First Aid to the Injured 11th edition 1908

BONES.

SRI'E NTH}

CERVICAL VERTEBRA

C OLLAR} HONE (davicle)

BREAST} HONE -(sternum)

ARM BONE (humerus)

4TH LUMRAR VERTEBRAHAUNCH'S BONE

ULNA

RADIUS

METACARPUS "

PHALANGP.s •••.

THIGH BONE (iemur)

KNEE CAP (patella)

SHIN BONE (tibia)

BROOCH BONE (fibula)

ARTERIES

The numl" ed dot:; sl>ow ores. re POl/ltS for. the arlerie!;. re In text. - -. OCCIII 1':;':-.--lfMP(HlAI. ('A ROTU',. SUII('L,'VIAN.

AXILLAIlY.

A(II'AI 'Digilal or 1ourniqut'I). _. RRAe"IAI (l-Iexion).

ILIAC.

• RADIAl•• IORAI (Digital -. "AR. 'ORAl Iquet).

NCl'MF.NT Of' PUPI.ITRAI )( (,IITEAI. Flexion).

fER I R IIIAI.

STRRIOR IIUlA!..

TARSUS

MRTATARSUS _

PHALANGES ,-_ ••

FIRST AID TO THE INJURED

ARRZ\:-lGED ACCORDIN(; TO THE REVI"ED SYLLABUS OF THE I-IRST AID COURSE OF TIlE

ST. JOHN ASSOCIATION.

BY J .\l.B., F. R.C.S.,

Honorary Associalo 0/ tILe Order 0/ St. jolm. jlonorary Lifl J/emba- <'/, awl LL'Cturcr alld Exam/llo- t<', file! Association.

\\'ith a ClIAI 'TER on c. [ret(her Tr:1nsport," rel'ise 1 from that o riginally written by Sir ]OH:-I Ft:Rl EY, A-me-ht o./justice 0/ t/I< Order {If St, jO/tll, 111 accordance wilh the .\rtny Stretcher Also a CH APTER (t,eing the Fifth ].ecture, ror Femal6 only), by E. ;\IAcDo\\' EL COSGRA\'E, M.D" F,R.C.P.I., ,A'nig/zt o/Grace o/tlte Ortit!r tif St. jO/IIl, HOllora)), Lij;: .llem('cr 0/, and Lecturer alld Examino' to. tltt! •.J.ssocialiOJl.

ELEVENTH EDITION, 430,000 to 480,000.

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8tattb ,rtotR of tbe ®tbet of tbe of cSt lobn of in '.ob'trtigu nub ll!dr.otl .of ±qt @rbtr.

His Most Gracious Majesty King Edward VII., K.G.

His Royal Highness the Prince of Wales, K.G. ,nlr-Jrtor. [ JTaC£lJlt.] .of (fr;glt.

Field Marshal

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

Qht.Clttifrt

Prelate-His Grace the Archbishop of YORK.

Challcellor- The Right Hon. Yiscount K NUTSFORD, G.C.:'LG.

Secretary.Gmeral-Colonel Sir HERBERT JEKYLL, !Z.C.M.G., R.E.

Receiver-Ge1teral-EDWIN FRESHFIELD, Esq., LL.D.

Almoller-The Rev . Canon DUCKWORTH, C.Y.O., D.D.

Registrar-Major-Geneml Lord CHEYLES\lORE, C. V.O.

GeIlp.aiof[ist-S ir ALFRED SCOTT SCOTT-GATTY, C.\'.O. (Garter).

Director oj tlte Ambulallce DejJarlJlle1.t-The tlost Hon. the :'[arquess of BREADALBAl\E, K.G.

Librarian-Lieut.-Colonel RICHARD HOLOECHE.

Secretary-Colonel Sir HERBERT C. PERROTT, Bt., C.n. CltairJlla1. of the Britislt OpMltalJJlic Hosrital, jerusalelll- The Rigbt

Hon. the Earl of Plymouth, C. B.

Ckief Secretary oj the A mbulal.ce Department-Colonel Sir HERBERT C.

PERROTT, Bt •• C. B.

®ffiurJ

AssIstant Director 0./ the A b l. • A CARNAC TEiIII'L:" fe/artl1letlt-Lieut.-Colonel Sir SSlstant Receiver-EDWIN H • F" " .

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Assrstallt Honorary Secretary (for S t/, Hospita i,jerusalelll- j. °Eif the Br,itislz OjJhtllalmic I'lT'T, • •SON, sq., UmcorrIPursui'1/ant.

T . he Councll of the Sub-P E 0 nor, as PreSident ex on;' h xeCUl1\'e fficers, and the following - :I/,C10, t e

Sir JOHN FURLEY C B (LL D j. C. R A .DVCE DUCKWORTH 1\1 D' .

The Right Hon. Viscount aJoGr-CGeneral ir OWEN'T. FORD, G.C.I\I.G -.' .I.E., K.C.S.I.

The Right Hon. Lo;d :'10STYN. rlr GEORGE HAYTER CHUBB, Bart. Colonel C. \V. BOW!lLER BOWDIER BELGRA\'E C.B. ., ",I NI'IS, M.D., R.N.

SIr JAClIES DICK K C B :'I D Sir RICHARD DOUGLAS POWELL R.N. , ... , . .., B:., K.C.V.O., :'I.D. '

Colonel ir CHARL ES;\ 1 W C?1. Ir CLDIEl\T :'1. ROYDS C B K.C.;\I.G., C.B. R.E: A1S0N, Lleut; .Colonel Sir ·C· , lE"II'I.E, Bt. C IE'

Th C . , ...

e hapter consists of the K . h . f J the Executi,e Officers; the °llI and Sub:Prelates de Jure' •• 1 em ers of CouncIl; the followin!1; ,

The Rev. the <!rbapTams. CHAPELS ROYAL, C.V.O., I The Rev. THOMAS W. WOOD. ii\ni ht f iIt" \\' .W NMAN DIXON E'q S 0 I:JIrare anlJ Esquires

Th" Rie-ht H on: Earl of I The L Right Hon. The E'arl of PLY?IOUTH, C.B. ATHOM.

ThE' . Right H on. the Earl f Surgeon-Gener:1 ir WILLIMI \ ARBOROUGH 0 \ ' TAYLOR, K . C.B K H P

Maj.-Gen. L. V: SWAINE C B ILELIA"I D. '"i V 0 C.:'.I.G. ' , Ir DWARf) O':'IALLEY' "

EmlUND OWEN, Esq. LL D C?lonel E. R. PRATT•• F.R.C.S. , .., Lieut.-Colonel IVOR PHILIPP

The Right Hon. Lord C D.S.O., .i\I.P. S, HA"IILTON. LAUD Colon el CHARLES F. ST. CLAIR

EUWIN HANSON FRESHFIELD, Esq. Ar-;STRUTHER, :'LV.O., D.S.O

B 2

faHaming Ilrc toe oE .3lusiirc:

H.R.H Prince CHRISTIAN OF SCflLESI\"I(j·HoLSTEIN, K.G., G.C.B.

H.:'Il. IZI:-:G HAAKON OF NORWAY, K G., G.C.B . , G .CS.O.

H .R. Prince A1.BERT OF SCIILF.S· WIG -H OLSTEIN, G.C.J3., G.C.Y.O .

H.S.H. The Duke of TECK, G.C.V.O

B B. Prince FRASCIS OF TECK, K.C.V.O., D -.0

Rear-Admiral B.S.H. Prince LOUIS OF BATTEN BERG, G.C.B, K.C.l\LG., R.N.

H.S.H. Prince AUl:XANDER GEORGE OF TECK, G .C .\'.O., D.S.O.

Il.R.H. PRINCE ARTHUR OF CONNAUGHT, K.G. , G.C. \ '.O.

Lieut.-Col. TREI'ENEN j A\!ES lIm.· LAND, C.B. [Bailiff) ·

Sir JOHN FURtEV, C.B. (HOIL

The Right Hon. Lord G.c.:'\l, G [lk

Sir THO:lIAS NORTH DICK-LAUDER,

Major ir ARCHIBALD Rt.

C ol. Sir HERBERT C. PERROTT, Bt. C.R.

The Right HOIl. Earl FERRERS.

C ol. Sir TAS GILDF:A, C. V .0 ., C. n.

HE NRY JOHN LOFTUS, Esq . Colonel I3ETHEL i\IARTIN DAWES.

The Right Hon. Lord AMHERST OF H ACRNEY .

Gen. Sir CHARLES \V ARREN, G.C .?ll. G., K.C.R., R.E.

M ajor General j A:lIES CECIL DALTON, R.A.

Col. AYI.:lIER GOU1.D HUNTERWESTON, D.S.O., R.E.

The Right Hon. Earl EGERTON OF TATTON

Colonel The Right Hon. Lord "-n.L1A:\! CECIl :'11.\'.0.

EDWIN FRESIIFIEI.O, Esq., LL.D. ([(OJ/ora)')' COJIIJllaJ/do").

His Grace the Duke of FIFE. 1'..T.

The Rt. TIon. Lord RRASSEy.G.C.B.

The Right Hon. \,i,count TE:lIf'I.ETOWN .

The Right Hon. Earl A:lIIIFRST.

The Right Hon. Yi,collnt IZ1'UTSFORD, G.C.:'ILG (I[on. Bailill).

R. :'IIACLF:A:-I :\LICLFA.·, Esq..

ARTHUR FRANCIS GRESHA:l1 LEI'E50:-1 GOWER, Esq .

Lieut-Col. F .A . HFYGATE T .\:lInERT.

Colonel Sir CH.-\RI ES \\' YNDIlA :l1 :\!URRAY, C. B.

The Rieht Hon. the Earl of RAN' FURLY, G C \LG.

The Right Hon. Lord SANDHURST. G.C.S.I., G.C.I.E. l:\LG.

Sir HENRY ARTHUR BLAKE, G.C.

TheRt. Hon. the Earl of l\lF.-\TH, IZ.P

A. ED:lIUND FRASER, Esq.

The Right Hon. Lord :'I[OSTYN.

The :\[ost Hon. the l\ I arqlless of DREADALBA:--F., K.G.

His Grace the Duke of IZ.G., G.C.V.O.

the Right Hon. the Earl ROBERTS, K.G., K.P., Y.Qi; ., etc.

ROBERT HRUUE:-IEIL CARTER, Esq., F.R.C.S. HAY FORBES, F.R.C.S. (Edin.)

Colonel JOHN AI.EXA :-IDER 1\L-\N STUART, C.B., C.l\LG.

Colonel C. " ". Roll' 01. ER 1l0WDLFR, Lieut.-Col. A. C. LITE.

:'Ilajor-General ASTI EY F. TERRY.

{[be foHoming rm tl)e

Thf' Lord Bishop of SAUSBl..RY. The Bishop of GIPR,ILTAR . Th e in I The Bishop ofD'::-IFOIN.

The Bishop of BRITISH HONDURAS. (Primate (1) j\', w /.mlalld.)

TilE A;\IBULA;:\CE OF 3ra:nb' Wriol:l! of tDe ®tbet of tDe of .%t. ]ODn of ]cmsmIrm in QCnglanb'. @atron.

HIS MOST GRACIOUS MAJESTY KING EDWARD VII .. KG . (SOVEREIGN HEAD AND PATRI)l' OF THE ORDER.)

HIS ROYAL HIGHNESS THE PRINCE OF WALES. K.G. (GRAND I RIOR OF TIlE ORDER.)

i.rntraI Errrutibc Qrommittrc.

Consisting exclusively of :'Ilembers and Associate- of the Order.

Dzrector 0/11:e Ambulance Detartmcn! and ClmirmalL of COlllmiUeeThe 110st Hon. the :\Iarquess of BREADALBA:-:F., K.G.

Assistant Dir.:ctor alld D,1'u{y ChairlJlatL - Lieutenant·Colonel Sir RICHARD C. TE:lII'1 E, Bt., C. I.E.

Deju!y.CI1.af))JlalL-Sir JOHN FURLEY, C B. (Life :'11 ember of the Commltlee Honoris Causoi). ,lI,·IIl!>t)'s.

Major-General J. C. DALTON, H. .A. N. HAY FORllES, Esq., F.R.C (Edin.)

C . 'V. BO\\,Ill.ER BO\\,DLER, C. E. Lleut.·Colonel A. C. \"ATE.

The Rev. T . W. W OOD.

COLL!. 'GRlDGE, Esq., :'ILD. Colonel Sir j. W. OTTLEY, .K.C.I.E., R.E. ] nspector-General D. NINNIS, :'Il.D., R.N

S. C. \\ ARDELL, Esq.

Surgeon-:'IIajor G. H. D.'oR\\,IN, :'II.D.

GEORGE S. ECI.ISTON, :'II.R.C.S.

CH RISTOPHER CHILDS, Esq., :'ILD.

<!tm trll l Qtommitt u - continued.

Colonel C. J. TRIMBLE, C.M.G., L.R.C.P.

General Sir RICHARD HARRISON, G.C.B., C.M.G.

Colonel Sir CLEMENT M. Royus, C.B.

Captain J. W. NOTT BOIVER.

EDMUND OWEN, Esq., LL.D., F.R.C.S.

Admiral ALFRED J OHN CHATFIELD , C.B.

The Right lion. J. L. WHARTO:-l, P.C.

Lieut..Colonel E. 1\1. WILSON, C . B ., C.M.G ., D .S.O., R.A.M .C

Surgeon.General Sir ALFRED KEOGH, K ,C.B., K H P.

Colonel G. HUNTER O·MALLEY.

Colonel Sir LEI!:S KN OWl.ES, Bart.

Lieut..Colonel Sir R . A. CLARK, Bt., C.B ., F.R.C.S.E.

Surgeon.General ir BENJAMIl'i FRA :-: KLlN , K .C. I.E .

JOHN GRIFFITHS, Esq., 1\I.R.C.S.

Surgeon.Colonei E. CURETON, M.D.

Sir EDWARD L. O'MALLEY.

EDWIN DAWES, Esq.

Surgeon·Major G. A. HUTTON.

Deputy.lnspector.General M. COATES, M . D., R . N .

F. R. CASSInI, Esq., M.D.

J. ASTLEY BLOXAM, Esq., F . R .C .S .

\VILLlAM E. AU DLANU , Esq., M.R.C.S.

Colonel T, H. HE NDL EY, C.LE.

J. HAMM ON D M ORGAN , C.Y.O., F.R . C.S .

Ex.Officio IIfemhers 0/ Committee.

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

ED\\'(t, FRESHFIELD, Esq., LL.D. (Recen er.General of the .Order). ..

The Right Hon. The Earl of PLYMOUTH, C. B. (ChaIrman, BrItIsh Ophthalmic H ospi tal).

([bitf

Colonel Sir HERBERT C. PERROTT, Bt., C.B. (Se::retary of the Order).

<!cronntllltt lln'tJ

WILLIA;,I R. EDWARDS, Esq., A.C.A. (ACCOIwiallt 0/ tlte Order).

®fficcs .

ST. JOHN 'S GATE, LONDON, E.C.

Telegrrtjlu'c Address- I< Firstaid, London." Telephone -Holborn, 861.

)S ankers.

LONDON AND WESTMINSTER BANK, LIMITIlD, (Lothbury, E .C,)

REVISED 1908.

REFERENCE No 58. 1908 .

FIRST AID TO THE INJURED

FIRST LECTURE.

A. Principle of Aid.

B. A bri ef Description of the Human Skelet on and of the Muscles.

C. Fractu res-Causes, signs and symptoms.

D. Trea ment of Fracture '-General Rules.

E. The Triangular Bandage and its appli ca tion. LECTURE.

A. Treatment of Fractures (continued ). Details of treat· ment.

B. Dislocation, prains, trains- . ign, symptoms and treatment.

C. The Heart and Blood Yes. els. The Circulation of the Blood.

D. H ::emorrhage and wounds. General rules for treatment.

E. The Triangular Bandage and its application.

SUM IARY OF CONTE NTS

Principles of First Aid

Explanatory

Questions on Chapter

I. CHAPTER II.

The Human Skull, spine, ribs and breastbon e, upper lIm bs (colla r-bone , shoulder-blade, armbone, bones of the forearm, ca rpus metacarpus phalanges), p elvis, lower limbs (thi gi1-bone , _ cap, tarsus, metatarsus, phalanges ) . .. .

J01nts ...

