Sir John Duncan states that the instructions ha.ve been .com~iled with the object of bringing the stretcher dnll contal.ned 111 the Manual of Drill and Camping up-todate and 111 agreement with that laid down in the official textbook, "First Aid to the Injured," 39th Edition. It is practic?,I1y identical with the stretcher drill of the R.A. M.C., and wIll henceforth be observed for the traininO' of the Brigade personnel. " Exercises. for "Furley" pattern and rigid metal type stretchers are ll1cIuded; also exercises for gas warfare and dimensions of numerous types of stretchers.

AID

239

Supt. L. D. White, Amb. Officer G. E. Mitchinson Mr C. W. Toovey (Commandant, Borough Casualty Se'rvice) and Mr. Craft (Deputy Commandant). Dunng 1939 no less than 12 first aid classes were held 970 .students attending. Forty students attended a hom~ nursll1g class. ~t the outbreak of war numbers of the Division went on full-tune and part-time A. R. P. first aid work j at the end of of last year 18 members had joined the R. N. S. B. and ~.A.M.C. ; 30 engaged on full-time A.R.P. and 70 on parttJme A. R. P. Some 3,286 cases were treated during 1939 and 6,800 public duties performed.

No. IT District COUNTY OF HAMPSHIRE AND ISLE OF WIGHT. During 1939 the personnel in this County increased by ne~rly ~o per cent. The total number, all ranks, is 3,686, whIch ~r:cludes 1,5?3 men, 1,225 women, and 556 cadets. In addItIOn, there IS the County Staff, Reserve, Honorary ?taff and A. R. P. Reserve. The number of divisions has ll1creased by 27. As alr.eady announced, Lady Louis Mountbatten has been appoll1ted County President in place of Lord Templemore, who had resigned. Nearly 10,000 cases were treated, and 3,841 removed by the 8 motor ambulances, "which travelled 42 %8 miles Ruad accident cases attended numbered 4,4-W, ~ith a mile~ age of 2,521. In response to the call for Civil Nursing Reserve, 602 members enrolled, 358 receiving hospital training and allocated to hospitals. Since the outbreak of war many members have Joined H. M. Forces, whilst in A. R. P. 85 per cent of the ambulance and. 68 per cent. of the nursing personnel have undertaken dutIes.

A Simple Treatment of Wounds. FOR thirty years I have used the same method of treatment for all wounds, from a pin-prick to a compound fracture. The method, which is simple, practical and efficient, is one of continuous drainage. Its advantages include the prl?vention of complications, a better functional result than can be obtained by other methods, freedom from inflammation and a minimum of scar tissue. Not only does it prevent sepsis in a clean wound but it overcomes sepsis already established. The technique consists in the application of wet boric lint to the surface of the wound. The boric lint must contain equal parts by weight of boric acid and lint. Immediately before being applied, it must be saturated with cold water and not wrung out. The entire area of the wound is covered with this wet lint, on top of which is placed oiled silk (hest quality), which must in turn entirely cover the lint to seal it off hermetically and keep it from becoming dry. The dressing is kept in place with a bandage or towel. If the correct technique is carried out, the lint will still be wet on the removal of the dressing, even if left unchanged for as long as a week. This treatment has proved satisfactory in such various conditions as compound comminuted fracture of the skull accompanied by laceration of the brain, wound of the h;md due to a pic1<axe driven right through it, severing of all tendons on the back of the forearm by a punctured knife wound, gunshot wound of the hand, wound of the hand due to explosion of a dynamite cap, severe laceration of the hand with severing of tendons by a machine, compound comm inuted fractures of the leg- and arm, and suppurating wounds and whitlows.-PHILlP WEATJlEHBE, M. D. Edin. F.A. C. S., in The Lancet

HEADQUARTERS ADDRESS.-On and after Monday, June 1 ~th, the Headq uarters ?f the St. John Am bulance Brigade wlll be Marshfield, Bmfield, near Bracknell, Berkshire (Telephone: Bracknell 338, extension (10 a m to 5 pm)

B.O.)

. .

All Brigade communications, except applications for forms, should be sent to the new address. The record and routine work of the Brigade will continue at St. J 011l1's Gate for the present. .

No. I (Prince of Wales's) District SOUTIIALL.-Last month, at a concert O'iven by the Contemptibles Concert Party, the Mayor Heston and Isleworth (Ald. H. Collar, J.P.) presented awards to members who had passed an examination in February last. The Mayor, who was accompanied by the Mayoress ~l\1~s ..Collar), thanked Supt. J. E. Taylor for his kind ll1VItatlOn. First aid was a very fine thing and on that Score alone he. counted it a great privilege to be asked to present the certIficates. . ~he Mayoress presented a polished wood and silver biSCUIt barrel to Mr. and Mrs. E. Wilmot, who had done 13 years and six years respect:vely in the Brigade, and to Mr. and Mrs ..R: .G. Colt?n, Mr. Cotton being secretary of the Heston DIVISIOn for SIX years, as a memento of their recent marriages.

ot'

. WATFOHD.-The annual meeting of the Watford DivisIOn. was held on May 27th, Div. Surgeon J. Buchanan preSIded, supported by Ald . G. Timberlake (vice-president),

GLOUCESTER COUNTy.-l\lore than a thousand officials and members of the Gloucester County Men and 'Vomen's voluntary aid detachments of the B. R. C. S. and Ambulance Nursing and Cadet Divisions of the S.J.A.B. attended th~ Annual Parade at Gloucester Cathedral on Sunday, June 1st. Members of both organisations assembled in the Barrack Square and then, headed by the British Legion Band, marched to the Cathedral, where they were joined by the Mayor and Corporation cf Gloucester. Amongst those present at th e Service were the President of the Gloucester Red Cross Society, The Dowager Duchess of Beaufort, Lord and Lady Bledisloe, Lady Berkel)" Sir Frederec and Lady Cripps, Mrs. Talbot Rice, Lord and Lady Bathurst, Countess of Berkely, Lady Marling, Lady Tubbs, Miss C. D. Allen (County Director of the Red Cross), l\1iss Faber (County Officer, S.lA. B.), Col. Stewart (Assistant Commissi oner, S.]. A. B.), and many other County and Corporation Officers. I n the unavoidable absence of County Commissioner Dr. Barrett Cardew owing to indisposition, Assistant Commissioner H. J. Lewis was in charge of the Parade. The Service at the Cathedral was taken by the Dean of Gloucester (Dr. Costly White), who described the selfsacrificing work of the two or~anisations as Christianity in Action and said that they had reason to be grateful for the great service rendered alike in war-time and peace-time to their fellow men by members of these or~anisations. As the parade returned to Barrack Square for dismissal, The Dowager Duchess of Beaufort and Lord and Lady Bledisloe took the salute. The procession left a deep impression upon the large crowds .vhich gathered en route. It "vas one of the most impressive demonstrations of

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voluntary service in ministering ~o the needs of the s ick and wounded ever witnessed in the City.

No. VIII (Duke of Connaught's) District Owin~ to the present emergency, the District Headuarters at Folkestone have now been closed, . q lL is necessary that the District sho~ld co.n tlnue ~o function with its usual efficiency, and w~th this. end In . C ommlSSloner ., E . A . Richards has hO'iven notIce that Vlew d until further notice all correspondence should be addresse to 1, Beaumont-court, Beaumont-street, London, 'vV.1. HORsHAM.-District Officer W. ]. Noble, assis~e~. by Corps Officer F. A. Trott, inspected the Horsham DIVISIOn on May 7th. Excellent work was demonstrated and the men smartly turned out. The Inspecting Officer, commenting on the parade, said-" You are a credit to our great movement. Keep it up ! " PORTSLADE.-The annual concert and presentatiojn of awards to members of the Portslade Ambulance and N ursing Divisions was held last month . !he Mayor and ;\layoress of Ho ve (Councillor A. W. HLllman, ].:., and Mrs. Hillman) gave their support to the concert, which ",'as given by the Kingsway Entertainers. During the interval, the badg'es of offi~e .",,-ere presented to Presidents and Vice-Presidents of each divISIOn; also first aid and home nursing- awards to members. District Officer 'w. ]. Noble, who made the pres~nta tions, paid 3 warm tribute to the keenness and enthusiasm of these newly-formed divisions. Di\·. Surgeon E. N. Gorman made aI', appeal for more funds to equip these active sections.

