First Aid to the Injured 10th edition 1907

)I.A., )1. B. , F.R . C.S., HOllo,.ary Associate of the Order of st. John. Honora,'!! Life oj, and Lecturer and Examiner to, the .Association.

Willl:l CHAPTER on" tretcher Transport," revised from tllatoriginlllly writlen by ir JOHN FURLEY, Knight of Justice of th e Order- oj f. John, in ac 'oruallce with the Army tretcher Exercises. Al 0 a (beinl!' lhe Fiftll LecLure, for Females only), by E. MACDoWEL CO GRAVE, M.D., F.R.C.P.I., K,tight of Gmce of the Order oj t. John, Honorary Life JIellLber oJ: a ne! Lecturer and Examiner to, the Associat ion TENTH EDITION, 380,000 to 4 30,000.

Price I s. Det; by p ost, Is. 2d. TO BE OBTAINED AT T. JOR T'C't GATE, CLERKEKWELL, LONDON, E.C. \\'. H. & L. C. 50,000-10/07·

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6ranb Wrtot!! of tb e ®rber of tbe

of cSt. Joun of Jerusalem tn

,$.ob.crtifllt limb- nnb' .of (!lhber .

His Most Gracious Majesty King Edward VII.

($ rnnb-

His Royal Highness the Prince of Wa les, K.G.

c$ll &- l}rr or.

The Most Honble. the Marquess of Linlithgow, K. T. .of

His Royal Highness the Duke of Connaught, K.G .

(6 xf.CH ti bc ®ffi.ccr z.

Prelale-His Grac e the Archbishop o f YORK .

Chancellor-The Right Hon Earl OF TATTO:-l.

Secretary·General-Colonel Sir HER BERT J EKYLL, K.C.1\I.G , R.E

R eceiver-General-EDWIN FR ESH FIELD, Esq., LL.D.

A l moner-The Rev. Can on DUCKW ORT H, C.V.O ., D.D .

Reg zstrar-Maj or -Ge n eral The Ri gh t Hon. L orJ C. V O.

GeJll!alog'£st-Sir ALFRED SCOTT SCOTT-GATTY (Ganer), C.V.O.

0/ the Ambulance DepaY/mcnt The M ost Hon. the 1\Iarquess of BREADALBA"E, h..G.

Librariall-Lieut.-Colonel RICHA RD H OLBECHE

Secret a ry-Colonel Sir HERBERT C. PERROTT, Bart., C.B .

Chairman if the British. O/>lttltalmic Hospital jerusalem-The Right Hon. Earl EGERTON OF TATTON . '

Chief Secret ary 0/ the Ambulance Department-Colonel Sir HERBERT C PERROTT, Bart. , e.B.

2\5si!5 t all t (1ixf[lItibr C9thu rs .

A,slsla nr DII'ccior 0/ lite ..J mbu/allCf! D"lartmellt Lieut.·Colonel S"r RICHARD 1 E. Ban .. C. I.E . ..JsS/slant ReCf:I1'<'r- 1:-1 H. I, IUSHI'II·IIl. L'q., 1\1.A. .riSS/slallt I,butn',,,. Cn\1I l) AI·I' :J·OI,I, .\t'G',aal), LnC""AHT STUC/-:II'[·,II., j·.sq. \\ H.. J..I>II',IRIlS, }.sCj., J\. \

II00L. Set I'l'lal y of flu: j)J ili.\'/' (ij>/If/lirlmic j, (>s/,llal , jt'JusalemL ieut.-Colunel j. T. \\'001 RI'CII ..

A sSlslant 1/01101 an' '\"" "Itlr)' C/;". ,S col/,lI/ti I Of lite I/rilis!t {i/>/II/Ift/JJ1ic flos/,iral,jeJ J. I [Ol<:-IE i'."q, , l.:1licoJ'n /'uYsllizlaut. u.[JC ([Ollllcif.

TI,,: Council COII,ish of Ihe- -Prior. rt" President ex· offi cio , the I· xeculile OIT""" .1Ilt! I c following itlrlllurrs :

Sir jOll:-l FURIF\,. e.n J, c. j)AI T ,:'<., H..A . The HUll. \ "COllllt rst;.C,\I.t"

The Right lIon, J.ord Colon"l C. \\', IloII'IIIYJ\ Jl()II'I)U:J\, ( n. ,ir JAm··s Dlc/-:, :'11.]> .• R,X, Colnnel Sir ;\1. \VA'ISO", r... e.\1.G , e.B., R.E.

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Sir IhCE J)t;C/-:IIORTH, :\Ln. :'I1.,jor·l;en"ral ";ir UII' E:'<. '1' BuR"E, t;.C. l.l:. .. K,( Sir (;FOR(,E CW'I II. Hart. I eneral :\1.J)" H..

Sir R leH A10) ] )"t:(,I.A S P011'EI I , Bart., KC.\,O., .:\[.1) Li"lIl.·Col"nel ir RICHARD C. Dar!., C.I.]·•

The Chapter ('onsi ,ts of the Kni:;l Is of J Istl e ant. Suh-Prt:btes de /urc ; t he Executile the st::i". \1,,111 't:rs of CoulH:Il ; Ih.: follOWing @ffiriatll1g (ChaplaIns ,

The Sub·Dean of the CHAPEl S I The ReI. \\'. \\ ·OOD ROYAl., C. \ .0" D.D. l.{rprrsrntati\.Jr Hnirrf)ts of Qiirarr, W I\,NM IN DIXON, The Right H on. The Earl of Tht: Right H on., tht: Earl of , PI. nlOUTH C. h. ,eneral SIT \\ It 1.1 A Th l'ight li nn. the Farl of TAI' l.OR, K.C'.J:, r... H.P. \ AIWCJROU(.H. \\ II 1).

\bj.(,n. L.Y.SII'AI'F,c.n.,C.\[ G, :-SIr El)\I'ARIl OIIE:-I, F 'q., F.l{.C.S., Col.ne! E, R. PRITT. LL,D. Lieut.-Colonel lI'OR PHILIPI'!;, The Right H on. Lord CLAUD V.S.O., :'ILl'. Lieut.,Colonel CHAR! ES F. ST. Emu, H .,\NSO. FRESHFIF.l.n, ESQ, CLAIR .\N STRI"THER-TH MSON, C o l.ir CL E,\IE'T i\1. ROYlJS, . H. :'If. \'.0 , D.S.O.

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General ir RlcHAllD II "RRISO:'\, G C.B., C.;\l.G.

Colonel 'i r :I!. RU"IlS, C.D.

Captain] \ \ ' . .:\ OTT Bo\\ EI'.

ED.\lU1\U O\\F.:,\, Esq, F.R.C.S.

Lieut.·Colonel _ \. C. \ 'A n:.

Admiral ALFRED ] OH:-I CHAII-IELD, . B. The Right non. ]. L. WIUIlI'01\, P.C. RRr;I1\AI [) HARRIS01\, Esq., F.R.C.S.

Lieut-Colonel E \L \\'ILSU:,\, C.B, C.:'ILG., D.S.O., R. \.:\!.C .

Surgeon·C;eneral :-;ir . \1.1. KEO(,II, K C.B., K .H.P.

Colonel G. HU1\TER O·\I.\l.l.H.

Colunel LEES K1\O\\LES, Bart.

Lieut.·Culonel Sir ]A"ES R. A. CLARK, Bart C.B, F.R.C.S.E.

urgeon-General Sir FHA,,(KLIN, K.C.l.L ]OH:-O GRIFFITIIS, Esq., \1 ].CC.S.

Surgeon.Colonel E. CURI!:TO;';, :'II.D. ir ED\\" \RD L. O ·:'IlALLEY.

1£0\\1:'\ DAWES, Lsq

Surgeon ..\lajor G . ,\. HUTTON.

Depuly.lnspector·General :'II. CUATES, l\I.D., R. N. F. R. CASSlllI, Esq., :l1.D. ]. ASTLEY 13U)XAAI Esq., F.H.C.. \ VILLIAM E. AUDLA1\J), Esq, l\l.R.C.S Colonel T. H. HE:'\lJLEY, C.Ll:..

Ex·Officio II/embers 0/ Committee.

Colonel Sir HERBERT JEKYLL, K.C . :'II.G., R .E. (Secretary. General of the Order).

Eow!;.; .FRESHFIELD, Esq . , LL.D. of the Order).

The Right !fon . l:.GI!:H l'O:'\ OF J ATTU:,\ (Chairman, British Ophlhalmlc Hospllal).

QI::bic£

Colonel Sir HERBERT C. PERROTT, BarL, C . B. (Se::reury of lhe Order).

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WILLIA;\I R. EDWARD, Esq., A C.A. (Accolmtallt 0/ !he Order) .

jl.'lrnlJ ®fficrs.

ST. GATE, CLERKENWELL, LO. DON, KC. Telegraphic Address-" Firstaid, London." Telt'jJJlOllc-Holborn, 861.

lB an!urs.

LO, DON AND W EST;\ II NSTER LIMITED, (Lothbury, E. C . )

REYISED 190 1.

FIRST

AID TO THE INJURED . SYLLABUS OF INSTRUCTION.

FIRST

:\. Prcliminary remarks, OlljcCh of Instruction, &c.

n..-\ hl'ief description of the Human , kc1ct(ln, Bones, JOlllts, amI th :-Init 'Ill .

l'. , i"n,.;, symptolll;; aml treatment of Fracture!:>, Di -lueatlPns. :-Ipl'aills, and :-,trains.

n. The Tl'i<111gu1al' 13anclagc and it· application.

,' Fro'.;}) LECT{;ftE.

. \ . The Hear t and Blood Yes 'cl The 'ireulation of the

B. T he g neral direction of the Main Arteri s, indicating the points where the circulation ma.y be llrres(.ed b\' digital press Ill' " or by the ap}Jlieatiun of the tourniquet, or by other means.

C. The difference between .-\rt ria l , Ycnous, a11(1 Capillary Blce(l'ing, and the \'arious c}..temp01'ary means of arro ting it.

D. The Tria.ngu lar Bandage and it applicntion.

8

THIRD Ll CTl'RE.

A. A brief de cription of the T enTOllS System.

B. First Aid to persons sufferillrr from shock or colla.pse after injury, injury to the collapse from tlril1k, ' fainting, hystcria., sunstroke, electric ;;hock ctfects of lightning, and eOI1\"ul ions in children.

C.. Aid in.cases of fro t-hite, burns or ,ca.ltL, injury by vltnol throwmg, wounds, hites of a.nimal., sting of insect.

D. What to do wh cn the fire.

E. The Triangular Ba.nclage a.od its application.

FOURTH

A. A brief description of the Orga. ·\ and ..\lec11ani"m of Respiration.

B. The .immediate treatment of the apparently clro\I'l1ed or otherWIse suffocated. Artificial Respiration, Tn:atm nt for Choking.

C. First Aid to tho<\e poisonell.

D. The immediate Fir t Aid trea.tment of injllric" to the Internal Organs, and of those suilering frolll rnt fIlal H::emorrhage.

E. Foreign Bodies in the Eye, Ear, amI K0 e.

FIFTH LECTURE (for only).

. Improvi ed methods of lifting and ca.rrying the sick or LnJured.

B. Methods of lifting and ca.rrying the sick or inj tired on stretchers.

C. The conveyance of such by ra.il or in country carts.

9

FIFTH LEC'Tt'RE (for Females only).

A. Preparation for reception of •.\ccillent Cases.

H :'.IeaIlH of Lifting and 'arrying.

C. PreparaLioll of Be{l.

D. Removing the Clothes.

E. Preparations for. 'urgeon.

-OTE I.-The fmhject of poison . houlll lIe treated in a gcneral manner. Th e poi::;on cla ·sitietl, and ouly their general al\d.efiect taught. .

To get riel of the p(Jlson IS the only treatment wInch can be safely practiseel 1),)' 1.lO n-profe ·.ional lhe admini lration of antidotes 1::i the medtcal. mall ·s duty.

NOTE n.-Th e la t half hour of each le cture should be devoted to practical work, such a::; the application of bandages and splints, lifting aml.carrying wounded on' tretcher '.

:NOTE IlL-There should be an interval of a week between each lecture. A Canclidate for examination must attend at leal>t four out of the ti\'e lecLures.

NOTE cIa ses must pass in that system of stretcher exercise mosL uitaule for the locality.

NOTE V.-As little time as possible is to be spent on instruction in anatomical anel phy iological details. Lecturers and Examiners are particularly requested to rem em her that it is (( First Aiel" that ha s t,Q be taught and tested , and not anatomy and physiology .

U DIARY

OF -4-

CrrAPTER I.

Ex.) lanatory

The Human pine, Flkull, ribs, hrea. tb?ne, extrenutlC , peh'is and lower extremitIes, and Jomts ...

Muscles. Voluntary and im-olnntary

Fractures. Causes, Yarieties, signs and symptoms

General Treatment of Fractures A . sp lints and bandages. General rule's for

o,r Fractures . pine, cranium, er Ja", nbs, brea L-])o11e, collar-bone, shoulderarm, forea l Ill, metaeal'pns, finver )clvis tlugh, knee-cap, leg foot ::> I ,

Dislocations, Sprains and Strains

CrrAPTER II.

Circulati?n the Blood. Organs; general, luna and. cIl'culations ; the arteries, cJ.pII.alles, blood, COllrse of cIreulation

Hcemorrhage cr Bleeding. At' 1 lary ... ... ... rena, venous, c(],pil-

Arre.t of Hcemorrhage. Pres,ure, direct ana in dlrect; lllstrumental (by toul'l1iquet). and c1i!Tital' flcxlOn, po 'ItlOn of pcttI3nL, de\7ation of limb

Course of the Main Arteries and Arrest of Arterial Hcemorrhage The aorta, arteries of the hea.d and neck, of the upper extremities, within the che t ancll1bllol,en, of the lo\\'er extremities ...

Venous Hcemorrhage. 'Varicose yeins

Capillary Hce morrhage .. ,

CUAPTER III.

The Nervous System. Cercl.ro -spil1"ll, sympathetic Insensibility. General treatment. examinal,ion of paLi 'nt, shock, conCllsSlOll allll comp.res 'ion .of the urain, apoplexy, collapse from drlllk, faintincr, 11 \'stcrical fi Ls, sunst-roke, electrIC shock, effects lightning I con "uUons in children

CHAPTER IV.

Wounds anI Injuries to the Skin. 13l'uisc'l, wonnrls, frost -hitc, burns anfl seallls ",11'1t to do ",hcn the dress ca,tehes fire, yitl'lol lhrowing, bite' of anima1->, sn lk llites, sLings of insects, &c.

C'IIAI'TETI Y.

The R espiratory System

Artificial Respiration. Ho\\ artl's and La.honle's mcLhocls

Drowning, Strangulation, Suffocation

IlAPTER VI. Hanging,

Poisons and Poisoning. ,'ill1plc direction for trea,tmcnt. poisons and their trea,tmcnt classified :-Nal'cotics, corrosive (acids and alkalis), irritants, ant! oLhcr deadly pois')ns .

12

CHAPTER VII.

Injuries of Special Or g ans. Foreign bodies in the eye, car-passage and nose. The chest (thorax) and organs contained in it (he'll'i and lungs), wounds of The ahdomen antI the organs con Lamed m lt (bYe1', . pleen, intestines, kidneys, bladder), with treatmcnt of injury to them . Rupttu'e . . .

CrIA PTER \' III.

Application of the triangular bandage to the scalp, forebeatl &c., shoulder, hip, hand, foot, chest, back, knee, elbow

CIL'I.PTER IX.

Carrying P a tients. Fonl', two and three-handed fireman ' s lift, tempOnll'3' >;tretchers, to eros a dItch or wall, to load and unloall a \\"agoll

CrrAPT1!.R X.

Stretcher Tr a nspor t. stretcher exercises.

Introdll0tory. Stretchers, The Ashford litter

CrrAPTER XI.

The Fifth Lec t ure ( for Fe m a le s onl y). Preparation for reception of accjclent cases. Choice and preparation of a room . Lifting and carryincr. Preparation of bed. Removing the Prep a ration for

Skeleton, showing position of main

\Tertebra

kull and vertebral column of the left upper extr mity

B J11 '8 of thc right lO\\'c r eXlremily

1 he lup joint ... .

Diagram showing reciu. muscle of thigh, with artery, vein and nen" . .

,' implc fraclurc of leg

Componll(l fracturc of lefT

Tria,ngllllll' Imnchl,Jc, RPl'Cil<l onL ... ."

Trin,ngula.r h"nt!cl.\Sc, ollec folel 'd ., .,.

Triangular hl111Clagc, folel 'cl broad bandage ...

Tria,ngular balllhgc, folllecl as narrow Imndclge

Reef ...

.\.not11er Illccho(l of securing splint ... ... . ..

Third mcthod of securing splint, with knot incomplete

The same, \\ iLh knot eOlllplelecl ...

Large arlll.sling

, 'lllctil arm-. ling

Coat Lail lume(l up to forl11 ling funn ed from slec\'c "li l up . ,.

B llH1ll!e for frtwturc of lower J11\\-

Bandn,ttc for fracl(lrC of ri1>s ...

Tre 'nL of fmeLure of collar-bone, witb LWO ocwdagcs

Altcrn ltiYe method of ditto

TreaLmenL of fracLure of collar-bone with one banuage

Tre<tlment of fra.cture of a.rm

Angular splinL ... .. . ...

T reatment of fr",cture of forearm

Treatment of fracture of metarcarpus

Treatment of fracture of thigh (man)

Treatment of fracture of thigh (woman)

Fracture of knee-cap

Treatment of fracture of knee-cap

Treatment of fracture of leg

Ditto single handed ... .,.

One form of dislocated shonlder .. ,

Principal blood vessels and organs of respiration

Diagram of circulation of the blood

Field tourniquet

Screw tourniquet

Digital compression of carotid artery ...

Arrest of hremorrhage fr0111 temporal artery

Arrest of hremorrhage from forehead .. ,

Arrest of hremorrhage from ralmar arches

Digital compression of radial amI ulnar arteries

Flexion of elbow

Digital compression of brachial artery from below

The same from above

Compression of axillary artery ..

Digital compression of subclavian artery

Flexion of knee-join t

Digital prl'ssure on femoral artery ...

Application of tourniquet to femoral artery

Brain and spinal cord, and nerves proceeding from it .. ,

The lungs and bronchial tubes

Artificial respiration: inspiratioll

A rtificial respiration: expiration

The organs of the chest and abdomen

Bandage for head

Bandage for shoulder

Bandage for hip

Bandage for haod

Ihndage for foot

Bandage for chest (front)

Bandage for chest (back)

Bandage for knee

Four-handed seat 15

Two-handed. scat .. .., ...

Alternative grip for lwo hal1lled seat

Another altcmative grip for same

Three-handed , cat .. '

Fireman's lift (carrying) ...

Fireman's lift (lowering I

.en.t improvi. ed ''lith anc1 coat ..

trclchcr improvise!l with poles and coals

tretcher improvised. with poles and s::c-k

Furley orc1il1'lry stretcher (closed) ...

FurIey telescopic-handle(l (open)

treteher exercise Yo. T.. pI' parmg to load

Ditto, placing n str 'teher

Ditto, placing on lr teher

Ditto, carryin" stretcher... ..: .. ,

fltretcher excrci e Xo. II., prepunng to load

Ditto preparin'1 to lon(l .. , ... . ... .., ... Yo. III., placing on stretcher

tretcher exerci e 1\0. 1\T., nrst posItlOn .. ,

• econd posi bon

Ashford litter

Bed rest, three forms

PREFACE.

-- ¢.--

AT tbe' request of the Central Executive Committee, I have written this manual as the official handl100k 01 thl3 St. J olm Ambulance As 'ociation.

The strides made in the teaching of "Fir. t Aid," and the req'lirements of the • t. J oho Amlmhtnce Brigade, baye nece itated n,n enlargement of preyiou orks on tbe subject published by ihe A ·socinLion.

I haye endeavoured to include only as much anatomical and phy iological detail as is neces ary to enable students to grasp intelligently the principles of treatment.

Tbe greater part of the direction for the application of tbe triangular bandage and for lifting and enrrying pa.tient, is adapted almo't \erbatim from the \\ orll of the late hephcrd, as re-writtell oJ Dr. Robert Bruce.

I wish to express my Ghanks to Colonel C. Bowdler, Dr . J. Bro\yn, C. ChiICLs, l\1. Coate.', "\V. CollillgTidge, J. R. Crease, G. H. Darwill, and H. A. Ln,tilller, \\'ho have, as a sub-committee of the .:\. as·i, me in my work.

J ilIES CANTLIE.

June, 1901.

I rro THE TXTH EDITION.

'l'IIll: t . .1ohn £\mlmlance £\.. ociation bas completed the t\\ cnty-ixth year e::-:istence.. During the period incc the .\-;,·ocmtlOll began ]ts work, hundred: of thou 'and of mcn and women have been tau(rht at the of tbe .A ociatiol1 ho\\' to help their· injured neigh bom.·. 1n eyery cmm.try \V here civIlization has pen ·trated doe the teaebmg of As ociatioll find a rrndy audience. All ranks uf society te, tify to t be uscflllne ,' of the in ·trndion given ." The' fo11o\\e]">; of .]10 religiou ' or creed cayil at it aims and Ideal. J e\\ and llcntdc, C']ll'i tinn and Brall1nin and Bllddhi ' li accept its tenet', and appreciate tbe hencfit it confer.'.

the an pice>; of the 't..Tohn As 'oc iation, "Firt Aiel" deycloped mto n. dIStinct 1ll'<1.l1ch of urgery, l1C'cei:l itating a special. traininn- . either in our medical .·dlOOls 1101' III our lto:pital' is "Fir;-;t . \it1 ., specially taught, and it. is to the initiative of Lhe . 'to .John £\mbulancc 'oelation that 1Jolh the public and the lllcd Ical prof. 'sio.n nre indebted for IHl\"illl.!,· dcyeloped al1rl taugllt thIS illlportant depal tment of general .'urger,)'.

The In begins and ends with "Fh'l AH1," a.llCl the subJect is taught thoroughly cUJd exhaustrvely. The duty of the ailllmlance pupil end where , and there Ollght to no oV81.lappmg 01' clnslung of duty or intere.'ts. 0

lIberal or u efnl truction has eyer heen gIven to the public, a.nd the work of the "'t Tol A b 1 A " ' 111 ill ance SSf)ClatIOl1 nn1.'i tontinue "hil·t dw,riLy remal11S to us. and sympathy for suffcl'ilW llUUla.nit,-, -endures. b ,i

August, 1904.

T .LlID TO THE JXJUHED.

l'llAPTER 1.

EXPLAX .\TOllY.

By "First Aid " meant that form of 'killed n-; , j Utnntc \\' hi Gh peL'em . tmillcd in H.mlmlnnce \\ ork call alford ill"talllaneou:-.l,\' to the bi<.;k or illjnrecl.

" Fir:-.t . \id til the Injured " i, a branch of pnwtical ,'\ll'gery demalJding "pccial training and cdncation.

The prilH.:ipal aim ,tlHl object of the . 'to John Am1mLmce .\-;()Gi ;tti()l1 to leach ill simple b ,ngtw.ge how to help a :-:.iGk or illjnrell person unLil the 'c'rYic'cs of a doctor nre oblained . ...\. furthcr and illlporbtl't brandl of amhulance \\'ork it;; the cltrri,lge of 'ick or injured per. on . hy ,treteher, 1)y HmlmttllGe wagon, by rail, or hy improvi 'cd 111e,Ul ' of tntnport.

Before proceeding to givc in detail the v<trion: .-tep8 to be l,tken in thc e\'cnt of n.ceident or welden illnc,'s it i· lleec,',',uy to know 'omething of the ·trncture of the body (elelllcntn,ry nnn,tom),), and the fUll -tion' of some of the more importa,nt organs nnd ,'y ' tems (elemcntnry I short of necct;; <try anntomical ,mel points of il1lpOl'tm)<.;e i ' therefore given as the eycrn.l 'llbject8 are eli 'en "cd in delail. It is essential to rcmember when studying amt.lol1lY that the human hody is

BUppO 'ed to be standing erect, with the pa.lms of the hands directed forward. and the thumbs ouLwn.rds, or away from the bvdy. The" middle line" of the boay is a line drawn vertically from the top of the head to a point between the feet.

THE KELETOX.

The hody is moulded upon a bony fl'ame,vork whlCh erves: (1) '1'0 give hape and finllnC-"lS to the body j (2) to H.ffortl a.tta.chment to the nll1sclcs ; (3) to protect the morc vital organs ill the skull, III the chest, and in the abdomcn.

THE BA CK B OXE, 'P[t\E, OR VERTEBRAL

The Vertebral Column. -En.ch SC"ll1011t of which the spine is compo 'ed is termed a t">\ Tertehra.

A Vertebra consi ,t, (1) of a eClltral hody or m,1.s. ' j (2) of proces e" two of which join behind to form a canal for the pinal corel-the Spinal Canal ; behind, bony projections-the ;' pincs of thc verteunc -can be felt benea.th the ,kin for the whole ICllO'tb of the back (Fig. 1).

0

IThe vertebrre, :33 in .n.ll, nr c groupecl into regions :1. The Neck or CervIcal vertebne are 7 in lllunber . the first or atlas form . a joint with the basc of the skull, at which the nodding movement of t he head tak.es place j the second or axi, , by t h e joint betw ee n It and the atla', allo\ys of the ,' ide to sid e

lllovemcnts of t.hc hc;tc1. II. The Back or Dorsal vcrte11l',l', 13 in 11l111d1cr, 11<1.\,c the 1:3 pair of riLs attached 011 either bide. 111. The Loin 01' L urn bar

BODY OF' VE RTEBRA FHi . 1. SURFACES SUPPORTING HEADS OF RIBS

vert ,1mB, .J ill lltlt1l1I er, are th e In!'O'e, t of all thc ' ·crtell),'l'. 1 The Hump Done or Sacrum con :ists of five YL'rtuln', " ullitcd in adult ,v a mass, \\ltic:h with th e t\\O hau11ch formR the Y. Thc Tail HOlle or Coccyx COIl 'i ' t · of foul' YCrtl hne ",hidl arl' joil1c(l tOt.?:cthcr to f01'111 a ,...; iude ill'Ol1p. The \ l'1'tclme in cat]} region arc kllo\\ II hy 11ll1111Iel':';, COUll ting c1o\rmnl.nl ' - i 't, 21ld, etc.

Hdm;ell the h)(lil's of t.he ycrtL'hne thick piecc of !.!'l'i',tlC' or l'mtiln,!.!'l' (illtU/!{ )'tf/II 'al . . ) are intcrpo 'cd, \\ lu ch, \\ hibL tlll'Y llil1d the hOlll' S together, alIa\\' of f l'CL' 111m CllH'llt to t h C colulllll a \\ hole. <111l1 .'c1"'o to hl'eak the bod: of <'my forcc applied to the

pille. The whole length of the pine i. -trapped together lrr lit!'aments l'eachillg to end of the colulllll.

THE SKt:LL.

The bone of the are arranged in byo groups, tho::;e of the brain ca e, or cranium. and of the face.

The IJouuc1urie ,' of tbe Cranium nre Lbe yault or dome, the r :..mnded portion forming the top of the hend; tho front or brow j the ' lJack of the head, where the gren-te ·t extent of brain exi t , and where, therefore, FIG. 2.

SKULL A'-;D VERTEBRAL

, howillrJ ?·i7J8 and portion of 7n-ea81-lJone. The right ?"ius are removed.

23

the cmnium i::; wide!' and deepe ·t j the side ' or temple::;, where the opcnings into the ear pa sages are ::;0011, and to which the ear i,' attn,ched. The ba,'e of the n<tlliulll it') hidden fro111 view by the bones of the f;1('(' ;md the yertebra.l colullln; in it arc l1umerous pcrfOl'atlOn ' tor tlle p<l ,,' age of the blood ye " e1:::; goiu tt to and .froUl the. hrain ; through the large::;t the lJl'1Ull and "plllnl l'onl arc COl1tillllon::;,

The bones of thc Face, \\ itll the exception of the lowcr jaw, are nrlllly juilltccl together . 0 tha,t moyement lJet\\'cell them i: illlpU ,.. ible.

The c.wities of the llOKe anel of thc cye ,oeket (orbit) are [orllled by Lhe lJUne ' vi' the cra;lilllu and fal'e conjointly.

The llluuth ca,yity i:-; form <l betweeD the npper and 10\ycr jaw ' , the palate 1Jc iu!.!; the hony roof of the munth, which , epamtc. it fro111 the nn::;n! cn\,it\· nbo\'c. '

TIlE HIB:-'.

The Ribs con.. i ' L of l\\ehe pair ' of cllnecl bonc s extel1clillg frOlll tile \'erte1)ral colnlllll Lchinc.l to thL front of the hody, alld nrc };.llO\Yll hy llullllJer:-,. 1:-;t, :2nd, 3rd, ctc., cOlllmellcing frolll alJoyc. The\' furm jUilltt') \\'ith th e c1orl-'al and their mont that of thc hamlle of a bul'h:et. The rib .. nre not ho\\'c\'or, bOlly LhrOllO'hout their entire lellCyth. At a hmt eli ·tallt;e from tile hrea::;t-hone the bony material end8, a.nd gritlc (CQ1't take8

p lacc. The uppcr CYC'll pam.,;, I1ntllCcl the trlle rilr, are a.ttu,<.;hccl by their cartib!.!.'('· 1.0 the hrea ,t oono ; the l owor fho lXlir ' a.rc tormed the ,1cd::;e l'iI1::\, <l their cartila.ges faJl short or the lllidcll line. Uf the false the 11 th a.ncl 12th pair,' nrc termed Ute fluating' or wingcd rib., as their encl . arc free in frullt. The rib enclo'e the chest, and seryc to proted tlte lung. , heart, liYer .' toma.ch, spleen etc, (ee Thul'(lx alld Abdomen).

TIlE BREA'T-BONE.

The Breast -bon e (sternum) is a c1ngger- '1w.ped bone with the point helo\\', ju ' t oyer the pit of the stoma.ch; it the inner clld ' of the 'ol1arbones u,hoye, a.lld the Seyell true rill. , arc cOllllected with it ("1 either ide.

Tml; PPPER l-<,XTRE:'lITIE

The Shoulder 110n('.' arc the collar-bone (dovic1e) and the honlder-hlacle (sclljmla), and tbey together constitute an imperfed girdle-the ' houlder girdle .

T he Collar- bone can oe felt heneath the ::;kin at the lower and front part of the neck as a narrow curved rod of bOlle, about the tbickne. ' of a flllger. Its inner e!ld rest on the upper part of the brea::;tbone; the onter elld joins with the .'houlder-hlade at t h e top of the shoulder: at either elld a joillt existr:;. The collar-bone is endowcd with extra elasticity, owing to its being posseslSed of a double CU1'ye, the PART OF COLLAR BO\E ___:;:::..,_

RADH'<:

inner t\\o-thir(l: of the 1)(11l1.! heill).!: curYl'd r(Jl'\\'(lrc1 <ll1<l the OHler third lnl'k\\arch, '1'his is llecl....;. ,U·y ill order to re , i. t 'the :--tmill th1'O\\ II 011 the ]Hlllt' llY fall Oll the hanel, e1hm\, or Tile Shoulderblade lies at thl' htl'k of the c:lte. t, nlld rOl'lll - j()illt. , with the c(Jl1al'-IHJlI \ awl the hU11e Uf !.h,' .Hlll.

The bone of the arm (I/lIl1/U u-') J'eaclll: fww t h . . 1\Uul<1l'l' to the dlH)\\ .

III the Forearm ar e t\\O l)OlJeS, the Radius Oll the ouLer, or thnmb . iele, ancl th e Ulna 011 the inner, or little Jingll iue. Both oone' rcach from the CIll O\\' to the

BU;\ES 01' 'I'll E LEFT UPPER EXTHDIITY,

wri,t, and they ch'1nge th'l1' r elative position with eyery turn of the haud.

T'tle Hand i' compo 'cd of: (1) tho bones of the w1'i , t or Ca1pnK, eight in number, arrangNl in b\,(l row' of four j (:3) tho (th e fnullewo.·k c: the palm), presenting TI \"c, bones w11iuh form the ::md . upporL th e honos of the the phalrtn 'fe...: or TInger hon e throe in en,uh tin!.!: r, and two in the thumb.

TrJE AXD LmYER

Thp Pelvis .-The large ha.sin-like of bone attached to the lower prlrt. of Lbe spine is l'Ollql()s{ 'cl of three bone ' , the two hannch hone ' and t.he sal'nUll (or rump l)o11 e). '1'ho ham]'h hones m eet (at the ImIno.;) in the middle lille in front, only a 'illall pi ece of !:!;ristle but, l) ehind the aurum is p1<tc cd h et\\-eon them. Th e p eh -j ' HClTes to sl'll]l()rt the ahdolll en anel its contents, to pro ted tllo organs within tl.e pclYic <':cwity, to giye attachment. on It.' out or .·urfaco to the llllvc1es of tho hip aucl thigh, and presents the cleep .' ouket fo1' the head of tbe thigh l)ono - the hip joint.

The Thigh bone (lemur) reach e.' from the hip to the knee joint. Tile ::;haft ot tho hOllO j" f'>tunL, ronneled, and arched forward .' . Tile upper encl pref3entf3 a rounded heael, "llpported on a neck \\ hich projects inward.. at an Hngle from the .. hnft of t.he

Fw . 4.

THE ES OF 'IRE RT(, IlT Lo\\ ER E:-"TRE;,1JTY.

(PATELL .\). BROOCH Bo:-m (FIBULA). HI;"; (TIBIA).

TARSU ' . METATAR ·US. PlIALAXGES.

PELVIS.

THIGH BONE (FDIGR).

CAP

2 bone to fit into the ock,t of the hip joint. The lO\H'l' end expands to form t\\·o projedioll, ' ht the knee joint.

The Knee Cap (patella) i.' a thick triangular pieue of l)one \"ith ba.'e up\mrc1, l,\-ill,!.! in frollt of the knce joint anel the 10\\ er cnd of the thi!.!h hUlle. It can be felt immcc1intch' henenth tIle

The bones o f th e leg are the :--\hill houe (11'/1/1() and the Broouh 1,one (nf)u/a) . Tlte Shin bo ne (hhia) i triangular in shape. It extellds frOtll the knec to the ankle, into 1'0th of \\'hich joints it l'llll'r.' and plays an important part. The cdg,e or shin uan he felt iUllllcc1ia1.cly hcneath 1.h, III 0\ the front o f the leg: at tile i'l1ner ,ide of the Hllkle <t stout pieue of l1011C c10\\'llW;ud:-; from thl' tihia.

The Brooch . bone (JilJ/da) lie,' paralIl'l to, ;UHl un the onter ide of, the tibin. Thi l'Olle cloc .' llot enter into the fOl'lnntioll of the knee jniut, 1JIlt it, 10\\'cr end form:-; the outcr llfJ111l '1ary of the Hllkll' joint.

The Foot ,-(l) The group of ir'rc!.!1l1ar liIll1l', ' ;;t the ill, tep constitutc,' the nrc .l'Yell lH)}lc,' in the tar:u .. of whiuh 1.he i.. thl' llce1 l,ulle, aml the (the allldc form,' the lowel' part of the ankle joint, U) Thc h\'C loug hCJlle,' ill front of the tar'us cOllstitu1.e the awl e;tch bone snpports a toc. (3) Each toc, exccpt the l,i£!; toe, pos 'c,'ses thrcc l'OIlO,', llrtlllccl the hit, 2nc1, alld 3rd phalanges . The llig toe Ita,' 1,\\'0 pnalau!.!c:-; ouly.

A Joint is fOlIlll'rl at th(' jtdlctinll ()f two or tl101e hlll l '. J 11 joint: ,' lICIt as thl' llip, klll'I', e]],()W, du.) 1.ltl'urfn.ccs .of the hOllL , arc CO"l'l'l'd l"Y gri,tle or ('(l/,fI'la!/e, a harel, (lL'IISL', "l'llli-ll'lJ1,lIICelJt l'(,Y('rill'" \I·lt;l'hlc"" t hl' yiulcuul' aw l ,' lloek of a f;dl. Lnl))'il'atillg' the ,i(/iIlL i , :l cb r, r:ltilel' ticky O\'S,\TllP.'·Il11id) tile .. joi II t oi I," 0)' "!lllOL'ia, clldu.l'cl within a "(/jJsule.

Tyiug' the 1)(111l' til'IIIIY l(;g'cther, l,ut yL'l

FIt:. 5,-TuE IIII' JUl\T.

illg ()f lllO\ ClllCllt, are a lllllltl'l'r of land: ( r "',/aJill nil'. BOIll ', cn p:111e aml lig'all)clIt' are therel'me the COl 11 pOll l'llt part ' ot'

,'(cliOJl (ljn Ball and. 'ocl.e:t./elltl. the li11l1, joints.

To C\plnill the fo1'lllH tion of Iimh joillt..;, t ,ho fullo\l'iug c:-.alllples are g't\ ell :-

The Shoulder, ;t l'lll-alld-sockct joillt. <:onof a shal1o\l' sattCl')' like sllrface on the outer ang'Ie of the SllOllldl'l'·],1.Hle (sl'lljdt/,I), nnd of the rOllnded head uf the arltl hone (ltlllllL/'W} 0\\ ing to

VEI

:\Iu CGL .-\R TbSUE

thc :-.hallo\\ ncss or the .·lwulder-hlade Slll'i'nCt"

tllc 1'01111<1 ('l)(l or th' Cll'lll-hllle i:-; \ l'l':, Pl'Ui.le to cS(;<lpe frulll n .... so<.;ket (dilocate).

:! . The Elbo w, it hill .!.!·e joiut, is

uf th e nn11 IH)jlC aiHl\ e, ,d}(l of the l\\ 0 f()r ' -a1'l11 hone IJC1u\\' (L1ll' radills aud nllla). TIll' llpp'l" eml of tllL'

a projectioll heh:lld - the tip lIf the elllu\\,-\\"hidl sel'ye.. to elJlhntl'c the nJ'lll -l)olJe and lltailltlliu thl' hOlle.' of the cIllu\\- joillt III pu. itiull .