Muscles. Voluntary and involuntary

General Rules to be observed in Fractures

Special

. hand.' pelvIs, thIgh- bone, knee-cap, leg, crushed foot Dlslocatlons

Bruises, burns and scalds, hites of

and rabid animals and wounds by

fish hook

Inse nsibility . Causes, general rules for t reatment, concusion of hrain, compression of t h e hrain, apoplexy , epilepsy, hyste ria, shock, fainting and collapse, H1I1stroke and heal-stroke , com'ulsions ill child ren, asphyxia

Electric Shock and Effects of Lightning

Questions on Chapter

CHAPTER VI.

Poisoning. Gene ral rules fo r treatment , special poisons

Questions on Chapter

CHAPTER YII.

Bandaging. Ba ndages for t h e scalp , for ehead, elc., h ip, hand, fool , c h est, back, k n ee, elbow, hngers and toes ...

CHAPTER VIII.

Methods of Carrying. Four , two, a nd th r ee handed seats, fi reman 's lift, fo r e and aft met h od, improvised st r etche rs, to c ross a d itch or wall, to load o r u nload a wa gon ..

C HAPTER IX.

Stretcher Transport. St retche r s, st r etche r exe rcises, litt ers

CH APTER X .

The Fifth Lecture (for Females only ). l'repa ration for r e c ep tion of acc id ent case s, choice and preparation of a room, lifti ng and ca rryin g , p repa ration of bed, r emoYing the clothes, p reparat ion for surgeon . ..

Questions on Chapter

206

Skeleton showing position of main arteries

kull and \'enebral column

Yenebra

Bones of the left upper lim b

Bones of the right lowe r limb

t..,llOulder Joint

Anklt: ...

Rectus :'II uscle

Triangular handage sp read out and folded

Large arm slin g arm <:ling

Reef knot

Gra nny knot ...

Loop knot

Bandage for fracture of lower ja\\ .

Bandages foor simple fracture of ribs

')t. John sl ing

Bandnges for fracture o f both collar bones

Bandage fo r fracture o f shoulder blade

Treatment of fracture of arm

Angular splint

Treatment of f racture of forearnl

Treatment of crushed hand ...

Treatment of fracture of thigh bone

Treat m ent of fracture of thigh (woman)

F racture of knee cap

T reatment of fracture of knee cap

Treatment of fracture of leg (man and woman)

T r eatment of crushed foot ...

D iagram o f the hea r t, lungs and ai r

Diagram of tl:e circulation of the blood

Digital pressure on carotid artery .. .

Digital pressure on facial artery .. .

Digital pressure on temporal artery ...

Digital pres5ure on occipital artery ... . ..

Pad and bandage to arrest hremorrhage from temple

Ring pad

Digital pressure on subclavian artery .. . . ..

Pad and bandages to apply pressure on axillary artery ..

Digital pressure on brachial artery (two methods) ...

Flexion at elbow ...

Digital pressure on radial and ul nar arteries '"

Pad and bandage to arrest hremorrhage from palm

Digital pressure on femoral artery... '" ...

Tourniquet on femoral artery

Flexion at knee ...

Organs of the chest and abdomen ..

The lungs and bronchial tubes '"

Schafer's method of artificial respiration ...

Silvester's method of artificial respiration ... .

Silvester's and Howard's methods of artificial respiration combined ...

Bandage for the head

Bandage for the shoulde r

Bandage for the hip ...

Bandage for the hand

Bandage for the foot

Bandage for the chest

Bandage for the knee

Bandage for the elbow

Grip for four-handed seat ...

Lifting by two-handed seat. ..

Grips for two-handed seats ...

Carrying by two-handed seat

Grip for three-banded seat ... upporting patient ... . .

Fore and aft method of carrymg

Carrying on improvised seat

Improvised stretcher ...

Furley .. .. tretcher exerCise, No. I. " Fall in "

Ditto, ready to li,rt patient

Ditto, lifting patlent .

Ditto, placing stretcher .... . ..

Ditto, to lower patIent. ..

Ditto, ,. Lower .

Ditto, No. II. Ready to hft patlent

Ditt o, patient . .

Ditto, No. IV. posmon

Ditto, second POSItion

Diagrams illustrating Army stretcher dnll

Ditt o ", ...

Bed cradle

Improvised bed cradles

PREFACE.

AT the request of the Central Executive Committee

I have the manual written by myself in I9 01 , as the officIal ha nd book of the St. J ohn Ambulance Association.

Throughout the revision an endeavour bas been made to the study of F1rst Aid to the Injured by drawll1g up a number of general rules for the of accidents and sudden illness, and by the omlSS10n of all detail \\ hich is not abso l utely necessary to enable the student to acquire an intelligent knowledge of the subject.

I "i. h to express my thanks to Professor E. A. chafer for furnishing instructions for pcrforminCT a method of artificial respiration, to Dr. L. M. b F . for many valuable suggestions, and to the MedlCal Members of the Central Executive Committee, especially Surgeon-ilIajor G. H. Darwin, M.D. and Dr. F. R. Cassidi, for perusing the proof sheets and for a number of useful additions to the work.

I cannot omit also to offer my best ackno\\ ledtrments to "'V. R. Edwards, the Accountant . 'torekeeper of the '.J..\.A., for his im'a luable co-operation.

JAMES CANTLIE.

FIRST A I D T O THE I N J U RED.

CHAPTER 1.

T he t. John Ambulance Association has now completed thirty years of its existence, and during t hat period hundreds of thousands of men and women have been taught at it classes, in all parts of the world , how to help their injured neighbours.

First Aid to the Injured is a special branch o f practical medicine and surgery, by a knowledge of which trained persons are enabled to afford skilled assistance in cases of accident and sudden illness. The instruction begins and ends with First Aid, and the subject is taught simply b u t thoroughly and exhaustively. The duty of the ambulance pupils ends where the doctor's commences, and there ought to be no overlapping or clashing of duty or interests.

OF FIR T AID.

T. The First Aid studenl should be-

(a) Observant, that he may note the causes and signs * of injury.

(b) Tactful, that he may without thoughtless questions learn the symptoms t and history t of the case.

Signs are what may be percei\'ed.

t Symptoms are what the patient can tell yon.

t History mean - the circumstances attending the accirlent or sudden illness.

(c) Resourceful, that he may use to the best advantage whatever is at hand to prevent further damage and to assist Nature's efforts to repair the mischief already done.

(d) Explicit, that he may give clear instructions to the patient or the bystanders how best to assist him.

(e) Discriminating, that he may decide which of several injuries presses most for treatment by himself, and what can best be left for the patient or the bystanders to do.

2. Remove the cause of injury or danger whenever possible.

3. Severe hcemorrhage must receive the first attention, no matter what are the other i njuries.

4. Air. - The patient must be in a posItIon in which breathing is possible; the air pas. ages must be free from obstruction; if breathing has ceased prompt measures must be taken to restore it.

5. Rest. -A restful position of the body will a sist the vital functions; support of the injured part \\ ill help to pre\'ent further damage, and is essential in the case of fractures of lim bs.

6. Warmth. -After every accident keep the patient warm so as to prevent the fall of temperature below the normal point.

7. When the skin is broken the wound

should be promptly covered with a clean absorbent dressi ng. Should the wound be poisoned, it is mos't impo rtant immediately to prevent the poison permeating the system.

8. Poisons swallowed should be got rid of, or when that is inexpedient, neutralised .

9. The best means of transport must be studied, and provision made for proper care when the patient is brought to shelter. .

10. Removal of Clothing. -Clothes should not be taken off unnecessarily, but when it is needful to remove them, the following rules will be found of service in serious cases :-

COAT: Remove from the sound side first, and, if nece sar)" slit up the seam of the sleeve on the injured side.

SHIRT AND VEST: lit down the front and remove as the coat.

TROUSERS: lit up the outer seam.

BOOT : lit the back seam and undo the laces.

OCK: Cut off.

II. Stimulants. - I t is incorrect to suppose that alcohol is the only form of stimulant, and far too frequent use of spirits is made to restore a patient after an accident, often with seriou results ' the safest rule, therefore, is to defer the administration of alcohol until the arrival of a doctor. "When the patient is able to s\\'allow, strong tea or coffee, or milk, as hot as can

be drunk, or a smn.ll quantity of sal volatile in water may be given . S melling salts may be held to the nose . 'prinkling the face with cold and hot "ater alternately, warm th applied to the pit of the stomach and over the heart, and vigorous friction of the limbs up\\'ards have a stimulating effect.

12. Throughout his work the First Aid student must on no account take upon himself the duties aI).d responsibilities of a Medical man . At times an apparently slight injury is accompanied by grave danger and may actually cause loss of life . ' Vhen sending for a doctor, state the nature of the case, and remem ber that" ritten particulars are safer than a verbal message.

It is necessary that something should be kno\yn of the structure of the body (elementary anatomy), and of the functions of some of the more important organs and systems (elementary physiology). A short description of the necessary anatomical and physiological points is therefore given as the se,-eral subjects are discussed. For purposes of description the human body is supposed to be erect, with the arms hanging by the side and the palms of the hands directed forwards. The" middle line" of the body runs vertically from the top of the head to a point bet\veen the feet.

21

QUESTIONS 0 ... T CHAPTER 1.

Tile JIIollerals illdl··ate the pages 7.illle} e tile answers 11,llY be foulld.

"\'hat is First Aiel to the injured ?.. ..

What qualities hould the First Aid student possess?

"\\ hat are sign ?

"\'hat are symptoms? ,

\\'hat is the history of a case?

\\'hat is uften the first thing to do in an accident?

\\ hat of injury must receiYe the lir t attention? , .

\\ hat three things are absolutely neces ar}' to an injured person? '.. ..

\\ hat must be done" hen the sl,in i!; brohen?

lIow must poisoning be treated? ..

\\'hat step.:; mU .t be taken beyond the actual treatment of inJuries? ..

Should clothing ahlays be remuved? ..

lIow would you re111o\'(' cluthing II hen necessary?

Explain the u e and abuse of timulants ... ..

"\\ hat mu t the First "-\iu student not do ? , 19,20

\\'hat is elementary anatomy?

What is elementary physiology? '"

For purposes of de cription how is the human cody s\lpposed to be plr.ced? ...

CHAPTER II .

FR ACTU RES, DISLOCATIONS, SPRAINS AND STRAINS.

THE KELETO T.

The human body is moulded upon a bony framework (the skeleton) which sen'es-

I. - To give shape and firmness to the body.

2.- To afford attachment to the muscles.

3,-To protect important organs, as in the skull, chest, and abdomen.

TH E KULL.

The Bones of the Skull are arranged in two groups, those of the brain case or cranium, and those of the face.

The Boundaries of the Cranium are the vault or dome, the rounded portion forming the top of the head; the front or brow; the back of the head, where the greatest extent of brain exists, and where therefore the cranium is widest and deepest; the sides or temples. The base of the cranium is hidden from view by the bones of the face and of the vertebral column' in it are numerous perforations for the passage of blood and. nerves; through the largest opening the bram and spJl1al cord are continuous.

The Bones of the Face with the exception of 23

the lower jaw are firmly jointed together, so that movement between them is impossible. The cavities of the nose and of the eye sockets (orbits) are formed by the bones of the cranium and of the face conjointly. The mouth cavity is formed between the upper and lower jaws, the palate being the bony roof of the mouth which separates it from the nasal cavity above.

The Lower Jaw consists of:-

(a) A horizontal portion in which are the sockets for the teeth.

(b) Vertical portions term inati ng on either side at the joint between the lower jaw and the base of the cranium, situated immediately in front of the ear.

The angle of the jaw indicates the junction of the horizontal and the vertical portions.

THE B.\CK-BOXE, P[l'{E, OR YERTEBRAL

The Vertebral Column (Fig. 1 ) i composed of bone called vertebrre, each of which consists of-

I.-A body or bony mass in front.

2.-Proce se projecting backwards, which enclo 'e a canal for the spinal cord - the spinal canal.

3.-Two tran \'er e processes, tweh'e pairs of which support the ribs.

'. CANAl. FOR • SPI!\AL CORD.

BODY OF VERTEBRA.

FIG. 2A.

__ " TRA:-.1S\ ERSE PROCESS.

..PROCESS.

Ul'l'ORTING HEADS OF RIBS.

FIG. 2B.

Co. 4

SKULL AND YERTEBRAL

Showing left rils and portion of breast bone. The right riLs are removed.

25

4.- A spinous process. The spinous processes of the vertebrre can be felt beneath the skin for the whole length of the back (Figs. 2A and 2B).

The Vertebrce, 33 in all, are grouped into regions, in each of which they are known by numbers, counting downwards :-

I.-In the neck 7 Cervical vertebrre. The first vertebra, tile atlas, forms a joint with the base of the skull, at ,,,hich the nodding movement of the head takes place; the second, tile ax/s, by the j oint between it and the atlas, allows of the side-to-side movements of the head.

2.-In the back 12 Dorsal ,-ertebrre.

3.-In the loin 5 Lumbar vertebrre.

4.- The rump-bone, or "aerum, consists of 5 <1.cral,'ertebrre united in adults as a solid mass.

5.-The tail-bone, or Coccyx, consists of 4 vertebrre joined together to form a single group.

Between the bodies of the vertebrre, in the upper three regions, are interposed thick pieces of cartilage (gristle), which, "'hile they bind the bones together, allow of free I11m-ement to the column a a whole, and help to break the shock of any sudden force applied to the spine (for example, ,,,hen falling from

a height on the feet). The whole spine is strapped together by ligaments reaching its entire length.

THE RIBS AND BREAST-BONE.

The Ribs consist of twelve pairs of curved bones extending from the dorsal vertebrre to the front of the body, and are known by numbers-fir t, second, etc., commencing from above. The ribs are not bony throughout their entire length, but at a short distance from the front the bony material end, and cartilage takes its place. The upper seven pairs, named the true ribs, are attached by their cartIlages to the Breast-bone (sternum), a dagger-shaped bone with the point downwards, just over th e pit of the stomach. The lower five pairs are termed the false ribs, as their cartilages fall short of the middle line. The eleventh and twelfth pairs are termed the floating ribs, as their ends are free in front. The ribs enclose the chest, and serve to protect the lungs, heart, liver, stomach, spleen, etc.

THE UPPER LnrBs.

The Shoulder · bones are the Collar-bone (davz'de) and the houlder-blade (scapula).

The Collar-bone can be felt on either side beneath the skin at the lower and front part of the neck as a narrow curved rod about the thickness of a finger. Its inner end rests on the upper part of the

FIG. 3A. BONES OF THE U:FT UPPEP_ LDIB.

FIG. 3B.

HOWT); G THE POSITION OF THE RADIUS A);O ULNA \YHE); THE IS TUR);ED I);\\'ARDS. Compare Fig. 3A, in which the thumb is turned outwards.

P ART OF COL! . AR BONK

BLADE (SCAPULA)

(HUMERUS)

2 breast-bone, and its outer end joins with the shoulderblade.

The Shoulder-b lade lies at the upper and outer part of the back of the chest, and forms joints \\ ith the collar-bone and the bone of the arm.

The bone of the Arm (llltl/lei'lIS) reaches from the shoulder to the elbow.

In the Forearm are two bones, the Radi u s on the outer, or thumb side, and the U lna on the inner, or little finger side. Both bones reach from the elbow to the wrist, and they change their relative position with every turn of the hand (Figs. 3A and 3 B ).

The Hand is composed of-

I.-The bones of the wrist, or carpus, eight in number, arranged in t\\ 0 ro\\ s of four.

2.- The metacarpus (the framework of the palm) ,; five bones which form the knuckles and support the bones of the fingers.

3·-The phalanges, or finger-bones, three in each finger, and two in the thumb.

THE PELVIS AND LOWER LDIBS.

The Pelvis. - The large basin-like mass of bone attached to the lower part of the spine IS composed of the two haunch-bones and the sacrum. The haunchbones meet in front (at the pllbes) in the middle 11l1e, only a small piece of cartilage interi'ening, but behll1d, the sacrum is placed between them. The· pelvis

4.

BONES OF THE RfGHT LOWER Ln[B, SHO\\,ING JOl;\'T WITH THE PELYIS AT THE HIP.

---.-5,,,, Bo» IT ,,) ./TARSUS.

FIG.

PRLVIS.

B O;';E (FEMeR).

KNEE c... P (PATELLA).

BROOCH ilONE (FIBULA).

30

s u pp orts the abdome n a n d its contents, and provides the de e p sockets for the thigh-bones-the hip joints.

T he Thigh-bone (femur) reaches from the hip to the k n ee joint. I ts shaft is stout, rounded, and a r ched forwards; the u pper end presents a rounded head, supported on a neck \yhich projects inwards, to fit into the socket of the hip joint.