No. IX District PENzANCE.-Before the annual meeting of the Penzance Division, Canon H. R. Jennings (Vicar of Madron) dedicated the new auxiliary motor ambulance. The Mayor (Ald. ] ohn Birch, ]. P., C. C.) ~resided at the meetinl{, supported by the l\layoress (MISS D. P. Harvey, ]. P.). Canon Jennings drew attention to the voluntary nature of the work of the Brigade. He also outlined the history of the Order. Supt. T. C. Cooper said the new ambu lance filled an urgent need. He referred feelingly to those who were absent, having answered the call of service. The annual report was presented by Amb. Officer W. H. Maycock. Twenty-four members were serving with H.M. Forces; all members were voluntary workers with local A. R. P. services. The divisional .-:ompetition team had won the County Shield, Sergt. Scarborough (the leader) gained the county individual cup. Removals totalled 352 (1,852 miles), whilst 17 road accidents (121 miles) were attended. Amb. Officer Maycock paid tribute to Supt. Cooper's work-he had actually been present at no fewer than 286 of the 352 cases. The Hon. Treasurer (Mr. R. W. Smith) presented the ilnancial statement. The Mayor, who presented awards, thanked the members for their work. Congratulatory speeches were also made by the Mayoress, Dr. F . Chown (Div . vice-preside nt), Dr. G. A. W. HaU, and County Offict:r Dr. R. H. Hadfield.

FIRST

AID No. X District BISHOP'S STORTFORD.-On May 19th members of the Bishop's Stortford Division h a d th eir ~rst experience of loading stretcher cases o n to a Green L1I1e coach adapted for ambulance purposes. . . The test was watched by County CommlsslOner H. Lan~ley Jones, who later inspected the. Divisi?r;t ! Countess of Lytton County President of Nurs!l1g DIVISions j Dr. Wells Co~nty Officer G. Widdicombe and Corps Officer W. Forbe's accompanyi ng the in specting officer. . Eight casualties were treated and loaded 1I1tO the coach which had bee n adapted to carry eight stretch er cases. The County Commissioner exp ressed pleasure at the number of men and nurses on' parade. The work of both Divisions was exceptionally good.

CHELII1SFORD.-County Surgeon J. T. Whitley carried out the annua l inspection of the Chelmsford A~bulan.ce, Nursing and Cadet Divisions on May 19th. The 1I1spectll1gofficer, who was accompanied by Lady County Supt. Mrs. Smellie and County Officer Norfolk, congr atulated the parade.

ST. ALBANs.-Increased membership, a steady fi n anci~l position, and the accnmplishment of much valued work 111 the training of new members, was. ~eported at the annual meeting of the City of St. Albans DlvlSlOn on May 18th. County Commissioner H. Langley Jones presented to Supt. G. Anderson the Service Medal of The Order. The President (Mayor of St. Albans, Mr. T. F. E.lm) added his congratulations to those of the County Commlssloner. Th'e past Hon. Secretary (Serg-t. . A .. A. Kitching) reported an increase in personnel of 33 bnng1l1g the total to 64. Ten members had joined H. 1. Forces. The attend ance at drill and public duties had been good and some sao cases received attention. The financial report was given by the Hon. Treasurer (Mr. F. J. Harwood, O.B.E.). . The reports having been adopted, the Mayor l?ald warm t ri bute, on behalf of the City, for the work the Bngade was doing. . ·Supt. Anderson thankej Mr. Kitch in g ~or hiS p.ast services as Secretary, a position he bad now resIgned OWlng to pressure of National importance work. Mr. L. W. F. Stokes was succeeding him . Div. Surgeon n. Hardy Kinmont, in reply to a vote of thanks, cong-ratulated the members on their keenness and said that it helped him in his work when members were interested in their work. The Mayor, who presented some. 30 awards, was thanked for his presence by Dr. Hardy K1I1mont.

INCREASE OF SUBSCRIPTION RATES. We much regret that owing to the increase in postage rates, we are compelled to raise the cost of subscriptions to "FIRST AlD." In future it will be 4/- for twelve months, instead of 3/6. We trust the time is not far distant when we can return to our normal arrangements.

Railway Ambulance News.

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AID Mr. Reid h a d been employed as loco fireman on the L..M.S., and his chief interest lay in ambulance work on the ratlway.

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Great Western. HONOURS.-As a res ult of r ecommendations from the Great 'Western Railway Central Ambu lance Committee, the following member" of the staff, who have rendered e?{cellent service in the furtherance of the Movement over a long period ot years, have received r ecog nition from the Order of St. John of J e ru sa lem : OfEcer (Brother).-l\lr. George J ackson, Signalman, Gloucester. Serving BrotherS.-Mr. A. Griffiths, Signalman, Pontypool-road; Mr. J. Payne, Syphon Pumper, Swindon j Mr. J. Huish, Stores Issuer, Exeter; Mr. J. Fox, Signalman, Aberdare; Mr. A. "V. H. Christison, Divisional Locomotive Superintendent, Newton Abbot j Mr. C. E. Bird, Goods Guard, Landore ; Mr. W. C. Drinkwater, Clerk, Gloucester. Serving Sister.-Miss R. A. Marsh, Clerk, Paddington.

DRINNICK MILL.-The annual presentation of alJl'ards to members of the Drinnick Mill class took place at the station recently, when Mr. H. Nodder, Asst. Div. Engineer, Plymouth, presided, and among others present were Dr. C. M. Wilson of St. Dennis, and 1r. W. R. Hill, J. P., St. Blazey. In his report on the activities of the class, the secretary, Mr. M. J. Rich, ]. P., referred to actual first aid rendered by many of its members during the year, and to the fact that they had also provided instruction for A. R. P. wardens at Lanjeth, Foxhole, Nanpean and adjacent districts, as well as to a women's class and a pack of Cubs at Nanpean. The awards, including a gold medal for 15 years' efficiency to 1\1r. W. R. Hill, were presented by Mr. Nodder, and the function was followed by tea, after which an examination of the members was held by Dr. Wilson.

BRIDGWATER AND DUNBALL.-:\1embers of the Bridgwater and Dunball ambulance class received their awards at a smoking concert, held recently, at the hands of the Mayor of Bridgwater, Councillor W. ]. Farthing, when the local A. R P. and fire fighting service were also represented. Mr. E. F. Cawse, station master, was in the chair, and "'\lr. L. G. Robinson, class secretary, gave an encouraging report of progress during the past year.

London, Mid land and Scottish. CAMDEN.-The annual individual competition of the Camden Goods was held on May 18th. The judges were lessrs. G. E. Crah, S. ]. Hattam and F. J. Tull; lr. S. A. Purves heing- the competition secretary. Each competitor had to undergo three tests, and at the close Mr. H. Salisbury was declared (he winner, followed by H. G. Aldridge and W. T. Salisbury, second a nd third respectively. Thanks were extended to the judges for th ei r assistance, a nd the hope expressed that more competitors would enter next yea r.

ST. ALBANs .-Members of the Sr. Alb ans class formed a guard of honour at the funeral of NIr. J ames Dowie R eid , who died s uddenl y on Sunday, May 26t h .

Th e annual competition for the St. Pancras ambulance cup, presented by the Dining and Refreshment Club for competition among cartage and porterage staff, was held on Jun e 9th, when t\lr. S. A,. Purves judged the work done. Mr. J . Hickey gained first place with S6~ marks followed by 1\ lr. A. Eyres, 43t, and Mr. J. Chopping, 37!. ' Mr. A. Dite was the competition secretary.

London and North Eastern. NORTH EASTERN AREA. The" Wharton" Shield Comp~tition Final was held at Gateshead on May 18th, when the six district competition winners presented themselves before Dr. K. H. Beverley, of vVorsbro' Dale. The team test setting was that of a station platform. A m?n attempting to board a moving train missed his footing, and was found one yard from the platform edg-e unconscious and left arm saturated with blood. Injuries included consussion, compound fracture left humerus and fractured right neck of femur. The individual tests were varied . 1\1r. C. 1\1. Jenkin Jones, General i\lanager, N.E. Area, who was accompanid by Mrs. Jenkin Jones, and supported by Dr'.]. Donald Gunn(L.N.E.R. ".\lec.lical Officer), District Officers and others, said it was gratifying to note that the num ber of classes had risen from 188 to 2-+9, and enrolments from 1,300 to -+,730. He expressed his appreciation of the good work done hy the District secretaries and committees, and said how well deserved was the promotion of 1\lr. S. Cooper (Centre Secretary) to Officer (Brother) of The Order. He also thanked Dr. Beverley for his good work as judge. Mr. Cooper announced the result, which was as follows: -1st, York C. & \V. Works, 152t marks; 2nd, Tyne Dock, 150~; 3rd, Leeds Wellington Street, 149t; -+th, Hull Dairycoates, 125 j 5th, Darlington Engineers, 119!; 6th, Saltburn, 96. The General Manager presented the Championship Shield to the winners and the Hornsby" Cup to the runners-up. He also presented Service Bars and Medals as follows :-i\lr. F. Rae, 25 years' har j :'Ill'. T. Stapylton, 20 years' bar; [\1r. ]. Brown, 15 years' medal. II

Southern. READING. -At a social and dance arranged by the Reading Corps, S.].A.B., held on :'Ilay 9th, Mrs. Uzzell presented awards to the Southern Railway members, including the gold medal for 21 years' service to Mr. Edward Hopkins, and the Centre Certificate to :'Ilr. R. Paling for passing an examination 30 years in succession. Mr. E. G. Blackman (Station Master) presided and, before the presentations, paid a tribute to the work of the am bulance men at Reading, expressing appreciation of the co-operation extended by the Brigade and their Great Western R aih\'ay friends. Mr. E. Uzzell (Southern Railway Welfare Officer) suitabl y expressed the appreciation of the Directors and General Manager and Southern Railway Centre of the excellent work put in at Reading.