PATELLA

rE:>lDO . T OR LWA:-'IE,\1'

O[i' P .-\TELLA

Fw. 6. -D I Al;}{A)1 l:{ ECTUS M p:;CLE OF THIGH , V,'1T H ARTERY, VEl,\, AXD :N ERVE . 31

TII :J [1 T CL K'

The muscl e s (If the llody arc dnshifie(l in to

two gronp.', the 1'olurziar!l and the illl"olunta1'lj

Th e Voluntary muscles the llla;nlnlE{ of llltu-;des lllet \yith in thc lilllh-;, the hen(l aml net.:k, .lU(l the of the tnlllk. The 'e lllU 'des arc nttn.l'hed to the hmcs, and n.' they pel. ... fr())ll Ulle l)(Hll' to another they 'I'os.' n. joint, and l)cill!! eudo\\ eel

\\ ith the of (;ontl'<1.<.;tion uncl rela"ntioJl, l'UllC the 1ll0\elllcnt. of the budy. a llludc cl'O.·.. e. n juiut, it lose ' its retl, fic::,b)T appecu:n.u<.;e <m<1 lIC<';01111" il tendon (leader). Blooel \ tmYCl':-;e amI ' llpply the lllll:-;cles, and the llcne the Jl1u:-.c!es In'ing t llL'1tl under the dired control or the brain aud ,' pillal tonI.

TI ll' In v oluntary tnuscles are met with ill the \\ all:-; uf the ,tolll<lth allc.l illtestine, in the air pa:-;sagcs, ,md in llW.-t of the intel'll<ll organ.- and lJ100d \L':-;('}i-i al. 'o in n.pet.:ial forlll in the heart.

T Ill'\" are llot under the iuiiuell<.;e of the will, lmt cOlltinue thei r work c1nrilw the hOUl" of ,' leep; they are , uppliec1 11)' n ::let of nCl'Yct> ( 'ce ), CrYuu ' 'ysteln).

FIL\ CT CHE A TD THE TR TREAT:JI E :\, T.

D) a Fra cture is meant a 1lrokcn hOlle.

AUt--F.::-- OF FIL\.CTUHE.

A hcm Duty hl' h1'okc11 11\' :-

1. Direct' Violence . . W hen from <l 'eyere bluw,

3""

itllpact of a bullet, or ern h of a wheel, et<.:., a, bone ureaks at the 'pot \\'hcre the force i ' applied, the fracture i termed direct.

Indirect Violence . , Yhen the bone breaks at ome distance from the ·C<1.t of iujury, the frautnre i' termed indirect. on the feet and fracturing the thigh-bone or the Lone' of the leg, or falling on the hand and breaking the radiu - or the <.:ollar-bolle, are familiar exam pI es.

3. Muscular Action. The knee cap and the ann hone are occa -ionall.r Lroken by a "iolent contraction of the muscles attached to thCill.

Y ARlETfE OF FRACTURE8,

1. Simple . The bone is broken in two, with but slight injury to surroundin()' part',

2. Complicated. The hone i ' broken and other important adjacent structures injured either by the yiolence "'hich cau ed the fracture, or by the 'harp ends of the bone wounding a blood Yc.' 'e l, nene, or any of the orgn,ns within the 'l\:u11 dlCSt, or abdomen .

3. Compound . The bone is brok n aml the skin and ti 'sues punctured or torn, allowi1lg the H,ir to communicate with the 'ca t of the fracturc. The fractured ends may protrude through the Hkin, or tho wound may lead down to tho fracture. The yiolen<':8 that broke the Lone, or the jagged end.' of the Louo

thell1l'h'c., e.'pecially c1lll'ing em·dc·. 1llOYClllent, may c(1u.'e it fnwtlll'e to hCCll111e <.;ompOllllc1.

l'a ' -j ug reforcnce may nl.. o Le made to three more

FIG. 7. FIt;. '.

DIAGRAM OF Ih,lGRA:lI OF • UlirLE FR,\CTURE OF LEn. FRACTl:RE OF LEl" WITH C

varieties . Comminuted :-The bone is sma hed into seyeral piece. Green-stick :-In children, owing to t h e softer state of the bony ti::; 'llC.', a huno llW.y beud and crack withou t breaking completely acros.

Impacted :- ,Yhen, instead of oycrriding, the brokcn ends of <\, bone are dri"cn the one into the otber, tIle f r acture i aid to bc impactcd. Scycral of the wmal ign ' and of fractlll'e mcntionl'd lHJo\\ nrc ab eut in green- 'tick and impacted fnwturl' .

IGKS AXD • 'DIPTO)l' OF FRACTURE.

1. Loss of Power ill thc limll.

2. Pain at or near the 'cat of fnwturl'.

3. Deformity. The inj mcd lilllb Jiet:) in all Ullnatural position, (l,ud i. mi. '-:shapcll at thc .'l'< lt of the injury.

-1 . Shortening. Owing to thc contmction of the Dlll 'elcs, the cnd::; of the bone Oycl'l'ic1L', shortening of the inj med lillll).

5, Swelling. The oyerriding cnc1:-; of the hrokcn hone, the contraction of the mu. ·ele ' Hnd c'i'm;ioll of b l ood, will call 'e the parts aroLlnd the cat (Jf tlw fmctm'e to increase in bulk.

6. Irregularity. If the fractured bOlle is (;lne beneath the skin as in the cal::iC of the ja w, collar-bOlw, :shin-bone, etc., the ga,p in the bone or the cnds of fragments may be felt hy thc finger.

7. Unnatural Mobility. ':'I OYClllcnt may be 35

Illadc Ollt at the :->eat (Jf thl' urcnk in the 110nc a ' wcll m; aL a joint.

K. Crepitus 01' hOJl."!1:rntil1g' mny hc felt or hcard \I hl'n thl' ll!'ukl'll clld IIHn' Oll) UpOll tb, othl'r.

The t\\() unly beollght 11,'- a Ul'gCOll.

FOJ{ THK\l';\1EXT OF FH \.CTURE,',

Spl ints a n d B a nd ages a1'C the appnmtll,' by "ilil'it l»'okl'll j)(l11l' arc to 11c trl'atcd, III ho.pitnl. ', :->pllllts awl llnll(1a!.!,· ':-> il]lpl'Opriatc to e\ Ynri ,ty of I'ral'till" are at halld, 1>11l rUl' "Fir:--t . \id " tl'catllll'nt Lbcy fn'(luelltl,'· han' t() 11c ilUproYisec1.

Splin ts 111<1,\- Ill' illlpr()\iscd 1'1'O1ll \\'nlkillg' stit.:k,',

1(1111)1'l'11n. ' , billiard cucs, brooll1 ur hrush handll's, a policCIlIHll'" tl'lIl1CitCOll, ;t musket a hayullet, or a \\ mel in its scalljl;tl'c\, n foldcr1 cont, picee of \\ {)(j(l, t1nltl," i'olc1l,d IlL' \\'.'pnpcJ' or allY utIlcr p,lpcr, a. rolled-np lllap,- 01:, ill fact, an!/tlti/l[/ thut i.' jitm and 10/11/ enol/rlli til ].-""/) fllp imliwliutel!l alJ'I'e and oe/()Il' the 1'/'((('1111'(,,7 /JOI/I' at l'e.·4. , Yhether any of the abClYC appliancl'.' arc HyaiJable or not, tllc nPl;cr limh lIlay he tied to til, trllllk or tlll! l()\\ er lindl to it. , felfo\\'.

Bandages Illily Ill' illlprO\' isccl from hamlkcl'chicf' belt" t:)trnps, In';tL'l's, lll'cktie:-;, nr any piece of liuL'l1 or eoLtoll th,lt (;O111l'.' t() hallcl.

Esmarch ' s Trian g ular Banda g es (Fig, 9) nre made uy (;llttillg a piccc of lincn or (;nli(;o ahout forty

D 2

E D _______ --------""" E ;0

LOWER nORDER

Fw. 9. BANDAGE SPREAD OUT.

E 0 END

LOWER BORDER.

F IG . 10. B'l.NDAUE FOLDED.

END /'\. &80

LOWER BORDER. FIG. 11 . BROAD BA DAGE .

END A

LOWRR BORDF. R.

F IG . 12. N ,HUW\v BANDAC; E.

inclH',' ,'cl1u1.l'c into two pieccH The bandage llln,'" lJe ul';cd ' ilhcl';u; n In'oHcl or narrow hl11c1agc.

T he broad i ' lll,tcle 1)), the bandage out,

Fll;. ]4 .

th cn hrill!.!,'ing th e point dO\Yll to t h e lower border (Fig In), awl thl'll f()lclill .!.!.' into two (Fi!.!.·. 11).

Thc n a rrow i. ll1ad e hy folding thL' hroad bandage :t!,!.'ain in t\\U (Fig.

WhCll not ill tl' e, the triangular 1mnc1ngc 'hould be foldccl at:; 11 11,UTOW lJamlngc, tIll' two cncli'> 'hould be t nrnc'cl to thc centre, HUcl the ballct'1.gc then fulcIcd into fonr, redu cing it to a paekeL ahout G in chcs by illehcH. , Yhcn thc bandage i fold cd ill thi, ' manner it i ,' only nCee ' aI'\" to cxtend it len!.!,'thwiHc to fo r m a llaITO\\ In-tl1 cttgc, to unfold narro\\ balldnge and , ' 0 douulc it · \\ iclth to make a br oad bandage.

38

The bandage should always be fa tened either by a pin or by tying the ends with a reef knot (Fig. 13).

FIG. I 5B.

FIG. I5A.

, Yhen u 'ed for ecnr· ing ' plints, the lJ<tlldage

r:;hould be folded nar1'0\\', and may uo applied either (1) by pa 'r:; iu{f it once, twice, 01' morc r ound the limu splint a.nd tying with a reef knot; or (2) by doubling it, par:;sing it r ound the lim band splint, in 'elting one cud

39

thr01.wh the loop formed by donl)ling the handage and tying it to the free nc1 with a reef knot (see Fig. 14) : or (3) by proceedillg' a. in No. (2), but pa:-;, ing uoth end!:) thnmgh the loop ill oppo ite direction,' (!:) c Fig. 1JA), and tJ1 ing them \\ ith it reef knot ( ee Fig. L313).

Knot' ,·honld a1 \\,ay ,' , where po''i hle, he tie(l oyer a 'plint, '0 tbat they lllfly not pres!:) Up011 'oft !:)lrnctul'e,' to do them injury.

L arge a rmsli n g (Fig. 16).:-';pl'eac1 out a h1llnage, put 011e end oyer the ,' houlder on the 'O U11<1 'ide let the other han!! dO\\,11 in

FIG. 16. front of the che·t; carry the point hehind the elho\\' of the injured arm, a11cl hencl the arm forward oyer the middle of the bandage; then carry the ecolld end oyor the of the inj 'ide, and tic to the at her enLl; brillO'

the point forward, and pin to the front of the bandage.

Sma1l armsling (Fig. 17).

F IG. 17.

- Fold the handage into the hroad 1l<tllc1nge ; then place Ulle end oyer the houlder on the 'oUltcl .'i(lc; eJ'o. s the forearm OYer the mi<lrllc of the banrhtge ha nging dowll til· chc.,t; then 1lring the other C1H1 oYer the ,' honlclcr Ull the illj ured ::;it1e, and tie at the Bide of the neck .

Sling8 may be extell1poriBed hy tnl'llillg IIp the tail of the coat and pinlling it on the :-;hon1(1e1' (Fig. 1( ), 01' if the 'cam of the blce\'c has been ,lit up, by re 'ting the arm in the strip of cloth 80 fonned, and pilllling as shown in Fig 19.

4L

RULES TO BE OBSERVF.D IN TIlE TREAT)t:u l OF FRACTURES.

Th e object of fir t aid treatment of fracture is to guard again t further mischief, and especially to pre-

FIll. 18 . FIG, 19.

v en t a ' imple fracture from becomiuO' complicated or compound. To attain this end:- b

1. Attend to the Fracture on the spot where the accident occurred. TO matter how

crowded the thoroughfare, or how short the clistall(:c to it more COllYelliellt or comfortahle place no attelllpt lllW:3t be made to moye the pntient until the ll(me 11a ' been rendered Hi') immoYH,ule ai') 1))" it 'plint or other 1'e'training appitratus . \Y ith great principle e the treatment of fracture' i::; it que 'tiOll of detail.

2. Steady and support the injured limb at once, '0 that it· fnrther moyement 011 the part of either the patient or the h:T tanclcr' i,' preY llted.

3. When a bone of the lower extremity is broken gently pull upon the foot until the liml) regain a more normal i')hn,pe. " Then the position of the limh i· improyed, on no nc.:COllllt let go of the lim h until it i' ecu1'ecl ill po,'itioll by 'plints, othel"\\ thc mu 'c le ' ,yill be allo,yecl to contract, and tIl, rough end::; of the broken l)one penetrate the ,'kill, pierce a hlood-ye,' 'el, or (10 further clmnage . It i,' not well to attempt exten,' iOll (i.e, 'tretc.:hing) in c.:a," of a fracture of the upper limb. Thi ,' .. llOUlcl l)L' . left to the surgeon.

4. When the fracture is compound and further complicated .. eyere lu:clllorrhagc , arrest the hremorrhage hefore further 'tep' ,tJ"e tah'll. In all ca e ' of compound fracture npply dean dn:i'),'ings to the wound.

5 . Apply splints and bandages to l":)ccnre the hllb in po::;ition, and to pre"ent 1ll0yemcnt ,,,hil ,t the

pntiellt i,' l'l'ilH.!,' CalTil'cl til ·his bPllH" to it h(, pital, (II" to temporal'.' 'r. 'lilc .. plints should lIe 1(lllg C'll!IUg'lt to ku·p tl,<; joiuls illlllll'tlintely abo, c and Ilell)\\ tllC fntctlll"ed bOl1e ai lC. t.

G. f11 e\ l'rY of fractllrc it i. to keep the patient warm,o a .. to the cft·cd.. oj' the .....IlOc ' ''" ur lhc accideut; thi . i dOlll' l.y a cloak, sba\\ 1, or cllat c)\ l'l" the IJ<ttiellt ullt;l he rOiH:lwt-> sheltel".

.'I'EC'IAL FRACTURF •.

Fracture of the Spine. -The yel'tel-,ral column ilIa\, 1), brOh"']) either by direet yiolence or hr illdi]' ct \ 11)'lellcC'. F;,l1illg froll; a height Oll the b;u..1 <tl'l'O:: a hal', or llpOl1 an UllCYC'll surface, i' an eXHlllple of dire ,t \'1<I1ell("e. Falling Oll lhl' head, or n cru::;hillg' force appliL'cL to tbe head, ;u e cxalIlple,' of inclired YinIelH:e, causing u . l1all., <L jlroken noek. \Yhnt is eOllJlllUnly rl'garrlcrl <l' a hrokell hack con .. of a fracture of the COllllCdil1g' the bone.. \\"it h eli 'plnel' I11Cnt of the yertehne, therehy cllclnllgcrillg the 1 c rd and OIC lll'l'ye" i::;:-ming' frolU it, lending to e< ll1plete partial par,tl."l-iis or the part. · helow tll' ':'ent of lllJ ttry.

T?"Ntfment.-PreYCllt n11 moycmcnt 011 tl1C 1 art (f the paticnt. 11' a doctor iH ,'\ ithill cn11, keep the pati 'nt quiet until hc Tf the of a doctor call1lot he ohtained within rea onallc time,

44

pa " n blanket, hect" tout plaid, piece of :,;ai ] 01' Callya ' , etc., hcneath t he patient. D o not roll the patient oycr in cloin o' so, hut pe1. ·s the blanket 01' 't, ctc . carefully first bcncath the hcad, t.hcn nncll'r the body and lo\\"cr extrcmitics as he l ies on hi. ' had\:. l'>ole ' arc then to bc rolled in thc l)lanket one on e<1.eh side. Thc patiellt lllay 110\\ be lifted 1»), fOlll' p niOll " t \\·.o all cither -idc, gnvping the pole' (eaeh U.'lllg hath hancli-», laid 011 a -tretdwr or t-;huttcr, ,mel carried to -helter. So fmther treatlllcllt is eallccl for l1util the dodo!' nrriyl", cxecpt to giyc thc paticnt water, tea, ete., if he i ' <..:011 'cious.

Fracture of the Skull. - Fraetnrc ' of the cralli lllll are dnngerou , in proportion to the ex t.Cll t of the inj lll'y to the brain cOlltained within it. ·boundaries.

1: 'ually there are .·YIlJptOlllS of injury to the l)}'nin (see 'o111p1'c 'ion and COllCU 'sion, page ' 108 anel 1ml).

Fractures of the "mlt nre clal1gc)'otl . t.hall fracturcs of of the enlllinm. 'W hcn any part of t].lC.YC1.ult 1 - fradurecl and a f-;etllp\\olllJ( 1 rc\eab t h c lllJLll'cd bonc, the fmetlll" may l)e seell or felt· t h it; mayor llllty not 1)0 n.ss()cic1.tecl with Cyj(lellCC of brain injury.

'\' hell the 1m e of t h e crnilllllll i ' fraei.ll1'e(l, blood

0 1' clcar fluid may i,'sl1e from the car: OJ' til, ll100d may e 'cape from the llO::>l', or lWl.Y pel " dO\\'ll to the stomach ",hcnce it may l le yomitcd. T h e fracture in \'Ol yc t h e orbit," \\'h en Llood ",ill eHcape illto

45

.' 0 kcts of onc or both ,Y hen the fract m'e fill' 1Hu:k, there lllay 1>e indicatiollH of a lll'lli .· l' at Lllt' htck of the head .

'l.'J'ea! III 1:11 1.- Arrest ,my b&UlOrrhagc from a bloodyessel III the . calp (Hec page P lace thc patient

11l an ca.. y po , itioll to hreathe; nllclo all tig-ht dotbing; carrY th e paticnt indoor - 0'1' uncleI' :-;hellC'r; apply a clean }umrlk c rchicf, a piecc of liut or lillcn clippccl in cold \\'nter, ()r, if a ynilahlc n.n icebag, to the henrl . Do not giy e lly th e lllouth if thl' pnticllt i ' in8e11 -i1)1e, and get a doctor . p eedily . F r acture of the Lower Jaw. - Th ere arc the u -ual sign.' of fractl11' " \\ ilh y to :-;peak ur nwyc th"c ja \\' frech ' irrcll'nlarity of the tccth nnc1 l)lccdinO' from the to .. T?·eatm ent . P lclce thc palm of tIle hand hc]o\\' t he l1lJ med bon , pres):) it gently upward ' against t he

1<'1l .. 20.

46

upper jaw, and mall1tain it in that pO ' ition lly a narrow bandage. rro apply the bandage, place the centre to one side of the chin, carry tho ends np theside of the head, cro ing them just above one ear, and pa the ends }ound the head, tying them on the ide of the head oppo. ite to the eros iug (Fig. 20). Another method is to tie the ends on the top of the head, and pa s a econd bandage in front of the ehi11, fa ten the end ' at the back of the ueck, and tie all four ends on the crown of the head.

Fractured R i bs. -The ribs fractured are tho'e occupying a central position in the che.' t, namely, the 6th, 7th, th, and 9th . The higher and the lo\\"er pairs are seldom fractured . A rih may he broken by a direct blow or hy a squeeze or cru 'h. It may be broken in any part of its course, but it i.' usually fractured halfway between the hre:1 t-bono and the back-bone. The danger of a broken rib yaries with the amount of injury to the lung. Practically, whereyer a rib i to be felt there is lung beneath; therefore any force which tends to drive the ends of the broken bone inwards may tear the lung .

,Signs and Symptoms.- 'When a rib is broken the patient complains of a severe pain, on attempting to take a deep breath j the breathing is short and shallow, and crepitns may be felt on placing the hand over the injured part. hould the rib penetrate the lung blood may be coughed up and expectorated.

47

Blood .coming from a t01l1 lung is coughed up; it is of a bngh t red colour, and presents a frothy appearnee.

Treatm,ent . - When the lung is '!lot h1il.lud apply two broad bandages firmly round the the t, with the centre of one llandage immediately a1 )0,e, and the centre of the second handage immediately below the cat of fracture. The bandages are to be placed '0 that the oyerlap the upper to half it , extent. They nre to oe ti d 011 the vOPPo 'itc 'ide of the body with the knots rachel' to the front of tIle body, and tight enongh to gIye the patIent npport and comfort

FIG. "l l. in breathing (Fi er • 21) . '''hell no handaae ' are procurable, thE; wai'tcoat by the back. or ecurmg It other",i e a aood plan. When the nbs /}.re broken, causing 17ljury tn, awl it may be hcel'l n7'rhage from the lung, do not place a bandage

43 the body, but lay the patient down, inclined n, httle towards the injured in order to give play to the ound lung; 100 ('n the <.:lothing, gn'e Ice to and place an ice-bag on the ehe ·t oyer the broken rib. A bandage round the cbe -t might tend to driye the broken hone further iuto the lung. A large sling to upport the ann of the injured side i acl·i'i.-able in either ..;ase.

Fr ac ture of the Brea s t - bone (str:rnulII).- \ Yhen this accident is suspected, or when hy pa. -iug the fingers oyer the brea -t-hone the fraGture can be felt, the treatment to be followed is. to unclo nJl tight clothinp;, to phce the pa,tiGnt in a ' e<l -y a [l..' po\ -ible until n, doctor arrives, and tU<lyoid rough handling or sudden movement.

OF TDE BOKE ' OF TIlE DpPEH EX1RKUITY.

Fr a cture of the Colla r- bone (elaz ide).-The arm on the injm'ed side is p,trtially bplple., and the patient usually .-upports it at the el1::o w \\ith ha1,(1, and inclines his heacl toward - tJ1C injl1l'ed .·iele. 'Vbell the finger pas. cd a.long the illj llre('l 1J0110 the fractured ends can generally be felt to o\,er]:lp, the ?uter fragl1lent having dropped IlelO\\' the level uf the mner one. The other signs and of fl"tcture arc mostly present.

}l'reatment.-Remove tllC coat with care, 'beginning with the Bound side and i::iuppurting the

injlll'cd limh the 1'e1110ya1 of the . leeye therdrom; tttk' otf a. 1I1\1(.;h more of the .1oUting n.' C'xpedient. rhtce a pad alJont the uf a Bath lnm in th armpit of the injured ide. Gent1y l)e11cl tbe forearm well up, keeping FIG. :?2.

the ellHl\\' a. far back a ' praetienble, and upport ill l:L brg) arm sling. In -tead of. the large ann cling in the ll.'nal method, It m1nable to p,t::;· the end, that in the unlillary way would go oyer

fiO bone, beneath the armpit of the injured and tIe the end hehind (Fig. 22). An alternatrve fo r m of ling, preferred by ome, is put on a.' follow : flex the fo r earm as above; place Ol1e end of

the on . the 'houlder of the uninjured . icle, keepIng the pomt toward .' the injured ide; pa s the ba e flexed forear111 anel the hody, then under the armpIt and acro'::; the back, and tie 51

FIG 23,A.

FIG. 23n. (Bandage ronnd body, omitted to show details of sling.)

the t.wo ends on the 'houlder of the iele. 'l'he point n,nd part of the side::; of the arc now to be folded to ::;upport the ell)o\\' and fixed with one or two pin ' (Fig. 23A. and 2:313); llY eitbcr of the::;e plan::; the broken Lone i::; llot prc.. eLl npoll Ly thc hmclage

Finally tin'htly beCl1l'e --1i11;1> to theidl' of the body by a bron,d applied imlllec1iately oycr and llpOll the cllJUw of the injured lim h n' .'hown in outlinc (Fig·:-;. and Q3_\) , carry tbe cud horizontnlhround the che.t 0 to ]eycr ont the ann at the :-;lwll1der joint, the pad for111ing the fulcrum.

FIG, 24. 'Y 11 nOlle llHl1dage only l nynilalJle place a pad in the armpit, flex the forearm as ill diagram (Fig. nppl.'- a narrow Lamlngc illllllcclintely aboye the ,Ibm\, In'illg 011C cnd acro" the front of the chL' 'L : CHlTY the oLlter l'ml hchincl thc ann, and thcn Lring it fo;'\\ nI'd

bebyeen the limb and the body; pa,' it .;0 as to em brace the portion of the bandage on the front of che.'t, it r ound the back; pull tIght and tIe off a III dUlgram (Fig. 2:1:).

Fracture of the Shoulder-blade (scapu1a ) is to be. treated, after the clothmg is remoycd, by applymg a broad triangular bandage firm 1y round the body, over the seat of mjury, and therefore cloe up to the m:mpits; the limb i::; then supported by a large arm slmg.

Fracture of the Arm (hum ,erus).-The bone maJ be broken clo 'e up to the shoulder, in thc middle of It::; shaft, or in the lllllllediate lleIrrhbOHl'hood of the elbow joint The usual sIgn' and S;PllptOlll' are pre 'ent.

T1'eMment.-- Wh , n the Hu,meTus is fmctU1'ed (J/ z{."; upper end to the shoulder Joint a 1'l'oad bandage WIth Its centro aboye the middlc of the arm and carry the end , round the ann and body, tying them on the Oppo.'Ite side; support the foren,rm by a arm sling. When the shalt of the HIlIIZerus i::; broken :-Bend the forearm at right angles to the arm; apply four splints of wood or folded ne\\'.'pap rtl, covers of books, etc. to reach from shoulder to elbow to the front, back, outer, and inner side::; of the (Fig . 25). The 'plint in front (o\' er the biceps muscle) m,nst on no aCl:oun.t. be so long as to pre 's upon the fo ld of the elbow Jomt, other\\'i 'e the blood-

ve ,els arc ill of being compres, 'ed. The straw cover of a wine l?ottle cut to a proper length forms an excellent :-:;plmt for the front of the ann, In ca 'C of difficult:r in procurin o' ,'plint, ' , it will be sufficient to place them on the outer and inner ,'idc,' onl}', 'ccure the splint · lly two lmnclage ,on e ahoye ancl the other Lelow the seat of fracture, In case no splint.' nre nvailal)le, Sel:lll'e the arm with two h1'o<1' handage' to the ide. , ' upport the forearm by n small arm , Fract'U) 'es ml'oh'illq the elbow joint m:e a ttcnded 1>Y ' 0 111uch

FIG, 25. s wclling," and it i ' o ditticult to ascertain the CX ctct nature of the injury, that when the accident Ol:cur ' indoor::) the limb 'hould be laid on n pillow in the 1110 t comfortable poition po::;ible; ice or cold water dre '

shonH be applied to the injured part, but no flll'ther tren,tll1ent hould be attempted pending the arrival of doctor. W hen t h e accident occurs out of doon" it

1 . treated by tbe application of an anglllar 'plint (li Ig. ", 6 ) made as fo llo",s :-T,Lke Lwo piece.' of thin £lett one long e11ouo'11 to reac:h from the armpIt to JU t below the elbow, the other 101112.' enongh to reach from above the elbow to the finger tips; tie

FIG. 26. remove the splint occurred indoors. them togeth 'l' as to furm n. right angle, etlld apply tl.le angula,r 'plin L so \ formed on eilher Lho mIter or inner ,'ide of the flexed limb. ,-'ecure hy nal'l'Ow bandage ' 'a1>o\' o .uHl below the eat of fractu re, and 'upport by a larg e a r m -ling. Un arrival at. home and treat as if the inj ury had of the Forearm. - Siq71,'; a7I(Z "!lIJIPtoms . - n hen ooth bones (th e Radius anrl [rIll (1 ) a7'P "TOken, the u sual signs and symptoms of fracture are p,resent; w h en one of the fico lJones on711 is Moken the s Igns a r e modi fied , but t h e limb will l ose power, a

55

rlcfol'lllity will be found at the seat of fracture, and aCll Le pain when llloyement i.' attempted. A fracture of the Ulna alone u.'uallv occur n,t the upper en(l uf Lh o bune, in the of the elbow. The tip of the elbow behilld i.. 10nned 1>y the ulna, and a. fall upon that pl'oce ',' of l)one i:::i apt to hl'en.k it ott'.

The Radius is frequently fractured immediately alH)\'c the wrist, the reult uf n, fall Oll the lw.nJ.

FlU. '27.

Thi fra,cLure i ' u 'lUtlly impacted and the ign of fracture arc con eq llcntly modified, hut th c.lefonlllty, the acute pain 011 mO\'ement, and the Jlowerle " ne 's of the hand aro 'ufficiently tl'ong proof that the hone i ' broken.

Tr eat //l ent.-The treatment is the ::iaUle \\ hcther the

56

fracture is of one or both of the bones. Be no the forearm at right anglo to the ann, ke eping tho thumb upward and the palm of the hand towards the body ; apply two broad splint 'whil e the for earm is maintained in the bent po 'ition, one along the inner, th e oth er along the onter side of the limb. Th e lllnCl' kplint hould b lon g enough to reaeh from the elbow to the fingers, and the outer from the dbow to the hack of tho hanel. , 'oenre the . plint · by handages, one auoyc, and another below the eat of frneture, and a third to fix the hand ill po ition (Fig. 27).

Fig. 28. F ina11y, support the limu by a large arm ling.

Metacarpus . - On e or more of the metiwarpal bones may be broken by direct or indireet violence.

57

Wh en a metacarpal bone i, fractured, place a round pad ' ueh as ,L telllli ' ball, in the palm of the band, bond the fingers ronnd the ball, and secure the whole by it hnncbgc, and apply a largo arm Sling (b'ig. :2 ).

Fracture of a Bone of the Finger (Jllwlan.c).

-The natur of the illjnry i · readily recognizable, a the deformity can be both cen and felt.

TI' Pfltmf'nf.-Drarr the injurcd finger gently into po.'i tiull, <lpply a narrow 'plint alonO' the front of the finger, anel secure it hy a picco of linen, tape, or phl,.'ter. 'Yh cn 'e ycml fingerR are injured apply a plint large enough to upport the whole hanel. 'upport the hand an(l furenrm l)y a large arm ·ling.

Fracture of the Pelvis. -Si.Qlls and Symptoms.

- \Yh en, after 80"01'0 injury in tho neighbourhood of the haunch hone, there i' no 'ign of injury to the lower e:\ lremity, hut the patient is unt11)le to 'tnnd, or 'Y<11k, or cycn to moye tho lower limb., without grellt clilliculty and pnjn, a fmctnrc of the pelvis may hc a'slllllcd to lUl\'o occulTcd. Deformity, crel)itns, ete., cannot u 'nally bo made out. The bloml-Yl" and orgn.n.', morc e pecinlly tho bladder, within thc pelvi ', arc in great danger of being wOlluded.

Tr ea tment.-Lay the paticnt in whatoycr po ' ition is founel to giyo grcate t ea c. Bind a broad bandage r ound the hip tight enough to support the pa.rt, but not so tight as to press the broken bone

58

furthet· im''1ard toward the cayity of the pclYi:-; and thercby can e more damage to the intcrned organs. Flex or traighten t h e 10'wc 1' limb' according ,tt, the patient ,'Ii hc , and lay him carefully on a blanket, .·h utte r , or stretcher beforc movin o' him to a place of shclter.

FRACTURE OF THE BOXER OF THE LOWER KWRK\nTY.

Fracture of th e Thigh bone (.tem71/').-The thigh bone may be brokcn at the ncck (the uppcr end); anywhere ill the length of .'haft; or at the lower end clo'e to thc knee. Frnc.:tul'e of the 11('('k of the thigh bone i. vcr." apt to o(;cnl' in 01(1 pcople and from yery slight injury. seyere hrni:-;c of the hip is apt to be mist,lken for a fmcture. It 11Ul.:" 1Je taken as a afe guide, ho\\ eyer, that \\ hCll, after an injury in the neighhourhood of the hip joint the illjnrcd person cau, whil. ·t lying on thc hl.(;k, raise the heel off the grolln(l, the bOlla i · 110t 1n'okell : hut if the heel cannot he raiscd it i' safe to tv,'ume that the bOlle is broken. Fractnre of the 10\\"e1' cnel of t11 > thigh bone i ' iLpt to inyolyc the knce in the injury, with .. erious detrimcnt to the joint.

Si(Jns a nd Symptoms -The u ' ual sign. of fraeturc. The foot of the injured limb \Yill lie in 'OIne ahllonnnl position, usually on it.. outer .. idc . The .. hortcning on the injured 'ide may vary from one-half to t h ree inches.

59

TI'Ntf1ilnlt.-(1) teacly tile injurccl lilllb IJY 1.101d. . tl I j' ()t (") ('''utly dm\\" clO\\ll tbe foot of tll_c ]l1(' IC U. \'..l\' .' • • illjlll'lid sic1c, a11(l ])rillg it into 1111e wILh fuot uf the I-'mlllc1 lilllb. \\ bcn t\\() or three a .... arc at hanel, it i.- one pel's n':-; duty to to the. foot, holding it in ]lo .. ilioll and 1l0t ulltIl :he .plint.· n])(l hllldngc,' nrc tlpphed. (:3) .•\ 1'1'1: 11 1lint e ll the outCI' i(le of the brokeu hlll1) , to rcach fro1\l tllc armpit tu JJl'yllld tbe foo,t. ' hroOl1l handle, n 11m ket (butt cnd ill arm-

pit) n.. d1001 map rollc(l uI, n. couple of 11il1iHl'd euc tied togcther or allY 1'i('(;e of \\ lod cut .to lellg;h may l)e l1:-;ctl as n :-;plinl. (-I-) _\pply n I pllllt 011 tIle in::;ide of the hrokell thig ll, long cll?ugh to reaeh from the in.-ide of the top of the th1.gb (tl:e. fork) to the knee. (!5) ,'ecnre the ·plint · :11 F SItlOll hy hnnclaf!e::>. Pa'" one ronnd the clm.,t t below the nXl11pit.' ; r ronnel thc .. : n thud and fourth 1)c1llc1ngc l)oth 'p1ll1t ' , nrc p!nccd thc thigh , onc nlJoyo and the other Lelo\\ the seat :f

GO

fra,ctul'e; ;1, fifth h1.ll'b:.re 1'01ln<1 tho leg; ,I, sixth i' to to he pa 'cd behind both ankle", the on(b cr()'"!..;ecl (wer til .... front of the foet, the. plint. and tied off b low t ho fcot. Fi nally, apply ,l :-;eyellth h1l1(lnge round both knem; (Fig . 29). Do 110t <l.l'pl.\· a 1mnclage over the abdomen, as it might ccm'c the patient to Yomit, and, moreover, wonldnot keep the :-;plint Arm . (6) rr r eat shock by keeping' the patient ,\',trlll. lnzpn a person is singl·e-hanrled, it i::; oxp 'client, after exten::;ion of the lilllh, to tic the feeL togcther to prenmt the bones from again oyerhtpping; and Illlclcr the 'e circumstance, a' <1.1:> the paticnt i: a woman, it is wen to pa:s all the limh bnnche;e::l round both limb, dispensing with the ill::;icle :llint (Fig 30),

F IG, 30.

Fracture of the kneecap (jJ'lte1lll ).-The kneecap ma,), be broken by falling on the knce (clircd violcllce) . freq....lently it i::; 1n'okel1 l)y JllllsC'u1nr action, an accidcnt \\-hieh m'lY <Ll'i 'C n. fullo\\'"

61

yr hen the foot slip' and an attempt i' made to preycnt a fall the mn cle: in the front of the thigh ad ,,,ith . nch force in HIe attempt to maintain the halance that the knee cap may l)e 'nn pped in two. ,igns and The limu will be quite belple s; a gap may l)e felt hetween the broken end8 of the kneecap' the knee joint will peedily'well. Treatmcnt .-Lay the patient on his back; rai e well and

FIG. 3]. FR,\CTURE support the head and houlders. OF KC\EEC U'. ,'traightcn and the limb. .Apply a 'plint along the back of the limh reaching from the hip to beyond the heel' apply a narrow bamlage with its centre placcd illllllccli<ttely aboyo tho broken kneecap, '1'0,' the end: hehind oycr the plint, and tic off in front helow the broken hone (Fig. 32) . rro eu:nre n second handage may be appli(;d in a similar way to the first, but comlllenced below, and tied aboy, "the broken bone. The plint i to be further ecnrc(l by handage ronnd the thigh and leg. The foot is then to be :upported well off the ground by n pillow, roll of clothing, etc. ; or if none of the 'e can be hacl, by resting the foot of thf\ injured limb on the top of the foot of the sound limb. An icc-bag or

rold-,vater dre' 'ing ' honlcl be applied all the front of the injured kneecap a ' 'oon <us po.' 'illle.

Fw. 32.

Fracture of the Leg (til)/a nneI .film/rl, .-Roth bOlle.' m·t), be broke11 at t.h n titlle : or l' itbl'l' 1ll.1.Y be broken alone.

•'iign;; and SU7nptom:::.-The II 'ual igm; and SYlllP-

FIG. 33.

tom. are present. Th, tihia is so c10. c to th . ' kin that t h e fractured cnd ' t.:an I)'encrally be l' .tclily felt,

63

A fracture of the fibnh three or four inches above its l o\\' '1' end is frecplCuLl) llli,taken for a Kprnin, and not illf1'c(lllClltly for a (li. ·lomtioll of the ,Ullde, o\\ing to di .·phu.;cment of the fuot heing the IllO,' t promincnt .·igll. \\Then one bUlle i ' brokell there \\ ill })e no llHlrkcd .·hortcning.