The Knee-cap (patella) is a tri a ngular bone lying with its base up" ards in front of the knee joint immediately beneath the skin.

The bones of the Leg are the Shin-bone (t/bI'a) and the Brooch-bone (fibllla). The Shin-bone extends from the knee to the ankle, in coth of \\ hlCh joints it plays an important part; its sharp edge, the slzz'n, can be felt immediately beneath the skin of the front of the leg. The Brooch -bone lies on the outer side of the tibia. It does not enter into the formation of the knee joint, but its 10\\ er end fom s the outer boundary of the ankle joint.

The Foot is composed of--

I.-The ta rs itS, a group of seyen lrregular bones at the mstep. The largest is the heel-bone, and the uppermost (the ankle-bone) forms the lower part of the ankle joint.

2.-The metatarsus, the five long bones in front of the tarsus \\ hich support the toes.

3·-The phalanges, or toe-bones, two in the hig toe, and three in each of the other toes.

3[

JOINT

A Joint is formed at the junction of two. or more bones. In moveable joints such as the hlP, knee, elbow, etc., the surfaces of the bones are covered by cartilage, which lessens friction and the shock of a

6.

LEFT A;;KLE.

FI r; . 5. Compare Fig. 4, Page 29·

fall. Lubricaung the jOlllt is a clear, rather .sti.cky fiUld, the" joint oil," or S),11 0 7}/a enclosed \\'l.thm a capsule. Tying the bones to 'f etber, but allowmg of movement, are a number of bands or To explain the formation of lImb Jomt, tbe

FIG.

ARTERY VEIN

MUSCULAR TISSUE

PATELLA

TENDON OR LIGAMENT OF PATELLA

FIG. 7.

SHmnNG RECTUS

MUSCLE OF THIGH, WITH ARTERY, VEIN NERVE.

32 examples are gIven :-

The Shoulder, a balland-socket joint, consists of a shallow socket on the outer angle of the shoulder-blade, and of the head of the arm-bone. (Fig. 5). Owing to the shallowness of the socket the arm-bone is very prone to escape frol11 its socket (dislocate) .

The Ankle, a hinge joint, is formed at the junction of three bones, the shin-bone above and on the inner side, the broochbone on the outer side, and the ankle-bone belo\\'. (Fig. 6).

THE I\1U CLES.

The Muscles of the body are classified into two groups- volulltary and /llVO!t{ II tary.

3 3

T he Voluntary muscles ale met \\ith in the limbs the head and neck, and the surface of the trunk'. Their ends are attached to different bones, and as they pass from one to another they cross a joint, and, being endowed \\ ith the power of contraction and relaxation, cause the moYements of the body. As a muscle crosses a joint, it as a rule becomes a fibrous co:-d or tendon. Blood-vessels traverse and supply the mus and the nerves entering them bring them under the direct control of the brain and spinal cord.

The Involuntary muscles are met WIth in tl e walls of the stomach and intestines, in the air passages, and in most of the internal organs and blood-vessels, also, in a special form, in the heart. They are not under the mfiul nee of the wIll, but continue their \\ork dunng the hOUIS of sleep; their functions are regulated by a sE'parate set of nerves (see ympathetic 'y tem, page II 0.

FRACTURES :-\1 D THEIR TREATMENT.

When a bone breaks a Fracture is said to cccur.

CAU E OF FRACTURE.

I. Direct Violence .- When from a se\'ere blow, impact of a buIlet, cn sh of a wheel, etc., a bone breaks at the where the force is ar plied the fracture is termed direct. a

34-

2 . Indirect Violence. - When the bo ne breaks 'at some d istance from the spot \\ here the force IS app li ed th e fr acture,is termed, in direct. Alighting on th e fee t a nd fr acturI n g the th Igh-bo ne or the bones of th e leg, or falli ng on the ha n d a n d breaking the radi us or the collar-bone, are examples .

3. Muscular Action. -The knee-cap and the a r m-bo ne are occasionally broken by a violent contractio n of the muscles attached to them.

V.\RIET[FS OF FR.\CTURES .

Fracture are classified according to the condition of the tissues adjacent to the bone as follows ;, ,1. Simple. -The bone is broken \\ilh but slight Injury to the surrounding parts,

2. Compound. - The bone is broken and the skin tissues are punc'tured or torn, thus allo\\l!lg dIsease-producing germs to obtain entrance to the seat of fracture, The fractured ends may protrude through the skin, or (for example, when a bone is broken by a bullet) the wound may lead do\\ 11 to the fracture.

3. Complicated. - The bone is broken and in additio n there is a n injury to some internal organ (for the brain, spinal cord, lu ng, etc.) or to some Importa n t blood-vessel or nerve.

A may be compound or c omplicated as the Immed Iate result oi the injury; or a fracture, 35

origil13,lly simple, may be converted in to a compound or complicated fracture-

(aJ By careless mO\'emellt on the part of the patient.

(b) By carelessne s or ignorance on the part of on e ren lerin rr fir. t :lld.

p::!cial vari 'tiCS offr<tctures may be claSSified according to the injury to the bone Itself as follo\\s;-

1. Comminuted. - The bone is broken into several pieces .

2. Green-st ick. -In children, 0\\ ing to the state of thc bony ti. SUeS, a bone may bend and crack \\ ithout co,nplctely

3. Impacted. - Th!.; bJ'l)ken ends of the bone are dri\'en one into the olher.

GE:,\ERAL A:-\n ,'\'\[l'TO:\l \\ HICH :\IAY BE. PRI . [. '\1.

(A fracture of the [em ur, humeruc;, or both bones of the forearm or leg, afford the' most complete example).

1. Pain at or near the seat of [racture.

2 . Loss of Power in the limb.

3. Swelling about the seat of fracture. welling frequently renders it difficult to perceiYe other signs of fracture, and care must therefore be taken not to mistak e a fracture for a less serious injury.

4. Deformity of the limb.-The limb ass u mes a n

unnatural position, and is mis-shapen at the seat of fracture. The contracting muscles may cause the broken ends of the bone to override, thereby producing shortening.

5. Irregularity of the bone.- If the bone is close to the skin the fracture may be felt, and if compound it may be seen.

6. Unnatural Mobility. -l\IO\·ement may be made out at the seat of fracture.

7. Crepitus, or bony grating, may be felt or heard when the broken ends moye one upon the other.

The last two signs sizollid Oll/.Y be SOl/gilt by a doctor.

Several of the aboye signs are ab ent in green-stick and impacted fractures.

In addition to the igns and symptoms tIle patient or the bystanders may be able to giYe the history of the injury, and marks on the clothing or skin should be noted, as they may serYe to locate the fracture. The snap of the bone may haye been heard or felt.

ApPARATUS FOR TREADrENT OF FRACTURES.

Splints and bandages for First Aid frequently ba\'e to be improvised.

A Splint may be impro,·ised from a walking stick, umbrella, billiard cue, broom or brush handle, policeman's truncheon, rifle, folded coat, piece of wood, cardboard, paper firmly folded, a rolled-up map, or, in fact, anything tlzat is firm and lONE?," enough to keep

the jOl·nts above and below the fractured bone at rest. \Vhen the above appliances are not available, the upper limb, if fractured, may be tied to the trunk, and in all cases a fractured lower limb should be bandaged to its fellow.

Bandages may be im provised from handkerchiefs, belt, straps, braces, neckties, or any piece of linen; calico, string or cord that comes to hand.

Esmarch ' s Triangular Bandages (Fig. 8) are made by cutting a piece of linen or calico about forty inches square dlagon.l.lly into b\ 0 pieces.

The broad bandage is made by bringing the pomt down to the base (Fig. 9), and then folding into t\\O (Fig. 10).

The narrow bandage is made by folding the bro .l d I a·1lbge once II).

The medium bandage i made by bringing the pomt down to the ha'>", and then folding into three. (Fig. 12). This banuage may be useu instead of the bro:l.d or [he narrow hJndage when it is better s'lited to the proportions of the patie nt.

It is sometimes advisable to halve the size )1 the b:llld8ge by l>ringing the l\\ 0 ends together before folding it into the broad, narrow, or medIUm bandage.

When not in use, the triangular bandage should Le fold ed narrow; the t\\ 0 ends should be turned to the centre , and the bandage then folded into four, reducing it to a packet about 6! inches by inches.

39

Large arm -slin g (Fla. 13).- pread out a bandage, put one end over the shoulder on the sound side, pass it round the neck so that it appears over the shoulder of the injured side, and let the other end hang down in fronl of the chest; carry the point behind the elbow of the injured limb, and bend the forearm

FIG. 9. BANDAGE Ol\'CE FOLlJl<..ll.

FIG. 10 BROAD BANDAGE. NARROW BANDAGE.

FIG. 12 . - THE DOTTRD LlNFS SHOW THE FOLDS OF THE 1\lEDlUl\I :J'3A:-'DAGE.

FIG. 13. FIG. 14. over the middle of the bandage; then carl) the econd end up to the first and tie them; bring the point for\\'::1.l'd, and secure \\ ith two pins to the front of the bandage.

Small arm -sling (Fig. I4).-Place one end of a

40

b road. bandage over the shoulder on the sound sid-) pass It round the neck so that it appears over the shoulder of the injured side; place the forearm over the middle of the bandage; then bring the second end up to the first, and tie them. Th is sling is used in cases of humerus, and occasionally when the large slmg would be too conspicuous.

Slings may be improvised in many simple ways, such

as pinning the sleeve to the clothing, turning up tI,e tail of the coat, passing the hand inside the buttoned coat or waIstcoat, etc.

Reef Knots (Fig. IS) are to be useJ. Avoid granny knots (Fig. 16).

GENERAL RULES TO BE OB ERVED THE TREAT.\IE:,rl' OF FRACTURES.

The object of First Aid o.f Fractures is to guard again t further mIschIef, especially to pre\ ent a simple becommg compound or complicated. To attam thIS end :-

1. Attend to the fracture on t he spot. No matter how ero\\ ded the thoroughfare, or how short the distance to a more convenient or comfortable place, no atternpt must be made to mo.ve the patient until the limb has been rendered a. Immovable as possible by splints or other restraining apparatus.

2 . Steady and support the injured limb at once, so that its further movement on the part of ei ther the patient or the bystander is prevented.

3. Straighten the limb with great care , and if shortenm a is ob en'ed in the case of a fracture of a bone of tJ1e lo\\er limb, pull upon the foot until the limb rerrain a more normal length, \Vhen the sh8pe of theb limb is on no let .go until it is secured in pOSItIon by splll1ts, otherWIse there is great danger of the fracture becoming compound or conap icatec\,

4. Apply splints (when practicable) and bandages as fol1o\\s:-

(a) The splints must be firm, and long enough to keep the joints immediately above and

FIG. I 5.-REEF KNOT. FIG. J6.-GRAN·Y KNOT.

42

the fractured bone at rest They shou ld, if practIcable, be padded to fit accurately to the limb and be applied over the clothi ng .

(b) The ban.dages must be applied firmly, but not so tlghtly as to constrict the circulation ?f blood in the limb. \ Vhen the patitnt IS 111 the recumbent position douhle Ule bandage over a splint to pass it umIer the trunk or lO\\'e r limb . A s a general rule:-

For tlze trunk the broad bandage hould be Pass i t once round the trunk fasten it by tying the .ends, or ith t\\() or three safety pm s on the SIde opposIte to the fract ure but if to secure a splint for a broken thillh 'orer the splint.

b ,

For the arm or fonarm the narrow bandage should be used . Pass it twice round the limb, a ? d tie the ends oyer the outer splint.

For the Ihlgll or leg the narrow or medium may be used. It is frequently co nvenIent to double the bandage at the cent re, pass it under the limb, bnng the loop over the lim b, pass both ends of the Landa.ge through it in oppo ite dIrections, and them over the outer splint (Fig. 17).

In app lymg bandages near a fracture the upper one sho uld be fi rst.

43

When accompanies a fracit mu t be atte n ded to first , and th e wound c over ed by a clean dressi ng.

FIG. I7.

6. No attempt must be made to remove a patient suffering from a f:acture of the spine, pelvis, or thigh , except in a recumbent p03ition preferably upon a stretcher. . .

7. In every case of fracture 1t 1.S necessary to cover the patient to keep h1m w .arm , and so les en the effects of the SHOCK of the aCCIdent.

8. In all doubtful cases, treat as a fracture.

:1'I-.C 1AL FRACTURES.

Fracture of the of the upper part is usually caused by direct Violence-for example, a blow ?n the.head. A fracture of the base is caused by indirect VIolence, through a fall on the

4-1

head, a fall on the feet or lower part of the s . or a severe bl pine, art . 0\\' on t?e lower jaw. .If tllf! upper p zs fractured, . the are S\\ elling, irregularit ' and . frequently msenslbIllty, either immediate commg on gradually. .If tile base /5 fractured insensibility may come on immediately, blood or a clear fluid may i. sue from the ear challnel blood may escape fron; the nose, or it may pa s dO\\'n to the stomach \\ hence it may be the fracture moly the orbit, cn.usmg a eye.

TREAT;\fENT.

Injury to the brain is the grea[ danger n.ttlndFIG . 18. ing a fracture of the cranium. For tr ea tmlnt

C. see "Concu sian and ompresslOn of the Brain " pages I" I "?

Fracture of the Jaw .) I f . (. bT . am, oss () po\\e\ I Ity to speak and to move the jaw freely) anty of the teeth, crepitus and bleeding fro ' t e gum are the usual signs and symptoms. m

TRF:AT;\IE:--IT.

I. - Place th e palm of the hand below the injured bone and press it gently against the upper jaw.

2. Apply the centre of a narrow bandage under the chin, carry one end. over the head, c rosS the ends at the angle of the jaw, carry the long end across the chin, and tie the ends on the side (Fig. 18).

Fracture of the Spine. - The vertebral column may be broken either by direct or indirect violence. Falling from a height on the back across a bar or upon an une\'en surface is an example of direct fracture, and a. fan on the head, causing a b.roken neck, is an example of ind.irect violence. \Vhat is commonly regarded as a broken ba k consists of a fra.ct ure of one or more of the yertebrce WIth displa.ccment of the fragments, whereby the spinal cord and. the ner\'e issull1g from it may be torn, causing complete or partial paralysis of the parts below the fracture. Pain IS present at the seat of injury .

TREAT:'!F.NT.

I.-Prevent all movement o n the part of the patient.

2.-Cover the patient warmly.

3.-To remove the patIent, place him on a stretcher or shutter as fo11o\\s:(a) Turn up the collar of his coat· roll up a stick or umbrella in each side of the coat

46

s? that the ends are le\'e l \\ Ith the top of hIs pass a broad bandage or handkerchelf under the head ano secure it to the ,sticks, If no coat IS \\ om, or doubt as to ItS strength and length exists, pa s a of bandages under the patient to sen'e Instead of, or in additIon to, the coat.

(b) A on each side gra ps the rolled coat \\Ith hIS hands \\ell apart; a third grasps the c1othll1g on both sides on a level \\ ith the hips; a fourth bearer takes cbarge of the legs.

({) On the word being, given, all lift together and carry the patIent by short . ide paces oyer stretcher alld carefully 10\\ er him on to It. If a fifth bearer is ;1\'aila hIe the should be passed under the pati e nt ll1stead of carrying him over it.

4·- On arrival at shelter nothing further is to be the arrival of a doctor, except to give the patIent \\ater, tea, etc., if he is conscious.

Ribs. - The ribs usually fractured are the sixth, eighth, and ninth, and generally the fr,:cture IS mIdway bet\\'een the breast-bone and spme. The fracture may be caused by indirect VIOlence, driving the fractured ends of the bone outwards, or by violence, driving the fractured ends of the bone lI1wards and sometimes injuring the

47

hll1,rc; or other internal organ. If the lower ribs on the sit.le arc hroken, the llyer may be injured, and fracture of the 10\\ er left ribs may wound the spleen. Evicience of the fracture is afforded by pain, e pecially on attern ptll1g to take a deep breath, and by short and. hallow brcathinrr. If the lungs :uc inblood, an I hriuht red, may be up an 1 c,>;pectnrated. If th c li\'c r or spleen is wound ed Il1ternal hc::emorrhag c (sec page 95) may occur.

TR F:.\ nfF"r.