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AID

Method of Transporting a Patient with Severe Injury to Jaw. A READER, Mr. R. L. Vincent of Twickenham, has sent in sketches and particulars of a method for the rtmo\'al of cases with severe injuries to the mouth and lower jaw, ..vith loss of control of the tong ue. Acco rd ing to E. i\1. S. in structio n, such patients should be carried face downwards on the stretcher ; but when this is done in actual practice, one beare r ha~ to suppo rt the head. Although s uch cases may be ve ry few in number, our reader's suggestion shoul d be of interest to other first aiders in A· R. P. organisations. Firstly, the stretcher is prepared in the u sual manner. Then a b lanket is rolled and placed on the head-end of the stretcher in line with t he patient's shoulders. An ang le splint is made from two splints, each about two feet in length, and when ready is placed on the stretcher against the roll of blanket, with the two ends p rojecting over the heau-end. The joint should be well padded. Th e patient is then lifted on to the stretcher , face downwards, with head projecting over the end of the stretche r, being supported by one of the bearers so that it lies between the a rm s of the angle splint. To keep patient's head in position, two triang-ular bandages are tied together, and applied as follows :- One end is tied r ound one handle, take n up and given a complete turn round splint end on the same side. The bandage is then taken downwards and passed broadly under the forehead of the patient and carried to the opposite splint end and continued around the second stretcher handle. From there the bandage is carried upwards outside the splint across the back of the patient's neck to the original handle, where it is tied off. It has been found that the whole is held in position by the weight of the patient's body and that no pressure is made on the injury. Further, nothing projects over the side of the stretcher.

Police Ambulance News. METROPOLITAN. In March last the Sub-Di visional Athletic Clubs of " l\1 " Di vision presented a shield fo r the furtherance of fi rst aid in the Di visio n among Regulars, War Reserves and Women Police. T en teams entered and met each other once, points being allocated for individual and team winners. The judges in ') 11 matches were P,S. 71 Berry, P.C . 526 Ferris and P,C. 534 Atkins, On Thursday, May 16th, the final round was held at Gilmour House, in the presence of Supt. Briggs, Supt. Peto, Women Police, and a large gathering of officers and men. Kennington-road Regul a rs were declared the winners and received from Supt. Peto the League Shield and replicas. D eptford R egulars were the runners-up and the members received medals.

Methocls of Sterilizing Instrulnents. * work un~ert3.1<en by \'olunta ry members has Increas 7d. g reatly dunl1~ the past few months. One part of the t ramln g necessary IS that of prep~ring surgical instrumEnts for use by the su rgeon, and therefore \ye are reprinting f:o~ Bailliere's Co.m plete :'Iledical Dictionary, by kind permlSS1?n of ,the p~blJshers, a part of the appendix which deals WIth thiS .subJect. In cidentall y, this is the most complete appendiX dealing with surgical instruments and their care to be found in any medical dictionary. i\letal instruments to be effecti\-ely aseptic must be well plated-cracks and defects are liable to harbour germs. !"IOSPITAL

H€FlD SLING

(1) A II instruments, otlter than tlzose lza'ving slwrp ed.ges or pomts. For Cse.-Place in a sterilizer of wa ter towhich a little soda has been added (this raises the boiling point) and boil for 30 m.inutes. The .water should co\'er the instruments, and the lId should fit tightly. Remo\'e for use on to a ster ile towel or into sterile \\'ater, as desired.

INSTRUMENTS AS A BASIS FOR ALL OPERATIONS N UMBER (> SIZE OF FORCEPS ETC ACCORDING TO OPERAT ION

~ E:-ID VIEW,

Supt. Briggs, who congratulated the men on their interest in first aid, was thanked by the m e n for his able co-opera tion which made the League possible. CITY

LONDON

SPECIAL

CO , STABULARY.

On May 29th Commandant Foxon presided at the annual fi rs t aid supper, supported by Sir Hugh Turnbull (Commissioner), Capt. Griffiths (Asst. Commissioner), Dr. Crabb (Poli ce Surgeon), Mr. D. G. Monteith (St.J .A.A.), Capt. Goodle y (Commissioner, S,J.A.B,) and officers and men of the Force. Th e chairman welcomed the guests and paid tribute to the work being done in first aid. Sir Hugh Turnbull exp ressed his appreciat ion for the work done generally and thanked Capt. A. C. White Knox (Chief Medical Offi cer) for his assistance in fi rst aid , On behalf of the membe rs of the first aid sec ion, Sir Hugh handed Mr. C. G. Emery an engraved silver cigarette box in appreciation of his services to the section over a period of many years, A presentation was also made to 1r. F. H. Sully. Both gentlemen expressed their thanks. Capt. White Knox gave brief particulars of the work of the first aid section during the past 12 months and referred to the assistance rend ered by the members of his staff.

- - - , _ . -- - At an eliminating district competition for the" Coroner Graham" Shield, held at Sunderland on Saturday, Jun e 1st, Eppleton Colliery "D" team gained first place and wi II compete in the final, to be held at Sunderland, on June 22nd.

V d7,D

AID r4 all kinds, either .lor sutureJ or injections saws, tonsil guillotz'ne, etc.

trocars scissors, "

(~) Place in rectified spirits for 30 minutes; or (b place m pur e carbolic or pure lysol for 3 minutes. ,After either method the instl uments are dipped into stenle wat~~ ?efore use. Stilettes are remO\'ed from needles before stenlizlng-.

Rubber articles as tubes, catheters, etc., are sterilized by boiling in water: 'ii'd/wut soda, for 30 minutes,

Fr"lacture of the Shaft of the Humerus I,'\'AS very much struck a short time avo when ,,'isitino- 111\' :\ o. 1.6 ~ e\v Cros Diyision to see a demonstrator, whoto> \\'a"s teachlng.a class of recruits, apply the splints for the abo\'(~ fracture .In a man~er which I had ne\'er thought of before ~nd, .whlch I conSider, is by far and away the best method m eXistence. . ~t has alway~ been difficult to hold the three splints in pos!tlOn for appl)'lI1g the bandage with the help only of tlte patIent. The method is as follO\\'s : Lay the three splints on the table, edge to edge, and oyer the upper third of all three la\' the centre of a na:ro\\' ban~age. Lift the splints, still edg~ to edge, by placlOg the ongers of both hands under and ~he thumbs on tor of the bandage O\'er the splints and holdHlg ~hE'm fiat, in this manner lay them on to the arm and contJl1ue the bandage round the limb in one r::o\'ement. The ,splints automatically fold into position and are held by the hrst ?andage c~ossed at the back and brought round to the outSide and tIed. The second banda o-e is then of course, arplied in the ordinary way. - A. C. ::""H1TE K~ox, ~1.C., M.B., Ch,B.

(jc~ 12 ,

,3 16 ,

15 I DISSECTION FORCEPS

17,

F1 19

B CURVED SCISSORS

14 DIRECTOR

2:rOWEL CL!P 9 STRAIGHT SCISSORS 15 PROBE FUINTED DIRECTOR 3 RAT TOOTH DISSECTION FORCEPS 10 NEEDLE HOLDER 16 VOLKMANN'S SPOON 4 }STRAIGHT & ANGLED II DOUBLE HOOK RETRACTOR 17 SCALPEL 5 ARTERY FORCEPS . 12 DOUBLE ENDED RETRACTOR 18 ANEURISM NEEDLE 6.RING FORCEPS 13PROBE. 19 AEVUS NEEDLE 7TISSUE FORCEPS BY COURTESY OF OOWN BROS LTO ,

. Ajter. Use. -\V~sh and ,scrub under running- cold water, wlth speCIal attentIOn to ndged surfaces and joints. Cold water re~ oves blood more readily than hot. Open joints, take ~o pieces t~ose made to do so, and place in the sterili zer to bod for 10 minutes. T ake out a few at the time a nd dry whilst hot. This not o~ly.ensures a thoroug-h drying-, but r~nders any furtl~er p?l~shlI1g unn ecessary. Special attent~on shoul~ be pa l~ to Jo.mts, a nd for a dditional safeguard a lIttle vaselm e applIed \\'111 pre\'ent rusting. They are then put away until again required. (2) Sharp instruments, e.g ., klli'lles r4 all hllds, needles

* Extract from Bailliere's Complete l\ledical Dictionary (Appendix II), price 3/2 post free.