'f'r ertlment - (1) .'teaely the liml) by holding the foot of the injure(l (2) Draw the fuot of the iujured ;,de level \\iih the foot of the 'olladlimb, with

Fig.

the to '.. pointing ancl do not let go until the hil.\'e l)Oe11 fixed. (:3) ApplY"plint to the leg, OtlC Oil the ollhide another un the in. ide. The t:>plint" 1)e lung (,llongh tu rent.:h from aboyc the knee to heyowl the fout, :0 that the knee and auk 1' joint ' an' kept at [f only one i. ayailnulc, plat: \ it on the out.er .icl', U) ,'ecure thep1illt' IJ,!" ballrhg'c,; placed oue abO\"e nml Hllother below tbe 'cat of i'radme. .A thinl J)(1.l1clage i ' to be applied illlmediate].\' al)oYe the knee, amI a fourth aud fifth round

both ank1cH and knee a' in th.e case 0.£ the rV/i pl1, ::-:mqle-Iuwded, aftcr extenelmg.th. hmll,. tlC thc f, ,t tou'ether eli 'pcnsc \\'ith the lll,'ldc ,' pllllt, and ee f'>' 1 b 1 l' 1 (T" .3+) \Yh '11 carr yall balld,l,ge r OUllC ot.t '.lg, , . , the p,l,tient i::l a \\'Olll<Ul the Imacle he pen::lecl with, n,nel all the m:\y lH.! r ounel both limb ' oyer th' dotllll1g. \\ hen no . plmt if:> <1,Yailabl e, tying the leg', ankle' clllc.1 knee ' ':H of (treat se ryi ce, . F;actures of the Metatarsal Bones and Phalanges (crushed foot).-Fractures of hl.me ' are commonly cau 'cd lly the pa.'sagc, of.n hea "y oye r the foot. Th e accident i .. recogl:1. ' ecl 1,y pam on moyemcnt of the foot or toes s\\ el1mg anello , s of power. ., " ,.

l'?·catment.-The t)'e;l.tmcnt con ') t , III the '\PpIt.C'ltion of a fiat .. plint of \\'00(1 or other lll;ltcnal, such a a book or piece of carcll,o<'ln1, to sole of thL' foot \vith a bandage to cnclose the foot.

Dr LOCATIOX .

A dislocation i' the di ,lacellleut of one.or more of the hOlle::; ellte rino' into the fO),I1l,ltion of n .lomt.

Th e joint, most freq llently ;u:e tho ' e of the 'houlder, the clbo"" the thll11l1), thc and the lo\\'er jaw. Thc joint::; of the lowcr extrl'llllty nre but seldom di located.

,'IGX , ' .\XD OF DISLOCATION.

(1) Unnatural position of the liml) .

(:2) Pain of H scyere , ickellillg <.:haracter.

(3) Deformity ill the ncio'hbourboocl of the ill j lll'ecl .i Din t.

(I) Fixity of the joint. rnlike H fracture the lilld) l'aulwt I'l' lIl()\ ed at the joint hI' cith'r thc Uatil'l1t II]' otbl'l's. v

Ui) Swelling and numbness of the part.. l)elow till' (If di"I(ll'nli(lll.

(Ii A bsen ce of the crepitus characteri -tic of (JI'rl ina r,Y frad\ In'.

UF lJr"lLO(

:\() nttl 'lllpt :-.ltoldd hl' lllade b,\ allyollc l'xcept a dildo!' to l' 'dncl' a di·.,]ocatioll. The followill!.! trC<ltIlll'lIt, III)\\'l'\,er, l'l 'lHlill<o' till' arriyal of till' do ,to)' shol1ld hc canied Ollt .- ,... ,

When the Accident Occurs out o f doors.(1) III the Citl' of dhl{)(' Ilioll of tl!ehollldl'r,upp()]'t lIll' IIPI)( ' 1' cxtrClll1t," III "llatl' \ l' r po , itioll giyc luost t'itsl' I)," " lal'!.!,·l' itl'lll sJiIl!.!; prL'\ l'llt all jolting of the lilll11 ],,' tyill!.!,· it hlllda!.!,'l' r01lnd till' limb awl llocly or 1,,\' pillllil1!.!,' the slillg to till' "-bell no m"l'<ln of applying' a slill!.!,' art' at hand, fasten or pin the ('nat 1'CYC to the <:Iothill!.!,·. en \Yhell the cl]'()\\- i.' (Ii.-. located, tic or fa .tcll thl' 1luper extremity tu the .. ido

66 of the body in the most comfortabl e po it ion po'. 'ible. (3) ,Vhen any joint of the lower cxtrcmity i. catecl, place the limh ill thc easie t po.' 'ible nnc1 ca rry the paticnt on a 'tr etc..:her to or home.

Wh en the pa. tient is indoors . -(1) Helllo\"e the fr()lll the inj lU"CCl joint anel lim]). (2) PlatC th' paticnt all 11 l!()llth OJ' 1)cel. (:3) RCl-it the 1iml) Oll c..:llS\tlOl1' or pill()\\" ill till' p()sitioll \\ hic..:h nt· ford ltlllt l·Olllrort. (1) .\ppl." cold (ic..:c, or io\\ cls \\ l'Illl!.!,· (Ill ()f c..:old watcr) to the clib1u(;(Llerljoillt. (:3)

FIG. 35. \Yh en tulcl to "FORM OF DISLOCATED SHOULDER give cOlllrort apply "'(\'l"ll1th (Hal1l11'b ()r towels ,yrung out of hot water), (6) " -hCll the shock ,ls sevcre the patient warm lJ'y appropriate ·r emedles. (. ee • hoc..:k.)

" -hell a .'Helden wrench or t,yi ,t the ligamcnt· 1l.llc1 the p:ll't al'lllllHl thc j()int arc and torn, till' joint i" sni(l to lIe .' pmincd. "Going oycr l) the ankle is one uf tltc COllllllunct example' of an ac..:l!ident flf tlli kiuel. :--;nrrTO)I ' OF ,'tHlclCll L'\"CI'C pain awl lllitlJility to ll,'e the joint aftl'l" it t \\ i.... t OJ" \\"l'L'llc..:h mark the ot:c..:nrrenee a:-. a .prain. (Jllickl., lltt' part :lnrl ])L'cumc: rli:l!()l()lll'ccl"hIad: awl Illne "-OWill!..!; tu the clt'u:-;inn of hlooc1 il\to and <tl'lJtlll(l the joillt. Tltere is, huweyer, 110 fm Ill" ,lispbcClllCllt of the llOnc·.

TIlL\.f\IE,\T OF . \.,\KLE.

When at some distance from house or home. Do W)t rcmm e thc . tod\.ing or lloot lInt Ilintl thc foot <111el nllklc tigltth- 1'01111(1 hy n hallclm.!·l', r The ll;twlage is t()' hc "pa..·.e(l the \\"ai. t of lh' hoot, nos.'cd Oil lhc front of the anklc, awl thell '<1rried rounel and ronnel the ankle \\ hCl'e it is firlllly ti (1. " -ct the l>:mclagc after applicatioll; it i 'thcl'ch:r A fte ·r reaching shelter, by the patient llo\\"ll rell1()\ e, "itlwut rlrag!.!.·il\g, the ho()t ,mel stockillg, cntting hoth if nccc:::;:::;ary; place the injured part in a' l!omfortab1e

a position as possible, apply ice or cold-water dres. illgs to the joint as long as they relieve pa.in, and when they uea::;e to give relief, apply hOG fomellLa.tiollb or a untll poultwe.

When other joint· arc sprailled they rC1lllilC llluch the ame im111ediate treatment a::; "hell they are di'located.

\Yhen, during eyere exertion, a.' and pUl1illg heay)' "'eio'ht, 11111 ·cle::; or tellclullti are uyer-.tn:tcbcd, they arc be " -trained."

8IGXS AXTJ OF

"\Yhcn a part is ::;traillccl a uddcll tillar]> palll rendering further exertiun paillfnl. ditliclllt. ut' illlpo' ·i1)Je. If the :"train has IlcculTcd ill the l)(lck, tile patient lllay be 1111(1)1e to 'tand uprkllt Ul' take a dL'ep breath without pain. "\YhCll ill a lil11 b, tIll' ...,traillerl 111u'cle lllay sl"elJ caning .e,ere cralllP-like paius.

TREA'nIE X'1' OF .

Place the paticnt ill ni:) cOlllfortal)le a poitin]) <1:-, po ' 'ible, and apply llot -\rater 111lttle IIi' hut fomentation "hell the pain i , ,cry :"c'YL'l'e.

A 'o-called ,train ill the t.!,'roin (rnptllre, OJ' hcrnia) is an injury of a totally clittercllt llatlU'C (:-;ec IGO).

'UAPTER II.

THE ORGAX' OF CIRCULATION,

TIrE 01'0'<1.11,' concern din the circulation of the blood [IT' the'" Heart, the Arteries, the Veins, and the Capillaries.

The Heart is in the che·t behind the clllc1 rib (;arti]nges, between the lungs and immedia.tely abovo the diaphragm; the heart lies ohlillllely no IIlHl.rter of its bulk to the :'ight, and the remaining three-quarter' to the left ot the middle line of the horly. The beat of the heart may he felt jn.. t l)dow anel to the inner . ide of the left nipple. The heart 11<1.' fOllr cavities, two on either of a central partition (.WjI//IIJI). The t\yO upper c:n·it.ies are named the right and left auricles. the two lower the right and left ventricles. The arterial, reel, ' or pme l,lood i driven from the left ventricle of the heart. intu the norta (the main central a.rtery of the horly ) . From the aorta hranche I are given orr to all parts of the llody. The<;e nrtcrie c1ivitle andnh·divide, and u O mall do the, heeome thaL the, <l. 'l1111e micro..:C'opic clillleni011 " they are terme'cl capillarie. Tn the capil1arie interchange of ga e take' place, whereby the 110uri hment and maintenance of the ti ' 'ne' and

L. Larynx (voice box); T. Trachea (\\iIl!l]llpe); R.L. Right Lung; L.L. Left Lung (the lungs are drawn back to expose the heart and blood vessels); R.A. Right Auride; L.A. Left Auricle; R.V. Right Yentricle;· L.V . Left Ventricle; P.A. Pulmonary Artery; Ao. Aorta; . " Y.C, uperior vena cava (the large yain c ar""!llg hloocl from the upper part of the Lut1y to the heart ) ; I.Y.C. Inferior vena cava (the large 'l·e.n carrying hlood from the lower part of the body to the Lcart). The four pulmonary veins cannot be shown in the diagram.

71

or the ll()d.'" ilre pro\'iclc-rl for, and the rCfl blond 'l.':-;Il) 1Ie a pllrple colour tbe pm'ple (\'enoll:)) 11looCl l]()\\ pa"sl" fmll1 tlw c.:npillaric:) to the \'eillH, \\ hieh ('on \ t':" it townrilH the heart, g 'tting larger and larger tl the,' pr()ceed 11\- 1Iei11(" j(lllH:cl hy nciD'hl)(>Llrillu Ycm. '

llulil tlll':- fiual]:,' 'as iaro'c right Huricle of the hcart. The \'ein, c,' pec.:iall." in the lilld!. ' , are p}'()\'irlec1 \\ ith yah e,' at fre(luent int rYn,b, \\ hieiJ prl'\' ellt the 1l1wkwarrl flo\\' of the 111()ud. A spl'cial ' ""telll ()f ]Jlu()(l H'ssl'l:), c.:aller1 the plll1110nary, i" (,ClllCl'l'lll'(l ill C<U'l'yillg' tltl' hlnorl throng'h the lung::;. 1"l'())11 Ule rii!'IJt rtlll'iclc thl' 11100d p:tsHe, to the right \ 'lltl'i<:k ,1.11(1 i:-; Lhent;e c.:H1'l'icc1 to Uw IlllH(" where it i:-, }>ul'ifil'tl 11:'- c.:olltnd \\ itlt air, ::tnf1 hec.:olllc::; l' d in col()u)' it i. theu c()l1n'nel to the left auricle of till' Ill'art and pase: the left Ycutride, thu ' thc cirt;ulatioll.

Thc heart c.:outnu:b ill adult. at an H,ycrng'c ratc of SC'\'Cllty t\\' O tillle:-; n. minute, but the rate yaric., ,t,' the po,ition i,' chnllg'ecl from the lying to the "itting or to the . tn.nclinO' po -iLion. ..:\.bOllt two ouncc,' ( a wil1l'gla ,, ' [ul) of blood nrc r1i:-;t;hnrgccl into the aorta at eycr" contraction of the left Yelltl'iClC and the hloocl i::;' ::icnt iuto the ill j ts or ",aYes, the pulse, which mn.)' he felt along the con1';e of all the main arterie whcrcycr the finger call 1Ie pLl,ced on all artery a it pa , ' e oycr a l)o11e. In the yein - no pul e is to be found, a ' the

Explanation. In the middle of the diagram is the bemt with i ts four chambers. A bove the heart i · shown the lung (pulmonary) circulation. The lo\\er part represents the general (systemic) circulation. V essels containing impure (yenous) blood arc .. hO\l1l black, while tho e uontaiTl1ng pure (arterial) blood are shown white. connecting ves>;cb r present the capillaries. Th e arrows show tho direction uf the flow of blood.

FIG. 37.

DTAGRA"l'I OF TIlE CIRCUL \ TIO," OF THE BLOOD.

heart wa\"e is expended during the P(\ ','aO'e of the blood through the capillaries and re(1ueed to a regula.r and e\"en flow.

H 1K\IOHRH .\.GE.

Hremorrhage or bleeding 'lg'nifies the e,'capc of blood from an injured or 'cd blood-,-es.'e1.

Arterial Hremorrhage. -Blood from an artery (l) scarlet ill colom' p) e 'cape' in spurt.- or jeL. - corre,'poneling Lo the pul 'atioll of the heart; and (3) fio\\. ' from the 'ide of the ,,"ound ueare ·t the heart. It i, however, chiefly \\ hen the \\ ounded arterv i· dO'e below the kin, a in the Lalld, foot, temp'le, etc., that the l)loocl lllc.LY be ,e 11 to e.'cape in jet... " -hcn the artery i.' deep 'eatecl, a· in the 1 g, the blood maT well up from the bottom of the wOllnd \\ ithout marke(l sign of pulatioll. The <ltHtl1tityofbloot.1lo.'( YClrie.' \\ith tbe of the artery wonncled. 'Yhen the aorta, or one OL the lurg . arteries H t till' root of the lleel{ i,· wOllnded, death i' in '(antimeons: ,,·hen the mn.in arwricB of the thigh, armpit, neck, ett:., ;tl'e \\'ollude(l, death \\ill oectll' ill a few momellts the linw i' Pre ',ure applied to meclimll .. izL'tl as tho, e of the leg' or f rearm, within a few minutes of being wounded, will ",l\ C life; h,elllorrhao' , frolll ,maller arterie:s UltlY C,lIl 'e .. eriOLl· 10.. of th unlcs, the tiow is ·l)eL'clily ;\lTeteLl. . Venous Hremorrhage, ,Yhell a yein is Cllt the bloocl (1) i'i of a clark eoilltu'; it tlll\\':> in a COl1tilltlOll.' ,tre,lIll: (:3) it i' 'lll'." from thL' . ide of Lhe \\ 0U11c1 fllrthc·t frolll the heart. 'Yound of Yeill:S of the liml)<.: nre some\Yh;\.t }e.. ' chlll!:!;cron.' than in the ",\.,e of arteries or .·ize.

Capillary H remorrhage. Blood tiO\\ from capillarie., as from ,1. :slight \\ ouml of the 'kin: (1)

1S li g ht-red in col our ; (:2) flows in It continuous str eam; (3) wells u p from all point,' of the cut. su r face

GEXERAL OF THE

)d-mEST OF j

.. HTEHIAL

The p r inciples of treatment to l)e followed in the C\Tent of blceding from a larO'e arc: l.·t, to apply direct pressure on the bl ee din g point ; and 2nd, if clircd is Ull. llL'l'cs:..;i'1tl Ill' siblc, to a,pply pressur e on the mai n t run k o f the arter y between the wound a nd the heart as close to the wound as p o ss ible. The closer to the wOllDd the artery i.' cOlllprc . ed, thc les ' will be the clamtll(e to the lilllb.

The employed in the temporary arrct of are digital and illstnullcllwl COlllpre '.ion and flexion of the limb. Layilll! the patient down n,nd the limh will Ie. thc forl'C \\ ith \"hiGh the blood cscapes.

1. Digital comp r ession i the applicatioll of t h e thLlmb or filll!Cl'S culler on the 1)lcc(liug poiut itself-clil'f.'{·t COIJI1J/' et>8i o n-ol' on the trunk of thc main artery leclc1ing to the wouncl-iwIirel'f c(JIJljI}'I.o.;silJn.

II . Instrume!1tal compression aL'o be applied by the dircct and indired (a)

D ir ect instrum enfa7 compr ession m1lT he carried out b y apply ing a luwdkcrchicf, p iece of lint or linen

75

a bard pad, and placed on tbe bIL'ed ing pomt, where It Id ccurcd oy a bandage firmly tied r ou nd the part. 'To fold the handkerrhi ef a, (l pad, pr oceed a.' follows :-Lay the handkerchief out on a flat surface; hring the four corner' to the (entre of the lHl.llllkcrchief; bring the corner.' to th e cen tre, and continue folc1illO' the corners toward the until the become a hard pad. 'rhe rOllml, . mooth surface 1 placed on the 'kin oyer th artery, and to prevent the pad unfolding, the : nrface may be fixed oy a afety pin, or stltchcrl wIth a 11o ce11e and thread, if such appliance ' arc at ktnfl. hard sull ·tance such as a tone cork nut, marble, etc., mel)', if nece::; ary, be encloscc1'in ccntre of the l)[u1. ' houlcl occaion permit, a graduatell ccmpl' l's s mily be made and applied as follows: rlace a .'mall flll,cled ri:l'e of linen or lint, or cotton, upon the 1>lec.<1. )1<' pOlllt; oy er thi ' place a 'c cond and larger 1>1 0 ('e of the same material; a third and a fourth nt' .l1lore p ,1.(b, each larger than its 0 1', 1.1l1til a regular cone is formed, iyith l ts pomt or npex. re,ting 011 tho wound, and its ba. e C?"l1 by a tightly applied handage . ( 1J) lJI:4l'umnilal C()lIIjJ1'I'ssion con i t in .. topthe flow of .blood through the main artery b)' a tonrnirl net. A tourniquet is an in trnlllel{t whorehy pre . nrc can be made on the trunk of an a rtery 0 a to . top tho flow of blood th r ough it. A.

tourniquet mfty C;011 'i ,t of n, pad to be placed 011 the trunk of a.n artery, n, strap or l)(lndrUle applied so aq t o the limb i::mel pad, anel a buckle, SGTeU', or tLCLSt'l,T/,;7 appa1'ntlls ('uc;h n,:) a ,'tick) whereby to tig?ten the strap or bandagc. The three princip;tl tourmq are the improvised, tho field, and the

FIELD TOC){'IQl'El'. 'C RE\Y Till scn.! \\ tUlll'nirl"nets. are :-;eldolll Hpplit,c1 exc;ept to the 1mld1wl Hurl fell10ml cutnit>,:. .\11 improvised tourniquet i.' lIlade awl applied follo\\',' :-011 the tJ'llllk uf tbl' lll<lill arterY.·a\' tlw femoral or the bnwbial, applya. firmly folded 1);((1, ;'tllout

the sizc of a telll1i. · haH eut in t\\'o for the thigh, Hlld of a \\ nhmt for t.he arm; over til i ' pad place the centre of a narrow triangular (or other) hlllc1age, and t.ie the 811(18 on the .. iele of the limb opp()ite to till' pad. "\ fter the half-knot of the hmdag'e i lllHde, place a ::;tid:, pCllcil, \\al killg-stic; k, poker, policClllHlI'.· tnuwheoll or SOllle .'uc;h instrument, npoll it, amI tllen c;olllplctc tbe knot, addill!,! yet ,ulIlthcr half-kllot \'ot'secnrit.'-. Th c (tic;k" i:-> to he t\\'i"tcd, whl'll L,be lmllc1ag c will 1)(.! tig'htencc1, and the pad prcsed Ill'luly upon th' trlllll- of the arterY with .. nfficient l'(Il'ce to arret the tlow of hl(){)(l. . ,'holl1cl a suitable parlllot hc at hand, n, knllt lll<lY ll o macle in thc Cl'ntre of the anrl WhCll 11 • tone, cork, etc., cnc]u.l,tl ill it to !!;iYe it nl'lllllC' and hlllk, S ec that the! hul!!;ing, allll !lot the Hat, .. ide of the knot i ll('xt the skin. The ". tick" i .. fiually "lockcr1" ill p()sition I,)' the L'nrl· of the 11 'ed for the tU'..ll'niqlll't, Ill' h,\' :l11lllhcl' 1,:tllcla!!;e p:t .... l·d round the lilld, and lilacle to encloc and fix thc ,ti('k.

The field tourniquet consi, b of a pad anel .·trap, ThL' 1 ad i", placed Oll the t'otll'::.e of the artery ancl tixul then' Il,' the strap. \\hic;h is plllll·d ti!.!ht a11e1 Jl.lll'k l( cl off The screw tourniquet (Ily .OlltC con:-;ldl'l'cd ()]P,()letc) ad on tile s;Ulle principlc, the trap, hC)\\,L·q·l', Jll'illg' tightenccl ll,\" n. S TCW ·tppamtll.. An elastIC bandage pa.scd rouIH1 the lill1l) imlllediately ahoye the ,'cat of an ,1.l'tcri<11 lm'lllOJ'l'hag-e awl

FIG

78

pulled tight will arre t bleeding. The imple t prepared form of this bandage is a trip of eIa,tic wehhing twenty-fiye or thirty inche long and two inche wide, with a picce of tape ewn at each cnd . An cIa tic b race or holt will, ho",cYer, an \\ er the pm'po e. It i' not adyi ahlc to n e a. corel or handage no other apparatu can be had, n,' the pres 'lue of the cord cut, off all circulatiun in the limb.

III. Flexion of the Limb .-Tbe arteries of the back of the knee and the front of the llCllcl uf the ellJow may be compre.' .. ecl Ly placing a pacl upon the trunk of the main iuten at the kllce 0]' ella)\\" llnd, after fully flexing tbe iimll, ecnl'llll; the limh in a flexed po ition l)y n 1mncLl!.!,'e, DJ'es< wouncZ. After the hrcmorrha!.!·c btl, been arre,'tecl lJY thc indirect the \\ (mnd Jll1l't lJe coyered oyer lJY n clean clres,' ill!.,!. (1IlIllb.)

In nll especially when the patil'llt !la, to lJC llluyed ::;omc distance, the ilJjurecl limh or part "b()lllcl lIe raied, if po.'silJk and maintained at ret hy 'plints and bandage ' , if need lIe,

'THE COUR ' E OF 'l'IIB: MAl X ARTERIE AXD THE ARRE .... T OF H ,DIORRHAGE.

( , ee F"Ollti,,} ,i ce)

The Aorta is the main arter, of the l)oc1\-. 'ommencing at tho left yontride it 'forllls an llehind

79

tIle 1lpper pmt of the hreast l)(]ne. From the arch are gi\ ell ott' the large trunks \\ hich carry the lJlood tu either :-;ide of thc hend and ncck and to the npper

The aorta pa,','e,' dO\n1 all Lbc left of the :-;pill(' to .i nst hduw the naYcl, "'herc it eud hy J iuto t\\O br!.!'e hrancho,' (tbe iliac,') "bich 'l'(lllyey the 1.1()ocl to till! organs in the pehi., and to the lower

, \nTERrRS OF TIlE HEAD AXD lS"EC'K.

Til - Common Carotid Arteries l"lm up the neck on - on cith l' of the windpipe, and (]11 n. leyel with ',\c1nlll '. Apple," just 0 -low the <tngle of the 10\\"er .ia\\, (li\ iele intu the internal and cxtemal

The Internal Carotid pn.'.' e · up deeply in the neck, aIHl entel'ill!.,! the cnwiu1l1 ju t internal to the ear

. npplic the brain \\"ith Llood. The External Carotid art cry \'es off hl'nlH'he to the tongne, the throat the 'the no e the tell1ple and the scalp.

'\ \ ' OUXDS OF TilE CAnOTID ARTERIE. AXD THEIR BRAXCIIE

When a Carotid artery is wounded, n, ' in the cast' or l'ut throat appl," c1i!.,!itnJ compre ' ' ioll by tit , tlUllllb 011 the nl'tt'l"y 11Y Lll' ,ide of the Willclpipe, either on the wound (ll' llctween it and the heart, 1lnckwilnl" H)..!·'lill.t the hnckholle, tnkil1!.!' care to a\'oid the '\\illllpipe. Pre " ure mu 't oClllaintained

place the ccntre of a llarrow h(llHlnt!.'c on the oppo'ite ,ide of the head to tIl, \\ ollnd , carry the hlllcl.lt!.'e horironnel the head Ju .. t al10Yc the leycl of the

make a t wi , t oYer the pad. pass the emb nnmd the bear! 1u,!'aill. OJ' carry 011e cnd OYC!' tIle top (;£ the hl'ad all! 1 tltc othcr

o by thumb (by reby of as istant· if neee. r:.nry), untIl the doctor arriYes; no other method heillg applicable in this ituation, Bleeding from the Temple is readily ane ted by the thlllllb 011 the wound or by placing a firm pad on the \\ ol1ucl, and making pre 'ure uya uctndage applied n fo11o\Y8: -Apply a mall P;leI on the point, tbell Fw,40.

HlHll'r the ('bill. and ti ' firm]y (FIt!'. ] rhage from thc Forehead. 01' from Hm" lJart of the Scalp can he arrested Oil the 'anw' prillciplc, HWlllOl'l'ltage from the Tongue i' mmal1y COlltl'<Jllcd by ::mcking ice; 'houlcl icc l)e 11llS1ll:cus:l'nl or llll<1m1 wound far fo],ward, till' 111ceding puint lllay lJe oTa.'pcd uet\\eun the fillger awl thlllUU .

Hi ll10rrhnge from th Lip s may be controlled by ice, )1', if "ery .·evere. l)y (;olllpres8ing the bleeding point between the fing r and thumb . He morrhage from tlle C heek it; coutrolled by pa 'ing tbe fore-tinger in.iele the cheuk and the thullJ h ()l1t,'irle, <lnd l'()lU pre , iug tirl1lly either on the or bclolf it, i. e" 1Jet" eell the \\ ouncl ancl tb e heart, The tnmk of the Facial Artery may ue cOlllpre, secl un the edge of the lo\\'er jU\\, al)()ut an inch and a-half in front of the aug-Ie, " "hen the llleetlmg' i:-, from tlll Tonsil, Palate, or the inside of the Throat) giyc ice to ,Ill·k : jf the F 1(1. 4J. 1Hl' ll IOlTl l<l!! ' ]-.; itllla\' llL' llL'l'c"saryto ('OIl1}ll'C 'S the caruti(l artery in tIll' fnllll the Nose i trl':tiL·r1 H'< follow' :- •.l'at the patient on a chaIr \\'ith the head , lightl) thrO\\,ll back: undo

2

a ll tia h t clothing r ound t h e che t and neck; mi::ie the hands above the head, a,pply cold (ice, a cold ponge, or a bunch of keys) oyer the spine at thc lcycl of the collar ; keep the patient in a Cllrrent of fref)h ai l' , and

PrG . 42. ARI EST OF H.EMORRHAGE FRO)! FOREJIEAJl.

on no account allow him to hang h1 head forward over a basin; place the feet in hot water. Blood issuing from the Ear channel, which generally

3

indicates a fraetul'e of t h e ha e of the cranium, must he wiped a\ray a' it i,',"uef:l; no attempt i to be made to plug the ear. ,rhen the external part of the ear 1t 'clI' i' ,rounded and bleeds freely gra,"p the bleeding point between the finger and t lllllllL.

RTERIE' OF THE L PPER EXTJlK:lIITTE:--.

The Subcla v ian a rtery pa'se. ' from lJchil'ld the illn r end of the collar-l)()Jle aero.. the nr.t rill to gain the armpit (fl,' illrt). In tll' armpit the A x illar y arter y, wllich i. a continnatioll of the nb('la viall keep. clu:-;e to the houlder joint, and call be felt puhmtillL:' whl'n the n11i!'cl'" arc deeply pre:-;:-:erl into th al'lllpit. Th e Br a chial a rter y is n (;( 11tinuation of thc axillar , and 1'1111 do\\ n the ann U11 tllc inllcr . ide of the llic 'ps lllll .(;le g'J'aclllally passint!,' fOl'\yanl. · ulltil it gaill.' the llliddle of the front of til, e]l,o\\,. The inller . ('am of til, coat . ll'L'ye alll)\'c the elllow l'Oughh' indicate' ito.; C()tll','C. .J list lJelo\\" the dIH)\\ the arterY eli, ide into the radial and ulnar artcl'ie... T he R a d ia l artery l'lms alont!,' the ()l1tel' sidc of the front of the fOn,"ll'lll : it, COtll':-;C lllay he il1(licatecl ln r a line drawn the l1lill(l1e of t.he ]lelHI of the ill front to the root or Ow ktll of thl' thumb. A1JOut one inch a1\u'"c the \\Tist. <llJtl olle -half ill<,: h from the outcr (th 11mb or mdial ) .ide uf the forearm, "here tbc radial artery lie upon tlle raclills, the pu]:-;e i:-; to be felt. The

radial artery, at the ,Yri 't, turns hack ward ahove the root of the thumb to the back of the hand, and pas 'cs forward between the m tacarpal bonel'! of the tlmmb and forefinger to reach the pnJUl of the banel. The Ulnar artery n111 nlOI1Q' the fro11t of tll' forearm, eorre:-;pondillg to a line c1nnnl from the Cell tre of the frunt uf the clhow to the root of the h<1,11 of tbe little fin}.!,'cL In the hand the hrallchcl'! of the radial artcrie, combine t() fOl'lll the superfieial amI cleep PainHu' m'che.', The superficial Palmar arch i.' near the snrfaee of the p<llm, and cone. pOlItI::; to the line that runs along' the illner side of the hnll of the thumb, The deep Palmar arch is nearer the iyri t, but liel'! deeply Ull tIle l)o11e ' , III the fingcr::>, the arterie ' run along t itheride of the fingers to the tip, ,,,here they unite,

ARnE l' OF ARTERIAL IX THE l'PPER LDIn',

\Nhen a Digital (finger) artery is wounded plnec the thul111) 011 the hleedillg point and C()lllprCSS palt finnl)' ; suhsc(lllcntl.'-, apply n Hllall IJnd on the wouncl, H11(l handag'e "ith a picec oj' tel]1/'. strip of lincll. or a trip of plaster, ],Ol 111 ( 1 tlle fill!.!;Cl' and paci. When the Palmar Arch is wounded, place the left thlllllh firmly Oil tlIl! l,]ccdill!.!' POil1t, tbe right hanel fl ee to npply n pul ,lwl bandagc. Apply a finn pad (n, folded handkerchief), or hctter

[j

tsti 11 , a gn.duated compress on the bleeding point, make the patient grasp the pad and apply a. bandage as follows :- 'proad out a bandage, turn up the lower border about four lllches, lay the back of the patient'. · hand on the centre of bandage, fold the point oyer the knuckle: awl t, the two ends round the wrist, make the patlClll

FIf; , 43.

pull

011 the pain t of Lhe hmdage, cross the cnc1::; ?'le , • che fingers twiee and Lie tllem as firmly a· poslble Briner the point (A) clown to the and fa:::.tell ,,,ithOa pin it:' B (ce Fig , Flllnll.,\ the forearlll well up and lmpporL WIth it lurge arm slmg-.

6

The Radial and Ulnar arteries mav be compressed by placing the thulIlb · on the Ol1e in ch aboye the wrist (Fig. 4: -1). '1his may be l1ceel')'ary when the wonnd in the palm i.' too laro'o to he covered by thmllh; instead of the thumb.', the cork of a pmt or quart bottle may be cut in two

FIr:. 44. length\yi. e, and one half bid on thc radial, and the other on the ulnar artery a little al)oYe the \\ ri ot . place the rounded sidc ' of the cut eork next the 'kin and secure them by a tight bandaae. ..'ee al ..o llext paragraph.

7

H cemorrhage from a wound of the Radial or Ulnar artery ill the front of the forearm lllay be alTe ·ted l)y a pad placed in front of the middle of

FIG. 45 .

the elhO\y, the forcarm being firmly flexed on the ,UUl and maintained ill the flexed po 'ition by a bandage

The pacl llln,y he made of a fo1d?d with a small stone 01' cork 'wrapped up llllt ; but ,\ hen 110 pad i' cwailab le the coat 'leel'e rolled or gn.thered up as far a the elbow will serl'e nH ,\, pn(l. Bend the forc'lum upon the ann and tie 11, l1<llTOW banclage .roulld the wri t and then rounel the upper part of the arm, cros:illO' the between the forearm and ann :so a' to hetter prCl'ellt the hUHlage slipping uir. 1"inall.", tic the limb to the 'ide 1»), u bandage cncirding tbe limb and the trunk.

FIr.. 46.

Hremorrhage from the hand, forearm, benrl

o f elbow or l o wer part of the arm, Ill' a.rrcHterl by cOlnpres iug lmtchinl TcLrter), 11.\' (.Iigit:tl cOl1l]Jre sion 01' hy a tOUl'1lHl'lCt. :' llen an improyi.. ed tonrnilluet to th' 1.)l't1.chwl artery, It L'. not always 'ary to ll:e the ·tIck; the ])e.t-.t plnl! IS to tie a ha,lf-knot awl pull the bandage tIght .; If the bleedinO' Stop', cumplete the reef knot, bnt if it does o 1 '1 1 .... not stop use the stick, as ( ecn Jee on I I

To apply digital compression to the Brachial arter y.-Extend the ann at right angle.' to the body, palm of the hund upward:::; , Stand behind the limh, gm.. p the arm the thumb on the outside of the limb, and pa 8 the finge)'.' uncler the back of the arm until the cam of the coat or the grooye on the in 'ide of the lllU 'cle (bicep) i.. reached. Press the pulp. (not the tip ') of the finger: firmly on the course of the artery ('eo Fig. 4,6). 'ome prefer to

gra p the ann from ahoyc the lllll:de. IJltt if this (:Oll1'.e i:-; :lrloptecl, great <:11.1'e I,m ' t· he takell to pr("s the altery the 110ne. :lllllllnt. against the hic:eps 1I1utide (Fig. <17). ..\ .Ii!!·hl tnl'll uf the hand out\\'ard' a,' it!..(l'asp" the arm \\ ill hetter cusn]' . c()ll1prCSlOll of the artery. In practi<:e feel the pnbe \\lth tbe free haud clnrmg attelllpts at <:mnpl'(';';:liOll of the brachial, to aSC:l'l'tain if the tiow of hloo 'l alollg' the artery is t:.toppccl.

90

Hremorrhag e from the arm pit or arm may be arrested by compre, sion of the axillary artery. Roll up a hard pad the size of a billiard ban in a triangular

91

lJl:tnclage; place the p:1l1 in the arll1P.it; cro;.' lntllrlage 011 the Hhoul<lll', 1)1:11 the. endB tight, all(: tic off ul1cle)' tlle ol'pol-.ite armpIt, takmg care that the pad HOI' hmdnge 1m,' ::;lippcc1. •'ccure the ll1Jurec1 anll to the patient'::, .'icle, a 11O"wn in Fig. 4

Fm.49.

Digital compression of the artery lllay l)l' lllade \\ helt the. wOllnd m 111;1:11 artery i hi!.!;h IIp in the ann or III the arlJqnt. 110cl'l,d a' foll()\\':-; :-Hnre the ned\. to b.elow the .collar hmc. place the i1ljured limb dose ngall11-.t the'lde of the Ilttlient" lJocly 'U as to clepre '::; the t:ihou1del'J ;md

t,Lke your tnl1d opposit t h e 8110111 (lc1', usc the l eft h and 'for thc right alte r." , awl "icc "ersa; p:nvp the neck low (10\\"11, plncinll; t h e fingcrs hebin(l :mcl the Lhmnh immeclinte l y abm'u the cent r e of the eollnl'hone in the hollo\\" 'heL\\cC'll the lllnsdc:.; ntta(;h (1 to Lhe bone (thl' hirel':.; nc:-.t) ; ('ompre ,' firIlll.'" the thllmll dl'cpl.'- c1own\\Hnls and ,:gallht the first rih, \\hi(;h is hellcHt h the chncle at thl. SP()t. (Fig. In prHctice thepnlse.llll1.'- he felt at the same tilllL' to H':i<..:ertain if the tio\\' 1S topped,

I)F ritE L \RlnC \ nTEHIES 'YITIIIN TIlE ('UE , T () II ... \ B!)(l) [ EX. (hTERX .\L n l:\l()RHHAGE.)

,Yol111d of til(' 1<11''''L' nrlt'l'ies witllill the truuk h II)! , h '.!.c into (;,l\' il,Y of tht' cbc:t or of tJll' aL d ()lllen, ;mll u' i n' rise toig'llS awl SYllLptUlll . uf intcrnal h,emorrhnt?:c.

,lrlllS ({ 1/,1 , or In/fI'lUllIlr,'"wJ'rlta.'le "I'r' : -_ .\. rapid 1(1 :-; of :-;trength ; pallor of thl' facL' and lip," : coldncss of the cxtl'emitie.', gir!lhlll":-' .111(1 1';1 lllore e.'pccin11.'- \\ hen tllC upright po,'itioll nsslllJled : the In'enthillg' 1)e<..:0I1lc· hurried and lnhOll],CIl, awl is accompanic(l 11.'T ."awlling· ,U1d . ig·hing tbc pllbc fail.-. uraduall\' and mn,' nltoo·{,thcr clisapp 'ar at the \Hit : tIle patil:nt his al)Ollt, tllt!',' n.t tl){, cllJthillg rOllnd the neck and cnJl ' for air. Finally, the patient may l)l' COllle totally ullcon,"t;iolls.

93

T7' eatill ent of Int ernal H cemorrhag e.- K eep the patient flat· undo all tight clothing round the neck; proyicle for fre circulation of air; fan the paticnt; ,'p rinkl e cold water on the face; apply .melling' ..alts to the nostrils' gi \'e i(;e to l:iuck or cold w,lter to ell·iule. H ai 'e the feet a foot or two fro111 the ground, awl ball(lilge the limb' firmly frolll tbe fect to the and from the h ands to the houlder A void stilllulants ill all ca,'e8 of hmmorrhao'e, at all e"cnts until hleeding has been controlled.

TIlE Coumm OF TilE ARTERIES Ii\" THE LOWER lTIE .