(a) rnlt'll tlle/radllre /s J/O! ((Jmplimtul aJl injltry to all /"terl/a! organ :-

I.-Apply two broad handages round FIG. 19. the chest sufficiently firmly to afford comfort, \\ ith the centre of the first immediatel\' abo\'e and that of the second immediatel)1 belo\\' the fracture. The lower bandage hould overlap the upper to half its

48 extent. The knots are to be tied rather to the front on the opposite side of the body. Another good plan IS to apply a strong towel, folded about eight inches "vide, tightly round tl:e chest, securing it with three or four safety pms.

2.-Plac e the arm on the injured side m a large sling. (Fig. 19 ).

(b) Tram all inferllalorgan zs z'lljurcd-

I.-Do not apply bandages round the chest.

2.-Lay the patient do\\n, inclined a little towards the injured side.

3·-Loosen the clothing, give ice to suc k , and place an ice bag oYer the scat of injury. Treat as for internal hremorrhage (see p:lge 95).

4·-Place the arm on the injured side 111 a large sling.

Fracture of the Breas t -bo ne (sterlllllll).\Vhen this fracture can be felt or is suspected undo all tight clothing, and keep the patient quiet in an easy position until the arrival d a doctor.

FRACTURE OF THE BONES OF THE UPPER LIMB.

Fracture of the Co ll a r-bo ne (da'Zl/de).-This fracture is frequently caused by a fallon the hand or shoulder.-The arm on the injured side is partially

4Y

helpless, and the patient u"ually supports it at the elbow with his hand, and inclines his head towards the injured side. The fractured ends can generally be felt to overlap, the outer fragment being the lower. The general signs anJ symptonls of fra c ture are mostly present.

l.-Remove the coat (see page 19), and as much more of the clothing as is expedient .

2.-Pl.tce a pad about t\\·o inches thick and four inches across in the armpit.

3.-Gently bend the forearm well up, keeping the shoulder as far back as practicable, and support it in a" t. J ohn" sling, made as fo lIo\\' :-

(a) Lay an unfolded bandage acros the chest over the injured limb \\ith one end on the uninjured . houlder and the point beyond the elb)", en the injured side. (Fig. 20).

(II) Pass the 10\\ er end of the bandaae under the injured limb, acros the back,oand tie the ends some\\ hat loos ely in the hollow in front of the ollnd houlder.

(c) Fold the point oyer the elbo\\' of the injured limb and secure it by one or t\\0 pin (Figs. 21 and 22;.

4·-Tightly secure the injured limb to the side by a broad bandage passed round the elbow and trunk, so as to lever out the shoulder, the pad forming the fulcrum.

S.-No\\ tighten the sling.

'Yhen both collar - bones are broken keep the

F IG. 21

(Body handage omitted to show details of Sling.)

shoulder back by llarro,,' bandages tied round each arm, close to the shoulder, passed across the back, m'er the opposi te arm and tied together in front. The forearms should be raised and supported by the bandages . (Figs. 23A and 23B).

Fracture of the Shoulder-blade (scapula).-

Apply the centre of a broad bandage in the armpit of

FIG. 23 A.

FIG. 23 B.

the injured side, cross the ends oyer the uninjured

53

mu st on no account be so as to press upon th e blood-vessels at the elbow joint.

3. -Secure the splints by bandages above and below the fra ct ure. If splints are not availabl e, secure th e arm to the side by two broad band1ges.

Fracture of the Arm

FIC. 24. shoulder and tie them under the armpit. upport the limb in a St. J ohn sling (Fig. ).

(/llImerlls) . - The bone may be broken :- (a) Close up to the shoulder; (/I) near the middle of the shaft; (t:) close to the elbow.

All the general signs and symptoms o f fracture are usuall y present.

IVhen the Fradllre is dose to tile Sizollider-

I.-Apply a broad bandage with its centre above the middle of the arm r ound the limb and body, tying it on the opposi te side.

2.-Support the forearm by a small arm sling. When the Fradure is Ileal' tile .Aliddle of Shaft-

I. -Bend the forearm at a ri ght angle to the arm.

2.-Apply splints, reaching from the shoulder to the elbow on the outer and inner sides of the arm, and, if enough can be procured, to the front a nd back also. The front splint

4. - upport the forearm by a small arm sling. (Fig. 25).

Fractures involving the elbow joint, whether of the arm or forearm, are attended with so much swelling, and it is 0 difficult to ascertain the exact nature of the injury, that \\ hen the accident occurs indoors the Ii mb should be laid upon a pillow in

FTC. 25. thE' most comfortable position; ice or cold water dressings should be applied to the injured part, but no further treatment should be attempted pending the arri,-al of a doctor.

T-V1Zell tile accidellt OC{l{rs 0111 of doors-

1.-Take two pieces of thin flat wood, one long enough to reach from the armpit to below the elbow, the other long enough to reach from above thc elbow to the finger tips; tie them togcthcr to form a righ t angle. (Fig. .:,"" 26).

FIG 26.

55

ju l abovc the \\rist is a cOlTJmon result of a fall on thc band.

This is the s:lm<.:, \\ hether tbe fracture is of one bone or of both.

1.- Bcnd the forearm at righ t angles to the arm,

2.-Apply the angular sp'int so made on the inncr side of the flexed limb.

3. - Secure by bandages above and below the fracture.

4.- upport the limb hy a large arm sling.

s.-On arrival at home remo\'C the splint. and treat the injury as if it had occurred indoors .

Fracture of the Forearm. - 'Vhen both bones (the Radius and "clna) are broken, the general signs and symptoms of fracture are usually present. 'Vhen one of the bones only is broken the signs and symptoms are as a rille pain, loss of pO\\'er, swelling, and irregularity. An imparted fracture of the Radius

FIG. 27.

FIG. 28. keeping the thumh up\\ards, and the palm of the band to\\ards the bod\. -Apply broad s'plints on the inner and outer sides from the elbo\\ to the finger.

3·-i\pply bandages. em bracing both splll1ts, immediatel\' abore r nd I elow the fracture and round the hand (Fig. 27).

4.- A pply a large arl11-SI111g.

C r ush e d h and (frac t ure (f the bones of the (arpus, metacarpus, or fingers).

'l'RLXL\lh1\T.

I.-Apply a Gtrefullr padded splint to the front of the hand, reaching frolll \H.!ll above the wrist to beyond the tips of the finger!::>.

2.- To secure the splint apply a narrow bandage crossed in the mannel of the figure 8 to the wrist and hand ( F ig. 28).

3. - Apply a large arm-sling.

Fracture of the Pelvis. - 'When, after a severe injury in the nei gh bourhood of the haunch-bone, there is no sign of damage to the lo\\er limbs, but the p3.tient is unable to stand or even to move the lower limbs without great difficulty and pain, a fracture ot the pelvis may be assumed to have occur red . The blooi-vessels and organs, especially the bladder, within the pelvis are in danger of being wounded.

TREATMENT.

I.-Lay the patient in whatever position is found to give the greatest ease, and flex or straighten the lower limbs as the patient d esi res.

2.-Apply a broad bandage round the hips tight enough to support the parts, but not so tight as to press the broken bone further inwards.

3.-To remove the patient place him on a stretcher, acting on the same principle as that described under " Fracture of the Spine 1/ (see page 45).

FRACTURE OF THE BONES OF THE LOWER LIMB.

Fracture of the Thigh-bone (femttr).- The thigh bone may be broken at its neck, anywhere in the shaft, or close to the knee. A fracture at the

neck is likely to occur in old people from yery slight injury, and is ofte n difficult to distinguish from a severe bruise of th e hip, but it may be assumed that when, after an injury near the hip joint, the patient cannot, when lying o n the back, raise the 11cel from the ground, the bone i broken. All the general signs and symptoms of fracture are usually present, and a prominent sign is the position of the foot,

which, as a rule, hes on its side. Shortening may yary from one-half to three mches.

TREAT rE i T.

I. -Steady the limb by holding the f?ot.

2.-Gently draw down th e foot and brIng ]t mto line with its fellow. 'When two or three assi tants are at hand, it is one person's duty to hold the f ot in pos ition until the splints a re secured.

3.-A pply a sp:int on the outer side from the armpit to beyond tl-:e foot.

FI G. 29.

58

4.-Apply a splint on the inner side from the top of the thigh (the fork) to the knee.

5.- ecure the splints by b::mdages as follows :(a) Round tbe chest just b e low the armpitf':) (II) round the pelvis on a le\'cl \\ith the hip jointf': , (r) aboye

FIG. 30.

the fracture, (d) below the fracture, (e) round the leg, (/) round both ankles and feet, and tied below the feet, (g) a broad bandage round both knees (FIg. 29).

\Yhen single-handed, or \\ hen the patient is a woman, it is exp dient, after extension (f tbe lim b, to tie the feet together, dispens "ilh tbe inner splint, and Tass tIle bandages round both limbs (Fig. 30).

Fracture of the Knee-cap

(patella).-The knee-cap may be

FIG. 3 r. broken by falling on the knee (direct violence), but more frequently it is broken by muscular action, as follows :-

59

When the fOJt slip'" in the attempt to prevent a fall the muscles in the front of the thigh act with such force as to snap the knee-cap in two (Fig. 31).

Pd. 111 , 10 s of p wel' (the limb will quite helpless ), and irregularity (a gap may be felt between the broken frqgments of bone) accompany this injury.

I.-L1.y

011 his back, raise \Yell and support the head and shoulders, straighten and raise the limb.

2.-Apply a splint along the back of the limb, reachin a from the buttock to beyond the heel.

3.- .Xpply a narrow bandage its centre imme-

diately above the knee-c8p, cross the Ends behind over the splint, and tie in front below the broken bone. To ensure firmness apply a second bandage ' 1n a similar way, but commenced below and tied a bove the broken bone.

4.-Further secure the splint by bandages round the thigh and leg.

5.- Support the foot \\ ell off the ground by a pillow, roll of clothing, etc., or if none of these :lre 2.t hand by resting it on its fello\\ (Fig. 32).

6.-Apply an ice bag or a cold \\ater dressing over the fracture.

Fracture of the Leg (tiNa and jiblt/a).- One or both of the bones may be broken. \Vhen both bones are broken all the general signs of fracture are usually present, but \\hen one bone only is broken deformity is not always noticeable. A fracture of the fibula three or four inches above its lower end is frequently mistaken for a sprain and sometimes for a dislocation of the ankle.

TREATMENT.

I.-Steady the limb hy holding the ankle and foot.

2.-Draw the foot into its natural position, and do not let go until the splints have been fixed.

3.-Apply splints on the outer and inner sides of th e leg, reaching from above the knee to beyund the (. 1

foot. If only one splint is available place it on the outer side.

4.- ecure the splints by bandages (a) above, (/1) below the fractur e, (r) immediately above the knee,

3+.

(d) round b oth ankles, (e) a bruad banda ge round both knees (Fi g. 33) ' \Vhen singl e-handed, or when the patient is a

FIG. 3J.

FIG.

62

woman, after extending the limb tie both feet together, dispense with the inner .splint, and pass the round both limbs (Flg. 34 ). 'When no splll1t 1S availabl·e tying the legs, ankles, and knees tot. ether is of areat sen"ice.

Crushed Foot (fracture of the tarsus, metatarsus and toes).- This accident is commonly caused by the passage of a heavy \\eight over the [cot, and may be recognised by pain, S\\ elling, and loss l [ 1 0\\ r

FIG. 35.

4.-Support the foot in a

TREA ' I J\lEl'\T.

I.-Remove the bool ( ee page 19).

2.-A ppl)' a wellpadded splint to thc 'o le of the foot, re ach ing from the heel to tl'c toes .

3·-Apply a bandage crossed aft r thc J1'3nn([ of the figure 8 (Fig. 35). slightly raised posit) n.

DI'LOCATIONS.

A dislocation is the displacement of one or more of the bones at a joint.

The joints most frequently dislocated are those of the shoulder, elbow, thumb, fingers, and lower ia\",

SIGNS AND OF DISLOCATION.

1. - Pain of a se\'ere sickening character at or near the joint.

2. - Loss of pDwe r in the limb.

3. - Numbn e ss of the parts below the seat of dIslocation.

4. - Swellin g about and below the joint.

5. - Fix ity of th e joint.-The 11mb cannot be moved at the jOl!1t by elther the p.ltient or others.

6. - Deformity of the limb. -The limb assumes an unnatural position, and IS mls -shapen at the joint.

No attempt should bE' made by anyone except a doctor to reduce a di:::,jocation . PendlJ1g his arriyal :-

(a) TTIlell Ille accidellt ormrs 01110./ doorsupport the limb m whatever positIOn giyes most ea e to the patient, bearing in Il1md the necessity of lessening the effects of jOltlllg during tranport.

(b) TJ'h en tile jer/lml z's z'lldoorsthe cloLhlllg from the limb.

2. -PLtce the patH..: nt on a couch or bed.

3·-Rest the limb on pillo\\s in the most comfortable poslLJon.

4·-Apply cold ( ice or cold water) dressings to the J0111t.

5·-\rhen cold ceases to gi,'e comfort apply

warmth (flannels or towel:=. wrung out of hot ,,-a ter).

6.-Treat shock (see page 135).

SPRAINS.

-When, by a sudden wrench or t\\"i t, the s and the parts around a joint are stretched and torn the joint is said to be spraIned. "Going over II the ankle is a common example.

SIGNS AND

I.-Pain at the joint after a t\yist or wrench.

2. - Inability to use the joint.

3. -S\\"e lling and dIscoloration_

TREAT;\[E:-.IT OF SPRAINl:.D A);,KLE.

Jf/J.e?l ottl of doors-

I.-Apply a bandage tightly over the boot, begi nning on the sole a t the instep, crossing it on the front of the ankle, and carrying it round and round the ankle, where it is to be firmly tied.

2.-Wet the bandage after applicaton; it is thereby tightened. readzillg slte/fer-

1.- Remove the boot and stocking (see page 19).

2.-Place the limb in the most comfortable position; usually that is well raised.

3.- A pply ice or cold water dressings to the joint as long as they relieve pain.

4.- \\ ' hen cold fad . to give comfort, apply hot fomentations.

When other joints are sprained, treat them as if dislocated.

When in doubt as to the nature of the injury, treat as a fracture.

TRAIN AND RUPTURED 'CLES.

\Vhen, during severe exertion, muscles or tendor s are over-stretched they are said to be strained, if the y are actually torn they are described as ruptured.

AND Y;'!PTO;'IS.

I.-A sudden sharp pain.

2.-When the mu cles ofa limb are strained they may s\\-ell and cau e severe cramp.

3.-Further exertion is difficult or impossible; for example, if the strain has occurred in the back the patient may be unable to stand upright.

TREAT!\fE TT.

I.-Place the patient in the most comfortable position, and afford support to the injured part.

2.-Apply hot water bottles or hot fomentations when the pain is very severe.

A so-called train in the groin (hernia) is an injury of a totally dIfferent nature ( ee page I q).

QUESTIO ON CH1\PTER II.

Tilt numcrals indirate tllc pages 'where the allS1i.'t'rS lila), be found.

What i the skeleton, anll \\ hat purposes are t.:d by it?

How are the bones of the shill arrangell ?

,Ybat are the boundaries of the cranium? the bones of the face

Describe the lower jaw

What is the angle of the jaw?

\\'hat other names has the back-bone?

,Yhal is a vertebra? ...

lIo\\' many vertebrre are there in the spinc?

" -hat are the regions of the spine, ancl 110\\ 111<\11) \"erlehrze arc there in each? .,

lIo\\" i the spine enc1u\\ed \\ith free muvement?

,Yhat is a l'ib ?

How many pairs of ri bs are there?

,\'hat is the breast-bone? ...

,\'hat are the bones of the upper limbs? ...

,Yhat is the pelvis? , .'

What is the hip joint?

,Yhal are the uone:; of the 10\\ er lim , ..

,Y haL is a joint?

Describe a mo\"Cable joint ...

D escribe the shoulder joint

Describe the ankle joint

ITow are muscles clas:;ifled ?

Describe voluntary mu:;c1es

Describe involuntary muscles

\\'hat is a fracture? ..

\Yhal arc the causes of fracture?

Where does a bone break when direct violel1ce is the cause of fract ure ? . ... ... ... 33

Where d oes a bone break when indirect viulence is the Cause of fracture?

I low maya fracture be cau,;ecl by muscular action?

[n what two ways may fracture:; be classillccl? ..

What is a simple fracture ? ..

\\-hat is a compound fracture?

\\-hat is a c1)mpliL'.lte(1 fracturt.: ?