The Hospitallet"s' Club. THE last meeting of the session was held on i\lay 2fth at the Bonnington Hotel, Lontlon. '\lr. G. C. Green, president, was in the chair, and he welcomed Brigadier-General Sir Joseph Byrne (Director of Ambulance). Sir Joseph tha nked the members for their welcome. As Director of Ambulance he was pleased to say that the delay experienced in the past in obtaining certificates had now been overcome, and that new certificates were issued with the minimum of delay. He also referred to the new arrangements under which di\'isions of the Brigade undertook t raining of personnel in elementary first aid. During the meeting members ga\'e talks on Brigade and other e'l:periences, which proved yer)' interesting. The next meeting of the Club will be held in the Autumn on a date to be announced.

Stanton Ironworks Division, S.].A. B., have, for the second year in succession, won the" Stanton " Efficiency Cup, awarded to the di\'ision gaining the hig-hest percentage of points in t he 1 otts. Alliance The cup was presented at the annual dinner of the Stanton Club House on Saturday, Ma y 18th, by 1\1r. E. J. Fox, managing director.

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Fevers. * (Concluded (rom j){f.r:e 2JO.) Sig-ns and Treatment of the Complications. . 1. High Temperature.-The l\ledical Ol1lcer may gl\~e orders that the temperature is to be reduced whenever It reaches a certain height, usually 104 degs. F .. Cold. and tepid sponging- are the commonest methods of domg this. 2. Delirium and Exhaustion.-May be due to want of sleep. A cold or tepid sponge at night, with a .change of bed and body linen, may produce sleep and relleve these symptoms. Stimulants may be ordered. 3. Hcemorrhage.-Usuallyoccurs in tbe third week of the disease. The symptoms are those of internal hcemorrhage-a rapid fall in temperature is a sign that this has oc~ur r ed. The blood which escapes from the rectum IS usually dark red in colour, and may be liquid or in clots. .The quantity varies from a few drops to a pint or more at a tlm~. Treatment.-Report a rapid fall in temperature, even If there is no other sign. Stop all food, drink and medici?:. Apply ice to the abdomen and warmth to the extremll1es. Prepare a hypodermic syringe and 1',lorphia. 4. Perforation.-May occur during tile third week. The symptoms are those of shock. The patient may complain of sudden pain in th~ abdon;en,. whIch beco~les distended and does not move wIth respiratIOn. There IS a rapid fall in temperature. Treatment.-Follow the rules given under hcemorrhage. In these cases an operation may be performed, if the patient is i1t enough, and the perforation closed by sutures. 5. Relapse.-A patient may have ~wo, three, or more relapses. They generally occur about ten days after the fever ends. The symptoms recur, but are milder and last a shorter time. Treatment.-The feeding and general management are carried out as for the original attack. 6. Thrombosis may occur during convalescence, and usually affects one of the veins of the lower limb. It is treated by keeping the limb raised and bandaged. To confirm a diagnosis of Enteric Fever a specimen of the stools or urine i<; sent to the laboratory, where the germs may be isolated, or a small quantity of the patient's blood is taken and tested by the Widal or agglutination test. Preventive inoculation is carried out for Typhoid and Paratyphoid fe','ers, and everyone in the Navy proceeding- on foreign service is inoculated. It affords protection for one year, after which it should be repeated. The value of this inoculation was amply demonstrated during the Great War. Not only is the inoculated person far less liable to contract Typhoid Fever, but if he does so, he is far less likely to die from it. MUMPS. This is an infectious disease characterised by swelling of one or more of the salivary glands-usually the parotid. Symptoms.-The patient complains of pain and stiffness on moving- the lower jaw, and there is a swelling of one or more of the salivary glands. His temperature is raised. The fever lasts abo u t a week, and the swelling- about 10 days.

* Extract from the Manual of Instruction for the Royal Naval Sick Berth Staff, reprinted by permission of the Controller of H. M. Stationery Office. Copies of the Manuai can be had of H. M. Stationery Office, Adastral House, Kingsway, London, W.C.2, or any branch, price 4j5d. post free .

AID Treatment.-An antiseptic mouth was h must be used frequently . Hot fomentations are applied if the pa in ~s severe. The patient is kept in bed till the temperat ure IS normal. Complication.-Orchitis or inflammation of the testicle may occur. . . . The temperature rises rapidly, and the testIcle IS palOful tender and swollen. If both testicles are involved sre'rility may result. Treatment.-The testicle is raised on a splint or by a suspensory bandage, and fomentations appl ied. WrlOOPING COUGIl OR PERTUSSiS. This disease is very common amon~ children, but adults occasionally suffer. It is characterised by signs of a cold and paroxysms of coughing, which end in a whoop. Treatment.-Consists of adequate rest, warmth, and fresh air, while later some tonic medicine may be given. DIPTITIIERIA. This is an infectious disease characterised by inl1ammation of some mucous surface (usually the throat) and the formation of a membrane at the site of infection. I t is due to the D i ph theria Bacill us. All sec1'etions jro1lt the nose and mouth m'e infectious. Symptoms.-These come on gradually with headache, sore throat, and moderate fever. A white membrane usually forms on the tonsils, and may spread to the uvula and soft palate. It may also form on other parts, such as the larynx, trachea, nostrils, conjunctiva, or on an open wound . The glands of th~ neck are enlarged, the pulse is rapid, but the temperature IS not very high. Treatment.-Absolute rest in bed is essential, owing to the risk of heart failure. The patient is kept Jlat on his back without a pillow and not allowed to exert himself in any way. Antiseptic gargles and paints are usually ordered. The gravity of Diphtheria has been greatly reduced since diphtheria ani£toxin has been introduced. This is a serum prepared from the blood of a horse which has been inoculated with increasing doses of the toxin produced by the diphtheria bacillus. The antitoxin is injected with a large glass syringe into the flank. It must be given early and in large doses. The nurse may become infected through the patient coughing in his face. To prevent this a gauze mask should be worn when in the ward. Complications.-Heart failure, middle ear disease, paralysis of various muscles-most commonly the soft palate, or obstruction of the larynx and trachea by the membrane. The obstruction may cause asphyxia, which may necessitate making an opening in the trachea (tracheotomy) and puttin a in a tracheotomy tube, so that the patient can breathe. Tracheotomy may also be required as a preliminary step in certain operations, or for obstructions in the trachea due to conditions other than diphtheria. A test known as the Sc1tick Test is now car ried out to determine if a person is susceptible to diphtheria, and is of value in controlling epidemics, and selecting nurses for attending diphtheria cases. If the test proves pos itive, an inoculation can be given which in the course of a few months will make a person non-susceptible, INFLUENZA . Is all extremely infectious disease characterised by sudden onset, with fever and signs of a bad cold, severe pains in the back, limbs and head. There is sometimes great prostration and the sufferer may sudden ly col lapse. In some (ases the lungs are 1110stly affected, and

FIRST P neumo ni a or Bronchitis may complicate the disease; in others, the heart may suffer, causing palpitation and dyspnoea; while in others diarrhma and vomiting may be the chief symptoms. The acute illness lasts about a week, but convalescence is usua lly prolonged. Treatment.-The patient is confined to bed and symptoms are treated as they arise. Care in recording the pulse rate is very important, as the heart is liable to become ai'fected.

Head Inju pies in War.* By HARVEY JACKSON, F.R.C.S., LR.C.P. Hon. 5U1:l?eon flVest London Hospztal and l'/alional Hospital j01' Diseases oj the Nervous S)'stem.

WOUNDS of the head differ little from wounds of other parts in that the immediate risks, apart from direct fatality, are those of hcemorrhage,. shock, and infection; hence measures should be constantly available to prevent or combat any or all of these contingencies. Anatomical damage will manifest itself in the aprearance of the wound and in the loss or impairment of physiological activity of the parts of the body served by the parts of the brain involved. In order that a true conception of the tissue loss may be gained and some idea of the prognosis formulated, detailed examinations will have to be made by persons with specialised knowledg-e of the nervous system. An intracranial injury does not necessarily show surface damag-e, and the absence of a scalp wound m 'lst not be interpreted as excluding the probability of iniury to the skull or cranial contents. Fractures of the skull can result from compression, or from falling on the buttocks, when the transmission of force through the spinal column may induce a fracture of the base of the skull. The possibility of associated injuries of other parts of the body must not be forgotten. Treatment must

be instituted early to

cope with Obviously, the earlier a head wound can be submitted to surgical intervention the better. Eight to ten hours from the time of injury is the longest time a case should be withheld from operation if a reasonable hope of cleanliness is to be attained, and recent experience in the Spanish War established the optimum time, in respect of wounds in general, as somewhere between four to eight hours. Damage to muscular tissue has a greater significance when considering infection, and gross destruction of muscle involves an increased liability to the inciJence of secondary shock. The relative deficiency, therefore, of muscle in the head, compared with other regions, may be to the advantage of the patient in terms of danger from infection. The dural membranes form an impenetrable bar to infection, hence the question of penetration of these structures by missiles is very important in relation to the likelihood of meningitis or cerebral abscess. H<.elllorrhage, infection, ancJ cerebral n..'dema are matters of concern in respect of all head injuries, and therefore demand some further consideration. h~morrhage and to reduce liability to infection.