The Femoral artery a continuation of the iliac, enter' tlll' thigh ill the ccutre of the folel of the groin, where it l1Iay be felt pul'ating iml1lcdiately belo\\ the .. kill. Tbe COlll'se of the artery lllt1. y be ill dicaLed hI' a line drawll frolll tlle (;clltre'of tile oToill to t11· part of the iUllur iele of the knee. c The artery occlll)les only the llPlk'r two-third' of thi ' linc, a' at tbe 10\\,(>1' part of thL' thigh the fellwral urter.\' pa 'es t'J the of tlie kllce joillt under the lIame of Lhe poplitl'al.

The Popliteal artery the arten' of tbl' IWIJluccupie. the celltre of the at tile ll;tl'k of the knee (IIJI halll). It i: placed deepl,\" l)L,twl'L'1l the proj eetioll,' ul' bOlll' at the ]()\\,er end of t hl' fL'1Il1ll" and is flll'ther protected hy the Illude::; and

around the ham . I n t helow <'I.uel hchincl t h e knee joint the poplilenJ a r tery into t ill' anterior (fr oll t) al1!l postcrior (back) tihial arteries.

The Posterior Tibial artery pa \ ' CS l()\\ 11 he ccntre of the hack of thc leg to the inner "idC' of the ;),ukle, where, het\\"ccn the heel 'mel the lo\\"('l" ewl of the tihia, it the '}ol' of thc fuot at> the Plantar arte r ies. In the upper p,trt of the leg the po:t riol' tihi;tl artery i · deepl)T ph"u;e(l henenth the mlU-id ,:-; of the calf, but to\Yitr<ls 1.11, ankle it comet> nearer the ,'urfnce, and cnn he fe l t plll .. in thc hollo\\ on the inner t>i(le of thc ankle. In the ::;u1e of the font the plctntar run forward t tile to snpply the foot and the toe: .

The Anterior Tibi a l a rtery comes from lhe popliteal and n.t OlH.:e pHs. e. fur\\'nl'ds 1) ,t \\ 't'll the leg IHlllC. The artery rllllS (lowll the front uf the deeply pbc(:'rl tlte lllll.cle-.;, to till' front of the 'lllkle. A lille elr;1.ii' ll fl'()1l1 the front I' i ill' 11l 11\l' t' end (he;tel) of the flhula to rill' Cl'lltre of d\(, (milt (If the <Lukle inrlicH.te ' thl' C()llr'C o[ t hc artery.

The Dorsal arter y of the foot i .. thc ('(llltilllllltioll of the anteri()r til,ial artery: it pa,sL's alol1g' a lille drawll from the miel(l1c of the front of the nnkk to the intcryal het WCCll thc llletntar.'nl 1JOlles ()f the 1 toe (\11(1 the ncxt, where it pa,t>e ' cluwl1\ntrcl to the tlole of the foot, to for111 all arch with the arterie of the :ole .

95

A RRE, T OF AHTEHIAL H 1E-'IORR II AGE I'S TIIE L OWER E XTRE-'lITIE·.

1. When the arteries in the Sole or Back of Foot are wounded , rClllOye the 1,oot and ; app1.." the left tlHllul) firmlY on thc lJleeclillO' and" \\l,th tbe right halld, p'rcpare and placc ,l p,tcl on the \\ OHl1(l and 1Jal1eLwe A . 1 . I-> , • 11 expencnce( per. on 11lldlt 1)c al,le to fnrtllC'!'ecnre the arre.L of 1]( 'llt<JlTha"" hI' me'lll ' of ] 1 . 1 I t"< , " m( , til)' It Y 01l the ankle at the POillt.

III the il'Ollti , pl..!ce:

FII:.50.

When the ar teries of th € .... H-am --Or- of Lel? a re wounded , or when a pad is Insufficient to arrest hremor r hage from the foot or an kle, place a p<.1.u the 'i:w of an orange

0' vU

behind the knc of the injnr (1 limh ; flex the leg upon the thigh until the heel almo::;t the ; secure the liml) in tile flexcel PO,'ltlOll 1)y pm;tll1lg n, na,now bandage (or n, tltmp) rounel t.be leg illllnediatel)' a1,oyc the ankle; ..s the cnd, ' l)cL\\Cell ,the leo' and thigh, c'll1d, cc1,rrylllg lhclll roun<1 the Illnb clu::;e tc the top of the thigh, tie thcm otI' firmly. When n0 pild i, tu be hacl, rull up the leg n' tar ns the 1m 0, and flex the leg on that cl.' ,t p,ul. It i::; not nccC . tHY tu take oft' the dot 11 iug to CClIlI pres the popliteal ,{rtcry 11y a piul. fic,i()Jl. Ex.ccpt at the }u\ycr third of the leo', It It:> selduJll P()s.' 11 ,le 11,\' direct pre 't-;lHe on tho bleeding' point to ,tlTcst hrcmorrhao'c from the arterie ' of the (:3. 'he femoral artery in the lower half of its course is wounded, and when a pad and flexion fail to c,or:- tro1 hre:norrhage from the popliteal or tlblal arterIes, apply

Lompres , ion tu the fellloral ,It tl1L' {I'win, until,\, tmJl'lIiquct c,m l)c npplw(1. r To apply Digital t.o Femoral artery at the Groln. -, nppO"'lIH.'; It I the rio'ht femoral that it-; tu he (;Ulllprc,t-;ed, proL 'ccl <t.' :-Ll.Y the patient c10\nl flat on the 11:1<'k ; 'tand or kncel 'a.' (;Oln' enieut on the Idt d the patient'l:) body' 5n<1 tbe groin, misc the bigh o a.' to flex t118 thig:h OJl the body (the fol(l III the .clothing at the top uf the thigh will inc1ietltc the

97

groin) ;. pa ' the fingers of the right hand oyer tne outer SIde of the right hip just below the edge of the front part of the haunch bOlle, and lay the fie ?-y part of the thumb flat on the centre of the Pa .::; tllG finger, of the left hand to the inner SIde of the rig'ht tbigh do 'e up to the fork, and lay the left thumb on the top of the right thumb

Fw.51.

i:l,Poition O\'.er the artery, Prcs ' firmly back\\ ,11 elK t t.ll ' bnm of the pclyi , \\ hen tho flow of hl()()el WIll he COllll)]cteh' alTe, teel (FI'o' 51) ,I , I ' th'

• " v t-" C ea 1 III h,ell1orrhngc .'0 large nn artery, it i '

Important not to \\nste tune rCllloyinO' the clothing' the femoml artcry at the groin cnn gl men be pre ed a, a tcmporary lllen ure oyer the clcthinO' 0'

To apply a Tourniquet to the Femoral artery. In practice it is good plan n?tlrk the of the artery by <lra\mlg a chalk lUll' hom the centre of the groin to the lmc k (1ft ---- part of the inner 'ide uf the LL knee' the artery can ],e ('01111)), a tou;'lliqnet at allY point on the middle third of the line thus i])(licatell or n, little hi gher. ) ..11 iec1. a fidd, or n, .'Crew tourlliquct IllHy lIe used, The pad uf the illlPJ'l)\'i:-;l'd tourniquet ::;houltl he <t.' lar!.!.c ns half an ()r<lllg'r-; a narro\\' ua.lldn"'e i' to],e plal'L'd \\ i til its centret' oycr thc pad, HlId the kllot ticd on the otlhicll' of tile thigh; tlle ".tick '. 1. to 1Ie platecl lH..:t\\'ecu tbl " ltnh c. " of the blOt, u a t() a\'oid inj lll'ing the ,kin \I hen it i.' twi::;ted . Finally, the "stick J> is to be " l ocked," aucl the limb put' in a splint 01' tied to its fello\\' (Fig. 52) . 4. When the artery is wounded in the upper third of the thiO'h the fellloral m:ter! lllust be compre sed by the thumbs at the ll1stead of applying a tourniquet. H.elnys of a tant· must

lI e cll1pl(J.Yecl to keep up the pre ','nre until the eloctor the frcsh as.i.tHl1t applying h is thumb.. on those of tho preyious \vho carefully slip. IIi,' thlllllh..; fmll) lJelleatiJ, so a. to preyellt gushcf; of bluod the change ' . ,Yh en .. j tallts are few, IJl' a dodo!' 1lot to L, had, an nitempt may he made to arJ'C'.t t lIe h," placillg a pad 011 thc centre of the !..:Toill, ,Ulf t lllaintailling pres,'l1l'e by au ela.tit: corel pa .. ,:cd frolll Ult' 11;1t:1\: of the thigh, cro,'.ecl Over the pad, alJ(l tlle cncl.' fa:-;tclled hehind over thc loius.

[I. E\lORHIIAGE.

'1'110 <.:UlTCllt of blood ill the veins is in a dircction tCJ\\<ll'ds the heart, thl'lef' rc, ",11011 a Ycill is t:ut thc l']I)(}cl \\ ill is 'Ile frolll the elld of the \\'oumler! yeill fltrtlw t l'CIllU"l'cl frlllll h· heart. TIlc why the ewl lJearer the heart dol' ,' llOt lJlcecl IS panly hy the dircction of thc flow of the blood, amI paJ'tl,\T hy the \'nh-cs ill the \'ein, \\hich ar':)o placl'd as to pre\'cllt a hack \\ Hi'll lio\\'. The snperficial nill ,P'e lllllre apt to lll' \\0l1I1c!l'<l than arc tlll' deep \'Cill ' ,

THE \T\fR\,T OJ" YE:\()U-'; H J1'l\IOImllAGE.

(1) Lay the patien t down tbe hL'<l(1 rc,'ting Oil ,\ lo\\' :-iUpplHt Ill' ]lilln" (:.?) :--hulllcl iL l,l' a \ ein III Olle of the cxtrcmitie,' that i, elevate the limb.

Undo the clothing and expose the l)leecli}'lg p;ll t .

(4) Apply direct pressure on the wound by the thumb, and maintain the pre ure subsequently by a pad and bandage.

(5) hould direct pre ure prove insufficient, apply a pad and bandage on the trunk of the vein, on the ide of wound furthest from the heart.

Varicose Veins. -The yeins of the legs are specially apt to become "arico e. ,Yhen a "arico e vein i examined, it \Yill be een not only to be dilated and tortnou " but bead -like (cal'ico'''t) projections occur along its cour 'e . A \'ein become yarico. e from varion causes, such as long standing, tight garters, etc., etc. Th e fir ,t effect i to thro,,' extra \York upon the yalYe , and the bead-like projection, are can cd by thc blood accumulating in the pod:ct hehind the val \' e , In time, thc channel of the "cin hecomes 0 " ' ide that thc "alYC can no longer pnn the "c::;el.

'When onc of the , e dilatcd "cin . , a.", ill the leg i ,younded or 1JUl' l. ' , blood fio'''" 1'1'0111 thc lowcr end of the cut "ein, hnt from the end ncarer the heart it flows in much larger amollnt. OWillg to the imperfect ::;tate of thc yalYe' in the nins.

'l'r eatment.- ,Yhcn hmmorrhage occur' from a varico e vein in the leg, the treatment i tu-

(1) Lay the patient fiat, the head rC 'ting on a low support or pillow.

(2) Elevate the limb, raising it high, at a right angle to the body if necessary.

101

(3 ) Remove the clothing ::;0 a::; to expose the bleeding pmt,

(t) Apply direct pressure on the wound by the thumh, and ub 'c<lllClltly by ,1, pad and bandage.

(:3) Apply bandages , fir. 't, on the .'ide of wOllnd I'lll'thcl' from the heart; ,econclly, 011 the ,'Ide ne.1.1'er the heart, ::;hould the direct pres::;urc prove in 'ntticient, OF CAP[LLARY ILE,)IORRII.AGE.

. 'ee also Treatment of \Younc1s.

T o a1're't h,Clllorrhago frolll c<lpilbries, a slight uf pro .'nre'llltieo·. Prcsme ,be applil'cl in ,' trlllt;meul1::51y by the thumh, and ' l11>.oqnenLly 11." <t pn,cl 01' pleelget of linen Pres mns n.l 0 he oxcrciod hy a plcce of ·trnppmg (pt\ ' tor) to the \\'onn(l oyor a pac1. J.neclieamcnt

')\'hieh airl in thc arrest of hiclllorrkv"c IS tcrmed a Styptic. 'del, a .' eol(l air or icc, arre,:,ts hremo1'rhage h,- uoutl't1,utin}2,' the l)loorl ye:-;:-;el ' . "atcr as hot a' c:tn he horne, hy cau. ing the lJlooc1 to clot, lllay check capillary hn; lwJ{Thagc.

, 'neh 1'0111 <lie' n ' fine .. t.mncls of woo], or cotton

\\'001, eO<1,l'"C hlotting paper, etc., ctc., hnyc, if clean, ,·olllothill!.!' to rccolllmeml thcm. ollodioll applied on ;t finc "'l'j, lit' cotton wonl is an efficient ,'t:"ptic Hnd pro\'ic1c-; an n.rtiticinl skin, helpiu o to exclude air from the \\'ollnrl.

CHAPTER III.

TR E NERVOU TE:JI.

Two systems of nerves, the erebro-spinal and the Sympathetic, preside over the movements and functions of the body.

T h e Cerebro-Spinal system i made up of the Brain, the Spinal Cord, and the :?\ erve".

'rhe Brain is situated within the cranium, :mrl i. divided in the middle line, so that, with the exception of a few connecting bands, the right and left 'idel) are separate.

The Spinal Cord is the long cord of nen'ons matter lying within the spinal canal in th,,:) bOlly an;h formed by the vertebrre (see Vertebral Culnlllll). It leaves the brain case through the base of the .kull, and reaches as low as the upper lumbar yertehnc.

T he N erv es proceed from the brain and . pinal cord in pairs; the former are termed thL cranlnl, and the latter the spinal nerves. A pair of 11 e1'\'O ' enlerges between each of the yerteunc. 'rhe llorn';:.. cross the brain about it.' base, and ill tlle ::;pinal cunl, so that the right half of the brain preidel) over the left hali of the body and limbs, and the loft half o\'Cr the right side of the body and limbs. In the and trunk the nenes are met with a!::i large pearly white trunks, and can be traced to tlle lllusule' and skin. ,\Vhen the nerves are torn through there is

103

paraly. 'is of motion and sen. atlOn in the region.' in \,·hich they are eli tributed .

The S y mpathetic System of nenes consi -ts of a double cbain of nerves and small nerYOll: masses (termed rla'f/glia) on either side of the front of the pinal column. The chain extends from the 1>a:e of the skull to the coccyx. The nerves of the ympath tic ystem send branche to all the oro-ans of the c11e .. 1, and abdomen. It i ' thi y tern that control the involuntar\" mn cle of the body j it Vregulate all our vital fUllctions a "ell as adju ts the . upply of blood to the secreting and excreting 01'FIG. 33.

DIAGRA:\I . JIOWT'<G TJIE BRAIK THE 'PIXAL CORD, WITH THE XERYE, OF THE LEFT IDE OF TUE BODY.

gan. The sympi::l.thetic ystem differ from the cerebo-spinal systelll, inasmuch as it acts during sleep, and knows no prolonged rest .

IN SEN IBILITY.

Unconsciousness or Insensibilit y arise when the function of the brain are in abeyance, either directly from injur y or di ease of the brain itself, or indirectly from disturbance of the action of the lung Dr heart.

GENERAL TREATMENT OF I1\" EX. IRILITY.

-WHEN A PER 1 FOUND IN A 01<' IN ' E T 'IBILlTY :

1. Arrest hremo r rh ag e , if present.

2 . Lay the person on the ba ck, or in the position in which breathing i mo t ea. y.

3. Undo all t ig ht cl o t h i n g round the neek, che t, and waist, unfat>tening the brace "and top hlltton of the trousers in men, and the ill \\UlllCll.

4. Provide for a utlic.:iency of fresh air 1)), keeping the crowd away if in the 8tl'eet, or hy opelling the doors and windows if the ac.:ciclent ha.' oec.:lllT 'll indour ' .

5. O bta i n a d o cto r ' s help at once: it ' n ,geneml rule, until he arriyc:-" keep thc head 10\\ :f the face is pale, and raise it olllewhat if the face i.' tiu 1IC(1.

6 Never leave the patient until you ha\c plac.:ed him in charge of a respon 'il)}e per on.

N .E. GiYe no food or finiu (neither stimulant', tea,

water, nor medicines) by the mouth while the patient is insensible.

THEN PROCEED TO EXAMINE THE PERSON AS I DICATED BELOW, 'fO LEARN THE NATURE OF THE IXSENSIBILITY:-

1. Feel if the pulse beats at the wrist (radial artery), at the temple (temporal artery), or in the neck (carotid artery). The pulse may be ab eLt, or it may be tmnaturally slow, quiGk: or feeble; it may mi s a beat oeca ionally (intermittent puh:;e); or, the may beat quickly and slowly alternately (Irregular pulse). All these conditions indicate some sm-iou' michicf whell as ociated with in ' ensibilitv. A feeule pul. e indicates that the use of stimU'lants (:-,al volatile, 10 drop ' in water, or a tea poonful of lJrandy ill n winegla ' 'ful of 'water) is adYisable, proyic1cd that the patient is able to swallo\y. ,Yith a ::.trong pul C \\ ithhold timulants.

If the puI 'e cannot Lo felt place the hand oyer the heart, or a.pply the car to the che t, to a certain if the heart l)cat::;.

3. Obseryc if the perSOll breathe, and llOtc the odollr of the breath. The breathing lllay be '10\\', lauoured, and ac:companiecl by lond 'llOring ana puffing of the cheek during expiration (t ertoi'Ous breatlu'ng). I

4. Examine the calp, temples and Lad: of the hea,d for injury; the ears and the nose for ign of

106 hremorrhage; and the mouth for blood, froth by a<.;icls etc., and for foroign lJOclio·.

5. Hcti 'e tho o:relids, and oxamine the 'tate of the pupil::>.

The pupil' are the (b,rk ronnd spot,' in tho 'entre of tho bluo, brown, 01' groy iri '. Cncler orclinnry conditions ill 'hctdod light the pupil.. dilate; ill In'ight light they contract to slll,tll dimension,. 111 sCleral conditions the pupil' arc altered, the,Y IlH1.y be uoth /rial:'ly dilated, ,)1' uoth lIIinutel.'ll'Ontrarterl, or, all the other hand, they may he u:le1lunJ or inegulal'that is, one may ue lar(/e a,nd the otllel' slJlull. Olle of such altorecl conditions a .. 'riulls ,tate. rrho pupil' are 'aid to he fi.cell \\bell ill eithor cL Hhac1ed or a bright light no alteration take. place ill their :-;ize.

6. Examine the hodv and oxtremities for of fnu.;tul'es, cli.. lo<';ittiolls the ncck for :--it.!,'ll. ' of tntngnlation or hanging and <.;Olllpare the t \\0 • 'i(le' of the a ' to limpno,'H tn' help1' . '110-;S.

7. :Xoti ce the temperatnre of the Skill, \\ hl'Lber it be natural, hot, 01' c:vl(1. The 'lui<.;kest of doillg this i' to pInce the Lack of the hand on the llak eel chest of the patient.

SnacK ('o:.\IETDrE LEADIXG ro COLLAP,'E FRQ:.\[ IKJURY).

After eyery acciclent of any se\"erity the patient suffer::; from shock. It is not :::;0 much a mcntal COll107

clition that results, as one dependont upon the physical con of injury.

'fir/n.' and Sympto7ns.-The patient complains of feeling col(l allclll1ay actually shiYer \\ ith cold . Th e face i.. pale, the skin is cold ancl clammy, the lJuj·c i .. " eaJ, the hreathing i,' 'carcely perceptihle, and tbe tempera· tme of the l'Q(h-, if takon by a thortJ1oll1cter, will lIe fOllud to l)e tho normc{l (9 1 • J) . III o,e re iujurio ' 'uch exteniye Lum.', In'oken 1)0110 , lacerated \\'cl1mc1s, or :cyore crn·h with de 'ea ted injuries, the temperature ll1ay fall to 94 degree.' or cyen lo\\"cr ; ill snch case. reeoycry is rendered clouMflll. The patiellt, llletllltime, lUay remain cOllsl'ioll", .1mt appenn; dazed. In some ca:e' of ' hod:: the patlOnt keep (plite (Iniet, Lut in cae' a llllrea."onal,le re preymb. '1 be patlent IllaY l)O("CllllC delirious o\ying to 'eyo re pnin ) 10' of . blood, or uleutal di ·turbancc, or may collap'e from extrcme Ius.' of llluoc1, or the 'c Ycrity of tbe hod..

'1 reatnz ellt. - Prcycnt tbe tem]K'J'atnre fnlling by cuyeriug tbe pnticnt up with a t:unt, . hit\d, 1,bllket, <lllythillg at ha11(1. .c\::; 'oo n a.. po.·.. il I1c get the umler coyer in it warm roonl, Ol' ill l)ec1, and promote \"anuth hy hot ftalllleb, hot hottle::; to the feet and alJelOll1ell, anel, if tho patient not UllCOl1·<.;ions, warm drink ' , tea, hot milk, etc . 'Yhen app1yillg hot Lottles ee that they ilre \\T<l!):1ed un

lOS

in a piece of flannel or cloth of some kind to prevent POL sible injury to the kin.

CONCUS ION OF THE BRA IN

'

Yhen the cranium is struck a seyere 1)10W, or in jured during a fall, the brain may be eoncu f:ledthat i , the per on may be tunned. There may be no ,yound of the scalp or injury to the l)one, but the brain is 0 shaken that for the time being it is functionles or paralysed.

S1'gns and Sympto'lns.-In en ibility, a fceble pul e, shallow breathing, the pupils fixed, and generally equal in size, Hi tory of a fall or a e,'ere blow may be obtained; or injury to the head may be evidenced by wounds, bruise , etc.

Treatment ,-See Apoplexy (page 109).

COMPRE SION OF TIlE BRAIN.

,Yhen from a fall or blow the cranium i' fractured, and a piece of bone driven i11\\"11.1'(1.' , the brain may be compressed. On the other I) <lllcl , the broken bone may injure a blood-ve,'f',cl "itbin the cranium, and <.:ompression may re 'uIt from prc.'sul'e of blood on the brain. In the former the in'ensibility will come on immediately) in the latter, after some minutes, po ihly 15 or 20, that i:--, ,,-hen the blood has accumulat in sufficicnt quantity to cxcrcise pressure on th8 hrain. igns and SY171]Jtoms.-Insensibility; evidence of a

\Vonnd of the scalp; the fracture of a cranial hone may be felt: a slow, fl111 pu18e; stertorous l)reathing, UllCCllHll pnpib, hecoming fixed whell the pre... ·ure is severe. 111 inj I1rie.' to the brain -ymptoms of concus::.iun lllay prevail .'ncceedecl by ,ymptoms of com prc.

2'l' eatlllen t. -Sec Apoplexy.

ApOPLEXY .

,Vhen a eli cased blood-ye "el o'i"os 'Way within the crnnilllll the 1>rai11 i · cOl1lpre.'r:;ed and it ti' uo partly c1e:-;lroYl:Ll b.,' the blood \I'11ic11 e 'capcs , \Vhen tbe of 1Jlood i · br<l'e the I-I'ymptom; cleyelnp ,'0 rilpi<lly that the condition i terllled an apoplectic fit or ,"-I'tU n ' ((luI ',IIlIljltoms.-In. on. a full, low plll.·e stert.,ron' nnc'l1.w.l . (one lan.!.'c and unc , mall) and ft\.ecl pnpil.." n. fin.-hccl Ll.ce) <l. hot .ki n (l1.lC tempemturc of the 1HJdy i· II 'ually llHtrkedly ntl.'ccl), awl the liUlk of one ,ide of the h()rl,\' limp, "hile, on the otlle}" th' normal ri!.!,'idit\' lIla\' I)l: retn,i n ,cl-;1re the indication ' of n .c, e\'c <q;oplectic attack. The H!.!,'C of the p;lliellt i ' a help ill r cco!.!,'ni"il1!.!,' the condition, n' it i. u'1.w.lly elderly people \\ 110 al e oized.

Trflltm ent /or Ap()ple.)'!I, COllcZtssion and COIII}J]'PRsion 0/ the Hmin.-(l) Ul:ncral treatmont for in 'CILibility (100 'en the clothing round neck, ehe t and

meI?; provide for a free draught of air) . (2) Ln.y the patlCnt on the bel,ck with the hend rnj,·ecl. (3) Uet a doctor at once. (.f.) Apply cold to tIle head either by n,u ice-bag or hy wrung ont of eold water. (5) Keep the feet warlll h,), hot \\'Htcr 1)ottle', 111u ' tn,rd le,1Ye , 01' n, mu'tanl pla Ler. X.B.-Preyent anything being giycn hy the mouth. Take cal" that the skin i' not injured by the hot water l)()Ules ; they ought to be tested by feeling tlteHl "itlt the back of the hand, n,nd thcn wntpped ill flalluel, etc., before placin g thelll against the skin.

COLLAPi:iE ])lUXK.

Phy ical collapse from chink is general1 y \\'i tnc,'. eel ill poor perSOllS, upon \\ waut of llOlH·i..,hment, immtticient ·10Lhiu!2,', de., (hink (it mil\' be eyell a 'l1utll ha. an undue dfed. It i. that drullk:trc1 . l)(!eOllle l'(lll<lp,elilll(mt,tl powcr ' mH \. he paral,\', ell. lmt the ein.:n· lntlOn of the blooc1 retain' its l)()\H' )'. ,.....'iUIlS wn[ llta\ k· eOlllor pD.rtial, the pnticnt being 'i't hL'l' "c<l]Jal>le of roused, or total1) UlleUllscioWo;. Tit, plllse is fec'Lic or cumpletely nh.,cnt at the \\ rist: tlll' l)reathillg is slow, nn(l pe1'ha]>' ,lig'htly th e of drink; thc pllpiL' ure clilnLecl, e<Itlal , and re:-;polld to lil.!'llt: the f,tec i' 1)ttle, <lnd Lhe SHl'fcte8 of the skin colrl 'a nd ebllllllY. .

III

N.B.-It must not be a.' Ulned that a iJer.'on has collap ed from drink merely becau 'e the breath of drink; frecp:ently,. when people arc feeling Ill, they take .or arc. glyen tllnulant', after which they may become 111 en'llJle, not from the drink but from the ?au e whi911 induced them to take it, e.g., apoplexy commg on, effect' of poi 'Olllng, etc., etc.

TJ' ea tmenf.-(l) General treatment for in en 'ibilitv (loo en clothing, provide free circulation of air and in pO 'itiOl: in which breath.ing i. po ( oJ) . I\.eep. the. patient ,,'ann by coyermg hIm oyer or takmg. mdoors, and applying hot-\yater bottles fnctIOn to the urface, more e. pecially to the lImb. (3) ,Yhen the patient can be roused oive tea or cof1'ee. (J ) ,Yhen the pul e is 1'e glye an emetic of a de el't- poonful of mustard in a of, wn,ter. (5 ) ,Yh en the emetIC ha, efie.ct.ed It pm'po e, UppOl't the patient' streng:th hy tea, beef tea, brandy in small quantIty, 0)' hy any of the prepared foods, soups, or e . ence.'.

The apoplcctic state and collap 'e from drink are not ullfreqnently mi:-;tnken the one for the other.

The more prominent mean of di tingui 'hing them arc a.' fo11o,,' :-

1. In apoplexy the patient i ' u nally getting on 111 year ; collnp 'e from drink may occur in a per on of any age .

2. The ab ence of the mell of drink ,,"ould indicate apoplexy.

3. Pupil generally unequal and fixed in apop lexy; equal and re ponding to light in collap e from d r ink .

4 . The pul e at the wri t in apoplexy i.' u ually strong and full' in collap e from drink it i::; feeble or al together ab ent.

5. The feature in apoplexy are u . ually conge ted and. uffu ed' in collap 'e from drink they are pale and pinched.

6. hould means of aHcertailling the temperature be at hand, it "",ill be found in apoplexy con .. iclemhly aboye, and in collap e from drink con iderahly uelow the normal (9 '4:) .

EPILEPSY.

Thi . di ease i. frequently termed the "falling sickne ... " It occur ' ill per, on: of almo:-;t allY age, but mo't frequently it i ' seel·l in young adult::;. It i.. a common form of "fit, " and a, il O(;Clll" , with lmt little if any warning, the .'ciwl'e may take place by night 01' day, at home in the :treeb.;, at pul)lic meeting:, in a. puulil: fact, anywh ere. O\ring to it: sudden de\'e1opmellt the patient may incur ::;eriou.' dangel', epecial1,:- "hell the attack come' on ncar a fire, n , teep bank or precipice, or \\11ere traftie <rreat.

11 3

, iUns and SY171pioms.-, 'ometime' with, but p;eneraUy without, a 'cream the patient fall::; to the ground, insensiule. The muscles of the body are in a 'tate of spa m, 0 that th features are di. torted and the hands are tightly clench d with th thumh ' inwardp Yery quickly, the rigid pa m hy which all the:e have heen fixed is exchanged for a tate of convul 'lOn, during wbich the face, liml>. and hor1y are contorted. The eye ma:r :quint, the pupil. are equal, c1iln,ted and fixed. The f,we at fir 't pale, hel:ome ' du:ky, and froth frequently appears at the mouth and occa ionn.lly at the llostril: . The tongue i apt to 1)' hitten, anel whell it i ' the froth from the mouth may he tinged "with bloorl.

1'he dumtion of an epileptic fit i ' un certain; it may continne for hut a minute or two, or for fiw to fifteen minute,.;. "\YhCll tlle fit cenc, the pati nt lllel:' recoyer completely) mny fall into a de ep leep, or mH:'" have a snc:ee ' ,ion of .' illlilar fits.

Tr erttm ent.-(l) Ueuercll treatment for in , enihility(loosen cluthi1lg, aHem free circulation of itir, attend to po. ition). (2) PI' 'Ycnt the patiell t from him C1f n.: h e and after he 11<1,' fallen. (3) Dunng the fit him n \\ ay frum n. wall, hCil' y pi ec e of furnitnr ' , or other :onrce of danger not ea:ily llloyed ; pu 'h lightcr fnrniture out of the "ny. Kneel dO\Yll 1 e 'ide the paticnt and 'upport hL h ead. (5) 'Yrn,p a piece of wood or allY hard material (handle

of pocket knife, inc1iaruhbcr, poncil, otc.) in a handkerchief, and hold it l>etween tho teeth to prcyent the tonguo heillg bitten. N.B. Tho moyell1ont of the limb 11lU -:; h 1'e 'trained, h :t not altoo'ether provented or cOlllpletel.y ehecked, a dnring the .'p,umls the mu cles might bo torn. Gil' nothing hy the mouth. (6)

After tho fit ee that tho patient i' cared for hy friend, or com'eyed to 'hdter, and allowed to re.·t Clnd 'leep.

F.AI ( YNCOPE).

Cu.llses.-A clo'o or crowded room tiuht cloLhino' fright, 'udden bad new., fatigne, fooel, of blood, heart fail nrc, ete.

Big/IS and Symptoms-Pallor, a feelillu of cyidclill" , , a feel)le puI e, 'hallow l)l'cnthing, follo "wed by in en'ibility more or Ie's C0ll11)lcte. '

TI·eatme71t.-(I) Uell ra1 treatment of ill.em;ibility (loa en clothing, 'proYiclc circnlation of ai J', attend . po ·ition). (2) Lay the patient do,,'u flHt all tho Ho())' all c01:eh, or on tJ;e gronnc1, 01', if po... ·ihle, a .. \\ hell tit patIent I ' on a form, let the h nd drop oyer tbe eclo'e of the form a little below the IeI'd of lho •. (3) Hai::>e the feet a. little. Uet n. ' much ail' to on tl?C patient a pO,'i')il)le hy creatillg a clmng-ht, hy etc. (4,) 'melling 'alt, held to the: nostril wIll ,lId recoyel'y. (5) 'When en. ihilitv i,' l' '.'tored remO\'e the patient into the open nil': Imt reco\'ery be delayed for eycral minute' after tho fiat

positioll I1n,s heell Hi-i,'nmec1, tho mn.'t l)c carricd whilst ye'L i11i')e11iJ)1e to the open all'. . J-ute.-lf l)lee(ling Ii') til cau,'o of thc falllt, nne't the hrcmorrhage Jldorc treating the 1f the patient i, froll) want of llounhlllcnt, giyc at fil'sL, FlT.' (lh. TEH.lA).

. iqns awl "yl/ljitolJ,s.-Tllc patient, u . nnll:y n young girl, 'in consequence of SOlllC I11clltal cxcitcnlL'llt, . ud, delll\' loses C()I11111ctlld of her ami actiolJ.', be . ·\lh...,·idl·..., oU a ('ouch or in some comfortnlll · po. ition awl eo11l111Cl\('C:-i Chl'lJwilll.!: Ill'l' , eH ahHlt g'l'iu(lilll.!: hc]' teeth, c1clleltillg' her fi .. . . hakilll.!: her hail' lc)():-;e. 110\\ l'lntL-hilw at ,1llnltilJO' or all\'Olle nenr hcl'. crying', The e'yehall may lIe

ll}l\\'ClnL awl till' elid . opellecl all(l . lllll l'Clj>idly. tillll'S a fruth appeal' at the lips awl :.'\,' \'\"1'111 otllel il'l'l'l.!:lllar Il 'Yclop. The patient i._ llot lllsClhJl.JC ill h,). teria. .

1"·I ·(1t,/I( · III. firmly to the patlellt: thl'Cn.tl' ll ltv!' witll a cold \\atcl' clo\lchl.·, and, if . he pCl':-;i L in her "'it, ;' spl'illlde bel' with col(l \Yater. :JIedical j" llCl'('SS<ll'\' t() Lill' paticllt of the ('Ollthtulll ()j lllill(l awl 'J)ody \\ hieh to the tendency to hy.. tl'l'ic.t 1 CI t tc{uks, THOKE.

Heat Stroke and He8C Apoplexy fin'

al '0 applied to thit:; condition. " -'un.. Lroke" is u 'ually applied to thn,t form of the aillllent "'hich com0 on suddenly ,,,hil t expo 'ed to great heat; and 'c heat troke" i' the term u 'ed ,,,ben :-;)'mptoll1 appear after the 'un ba 'et, in COlll-.equenco of expo ure to eyere heat during the day.

Signs and DYll1pfo7J/$.- ,Yhi1st expo:-;ed to great heat, a in the engine-room or ,tok '-hole on l)()<lrd ' teamer., e peciall)' in the tropic, or <luring a march ,,,hihit heayi1y lmrc1ened in yen hot weather, per ons ::;0 'ituated 'may develop a '11 :-;it;knc.. ', el, feeling of faintll SS, gicldine.... , and ditliculty in brea.thing. The pationt complain of tbin5t, the .. kin l)eco111e ' dr, and the face C0l1O'C. tcd, the pu] e and Finally, result, with tertorou' br atlling, followed hy collapse.

Tl'eatmellt.-Undo all tight 'lothing; 1'e1110ye the patient to a cool, shady spot-if on board.hip, het\\ecn deck. ; if in the open, to the .. bade; if n ar n 1Wll . e, carry him indoor and darkell the room. trip the patient to the waist, procure (l' free n Cil'Cldatiull of air a . pO:8ih1e lJY fanning: yigorou 'l)" lJY opellillg the door and windows if in the hou. e, OJ' piaclllg in a draughty place if on 1Jonnl 1\ l'ep the pntient lying clow11, lmt ,,,itll the 11 ael, neck alld llGu1der' well rai ' eel on a pillow or folded coa t. Pour cc1d water on the head, neck and body, jugfu1 after

117

jucyful, until con:cion:ne' returns. An ice-bag to the hCeHl and t:;pine or cold \yater hould ue continued for f;OlllC 11Olll,}). Tllc p-a.ticlIt may haye cold wettcr to drink when cOllsciou ' , 1JuL llU ·tilllulant.

ELECTRIC 'HOCTC

rrllrough contnct "itll all elecLric cnille, "irc, or othcr electrit; ])ledilllll the . hock way lIe ,0 , c\'erc a, to can'e in.'cll.ibility, allCl the .ufferer \\ J11 lIe llllall1c to extricnt' Jlllll1edinte 1:>tep, lllll t lIe taken to re11lO\'e him frolll COlltact, hut an attclupt to do t111 . i.. attended \\ iLh as a11)'one touchi])!..!: the 'jufferer without proper precatl tion.' i liable him , elf to rcceiye a .ho 'k. Thc ri.k call 1Io\\cyer be matl'l ia]]y lecluced if IloL cl,lir'I\' obviated lJY aY Llilillg ollL·,'elf of .. "h'ich are al'parcl;t to all': 011e all clellll'lItalT knu\\lec1!ie (Jf the which uOYCrll all ell' 'tric • llcxlie", knowll n.' ," are particlllarly llited fur tll ' of electric1t,\' and nrc ill tanL1,:' .cized, whell po._ sihle, 11':a ClllTent <t ,' it:-> path. ill tanccs of sncll lJoc1ic. llHlY be mcntioned, iro]), 111'<ls, "ater or llwistuJ'c, allel O\\,ll hu(ly. ()ther Ilodie. ' , t;<lllecl c'noll-coJl(luctor " 01' .. insulntor.," l'C 'i. L thc 'l1lTCllt, Hnel these are illdiarnbllcr, e:Lt.... , ell'Y .' ilk, elry cloth, dr, \\(J cd amI drv bay or . traw. All electrit; Cl;rrent <11\\'a\ _ clwu.'e ' 1Jl·.'t l'IJllclnl'lul' 'mel thl' :-ltortc. t \Yav til 'tlt L eartl] llllt it:, will llut pH '::; iuLo ,l body, 110 l;lattel' hu\\' a

11

conductor that body ma,y ho, if ib) egrcss prcYcl1ted by an in ulator through whieh the CUlTellt emmot pa, R.

No clonht tho simplc:-5t \\<1)' Lo free a, 'nl1'erel' fl'Oll1 contaet with an eloctric Cllrrent won1(l he to ,'\\ itch off the current, 111lt this C0111"'O ,,'ollld oftell he quite impo "iblc, and e"Cll if '0 llluch il1(;{)llH'lliell(;C and pel'hnp clanger to the of others ario that ,'omc other methocl hns wmally to he ac10I,tC(1. the :-5uffel'c)' from contaetrelllellt1 'l'l' -

1 t. Do not touch with nakc(l tho ' ldferer or his clothing if it is clamp.