\\-h,ll is a c Hl1minutcc1 fracture?

the

that

,\'hat fractures a ffu n.l the most c()mplete example of tht.: sign..; and symptoms? ,..

In making up yuur mind whether a fracture had uccurreri or not, what points should you take into considera· _ lion beyond the "igns al1l1 symptom,;? .. , \\ hat apparatus may be neces ary for the treatment (If

fracture,; ? ... ... .., 3b

lTow may splints be improvi-;t:(l ? ... 30, ,,7 lIow may bandage: be impru\'ised? ... ... 3 7

Describe E march's tri?ngular bandage... 37. 3

In \\ hat ways mal the tnangular bandage be folded for UL? 37

JIow many kind..; of arm-slings arc Lhere, and \\ hat arc they called? ......... 39. 40, 49

\\-hat knot is to be tied, and what knot avoided? ... 40

What is the ohject of aid treatment of fracture,,? of t;i'L the general rule for the treatment of fractures 41

][ow should splints be applied? ... ... :.p, 42

TIow should bandages be applied? .. 4 2 , 43

\Yhat may cause a fracture of the upper part of the cranium? 43

\Vhat may cause a fracture of the ba e of the cranium? 43, 44

"Vhat are the signs of fracture of the upper part of the cranium? 44

" 'hat are the igns of fracture of the base of the cranium?

\\'h?_t is the treatment for fracture of the c ranium?

\Vhat are the signs of fracture of the lower jaw?

How maya fractured pine be caused? ...

\\'hat is commonly regarded a. a lJroken lJack? ...

\\'hat are the symptoms of a fm.ct ured !-pine ?

II ow may ri bs be fractured?

How maya fracture of ribs be complicated?

State the igns and symptoms of a imple and of a cumplicated fracture of ribs

\Yhat i a frequent cau e of fractured collar-hone?

\\'hat are the signs and symptoms of fractured coJiar-

bone?

At what points may the bone of the arm he hroken ?

Are the general signs and symptoms of a fracture al \\:1)" present in a broken forearm? ...

State the cause of a common fracture of the radiu s Irow ,,-o uld you recognise a fracture of the pehis?

At what points may the thigh-bone ue broken? ..

\Yh at are the signs and symptoms of fracture of lhe thigh-bone?

" 'hat are the causes of fracture of the knee-cap?

\\'hat are the signs and symptoms of fracture of the kneecap?

Are the general signs and symptoms always present ill a fracture of the leg?

\\'h at mistake may easily be made when the fibula i broken near it:; lower end?

First Aid Students should practise matl'lial, fulding bandages, tying knots, making slings, and the treatment of the folloll ing injlllics.

splints

. m ll! arm sling

Reef and granny knots

Knot for applying splint to lower limb

Fractures Lower jaw, 44. Spine. 45. 46. l{ih-; (simple and complicated fractures), 46 tll 4. Bnastbone, -t ' . Collar-bone, 48 to 5I. Bolh collarbones. 5I. Arm, clo e up to shoulder, 52. Arm, near middle of shaft, 52. Arm or forearm II hen the elbow is involved, 53. Forearm. 55. CIU. hed hand, 55, 56. Peh'is, 56. Thigh (man). 57, 5. Thigh (woman, or man when ;,ingle-handed), 5. Kneecap, 59 , 60. Leg (man). 60. 6I. Leg (woman, or man when single-handed), 62. eru hed fuot, 62.

Dislocations-Out of doors and ind oo rs

THE OF CIRCULATION.

THE organs concerned in the circulation of the blood are the Heart, the Arteries, the Veins, and the Capillaries.

The Heart is situated in the chest behind the bre::lst-bone and rib cartilages, between the lung-s ani immediately above the diaphragm; it lies obliq'.lely with a quarter of its bulk to the right and the rem3.ining three-quarters to the left of the middle line of the body. Its be3.t may be felt just below and to the inner side of the left nipple. The heart has four cavities, two on either side of a central p:utition. The two upper cavities are named the right and left auricles, the two lower the right and left ventricles.

Artenes are vessels which convey blood from the heart. Veins carry blood to the l;eart. apil1arics the arteries and veins.

In general (systemic ) circulation arterial blood IS driven from the left ventricle of the heart into the aorta (the main artery of the hody). From the aorta branch arteries are given off to all rnrts of the body. These divide and suh-divide. 3.nd become so as to assume microscopic dimensions, when they are termed capillaries.

L. Larynx (yoice box); T. Trachea (\\ind-pipt:): R.L. Right Lung; L.L. Left Lung (the lungs are to expose the heart and hlood :vessels) ; .R.A. P. unc}e ; L.A. Left Auricle; R.V. RIght Yentncle; L \. Left \ entricle; P.A. Pulmonary Artery; Ao. Aorta; S. Y.C. Superior yena caya (the large yein carrying blood from the upper part of the body to the heart); LV.C. Inferior vena caYR (the large yein carrying blood from the lower part of the body to the heart). The four pulmonary veins cannot be shown in the diagram.

I n the capilbries an interchange of ga e and fluids t akes place, whereby the nourishment and maintenance of the tissues and organs of the body are provided for , and the blood becoll1es dark and impure.

V e nous blood passes from the capillaries to the veins, which convey it towards the heart, getting brg2r and larger as they proceed by being joined by neighbouring veins until they finally, a two large V2SS2Is, reach the right auricle of the heart. The v2ins, especially in t h2 limb, are provided with valves at frequent inten·a.l, which prevent the back ward fl.)\\, of the blooJ.

pulmonar y syste m of blood vessels is concerned in carryinJ' thv blo.)d through the lungs. From the right auricle the blood passes to the right ventricle and is thence carried to the lungs, where it is purified by contact with air, and becomes scarlet in colour; it i then conveyeJ to the left auricle of the heart and pJ.sses into the left ventr.icIe, thus completing the -circulation.

The heart contracts in adults at an average rate of seventy-two times a minute, bu t the rate varies, increasing as the p)sition is changed from the lying to the sitting or to the standing position; hence the importance of adiusting the patient's position in cases of hceiTIorrhage At every contraction of the left vent r icle blood i forced into the arteries, ca u ing the pulse, wh ich may be felt wherever the finger ca n g e

Ext>iallatioll.- In the middle of diagram is the hea rt with \ its four chambe rs. .A hove the " heart is shown the lung (pulmonary) circulation. The lower part represents the general ( ystemic) cir culat ion. Vessels containing impure (venous) blood ale sh own black, while those containing pure (arterial) blood arc !>hown \\ hile. The connecting vl:ssels represent the capillaries. The arrows show the direction of the flow of blood.

FIG. 3; . DIA (;RAM OF THE CIRCULAT IO N OF THE BLOOD .

p la ced on a n artery as it passes over a bone. I n the vei ns n o pulse is t o be found.

H lEJ\10RRHAGE.

H cem orrhage, or bl eed in g, is of th ree k.i nds :1. Ar terial. 2 . V enous. 3. Caplllary.

ARTERIAL HfEMORRHAGE.

I. - Blood from an artery is scarlet.

2. - If the wounded artery is near the skin the blood spurts out in jets corresponding to the pulsation of the heart.

3. - The pressure point (see below) is on the heart side of the wound.

ARREST OF

Arterial hremorrhage is, when practicable, to be arrested by pressure, position of the body, and elevation 'Of the bleeding part.

Pressure may be :-

I.-Digital -that is, applied" ith the thumb or fingers, and may he ((7) on the wound; (h) at a spot called the pressun' point Th8 pressure points are indicated by n um bered dots on the fron tispiece.

2.- Bya pad and bandage (tourniquet) ((7) on the wound; (b) on the pressur<: point.

3. - By flexion.

To apply a pad and bandage to the wound, place a piece of lint or linen or a clean kmJkcrchief folded inlo a hard pad, on the bleeding point, and secure it by a bandage tightly tied round the injured part. To fold the handkerchief, bring the four corner' to the centre, and re 1leat the process until a hard pad is formed. The smooth surface I::>

75

pbced on the \\ound, and, to prevent the J?a d from unfolding, the puckered surface may be sutchec1 or fixed bv a safety pin . A hard substance, such as a stone' may be enc los ed in the centre of tbe pad.

Amay consist of a pad to be placed on tbe pres. ure point, a strap, or. batlda,r,e to encircle the limb and pad, and a tlgltlt'llLil/{. ment, such as a stick or other means of t\\ Isttng the band to tighten It. .

To improvise and apply a tourmquet.:-

1.- Apply a firm pad on the pressure pomt. . the limb by a narrow bandage mth its centre 0\ er the pad .

., _ Tie the ends of the bandage in a half knot ,). on the opposite side to the pad.

4.-La)' the t\\ i. ting stick on tre half knot, and 0\ er it tie a reef knot.

5.- Twist the st:ck to tigh en the bandage, tbereh} pre. ::ll1g the pad UT on the artery, and arresting tbe Ho\\' of blood.

6.-Lock the stick in' position by 111e ends of the bandac;e already applied, or b) another bandage p'assed round the stick li mh.

The pad of the tourl1lquet must be a(cmately placed upon tbe pressure point so as to compress the artery; othen\ ise arterial blo .d \\ III . be allowed to pass along the lim b, and the veInS, bong compressed by the tourniquet, \\ Jll not allow the

blood to r et u rn through them to the heart, and the res ult will be dangerous swelling and congestion.

Should a s u itable p ad n ot be at ha n d, a knot may be made in the cen tre of the ba n dage, a n d when avai lable, a stone, cork, etc., enclosed in it to give it firmness and bulk. 'ee that the bulging and not the tl. lt side of the knot is next the skin.

An elastic bandage passed tightly round the limb, immediately above the seat of arterial h::emorrhage, will arrest bleeJing. The simplest prepared form of this bandage is a strip of elastic \\ ebbing, twenty-five to thirty inches long and two inches wide, with a piece of tape se\\ n at each end. An elastic belt or brace will serve the same purpose. E:...cept when p :ut of a limb is torn off, it is not ad\'isable to use an elastic cord or bandage if other appara.tus can be had, as it cuts off all circulatlOn in the lim b.

Flexion consist of the application of a pau on the pre sure point at the knee or elbow joint, flexing the limb to make pre sure, and securing the lllnb ll1 the flexed position by a bandage crosseu like the figure 8 .

RULES FOR TREAT:'I[E:'\'T OF ,\ \Yoe::\D

AcCmrPANIED BY ARTERIAL H.E:'IfORRHAGI.

I. Stop bleeding.

II. Prevent injurious germs from getting into the "'ounu.

To attain these ends :-- . . .

1. Place the patient in a sUltabl.e posltion, bearing in mitld that the bl.ood. escapes WIth less force when the patient sits, and IS stdl more checked when he lies down.

2. Elevate the bleeding part, as thereby less bloou finds its \\ ay into it. ,

3. Expose the wound , remo\'JI1g \\ hate\'er clothll1O' is necessary. (ee Rule 8, a.)

4. Apply digital pressure . . (a) If the wound IS . mall on the bleedll1g spot: (lJ) If the wound is large on the POlllt next to the wound on the heart sIde. The nearest pI essure point is . in order to avoid cutting off the clfculatlOn fron: as much of the part a possible, but it is necessary to apply pressure st1l1 neartr to the heart.

5. Remove foreign bodies, as broken gb:-: ' bits of clothing, hair, etc., seen 111 the \\{HInd; to not search for foreign bodies you cannot see.

6. Cover the wound with a clean and firm absorbent dressing. A hard dry pad of boraCIC gauze or lint is to be preferred, but. absorbel:t wool lint, or gauze, or a clean pIece of llllen \\]11 answer the pUI pose. houlcl any be enter· tained as to the cleanline s of the dressll1g, a c!ean piece of unprinted paper, such as the inside ot an

78

e lwe l?p e, should be p bced n e xt th e wou lld before app lym g- tbe p :l.d. (Co mp are pages 75 a n d 76 .)

7· over the pad unless :-

(a ) bou le are :,uspec te d to be lefl unseen I n the wou n d.

(b ) Th ere is d_lI1 ge r of causing i n iun' to a fracture, I n, th ese cases a light dressing' shou ld be app li ed .

8. Apply a pad and bandage or flexion on the point (see Rule 4, b), but only in the followmg cases :-

(n) .A s a t emporary measure "'hile the wound bei ng exposed, examined ancI covered,

(b) A s a more permanent measure when blcecIin<r be stopped by the pad and on the \\ ound, or when, in accor<.hnCl! \\ ifh

7, the tight bandage has not been apph..;d.

9· Afford support to the inj ured part.

. 'When part .of a 11mb has been torn off or the \\ ound IS bcerat,ed (lor example by the clel\\' of an anil11LtI or by machinery) bzemorrhage frequently does not come on at once, but as there is a of sen:]e h<en:lOrrklge means for its arrest should he applied to tl?e lunb, but not tightened lll11ess necessary, not d isturb a clot of blood formed over a \\ ound.

o att,empt s,hould be made to cleanse a \round except wIth stenlIsed \\ ater (that is pre\'lOusly boiled

and allo wed to cool), and experie n ce, lspecially in recent wars, has sho\\ n that those wou n ds '\\ hich \\ ere prOVisionally trea ted \\ith a d r y d r cs!:ii ng a n d suhsequent ly dressed by a surgeon \\ ith prope r Jid best.

tudents practising arrest of arterial hxmorrl1age should feel the pul'3e to see \\ hen the current of hlood in the artery has been . topped, ::'.l1d should tlltn Immediately relax the pressure made on the artery. In this way the importance of the accurate application of pres, ure \\'ill he r{'ali . eel, and the of force necessary will be ascertaincd.

THE COURSE OF THE ARTFRIFS, AJ'D THE .\RRE T OF

(The numbers of the prLc,sure points rcfer to on the Frolltispiece,)

THE L\RGE l\RTl RH-' 'YII HI'l' THE CHEST l\BDcnH. X.

The .i\orta is the central or trunk a.J tery of the bodv. Commencing at the left ventricle it forms an arch behind the upper part of the breast-bone.

From the arch are given off the laroc branches \\ hieh carry the blood to either side of the head and neck and to the upper limbs. The Aorta pas cs down on the left of the spine to just below t he na\'el , where it di"ides into two great branches (t h e il ia cs )

So which co n vey the blood to the organs 1I1 the pelvis a n d to the lower Ii III bs ,

\ Vounds of these arteries are one cause of i n ternal hc:e:norrhage (see page 9 6 ),

ARTERCE OF THE HEAD AND NECK,

The Carotid Arteries (right a n d left) leave the upper p:lrt of the chest and pass up on either side of the windpipe a n d, just below the level of the of the 10\\ er jaw, divide into the Internal and E:\ternal Car0tid Arterie?, The Internal Carotid Artery ascends deeply 10 the neck, and enters the cranium to supply the brain wilh blood , The External Carotid Artery g1Yl: S off a number of branches; to the front the artery of the tongue (Lingual), the artery to the .face (Factal); to the b:lck the Occipital; the artery Itself IS contll1ued upwards in front of the ear where it changes its name to the Temp-wal, and supplies the s -.:alp in the neighbourhood of the temples.

When a Carotid Artery is wounded as in the case of a cut throat, apply the thumb 'of one hand o n the artery at pressure point I pressincr backwards against the backbone and takin'a care avoid the ',>,indpipe, It may also be necessary to apply pressure with the other th um b abO\'e the \\ ound f or t\\ 0 reasons: (a) To arrest the flo\\ of blood from the main (jugular) , 'ein in the neck, which runs

Sr

a longside of the carotid artery and is usually \\ounded at the same time; (0) To check the flow of from the upper end 01 the carotid artery \\ hlch is often considerable o\\jng to commUl1JcatJOn bebreen the branches of this artery and those of its

fello\\'. Digital pres. ure must be m,aintained, by relays of assistants if necessary, untIl the doctor arrives (Fig. 3 ). . '

The Facial Artery crosses tbe lmyel' pw Jl1 a slight hollo\\' t\\ 0 breadth in front of the angle , and sends br<lnches to the chin, hps, cheek, and

FIG. 38 , FIG. 39.

82

outside of the nose. Hcemorrhage from wound of the face below the level of the eye is to be arrested by:-

(a) Digital pressure on pressure point 2 (Fig. 39), or

(b ) Grasping the lips or cheek on both sic1es of th e \\'ound by the finger inside ·a nd the thumb outside the mouth or 'll/[e Vl'rS(l.

The Temporal Artery may he felt pulsating in front of the upper part of the ear. Bremon hage from th e region of the temple may be arrested by pre 'sure applied at pressure point 3 (Fig. -1-0).