Adequate measures of control for external hrcl11orrhag-e are easi ly applied, bul bleeding within the cranial cavity may escape recognition, with fatal effect. Progressive

* Extract of lecture given at Exhibition and Conference.

the

London Nursing

AID d~~erior~tion of a pati~nt shoul~ always suggest the possibdlt~ of lJ1t~rna! bleed~ng, esp.eclally if the pulse is slowing and lJ1creaslOg 10 tenSIOn, whtlst the patient becomes more and. more drowsy and, perhaps, exhibits twitches or convulsl ve ~ovements, followed by increasing weakness of affected hm~s. The ,Pulse of such a patient next shows a t~ndency to I~regulanty, finally becoming rapid and weak as Circulatory fallure encroac:hes. Associated wilh these circulatory changes are alterations in the hreathing. This slows ~nd later devel~pes a Cheyne~Stokes character (a form of Irregular breathll1g- caused. by lI1creased acidity in the blood) as pressure on the respiratory centre increases. Even thou~h the pulse appears satisfactory, deerening coma is a bad slgn. CEdema of the brain occurs in all head injuries to a greater o~ le~ser ~egree. It may be progressive, however, and then It gives n~e.to venous obstruction, with consequent development of a VICIOUS cycle. Effusion of fluid into the tissues i.ncites a state stimulating that induced by hce morrhage ; l~ fact, a differentiation at times may only be made by obser~lOg the effec.t of active dehydration. CEdema may be restral?ed by keeplOg the head higher than the body, but more actIve measures may be called for, such as saline purgatives by mouth, magnesium sulphate enemata or intravenous administration of hypertonic solutions of ~alt, glucose, or sucrose. PlOmp~ an.d pr~per measures must be taken in any wound agalOst infectIOn. To keep the head clean, it should be shaved completely and, wilh hcemorrhaae controlled mild antiseptic dressings applied pending the °ayailability of more ;:l.ctive measures. Rememher that head wounds should receive the same prophylactic measures against tetanus and gas gangrene as lesions of other parts. Antiseptic dressings, to be germicidal, have to be used in such concentrations as to cause tissue destruction, so we see that a gradual change has taken place in that carbolic and the mercurials gave way to the hypochlorites, and the latter, in turn, ha\'e tended to be displaced by hypertonic solutions which encourag-e freer drainage. Azochloramide has been given prominence by some for cerebral work, but, in my opinion, is no better than simpler and less expensive materials. As soon as is practicable all \\'ounds should be explored, Jamaged superficial tissues excised, loose portions of bone removed, and then, after removal of debris and any other foreign bodies, reconstruction of the I art effected, so far as is possible. The removal of foreign bodies from within the brain depends on the location; unless the foreign body is readily approachable the necessary manipulations should be carried out only by those with special expE'rience. In the attempt to prevent infE'ction by the common pusforming organisms, local operati\'f~ measures are of primary importance, but we ha\'e some drugs which are excreted into the cerebra-spinal fluid. For a considerable time Hexamine was the only substance which had much value; it was given by mouth in fairly larg-e doses. The introduction of the sulphonamide group of drugs has altered the position greatly in respect of varied forms of meningitis. Of these preparations the one known as M & B 693 has, in my experience, proved most valuable. M & B 693 is commonly given by mouth, but it has rather nauseating properties, which, in the presence of vomiting, may result in inadequate absorption; in such circumstances the drug can be given intravenously. All head injury cases should be submitted to X-ray examination at the earliest ayailable opportunity. By this means alone will foreign bodies inevitably be shown up. The tomograph, a specially constructed X-ray machine, by which X-ray exposures can be focused for varying depths or planes of the part, is 1110st useful here, as the exposures are made for known depth, and it is possible thereby to gain accurate knowledge of the position in which a foreign body lies.

FIRST

AID

FIRST

A.R.P. Topics.

New Stores Manager at St. John's Gate.

-EQUIP YOURSELF

FOR WAR

GOVERNMENT P UBLICATIONS.

IT is officially announced that Mr. H. J. Wrigglesworth has been appointed to the pos ition of Stores Manager of the St. John Ambulance Association. Mr. Wria(Ylesworth will be remembered by members of the Brigade r--~~ the energetic p,.ssis.tant Brigade Secr 7tary, which position he has now relmqOlshed. At the Bngade F inal Competitions and Week-cnd Gas Courses, "Wriggy,"

MR.

H. J. WRIGGLESWORTH.

as he is affectionately known, had a cheery word for all, and by his manner and assistance gained the confidence of the members. This confidence will be continued in his new sphere of activity. Being a member of the Brigade (he is still retaining his position as an Assistant Commissioner), he well understands the workings and difficulties of divisional stores, and it will be his aim to assist all who are desirous of his)d vice on stores matters.

Home Service Ambulance Committee. THE Committee can now look back on 21 years' unremitting service to the community with justifiable pride. Since the declaration of war in Septem ber last, the Home Ambulance Service Stations have carried on. A number of ambulances were commandeered by local authorities, but after representations to the Ministry of Health, a n ambulance required for its legitimate work was released. Additional work has been undertaken in the evacuation of London and la rge towns. Valuable ass istance has been given by Coastal Ambulan ce Stations. The annual report for 1939, gives particulars of work undertaken by the Service, which h as 141 ambu lances, together with 284 affiliated, making 425 in all. During the twelve months ended December 3 1st, 1939, the ambulance carried 220,365 patients, and the total numb~r of patients carried by the Service since it was set up, is 2,277.162. Of this number, Devonshire have carried 446,100 and Lancashire, West, 237,878.

Memorandum No. 14 (4d. post fr ee) deals with Domestic Surface Shelters; numerous types are illustrated and dimensions are given. Memorandum No. 15 (7td. post free), "Care and Custody of Eq uipm ent," gives information and adv ice a bout the care and custody of air raid precautio.ns equ ipment. Home Security Circular No. 75/ 1940 (2d. post free) deals with "Retention of Items of A. R. P. Equipment by Individual Members of Services." We note that it is suggested that if an authority holds 60 per cent. of C. D. respirators required for the warden's service, this is sufficient to ens ure that, with 50 per cent. of wardens on duty at one time, there is a respirator for each. ., The Choice and Adoption of Shelter in Houses" is the title of a J\1ini stry of Home Security booklet (4d. post free) ; whilst the Ministry of Food has issued a publication on " Food and its Protection Against Poison Gas" (4d. post fre e). This is divided into six parts-General Considerations; Growing of Crops, etc.; Bulk Stores in Warehouses, etc.; Protective Measures-Shops, Ho tels, etc.; Domestic Protection; and Food and Livestock in Mari,(ts. E.M .S. Memorandum No.3 has now reached its 2nd edition. This gives procedere on the admission, transfer. discharge or death of casualties, and for the provision of outpatient treatm~nt. Another publication, expressly published to assist the general public, is "Your Home as an Air Raid Shelter" (4t d . post free). After referring to the dangers of high explosive bombs, three methods in which hou~eholders can provide sheltEr are given. The first is by the purcha<;e of a ready-made shelter; the secon d by building a shelter into or attached to the house; and, thirdly, t o improve the natural protection of the house by forming a "refuge room." Whilst the first two methods generally give better protection against bomb splinter, the third method can give almost as good a protection as a garde n shelter. For a fixed fee of ha lf-a-g uinea, a consultant appointed by one of the professional Institutions (Architects, Engineers and Surveyors) will inspect a house and give a wriLlen report stating the best place in which to s helter, and describe ways within the householder's means by which protenion can be improved. Many illustrations are set out and particulars a re given Oli numerous items, including windows, doors, glass, fi re precautions, etc. WATER IN AIR RAIDS. It is no exaggeration to say that in the event of certain forms of attack from the air, the provision of ample supplies of hot water is essential for the satisfactory treatm ent of cas ualties. There are available to-day hot water appliances capable of giving- copious and contin uo u s hoi water. Messrs. Ascot Gas Water Heaters Ltd., of Ascot Works, North Circu lar-road, Neasden, London, N .W.10, have issued a booklet on the subject of hot water by gas for A. R. P. requirements. Some 61 illu<;1rations of Decontamination Centres, First Aid Posts, Canteens, etc .• are g iven, and any r esponsible authority or business exec uti\·e interested in the subject may obtain a copy of tbe boo ld et , post fr ee, on app li cation.