2nd, Keop YOlll':-;olf insllhl.tecl from tho (;;t1,10 or from the '!llfcr '1', nnl from the cm'th a::; \\ell. . 3rd. incli'll'ltl,ter i' prall tl1l,r tho bc,·t III ulator do not timo ill l'111111illg fol' illClinl'lll,llor g10"o or mat., lmt u '0 dry artidcs of an indiarllhlJer tolyl.cCO pOllch or pouchc,', or (;ap, wOllld sen'e to protect the hand::; in all elllCl''''Olll':Y.

Electrie current is conveyed by a \\ Ire, rail, or tal', called the" Po,'itiYe," and returns to the SOllrce of supply by another cable, wire, rail, or bar, called the " Negative," or through the earth. In the ert::-ie of an elcctric ra,il \Yay, the current i::; general1y C011Yclyer' by an insulated rail called the third rail, a.nd returns throllgh the running rails or an insulated rail called the fourth rail, and in the case Df an e.lectric tramway it is frequently conveyed by an over119

head conductor or trolley wire, and returned tllrough the running rail.

,'houhl an nceidcnt occur, and the sufferer lJe in with the po itive, insulate yonI' o\\'n P '1', on by stam1ll1g on a, dry board, dry clothing, a l)unclIe of dry bay or straw, gla ',hricks, ·la.te, or an indial'ubl,er mat, .material, or s.heeting. Protcct your hnllds hy l?laelUg a many thICknesses a po::ihle of dry elothll1g, or bolter still, india-rul)lJer lllaterial heL\: eOll .them and the anrl enden. \,our, h; pUlllllg hI ' to 1'0111o\'e hlln from contact with the po:-.itiYc. ('arc l-ihmdd he taken to a\'oirl toue1lil10t11e Ililud:, \\ l't e1othing, or hoots if the l1<:iled. The armpits ,llOuld be }L\ oided, as perpmltloll usually lllHkes the e10thing claIJ1p tIlere.

'Whon the ,lltfcl'l'r i.. removod from contact:-

1. .\ppl,\- the treatlllont frJl' i1)::,on 'ihilitv (lowell cluthillg', }lJ'(}Gllrc free circulation of air ancl place ill a ree1illillg P()' ition).

1>ip a towel. in ,collI \\ater and attempt to aroll e bun L.Y ·ltarply Hwklllg the face and ehl','t. 01111110l1eC nrtificial rc.piration if nth r Inctbnds fail to ]'ostoro ., Lahonle's ., lllethod (, ee page 14:2) 1m ' heon f{)1l1ll1 to te yery sncce, 'ful.

L Trent 111l'11S, if there are any (ee page 1 ).

EFFECT' OF

A per on trnck by lightnin!! i' n , nnlly morc 01' Ie s

COIl ne '8, The treatment is the ,'ame . t clectllc hock, except, of cour '0 th'1t the ructIOns fo:' removing the patient fro;n c:llltact "lth the .eloctnc medium do not apply,

rONf; IN CHILDREN,

. Tee,thing or :::;t.omac.'h troubles al'e 4110 c f lJ com111one t ",u 0 convul IOn: III infant ' , S'l(J?18 and ym'P ton ' tl I '· b 18,-,- pa ' m of Lhe nm.. cleH of 1e 1ill sand trunl- liv' l't T f tl f . QCC'l' 11 . IC 1 ) 0 le n.ce, 111 C])Hil )il i ty f' < IOna l Yf 'qumtlllg, "uspendecl re 'piratiol1 and 109;lent y roth at tho month. '

1 reatment -Put tl 1 '11 . t l . 1(' C 11 ( 111 a warm 11'11,11 'l.hout , tempel'H,t1ll'O of the hody (98 e1wator reaches as high as the of lun J anc place a 'pOl)O'e dipI)ed III 11 the top of the head, 0 co C ,Yater on

CIIAPTE R IV

WOUND AN D 11. J'CRIE OF THE SKIN. BRUL 'ES .

A BLOW anY"'here on the surface of the body may cau 'e exten iYe lucmorrhnge 1elow th skin, without the skin being "'OlUlded, A" black eye" is an injury of thi nature.

IgllS ((wl !}lIIptOIJ/ . - The injured part i at first r ddencd by the blow, lJut the colour quickly a urnes a du ' ky hue and then hecome ' purple, and afterwards nln10 t l)lack. In a few days the colour appears of a lighter tint, and after gradually passing through pm'ple and violet 'hade, it change to a greenish colour and then to a yellow tinge b fore the normal colour of the , kin i attained.

Tn; atJlI P71t.-13eyoncl the immediate application of ice or cold-\\'ater dreing,', no " fir ,t aid" treatment i ' required. The yirtlle popubrly ascribed to raw meat applied to cl bl ,lck eye luv no foundation heyond the faet that the piece of lllL'at i ' cold, '

•\.urface \\ Ollllrl nuw oe defined as an injury an opening in tile t>kin, OF \YoU,\DS IX

B e sure that your H ands ar e qui t e C lea n. 1. A rrest H remorrhage at once when the

1:22

source can be fl.'certa ined. ill tcmal 1'ha,o'e is uspected the mca,::;ure to be adopt cl are:Rest, free circulation of air, loosenin g clothing, ,wd fr ee. lre of icc t-;uck;. an ice-hag lllay also l)e applIed externally 111 the neIghbourhood of the wOllnd.

:2 . and Dress the Wound -( A .) lrJu'lI it 1 but ' dclom that appropriate mcall' of clea,nino' a wound are [tt Ca) If no ,,'ater i' !l.t hand, and b\lt If i' to llC had \\ipe the wound, If It It-; duty, wIth a c')1'ner of the hnnclkl'r· chief, then fold the handkerchief ,wcl tic it oyer the ,,"ounet If .the handkerchief i::; soiled apply a piece of clean (unp1'mtcd) a' thc in ide of an cm'elope, on the wound, and tIe n, handkcrchief necktic or brace oyer it. (h) If water is by and'thc wound i::; dirty, hut not othe1'wi::;e, wn.·11 t'he woun(1 freely clip (or wa::;h if 11ccc::;::;ary) the hnnclkerchief ill the ,Ynter and apply OY l' the wound.

( B .) TVlten £n-doOi':j l'1eal1sfl the /lloUJul with "ate!' that h'1. · been boiled and allo\ycd to cool. To the :vater might be n,dded, in the following proportion , If at hand, a few cry tals of permangannte or pota'h to a hlllf-tumhlcr of wllte1' ; homcic-aeid (n. terl'poon ful of the to a half-tumhlel'ful of : 01' any of the ell 'mfectallt lotion in COlllm()n H.'O. 'l'he w'owu:l the wound are to he don.n ·C ( l l)y \'tahing. with soap an(l water. 'When the part Ita,'s been dned, ab olutc clcanlinet-;s "ill l)c cll:urecl 11y

123

m.opping around the wound with spirits of "me or WIth WIll 'kyo Dress the 'Wound.-The wound mny no\\' hc dre' ed by one of the followina methods' -.(a) piecc of elry lint, linen, or cali coo of eyerai thlCkne ,,·e·. and (u) The dre,' ing may 1)e l'lOaked III ,,,ateI': bOIled and cooled, or in anT" of the a:lti lotion::;, or in !riar ' balsam. (r-)' 'otton" 001, hnt, or g,l,Uze (medIcated) may l)c applied wet or dry, next the "ounel, in . tead of the a1)0v-e cll'c.·.. illg, or applied oycr the dre ·::;illO'. (d) AntiHeptle powder, such al:l horacic acid, lllay l)e du,teel oycr the WOHlld, llnd then co,ered with lint or cotton wool and bandaged. I .B.-Carbolic acid as an anti 'e ptlc, Oll account of many aecillellt hnYlllg oceulTed in rccent Yeell" tbrOll"'h it::; mi:appli catioll i... not ,a 'nfc lotion l)c kept the homc .as a. for wound " Yes 'el: cOlltaining ctlrllolll': aCHl lotlOll :hoHld not be left alloHt. The dcanlilles' ()f ,II' . 'ing' of lint. eottoll w001, or gau:-' <.:an 110 t.!;uarnntcerI onl.' aftcr they lw.\'e been t.o !l,eat. Thi ' can he neeolllplihed 1),Y pIn 'll1;.!.' the quantity to 11e H'cll in a dOSl'cl tin in it hot u\'eu for half an hour. It i n.chi 'al)l' (lOt to elc,.tn witll the hanel, lmt with eleiUl lore 'P:-';, pUH.! '1' , Sll!.!,"ar &e. the l)luod lin: cl'lltcd 0' cr wound do !lot eli ,turb it unle: ' the wound i· known to be dirty.

3. Rest. The wounded part, \yhen dre', ed, should pe kept quiet by splints, slings, or by rest in bed.

WOUNDS AND THEIR rECIAL T REATMENT.

The treatment of wound in general applies to the e wounds :-

Incised Wounds .-"\Yhen the, kin i' cut by a knife, a piece of gla ,or other harp in trul11ent, the wound it:; termed inci ed. The edges are clean cut and the wound gapes.

The edge of a large inci ed wound may be held together, after it has been clean 'e d, by narrow strip of adhesiye pla -tel' laid aCl'OS - the wound with (1, slio'ht . b b 'nterYal ebyeen each, trip.

Punctured Wound s . -The wound caused by the stab of a knife, dagger, bayonet, etc., i· termed punctured. The wound i u ually small, rOllnded, or jagged, and the edges driven inward by the weapon. The danger ari ing from the injury depends upon the situation of the wound, or the depth to which the instrument ha penetrated.

Punctured wounds mu t not be probed. FOl'eign bodies in wounds, when hidden from yie\,", are not to be 'earched for by probing, they are to be left till the doctor arrives. (ee also Internal Hlcmorrhage.)

Lacerat e d Wou n d s .-"\Yben a part of the hody is torn off by machinery, by the bite ()r cla\\' of an animal, by an artillery shell, etc., a lacerated wound

125

r esults. T he parts are torn unequally, so that the surface of the wound presents a very uneven and ragged appearance.

Lacerated wounds seldom oleed much, but when part of a limb has been torn off, say by machinery, a tourniquet is to be applied loosely round the limb above the \Y01mU, ready to be twisted tight should actual hccmorrhage come on.

Contused Wo u nd s .-When from the olo\\' of a bluut in trument, such as a stick, truncheon, etc., the skin is broken aud the parts around seyerely bruised, the wound is said to be contu 'ed. Th e edges of the w01.mrl are uneven and driven inwards; the hmmorrhage icl usually insignificant, a few drops of blood merely trickling from the wound.

Treat a a wonnd and a brui ·e.

G unsh o t W ounds.-"\Yhen a person is "peppered)/ at orne di ·tance with small hot from a lSporting gun, 0 that the hot has time to 'p read, the wound ' may be wide apart. Eyery shot cau 'es a small painful wound, from which a little blood oozes, and 'peedily gets hardened into a scab. lTnless the "hot)/ has penetrated the chest or abdomen, or wounded the eye or n, joint, there is little danger frolU the injury The wound from a rifle bullet will show one or two ,Yo1.111d., according a' the oullet remains in or leayes the body, forming the apertures of entrance and exit,

Gunshot wound are to be covered over by lint gauze, or cotton \Yool (medicated), if either is to be or if not, by some other clean dressing. \Vhen the surfa,ce of the body ha' been "peppered" by a number of small shots, do not attempt to remove them, but wrap the part wounded (a whole limb it may be) in a or towel wrung out of hot or cold water, whichever i the more comfortable.

Po is o n ed Wounds . -'Vounds may he poi oned at the time of the injury, or may b ecome 0 afterwards by the nature of the di charges. Under thi8 heading might be included the bites of animals, the sting8 of insects, the poisoned wounds caused hi native weapons p urposely poi oned by some drug, etc.; the e will he con. idered in detail later. 'Vhen wound becol11e poisoned by dirt, reglect, in ani tar? surroundings, etc., they are said to be" septi0," rrhe word eptic lllean ' putrid, and antiseptic lllaterials and :substances are those that prevent a wound becoming putrid or 'eptic: with the treatment of these conditions "fir.'t aid" has little to do, bnt all that i.. po ':-,;ib1e to prevent a wound becoming septic when it is tir:st seen ':lhould be attempted.

For treatment, ee Bites, Sting, etc.

When a j oint i s wounded , .'ay l)y CL 1mllet other foreign body, or by a stab, the part is to he wrapped up in cotton wool and the limh put in a splint. The limb should be maintained in the

}?o::;ition Lcst calculated to prevent gaping of the \\ Oll11(1.

When a needle breaks off after penetrating the ,kin etnd clis<\,ppeal's, take the patient to a. doctor nt once. If the \\ oUlld is ncar a joint keep the Joint at rcst 011 n 'plint. ,\Yh Cll ,t fis h - hook is el1l1Jeddcrl in the ,kin do not nttelllpt to withdraw it 1)\' rctractiollLlmt' is l)y thc \\ ,ty it wcnt in-lmt cut otf the ( clrc".. j, uf the . 0 that only the metal is left, an(l thcn foree tile poiut throll!.!h th e . kin, lllnkill!.!,' t) y , 1 001 - to tl'a\'e1 ol1\Htrd ' nntil it call lJe \yithdrH \\'11.

Fno::;T BITE.

During e:s:pourc to .'e\ere cold, parts of th e l)()(ly, u nall \' thc fe et, till!.!' '1'::>, llO ," , or cars, 10 ' C .'cllsati(Jll, ancl til'st waxy \\ bite, and th cn C;Ol1!.! c, tccl and or a pllrple appeanu;cc. ,-'cllsatiull lut in the part, it is oft en tl1C bystander:-; elra\\ ill!.!' attelltioll to the alteratioll in c(Jlollr or tbc utI', n(J 'C , etc ., that tbe l'rot hittcll per....oll 1. made awar e of the fact.

TJ'Ntfll ll' lIt .- I>o llot Lrin!.!' the patient into a \\'arlll room until b,\ fridion l ' y the hanel, 01' l>y rnulJill!.!' \\ith :-;oft SUO\\, thc . 'nation and circulation in the fr(J:-,thittcn parts are restorcd. X eglcct of thi., precaution may len(l Lo dcach of thc ti ' ues atfcdc rl. 'Yhen cin.: nlation is rcstorcd the patient oudlt to be kept in a rool..!...l r.t a te mperature at 60 c1eg. Fahr.

bURr' AKD 'CALD

A hurn IS can 'ed hy d ry beat, .'uch a flames, hot meh ' . e-tr.. a scald i::> cau 'ed by moist heat, such as boiling \Yater, hot oil, tar, etc.

iyns awl !/1II}Jtollls .-The effect of heat on t h e body may be a mere reddening of the kin' if mo re severe it may can e l>leh or" bli tel's" to form . ,Y hen the burn i yery 'eve r e the deeper ti' 'ues of tb e limb' or trunk lllay he charred and 1>lackened. The clothing may adhere to the burned r:;kill, rendering it impos:::;ible to :eparate them. The immediate danger to life is SHO K, cau:ed by the extent of injury to the skin: the more remote danger:::; are exhaustion, seyere r8actiOlmry inflammation, defo r mity f r om scar, etc.

Trerdment.-(l) The clothing o v er the i njured part must be car e fully r emo v ed. If Etuek to the Ekin, the adherent clothing lllU.t cut around "with sei :01':::; and left to come away 1'll1>.'equently. If the foot is ticalded, the hoot ;m1't he carefully rellloyed, nndoing the lace and cutting the back seam of the l)oot, .. 0 tbat the hoot may fall oft' instead of bein o' pullen off; the tocking' lll\ltit al'o be cut all along, so that it fall .. away from the Dcalcl.ed part. It is the duty of the to prepare the dre sing while the clothing is heing remoyec1.

(2) Immediately cover up the wound from

the air. (a) , Yhen the skin is merely reddened the air may tie ox 'hldecl by dusting it with flour, "wh iting, powderod clmlk, ('c . The part i. then to l)e cove r ed by a tbiek byer of cotton \\'001, ligh tly lmnclagecl and main l;ained in the mo't comfortahlc plJ:ition pOD:::;ible. (Ii) , YhCll bli.tcr· are forllled, or whcn the snrface is :oak or sme,Lr piecoD of lint or linen, with oli ve, ·nln.cl, lill,'coc1, almond or eod-liyer oiL, or with YH,'eline, lanoline, or cold crcam. Carron oil n. f;t\'Ollrite remedy, i' l11,lcle by mi:\illg equal parts of linseed oil and lime water; olive oil 1ll,Ly he 1l 'eel il1,-;to;td of thc lin,'oed oil. the burnt is extensi\-o, do not (;U\-01' the pn,l't with one liLrt?;l! shoot of liut, lmt \\ith strips about the hreaclth of the h,Uld' this i' achisable n,:::;, luring ubsoqnl'llt dres 'ing., 0110 Dtrip ean be rellloycd at n. time anel a fre 'h clre applied beforo the adjacent strip is taken off. Thl' shock to the sy.tem i, therchy lc's' than "would he the case w rc the ",hole of the hnrnt ,'llrfn,ce l<1.i(l haro to the air hy l'emo\'ul of all the dres 'ing at ono tim e. When eovcl'ed hy tho oily drc .. ing, elwc10p the part in cotton wool, or if that cannot be oht.tinecl, with a p iecc of fhnncl. ,YhCll tho face j:::; blll'l1t, cut a "mrl.'k ' for the face ont of lint or lincn, le<wing h oles fur the eye', the no 'e, and the mouth. Dip the rna k in the oil or va eline, apply it to the twc, mId cover oyer ,yith 'otton wool, lellYing apertures for tlL ,.

eye, no c and mouth. ,Yh en thc hand or foot is burnt or scalded, and warm \\'ater- that is, watcr at the temperature of tho lJO<ly (90'-:1:) i.' at hand, placc tho injured limb in the \\'ater llntil uitn1lje dre ... <.:an be got; and if a .. poonflll of lll1king Hodn, (bicarbonate of 'o<1n) be adcled to a hlsi 11 t\tl of the warm water, a 'oot hing alkaline lotion is prC'pared . Do 1Iot prick the llleh, OJ' llli.·ter' ; le,He that lo the doctor to do if he it ri!.!,'ht.

(:3) Treat Shock. - Tho f-.eycrc . hOGk, \\'hieh accompanies cycry 1mi'll of [lll:T'ize, lllll.t he (It'alt with lly applying warlllth to the sllri'nl:e fI[ the hody gencmll:-, am1 hy gi\'ing \Y,tnll rlrinkH. (:-;('e :-;hnd\.. )

Bc yory apprehcll.'i \'C of the clallgor of Cyell blll'llH of the lleek..

When a Woman 's Dress catches fire, proceed as follows :- Lay the pcrson flat 011 the tioor at 011(;C. Placc her '0 that the flam' are nppcl'mo,t ; that is to a\T, if the frollt uf the clres' i.. on fire, In' her 011 her "back, and if the baek of the dre.s i.' 0;1 nrc, placc h er faco dO\\'l1\\'arcl·. The reason for thi pO'ition i.' readily WhCll it iH rClllemllered that flames ascend vertically; '0 that if th) upright po 'itioll i,' as '1.11nccl, the flamc.' will (luieklyascend n11(l em'clop the body ned:, ancl face: or if thc per:-;on i thrown clown with the flamc umlcl'mo.. t they \\ ill, if unextinguishcd, over and hurn the limb.- and set tire to the rest of thc clre.'.'. . \ '. oon as the pl:r-

131

son is placcd flat, ,mothcr the wi th anytllillg' at hanel, a.' n. rug, coat, blauket, tal)lc (;oycr, ete. If made \\ ct I:)() llluch the l)eLter. . \ \I'c>luau rcndering 1u:i!-ii:-;tal1ce, hold a rug: or LJauket ill front or bcrscH ",hell npproaching the Hallles. If a. \I c1re.'s cal·h fire wh en no Olle i· In', she lic flat, flames upperlllo.'t, mother the with anythillg handy al-' a table-co\'er mat, Ltc., and call 1'01' n 'si.·ta,llec; on 110 ac(;ount 'liould he rush ill to the opcn air.

YITHIOL

Vitriol is frcqHcllt1y l1o.;ed as a \\ L'npoll for deadly illjnr)'. 1f it is dH.hed ill tile fttCC it i.. a ycry Hcriou Illatter. if it tOllehe' the cye it wOllle! 1l1e;1Il los.. of si!!ht; \\ pnrL of ;-,kill i"s tOll 'hcll hy the acid i:-; f1llT()\\ cel alld lJ1lrllt. l'l'e(/fment.-Carcfllll:- "H.lI all the yitl'i()l po '. siblc from the ,kill. ll." 'qlll'eziug' a .POl1!.!·c clipped in tepid \rater to \\ hich \rH. hing or soda. lIa ' llecll addecl, allowin!! thc water to 1'1lJJ!.!,'enth oyer tho inj med part thcn treat n, an ordimtr:' Iml'll:

OF A};DfALS.

lTyclrophol)ia i' can 'eel bv the hite of an allimal .llf r ' ring from rallie. c\'cral nch ;1.' clug.. , foxes, \\ ohe, dcer, &c., hccome rabid. The poi 'o n is 'olltnil1ccl in tllc animal' saliya, and may bc cOllycyed 011 thc teeth llcncath the :::kiu a.nd F :2

J3Z

thus into the blood of huma.n being. 'Vh en the bite is through the clotlliug there is les.3 danger of hydrophobia, as the s<.\,li"H, is wiped off the teeth by the clothing. It is therefore by wn,y of .the expo cd parts (the hands and face) that the pOl 'o n u 'ually -enters the body.

l'?·eatment.-In case of a bite by a dog 01' other .,1.n1111;\,1 , do not lose time in the attempt to ascertain wheth er the animal has or 1m not r abie" but procced imm ediately as fonow :-( 1) Pre"ent the "C11011 .', blood from carrying the poison through the hody 1)y 11))111Cplacing a cOllstrictioll between the \\'ol1nd and the hec\'rt. Suppose, for example, a finaer i l littCll, it should be encircled above the I:;eat of the 1,iLc (th;\'t i , on the side of the \yound neare t the heCll'L ) \\ ith the fore-finger and thumb. A .oon a pm; 'i 1)1(' pla?e ;.\, lign,tlll'e (that is, a string, a pIece of tape, it ,t np . of h andke rchi ef, etc.) tightly round the root of th e fino'er' do not 'e to com pre . \\ ith the o ) '1 l ' d tinger n.nd thumb until the ligature ha. )ecn app 1C • ('2) ' l1ck the wound vigorously, proYlded tha.t :Y0\lr 1ip' are sound, spitting out the saliva; (3) wash m W<Lter (warm water by preference, as It encourages bleeding). (4) As soon as po ible the should 1,e Imrned by a fluid ca.u ·tic, uch a cau t1C potash, pure ca.rbolic acid, nitric acid, 0 1' if these arc llot at nanel, by a red-hot \yir e, fu:-ee, etc. It i. not t:>uffi<:ient to apply !1 solid calls tic, such as lunar

13::l

cau tic, to the wound; it doc.' not rca,cll any deeper than the skill, and the poi "on is at the botLom of the wound. To eu 'ure the caustic re<1chin<r the hotLolll of the wound apply it on a sharpened piece of wood, ,' uch a' a woodell match cut to a point. (5) Dress the \y01llHl, anrl when it is in the llpp l'l' xtremity 'l ing the arm. (6) Treat hock, if it occurs.

XAKE BrTE.

Th e pui 'on of the conveyed the poi.. on gland along a III the .. fa.ngs, so that wb en a snake b1tes the. ecretlOll IS conveyed beneath Lhe skin along the hollow in thu fang, a.nd thus gain' direct entrance to the blood.

ifJ71S rind (!lmptoms.- \\'it hin a few after being bitten the part will feel . tIff; t1:e pati ent become pale and fcunt;. and If .u rp ent IS. one of the hi(rhh' venomotl pecle the tram of .'ymptoms will be as r;l1ow::;: hurried hrc,tthin!!,', flui<.:k pHl 'e, mental excitement, COlHUl .. ioll ' and in 'cusihility.

T

reatm,ent.-Tie a (a, string, leath er striI of handkerchief, brace, etc.) at once betwcen wound and the heart, '0 a to ob,tract the vems leadiuO' from the cat of the bite. Two or three such ligatures may be applied at intervals up limb and tightly twi ' ted (tourniquet). Ap-ply a. flUlu cau tic, such a cau -tic pota 'h pure carbollc aCld,. or any trong acid on a pointed piece of wood, bur11lng

deeply '0 a to de troy the POit)Oll at tllC hottom of the ' Yhen tho cau tic 11a beell tJlOl'OlWhlv applrec1, but not till then, the ligaturo.' mayh r cmo,:ed . wonnd is not wi thou L but If no Ca1.l.'tlC It) at hand .'ucking llHL'L ho enlployed, the .'aliya heing immediately ont and the month w<l:shc<l out with water or anel water and the wOllnd he hurncd with a or in other (\Yclilal)Ic manner. hock i to he treated III the ut>.nal \\'<:y, and pirit of .'al \'olctti1e (n. teaIll n. wmeg1a... , of l\'ate.r)! or 'pi rit::; (\\'hit)ky 01 In,md)), ale to 1)0 freely ac1mllu.'tered.

Bees Centip e de s, Scorp IO n s, Tarantulas, SpIders , Jelly - F is h , H arves t _ Bugs , etc ., may cadI give ri c to 'e\'e 1'e SylllptOllls attended actual dn.llger to life ill .'ome ill.· Lall(:e . Remoye ..tillO· by squeezing the part, or hI' pre ' 'm'e wIth the barrel.of a \\ hell that i . po:-;si1)le' ; m.op the part freel! wIth hqmd ammonia, .. pirits of W111e, or brandy, Idll ,'ky, etc. ; if thc.'e arc llot at kl.lld the application of the hlue-bag, or 'trollg of carbonate. of ,'oela or pota!:lh, will relieye pain; a paste of bIcarbonate of .'oda and pirit:-; of .:al \'olatile IS an efficient application. Tho patient',' -trelH!,th TIlU t be supported by the free adminitration of or sal yolatile. A,' the hmTe 't-bng hllric.' elf beneath the ::;kin, it it) nece::;sary to hayc tbe ll1sect removed by a doctor .

HAPTER V.

TH E RE P llL\ TORY Y TE:'II.

T IlE air reaches the lungs by way of the nostril ( !)]' the mouth), the pharynx, the larynx, the tmchea, aud the h1'o11chial tuhes.

The Pharynx is the space at the hack of tll<' throat and 11o.'e, partly seen l){;']lill(l tbe tOll.il ",11e11 the ))louth I,' ope11e(l \\ ideIy; tIle pharynx gi\'c::> pn.s.. n!.!;u to fooel awl air.

Th e Lar ynx (Lll \ YoiG -l)ox, Adam' · apple) il> .. ituate<1 on the t.op of the winri-pipe ill the llli(1c11c lille of the ned\:; it is COlllp().'eci of Gnrtilau'f' (!.!;l'iUe) and contains the wl('al (;orcb mid tho l1lu de· COllcel'Iloc1 ill the. 11l'ollltdi(J1} of tbe \"oi(;e.

T h e T rachea, or \\"illrlpipe, is compo,'ecl of strips of (;mti1agc 1)0\1l1(1 her In" eia tic a 1111 h1Jl'ons ti .. ·ue..." <1.s to fvl"lll an open tll1Je; it extends frolll t.he laryllx to t\\·o inc ite. helo\\" the top uf tbo 1n·l"l.' t-l lone, "here it cll\ ide into the ri!..dlt a11d left Imllll·lti.tl tube.. Ell·11 j,rolJ(:hns '.\ hL'll it 'nter') the lllng diyiclc.. into slllall aml ::itill 'lHaller tll hes, Hutil the ultimate rccc",'es o\' the lung-the air . ·11. or air ,'paGe' -are rea<.:ll ecl.

T he Lungs. Hight and Left, the greater parL of tIt \ lllOl'<l'\; tlwy lie imlllC(litl.teiy \\ iLhill the rib, and prat:ticalJy \\"ho1'oyer n. rib i· felt, wheth t' frOllt, bcll;k or sides, tben; i,' n portion of the lung beneath

E ac h lung is em'eloped in a hne membrane (the p l euTa) whi ch allows it to move witbin the chest during breathilw without friction.

rfhe Air enter::; the chest during Inspiration, and lcaycl-> it dnrillu Expiration. The movements of l>rcalhillg arc call1->c(l pa r tly hy the mu cles of respiration attached to the cbe ,·t lmt chiefly hy the Diaphragm , the large llloYH,l>le 111U cular partition which 'epamte ' the thorax 1'1'0111 the a1JClomen. c()ll , i.. ls of two acts, inspiration and expiration. The procc" of ill, pimtion if) chiefly a J11l1l->Gll1ar a 'L ; cxpiration i::; n,lmo, t\\ 11011y 1l1eehanicaL ]n ill . piratioll the l'ik arc rai -cd 1>:' lllll. cles attached to them: and abo the (linp l1r<lgm, whiGh in a quiescent tnte i.. (;OllYCX (or cun ed) upwards, heCOllle::; flattened, thns increaing thc capacity of the thorax, and the air fio,, ' in. In cxpiratiou the ril)s fall, and t h e diaphnwlll again hcc011lcS conyox upward ' : this lessens the capncity of the tho]'[tx and force the air out. The meGhanism of re . pimtion i 'omc" hat like that of ordinary hem hold bello\\'. hut wiLho.ut [t yal \'C. The rib' m,;y l)e compared to the of the bellow', "hil e the diaphragm to the lcather, the air heing equiynlent to the nozzle_ Fifteen to eierl1teell breath ' are tahel1 per minute in health.

h -truGtion to hI' athing whel1 COl1Jp1ete, cau es [t phyxiil, c)..ample of which ar afforded in cases of drowning, nffocation, choking, etc.

FIG. 54. THE LU.NGS AND BRON CH IAL T UBES.

A. TraclH'a, or Win rl -pi e B L f Bronchus lJ S II B p. .' e t Bronchus. C. Riouht . . rna er ronchlal Tubes.

ARTIFICIATJ RE PfRATION.

D r . vlveste1"s .J.1Jethod.

l-tULE I. - A djust the pah'ent's positt'on.-Pb.ce t h e patient on hi back on a fiat Hrface, inclined if po ' ible from the feet upwarcl. '. Hemoyc all tig'ht

FIG. 55. Ix

clothing from about the ned\: and chc.. t, Hnrl harc the front of the body a .. far <1..' the pit of the stlllllach; unf<1. ten the brace!:) and the top lmtton of tl'Oll:-iL'1'8 ill men, and the coret.. in WOUlCll. Rai. e clnd .n pport the 'honlders 011 a small firm Cllbhioll or fulded article of dre placed under the 'houlder-blac1c, ' .

RULE II.-JJaintain a (ree entrance of ai?' into tlte

139

the lip' and llo.. trib; open atlll wipe the 1l10Hth; cll·(-).\\, fOl'\\ard thc patient's tOl]ffl1C itS fin' a;-; po and keep it fUl'\\ill'cl either lJY gettillO' . (Ime onc tu hold it with a ha,l1(lkerchicf or pie(;e doth, or l,y P lssill g' ,L l1mTO\\', sligh tty twi"tecl stri p of h ,lllclkel'('hiei', a -;trillg', or tape, over thl' tongllc, as far back a. the HIl!!;les of the mouth \\ ill allow;

In'ing the ends l!lHlcr tltc lower jaw and tie tllel.!l 'cc lll'el\-. The l'lH]" Ill:t,' be again fa .te ner1 OJl the top or' tbe he,tcl to P;'Cycut .An ela tit; band lllay l)c ueel in.ten,cl of tbe .'trip of handkerchief, etc,

HUf.E II L-lmitl/fe th e IJlOCf'Jl/fllts of' bJ'eathin(j_

Fir"t: IllIlllce /l/-'1J/·ra!i()/I.-KllCc1 'at a dit1l11ce behind the paticnt\ heael, the patient's fOl'carub ju.t lwlow the cUm\\'; elm\\ the anll:-; up\\anl->, 011 t\\ arLls, aUll towarc1 you, with a s\\'cepilll.!,' Ill()YClllcnt, l11aking the c]bo,,-' allllo. t touch the grollllCl on cithcricle of the patient'· head, or cl'o.'sing the f()re111'111 OY('1' the top of t]le head . B,Y llle,ll1 the en\ ity of the chest i· cnlnrged, and air i· dra\\ll into the ]ung ' .

Sec()ndh- : Induce c,lpz'ration,-Bring the patient': flexL'd sl()\\ h rOn\ Iln], clo\\'l1\\'anl allcl inwards, press the arm t:lho\\ firmly against the l)(Jdy with the clllo\\. .'0111e fUllr OJ' f1\'e inchc - from the

•'ce abo Dro\\'ning, pa 'C" 143 antI 114.

urea t bone ('ee Fig. 56). By this means air is expelled from the lungs.

Repeat these movement, alternately, a.nd perseveringly at the rate of about Ii fteen a Continue until , pontaneous oreathlllg lS establulhed, or until a doctor arrives.

FIG. [6.

When spontaneons breatbinrr commence r cgulate tbe artificial respiration to cor;esponcl with the n :Hll l', d Hopes of restoring the patient may lJe entcrtUlned even after t\yO hour " timc.

RULE lY.-Excit e 1·espimfion.--,Yhil t the aooye measures are being taken, other u efnl steps may he employed, such as applying sme llin g salts or snnff

141

to tbe no b'ils, and clashing hoi 8. nc1 colcl water alterm'l.tely oyer 1,11, h ead and neck.

RULE Y. In rlure ('1'J'('ulation and warmth after n atl1ml hrel.thing l)een re, tore(l. ,\Tra.p the patient in dry hlanket' or other coyering, lUl<1 rllb the ]i1l11>::) the heart. Promote warmth hy h()t flnlllH":1s, hot-water or hot urick .. (wrapped ill lIanncl) applied to the feet, to the lil1ll>: and Imdy. ,YlI en the power of\\'allo\\ ing has r etlll'lled gi \'e sip' or hot water, tea or coffee, or of wille, Immely and ,mLer, etc . The paLi 'ut l'hould he kept ill l)ed nnd el1(;onrngec1 to go to .. leep. Large pOllltices or f()]llentntioll .' applie(l to the front and hu:k uf thc c: h e.. t will ,e n' to H llreathin<f. \Ynt ch the patient for .'ome to 'ee hat the Im.? athing docs not fail; '110111cl any :igns of f:tilnre nppear, at Olll.:e 1) 'gin artificial 1IOll'lln".· ,)j ('tlwti.-This method i.. ·inJly applicjthlc to ease' \\ hen the patient " ann is broken. V ca1 ",ith the clothing: and tongue, etc., as described under the SylYestcl' 1ll,tho(1.

Turn the' patiellt on the 11ack. Place a roll cf dothing l) Cllcath the hoely, so a, to misc the region d the stomach aboye the ICl\·cl of any uther part of the body. Place the patient'.. hands allOYC his head. Kn ee l a tricle thc patient' .. hip., and with the ball of the thumh re ·ting on ither side of the pit of the stomach, let the finger' gra'p the adjacent part of

the che 't , No\\", u 'ing the kne s a a pivot, throw all your weight forward on yom iland ', and at the same time queezu the waist bUt'YCCll them a:-; if you ,,"i 'hed to force c\'el')'thing in tbe (;he't UP\\ ard toward the mouth: deepen the pres.' lll·e \\ hile you can count lo\\'ly 1, 3: thun suddenly let go with a final pu ' h which ·pring .' you back to your til' 't kneeling pO ' itioll, Remain rud on yunr knecs "",hile )·on can COllllt 1, 2, 3, Thcn rcpeat the same as before, at n, rntc nally from 4 or 5 to 15 time,' in a Illillutc, a{lel C(JutilltlC the moyement ' ",ith regularity, 1ndnce circulatioll anel warmth in the manllcr dcsnih ucl under Hille y " ...'y lyc , tel'" method, ,\" hUll a sufficicnt numher of are H and'ylycster's llwtlwd. may he comhined, i.he pre ' ' ure 011 the ]ICiIlU: lllade 'imulLaneou . ly, W hen from any cau:e, a' fmctured rib, neither of "Ie abo\Te call be carricd out 'I/(:thod of mtificial rc . piration sbould Le tried 1t i' (' 'pec ially n.'ernl ill bldi'()cn,tecl chilrhcll. 1t is l'<lrricc1 uut a The patient i' placc rl all 11i " llncle; the month clean:cl: tlll' tongllc j, <.;uized W .. a J'H ndkeruhid or ,()ll1et hillg to Pl'CYL'llt it ,lippilw from thu flngcr .. --t h 10\\c1' jaw depn> .. ed; the tongne i .. pulled fon\arcl and hcld for t\\O in that pO 'i tion, then al]u\\'ed t.o recede into the llHluth. The 'C 1ll0YCment. · houlcl be repeated allont fifteen

143

times a minute. After treatment is the same in and Howard's methods .

T o RESTORE TilE ApPARENTLY D ROW l ED.

P Cl'i::lons completely illllllen,ed in water for t?Il or fifteen minllte ' han.) ]leell restored by al'tIficw1

mean:::>. If, therefore, the hody i' recovered within a.. rea.'onable tilllu all 'e nce of :-;igns of life i · not to deter immediate nttelllpt:-; to restore anilllation.