Hcemorrhage from the Forehead or anywhere in the Scalp may be arrlsted by 8ppl)ll1g a mall fml1 pad on the hleeding point and sccunng it by a mrro \\' bandage \\ Ith its centre bid on the p,ld, the l:t1ds Llrried roun d the ht:ld 111 the direction most COl1\'C'I1lt:t1t, and liLll tightly 0\ 1..' the lnd -t2)

Wh l'1l a \\ oun 1 of the forehead or scalp IS assoCiated with a fracture, the he·t plan is to ::tppl:-.· a ring

FIr., 42. pad arouncI the seat of injury. To make a ring pad, pass 011'; end of a narrow handage round ) our pass the other end of tbe bandage through tht: ring thus formed and continue to pass It through and through until the whole of the bandage IS used and a ring as sho\\ n in Fig. -1-3 is iormed.

The Occipital Artery supplies branches to the r egion of the scalp from behInd the ear to the back of the head. Hcemorrhage from this region may be arrested by di gi tal pressure on pressure point 4, four fingers' breadth bchIl1d the ear (Fig. -1-1), ThiS point is difficult to [md, and it is usually to appl} pressLlre immediately below the \\G!Jnet

FIG 40. FIG. 41.

4

ARTERIES OF THE UPPER LIMBS.

The Subclavian Artery pa ses from a point bC"hind the inner end of the collar-bone across the first rib to the armpit.

FIG. 43. FIG. 44.

To apply digital pressUl e :-

I.-Bare the neck and upper part of the chest.

2.-Place the patient's arm against the body so as to depress the shoulder, and cause him to incline his head to\\ ards the injured side.

3.-Take your stand opposite the shoulder.

4.- Using the left hand for the right artery, and vice versa, grasp the neck low down, placing the fingers behind the shoulder and the thumb immediately above the centre of the collar-bone in the hollow between the muscles attached to the bone (pressure point 5). 5

s·-Press the thulnb deeply dO\\l1\yards and backwards again. t the first rib, which is the collar-bone. at t?is spot (Fig . 44).

The AXIllary Artery, ,\'I11ch IS a continuation of the subcb.\'ian, keeps close to the shoulder joint. and can. be felt pul at!ng the fingers are deeply pressed ll1to the armpIt. DIgItal pressure is difficult to apply to this artery.

To apply a pad and bandage:-

1.- Place a kl1'd pad the 'ize uf a billiard ball 111 the arm 2 pit (pres ure point 6). pply the centre of a narrow bandag-e on the : cross the bandage on FIe .. 45. the shoulder; pull the tight and tie them under the oppo ite armpit, taking care that the pad does not slip.

3·-Fle \: the forearm and tie the limb tightly to the trunk \\ith a broad bandage, applied on a le\'el \\ ith the elbow (Fig. 45).

The B rachial Artery is a continu.alion (?t the Axillary, ami runs down the arm ?n the mner the biceps muscle, gradually pas mg forward unt}l It reaches the middle of the front of the elbow. . fh.e inner seam of the coal abm'e the elbow roughly mdlcates its course.

Digit:tl or instrumental pressure may be applied at or near Ilressure point 7.

FIG. -+7.

To apply digital pressure extend the limb at ,right angles to the body, palm of the hand u pwards. tand behind the limh, and pa. s the fingers under the back

of the arm over the seam of the coal ()r the groove on the insIde of the biceps muscle. Press the pulps (not the tips) on the artery (Fig. 46). ome prefer lo pass the hand over the front of the muscle (Fig. 47). A slight turn of the lland oUl\\ards as it grasps the arm ."rill better ensure compression of the artery.

The Brachial artery mal be compressed at the

Flc. 49.

elbow (pressure point 8) by flexion. The pad be a folded handkerchief with a slllall ::,tone or a cork \\ rapped up in it, but \\ hen no pad is amilable the c.oat sleeve rolled or gathered up will serve Instead (Fig. 48).

88

Just below the elbow the Brachial artery divides into the Radi a l and Ulnar arteries, which run along the front of the forearm on the outer and inner sides respectively. Th e pre sure points (9 and 10) are about one inch above the wrist and about half an inch from the outer and inner sides of the forearm, where the arteries may be felt pulsating. Branches of arteries join to form the Palmar A rches in the hanj. The arteries run along 0n either side of the finzers to the tip.

Pressure may be applied to the Radial and Ulnar arteries at pressure p8ints 9 and 10, by the thumbs (Fig. 49) or as follows:-

I.-Cut the cork of a quart or pint bottle in two lengthwise.

2.-Lay the rounded side of one half on the Radial, and of the other half on the Ulnar artery.

3·-Secure them by a tight bandage.

To arrest hc:emorrhage from the palm of the hand :-

I.-Apply a firm pad, and make the patierl! grasp it firmly.

2.-Spread out a triangular bandage, turn up the base about four inches, lay the back of the patient's hand on the centre of the bandage, fold the point over the knuckles and wrist, pass the two ends round the \nist, make the

89

patient pull on the point of the bandage, cross the ends over the fingers twice and tie them as firmly as possible. Bring the (A) down to the knuckles and fasten wIth a pin at B (Fig. So) .

.) -Elevate the forearm and suplJort it with a " t. John" sling (see page 49).

Arterial hc:emorrhage from the :fingers n ,a1' be arrested by applying a small pad on the \\ound, and it firmly" ith a stnp ot tape, linen or plaster.

ARTER1L OF THE Lo\\ ER LIMBS.

The FEmoral ArtEry, a contin uation cf the iliac, enters the thigh in the rIG. 50. centre of the fold of the groin where it may be felt pulsating irrmediately the skm. The course of the artery may indicated by a line dra\\ n from the centrf' of the groIn to the inner side of the back part of the knee. After traversina two-thirds of this line, the fEmoral artery passes the thigh bone to the back of the knee joint as the Popliteal artery. .

Digital pressure may be applIed to the Femoral artery at the groin (pres ure point II) as follows :-

I.-Lay the patient on his back.

2.-Kneel beside the patient.

3.-To find the groin, raise the foot high so as to flex the thigh j the fold in the clothing at the top of the thigh will indicate th e groin .

4. - Place th e thumbs one on the other upon the! pressure point, grasping the thigh with the hands (Fig. 5 I).

s.-Press firml) against the brim of the peh·is.

As there is Immediate danger of death it IS important not to" aste time in removing the trou ers.

,Yh en the Femoral artery is \\ounded in the upper third of its course, pre sure must he maintained at the groin. No really satisfactory tourniquet -ha<; heen

FIG. 51. de\"ised for compressIOn at this point, and relays of assistants should be employed to keep up the pressure until th e eloctor arrives; each fresh assistant places his thumbs over those of his predecessor, \\ ho slips his away from beneath, and thus gushes of blood prev entpd during the change. o.

Application of a tourniquet to the Femoral artery (pressure point 12) :-

'When practising compression of this artery, it is a

FIG. 52.

92

good plan to draw a c halk line from the centre of the groin to the inner side of the back of the knee' place the pad of the tourniqu et on this line as high up as bandage can be app li ed . The pad should be the SIze of a lawn tennis ball (Fig. 52).

may be applied to the Popliteal artery by flexIOn at the kn ee (pressure point 13) ; th e pad should

FIG. 53.

be .the size of a lawn tenni ball, or if no pad is avaIlable the. trouser leg may be rolled or gathered up t o serve mst ead. It is n ot necessary to take off the clothing (Fig. 53).

Just a?d behind the kn ee joint the Popliteal a rt ery dIvIdes 111tO the Anterior (front) and Posterior (bac k) Tibial arteries.

The Posterior Tibial Artery passes down the

93

back of the leg to the inner side of the ankle. It is at first deeply placed behYeen the muscles of the calf but it app r oaches the surface as it proceeds so that it can be felt pulsating behind the large at the inner side of the ankle. It enters the sole as the Plantar Arteries, which tun forward amongst the muscles to supply the foot and toes.

Anterior Tibial Artery, on leaying the PoplJteal at once passes fon\ ard bet\\ eEn the lea bones, and deeply pIa ed amon,!! t the muscles, down the leg to the centre of tIle front of the ankle. This artery is as the Dorsal Artery of Foot, \\hlch pas. mg fOI\\ard oyer the tmsus, dips down to the scle iJt:l" cen the first and metatar al bones. IIere it fonT'S \\ith the Plantar arteries what is kllown as the Plantar Arch. At the ankle (pressure points 1-1- and 15) pre sure may be applied by the flngers or by pads and bandages.

YE\" OUS H ,£\IORRH.\GL.

I. - Blood from a vein is dark red.

2. - It flows in a slow continuous stream.

3. - It issues from the side of the wound further from the heart.

4. - In the case of a wound of a varicose vein it flo\\s also from the ide of the \\ ound nearer to the heart, e peciall) if the patient i kept standing.

Varicose Veins. - The veins of the leg are speci3.11y apt to becom.3 A vancose vein is dibteJ, winding, and with beJ.d-like (varicose). projections ::tIong its course. A vein v::trl ose from several causes, such as long standll1g or tight (Tarters. The first effect is to throw e .\tr::t \york upon fhe v::tlves and the be::td-like projections arc cau')ecl by the accumulatmg in the pockets behind the v::tlves. In time the vein becomes so dilated that the valves can no longer sp:ll1 it.

GEXERAL RULES FOR OF A ,-rOUND BY I-LE\lORRHAGE.

I.-Place the patient in a suitable position, beanng in mind that the blood escapes \\ ilh forc e when the patient sits and is still more checked as he lies down.

2. - Elevate the part, as thereby less blood finds its way into it.

3. - Expose the wound, removing \\ hat cve r clothin!; is necessary.

4. - Remove any constrictions, such as collar or garters, from the he3.rt side of the \\ound ..

5.-Apply digital pressure on the wound untll you can apply a pad and tight bandage. If that does not stop the bleeding, make pressure near the wound on the side away from the heart. In the case of a wound of a varicose vein it may also be necessary to

apply a pad and bandage to the vein imn,edlately above the wound, especially If the limb cannot be ma1l1tain e d in an elevated position.

6. - Treat the wound as directed by Rules 5, 6 and 7, stated on pages 77 and 78.

7. - Afford support to the injured part.

C\PILL \R Y HJE:\lORRHAGE.

1. - The blood is red.

2.-It flows briskly in a continuous stream, or may merely ooze from the wound.

3. - It wells up from all parts of the wound.

1\ slight amount of pres!:>ure \\ III suffice to arrest rapillary bremorrhagc.

I:\TFRxAL HJEi\lORRHAGE.

'Wounds of the hlood \'cssels \\ ithin the trunk uusc hrcmorrkl.ge into the caYlly of the che t or of l:1C abdomen.

:\ '\D ...' nIPTO\lS OF \":\L

I. - R apid loss of trength, giddiness and faintness, (specmlly when tIle upright po ition is assumed .

2.-Pallor of the f:lee and lip s.

:;.-Breuthing hUrrIed and laboured, and accompanied [)y )<1\\ nin u and sighing.

4· The pubt: L1.ils, and may altogether di "appear at the wri::.t.

5·-The patient throws his arms about, tugs at the clot hing round the neck, and calls for air. the patient may become totally unconSCIOUS.

TREAT.\rE:"'JT.

I.-Keep the p:ttient in a recumbent position.

2.-Undo all tight clothing about the neck.

3·-Provide for free circulation of air; fan the p:ltient.

4·-Sprinkle cold water on the face; hold smelling salts to the nostrIls; avoid ocher forms of stimulants, at all events until the hremorrhage has been controlled.

5·-Give ice to suck or cold water to drink; if the se:tt of the hremorrhage is known, apply an ice bag over the region.

6.-Should the patient be reduced to a state of collapse, raise the feet and bandage the lim bs fil mly from the toes to the hips and from the fingers to the shoulders.

HlEMORRHAGE FROM THE NOSE (NOSTRILS).

I.-Place the patient in a sitting position in a current of air before an open window, with the head thrown slightly back and the hands raised above the head.

2.-Undo all clothing around the neck and chest.

3·-A pply cold (ice, a cold sponge or bunch of

keys) oyer the no t anJ al::,) the spine at the Jeycl of the collar; place the feel in hot \\ater.

-t.-Cause the patient to keep the mouth open, and so ayoid breathll1g through the no e.

Blood issuing from the mouth may come from the tong-ue, the gums, lh(' socket of a tooth after e\.traction, the throat, the lungs, or the stomach.

H , E .\I 0 RRH,\GE FRO\[ THE TOt\G1JE, 1HF. CUr-IS, THE·OCKJ· T OF .\ TOOTH, OR [HE THROAT.

J .-C 1\ e ice to suck or cold \\ ater to hold m the mouth. If thIS IS not successful gl\ 'e \\ater as hot as can be borne to hold in the mouth.

.., If llece sary make pre sure on the carotid :nlerJes.

3 . If bJeedJllg from the front part of the longue ' s e\ces I\'e compre the part by a piece of clean 1ll1t helel het\\een the finger and thumb.

4. If the bleedmg is from tl' e socket of a tooth, plug the s ckel "'Ith a piece of clean lint or cotton \\001; over thl place a small cork or other sub of suitable size, and instruct the patient to bIte on It.

HtE\JORRHAGE FRO .\[ THE LC''';Gs.

Blood from the lungs IS coughed lip and is scarlet and frothy in appearance.

Treat as for Internal H (see page 95)· E

C;7

HiE\IORRHAG E FR O M THE STO\fACH.

Blood from the sto.11ach is vomited; It lS of a dark colour anj has the appeara n ce of coffee g rounds; it may be mixed with food. , .

Tr ea t as for Internal H;emorrhage ,see page 95), except, that nothing is to be giYen by the mouth

Blood issuing from the Ear Channel , \\ hlch generally indicates a fracture of. the ba e of the cran ium, must be wiped away as It Issues; no attempl is to be nude to plug the ear.

QUE 'TIONS 0 CHAPTER III.

Tile 71lIlJlCra ,S indiratc tht pages 'where the all SWCI S lIlay be found.

\\' hat organs are concerned in the circulation of the

Llood?

the circulation o f the bloud through the bed)' and lungs

of

part of a lim b had been torn off, out there \\ as Ih. t much bleeding, how would you act?

100 PAGE:

Describe the arteries of the head and neck 80

"\Vhy is it sometimes necessary LO compress the carotid artery both below and abuve the wound? ... 80, 8r

"\Vhat is a ring pad, and what is its use? 84

Describe the arteries of the upper lim be; 84 to 89

Describe the arteries of the lower limbs ... 89 to 93

How would you know a case of venou hremorrhage?.. 93

\Vhat is a varicose vein? 94

How maya vein become varico e ? ... ... .,. 94

State the general rules for t reatment of a wound accompanied by venous hremorrhage ... .,. 94, 95

H ow would you k now a case of capillary hremorr hage ? 95

How would you stop capillary hremorrhage ? 95

\Vhat is internal hremorrhage? ... .. ... ... 95

\Vhat would lead you to suspect internal 95, 96

State the treatment for internal hremorrhage? ... 96

H ow would you arrest hLemorrhage from the no. e ? ... 9 6 , 97

\Yhere may blood i uing from the month come from?.. 97

How would you treat bleeding from the gum or throat? 97

\Yhat else would you do if the tongue were bleeding?.. 97

And if the bleeding were from the socket of the tooth? 97

How would you distingui h between bleeding from the lungs and from the . tomach ?.. 97

And what would be the difference in the treatment? 97

Of what is bleeding from t he ea r channel generally a sign? 98

'!'he Student should practis.e placing uppo ed patients in a proper po ition for the arrest of hremorrhage (see pages 72, 77 and 94), folding firm pads (74 and 75 ), tying hard knots in bandages to form a t':)Urniquet (76), and the application of pres ure at all the pres ure points shown in the frontispiece, at various points on the forehead and scalp, and on the palm of the hand. Pressure shou ld be digital, by pad and bandage, or flexi on, as directed in the text.

10I

Pre"..,ure points-Carotid artery, 8::>. Facial, 2. T emporal, 82. Occipital , 83. Subclayian, 84· Axillary, 85. Brachial (by pad and bandage, pressure being made again . t the humerus and by flexion at the e lb ow), 86. Radial and Ulna r, 87. Femoral at the groin, 90. Femoral in the thigh, 92. Popliteal, 92. nterial and posterior Tibial arterie ,93.

JTxmorrhage from the forehead or scalp ...

IIremorrhage from the palm of the hand ..