HOT

At the annual meeting of the Sandwich and District Division, S.J.A.B., it was reporled that 395 duties were performed by members of the Division last year a nd 448 patient s were attended.

AID

Essential

EMERGENCIES-

knowledge to treat successfully, ALL possible injuries,

THE

HOUSEHOLD PHYSICIAN Describes in SIMPLE LANGUAGE such necessary information with helpful plates and diagrams.

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The 500 illustrations and full-page Plates makes the reading matter more easily understood.

ACCIDENTS A few of the Subjects treated:

WAR EMERCENCIES :Gas Warfare First Aid Bandages Splints Burns Scalds Hremorrhage Fainting

PEACE TIME SUBJECTS : Influenza,Colds, etc. Measles, Mumps Catarrh Corns and Warts Physical Culture What to Do in Emergencies Treatment for all Skin Diseases The Lungs, Pleurisy Hygiene, Anatomy, Pharmacy The Principles of Nursing The Eye, the Ear The Throat, the Nose The Chest, the Heart The Stomach, the Liver The Teeth, the Muscles I nfant Welfare Homcepathy, Neurasthenia 375 Prescriptions, etc., etc.

J/Vhat

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of:

Bod ily Injury, Burns and Scalds, Clothing Alight. Fore ig n Bodies in Eyes, Ears, Nose, Throat. Mac hi nery Accidents, ElectriCit y Accidents. Drowning, Suffocation , Bleeding, Poison, Broken Bone s, Fractures , Dislocations , Sprains, Fainting, Concussion, Etc.

THE YOUNG WIFE will find just the information she rt'quires. MOTHERS who wish their daughters to develop naturally will find exactly the teaching they need. WOMEN OVER 40 will frankly discussed.

find

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BEAUTY CULTURE-Complexion Diets, Wrinkle Cures, Care of the H a nds, Mouth, Eyes, Hair, Recipes, etc. PRESCRIPTIONS -375 proved remedies. There are hundreds of subjects. The muscles, teeth, digestion, hair, food values, J ujits u, Phrenology. How to diagn ose diseases from appearance of head, face, neck, tongue, throat, chest, perspiration, etc.

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FIRST

Our Nurses' Pages. COl\IPILED BY AN AMBlJLANCE SISTER.

CIVIL NUHSING RITSERVE. Six-thousand members of the Civil Nursing- Reserve are working at first aid posts, in hospitals, and und~r. the Government evacuation scheme, it is reported by a l'vllnlstry of Health official. The Civil Nursing- Reserve is composed of 20,000 trained nurses and assistant nurses, and 100 auxiliaries including members of the St. John Ambulance Brigade and the British Red Cross Society. All those now working are being paid, but those wllo have not yet been called up from the Reserve are not. This body is a pool of different types of nurses covering all medical Ileeds under emergency conditions througtlOut the country. There is still a great need for full-time workers who a:-e willing to go to any part of the country to ser~e, and anyone who can do so is urgently asked to take up thIS g-ood work.

No. 1 DISTRICT, S.J.A. B. No. 45 (ST. LVIARYLEBONE) NURSING DIvIsION. - On Wedne~day, May 15th, a friendly competition was held between a team from this Division and one from the" X " Division Met. Specials. Lady Div. Supt. Mrs. Hathaway arranged the function, the tests being judged by Mr. G. E. Craft, Editor of FIRST AID. After a very close contest the Specials' team was declared the winner, having gainp.d 150 marks to the nurses 140. Alderman Stiles Allen, D. L., J. P., President of the Division, handed each competitor a little memento and congratulated them on their work. He thanked the judge and other officials for their help, and hoped that the competition would be the forerunner of others. The captain of the nurses' team handed Lady Div. Supt. Mrs. Hathaway a bouquet of roses in appreciation of the work and assistance she had given the team. No. 115 (ST. JOHN'S WOOD) NURSING DIVISION.-A very successful con : ert was held at the Old Baths, Marylebone-road, on Thursday, May 23rd The occasion was marked by the presentation of badges of office and warrants of appointment to the officers uf this recently-formed Nursing Division. Among those present were Mrs. Hugh Paul, Lady Div. Pres:dent ; Lady Josephine Hartley, Sir John Fitzgerald and Dr. C. Porter, Vice-Presidents; Lady District Supt. 1\1 iss \Valker. Asst.-Commissioner Capt. R V. Steele, District Officer T. l\1cBride, Lady District Officer Mrs. Tapley, Lady Greenslade, Alderman R Stiles Allen, Councillor 1\1 is~ J. Marsh, and Mr. C. J. Bentick (A . R. P. Controller, St. Marylebone). The company was entertained by a number of wellknown artistes and, during the interval, Lady District Supt. Miss Walker made the presentations. In doing- so, she spoke of th ~ tremendous amount of work which had been thrust upon the Brigade during the past nine months, and of the new members recruited. It was due to the enthusiasm of some new members that this Nursing Division had been formeu, and it was pleasing- to see that it was worl<ing side by side in the Borough of ~t. 1\larylebone in complete harmony with No. 45 (St. Marylebone) Nursing- Division. She hoped that the two Divisions would do good work together. In welcoming the new o/Tlcers and members, Miss Walker trusted that they would remember the ancient

FIRST

AID tradition of the Order of St. John with which they had associated themselves. A vote of thanks to all who had assisted to make the event a success was proposed by Div. Supt. W. V. M. Allen, who mentioned that the whole of the stage, lighting; scenery and effects had been erected by members of No. 58/ 5 Ambulance Division. No. 64 (EALINC) NURSING DIVISION.-This Division is cuntinuing- its good work as zealousl y as ever. There an; now some 135 officers and members of the adult Division, and 30 cadets. The enthusiasm of all is shown by the fact that despit(:. the blackout, not a single practice was missed during the winter; and the cadets volunteered to give up their Saturday afternoons to instruction classes when it was not possible to continue these in the evenings. Five members of the Mobile V.A. D. are on service in various parts of this country, and Dr. Forest Hamilton and Dr. French, the Divisional Surgeons, are also serving their country, the former in Palestine and the latter with the

249

In the presence of blood

it is a marked property of 'Dettol ' that it maintains

high germicidal efficiency when blood or pus is present- even in considerable quantity.

The value in emergency of this

modern antiseptic- which can be used rapidly without danger, discomfort or staining-- is now everywhere acknowledged.

RA.F. No.4 DLSTRICT, S.J.A.B. ST. HELENS NURSING D[\'ISION.-On Tuesdayevening, May 28th, a very enjoyable Social was held at the Nurses' Headquarters, Bridge St., when all the Brigade members who were not on hospital or first aid duty, were present. Miss Coulthorpe very kindly arranged a splendid exhibition of dancing by her students, which was greatly appreciated. After this, 1rs. Merrick, Lady Div. President, presented awards gained by the members of the Division. In a short address, Lady Div. Supt. Miss Luckett outlined the invaluable help given by Mrs. Merrick, and said she hoped the members who had now received awards, would use their knowledge to advantage for the good of the community, and that they would spare no effort to devote all their available time in assisting the sick and wounded, and so uphold the traditions of the On':er of St. John, and make Mrs. Merrick proud to be their President.

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The Modern Antiseptic RECKITT

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No.9 DISTRICT, S.J.A.B. PAIGNTON NURSING DIVISION.- The annual inspection of this Division was held on Friday evening, May 3rd, at the First Aid Station, Curledg-e St. The Inspecting Officer was Lady County Supt. Mrs. de la Pryme, who was accompanied by Lady County Officer Miss D. Whitehead. Asst. County Commissioner Hing-ston was also present. There were on parade, Nursing Officer Mrs. Pidgeon, Lady Amb. Officers Webster and Sharp, and 46 members of the Division; also Lady Amb. Officer Mrs. Maker and 16 members of the Auxiliary Reserve; and Lady Cadet Supt. Miss Hibbs, Lady Cadet Officer Mrs. Webber, and 27 nursing cadets. All were under the command of Lady Div. Supt. C. B. Golding. After an inspection of uniforms, teams were formed who carried out tests to show their efficiency in practical work. Mrs. de la Pryme congratulated them on their smartness and neatness, their quickness, ability and keenness in dealing with their cases, and on the large increase of membership . Before leaving, she presented Cadet Sergt. B. Webber with a writing case from the officers and catlets of the Division, on her leaving the town to take up nursing at the Princess Elizabeth uethop:rdic Hospital, Exeter. BARNSTAPLE NURSI",c; DIVISION.-The com petition for the "Dr. Hoerman" Cup was held at 1he home of Lady Di". Supt. Mrs. Laramy, the judges being Dr. R. C. Probyn 'vVilliams, Dr. Walton and Nurse Cami'leld. Mrs. Laramy won the cup, and Miss Betty Sanders a medal, g-iven by Mrs. Probyn Williams to the runner-up. .