Drowning peron attelllpt to ",hilt . nhmerged, tmel, in 'yater I::. mha,lcel ll1to their air passn,ge.' and they h C(;(1l11e a phyxia,tc cl in 'c nsil)le. The fir. t thing' to do when the body l rec()\'l'l"cl IS U) g ,t 1'ld of the \rater aml froth oJ> ·t,rncting the a.ir alld thcll to a1'tifiuiall,Y rcstlll' c bre 'L thing. 'fhi i bet aCC()lllpli 'hcel hy loo:'cnillL:" clothing anrl opl'lling the month, and dCtLl'lllg ]Joth It and the bad>: of thl' throat. The patient 'llOUlcl theu ]J e tlll'lll'cl b 'e rl()\\·llw,ml.', wilh a pael ]Je1uw the chet and with the f()l'ehcHll up Il the ri!'!'ht forearlll. 'Yhilst ill thi .. poiLioll Hppl," Pl'l'''''Sl1l'8 hy the lwnrb til the p :ltient's hu.:k O\'CI' the IU"L'r ribs, awl the up fur thrce TIU'Il til> pat1Ullt ()n the 'i( la, that ]l )Sitioll abu ['or three ,'L'COlH/s. thcsl' ll)(IY VlIlClll-i alt ' ['nately, :1,' l()ll!.!,' a: froth llnrl ",ntvl' 1 ,I1C frolll the m()uth. Tlw:-. e oP(') 1',1.tiolls in the111SL'ln's Lewl tu promotc respimti()ll, lalt it i::; llnn}, wh ell th, ail' pasaL:"c<; arc cle:lr of froth

144

and water, to adopt Sylyester's or one of the other methods of artificial re pi ration already de 'crillcd . While performing these operations send somcone to the nearest house to procure blankets and dry clothing, hot-water bottles, etc., and to fetch a doctor.

STRAKGULATION.

Owing to constriction of the windpipe by a cord a Tope, or tightened necktic, ctc., round thc n <.:k, the breathing may be arrc'ted and asphyxia

Treatrnent .-Cut the con tricting Land and commence artificial r espiration.

CUOKING.

When a foreign body, as a coin or pi cc of mcat obstructs the air pa age, suffocati n may en,'ue.

Treatment.-Op en the mouth, forciLly if 11 'ed be; pass the for efinger right to the back of thc throat and attempt to dislod<re the obstructing Lody; if yomiting results from this step 0 much the llcttcr. If nnsuccessful, thump the back hard Let,Yecn the shoulders whilst the h ead is bent forward. ,\'b en the foreign body is r emoved, but breathing i suspend d, commence artificial re piration.

nANGING.

Grasp the low er limbs and rai e the hody to take the tension off the r ope . ut the rope, free the neck, and commence artificial re piration.

145

• BY 'uIOKE OR GASES.

Remove the patient into the fre?h air, 1 clotheH, n,lld flip the lm,re (;h m;t with. a to.wel, wet cold water for 15 "cl'oncls . If thIS falls to restOle breathing,' apply cl1'tificinl 1'c yiration. Befor: entering a 1Jl1ilcling full of 'moke tIC a wet, if pm;sihlc, ronlld the hcad, coyermg th.e nORe and month It j' \\ell to moye Dlo\\'ly, keepmg low, ?l'

eycn crawling, \\ hilHt in a room full of search of a 'utfocatecl l)er,'on. Eyery of l etting ill f1'c;:;11 air by opening doors or wmdows should l)c seized.

BY 'WALLOWIS(T VERY HOT ,VATER. Thi .. fwciclcnt llot infrcquently occnr. to children att mpting to drillk from tbe of a . 1'1'ea[l/Ient. - Apply n, .. ponge or flannel (or othcr) clotb, wrung out of ycry hot ,,"ater, to the front of the ncek, from th chin to the t?P of b:ea and sct the patient hdorc the fire. GIve.lee to suck if it can llc had, or if not, colel water. OlIve or salad oil, a c1e.. cr .. poonfnl at a time, soothe the scaldcd thro<l.t and tend to <l,'e thc pam.

IIAPTE R VI.

POI ON ND POI 0

W HE J a hn,:::; ta k on p oi:::;o n , tho ud clc n 0 11 ct of ymptom', t h eir appea.l'an co soon afte r h a vi ng tak en food o r d rink , or after h aYi n g swall o wed 'ome substan co inach 'e r tently, lllay bo th o fir't intirnation of th e dango r.

U.mURY OF SIM PLE D IRECTWNS FOR TITE T rmAT-

:,\fEN1' OF P OISOX I NG,

Send for a doctor at once , stating what has occurred .

When the patient is not insensible , g ive : _

1. Milk - I t ii::l to I)'iyo copion' clrallo·ht., of mille M ilk, Whell :-;\\ dot:-; or a11(1 tho poi 'on 1ll[t,Y 1)0 thereby cnelo 'eel ill lIlilk 'cl()t, and the whole g'ot riel of hI' an emetic. 'ream alld flollr boa.ton up together n;ay bo <>'in'n as "ell n,' or ill ·toad of the milk.

Eggs .-Bcnt np a coup l e of nny eg·.g·:-; " ' itb milk or W[tter. The raw egg set.' 01' coagl1lale", in tho 'tomach, and a:-; in tho ca.'o of milk lllay inducle Lho p oison in the clot. .

3. Oils .-Giyo se\'eral .'poonfll].' of oli,'c, ,'abel, or l in oed oil ,. ib n' Yoo'L'btl!lL' 0]' animal ()il such as t h at in ",hich 01' ('(lcl Ii \'e1' uil, m ay be giYen. oili::l are not ,·Ilitahle. Tlte

147

o il .'ooth e, t h e s urface a lr eady inju r od by t h o p oison, a nd protects t h o 1.1l1i l1 j m cd part, of t h o stomaoh g ullct. Oi l is n ot to be gii'en w h en ph o p llOr u s I S t h o call e of t h e

4. Tea .-Strnllg' tea (n. h andful thrown i nto t h e k ett le a.nd boilecl) act.. a' a nentrali er of many poi,oll and i ' abul)," ..a.fc .

5. An Emetic .-Giyc an emetic, e./'('ept when it is seen t hat the and mOlltl, are :4rtlned or lmrnerl (11/1 arl'/1s OJ' u/k({/i'c",) . The emetic may 1)0 :-(a) a de .. c r t· ,p(l()llful of mll..,tarcl ill a tlllllb l rrful of lukc·'Hl.nn wate r : (h) a tallle!-;p()Ollrlll of i)alt in a tumb l erflll of luke-witrm "ate!': (r) for a YOUllg chilcl, a toa poonful of ipccacuanha willc repeatec1 twice at interya1.' of 1:- lIIilllltf'S, 1llay \Io!.d, ell in 'tead: rl) the finger or a fcather to the hack of the thl'oa and moyed about mHYCl'Ye to ullloacl Oll.' st()lll<1eh . Tho emetic 1I1'l \' he n·iYl'1l or after 011e Or morc of the nhovo 1'01l'lCelic 1" hayc hCl'n ac1111illi ' tercel.

G. If :1n a cid is kllo\\ 11 to hn\'e heen ,wallo'wed, giYO an alknli at 011l'l' : awl , l1Oll1<1 an alkali hai'o been the poi . 011, gi'L' all Huiel.

7. Treat for Shock "hen it occur:.

In all cases , any vomited matter ant! food , or ot h er sub s tance suspected of being the poison , should be preserved ,

BROAD FACTS , VOH,THY OF REMEMBRANCE.

When a person has swallowed a poison and threatens to go to sleep , keep him awake.

When th e re are no stains about the mouth g ive an emetic , also milk , e gg s , oils (e xcept in phosphorus po i sonin g), and end up with stron g tea .

When there are st a in s a bout the mouth g ive milk , e gg s a nd oils , but no e m e t i c .

POI OS ARllANGED ACCORDIXG TO THEIR ACTION.

KARCOTrC

Opium, or one of the ub tance deriyed from it, SllCh as or ome one of its preparations, :-;\1ch as Laudn,lllllll, or Paregoric, or some of the popular r emedies, sneh a.' Chlorodyne, syrup of poppie.. and yarion soothing yrnp and cordials all pos.. c 's the }JOi:-;011011S narcotic properties· as ociated with the name of opium.

I YIJl7JtIJ'Jls.-Tendency to go to sleep, which cont inues to illcrease until leep becomes deep and breathing -tertorous . Finally, it may be impo 'iLle to rouse tile patiellt, and death is immment. The pupi ls are H 9

contracted to the utmo.. t extent (pin -point pllpib) ; t hey do not re 'pond to light . T he faee is pall:', the skin clammy, allel a smell like that of poppyheads may be detected in the breath.

T?·eatm ent. - Givc an emetic and k eep the patient awake . T e\'er giye an emetic when the patient is im:ensible. Keep the patient a "wake by walking him about , slapping his face and neck or chest with a wet towe l, and by giving strong black coffee to drink 18pping the ole ' of the fe t with ::t slipper may be tried when other means of ron illa fail. Employ artificial re piration if the breaLhiug has cea ed .

ORRO IVES

Acids and Alkalies are the chief examples of this clus of poison .

Acids .-The acids most commonly taken aq poison' arc Oxalic (tbe salts of lemon alt of sorrel)' Carbolic; ul phuric (oil of "itrol); ?\itric (aqua fortis)' Hydrochloric or :JIuriatic of sal t).

ympfoms.-Burning pains in the month, throat. and stomach; acid t a -te; taining of ti le lips (ll1d mouth of a white, yellow, or dark-brown colour: retchino' and Yomitilw; ,'hock' exhal1::;ti( 11 and collapse, or suffocation . "When the poi on l' mrbolw acid the smell of tho breath helps to dir:;clo e the fact.

150

Tl'eatment.-First wash the mouth out fr ely with lime water or other alkaline mixture, such as chalk, whiting, magnesia, or wall plaster, in wa.ter, milk, or oli \ '0 oil, and afterwards let the patient sip some of it. D'll1ulcent drinks snch as barley ,Yater, milk, etc., lllHy be given suI) 'equentl)' and ueaten up with \\ater (lr milk. Treat shouk.

A lkalies.-Cau tic Potash, Cau tic Quit'1c Lime, and strong Ammonia are the principal examplc;.; of alkaline corrosives. 'l'hey cau 'e ylllptOl11S "0semblino' tho e 'et up by a<.;id', and it i ' only by seeing the bottle la.bel that ullkilleel pen:iOllH Can be S11re of distinguishing oetween <.tcid [lnll alkalme poisons.

Treatment,-Wa h the mouth out with an aciel mixtnre, [l lemon juice or vinegar, diluted \\ ith nn equal quantity of water. AfterwHrch; g'i\'L' lllilk, olive, salad, linsced, or cod 1i"er oil, or eggs beaten up in water or milk. Treat hock.

Do not give an emetic when the lips and mouth are seen to be stained by a corrosive fluid, whether acid or alkaline, as vomiting is likely to further injure the corroded surfaces of the stomach, etc.

IRRITANTS (METALLIC PorSON ).

The chief substances contained in this group are :

- Arsenic (Fowler 's solution); Mercury (cor1'08tYe sub151

limate)' Antimony (butter of antimony, eme.tic); Lead (sugar of lead); Copper (:erdi gn ); SlIver (lunar caustic): Phm;phorus (rat pOl."on, matches), 'ymptoms hurning pain in throat at the pit of the stomach; a metallIC taste 111 the mouth; retching and yomiting and weat dread and alarm. The appearance of the VOlllIt, such as the culour in poi oning hy copper, and the. fa?t that pho 'phorn8 in the dark, lllay a' I ·t 111 determining the poi 'on taken. ,. . .

'l'r c(l/lIl cJI/,-A';-)';-)ist the YOllutm.g l)y gll'lOg an elllctic. After or hefore it ha ' auteel giye a couple of egg:-; beaten up in water or milk, or if they nre l1?t at Jmml giye plain milk, .. trollg ten, and, cxcept Ill , the CH,'e of olive or alacl oi.I. .. .

E"pcl'inlly after PUi."Ollill 't by llletalhc Irntant . It i' llc<.;cssary to eOllllteract ])y prompt treatment the depre ,ing:illtiuenuet-; of shod\:.

Other ' deadly poisons are trychnine, Pru" ic ' 'yunicle of PoUI. ' ium, Belladollna (deadly llightshade plant ), Digitalis (fox-glovc ), JIemlock and 'eyeral yarieties of plant:, as fungI (often mi taken for mushrooms), lalml'llum eeds, monk hood etc.

'umptoms. - Each of the e poi on ha ' it own symptom. COl1Yul 'ion ' and everal ner,ou' yml?toms appear early in mo t, and are the rno t pronllnent eyiLiencc of the poison haying been taken.

T7·eatment.-Administer an emetic before convulsions or insensibility come on. a.nd when cessation of breathing threa,tell apply artificial re ·piraLion.

KRAT. TOTE.

.Many poi ons ha.ve a double action, and technically lTIlght be grouped under more than 011e of the headings given. The rule in dealing 'with a poison of this c0mpiex nature to note the train of symptoms, and treat the patIent, as the symptoms ari 'e , accordmg to the general directions given on l)ao'es 146 to 1 48 . b

I NJURIE' OF PECIAL

'rHE EYE .

The eyelids moye upon the eyeball, moistening and clean 'ing the urfa,ce; and when closed the eyelidl:; preyent foreign hodies injuring the eyeball. A mucou,' membrane COYC1'1-3 the inside of the eyelid, anf1 the of the globe of the eye, and it is on memlmme that fOl'ejo'n collect.

BODY r T TIlE EYE.

Tr eatmprlt.-Prevent the pR.tient rubbing the eye, tying a child" ha.nds down if necessary. Pull dO\\'1l the lower cyelid, when if the foreign body is 'een, it em) he readily remover1 with a, camel' ha.ir or the corner" of a handkerchief twirled up anc1 wetted.

",Yhen the foreign bodyi . beneath the upper eyelid :-(l) rasp the upper eyelid between the fillaer a.n(l thumb and lift it forward from off the eyeball; thcn pU1::lh up the lower eyelid beneath the upper, and let go. The hair of the lower lid brush 1::l the inner surface of the upper lid and lllay di1::llodgc the body.

hOllld a ingle mani pulntiol1 not be su('ce 'sful, repeHt it two or three time::; if neCeH1::lary. J f the foreign body i ' not eli 'lodged, call the 2cnicc. of 11 doctor tl.1::l soon as po::;sible. (2) When, huwever, ;;kdled lt eljJ

cannot be had, as on board ship, or elsewhere, proceed as follow to examine the inside of the upper eyelid :_ Seat the patient so as to face the light j stand behind the patient, steadying the head again t the che t j place a tooth-pick,' woodell match, knitting needle, 01' any narrow, firm rod, on the upper lid of the injured eye half an inch above the edge, pre ing it backwards as far as po ible, Now eize the upper-lid eyela hes between the finger and thumb, and pull them npwards oYer the rod. The eyelid will be eYCl'ted, and the foreign body, if it is there, can be readily . cell and removed. (3) 'When a piece of teel i · emuedded in, the eyeball, drop a little olive or castor oil on the eyeun,1 I <Lfter pulling down the lower eyelid, clo e the lid ' , apply a oft pad of COttOIl \\'001 on the 1iel, and secure by a bandage tied uffieiently firmly to keep the eyeball 'teady, and take the patient to a doctor.

FUREIGX BODY IX THE EA.R P A . 'AGE.

'When a doctor can be had, evcn within twenty-fonr l10llr , never attempt to treat a patient \\ ith a hody in the ear, A pea in the ear i ' a . erious and any attempts at removal may lend to i';lt"L1 conseq llence. If the patient, a child e 'pcei,llly, (;rt.1l110t be induced to keep the fingers from tbe car tie Lhe hands clo\vn, or cover np the car hy tying a handkerchief round the head and over the ear::;. If an insect is in the ear-pa ' 'age, fill the ear witll oIi,' e

oil WI1C11 the il1,'ect, will noat, and may be rel1loycd. , T eve]' syringe or pro1Je the car.

FOf1El(;x BODY 'lITE T m':lE.

Induce the paticnt to 1>10'" the 110se "iolen:1,)';

n, pineh of or Iwpper to lll1F1.ffectecl

)0\0 to indu e .11 'czinp:, up water 01 " t tl1e 110 tril WIth water m[ly effect

l-iYlTll 0'111 0' ou . . v

There j' no imlll?(hate danger from a body, ':lay a shirt 1mttol1, 111 the no,'c,

TIlE ('flEWP (Tmlf1Ax)

The thorax in front Ly the ,1)re<1. t -bone mIll the rib cal'tilnge:-\: oehl11(1 hy the YCl'tcl)l';tl 'colllu \1) (qw 12 clor;-;al vCl'tel)n'C!; and (\11 either ' iel ' hy the ,\ bo, c, th thomx]. ' 1)onn<1e:1

hI' the .tructnrcH ,tt the root of the neck: nn(1 l)elo\\, the c1iaphr;1g'lll (lllidrifl), th e l1l0ynLl e 11l1l. cular which scpnratcK t h(' ehc:t a11(1 nhlomen.

THE ORGA.,'S OF THL ('IIEST (TrroRAX).

The bcnrt ane1 ]llng:-; po;-;itioll and . tl'Ud:ll'e of ,the Heart, I,' c1esenhecl WI 1 the on,::nn,-; of the Cll'elllatJOIl (sce page ,69).

\\ ()1.111cl of the heart nrc u . nally III tnntaneously fatill.

lId

The Lungs the chc.'t-front. )ac{, an side.' , The\' nrc dl';-;cril)ccl uncleI' the Re::;pil'atory y. tom (ee Ilnge 13.)).

15j OF THE LUNG.

, Vhen a rib is broken, and the ends driven inwards, th e p l eura and lung arc [l,pt to he torn. These org[l,ns mayal 0 be inj ureu hy a stab with a knife, tiletto, or b[l,yonet penetrating between the rib::;. A rifle lmllet may traverse ihe che 't, wounding the lUlw in its pa age.

,,-'z'!/nsand ympto1ns . -Difficulty ofbre[l,thing, ymptom of collap.. e, failltnm3s, .. pitting or blood (red and frothy), usually in(liccl,te injury to the Inng. Air lll[l,y escape bcne;),th the ::;kin or into the cn,yity of the che::;t. Intel'll"] lucmorrhage lllay result the blood acculllulatillO" in tho cl\,vit\T of the chest, cmlsing pallor, of hlurr el vi::;ion, feeLle pul 'e, siO'hing, yn wllillg, delirium, and faintnes , going on to unconsciou ' ness.

'1', eatl/l ent .-L<l,y the patient down \vith the head low, giye ice to suck, apply icc oyer the injured part, keejJ the room cool by free Yentilation, turn the patient towards the inj ured siele . D? tie ,l, bandage round the chest when the l ung IS lllJ1.lrecl by a broken rib, as there is danger of the rough ends of the fracture causing further damage to the lung . Should the injury be accompanied by a surface wOllnd, a p p ly clean dressings, &c .

T HE ABDOMEN

Th e abdomen is boundeu above by the diaphrag m

( midriff), below by the hOlle,' of the pelvis, behind by the vertebral column (Lhe lumbar vertehnc), and in front ,wc1 at the side::; by the muscular walls of the a,Ldomell.

Wounds of the front wall of the abdomen may he either verticn.! or tmnsverse. , Vheil the cavity of the alJdomen is opened, the inte -tines or otber o rgalls lll[l,Y protrude through the wound.

Treed m ent - ( 1) \ Vben the wound of the front wall of the ahdomen i Yertical, lay the patient down fiat wilh the lower extremities stJaight j coyer the wound oyer by a pad of dry lint, or linen, and place a bandage ruunel the Lody fairly tight . p) \\ ben the wound i8 tran ' verse, bend the knees so as to l' lax the ti of the wall of the abdomen, and rai::,e the shoulder.. to allow of the edge ' of the wound coming together j app ly a pad and bandage. (3) \ Yhen the intestines or other org 1S protrude through the wonnd in the abdominal wall, bend the kn e:::>, rai e the shoulders, and apply lint, a towel, or n. clem1 .'ponge \\T<l.pped up in soft linen, wrung ont of warm water, and keep the part warm until the dodor arrive.

Every wound that injures the tomach, liver, spleen, inLe tine " , or pancreas, mll::;t traverse the abdomen. Blooel or the contents of the tomach or inte tine \\'ill therefore e cape into the abdominal cavity, cau 'ing sYlllptom::; of internal h<Clllorrhage.

· 158

TilE ORGANS OF THE AnUOiIlEx.

The Stomach li es it11Jl1 orlinie ly bcneath the <C pit or the stomach" just Lelol\' the ,"... LARCE. n'INTESTINE

FIG 57.

Injuri es of the tomach are attended hy extreme collap e, and sometimes by retching, aud YOllliting, of dark blood lik e coffee grouuds.

150

T1'(,(ltl7lent Lay the patient clown on hi , hack, apply an icc-bag over the pit of' tho 'othillg s h ou ld b 1 giyen hy t he JIl(mth.

The Liver lie.' ill tlte Ilppcr part of tl1c abdomen, \\'horo it is mo:.,;tly CO\ l'I'ed hy tbc right ]u\\,or ribs.

Tnjlll'io' of the 1iYcr may be cansed hy <l blow O\'C1' the organ, by fracturcd l'il)::; penctratillg it, or hy tll(l ·tal) ()f a :-;hal'p \\capon, or hy ;t lillllet. 'I'll great dangcr of a \\'0111Hl ()f the liYcr i .. hCCIII{)rrhago, tiJ(. 1)100<1 c,'capillg' illto the cn,\'iLy of tJle nhdollll'll. TI. ' injury i attclHlccl l)y pain rllld ill the l'rg:(Jll of the Ii \ el', and tlte sign,' ancl . YliIptom:-; of intertlal Il(clllorrhage.

J'J'wtmellt. Lay the patil'nt c10\\ll, ice io suck, apply icc oycr th(, of the liver, tll1'll the patieltt to\\;trd , the ..,idt.J.

The Sple en lil'. hl'lll'Hth the rill::; at the npper part or the lcl'L . of the :t1H10lnen.

The t;lllSC,'j of inj lit',\' anil the dangers are illlilar to those of thc li\'cl', :1I)(1 L1IC in'aimcnt i.' . ill1ibJ', ollly il1<1.1. tho Pilticllt he tll1'l1ed to\\arcb the left tlljmil', of the Splt'Oll arc ll'il1,tlly pecclily fatal. Injuries of the Intestines can. 0 sYliJptol11s of (;ollap:-;c, and intl'l'llal mily OCt:llI" or the cUlltcnt Jllay c:-;('ape il1to the ta\ it)' of the abdomen.

Treatmt:lIt,-Kel'p the patient d(lwll and as quiet il'i pn,' . lllle. .\ ppl.\' H pad ()f Halll1c] or cotton ,, ' o()l to the nLdollll'lJ kept in platc by a to\\d

160 applied fairly ti ghtly the and pinned 1il three or foUl' phwe. Grve nothl11g by the mouth.

The Kidneys lie at the back in the region. of the loin. They may be injured when the low e::;t nb , (the IUh and 12th) are fractured by a cru h, blow , 01' by a bullet or some sharp weapon. Blood. would e cape with the nrine, and there would be pam a,nc1 perhaps ' wel1ino' over the injured kidney.

Th; Bladder lies in the p elvi, and may be wounded by a fracture of some of ?one . The signs and symptoms would be hty ,to pass water, or if a little i::; pastled it 1::; tlllged \nth blood.

.

l'?· eatment.- When either the kidney or llhc1d er 18 \vounded, keep the patient quiet until doctor arrives, and meantime apply hot IomentatlOn oyer the painful or illj ured part. .

Rupture (hernia) cOl1si t of a protl'HSlOn of an internal organ, usually the bowel, through the wall. of the abdomen. It most frequently OCl:ur at the groin. Should a sudden swelling, aCl:olllpttniec1 ?y pain and sickness, take ph-we, end f.or a, doctor 111stantly, and meanwhile put the patIent <:11 easy position, and place ice or cold "wat er on the affected part.

161 CHAPTER VIII. BANlJAUI G.

Esmarch 's Triangular Bandage has been de 'c l'ibed in Chaptvr 1. It illity be applied to any part of the body.

For the scalp ( Fig 5 :"1) ._ Fold a, hem about inch s deep alollg' the lower hon1 er, place till' 011 the b ead so tll;Lt tlll! helll lie' 011 the fo],ehead ,lllcl the poiut hiln gs dOW11 at the lJa<.:k; tltClJ <.:arry tIle tW(} IHI. · rOlllld the head a])()\'c tIle ca l' ,' , e1'O ,'::; them at the l)aek, and brin g them forward and tie on thc f()rehcac1; then draw the pnillli tluwl1wnnl ' , Hnd till'll it up « aud pin it 011 to l h e tup of the h ead.

FIG . 5 .

J11 apl,lyillg' thi' bandage, ca re O111 ·t be takcn to pllt the h em dose do\\'n to the cycb row , to the Clltts ((ilolle, not Ollt}', the car, and to tic them do\\ n to til eyebrow, and not hi gh up on the forehead.

For the forehead, side of head, eye, cheek, and for any part of the body which is round (a the arm or tbig}) etc.) the narro\\' ])andage lUll ·t h(' it .. ccntre beillg placcd U11 the wound, and G

the ends bein o' carried round the limn and tied over the wound.

For the shoulder (Fig. 59) . - Pla?e the of a bandage on the injured , hould er, wIth the ru:ming up the side of the neck.i turn up a hem,

FIG. 59.

FIG. 60.

carry the ends round the middle of the arm and tie

; take a c<.:ond bandage, fold it into a broad band,tge place one end oyer point of the fir t bandage, sliner the ann b:'T carrYll1g the end of the hand age oyer the onnc1 honlder and tymg at the sid e of the n eck; bring the point of the fir ' t bandage

und er that part of the sling restillg on the injured shoulder, draw it tight, tarn it do\nl, and pin it.

For the hip (Fig. GO).-Tio a narrow bandage round the body allOYo the Jl(UllH.: h-bollC', tying the knot on the 'aUle Hide afi tbe illjnrj'; take another bandage, turn np a. hOlll acc()l'(lillg to the si7.e of the patient, pla<.:c itH centre on the wound, carry the ends

FIG, 61. FIG. 6:2.

round the thigh, aud tie them' then carry the point up ullder the wai::;Luand, turn it down oyer the knot, ancI pin it.

For the hand (Fier. 61).- pren.d out a bandage, place the ",ri ,t on the border ''lith the finger: towards the POillt : then bring the point oyer the ",ri.t, pass the t\\"O emb oYer the wriet, crOB ', rwd tie them.

164

For the foot (Fig. 011t a bnwbge, place the foot on it· with tho. tOG to\Y<\,:'c1s tho point, nn.,,'" up the POUlt oyer. the 111 te]!, hrll1g the two encl.' forward, CI'O::;', and tie them either on the sole (if to keep a 'plint on) or rouud the ankle.

FIG. 1)3. FIg. 64.

For the chest (Fig. 63 and G1). Place the middle of the bandage on the injured side, with the point over the shoulder' carry the two end ' ronnel the \yaist and tie them; then draw the point oyor the shoulder and tie to one of the end::;.

165

F?r t?e back. . Jmmlage is applied as the jOI'l'!.!,·Olllg, lJllt bcgll111mg JJ,)' placillg tile balldao'e Oil the lntek. b

For the knee. 'preH(l ouL a balldage, fold a llarrow hom 011 the lower border" lay the P?illt on the tlligl; amI the 1ll1cldlc of the ]0\\ or l)order jll. ' t below the kneecap, C'm,. the ends first l)ehillcl tlte klll'O, then oyer the thigll, ngain under the knee, and tie in frOllt h ·low th? knee-cap. Brillg the P,?ll1t (A) dow'n to (n) (.:;oe I'lg. 6;») and fasten with a safety pin. I f the l)alldage is not lar!.!,'e elloncfh to be IJl'ought the 'ccond time helow the knee, tie it on the thigh .

Fr G. 65.

For the elbow.- This it) imibr to that for the knee, the point and mid(l1e of the 10\\'er border placed on the back of the and forearm re ·pectively.

166

167

CHAPTER I X.

CARRYI NG PATIENT

In accidents whore the pationt has born rendered un abl e to wal k alone, he may be carried by tho bystanders making either of the following seats:-

(1) The four-handed seat is made by two

FIG. 66.

pel'clOnS grasping their 1eft wrif:lt wi th til e i l' ri g ht hands, then grasping each other' right \Hi ,t wi lh their left hand (as Fig. 66) , After the hand are cIa ped together, the lJ ca rcr ' down behind the patient, who. it.' on the !taud " and at the same time place one arm rounrl the neck v f each bearer .

FIG. 67.

168

T hi seat is used where the patient is sufficiently can cious to give am a i tance to the bearers and i s a,ble to u e his arms, but is unab l e to wallL T o

FIG. 69.

l mver the patient the b0arers ' loop down or kneel on one knee, gently place the patient on a chair or bed &c., and u nclasp and withdr aw their ha,nds.

169

The two-h a nded seat is ma,de hy two bearers cIa ping their hands a,s in Fig. 67, and placing their free ha,nd on each oLher's sholllrler. In case of the patient beinIY a short portion the bearers place thei.r haDcl on ach other's hip (as shown III the flo'llr ,), ill .·te,tcl of on the sholllcler . bIn ' Lea(l of the grip shown in Fig. G7, either of those 'ho\\'n in Figs. G and G9 lllHy 1)0 lL'ec.l. If that hO\\,11 in Fi:.;. (if) he adopte(l, it i, well to wear gloves or to hold a h,tlldkereilief in the ltalldl'l, rrhil'l . eat i.., u.'e(l \\'hen the pa,ticnt is una,lJle to give allY lLS.'i, t'lll(Je wiLh his a.nns, and may be used to lift a pIes. Imticllt: -

A 1Jear'1' Oll eat.:h l'licle of the patient stoops clown, pn '. 'e:-; Olle anll Illlder his thit!,'h.', near the knee,', a,nd ela the hancI of tbe other hearer. The hearers then pa,'stlwirHl'IllSl'Ollllcl the \lack of the patient :tllclgra p eac.:h oLher' , .. houlder (or hip). To 10\\ or tho patient the b arcr. shOlllcltoop dO\\"l1 or 101 ,01 011 one knee. \\Then the lower part of the pntiL'llL'. hor1,Y is npon the be'd, or plac.:' \\'here i i .. d "ire(1 to plate him the bearers .. houl(l unda 'P Lhe llawb; ",hidl are under his l>nttol'k ' , tn,king care to support the npper l'n.rt of the bocly, \\ hid) call then l)c gontly l(m crecl.

T he three-handed seat i . a llloclific'ati()tl of the above, al1rl i · 'olllotime ' u . cd for a 'hort or chi1cl.

It i · made a' follows :-One bearer gra.'p hi ' own

iO. 171

l eft forearm; the other heaxer grasps the right forearm of the fir.·t l)earer with ll is left hanel, H,nd the first bearer grasps the left £o1'C(1,1'1n of thc .'cconc1 hearer with hi ' left hand; the sccond hearer phccti hi . right llancl on the left tlhol1lcler of the hr.t bcn.rer. Th e fore· arm tihonld in a.ll ca,.'es be gra..-pecl , lightly ",l)o\'e the wri ·t (Fig. 70).

To lo\\'cr the pn,ticnt the hearers .. h()uld r-;tO()P down or kneel 011 011e knce, gcntly place the paticnt on a chair 1JCd, &c., ,ulll unclasp and ",ithdrn,\\' their hanel..

One 1,carer lllay carry n, patient by the Fireman ' s lift a ' follow ' :-

'To Lift the Pali ent . - Turn the pati ent fa ce (10W11w[l.l'd::; with 11iH lcp:s extended and arlll ' clos e to 11is 'ideH; place your"clf at hi. head, stoop dU\\,ll, sligbtly rai 'e his head and f:'houlc1ers, and tal,c huld of him cl():-;e uncleI' hi: armpit.', locking your hand .. on his bade H.ai c his body a:-i high a it cun 1)0 lifted with your hands <tu(l anus in thi ' po ition; then re ting hi .. 110ciy <t. fill' a s possihlc on Tonr left klle e,hift your a,1'111.' and take him round hi ' ",ai. t, lock Tour hn.nch <lncllit't him to all allllo 't uprigllt po. ition with hi . he<.'\,d re 'Ling on : ' our left 'houlcler, yrJlU' left thigh npporting a lUtwh of hi ' weight a , po,','ible. Holding the patient in thi po ition with your left ann, grn:;p hi:; left \\'ri ·t ",ith your hand, throw hi .. left ,Lr111 oyer your head; and at the ame time drop yourself into a stooping po 'ition .: lot go of tho

FIG.

172

patient with your lefL arm which then place between his thighs . '11he body will 11 0\\' fall acro s

FIG. 71.

.shoulders, and you should now rise to an upright posltlOn, and bala'l1 ce it carefully. Tran fer the

173

left wriHt Lo WlIlr ] ft hanel, nnel HO leave YOllr right hn,ml fr ee for Hteac1ying YOllrHclf when ("anyi ng the do\\"nfo)1cLirH, or dowll a hclc.ler Fi g. 71).

1'rl [ m{"a fltp P rtiient.-Tmn"fer the p;ttient's left \\ ri" t to your rigbt hand, take your left arm from

FTG . 72,

l)etween hi ' tlliglJ,' and phec it round them, bringing them to the rill;ht-hancl. 'ide of ,our bod v ink down llpon yuur rigllL 100e" Ie'" the l;u,ticnt " leg l'C, 't on the grollnd while v'ou l:lupport hi.' hody on YOllr left thigh, plnec yum left arm runnel hiH right 'houlde r let go uf hil:l left 'Wl it, ,md putting your right arm under-

174

neath hi left arm and round his back, pbce him gently on the ground (Fig.

N.I3.-Thm:;c bea,rers "'ho prefer to ca,lTY the weight of the patient on the right should rea.d "left)) for 'right)) a,nd 'Vice ve?'sa throughout the aboye in:::;trnction ' .

The plan of can'yint! the patient by the a?'ms and letlS with tho. fac p dou.Jnu1al'ds, cOJnlJlonly called the "f),ogs' march," mu't never oe as death may ensu e .lrom th1's t1'eatrnent.

'Wherc a propcr tretchel' Call110t be ohtained, a, temporary OlH) may be made in of the follo,\'ing ways :-

(1) The sleeycs of a coa,t ma,y Le tUl'Dcd in.ide; two tout poles are theu pa 'sed through them, :mcl the coat buttoned. '1' his makes a gooel ,' ea.t. (Fig. 7 :3).

The patient it on it, and rest · against the hack of tho first bearer,

If a longer tretcher i ' required, t,yO coat ll1U l be trea.ted in the ""lmo way. (Fig. 74. )

(2.) A 'ack lllily he taken; a hole i' made in en-eh corner of the l)ottom, and t,\,O pole' pas:-;ed through tIle ack a,nd out of the hoI s. (Fig. 7f).)

(3 . ) A large picc;e of carpet, 'acking, tarpaulin, or a blanket may he "pl'cad out, and t\\·o stout poles rolled up in the 'ide ' .

Two bearer thcu on ca,ch ide. They gra.' p the middle of the pole with one hand, and near the

175

end with the other. To carry the patient they must walk sideways .

(4.) A hurdle, broad piece of wood, or shutter may

FIG. 75.

be employed a a s retcher: but if either of them is u -ed, 'omo straw, ha,y, or doti:lin cr hould be placed on it, and then a piece of tout or sacking; the

176

sacking i u efnl in taking the patient bff the stretcher when he arrives at the bed-side.

Al ways test a temporary stretcher before pln,cing the pa,tient on it.

Temporary tretcher must be carried, and the patient pIa,ced on them a' laid down in the" treteher Exercisc' "

N e\'"er allow tretchel's to be carried on thc bearers' shoulder '

As a general rule carry patient feet The exceptions aro: (1) \\'h 11 going up hill with a pn,tiont whose lower limbs are not injurod ; p when going down hill with a pn,tient who '0 limbs nrc injurod.

In carrying a patient on a stretcher care ,' [lOnld be taken to ayoid lifting the \ b'otchor over ditches or wall, but where tho 'e cannot be ayoided the stretcher must be carried in the following way' :-

To CRO A DITCH.

In a ditch, the Htrotcher ' honld be lowcred on the grolllld, with it, foot one pace from the cdge of the ditch. Nos. 1 and 2 thon descend. The stretcher, with the pa,tiellt upon it, i · afterwards advanced, No . 1 and 2 in the ditch 'upporting the front end of the trctchel', while its other enrl rests on the edge of the around auoye. While the

"These numbers are explained later in the detailed Stretcher Exercises.

177

stretcher ii:l tllU,' supportcd, TO. 3 dc, 'cclJ(]s. All the No'. no\\' carry the str teller to the opposite side and the foot of the stretcher is made to rest on the 'edge of the ground, while the head of the stretcher is snpported by TO. 3 in the ditch. No.1 climbs ont, No. :3 remaining in thr ditch to a sist No.3. The stretcher is lifted forwn.rd on the ground above, and re t , there while 1 0 ,' . 2 and :3 climb up. os. 1 and 3 then resume the carriage of the streteher.

To CRO'S A ,yALL.

The Rtretcher is lowered with the foot aholl L nne pace from the wall. Tas. 1 and :2 bearers then take hold of the foot of the tI'ctcher and No.3 of the llead; the ,· tretcher i.' raj ' ed till the foot is placed on the wall. No . 1 then climhs oyer the wall and takes }lOld of the foot of thc :trett'hcr, while X os. :2 aud 3 support the hc.tcl; the :tret(;hor 1 then carried forward till the head rest on thr wall, 1\0. 1 ' upporting the foot. No " 2 and 3 thell climb oyer the "\vall and take hOld of tlJe head of the stretcher, which i then slowly lifted off the wall on to the ground, and the bearers take their u ual phLCes.

To LOAD A 'YAGOK.

The ,tt'ctcher i lowered with the foot one pace from the end of tho ",c:won. a . 1 and 2 take hold of the foot of the tretcber, 0, 3 the head. The tI'dcher

17

is then rai ed and carried forward till the front wheel rest on the floor of the wagon. No. 1 then jumps into th e \Va,gon, while No.2 goes to the head of the strctcher and No.3. The str eteh er is then pushed ·low ly into the wagon. If the tailboard canllot be shut, the stretch er must be lash ed firmly to the side of the wagon.

To KLOAD A \V AGON.

Nos. 2 and 3 take hold of the head of the. b'etcher, whil e No . 1 gets into the wagon; the teher i.' th en gradually drawn out till the rest 011 th e edge of the wagon . J o. 1 jump ' out of the wagon and with No.2 takes hold of the foot of the stretcher, No.3 uppoI'tinO' the head. The is then gently drawn away one pace and lowered. Th e bearer' then fall in in their u 'ual place.·.