Y cnons hremorrhage fr om a yaricuse or 0' her

CHAPTER IV.

BRUI 'ES .

A blow anywhere on the surface of the body may cause extensIve hcemorrhage beneath the skin, \\ ithout breakmg it-a" black eye " is an instance. The injury is accomp:lI1ied by and swelling.

TREA·nfExT.

Apply ice or cold \yater dtessings. .i\ piece of lmt soaked in extract of \\ itch bnd may be placed on the affected part.

BUR J A:\]) C. \ LD ..

A burn is caused--

((1) By dry heat, such a , fire or a piece of hot iron.

(b) By a raIl, wire or d) namo charged with a hIgh pressure electric current

(c) By a corrosi \' e acid, such as oil of \ itriol.

(d) By a corrosi\'e alkali, such as cau lic soda, ammonia, or quicklime .

(e) By friction, caused, for e,all1!,le, by contact with a revolving wheel. (Brush burn.)

A scald is caused by moist heat, uch as boiling \yater, hot oi 1 or tar.

The effect may be a mere reddening of the skin; blisters may be formed ; or even the deeper I issues 103

of the body may he charred and blackened . The clothing may adhere to the burnt skm, and ItS removal is impossible without further detriment to the injured part. The great danger is hock.

TR E \T\fE;,\T.

I. - Carefully remove the clothing over the injured part. If stuck to thf' skin, the adberem mu'>t he cut around wIth scissor<; . soa k ed wIth oIl, and left to come al\Lly subsequently:

2. - Do not break blisters.

3. - Immediately cover up the part. Soak or smear pieces of lint or 1m en \\ Ilh 011, or vaseline, bnoline, or cold cream; a small quantity of boraCIC powder added to the 'e \\ III he of benefit. The inside of a r.1\\· pot.1to scr.lpul out and spread on lint make a. oothing- :1ppltcJtlon. When the injured surLlcl' ise,ten i\-e rIo notro\er It \\Ith one large sheet uf lint, but \\ ith strips about tIle breJ.9th of the hand; this IS ad\ i<;a.hle as they fit better on the part, and during suhsequent dresstngs one strip can be removed J.t a time, and a [re'ih dressing J.pplied before the adjJ.cent strip i: taken ofr. The hock to the system IS thereby Itss than if th e whole of the burnt surface \\ere (aid hare to the air hy the remoyal of all the dressings at o ne time. ,\VI{en eO\'erect by the oily elr Ing er1\'elop the part in cotton \\001 or a. pIece of Jhnnel and apply a bandage.

'When the face is burnt, cut a IT!ask out of lint or linen, leaving holes for the ey s, nosE', and n outh. Dip this in oil or smear it "ith vaseline and apply it to the face and cover it with cotton wool, laYing openings to corre pond \\ ith the holLs in the mask.

\Vhen po . sible place the injured part in water at the temperature of the body (98 degrees) until suitahle dressings can be prepared. .\ de. ert-spoc nflll of baking soda added to a basinfulof tIle "arm ,,'ater will make a soothing lotioll.

As it is important not to I aye the part ,-posed to the air, it is the duty of the b) standers to prepare the dressings \\'hile the clothing is reing remo\ ed.

4.-Treat Shock .-This i. particularly nece. sar)' in the case of every burn or scald of any considerable extent (see page 135) Be yery apprehensive of danf,er in the case of eyen slight burns of the neck.

S.-- If the burn is caused by a corrosive acid , bathe the part with a weak alkaline lotion, such as wClshingsoda, baking . ada (licarbonate of soda), magnesia, or slaked lime in \\ arm \\ aler before applying the dressings.

6. - If the burn is caused by a corrosive alkali , bathe the part with a weak acid lotion , such as lemon juice or vinegal diluted with all equal quantity of water. Calli/oll.--Before using \\'ater brush off any lime that remains on the part.

105

7. - When a woman ' s dress catches fire -

(rz) Lay the \\'oman flat on the floor at once, so that the flames are uppermost; that is to say, if the front of the dress is on fire lay her on her back, and if the back of the dress is burning, place her face downwards. The reason for this is that flames ascend so that if the upright position is assumed, 'the flames ",ill quickly reach an-l burn the body, neck, and face; or if the woman lies With the flames unclermo t, they will, if une\tinguished, pass o\'er and burn the Ii m bs, and set fire to the rest of the dress.

(II) As 50011 as the \\'oman i laid flat, smother the Aa.m e \\ ith an\'thina at band such as a rug, coat, blanket; or coye;; if made wet so much the better.

(c) A woman rendering assistance should hold a rug or blanket in front of herself when approaching the flam es.

( d) If a woman's dress catches fire when nobody is by, she should lie flat, flames uppermost, smother the flames \\'ith anything handy, and call for assistance, or crawl to the bell-pull and ring; on no account should she rush into the open air.

The Ilse of fire guards would prevent many caIamllies.

BITE OF NAKE AND RABID A TIMAL , AND \YO"CND BY POI 0 TEl \VEAPO T, •

Hydrophobia is caused by the L '_c of an animal, such as a dog, cat, fox, \Yolf, or deer suffering from rabies. The special poisons introduced into \rounds camed by yenomous snakes and poisoned \\ eapons cause immediate danger to life. T.

I.-Immediatelyplace a constriction between the wound and the heart so as to pre\ ent the venous blood from carrying the poison th rough tIle body. If, for example, a finger is bitten it should be encircled on the side of the wound nearest to the heart, with the finger and thumb, and as soon as possible a ligature (a string, piece of tape, or strip of handkerchief) should be placed tightly round the root of the finger. Compression \\ith the finger and thumb must not be relaxed until the lIgature has been applied . Additional ligatures may, with ad"antage, be applied at interyals up the lim b.

2. - Encourage bleeding for a time :-

(a) By bathing the wound with warm \\·ater.

(b/ By keeping the injured limb 10\\- ; the upper limb should be allowed to hang do\\ n, and in the case of the lower limb the patient sl:nuld be seated \\ ith the foot on the gr,)und.

3. - Cauterise the wound, if it is quite impossible to obtain the services of a doctor. This is best done by burn in,2; with a fiUld caustic, sLlch as caustic pota,>h, pure carbolic acid, or nitric acid, or if the 'e are n t at han I \\ ith a rcd hot \\ire or a fusee.

Th e usual s()lid is insufficient, as it does not reach th e bot to '11 of the \\ oLlnd, where the poison is.

To ensure the caustic reaching the bottom of the wound, it should be applied on a piece of wood, sur'h as a match cut to a point. \Vhen the cau tic has been thoroughly applied, but not till then, the ligJ.ture 111.ly be removed.

4·-Cover the wound, after a ",hile, with a clean

5·-Afford support to the injured part.

6 - Treat shock if it occurs (see page I35).

7· - In the case of a bite by a venomous snake, rub in powdered permanganate of potash and Inj ect under the skin in the n eighbourhood of the \\,ounu a solution of of potash.

TING OF PLANT AN D ANIMALS.

These give ri e to serious inconvenience, and ll1 some cases gra\'e symptoms develop.

TREADIENT.

1. - Extract the sting if left in.

2. - Mop the part freely with dilute ammonia

108 or spirits. A paste of bicarbonate of soda and sal volatile is an efficient application. A solution of washing soda or potash or the application of the blue bag will relieve pain.

3. - Treat collapse if it occurs (see page 135)·

FRO T BITE.

During exposure to severe cold, parts of the body, usually the feet, fingers, nose, or ears, lose sensation and become first waxy \\ hite and aften\ ards congested and of a purple appearance. As sensation is lost in the part, it is often only by tIle remarks of bystanders that the frost-bitlen person is made a\\'are of his condition.

TREAT.\I.E.NT.

I .- Do not bring the patient into a w a rm r<?om un til, by friction of the band or by rubbing \\ Ith soft snow, sensation and circulation in the affected parts are restored. Neglect of this precaution may lead to death of the ti:::sues of the frost-bitten part.

2. - When circulation is restored, keep the patient in a room at a t e m perature of 60 degrees.

NEEDLE EMBEDDED UNDER THE KIN.

\Vhen a needle breaks off :tfter penetrating the skin and disappears, tak e the patient to a doctor at once. If the wound is near a joint, keep the limb at rest on a splint.

109

FISH-HOOK. E'\IBEDD2D I:\T THE KIN .

D? not to withdraw the fish-hook by the way It went 111, but cut off the dressing of the hook so that only the metal is left, and then force point onwards through the skin untIl the hook can be pulled out.

I NJURIE T O J OI NTS.

\Vllen a joint is injured by a bullet, stab, or other canse-

I . - Wrap the part in cotton wool. . rest. and support to the injured ; If the 11mb, in a flexed position by a sling ; If the lower 11mb, 111 a straight position by a splmt.

FOREIG:\T BODY THE EYE.

.I. - Prevent . rubbing the eye, tyll1g down a chIld s hands If neces ary.

_

2..- Pull the lower eyelid, \\ hen, if the l orelg n body IS seen, it can readily be removed with a camel 's hair brush, or with the corner of a handkerchief twirled up and wett ed .

3. - Wh e n the foreign body is beneath the eyd.id lift the lid forward, pu h up the lower lld beneath It and let go. The hair of the lower lid b:ushes the inner surface of the upper one, and may (!Jslodge the body. ho'uld the first attempt be '..ll1succes ful, repeat it se\'eral times if necessary. If

the foreign body is not dislodged call the sen'ices of a docto r as soon as possible, When, however, skilled help cannot be had, proceed as follows ;-

(a) Seat the patient so as to ,the light, stand behind him, steadymg hIs head agamst your chest. ,

(b) Place a small rod, such as a match or bodkm, on the upper eyelid, half-a n-inch aboyc the edge, pressing it backwards as far as

(c) Pull the upper eye-la hts oyer the rod, and thereby eyert the eyelId.

(d) RemO\'e the foreign tody. .

4. - When a piece of steel is 1ll the eyeball drop a little oli\'e or castor, oil (n tbe eyeball after pulling down tbe 10\\ er eyelId, the lids, apply a soft pad of cotton \\ 001 and It by a bandage tied sufficiently firmly to keep tbe e) cball take the patient to a doctor.

5. - When quick-lime is in the eye bru,sh away as much of it as possible; bathe tbe e)e \\llh vinegar and \\'arm ",ater, and treat as for a piece of steel em bedded in tbe eyeball.

FOREIGN BODY I THE EAR P .. \ ' AGE.

As a r ule make no attempt to treat a patient with a. foreign body in the ear if the services of a doctor can possibly be had; any attempts to remO\'e the foreign body may lead to fatal consequences, If a child

III

c.lnnot be induced to keep the fingers from the ear, ti e his hands do\\ n or cover up the ear. If an insect is in the ear-p.1.SS '1ge, fill the ear \\ ith olive oil, when the insect will flo:lt and may be removed. Never syringe or the ear.

FOREIGl BODY THE XO -'E .

Induce sneezing hy pepper or snuff. Cause the p:ltient to blow his nose after the mnffected no . tri1. Ther e IS no Immediate danger from a foreign body in the nose.

TIlE .\BDO)IE..

Th.e is bounded aboye bv the diapbragm ; belo\\ by the behind by the lum har vertebrre; and in front and at the sides by muscular \\alls. (Fig, 54.)

TIIE ORG _\ :\ OF THE A BDCJ:\[E'I'.

Th e Sto m ac h lies Immediately belo\\' the" pit of the <,to,1l1ch " just belo\\ the breat-bone.

Th e L ive r 'lies in the upper part of the abdomen, where it is mostly coyered by the right 10\\ er ribs.

Th e Sp lee n li es beneath the ribs at th ,; upper pMt of the left . ide of the abdomen,

Th e Intesti n es 0 cupy th e greater part of the I,witv of the ab l() 11e n,

Th e Kidneys lie at the back, in tl-}e region of !he loin,

The Bladder lies in the pelvis .

FIG. 54.

IN THE FRONT \VALL OF THE ABDO;VIE

TVhm the z'ntestz"nes 01 oflzer O1l{ans protrude through the wound, whethe r vertical or trans,-erse, bend the k nees, raise the shoulders, and apply lint, a to\\ el, or c o tto n wool wrapped in soft linen, and keep the

II3

patie n t warm until the doctor arrives. \\'hen there is no protrusion of organs, if the WOUJld is vertical, lay the patie n t fl at o n the back with the 10\\ er limbs straight; if the WOlllld IS traJlsverse, bend the knees and raise the shoulders.

I.'i)URIES TO THE O RG_\X THE P.b;LVIS .

Injuries of the Stomach are attended by extreme and sometimes by vomiting of dark blood lIke coffee-grounds. For treatment see " Hre.rno:rhage f,ro 11 t?e'tomach II (page 98 ).

InJunes of

tne

LIver, Spleen and Intestines

1:1<1.Y be caused by a blow, a stab or a bullet; the liver or. spleen may beinjurecl by a fracture of the 10\\ er nbs. The "'igns and :'ylllptoms are those of Il1ter?al hremorrhagL accompanied by pain and s\\ ellmg at the seat of injury, anci the treatment is a-; for that (. ee page 95).

The KIdneys may be injured by a fracture of the ele\"enth or twelfth ribs, also by a cru h, blow, stab or bullet. Blood may escape \\ ilh the urine, and there may be pain and s\\ elJina O\-er the injured kidney. 0

The Bladder may be injured by a fracture of the pelvis. The sign and symptoms are either inability to pass \yater, or if a httle is passed it is tinaed \\ ith blood . 0

TREATME T OF I 'jURY TO THE KIDNEYS OR BLADDER.

I IS QUESTI CHAPTER I V.

I. - Keep the patient quiet until the doctor arrives.

1 . f 1

2. - Apply hot fomentations over t 1e pam u or injured part. . '

Rupture (hernia) conslsts of a pratruslOn of an internal organ, usually the bo\yel, throucrh lllUScular \yall of the abdomen, most frequentl) ,at the . Sh ld a sudden s\\elJing a compamed by grom. ou , d for pain and sickness take place in that reglOn, sen a doctor instantly, lay the patIent \\ ith buttocks raIsed, and apply ice or cold \yater dressll1gs to the affected part.

1.- Send for a doctor .

2.-Lay the patient do\\n \\Ith the buttocks raIs;d.

3.-A pply ice or cold water dressll1gs to che ed part.

Tile numerals ind/cafc lite pages where the answers lila), be fOllnd.

What is a bruise?

I l ow would you treat a bruise?

I low maya burn be clused ?

H uw would you treat a burn caused by a corrosive acid?

Trow would you treat a burn caused by a corrosive alkali?

Wh'1.l steps should be taken when a woman's dress catches fire? ,

State the general rules for treatment of wounds call ed by piJisonolls biles or weapons '" 106, I07

\Yhat special treatment requir<!d for the bile of a \'enomou snakt:?

How would rOll treal a Li'lg'? .. , .. , .. , 10 7, I08 the sign. ympLO :lh and treatment of frost-bite .. , lOS

\\'ould YOll attempt to remwc a needle embedded under the skin?

IIow would YOll extract a fish in the skin? ' ..

State the treatment for injuries to joints.. '" .. ,

State the gencral rules for ren10Ying a foreicrn body from the eye .. , .. , .. , b I09. lIO

\Vhat would you do if a piece ot ;leel were embedded in the eye baJJ ?

And when quick-lime is in the eye?

lIow would you try to remove an insect from the ear passage?, "

W U ld yuu try to r e move an y oth e r form of foreig n body o ? ll O I I I fr om t he ear passage , ..

,

H ow wou ld yo u r emove a fo reig n body fro.m the nose ? I I I

St te the b0u ndaries of th e abdomen and 1ts conte n ts II I the t reatment fo r wounds of the I 1 2, 1 13

How may injuries to the liver, spleen and 1I1testmes be caused?

, ... 1 13

What is the difference between treatme.nt of 1I1Junes to the stomach and of injuries to the hver, spleen and intestines?

II3

State the treatment of injuries to the k .dneys or bladder 11 4

State the treatment of hernia I 14

T HE NERVOUS SYS T EM

.

Two syst?ms of nerves, the Cerebro-spinal a n d the ympathetic, regulate the movements a n d f u n ctions of the body

The Cerebro-spinal System is made up of the Brain, the Spinal Cord and Nen'es, and through its agency sensations are rec e ived and the will causes the action of the voluntary muscles . For example, when a part is injured a sensation of p:tin is conveyed to the brain by the nerve, thus affording an lI1Jlc1.tion of the seat of injury, or a warninO' of a possible danger of further damage. On attention being directed to the injury, an attempt is instantly Il1J,de to the pain or to move the injured part [rom danger.