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THE NEW "PORTLAND" GEAR (Pat. No. 18°963).

Th.is new patent Ambulance Gear offers many unique advantages whether the Ambulance is carrying two stretcher cases or only a single case. A self-contained unit, it can be placed in almost any vehicle, and it makes the loading of either top or bottom the simplest possible matter. 'rhe "PORTLAND" Gear should be specified for an y new Ambulance and it 125, 127, 129, provides an ideal Great Portland Street, method of modLondon, W.I. ernising vehicles Telephone-Langham 1040. already in use. fc:legrams-"Bathchair, Wesdo, London.'

This illustration shows the clear gangway for 10adingoLthe lower stretcher when only one C:lse Is being carried.

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FIRST On Wednesday, May 22 nd, the a nnual inspection of the Nursing Division and the Cadet Nursing Division \\'as held at the ambulance headqua rters, when members were inspected by Lady County Supt. Mrs. de la Pryme. A first aid and home nursing competition was held on 1\1onday eveninR, l\lay 27th, for the shield given by 1\1r. F. J. Richards, e.C. This test is open to the nursing cadets, and was won by Rosalind Eastman, Joyce Burgess, last year's winner, being second. Those present included the Rev. e. Dimond, Chairman of the local S.J .A.A. , 1\Ir. C. Bishop, Hon. Secretary, and 1\1 r. J. J. Ri chards. The latter complimented the girls on their wo rk and kindly presented the shield to the winner. O. 10 DISTRICT, S.J.A.B. WISBECII NURSING DIVISION.-Lady Corps Supt. 1\1rs. A. F. Manley inspected members of the Division at the headquarters at the First Aid Depot, Wisbech, on Wednesday, l\lay 22nd. This Division has progressed remarkably in efficiency since it was formed about twelve months ago. Mrs. !\lanley, who was accompanied by Lady Div. Supt. Mrs. H. L. Groom, Nursing Officer Miss Gibbons, S. R. N., and Lady Amb. Oflicer 1\1rs. Blair, congratulated the members on their keenness and expressed her satisfaction with their work. She was interested to hear that as rart of their A. R. P. duties members of the Division staffed the ambulance service in the district and also gave assistance at the Wisbech Hospital. EIRE FRgE STATE DISTRICT, S.J.A.B. The annual competitions for Nursing Divisions \vere held at the Brigade Hall, Dublin, on Saturday, May 22nd, under the direction of Lady District SUpE. Mrs. Seton Pringle. The results were as follows :Irish Women's Challenge Cup-1, City of Dublin, 160! marks; 2, Harcourt No.1 team, 160J; 3, Headquarters, 156. Five teams entered, and were judged by Dr. Desmond Reddin (first aid) and Miss Melville (home nursing) . "Dr. Webb " Cup for Novices - 1, Earlsfort, 111 marks ; ~, City of Dublin, 110 ~; 3, Headquarters, 105t. Twenty-eIght teams entered, and the judges were Dr. Margaret Nicholson (first aid) and Dr. Margaret Merrick (home nursing). The Individual Cup competition was held on the previous !hursday, the iudges being Drs. Speedy Bertin and SterlIng Berry for first aid, and Drs. El izabeth Budd and R. Stokes fo; horne nur~ing. The cup was won by Am b. Sister M. Mcneill, of the CIty of Dublin Nursing Division, with 175 marks, the runner-up being Lady Amb Officer E. Summers, of Harcourt Nurs in g Division, with 173 marks. Lady District Supt. Mrs. Seton Pringle presented the Cups, and conveyed to them Commissioner Sir J obn Lumsden's regret at his inability to be present. On his behalf, she thanked the doctors and matrons who had acted as j~dges during the week and the officers who were responsible for the setting and staging of the tests. She expressed. her gratification at the keenness displayed by all competlt?rs, and .refer~ed to the work they had done recently In connectIOn WIth the successfu l appeal for Bri<Yade funds, b INSPECTION OF B. R.C.S. DETAC IIMENTS IN TIlE ISLE OF ELY. Dame Beryl Oliver, D.B.E., R.R.C., Headquarters Staff, B. R. e. S., made an extensive tour of the County an d Isle of ~~y. Detachm~nts on Saturday and Sunda:v, May 18th 19th, VISIting Ely, Llttlep~rt, Wisbech, March, Whittlesey, Swavesey, Papworth, Hlston, Waterbeach, Linton, Fulbourn, Soham, Sawston, Steeple Morden and Orwell.

FIRST

AID Durin g the tour she was accompanied by the County Director, Maior Lee Warner, and several county officials. She visited a hospita l at Littleport, the N orth Cam bs. Hospital, Addenbrooke's Hospital, the sick bay for evacuated civi l servants at Grantchester, an d the Borough Divisional Headqu a rters. Dame Beryl a lso attended ch urch parades of the Chippenham Divisional Detachments at Soham on Sunday morning, a nd at Orwell in the evenin g when D etachments from Arr in glon Divis ions 1 and 2 and Shelford paraded. The County President, Mrs. Adams, was present with the Lord Lieuten ant on severa l occasions, a lso the R eg ional Commissioner and Lady Spens, the 1\1 ayor a nd Mayoress of Cambridg-e, Sir Lional Halsey, County Director fo r Bedfordshire, and Lady Halsey. Miss 1\1. Gray, Regional Administrato r, W. V. S., and Miss Ha wl<ins, W. V. S., acted as drivers during the two days. Throughout the visit Dame Beryl Oliver laid emphasis on the need for further en rolment fo r nursing auxiliaries, especially for full -time workers

B. R. C. S. INSPECTION AT FLEET. The Countess of l\1almesbury, as County President, visited Fleet on ·Wednesday evening, May 29th, and inspected the Hartley Witney, Fleet and Crookham Detachments. Others present on this occasion included Mr. Murray Williams (Counly Director), Lady Symons (Asst. Coun ty Director), and the Hon. Lady Anstruther-Gough-Calthorpe (Vice-President, Hartl ey Witney Division). The three Detachments were under the command of their respective Commandants, Miss Cal thorpe (Hartley Witney), Miss Poynder (Fleet), and Mrs. Latham (Crookham). Addressing the Detachments after her inspection the Countess referred to the great tradition and esprit de COl ps of the Red Cross, won in the last war by the V. A. D. 's who served so well. She knew that when the time came those on parade would do their work as well as did their mothers and aunts. Lady Malmesbury congratulated the Fleet Division on winning the" Cooper" cup last year. She was glad to hear that the Division was going to form a mobile first aid party, which would probably come under the Aldershot Sub-Control as part of his A. R. P. R eserve. Mr. Murray Williams spoke of the Civil Nurs in g Reserve, and emphasised the need for mobile whole-time nurses who are prepared to go wherever they are required.

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FIRST

Queries and Ansvvers to Correspondents. 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 FIRST AlD, 46, Cannon-street, London, E. C. 4. 2.-All Queries must be written on one side of paper only. 3.-AIl Queries must be accompanied by a " Query Coupon II 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 39th (1937) Edition ot the S.].A.A. Manual of First Aid to the Injured. TR EATMENT OF FRACTURED KNEECAP. R. S. (Muswell Hill).-At a recent competition the question was raised as to whether or no a pad should be placed uuder the knee as well under the heel in the treatment of a fractured kneecap. The squad in question put no pad under the knee maintaining- that the knee should be kept as straight and ri g id as possible. The Textbook also appears to indicate no pad under the knee but only under the heel. Can you please give us a ruling on this ponit ? A pad placed under the knee-joint would neutralise the effect of the pad in tht' hollow above the heel, which, by raising the heel off the splint, serves to keep the knee-joint extended. Further, it would slightly flex the knee-joint. So your squad was strictly correct in refusing to apply a pad behind the knee-joint. - N. CORBET FLETCHER. EXAMINATION

HOWLER.

D. S. (Eastbourne} .-In a recent examination I asked a candidate to tell me what is the treatment of bites by insects; and I was greatly amused when she replied : " 1 would not disizwb the insects.''' Perhaps the howler may amuse others for which purpose I send it to you. Good!

Next, please! !-N.C.F. SIGNS AND SYMPTOMS OF SYNCOPE.