'Wh en four bea.reI" a.re attending to the patieut.

o . 1 and 2 would lift the foot of the b'etcher, while N' 0 . 3 and 4: lift the hea.d. Thi' a.pplies to cros ing a ditch or w[)11, as well as to loa.ding and unloadin g a wagon.

CHAPTER X.

STnE1'C'UER TRAN SPORT.

The cc Fnrley" Stretchers (Model 1 99) are of three patterns, viz., cc cc T el e,'copie-h andled/' and "Police." In genera l principle they are the component parts lJcing de.ignated the poles,

jointC'r] han;, f00t-,\'heel , hed, pillow saek all(1

The Ordinary (Fig. 76), i. 7 feet 9 i'1che in length, and 1 font ID iIlC1H'''l wide. The bed 6 feet in length, anr1 the hnn(11e.' lO} The foot-wheel rn.ise the .. tretcher .g from the ground. At the head of the stretcher is n CaIwa (the pillow sack) which can be filled with stra"\Y, hay,

:FIG. 70.-0.H.DI NARY tlTRETCliER-CLOSED.

FIG. 77.-TELESCOPIC-HA'IDLED STRE'l'Crr"FR-O'PEN".

1 0 clothing etc. to form a pillo\\'. The jointed tm bars ':1,1"0 pro\'idecl wi til j()illt, 0 al'l'illl o 'c c1 to "'\lil rei agt\,il;st t he po ','i hility of tl;e 1Je,ll'er ,'" catc.: hin g htllcir fin gers ill thcm \\"hcn opening or thc sLl'cLeher. Th e pol, ' arc rounded Oll the top ,lml il,t\'o all il1side beyel to add to the cUlllfort of tllC paLi('nt and pl'c\" el1L cutting the cnnycts. 'J he Telescopic-handlecl paltern (Fig. 77) i' yery ::;imihtr, hut is '0 arl'allt!,'o(l tha t Lhe handl e,' C<1.11 be ,'liel uIHl'l'lleath the pule:-;, tims reclllc.: ing tho length to G f(Jl1t the length of Lhe hl,d \ll'illt!,G feet. Thi ,' alTttllgt)ll1Cllt i' of o'!'eat "aIIH' \\' hell workin g ill connnod "' pacL's, or " 'holl a patil'llL has Lo be taken up or c10\\'1l a llarrow 'tnircnso \\ itll :-.Il:lrt> tLll'llS. The Pol icc stretchl'l' is 'imilar t() LhL' ()l'dil :a lT pattern, but is' morc ,t rong-l)' mad, ;(1)(1 addition, traps for eCllring a refractory pntlcllL ,Yh en c]m,;ed the pole:-. uf the ,tl'otcill'r lie c 10,o together the tnnCl':e lnl.n:i l)eing 1H.:nt ill\\<ll'd., the cann-v bed neaLly folded on the top of thc pille.' and held in po 'ition 1»), tllclillf!':-; ,,11ich are laicl alung' the Ca1was, and sccured by a Btl'ap placecl tmll ' Yer, ely at the end of each sling being pa ','c d through til ' large loop of the other, round the poles and heel, a nc1 Lilen buckl ed .

In clo ing a ·trctch er carehould b taken to rai 'e the centre of the ClUIya. when pu hing in the trayerse bar, as it is othel'\\'i'e liable to get ca,nght in the joint of the trayer 'e bal'.

181

To prepare, or open, a st reteher, nnbuckle the trallsverse straps of each 'liu g; relllOn! the .. from Lhe strct ,bel' ; separate the pole.. ; take iJold of each traverse betr and dra.w it forward. rl'helillgs will then 1)0 folded to balf their ]cngtlJ, one 1JCillg laid ncatly oyer tJ.le handles at eaell end of the .. trotcher.

.A. a gcncral l'nle, the .. Ll'etcher \\ ill be prepared l)y Jos . 1 and 3 hearcrs ill 1. 11. and III.; and 1JY o. in 1Y. The.e l )e nrer.' will, ho\y o\,el', if reqllircd, <1 .. .. i!:it the otllcr bearers ill attendillg to the paticllL't-:i.

.Ly(J{p.-Th' \'ariollB nlO\ 'C lllellLs ddailc(l in the following Excrci 'es shuuld be c,llTierl onL . teadil,}', the hearer ' working ill \llli. U11, ])Cillg' carefully n,yoicled, and eyery attention ]leing' paid 10 the hearer \\'ho 'e duty it is to gin the \\orch; of comBlauel.

TTIETCflER EXEIlC

Originally drawll up lly. Oil' .1 ()llll Fude)" and rcyj cd ill L9Q l to accord with the drills adoptecl by the Hoyal .Army ,jl edical orp.;:

EXERCI 'E :Xo. 1.

FOR FOUR BE.\REW.

1. The Instrllct or 'elect:s the bearers and llumhers thrlll -1, :2, 3, 4, at hi· di.'cretiono 'hollld one man be taller and 'tronger than thp otllcr:, he sholtld Le

styled No . 3, as he will have to bear the heavi er part of the burden. *

2. "Fall In. ''

At the words "Fall in," Nos. 1, 2, and 3 take position on the left side of and facing the patient. No. 1

FIG. 78.

places himself at the patient" knees, No. 2 at the hips, o. 3 at th e patient's shoulders. At tIl same time No. 4 pa.' ' es the prepared stretcher on the ground by the right side of the patient about two

• Bearers honld, however, be taught to Lake any of the positions named in the following Exercises, whether that of No.1, 2, 3, 01'40 bearer .

tPacesdn'r",a:y from him, and then takes position opposite o an aClllg o. 2.

3. cc Ready. "

The ,hearer. kneel down on the l eft k 1 1 h Id f th . nee au( ta {e o 0 e patwnt, o. 1 passing his hand s and fore

Fm .79.

arms beneath the patiellt'l:l leo's hands ,'d rt NOb. :2 and:! I' " tl ,', 1 0' c \\1 e apa . th t · S lCm l<1ndl:l and forcarm' beneath e pa lent s hlP ' 'md 1 . 1 h. 1, K' " om, am gra 'p each other's do.:3 pH. 'C ,' hi ' .left hand aero " the patient's hand ltlhndehr the nght. 'boulder, and his right /Jenca t e left shoulder.

184"

4. "Lift. "

On the "word" Lift,>' the benrers raise the patient gentl y nnd re t him on the knees of 1 T Oi::i . 1, 2, and :3 bearer . a oon as he i.' sccurely rcsLecl, -t, engage!'; hancL with No.2, l'l1l1 ' round by the he(\,cl of Lhe stretcher nnd phtces it nncler the p,ttient, dOi::ie Lo the ot ber

FIG . O.

beareic,' feet, being ea.ref III th,tt the pillow i.' imlllccliately under the pH,tient" hend (Fig . 7t3) ; he then kn ,,1::; down nud lock ' his hnnds "with those of o. 3 (Fig 79).

5. " Lower. "

The bearer. pInce the patient on the streteher (Fig. 80), di engage their hands, and thcu ::;tand up.

18·)

6. " Stand to Stretcher. "

o. 1 goes to the foot of the stretcher, with his back to the pntient ; TO. 3 to the head with hi.' face to t llC pn.tiont; Nos. 2 a.nd 4 remain on each side of the .-tretchcr.

7. " R e ad y . "

'. 1 and 3 place the slings (if n.'ed) oyer their 'hOllldero:i, .'toop down, nnd slip the loops of the 'linD's on to the 11<1.n(11os of the stretcher, "which they then gm p.

As soon ns all i right the word is given-

8. " Lift. "

At the word, TO'. 1 and 3 bearer,' rai 'e the stretcher together and ' t:md up.

.-Xo . 2 (lnd 4 ",ill nmv adjust thc sliners on the shoulder::; of Xo". 1 and 3, tlking care that i well helow the le\' cl of the collar and lies accurately in the hollow of Lhe houlder in front . They will also sh?rten the slings, having regard to the s InJunes and the relative heights of the bearel's.

9. cc M a rch. "

Th.e lJCHrCl" moye off:- TO . 1, 2, an rl ± ·toppillg off \\'1 Lh thell' left foot, and o. 3 with his right foot

L 1). The 'honld Le a hort one of twcnty ll1ehes, and taken \nth bent knee ' . There shoLlld be n o spring from the fore part of the foot .

10. "BaIt."

.The being renched, on the ,yord "Halt" b em g gIven, the bear r rema.in teady in positron.

3 4- 2

J:i'ig. 81.

11 "L ower. "

At this the bearers place the :";lretc:her cYently on the ground, ,lip the loops of the ;ff the handl es of tIle tretchel', remove the 'ling,> from the

1 7

;mel then ,'tn,llel np; cnre heing tnken to l et the patient':.,; feel rmch the ground before his h eml.

12. t, Unload Stretcher - Ready. "

Th e l.w<lrens prepare to t;\'ke the patient off the Dt r etc h er , (to' at Onlers J l\.11(l :3.

1:1. Lift. "

The hearer"> mi ,e the patient as not Order 4 (Fig. 79) ; ,-n. i , ill thiH C:;t.e, cli:.,;engages hands from o. 2, l'l'moyes thl' (Fig. 7t!.), and rC,'llmes hi, former positi()n. if llCCCS:-ln,ry, the lJearel':"; will then steadily rise an(l ('<l,rcl'n11," C;llTY the pa,tie nt to the ychic:]c, hcel, or other plac:e to which it has been nrr<1.ngec1 to cOll \'(;)' him.

1 I. " Low er."

The paticnt i::; (;lU'efllll,r lo\\'ered.

EXEHC1SE 1"0. II.

FOR THREE BEARER.

1 . llml) '1' t h ' 1)eare1':"; 1, 2, :3.

All order' \\ ill 1)0 given hy \y ho \yill look after the inj med part of the patient's body or limbs, to 'ce that no lmndnge ' or splint become displaced, and <1bo that 1'\0. 1 l)cn.1'c1', in lifting or carrying the trctche.r doc not touch the patient's feet .

2. " Place the Stretcher."

No. 1 taking the font of the stretcher, and No. 3 the head, place it in a line with Lhe patient'/:) bod.)', the foot of the stretcher llclllg elo e to his head.

3. " Fall In. ''

K o. 1 place ' him elf on the left side of the patieut 3 2

FIG. 82.

in a Jine with hi knees, No.2 pn the left ide just below the patient's shoulders, and No. 3 at the right side, and faces No . 2.

4. " Ready."

All kneel on the left knee. N o. 1 places his hands, well apart, underneath the lower limbs, always taking care, in case of a fracture, to have

1t>9

one hand on cn,eh side of the seat of injury. N os. and :3 nLlI hallcb under the shoulclen; and t h igh ' of Lhe paticut (Fig . '2). .3 2 FIG . 8:).

5. " Lift."

All three bearer risl2 together to th eir feet, keeping the paticnt in a horiwnLal po ·itiOll. (Fig. '3).

G " l'l1arch."

All take short siC:e-paces, carrying the patient oyer

190 the stretcher until his head is immodiaLcly n.uo\'o the pillow.

7. " Halt."

All three bearers romain steady .

8. " Lower. "

The bearers toop down, gently place the patiC'nt on the tl'etcher, disengage their h'l.nds, and then sLnllLt lip.

9. " Fall In. ''

On thi::; order being given, No. 1 plac ::; himself at the foot of tho ·tr tchor \\ ith hi,' oack to the patient, No. :2 placcs him elf at the loft Ride of tile patient, and TO. 3 n.t the 11 ad, with his Lwo LowtLl'Cl::; the patient.

10. " Ready ."

No. 1 and 3 place the sling (if used) oYor their shoulder, toop down, and -lip the loops of tho 'lings on to the handles of the -trotchor, whidl they then gra p.

.A.s oon as all is right the i::; giycn-

11. " Lift. "

At this \Yord, J 0, . 1 and 3 bearer::; 1'a i ·o stretcher steadily together and 'tand 11p.

No.2 will now atljust the Rlings on the of Nos. 1 and 3, taking care that each is ,,'ell 1 ·lm\' the leyel of the collar, and lies accl1l':1tely in the hollo", of the in front: He "'ill also lengthen or shorten the slIngs, havll1g regard to the natient;:;' injuries and the relative heights of Lha Le,ll'Ul:s,

12. "March." On this word being given, Nos. 1 and 2 step off 'wi th the left foot, and No. 3 with the right. The step should be a short one of twenty inche" and t,,'\,ken with oent knees. There should bo no spring from the fore part of the foot.

13. " Halt. "

The de::;tination being roached, on tho word" H alt" the bearers remain steady in position.

14. " Lower."

The oearo1's placo tho stretcher gently on the .'lip tho loops of tho .'lin!!'., off tho handles of the strotcher, remoyo the slings from the 'houlders, a.nd then . tand up' cn.re b8ing taken to let the patient's feet reach tho ground )efore head.

15 . " Unload Stretcher - Ready."

The bearer prepare to take the patient off the stretdler, a.s at Orders 3 and 1 (Fig, 2) .

IG. " Lift.'

Tho hearers rai, 'o tho patient, a at Order 5, and carry him by short, ido .'Lop', clear of the stretcher, to tho ychicle, Lcd, or other place to which it has oecn arranged to COllYC,Y him (Fig. 3).

17. "Lower."

The patient i' carefLllly lowered.

EXERCI E J o. III.

'VHEN ONLY THREE BEARER ARE A YAIIJABLE A'D THE TRE'l'CIIER CANNOT BE PLACED AS IN EXEHCISE II.

1. ']'he III trllctor 1111111be1's the bearers-I,

All order ",ill be oiyen by No.2. "P lace the Stretcher."

XC). 1 taking the foot of the stretcher, and .iTO . 3 the he;ld, pl.we i L 011 the grollnd by the side of the patient, and a clo.'e to him a' practicable.

3. " Fall In. ''

'rhe thrce hcarer.' tn,l;,e the same on one side of the patient, a' laid down in Exerci::,;e No. 1.

4-. " Ready. "

0::,; 1, 2, and 3 kneel do\\' u on th e left knee, placing th em 'ehe ' a, cIo e to the patient n,' they cOllYel1iently can, and then ta.ke hold of him as directed in Exe1'ci .'e Xo. I.

5. " Lift. "

No 1,:2, and ::3 rai e the patient as c1ireeted in Exercise K o. 1., a.nd then 1110Ye in a. kneeling po 'ition up to the ·tr etcher (Fig. 4:).

6, " Lower. "

Th e bearer hend forward, carefully lower the pati ent on to the tretcher, and di engage hand .

193

7. "Stand to Stretcher. "

At this direction all the bearers stand up; TO. 1 goes to the foot, o. 2 remains in position at the side, and o. 3 goes to the head of the stretcher,

8. "Ready."

Nos . 1 <md 3 place the slings (if used) over thei r

3 2 1

FIG. 4.

sh oulders, stoop down, a.nd slip the loops of the slings on to the hundle of the stretcher, which they then grasp.

9. " Lift. "

Nos 1 and 3 bearers raise the stretcher steadily together und , tand up.

)94

.No. 2 will now ad just the slings on the shou lders of Nos. I and 3, taking care thn,t each is well be low the level of the collar, and lies accurately in the hollow of the shoulder in front. He will also lengthen or shorten the slings, having regard to the patient's injuries and the relative heights of the bearers.

10. "March."

Nos. 1 and 2 step off with the left foot, and No. 3 with the right. Fl'he tep should be a ::;hort one of twenty inches, and taken with bent knees. There snould be no spring from the fore part of the foot.

11. "Halt."

The destination being reached, on the word" Halt" \'he bearers remain steady in position.

12. "Lower."

The bearers place the stretcher gently on the o-rollnd, slip the loops of the sling ' off the haucllcs of the stretcher remoye the from the shoulders, and , '-' . , then stand up; care being taken to let the patlCnt s feet reach the ground before bis heacl.

13. "Unload Stretcher -Ready."

No. 1 places himself on the left side of the and in a line with his knees, No.2 on the left .·Hle just below the patient'::; shoulders, and No.3 at the right side, and faces TO. 2. .All kneel on the left knee. No.1 places hi::; hand::;, IYell apart, lllh.lorneath the lower limbs, alway taking care, ill Col '0 of a fra,<..:liure, to have one hand on each side of the of

195

inj ury. No. 2 and 3 grasp each other's hands under the shoulder and thighs of the patient. (10m pare l'-'ig. 2).

14. "Lift."

The bearers rise together to their feet, keeping the p:ttient in (L horizontal i){)"itioll, and curry him l)y 'hort bide step.', clear of the btretchcr, to the ychide, bed, or 0ther place to \\ hi<..:h it has becn arranged to con\'ey him (Fig.

13. " Lower. "

The paticnt is carefully lowered.

E_· No. IY.

FOR U E IX :J[ [l\E.' AND X ARROW 'UTTIXG \\ HERB 'l'wu .Jlr:x OXLY CAN liE EXUAGED.

:\os. 1 amI will <..:1tl'cflll1y pla<.:e the stretcher in &. line with the illjllrecl m:ln':-; l)od,Y, the foot of the ::;trdeher 1)eil1!.,;', if po:->. il)le 1,' do, 0 to hi:-; head.

So. 1 :-;tm<lrlle::! aeros::; tlw p;Ltiellt" legs, placing his ril<ht foot with the toe tnl'llcd uutward ' , a little below paticl;t'l) kuce , , and \\ Jcll the tue uf the left foot tOllching the hed uf X o. :2; he then toops dO'\m,

• It i not alh' isahle to be too llartieular a to the head or font of a stretcher in a mine, it would probably be quite Lo reverse it.

196

passes the left hand under the patient's thighs and the right hand across and under the patient's calves. No. 2 places his feet one on each side of the patient between his body and arms, the toe of each root as near the armpits as po sible. He then stoop' down and pa e bis hands between the sides of the chest

IJ, -==-=-

and the arms underneath the should ers, and locks the fingers (Fig. 85). If the patient's arms be uninjurec. he may put them round the neck of TO . 2, and by this means greatly a i t him in liftmg.

"Yhen both are rea.d v, No. 1 will \'e the order " L ift and move forward." The patient i' then to be slowly lifted just sufficient to allow hi::; Lody to clear

197

the stretcher. Both bearers will s10",1;y a nd gradually move the patient forward, o. 2 by vel y short steps, No.1 by bending hi' body forward as muc!... he .can withont 7/w1Ii?l:1 his feet (Fig. '6) . No.1 now gives the order " H alt" whereupon I 0.2 rema.ins. toady, and ' 0. 1 advances his right foot to his left, and

[.gain adyance his 1 ft foot till the toe touches the heel of No.:1 .J: To. 1 then gives the order " A d van ce" "hen the patient will again 1e moved forward. illovem nts are to be repeated until the patient i over the stretcher, when he is to be gently lm-rered.

The bearer will then act in the ordinary manner a<l. far as. the nature of the locality will permit.

The Ashford L i tter is l11n.de up of either of the FurIey tretchers on pagel:) 179 and 1 0, a hood and apron, or, If preferred, a lIght wet-re Istlllg CaIl'ms coyer. The

Fw.87.

stretcher is kept positi?ll on the under-carriage hy the wInch fit mto lot, in the ,'idcs of the under-carnage, ,and i,t can be r emoyccl at pIca 'ure. under-carnage IS fitted with a cranked axle, wlllch allows t'2e bearers to pa s with th stretcher

199

between the wheels instead of lifting it over them. At both ends are two legs fitted with automatic se1£locking hinges which allow the legs to be turned up as handles when wheeling the litter, and securely lock them either as legs or handles. The hood and apron fit into sockets screwed to the stretcher. In wheeling the litter, care should be taken to keep the patient in a horizontal po ition. 'hould it be necessary, two bearers can easily lift the litter and patient.

The Rea-Edwards Litter, introduced in 1904, i used ill a similar lll<.U111el', and one model of it is fitted with pneumatic tyrc , which add immensely to the comfort of the patient and to the ease of propulsion.

CHAPTE R XI.

{Being the Fifch Lecttwe for Females only , in acc01'dance wit h yllabus 58 .}

BY E . :MACDOWEL COSGRAVE, M. D. , F . R . C. P.I.

PREPARA'£IOK FOR OF ACCIDENT CASES.

·WHEN news of an accident comes, preparations hould at once be made so a to have everything ready hefore the injured persoll is brought in . Of the preparations needful will "Vary according to the nature and extent of the injury, but the following are the chipf things which may have to be done .

CHOICE AND PREPARATIO:N OF RomI.

A room mu t be chosen. In a bad ca.. e thi .. hould be one ea ily reached. a it is difficult to carr;,>, an injured person through natTO''" pa ages and up - 'tail' . nless there is some uch rea 'o n again, 't it, the injured per on's own room i be t .

The way to the room must be cleared, proj cting furniture and loose mats in the hall or in lol)hies should be removed. If the injured per. on i,' carried on a door or shutter, or eyen on a stretcher, n, couple of strong kitchen chair' should be placed ready to support it, wherever the bearers would be likely to r equire rest.

20 1

Usel ess furniture should be removed from the Ledroom . The bed should DC drawn out from the wall so that both sides ca.n ue approached, aud the clothes tn rned hn.ek to ono side to their full length. A hot uottle ShOlllcl Dc got ready . If there is mueh colla Pt)o 'e "cral hot Lottles and hot lJlankeb:; may Le required; coyor the hot ,,,i th ilallue l.

If the inj my is yery HCyerC, if mud-stained clothe ha,yc to he rellloyed, or if cxtenl:llYe dre' 'ing , have to uc applied, it may he llece.. a ry to IHLve another beel, a couch, or ,1, tahle placed near the bed to lay the 01l in the nn;t in:-;tance. This 'hould be so arnwgcd that 'oiling ll1ety do no harm; old sheet', waterproof lll,lLcrial:-;, thin oilcloths, or eyen ne'Ysp.lpcr, mH,\' l)c n:ed a' a protection.

CARRYING.

If pre, eut at the pln.ce where the accident occurred, it will he llece: 'ary to 'ee that the patient is care fully lifted after proper "Fir t Aid" has be ell rel1clcrc( I.

The follow ina rule should be remembered:- elect the proper n lltll her of pcrson to a' ist, and do not let them lift tho patient unLil they thoroughly undor ho\y they are to do it.

For onlinal:.r ca·e', where the injured per 'on ha () he 1iflecl a Ycry short clit-;ht!lCe, tbree help er ' are ::;ufficicllt. Two l \\ ho be as far a po ' ihle of

equal height) are to bear the weight, the third is to support and take charge of the injured part. rrhi is best dOl) by a person who has been through a ,( First Aid" course.

If the injured person is insensible, another helper . hould upport his head.

The lifters, one at c<.'\,ch side, should kneel 011 knee, and pasl::! their hands under the patient' · ba,ck itt the lower part of the shoulder-blades, and uncIer the hips, clasping each his right hand in the other's left. The injured patient should, if practicaole, place his arm round the necks of the bearers.

The third helper should attend to the scat of injury; if tbi ' i::; a fractured limb, he should support it oy placing the palms of his hands under the limh, olle a.boye and one below the scat of the injury, grati ping it firmly hut avoiding unneces ary

The h elpers should remain thus until the order "Lift)) is giYen, and then they should all lift 'lowly and steadily, avoiding jars, attempts to change position of hcl,nds, etc.

If the injured person is to be placed on n or shutter, this should be previously placed with t he bottom end at his head; the bearers should then mo"Ye, one at each side of it, until the patient is OYl'r it. The word "Lower)) should then be giYCll, and the injured person should then be slowly lowered. A pillow or folded-up coat should be ready, and as the

203

::mfferer is lowered, this should be placed under his head.'\<

MEANS OF CARRYING.

Beside' a stretcher, and substitutes such as a gate.; a. ::;hutter, or a door, other means of carrying can be impro\'i:cd. . . .

In slight injurie.·, where the m.Jured unable to 'walk, two bearcrs C,L11 carry hIm by formlllg a fourhanded three-handed, or two-handed seat.

A f;ur -handed seat is formed as de cribed on page 166.

A three-handed seat IS made as described on page 169.

The two-handed seat IS made as described 01.: page 160. . .

A l::iingle helper CiLl} lift by supportmg WIth one <trIll tho two knee', tUHl wiLh tho other the back. The mllst 1)0 pa8sed 'wollunder before commencing lift..

Aillgle helper can give support by 11 _ arm round the waist, grasping the nght anel pbeing the injnred per 'ou's left. a.rm. round hI 0\\ 11 ncd:, holding the left h,llld WIth hIS own left iJaml.

e'l.pital stretcher crm be improyi.sed out of GI. 'tron')" sheet and two broom ha.ndles or other hart o . pulol::!. Each side of the sheet IS wound up on a broom

* Full directions are given in Chapter X.

handle until there is just room for a person to lie between. This requires four bearers, two at each side, to prevent the sheet slipping.

CARRYING ur STAIRS.

In carrying a stretcher up stairs the head hould go first, and an extra h elper should as i t at the lower end, so as to raise it and k eep the stretcher nearly horizontal.

The two, three, or four-hand ed seat may be u ed for carrying up stairs; or a strong chair, the patient being carri ed up backwards. In the latt er cat:>e one helper should walk after the chair and help to support it, and to preyent the injured person slipping out.

LIFTING I TTO BED.

If th e bed is narrow and there i room the stretcher should be placed on the floor "with the head clo e uV the foot of the bed. The injured p 1"on ,' hould then be lifted oyer the foot and placed on the ued. If the bed is too wide to admit of thi', the stretc:her should be placed beside it, and two helper' should stand at the far side of the stretcher . One helper pa es one arm beneath the shoulders and one uencttth the middle of the back, the other helper placing h is under the low er part of the back and under the knee . The injured per on i then lifted, another helper pulls away the stretcher, and after a ingle step forward the bill'den is placed on the bed.

205

PREPARATIO:-I OF BED.

A firm mattre"H, not a feather lJ ed, 8hould be se1ecte(1. J t there iH mllch injury, or if clrcH,'ings ha,ve to 1) e applicd, ct draw-.. h eet ought to 1) e plc\.Ced all 1,11 heel. 1t . hOllld he of tOUl' or more tbielme.'Hes, extend (\ (;l'0!-':-; t 11 e beel an (l rcach from Uw lllidcl1e of the patient'::; Uceel- tu the knces. A picee of w,tterproof 'hcetillg or of thin oil-doth, lIould l)e phtced uncler tile clnl.\\'-sheeL. Lhe (lnt \H-il!eeL hccumcs .uiled, the 'o iled portion llUuld he rolled up and a dcm} part (11'<1.\\,11 uncler the patieut. In frH.('Lnre of the leg or thigh, .. prain Icl ankle and ::-;ome olher e<t:-;cs, <1. "C1'<"vUe" (FiO'. c ') .. hon1cl be improyi.cd. The u:-;c of a (( crnclle" is tonpport the he(l-dothe nnd kecp them from pres 'illg all the limb. Band-hoxc.. (Fig. 19), three-legged .. tooL "(Fig. 90), and :,;imilar artidc::> he u.' ,d. A cork'crew p,v:sec1 through the 1'c(1-d()tl!e ' with it.. poillt gnanlecl hy n. cork, and tioll by lring to the beel 01' a llai1 ill the \n"tH, \\ill reliey thc presure of the Led-dothe.. etfcetll,tlly.

llE)WYIXG 'fIIE LOTHE ' .

In takilJg dothes off an injured per 'on <.\, few rule' ,' hollld hc lJorne in mind.

In 'criou' c:a 'e' it is much uetter to 'R(;rifke the clothe ' than to run any ri ,k of inC:l'ea 'ing the :njury.

In remoying a coat, etc., in a ca'e of frh,durcd arm the unillj ured urm :should ue dnl"\yn out fir 't.

FIG. 90.

In putting on anything the injured arm should b6 put in first.

In burns and scitlds nothing shonld ever be dragged off. A sha1p pair of scissors should be and everything not adhering should be cut away. If anything adhere' it should be left until medical aid ca.n l)e ohtaincd. The clothing adhering may, with advantage, he ,'oaked with oil. To rcmove the trou er from n, ,'eYerely injured limb, the oufside seam be ripped up.

PREPARATIONS FOR SURGEON.

A ,0011 as the injured person has becn attcnded to, preparation 'honld be made for the ;)1lrgeon' visit.

The preparations needful will depend 1lpon the na.ture of the case. The following hints may be of use:-

A fire in the rOom 'win generally be of sen icc, e,en in 'UIllmer. There hOllld be plenty of "ater l)oth hot and cold, also several basin, plenty of clean towel:,:; and 'oa p. There should be something to empty water into; a foot-bath docs well. The hct'in hould 1)0 placed on a table, covered \yith it dean white cloth: a large towel makes a uitalJle doth; the towel " folded np, should be pbcecl 011 the !'>ame table, and the hot and cold water bhonld be within

ea y reach. The foot-bath should be under the table or close at hand.

In the case of a burn, cotton wa(lcling, . :)ft c:oth , old linen, oil flom, bread, and bicarbonate of soda, (baking oda) should be ready, and llln,terini' should be torn up for If fl, chemi .. t'J· 'hop i within reach, carron oil and plenty of cotton wool should be ent for.

In the ca. e of hrcmorrhage, ponge, plenty of water, and at lea t two ha::;i1l8 ::;110U ILl h e r cacl.".

In the ca e of a per.. on rc 'cueel from drowning the sheet · shonld be taken off the hed, pleuty of hlankets should Le heated before the fire, and :several hot bottle should be ready.

If poultice are likely to he required, boiling water, lin eed-meal, mu tard, a. loaf of stnJe bread, n. .. mall ba in, a large poon .'\yeet oil, and to\Y, flannel or ha.ndkerchiefs may be required.

For fomentation, have boiling ,,'ate!', flanllel, a kitchen roller, and two tick:-; or a large towel.

, Yhen snmmoning a. meelical man to an accielent always let him know "what kind of ca e he i.. required to treat, so that he may bring whate-v er is needful. By this means valuable time may be sa,ycd.

IN DE X . Pag e

Abdomen ... 136

Accitlcnt cases, preparat.ion fur ... ... 200

Acill s, by ... Alka,li es, poisonmg by .. ] :)0

Ammonia, poisoning by 150

An·lt.omy... ... ... 19

Ankle, HJlr.linerl 67

Anterior tibial arlery.. 94

Antimony, p oisoning hy( A ort.a ... .., 0,), I

Apople"\.y ... . .. 109

" to c1isLinguiRh fr0111 collap,.;e from drink .. J 11

Apparently tlrownetl, to 1-1:3

A(lua forti!';, poisoning by... ... .. 1-19

Anil, hlee(ling from L', Ilolle of :,.;) " fradure of ... ;12

AnnpiL. hlcetling frol11... DO

.A r senic, II)' ... I.-I)

Arterial hremorrbage .. , 7:3 genC'ral

arrest lJ.f

axillary hrachial

" carotid ... digital... .. . c1ol'Ral, of foot . . facial femoral... iliac plantar ... popliteal radial ... Ruhc1avian tibial ulnar ...

Art'l'llcial reBpiration

Aunde,>

Bctn(lagiJl(1 ... 161 13·tl pre1flration of 205

Belladonna poisuning by 151

Bites (If animal:>... 131 BLtdder ... 160

Blood Parte 69

Bones, general deseription of,.. ,.. , ..

Brachial arterv .. , " • cligi tal pre, ure to Brain compression of " conclls<;ion of Brea'tbone ,. fracture of .. .

Breathing. tertorou' .. .

Broatl bandage .. ..

Broken bones, see Fracture.

Brooch-bone

Bruises Burns

Capillaries ... ..' 69

Capillary h«:11101 rharre 73 , 101

Carotid arteries... .. , 79

Carpus wound of 79

Carrying, means of " patipnts " upstairs

Cartilage... ... ...

0a:u tic (Lunar), poi 011mg by... ... ...

Oerebro- spinal system, ..

Cheek , bleeding from Ohest .. , ... bandage for :26 :?O:3

Ohlorodyne, poisoning hy ... '"

Choking ... ...

Circulation of the blood

Circulation, organs of .. . C1<'''''1cle ... ... .. . " fracture of 148 14-1, 69 n9 24, ..[

Clothes, removal of 128, 20.')

Coccyx...... 21

Collapse fro111 drink 110 , injury 106

Oolhr, 24, " fracture of".

C0111ll1inuterl fracture ... 34, Complicated fradure '" 30

Compress, gratluated 7;'5

Compression of the hrain ... '"

Compound fracture

Concus ion of the br 'l in... , ..

Contused ,,,ounds .. .

Con'\"u1. ions (infanti le) .. .

Copper, poisoning by .. .

Corrosive poi ons

Cradle '"

Ora.nium ' .. " fracture of

Crepitus... ... . .. yan,icle . of potassiuIIl, pOlsonmg by ... ... 108 :i:t 10, 12,') l?O Ifi 1 149 2().) 2:2 44 3;') 151

D eep palmar arch 8.t, Diaphragm ... 137

Pag e

Digital artery, wounel of 84

Digital compression ." 74

Di gitaliR, poisoning hy ... Hll

Direct compression 74

Direct violence... 31

Dislocations 04

Dit ch, to cross v,;iLh strctcher .. 176

Dorsal artery of fooL ... 94

])re,'R, woman's, 011 fire ]:W collapse frOJll 110

Drtmning 143

Ear-channel, fl'olll hlceding

Eal' -passnge. fmeign 2 hody in Hi-l.

Elasti'c halltlagc tuurniquet....., 77

Elhow, ba1ll1age for lU5

Elhow, bleeding from bell,lof

Elh()w joint 30

Electric shock 117

Emetics ... 147 " caution as to giving li)O

Epil 'PS,\' , 112

E:nnarch triangular bandage 3;)

Expirati()Jl l:n

External carotlll arterY 79 Eyl' ' }.'):3

}"'ace 23

Facial artery, to compress ,.. 1

Fainting... lJ4

}'emoral artery... 9:3 " " digi tal compression of 06

Femoral a.rtery, to npply tourniquct w ." 9

Femur 26 " fracturc of .,)8

Fibuh :2

Vibula. fracture of 6:2

Field tourniquet 77

Finger) bleedIng f]'(jlll ..J

Finger bone, fracture uf .1/ Fircman's JifL .. , II]

First aiel, meanillg flf 1!J

Fish book cUlllerlded 127

:Flexion ofliIllh ... 7S

Foot, llandage for 164 blceding hom 0.'1 bones of ... :::?:-; cI'uHheu 64 hleeding from , hones ,If 2.') " fracture of .. ' ;).1, Forehead, hanrlil<,e fol' ... lUI ,. hlecc1illg from '0

Forcign body in Lhe cal' passage 154<

Forcign boely in the eye 133

Foreign bo(ly in the nose 15,>

Four-hantled seat HiG

213

Page

Fracture, apparatus for treatment of ... 35

Fracture, causes of 31 definition of... 31 general rules for treatment 41 of arm 5:l of bones of foot 64 of breastbone 4 of co11a1'- bone 4: of tinger Lono 57 of forearm 54 of knee cap ... 60 of l eg 62 of lower jaw 46 of met'lcarpus 56 of pelvis 57 of ribs 46 of shoulderhlal1e 52 of kull 44 of spine 43 of thigh-bone 5' signs and symptoms of 34 " varieties of ... :32

Frost-bite 127

Fungi, poisoning by 151

Ganglia... '" 103

Graduated compress 75

Green-stick fracture 34

Gunshot wounds 125 212 Hremorrhage Paoe 72 74 92 arrest of . " inl,ernal Ham, bloeding from Hanel, uanda.ge for bleeding from " bones of Hanging .. . Haunch bones ... H eart " contraction of H eat apoplexy ... " stroke H emlock, poisoning Henhane, p oiso ning H ernia 26 144 26 69 71 115 115 by 151 by 151 160 Hip, banl1age for H oward ' ,; mothod of 163 artiticial .. . Hum erus... .. ., fracture of Hysterical fits ... 141 25 52 115 Ilia.c artery 79 Impacted fracture 34 In cised wounds... 124

I ntestines

I nstrument'll Page 159 com pression

Internal carotid artel'Y

Intcrnal hremorrhage

Interv cl'teural cli . cs

Involunlary mu cl es

Irrita,nt poisons ... 74 79 92 21 :n 130

Jaw. l ower, fracture of 4')

J oi nt, wounded... ]:2G

Joints :29 .. , ]60

Kn ee, 'handage for 165

Kn eecap ...... 2 " fracture of 60

Knot,; 37

LalJ<lI'Ik' .; metho(l of artifieial respiration .

Lahul'l1nJl1 seeds, pui.-olling hy ... . ..

L'\l'g' arm-sling . .

Larynx .,. . ..

Lau'(lanum, poisoning hy

:Mercnry, poisoning hy .. . M etacarpus ... .. . " fractl1re of .. . 1J tatarsal bUllcs, fl'act.ure of ...

Met.ato.l"us

M elallic poisons

Middle line of hocly 1lonkshootl, poi-<oning

Indirect compression 74

Indir ect vi olence .. 32 Injuries of pecialorgans 153 stings of 134 Insensibi lity 104 general treatof 104 Inspiration 137

LaN'rated " 'onn(ls ],')1 1:2-1 39, 4n, ;iQ ] US ].')1

Le1'l.<l, poisoning hy

Leg, hleeding from " hone,.; of ... " fracture of...

Lifting 1111,1 carrying intu IJed I igll tiling, cffect" of 9,,) 201 119

::\ ecelle, a hroken .I. Hi2 T eryous sy;:;tem 102

Nose. bleeding from L l foreign 1J0lly in 155 Oil of yitriol, pois oning II\' 149

Opi1.lIl1, poisoning by 14

Page

Pact, to make . . . . . . 75

Palate, b l eeding from. . . 81

Pu.lmar arches . . . .. . 84

" " b leeding from 84

Paregoric, poisoning by 148

Patella ... 2) fracture of 60 26

., fracture of 57

Phalanues 26 of 57

Iha,rynx... . . . . .. 135

Phosphorus, poisoning by 151

Physiology... ... 19

Plant 'lr arteries 94

Plants, illg hy '" .. . . .. 151

Poisoned wounds 126

Poisoning, directions f;; treatment of 146

Poi.ons and 146 elas ification of 148 wi th doll. ble action .. . 152

Popliteal artery ... 93

Po..;krior tibi artery... 94

Po. Lash, caustIC, poisonmg by... ... 150

Prcparation for surgeon 207

l)rus 'ic acid, poisoning

P by ... 151 ubes 26

Pulse .. . ... 71, 103

Punctured wounds ... 124

Rabid animals bites of 13 1

Radial artery , ' " 3 6 bl eding' from ... 7 compressioll of Raclius " fracture .. .

Rcspiration, artificial :::

Respiratory system Ribs " of:::

Room, choice and preparation of Rump-bone

Rupturc ... 'acrum 'calds ... . .. 'calp, bandage for " bleeding from capula... .. . " fracture of I cats I crew

Shin-bonc

Shock ... ... I hock, electric I 'houlder

Shoulder:' imndage for::: " l!lac1e... ...

" fracture of Shoulder juint ...

PCL(Je

,ickroom, eholce awl prepwation of 200

Simplc fracturc... :32

Sk ,Ie Lon ... 2()

'kill, wounds and ill,juries of ] 21 :22 , fracture of 4! lings ... 39,49 & 50

Small flrm-sling 40

Srake-bite. 133 caustic, poi soni ng 1,y ... .. 150

laIc, arterial blec(li Ilg from 9.)

Spleen 1;')9 pinal canal cord ]m

Spine 20 pine. fracture of 43 'pirit of fialt, poisouin cr hy 149 plint, angular... fi4

Splints .... 35 to secure 3 ) prains 67

Sternum... 2-1, . fracture of 4, • tertorous breathing 105 tingfi of insects &e. 13l: tomach ... 15 trains 00 6 '

Strangulation ... 144

Stretcher exercises

lI'atinll 1,\, S\\ 1l1l\\'\el \' 1I1)'t \\<Ltcr ... ]-1,'5 115 :--t pl'dIL'ial palmar arch .!('OIl·S yj 'it, preparatioll fill' 00_ 207 c... tu'.· mctho(l ot . dl'ti ficial l·l'spimtiull. 00 :38 IIIJlathetiL! systcm 103 } IH:Opl.! 114

Tail-bone 21 'rarsm; 28 T emp I!" , bleelTing from.. 3 '1'hi "11-bone 26 0" of':. 58 Thorax 155 Three-han<1efl 'ea t ]69

Tibia, 28 fracture of 62

216 Page

Throat, b l eeding from inside of 81

Tibial arteries .. , 94

Tongue, blccl1ing from... 0

Tonsils, bleeding frolll... '1

Tourniquet 75

Trachea .. .

Two-handed seat ] G9

Ulna 2,) ;i,) " fracture of Ulnar artcry 84,86 hlceding '£1'0111

Ulnar artery, compl'csiOll of ...

U nconsciou nCEs

Yaricose yeins

Venlr'ides ...

Verdigl'i8, poisoning

Vertclmt ...

Verteorx, cervical (10rsal " Imnhal'

YcrLchra1 column

YiLrol tl!ro"ing

Yuiee l10X

Veins 87 100 71 V cnOllS hremorrhage

Yolnutal'Y muscles Page 7:3, !:J9 69 by 15t 20 20 21 21 Z() 1:11 J :{,j :31

'Yagon, to load auel UlllWHl 117

'Y all, Lo cro,,; \"ill! strctcher

'Y inel-pipc \\ \mml of ahclul11en ,yoUllll of hlllg ... 'Younds ._. 1// ]:n .. 1,i7

INTRODUCTION.

This Price List, which is subject to revision from time to time, has been compiled with a view to assist members of the Association and others in the purchase of the necessary equipment for corps and divisions of the Brigade, ambulance stations, classes and first aid and nursing work generally.

A complete and reliable Ambulance Equipment is an ftctufl.l necessity, and experience has proved that employers of labour and others interested in the district readily subscrihe for the purchase of such appliances. Collecting cards, :;tating the purposes for which subscriptions are required, "'i!l be supplied gratuitously on application to the Head Office of ASRociation, where also any information with regard to lts work can be obtained.

, tores of the value of lOs. or upwards will be sent carriage paid to any part of the United Kingdom.

Owing to fluctuations in market prices it is impossible to guarantee that the quotations herein can be adhered to.

Quotations will be furnished for articles relating to Ambulance Nursing and Hygiene, not mentione<l in this list.

Orders and correspondence should be adclresRc(l to the St. John Amhulance Association, St. John's Gate, Clerkenwell, London, E. C.

Remittances should be made payable to the St. J olm Ambulance Association and crossed "London and \Y estminster Bank, Lothbury."

HORSE AMBULANCE CARRIAGES & WAGONS.

Registercd design 418,030.

A number of improved designs for Ambulance Carriages have recently been perfccted, and several specimens can be seen at St. John's Gate, varying from a light to be drawn by two men or by a pony, costing with tyres to wheels £32 lOs., to a large single or parr-horse wagon capable of accommodating three patients in ?' recumbent position and an attendant inside. A fully illustrated price list will be sent on application.

"ASHFORD" UTTERS.

Tll c "Ashford" Litter (1899 model) consists of a twowhcclcu unelcr-carriage fitted with elliptical springs, and either of the" Furley" stretchers, with a cover so arranged on a jointed frame that it can be folded up inside the stretcher, or with a hood and apron (as shown above). The unclercarringc, having a cranked axle, the bearers can pass between the wheels with the stretcher, and thus avoid lifting it over them. \Yhen travelling, the legs of the under·caniage are raiRcd, and thus form the handles by which to propel it. Should it be necessary to pa s over rough ground, two bearers can easily lift the litter and patient. The "Clemetson" stretcher can be used instead of the" Furley " pattern.

PRICES OF THE IMPROVED ASHFORD LITTER. 1899 MODEL.With Iron Tyres to Wheels. With India Rubber TYles to Wheels With out With Without With Oover or With H ood an d Oover or With Hood and Hood and Oover. Apron. H ood and Cover. Apron Apron Apron.

Un (no

• Priccs quoted for Li tel' with Ordinary Stretcher inclnde Wide Webbing Slings bnt no Ohest Strap. Leather, instead of Webbing Slings, 5s 6d. extra; Chest Strap, I s. tid. extra. If supplied wilhout any Slings, 4s. allnwed.

t Prices qnoted for L itter with Telescopic.handled Stretcher include Wide Webbing Slin gs and Ohest Strap. LAather, instead of Webbing Slings, 5s. 6d. extra. If suppli ed without any Sli.J:Jgs, 48. allowed; and if wiLhont Chcst Strap, ls. 6d. allowed.

t Prices quoted for Littt:r with Police Stretcher include Wide Webbing Slings and L eather Straps for securiug a refractory patient. L ea,ther, instead of Webbing Slings , Sa. 6d. extra.

Hood and Apron, complete

Extra Sockets and Studs, per set

Waterproof Sheet (washable) to be laid on the stretcher bed Crates (returnable) charged 4s. 6d. for each Litter.

c;. g- (I) g.. t;:

0 "1 en« "1 0'

::: g: t;: S :: &; p, II 0:1 (Jq ::9.:@ 5

5 GciQ' 0 5- "':. C/::) ,.,. S p>::j t'1 -4

:::-- &r (t) .... fgt.'i :n C/Q en D" :: en DlJ' P>'O

00 g. :: n-

o 0 n-"d (p n- .0..(1) ,.,.D" (I) en (l) 0 P, H;()Q g: d g,:::J 0" 0 00 P>°D":acz:g ....... -c+(l) c+ Dl(l) ;::L (I) :::J t'1 g- "1 rn (I) /'l) "1 ()Q ::;:::r"1 o..t:r ;::l.. (I) £" (I) §" g. <1l &. s· g: :, 8" 0 S H (I) t:r t:r t:l C+1; <1l • 0 s' g. Q' rD' CP g, g,

over them, and the cranked axle has, theref uro, ooon replaced by a straight one constructed of tubular steol.

"REA-EDWARDS" LITTER, fitted with pneumatic tyred wheels, showing the" Clemetson" Stretcher.

Ball bearings are fitted to the wheels, both cycle pattern and wooden, and the hubs are so apranged that the wheels can be pemoved fpom the axle without distupbing bearings. In place of the four legs made to raIse as handles, two fixed legs fitted with small indiarubber wheels or rollers are placed at the foot end, while a combined leg and handle fitted with a crossbar and capable of being raised or lowered is used at the head end. When raised as a handle it may be locked in one of two positions, and when lowered it is locked in a \'ertical position. The advantages claimed for this arrange-

ment are simplicity, ease and rapidity of and the facility afforded by the two fixed legs for ralSln.g the litter if necessary, on to the pavement. The questlOn of balan'ce has been carefully studied, and the stretcher is shifted f orward so that the middle of it is several inches in front of the axle, a porfect balance when the stretcher is in a horizontal position being thus obtained, and consequently there is no woight on the hands of the person propelling the litter. .

The pneumatic tyred whoels are strongly recommended m cases where the sma.ll amount of care necessary to keep them inflated can be given, as the comfort to the case in propulsion are increased heyond all companson ,,:lth any litter yet produced. It will be noted that the pnces are considerahly lower than those of the Litter, and the following are given as oxamples, but oWlllg. to the vast numbor of combinations that can be made WIth the different stretchers and coverings, it is impossible within reasonahle limits to set out quotations for the whole of them, but the e may be calculated by adding together the prices of the under-carriage, stretcher selected, and hood and apron or cover, see pagos 4: and to 11.

SPECIMEN PRICES.

Undor-carriage only, either with pneumatic tyred cycle wheels or solid rubber tyrod wooden wheels,

Litter completo with ordinary stretcher (no slings or chest strap) and hood and a.pron, £14 3s. od. .

Ditto with Telescopic Handlou Stretcher (WIth chest strap) and hood and apron, £14 11s.

If with iron tyred whoels prices £2 less.. . '1'he lowest priced litter complete IS WIth Iron tyred wooden wheel, ordinary stretcher (no slmgs or chest a.nd "·over. Price £10 ' s. 6d.

When ordering please stato which wheels are required_

PRICE LIST.

THE" CLEMETSON" STRETCHER.

" STRETOHER, with back raised, also showing extending legs.

On this stretcher the patient can be moved as desired, from the recumbent to the sitting position. T h ere is no complicated mechanism to get out of or der, and the adjustment depends simply on the balance of the patient's The stretcher will fit either the" Ashford" or the" R ea-Edwards" UnderCarriage. Price £ 3 3s. ; with extending legs, £4.

H ood and Apron, Ventilated, £2 15s.

PRICE LIST 9

ADJUSTABLE L E GS FOR STR E TCH E RS.

Primarily these legs, which are independent of and additional to the ordinary foot wheels, are intended to facilitate the carriage of a stret,cher in a railway compartment, in which case two on one sid.e would be lowered and adjusted by a telescopic arrangement to the prop er height, so that the foot wheels on one sille would. rest on the scat, and the a(ljustable legs on the other side would rest on the floor. The four legs may be to raise the stretcher as required.

"Yhen not in use they are fold.ed. up immedi ately under the poles of the stretchC'r.

Price per set of four, 17s.

FIRST AID BOX

To be fixed below the axle of the" Rea-Ed\\-un i::;" or "Ashfurll-Ellwarcls" Litter.

This is intended to be kept permanently attached to the litter , and is not designed to hang in a station or to be carrieel by hanll.

Contents :-Set of Splints, 12 Triangular BanJuges, 12 Roller Bandages, 2 i-lb. packets each Cotton Wool and Boric Lint, Adhesive Plaster, Pair of cissors, Knife, 2 oz. each Olive Oil, Tinct. Eucalyptus B.P.C., Sal Volatile, and Spirits Ether Comp., Gl'aJuatecl Glass, Kidneyshaped Dressing fi Tampons for washing wounds, Tourniquct, PillS, 'afety _ -cCllIe , 1'hro<:<l and Tape.

l'ri..;c £2. T

"FURLEY" STRETCHERS WITH THE LATEST IMPROVEMENTS, 1899 MODELS.

TELESCOPIC 11 bTRETCHIiR-

ORDINARY STRETOHER-OLOSED.

The improvements in all patterns of the "Furlcy" Stretcher, 1899 Model, are numerous. The comfort to the pa tient is increased; the stretcher is stronger, more rigid, and lighter, it folds up more closely, and its h[mdles are more comfortable to hold and afford greater protection to the hands of the bearers in passing through narrow doorways or passages. Should it be necessary to red nee the width of a loaded stretcher in order, for example, to carry it into a railway carriage, this can be done, either when it is re ting on the ground, or supportetl by the bearers, without trouble and without the slightest jar to the patient. The price of the stretchers is lowered. All minor points have been most carefully cunsidered, and the stretchers are conficlently recommended as thoroughly efficient in every wnv.

these stretchers are a clap ted for use alone or as part of the " Ashford" or "Rea-Edwards" Litter, and the cover, hood anci apron, army rug, and waterproof sheet described in this list are suitable for use with them.

PRICE LIST.

THE EQUIPOISE BED .

INVALUABLE FOR INVALIDS, CONVALESOENTS, AND THE GENERAL PUBLIC.

The movement of the bed to any position is so easily effected that the person lying on it can regulate the movement of the bed to any angle without assistance. It can be locked in seven different positions. Price from £5 15s. 6d.

FOLDING CAMP BEDS.

This can be folded in a very small compass and can be readily set up to form a comfortable bed. Price, case for same when folded, fitted with carrying strap, 58. 6d.

Pocket Cork Line and Drag, with 80 feet of line, in case. For recovering a drowning person from the water. Price complete, with instructions for use, 6s. 6d.

Pocket Reel and Ice Line for use in ice accidents, with 80 feet of line in case. Price complete, with instructions for use, 6s. 6d.

JACKET."

For use in mines, ships' holUs, &c., to secnre a patien t on a stretcher (see illustration), which can then be placer! in an upright position. Price £1 5s. WATER BOTTLE.

Copper tinned, wiLh carrying slrap . ]>rice 10". OIL

Enamelled. Iron ,Yater Bottle, il Cloth covered, with trap, 5s.:

LAMP.

This is fi tted with 11 socket, by which to fi x i t to a LiLLer, or it can be conveniently carried by hand, or attached Lo a belt or Lhe cloLhing.

Price complete, 6l1.

Dressing Basin, kidney shaped, made of enamelled iron.

Price I s. 3d .

Knife with strong blade ... Pair of Scissors ... each 9d. ; per doz. 8s . each Is. ; per doz. l Os.

Carrying Sh e ets for carrying patients u p and down stairs or ot herwise about a house. Designed by J. C. Derham, Esq., Blackp ool , and Mrs. Alfred Paine, Bedford . The sheet is fi t ted wi th r ope handles and detachable bamboo poles, and ma y be p laced on a stretcher without disturbing the patien t.

Pri ce complete, 15s.

PRICE L I ST. 15

LARGE HAMPER FOR AMBULANCE STATION AND R.AILWAV PURPOSES.

For contents see next page.

THE HAMPER CONTAINS

1 Set of Cane Splints.

I Elastic Band Tourniquet.

i-lb. Carbolic }In Tin Cotton Wool ... Cases.

i-lb. Boric Lint .. .

I Roll Adhesive Plaster.

20 Roller Bandages, &Ssorted.

1 doz. Triangular Bandages.

3 pieces Tape.

, oz. Sal Volatile.

4: oz. Bicarbonate of Soda.

4 oz. Olive Oil.

4: oz. Spirit Ether Compo

i-lb . Tin Powdered Boric Acid.

4: oz. Tincture Eucalyptus

B.P.C.

1 pair Pean's Forceps.

SMALL AMBULANCE HAMPER.

,Yith waterproof cover and strap , f or u e in factories, collieries, stations, and large works, as '.... ell as for parochial and c10meRtic use.

1 pair Scissors,

1 Knife.

12 Surgeon's Needles.

1 packet each afety and Plain Pins.

Carbolised Chinese Twist.

Silkworm Gut.

1 reel each Black and 'White Sewing Thread.

1 Kidney-shaped Basin.

1 Stopper Loosener.

1 Graduated Measure.

1 cake 20 per cent. Carbolio Soa.p.

1 Nail Brush.

3 Empty 8 oz. Bottles.

Price complete. £4.

Set Splints. 1 Elastic Tourni(ltlct. 3 Tampons, IO.r washing wounds. 2 Packets Lint. 4, Roller Bandages \wlde and narrow). 4 Triangular Bandages.

Cotton Wool... ... 1 In Tin Cases. Boric YVool ... ...

Spool of Adhesive Plaster. . Knife, Scissors, Thread, Tape, Needles, and PillS.

Weight complete,

Length, 1 ft. 6 in. Depth, 5 in. Width, 7 in. Price £1 lls.6ci.

SURGICAL HAVERSAC .

1lI1PRO\'ED PATTERN, fitted with a tin, so arranglxl that any article can be taktlu out without disLurbillg the l'eti L of the contents.

Contents: 1 of , plints, 6 Triangular Bandages, GRoller

Bandages, wide and narrow; Cotton \\ rool, Hori0 Lint, ill Lin cases; 1 Roll Adhesi ve Plaster, 1 Pair \ ;issfll"s, 1 Kllife, oz. Olive Oil, 2 oz. Tinct. Eucalyptus, B.P.C., :l oz. 'al \ ' olatile, 2 oz. pil'its Ether Comp., I Graduated U !a s;.; ,le,ltiUte, 1 Elastic Band Tourniquet, l>ins, Net:(Ues and Thread.

l'rice £ 1 lIs. 6d.

\ Vhite Linen Ration IIaversacs, Is. Od. each.

PRICE LIST.

NURSES ' WALLETS.

ORDINARY PADLOCK HAPE.

\Vithout instruments, 4s. 3ll.

Fitted complete, containing B nw

Dressing Forceps, 'patula, Probe, pairs (ro11l1d and sharp pointcd), Clinical 'l'hermometer, and Knife.

Advanced price lOs.

1'. PATTRRX, a illustrated, but improve(l by the n,lltlition of flaps tn protect the im:;trumen

" ' ithout instr..lments, 7s. OJ..

FitLed complete, containing Bow

Dressing Forceps, .l\.rtery Forceps (also useful for tlressing), ,'patula, Probe, Director with Ear Scoop, 2 pairs cissors (round and shnrp pointed),

Clinical Thermometer (minnte, round), Knife, Pencil,. and Safety Pins.

Price 215

20 PR1CE LIST.

CO TEl TS OF FIRST AID BOX. (Illustrated on previons page.)

Set of Wooden Splints; 1 Elastio Baud Tourniquet; Oarbolio Wool, Eorio Lint, in tin cases; 1 Roll Adhesive Plaster; 12 Roller Bandages, 6 Trtangular Bandages; 3 Pieces of TR.pe; 1 Pair Sci88ors; 1 Knife; 1 Kidnoy.8haped Bapin; 1 Graduated Measure; 2 oz. Olive Oil; 2 oz. Tinct. Eucalyptus B.P.C.; 2 oz. al Vulatile; 2 oz. Spirits Ether

Comp.; 8 oz. Carron Oil; Pins, Safety Pins, Needles, Thread.

Wound Pad.-This cOI1Rists of a pad of cotton wool and ganze, to which a bandage is attached. By a clever contrivance the surface of the pad coming in contact with the wound is not touched by the haml of the person applying tho pau. Price 4u. each.

SAFETY PINS.

FIRST AID BOX FOR" ASHFORD" LI ITER OR AMBULANCE STATION.

This is primarily designou to be plaoed on the "Ashford" Litter (18\:19 Model), but it is further adapted to bo hung up on a wall. A detachable leather handle is also fitted for carrying purposes.

For contents see next page.

Ambulance Station Plate, Ennmolle<l Iron, 6<1. each. Stretcher Depot Plate, Enamelle(l Iron, 3s. 6d. each.

22 PRICE LIST.

Nursing Chart , designed by Miss Inderwick, each. Temperature Chart, each . Registers. Class Attendance an d Certifica te (two to set) 6s. Case Rep ort Is. '

Large Physiological Diagrams. For Lecturers' use. Comprising: The Human Skeleton, the Muscular Arterial and Venous Systems, the Heart and of the Simple Fracture, Compound Fracture, Di slocations.

PrIce, per set of six, 15s. These may be hired for a course of Aid" lectures, _given ,:nder the auspices of the Af;socIatIOn, for a fce of os., or wIth the addition of Splints, Tourniquet, an<1 plain Triangular Bandages, for a fee of lOs.

Boxes o f Stationery for the use of Class Secretaries aJ J others connected with the Association, containing twelve sheets of paper, suitably headed, and twelve en velopes bearmg the device of the Association. Price 6d. by pos.t Yd.. Twice.that quantity, Is., by post Is. 3d: Issuetl In WIth special regulations, for wInch see leaflet 1\ o. 1 g3-5-, to be had on application. Coinage Bronze, 2s.; Silver, 7s. 6d.; Gold £:2 lOs.. including engraving name and number on back. velvet-lined case, 2s.

Lab e l,s, to above. Medallions f or subsequent year s exammatIOn Issued m accordance WIth regulaLions, as per paper Coinage Bronze, 6d.; Silver, Is. 6d. ; Gold, 12s. 6d.

NURSING INSTRUMENTS.

Bow Dressing Forceps, full size, Is. 3d. ; small, extra well finished, Is. 6d.

SCIssors, round-pointed, I s. 3d. ; sharp-pointed, for delicate I s. 3d.; small round-pointed, blades take apart fo r cleamng, Is. 9d.

Spatula, 9d. Probe 9d. Director, with Ear Scoop, I s. 9d. Artery Forceps, 2s. 4d. Knife very thin i vory handle, two ula<1es, I s. 9<1. ' ,

rr. 1Clt LIST.

CLlNICAL THERMOMETERS.

Reduced Prices.

Round. Ordinary, I s. ; minute, I s. 3d. ; half-minute, I s. 6d. Flat . ,'Lrongly recommended as they will not roll. Ordinary, Is. 6d. ; rapid (specially selected and reserved for the Association), with very open scale, 3s.

Lense Fronted. 'When held in the proper position the column of mercury is magnified, and so easily read. A little practice is required to ascertain the correct position in which to hold the instrument. Price, or<1ina1'Y, Is. 6d. ; minute, ] s. 9d. ; half-minute, 2s. 3d.

Kew Certificates (to o1'(ler), Is. 3d. each. N.B.-These certificates either state that the instrument is correct or point out any slight error there may be; they are not usually considered necessa,ry.

N ..B. and half minute instruments will only register ill the tIme stated under favourable circumstances.

BATH THERMOMETERS.

To Dr. Forbes' specification. Japanned, with zinc scale, 3d. ; Clinical Thermometer size, in case, ) s 6el. No liability is taken/aT bl'eakage of Thermometers in transit .

TEXT BOOKS, &c.

AID TO TIIE I JURED." By James Cantlie, 1LB., F.RC.S. The authorised Text-book of the First Aid Course. I s.; by post, I s. 2d.

" CATECHISM OF FIKST A lD." Compiled from Dr. Cantlie' s fanual. By J. Brown, L.RC.P., L.RC.S., and J. M. Carvell, M.R.C.S., L.S.A. Price 6d. ; by post 7d.

"HINTS AN D HELPS FOR HOME NURsh G AND By E. Cosgrave, M.D., illustrated, with cha,pter on the applIcatIOn of the roller bandage, by R J. Collie, M.D. The authorized Text-book for the Nursing Course. Is. ; by post, I s. :2d.

PRICE LIST.

TEXT BOOKS, &c.-(continued).

"HOllIE HYGIENE." By John F. J. Sykes, D.Sc. (Publl0 Health), M.D., &c. TIlustrated. The authorised Text· book for the Home Hygiene Course. Is.; by post, Is. 2d.

"CATECHISM ON HOME NURSING" (based on Dr. Cosgrave's Text-book). By J. Brown, L.R.C.P., L.R.C.S., and J. M. Carvell, M.R.C.S., L.S.A. Price 6d. ; by post, 7d.

"QUE TIO;-<S AND ANSWERS UPON ,VORK." By John VV. Martin, M.D., of Sheffield, and John Martin, F.R.C.S. Ed., of Huddersfield. Is.; by post, Is. 1d.

"QUESTIONS AND A SWERS UPON NURSING." By John IV. Martin, M.D. Is. 6d. ; by post, Is. 8d.

"FIHST AID TO TIlE INJURED (Six Ambulance Lectures)." By Professor Fredcrich Esmarch. Translated from the German by H.R.H. Princess Christian. 2s.; by post, 2s. 2d.

"ELEMENTARY BA DAGING AND SURGICAL DRR ' SING." By 'Walter Pye, F.R.C.S. 2s.; by post, 2s. 2d.

DR. G. H. DARWIN'S" FIRST AIDS," being a card to hang up, gi ving treatment of various accidents. 2cl.; by post, 5cl.

"'1'0 RESTORE TAE Apl'ARENTLY DROWNED," printed in large Type with two Diagrams. Unmounted, each 2d. Mounted, with red border, and varnished to hang up, 6d. ; post free, packed, Is.

"How TO ACT WHEN CLOTHING TAKES FIRE." By J. E. H. Mackinlay, M.R.C.S. Unmounted, 2d.; by post, 3d. Mounted on card and varnished, 4d..; by post, packed, 7d.

"FIRST AID PRINCIPLES." Cards of concise directions for waistcoat pocket, each !d., 4d. per dozen. Special quota. tions for large quantities.

"SPECIMEN EXAMINATION PAPERS, First Aid and Nursing Course." 3d.; by post, 4d..

SMALL ANATOMICAL DIAGRAM. Showing the human skeleton, main arteries, and points where pressure should be applied to arrest bleeding. 2d.; by post, 3d.

PRICE LIST. 25

TEXT BOOKS, &c.-(conti-nued).

DIRECTIONS AS TO TilE RESTORATIO;-< 01" PERSONS SUJ.I'FF:RING FROM ELECTRIC SHOCK. Large print, poster size. 3d. each or 6d. per dozen.

AIDE MEMOIRE. On cardboard, in linen-lined envelope, for the pocket. By the late urge?n-.M:ajor P: hepherd. Containing useful hints for First Aid to the InJured. 3d.; by post, 4d.

GENERAL NOTES ON FIR T AID TO BE RENDERED IN CASE OIP PorONI G. By Iilnes Hey, M.A., M.R.C.. , L.R.C.P. Price 2d. ; by post, 3d.

"AMBULANCE TABLETS." By Sydney Partridge, M.D. Price Is.; by post, Is. Id.

NOTES ON MILITARY SANITATION. By Lt.-Col. H. P. G. Elkington, R.A.M.C. Price Is. ; post free, ]s. Id. "EMERGENt:Y for instantaneous refcrence, giving concise instructions, to hang on wall. Size about one foot square. Price 2s. 6d. ; by post, 3s.

A HISTORY OF THE ORDER OF THE HOSPITAL OF ST. JOHN OF JERUSALEM. By the Rev. W. K. R. BEDFORD, M.A., Genealogist of the Order, and Lieut. -Colonel R. H. HOLBECIlE, Librari::m of the Order.

In one Yol., Demy 8vo., 230 pp. Profusely illustrated. Price 7s. 6d. ; by post, 7s. 10d. A limited number of copics, injured by damp, can be had at 2s. 6d. each; post free, 28. lOLl.

THE KNIGHTS HOSPITALLER.S IN SCOTLAND, AND THEIR PRIORY AT TORPHICHEN. By GEORGE THOMAS BEATSON, M.D., C.B. IVith 13 pages of illustrations. Price 2s. 6d., bound in cloth; post free, 28. 8d.

PR.ICE L'lST .

ROLLER BANDAGES. (6 ya,rds l ong).

Open Fine Grey Galioo, Best qnality, Wove or Super'or Grey White Open Wove. white, with s. d. d. woven edges. in., per doz.

1 in. in.

2 in. in.

a in.

4 in. ti in.

ROLLER BANDAGES in Assortment.

Each packet contains 6 bandages as follows :_

6 yards l ong-one 6 inch, two J-inch, one i -inch,· 4 el long-two 2k-inch. yar s

]< ine Grey Calico '" per packet

Plain Triangular Bandages per doz .

TIlustrated Triangular Bandages (after Esmarch) showi 21 I ' . ' . lCatlOns of the Triangular Bandage, wIth pnnted Instructions ... each

ROLLER B.\NDAGE MACHINE.

Designed by Dr. A. C. Tunstall. Price 2s. Gd.

COTTON WOOL.

White absorbent, good, 1 oz. packet, 2d.; 2 oz. paeket, 3el.; -1 oz. packet, 4d.: lb. leL; I lb. Is. ANTISEPTICBoracic, per Ih., Is. Gel.; Carbolic, per lb., Is. d.; Alembroth, per lb., Is. Gd. ; Dou bie Cyanide, per lb., 2s. 6el. LINT.

Medium quality, 1 oz. packet, 2d.; 2 oz. packet, 3d.; 4 oz. packet, 6el.; lb. packet, 10cL ; 1 lb. packet, Is. 6d. ; Boracic, 1 lb. packet, Is. 6el. ; 4 oz. packet, Gd.

Tbese are supplied inches.

U nmeclicated white ... Alembroth

Doubl Cyanide Boracic

GAUZES. in 6 yartl lengths, width a,bout 36

GAUZE TISSUE .

A layer of absorbent cotton wool between two sheets of gauze , gooel quality, per lb., I s. 6el.

. M a nufactured b y Messrs . A . De St. D almas & Co P laster on Cambric, in tins of ' i yard, 6 mches wIde .•. 6d.

The Leicester Adhesive

Ribbons, in tin boxes, 6 yards long.

National Rubber Adhesive

Plaster (Autiseptic), on spools.

5 yds. 10 yds.

inch wide 9d. Is.

Is. Is. 6el .

2 Is . gel. 2s. 3d.

Ditto in box, ! in. wide, Jl ydR. l ong " tm " 1 " !t 3" 5" 5"

Cou R1' PLASTER, T RICOLOUR.

L a r ge Size, 9d.; Medium, 5el.; Small, 3d.

Badges, with the device, issued under the authority of the Central Executive Committee, haying been

approved by H. RH. the Gl'nnd Prior as the sole offil:la) and recognised Badge of the Association and Brigade. N.B.-Til is design is lJrotccted, and mllst be obtained direct from th9 Centra.l Office No.1, for the use of indi,idnal certiiicated

Small Celluloid Dad;;e for button hole, arm, or

Black 'ilk .Armlet, with printed Badge .. 0 6

N .B.-Thcse al'C not to be 'U'Ol'lt as decorations.

BADGES. No . 2.

No.2, for members of the St. John Ambulance Brigade, having the name of the Corps or Division annexed on a label, only issued in quantiLies-

In German Silver, first doz., £1; subsequent dozs., 12s.

In Electro Plate, first doz. £1 12s.; subsequent dozs. , £14s.

In Cloth and Silk, per doz., 12s.

In Cloth and Silver, per doz., £1 lOs.

All the above may be worn by members of the St. John Ambulance Brigade, not wearing uniform, and the German Silver a n d Electro Plated m}ty be worn as Lhe Arm Badge fo r a ll r ank s on the Brigade Uniform .

PRICE LIST.

BR.IGADE U N IFOR.M BADGES, etc.

O ffice r s.

Collar Badges (Registered Xumbell', 3,52-") per pair

Pouch Baclge ( 3,657) each

S ergeant s .

Cap Badge (Regigtered Tumhcr, :l,.')20) each

Arm Badge (" ,,3.5:2:3) "

F atigue C ap B adge for Officers and crgeants (RegisLered Number, :3,55 )

Corportils and P rivates.

Cap Badge (Regi,;tered Xumber, 3,5'21) each

.Arm Badge (" ()ycrcoat Badge ( " ,,1,:) :2)

Field Service Cap Badge for all ranks

L Ady Officers of N ursing- Divisions.

Cloak Badge (Reg. "-0.3,fl5)

Arm Radge

Other Nursing OiIiccr's Cloak Badge ( 3,.35;,))

OLher Xur;;ing Otlieer's Arm Badge ( "

Nursing S isters.-Arm Badge (Reg. Xo.

Cloak Bach:e ( " 3,5:21)

Honorary Surgeon's Silver '\ire Cruss (pattern B)

Superintendent's 'Wire 'tar (pattel'll A)

Medallion Bftdge (pattern D) ...

N ursing B adge (pattern E)

Satin Badge for NUl'sing Pin Cu::;hion

Bugler's .. , Cord

Wh istle aT'd Chain cach

F ie l d Service Cap. complete ...

P rivate's B rown W aist Belt ftnd Pouch

W hite P iping, per PackeL of yards, enough

:3 pair of trousers (packets cannoL be broken)

L ace, •'il \'cr per yard

" (A Cap Ba.nd gener ally Imns about 24 inches. )

BUTTONS FOR THE U N IFORM OF T HE ST. JOHN A M B U LA N CE BRIGAD E.

Issued only for the use of Officers and Members of Corps and Divisions wearing the prescribed uniform.

Plate, large ...

ELECTROTYPES OF THE ST. JOHN AMBULANCE DEVICE.

1\o. I. For Cards, Ti ckets, &c.

2. For l\ ote Paper, I:Jlllull Circulars, &c.

" 3. For Quarto and Foolscap LeLLerpaper, Circulars, &c.

4. For Small Posters

" 5. For Large Posters Complete Series

Prints of the above electr otypes, with the exception of No.4, which is shown on pFige :29, appear on the following pages.

BR.IGADE FLAG.

For marking the position of Ambulance Stations a t Fetes, Exhibitions, &c. , 4 f t . in. b y 3 ft. Price 128.

UNIFORMS.

These may be obtained direct. from Messrs. Hebbert and Co., 35, Bethnal Green Road, E. Telephone No. 909 , London 'Vall; Telegraphic Address, "Otherwise, London."

AND

CIIIEF OPT. A,\D

SWAGGER. STICKS

for t he use o f Office rs and M e m b ers of the st. John Ambula nce Brig ade .

Ebonised Canes, German· Silver Mounts bearing the Brigade Deyice. P RICE Is . EACH

Two-inch 1I1obair Braid

'''hite Patent Leather amI

Pouch (D<Hlge extra)

All Orders for the foregoing Stores should be given to the Local Secretary, or to the Stores Department, St. John Ambulance Association, St. John's Gate, Clerkenwell, E.C.

Two ·illCh 1I10hair Braid down side

Cross-belt, 'Yhi te l)a tell t LeatHer and Black

Morocco Pouch (Ba(lge extra)

Forage Cap and

38 PRICE LIST.

MESS DRESS FOR OFFICER.

Jacket (Badges extra)

Vest

1ST CLASS SERGEANT.

Patrol Jacket (Badges ex(,ra)

Chevron, 4 bars Silver, 3s. Gd., Trousers

Forage Cap (Badge extra)

Cross-belt and Pouch (Badge ex('ra)

Field Cap (Badge extra)

Buckskin Gloves

Cotton

Leggings

Great

SERGEANTS, CORPORALS, Al\D RANK AND FILE.

Patrol Jacket, Black Tartan (Badges extra)

Trousers, Black Tartan

Forage Cap (Badge extra)

Waist-belt and Pouch

Field Cap (Badge extra)

Great Coat (Badge extra)

Gloves (per pair)

Leggings (per pair)

Sergeant's Chevron, 3 bars, Silver, 2s. Gd., 'Vorstcd 0 1 0

Corporal's 2 bars, Silver, Is . 8el., ''.7 orstcd 0 0 8

CYCLISTS-SUPERINTEND.F.NT.

Patrol Jacket (Badges ex(,ra)

Cap (Badge extra)

Breeches : Grey Serge houlder Belt and Pouch

Gloves

Gaiters

PRICE LIST.

CYCLISTS-RANK AND FILE.

Jacket (Badges extra) '"

Cap (Badge extra) ...

Breeclles: Grey Serge ' " 'houlder Belt ... ... Gloves (per pair) Gai ters (per pair)

All Badges to be obtained by the Corps or Division from St. John's Gate.

If the .Corps or Division is out of London, measurements to be suppheu. to contractors froe of charge.

Carriage out of London extra.

INDEX TO PRICE LIST.

Ambulance Hampers ... 15,17

Station Plate 21

Badges .. . ... ... ... 29,31

Bandage Rolling Machine... '27

Bandages 20 Basin, Dressing 1 !

Bed, Equipoise 12 Camp 12

Books ... ... 23, 25

Bottles (Water) 13

Buttons 32

Oarriages Ambu· lance) ... 2

Oarrying Sheet 14

Cotton Wool ... 27

Cover for Stretcher or Litter .. . 12

Dia.grams, Large 22 "Small 24

Dressing Basin H

Drowning Tackle ... 12

Electrotypes .. ... 32, 35

Emergency Book 25

First Aid Box ... ... 10, 20,21

First Field Dressings 21

Flags ... 36

G1I.uzes ... ... 27

Gaul!>e Tissues... 27

Hampers (Ambulance) ... 15, 17

Haversacs 18

Hood and Apron for Litter... 4

Jaconette 21

Knue 14

Lace ... 31

Lamp 14

Lint ... ... :d5

Litter (Ashford) 3,4.

Litter (Rea.Edwards)

Lowmoor Jacket

MedalliolJs ..

5,7 IS :!2

Nurses's Wallets 19 Nursing Charts . . 22 .. I DBtrum:mts 22

11

28

... ... 22 Roller Bandage Machine 27 Rng ... 12 Saf0ty PiDB 21 Scissors. ... 14 tll1ngs, Stretcher 12 tlplint Padding 20 Splints.. 2L

Stationery ...... 22

Slretcher Depot Pla.te 22

Stretchers ..... 8, 11 Adjustable Legs fur 10

Swagger Stick... 36

Temperaturo Ohart ... .. . 22

Text Books .. 23, 24

Therm ,meters 23

Tourniquets 21

Tuw, carbolized 21 .. plain... ... 21

Unform Sundries 29,31

Unifurms ......37,39

Wagons (Hnrse Ambulance) 2 Water Bottles 13

Waterproof Liut 21

Waterproof Sheet 4, Whistle and Chain 31 Wool (OottfIU) .. 27 Wound Pad 21