S. H. (Manchester). - (1) Are the signs and symptoms mentioned on p. 165 of the Textbook particularly relative to syncope, and or to shock and collapse in addition? I know that they are in the main identical with those for shock as detailed on p. 44. Also (2) is there any particular reason for shock to be included again on p. 164? Lastly (3) is there any special reason why collapse is omitted from the current edition of the Textbook in so far as its little discussion is concerned by comparison with the previous (38th) edition. I thank you in anticipation of your replies to these queries. (1) The signs and symptoms on p. 165 of the Textbook refer particularly to syncope, which, first and last, is due to a disturbance in the action of the heart. They also refer to syncope and collapse, because when the brain and nervous system are depressed by any cause the heart is also affected.

AID

FIRST

(2) Shock and collapse are included among" Other Causes)) as a reminder to students to look up the details given in the Chapter on Shock on pp. 43-45. (3) From the first aid standpoint collapse is to be regarded and treated as an extreme degree of shock. It, therefore, calls for little discussion; and on this point the current edition of the Textbook is, in my opinion, an improvement on the previous edition. -N. C. F.

AID

253

MUS T BUY • T HIS BOOK

YOU'

EVERSION OF TIlE UPPER EYELID. A. B. (Coventry).-When a foreign body is beneath the upper eyelid, the Textbook (p. 184) tells us that we rnay evert the lid "when medical aid cannot be had." In spite of the detailed instructions given I have found it impossible to do this; and so I shall be obliged by any suggestions which you may offer.

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E version of the eyelids is rendered easy if we persuade the patient as he sics in a chair to look upwards towards the ceiling while we are exploring the lower lid, and to keep his eye fixed on the ground while we are everting the upper lid. In other words, the patient must turn his eye (and keep them turned) away from the foreign body. This done, we follow the instructions of the Textbook and find that eversion of upper lid is easilyaccomplished.-N.C.F.

3/2

• •

CONTROL OF FOOT WITH FRACTURED LIMB. P. F. (Brantham).-In connection with the Thomas Splint Drill, the Textbook states that Bearer No. 4 steadies and supports the Jimb above and below the fracture. This I interprel as meaning both hands behind the limb, with one hand above and the other below the injury, i.e., with the body in the prone position, both hands underneath. During recent instructions we have been told to place one hand in front and the other behind the fracture, i.e., with the body in the prone position, one hand on top and the other underneath and at back of limb. As I feel that this would be impossible in the case of a compound fracture, will you please state which of the two methods is correct? The second sugg-estion is correct and is based on instructions in Rule 4 on r. 66 of the Textbook. This method secures proper control of the foot; and it can be used with compound fractures of the lower limb provided that no traction is applied to the fooL-N.C.F.

• • EVERYTHING

The word" short" means" not long in ti me or space." Applied to the breathing- it signifies that each breath will be carried out in less than the usual time. Consequent on this chang-e the breathing must be shallow and also hurried. N.C.F. CRUSHED FOOT AND FRACTURED TIIIGH.

3. BANDAGES AND BANDAGING. 4. WAR GAS TREATMENT.

M.W. (Birmingham}.-If we had to treat a patient who is suffering from a crushed right foot and a fractured left thigh, I am puzzled to know how, after applying extension, we should secure the left limb in view of the injury to the foot of the other limb. We shall be grateful for your advice and thank you for your help.

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FIRST With this combination of injuries there is a risk that the broken bones in the right foot may be further displaced by the application of Bandages A and D used in treatmen~ of fractured thigh (Textbook, p. 28), because ".to be effective" they must be firmly applied. In these circumstances I would tie the limbs together as best I could; and I would be content to substitute for Bandages A and D a bandage which would tie both legs to?"ether at the ankl~s. Such action would, of course, necessitate extra care dunng transport of patient to hospital.-N. e. F. PIN IN TONGUE DURING INSENSIBILITY.

M.e. (Potters Bar}.-In your reply to a query publishe~ in the April issue of FIRST AID unde.r the above .headlO~, you have dismissed entirely the Idea of puttmg a plO through the tong-ue of an insensible person and pref~r to confine [he treatment as laid down in the Textbook, I.e., keep the unconscious patient's head turned to one side. What would be the procedure in the case of an unconscious patient who has a broken neck? The Textbook at page 74 permits of no movement of the head and neck. On the presumption that no assistance is available to depute a first aider to hold the patient's tongue, do you not consider that this w~uld be a case in which a pin should be put through the tip of the tongue to prevent it falling back and choking him? You imag ine an ex treme case with which I hope ~either you nor I will ever have to deal. As I wrote prevIOusly, thus far I have never had to pass a pin through a patient's tongue for the purpose named and I doubt if you or I will ever have to do so. Consequently, I feel that those who on this point teach first aiders to usurp "the duties and responsibilities of a doctor" are not helping the cause; and that is that !- N.C.F. TREATMENT OF SCALD BY TAR.

M. W. (Birmingham}.-Please tell me the best first aid treatment for scalds caused by hot tar. We have in our equipment bicarbonate of soda, tannic acid jelly and acriflavine emulsion. 'Which would you use and why? As a first aider I would adopt no local treatment for a scald caused by tar, because it is good first aid to take action only when there is need to prevent aggravation of injury or condition. I gave this advice with reference to tar sca.lds in the March, 1934 issue ot FIRST AID ; in the June, 1935, issue, I published in support thereof a quotation submitted by a correspondent from an eminent German surgeon who wrote as follows ;"When scalds are caused by tar or other strongly adhesive material, it is well advised to wait until drying has taken place, for thereby a covering that is practically sterile and that diminishes pain is formed. After hardening and after amelioration of the pain, the tar is removed by benzine or ether."-N.C.F. TREATMENT OF FRACTURED SPINE.

J. R. (Middlesbrough).-The members of our Division would . be very much indebted to you if you would settle a problem which has arisen between us, concerning the treatment for fractured spille. \\Tell, Sir, th~ problem is this ;-1£ you had an unconscious patient with a definite fracture of the spine in the lumbar region, would you transport him in the faceupwards (supine) position or the face downwards (prone) position? We hope you will solve this problem for us, for which we will be very grateful. If the patient is unconsious, it is extremely unlikely that you will ever diagnose a fracture of the spine in the lumbar

FIRST

AID region. As, however, you lay it down that in an imaginary case you have done so, then the instructions in Rule A, on p. 73, of the Textbook can be read as justifyi.ng yo~ i.n removing such a patient face downwards. Aga1l1st thlS IS the fact that a member of the Revision Committee once told me that the Textbook instructions were drafted on the principle that all such patients, if unconscious, must be removed face upwards. If you paraphrase the instructions of the ·Textbook on pp. 73 and 74 with reference to treatment of fractured spine, you will simplify the instructions, thus ;-" If tl~e patient tells YOM that he can move his upper, but not hIS lower, limbs, you must remove him in the face downwards position."- N.C. F.

AID

I •

255

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L. F. (Lothbury).-(1) Should liquid stimulants be withheld from a conscious patient, who has had an external wound anywhere on the body, or limbs? The Textbook on p. 155 says-" give hot, strong tea or coffee, provided hremorrhage, either external or from an internal organ, is not apparent or suspected." Yet on p. 45 it only says-" gi ve freely hot, strong tea or coffee with plenty of sugar, except when injury to an internal organ is present or suspected;" and it does not mention external wounds. Also, (2) as milk is not mentioned, am I right in thinking- that the tea or coffee would be more beneficial without it ? I thank you in anticipation of your kind reply. (1) The instructions quoted from the Textbook in each case emphasise the danger associated with the administration of stimulants while blood is escaping- freely either from a wound or from an organ within the body. If, therefore, you know that the hce morrhage has been controlled, you would be acting in accordance with these instructions if you should decide to administer stimulants, more especially in view of the fact that after any severe h cemorrhage the patient suffers severely from thirst which the administration of fluids would help to alleviate. (2) There is no point in omitting milk from the hot tea or coffee.-N. C. F.

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Measurements: Sf' x 4",

Price 1/3 post free. SpeCial Terms: 1/2 each for 6 copies and over. "Police Review" Publishing Co., Ltd. 5 & 6 RED LION SQUARE, LONDON, w.e.1. ~IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII1 11 1111I1I11I1 11 11I11I1I1 1 11111I11I11111I1I1111111~

THE ST. JOHN AMBULANCE ASSOCIATION, ITS HISTORY, AND ITS PART IN THE AMBULANCE MOVEMENT.

ASEPTIC OINTMENT (1/3 & 31-) Of all Chemlsu throughout the British Empire. Sole Dlstrlbutors:-

THE

VENO

DRUG

CO.,

Ltd.,

CORBET FLETCHER.

M.A., M.B

M.R.C.S.

"As a work of reference, the book will be excremely lseful and should be in the library of all ambulance workers."-FIRsT AID.

Price, 3/6; post tree, 4/~.

M anu/actu1'in,f( Chemists,

Manchester,

England.

THE

ST.

JOHN

AMBULANCe

ASSOCIATION,

Willey Park, Broseley, Shropshire.