The Brain is ituateu within the cranium, and is di\'ided in the middle line, so that, with the exception of some conne cting bands, the right and left sides are sep1.rate .

The Spinal Cord is the lo ng cord of nen'OUS matter lying within the spinal canal (see Vertebral Colum n, page 23). I t leaves the brai n through an opening in t he base of t h e crani u rn a n d extends to the uppe r l u mbar vertebr::e.

The Nerves proceed from tbe brain and sr inai cord in pairs as pearly-white trunks, ::l11d their branches can be traced throughoL.t the . 'ss ues of the body. When a nerve is tom through there is paralysis of motion and sensation in the region in which its branches are distributed.

The Sympathe t ic System extends as J. nervo :.:S chain on each side of tbe front of the spinal column along its entire length, anu sends branchEs to all the organs of the chest and abdomen to control the involuntary muscles, and thereby regulate the vital functions. This sy tem is nut under the control of the will, and acts alike during sleep anu acti\'it)'.

THE RE PIRATORY

The air reaches the lungs by way of the no trils (or mouth), the throat, the \\ind-pipe, and the bronchial tubes. The nostrils convey it to the back of the throat, ",bence it enters the \\ ind-pipe by an opening guarded by a sort of trap-door or valve, so that in health air, but not solids or fluids, may enter. During insensibility, however, the valYc fails to act, so that should .solids or fluids be given by the mouth, they may enter the '.vind-pipe and cause asphyxia. The wind-pipe e.\.tends to two inches below the top of the breast· bone, 'where it diyides into the right and left bronchial tube. Each bronchial tube enters a lung a!ld divides into small and still smaUer tubes, unt11

FIG. 55. TH E Lu.\' ...s A:-- D BRO.\'CHIAL TU BES.

A. !rachea, o.r Wind-pipe. B. Left Bronchus. Dronc,1us. D. Snnller Bronchial Tubes.

the ultimate recesses or the lung -the air cells or air spaces-are reached .

The Luncys R ight and L eft, occ upy the greater part of the they lie imme.dm.tely within the ribs, and practically a l'Ib IS felt, whether front, back or sides, there IS lung beneath. Each lung is enveloped in a fine (the plw,:a ) which allows It to move wlthm the chest dUrJng brelthmg without friction.

or consist ,of two

In3 piratlOn ) an expanslOn of the cllest,. du.nng air is dra.vn into the lungs, and EXplratlOn , a contraction of the chest, during \\hich air leaves lungs. A pause follow,; the act of expiration.

In health fifteen to eighteen breaths are taken minute and at each inspiration about 20 to 30 cubic 'of air enter the lungs, and a similar quantity is exp;lled at each expiration.

exp:l11sion and contraction of the chest are effccte:i putly by the muscles of respiration attached to th; ribs, but chiefly by the Diaphragm, the large arched muscuhr partition \\ hich separat.es t?e chest fro.n the ab::iom en. In inspiration, \\ hlch lS chIefly a muscular act the ribs are raised, and the arch of th diaphragm ' falls and hecomes flattened, t.hus i,ncreasing the capacity of the c)lest and causmg tne ir to enter. In expiration, an act performed almost out effort, the ribs fall and the arch of the

121

diaphragm rises; this lessens the capacity of the chest a n d forces air out. The mechanism of respiratio n is so me\\ hat hke that of ordi nary household bellows, b u t "ithout a valve; the ribs may be compared to the boards of the bello\\ s \\ hile the diaphragm corresponds to the leather, air passages being equivalent to the nozzle.

. As the blood depends upon the air for its purificatlOn and the oxygen necessary to maintain life, interference with breathing n :ry soon may produce a dangerous state called asphyxia, e:-..amples of \\ hich are afforded by drowning, suffocation, choking, etc.

ARTIFI L \ L RE. PIRATIO •.

P ROFESSOR . CH AFER'S )\fET HOD.

I. - Waste no time in loosening or in removing clothing.

2. - Lay the patient in a prone position (i.e ., back upwar?s) with his head turned to one SIde, so as to k eep hIS nose and mouth away from the ground. No pad is to be placed under the patient, nor need the tongue be dra\\ n out, as it ",ill fall naturally.

3. - Kneel at one side facing the patient's head , and place the palm of your hands on his nbs, one at each iue, the thumbs nearly touchl11g one another in the small of the back. Leaning your bou)" forward, slo\\ 1)' apply firm but

not violent pressure strajght upO!: the back and lower part of the thus dnvmg aIr out and producing expiration (FIg . 56). U ra\\- back

56. ExpIRATlO

57. INSPIRATION.

12 3

your body s0'11e\\'hat more rapidly and relax the pressure, but do not remove your hands; this produces inspiration (Fig. 57).

4·- Alternate these movements, by a rhythmic s\\3ying back\\ards and forwards of your body, twelve to fifteen times a minute, persevering until respiration js restored, or a doctor pronounceS life to be extinct.

DR. :'[LVE. [e.R' :\[ETHOD.

I . Adjust the patient's pos iti on. - ,Vithout wlsting a moment place the patient on his back on a fhlt surLlce, inclined If possihle from the feet upwards. RemO\'e all tight clothing from about the n eck and chest, and bare the front of the hody as feu as the pit of the stomach; unfasten the braces and the top buLLon of trousers in men, and the corsets in \\ omen. Raisp and support the shoulders on a small, firm cush ion or folded article of d less placed under the shoulder-blades.

2. Ma i ntain a fre e en t ran ce of a ir in t o t he wi ndpip e.-Cleanse the lips and nostrils; open and \\ ipe the mouth; an as istant must draw fOf\\ard the patient's tongue as far as possible, and keep it in that position.

3. - Imita t e the movements of b re athin g.

Jilt/Ita' .lJlS/t"mlzoJl.-KneeJ at a convenient distance behind 1)e patient's head, and, grasping his forearms just belo\\' the elbo\\', draw the arms

FIG.

FIG.

FIG. 58. INSPIRATION.

FIC. 59. EXPIRATJO:--:.

12 5

up\\"ards, outwards, and towards you, with ,a sweeping movement, making the elbo\\ s touch the ground

61. EXPIRATION.

(Fig. 58). The ca\'ityof the chest is thus enlarged, and air is drawn into the lungs.

FIC. 60. IN SP IRAT ION.

FIG.

IJlduce the patient's flexed arms slowly fOT\y a rd, downwards a nd inw ards, press the arms a nd elb ows firmly o n the chest on either side of the breast-bone (Fi g. 59) ' By this means air is expelled from the lun gs. .

Repeat these movements alternately, delIberately, and perseveringly abou t fifteen times a minute.

When a sufficient number of assi stants are present, H oward 's method may be combined with 'iln.ster 's, as follows :-

The additional assistant kneels astride the patient's hips with th e balls of the thumbs resting on eaber side of the pit of the stomach, a nd the fingers grasping tile ad jacent parts of the chest. Using his knees as a pivot, he presses fnrward on his hands. Then suddenly, with a final push, he springs back and remains erect on his knees while he slo\\ Iy counts I, 2, 3. Th ese motions are to be repeated to correspond with thos e being perfor med by Silvester's method, pressure on the chest being made simult aneo u sly by those performing the b\ 0 methods (Figs. 60 and 61).

LABORDE'S METHOD.

\Vhen from any cause the above m ethods cannot be carried out, Laborde's method of artificial respiration should b e tried. It is especially useful in suffocated children and when the ribs are broken. 1 2 7

T he patient is placed o n his back or si:-le; the mo uth cleared; the tongue i') seized-using 2 handkerchief or something to preYent it slipping fre n the rll1gers-the lower jaw depre. sed; the tons, le is pulled forward and held for t\\ 0 seconds in that position, then allo\\ed to recede into the mouth. These movements should be repeated about fiftee n times a minute.

Artificial respiration must be continued until breathing IS established, or until a docto r arriYes. ·When lMlural breathing commences, regulate the artificial respiration to correspond with it. uccess may result eYen after two hours ' time.

Excite respiration. - \Yhilst artificial respiration is being applied, other useful steps may be employed, such as applying smelling salts or snuff to the nostrils, and flIcking the chest with a dam} towel.

Induce circulation and warmth after natural breathing has b CL:n restored. "Trap the patient in dry blankets or other co\·ering, and rub the limns energetically towards the heart. Promote warmth by hot flannels, hot-water botlle ' , or hot bricks .(wrapped in flannel) applied to the feet, to the limbs and body . ,rhen the po\yer of swallo\\ ing has returned give hot tea or coffee, or meat extract. The patient should be kept in bed and encouraged to go to sleep. Large pOUltices or fomentations applied to the

front a n i back of the chest ,,·ill se rve to assis t

Wa : ch the patient carefully for so me tIme to th :lt the b reath ing do es n t fail; should a ny sign s of hillre appea r, at on ce begin artificial respiration.

I J'E

Unconsciousness or Insensibility may arise as fJ llo \ys :-

Injury to the Head. -Concu . sion and Compression of the brain.

Disease of the Brain. -Apoplexy, Epilepsy, Hysteria , Various Causes. -Shock, Fainting ( yncope), Collapse, Alcoholic and oth er poisoning, Sunstroke and Heat-stroke , I nfantile Conyulsions, Asphyxia .

G ENE R A L RULE " FOR OF I

, ' EN ·IBILITY.

I. -- If a person appears about to lose consciousness, p revent hi'11 fr om falli ng, and by him gently do\\ n.

2. - Arrest Hcemorrhage when apparent; attendi ng to minor injuries is less important than treating the unconscious state.

3. - Lay the patient in the position in which breathing is most easy-usually this will be on the b:lck, or incli ned to one side . As a general rule

ralse the head and shoulders S!t:fh l l]' wh en the f[tce is flushed, and keep the h ad lo\\' \\ hen the face J pale.

4. - Undo all tight clothing round the neck chest and waist, u nfaste nin g the bra ces and to p butto n of the trou ers in me n, and the corsets in V'. omen, the object bei ng to relieve prtssure on the air passages, lungs, heart and abdominal organs. Be sme that there is no obstruction to the aIr passa ges by the tongue or by a foreign body in the throat. The pos ibility of false teeth obstructmg breathin g must be con idered .

5. -:- Provide for a sufficiency of fresh air by openlllg doors and WIl1<..lO\\ s, and by kel pmg t ack a cro\\d.

6. - When breathing cannot be discerned apply artificial respiration.

7·- 0btain a doctor's help as soon as possible.

8:- Unless unavoid a ble , never leave the patient until you have placed him in charge of a responsible person.

9·- Give no food or fluids whatever oy the mouth while the patient is insensible.

lO. - Should the spine or an important bone ?f the upper or of the lower limb be fractured, It must be steadied and maintained at rest as co n a s possible. hould the u nconsciousness be prolon Ted, the patient may be removed III a recu mbent po Ition F

t o shelter, provided that the broken bone is adequately s u pported.

II. - When the patient is in a state of convulsion, support his head, and after \:'l"apping a piece of wo od or any ?tiler hard matena l m .handkerchi ef, hold it in his mouth to prevent bltll1g of ton 6 ue . D o n ot forcibly restrain his limbs ; prevent him from hurting himself by dragging hi m a\\ay f ro 11 a source of danger, such as machi n e ry, a wall, or fi replace; light pieces of furniture should be pushed out of the way .

12. - On return to consciousness \\'a ter may be given to dri n k . If the pulse is feeble gi\"e warm tel or coffee, provided hzemorrhage, either internal or externStl, is not present. A deSI re to sleep should b e ellcouraged, except in cases of opium poisoning, a conJitio .l that may generally be recog n ised by the history of the case, and also by the pupils of the e yes (the black openings in the grey, blue or brown iris) bei ng minutely contracted (pin-head pupil ).

13· - It must not be assumed that a person is insensible as the result of drink merely because the breath smells of alcohol ; frequently when peo p le a r e feeling ill they take or are given stimula n ts, after which they may become insensible, n ot fr om the drink, but frolll caus.e that i n duced them to take it, for example, InsenSIb ility c oming on, effec t s of poiso n ing, etc. Even if

13 r

drink is belle\"ed to be the actual cause of insensibility, Jt must be borne in mind that the patient IS In a "ery dangerous state, and he must be treated for ollapse by bell1g co\'.e red up and kept

The abo\"e general ruks \\ill enable . be rendered efficiently in most G\SCS of lI1s e nslbJllty, although the exact form frol11\\ hich the patient is suffering is unknown.

COi'\C\J: . 'IOi'\ OF THE

fhe patient may be stunned by a blQ\\ or fa!l on the head, or by a fall on the feet or er part ot spine. He may quickly regain consclOusn S., or 111sensibility, more or les complete, may be prolonged .

TREAT.\IEXT.

I. - Apply the general rules for the tr eat ment of In enslbility

2 . - Be very apprehensive of dange.r in all cases of injury to the head. The patient may be stunned, and after a short inter\'al may recover some degree of consciousness, or e,'e n the L!"al11 may apparently have escaped injury' yet in both there is a gra\'e risk that a structure \\.lthm the craniulll has been in :ured, and t h at a senous state of insensibility may develop later. (ee Fracture of the Cranium, page 43.) A cautio n should therefor e be given to a patie n t who has lost conscjo u sness e ven

f or only a moment after an injury to the head not to resume physical or m ental activity without the consent of a doctor.

OF THE BRAIN, APOPLEXY

.

Compression of the Brain may result from the same causes as produce Concussion; in fact, Compression is frequently preceded by Concussion.

Apoplexy usually occurs in elderly people, and no signs of injury are necessarily present .

In both conditions the face is flushed; the breathing stertorous; one side of the ?ody may be more limp than the other: and the pupll of one eye may be larger than that of the other j the temperature of the body is generally raised.

TREATME T.

I. - Apply the general rules for treatment of

2.- Promote warmth in the lower part of the body by the application of hot \\ater bottles to the abdomen and lower limbs. C'ne must be taken not to burn the patient with the bottles, which should be wrapped in flannel, and their heat tested with the elbow.

EPILEPSY.

Epilepsy may occur in persons of any age, but u sually occurs in young adults. The patient falls to 133

the ground, sometimes with a scream, a n d passes into a state of convulsion, throwing his limbs about.

The treatment is accordi ng to the General Rules, especially Rule 11.

HYSTERICAL FITS ( HYSTERIA).

Srexs AND Y:'IIPTO:'ll.

The patient, usually a young girl, in consequence of mental excitement, suddenly loses command of her feelings and actions. he subsides on a couch or in some comfortable position, thro\\"s herself about, grinding her teeth, clenching her fists shaking her hair loose; she clutches at anyone or anything neJr her, kicks, cries and laughs alternately. The eyeballs may be turned upwards, and the eyelids opened and shut rapidly. At times froth appears at the lips, and other irregular symptoms may develop.

TREAT'IfENT.

I.-Avoid sympathy with the patient, and speak firmly to her.

2.-Threaten her with a cold water douche, and if she persists in her "fit," sprinkle her with cold water.

3·-A pply a mustard leaf at th e back of the neck. treatment is necessary to cure the condition of mind and body which gives rise to hysterical altacks.

S HOCK, FAINTI NG (S Y TCOPE), COLLAPSE . CAUSES .

r. -·I njury i n the region of the abdomen, extens ive wounds a n d b urn s, fractures, lacerated wo un ds, severe crush are some of the more freq uen l ph) lcal causes of shock.

2.-Fright , anticipation of injury, ar:d sudden n ews or so m etimes udden removal of fear and a n :-"Iety afte r 'prolo nged suspense, produce shock or fainting.

3 - 'ome poisons cause shock, \\hile oth rs, sllch as alcohol, so depress the neryous system that collapse e nsues.

4.- H temo rr hage or heart weakness, a close o r c ro wded room , tight clothing, fatigue, or \\ ant of food may bring on fai n ting or collapse.

SIG}l"S •

Th e general co n dition of shock may be by ext reme pall o r, a feeli n g of c?ld , clammy fe eble pulse, a n d shallow breathll1g accOl:,pal1led, i f h tem orrhage h as been s by ?aw n 1l1g an.d s igh i ng . T he ter m "collaps,e slgl1lfies, a seriou s conditio n i n whic h the lIfe of the patIent IS 10 t he greatest da n ger; the of the body falls b elow the n or mal, and one great o bject o f, treatmel:t is t o preve n t it si n ki n g to a poi n t at whIch, IS i mpossible . An attendant danger of the c ondltlOn of

135

c o ll a pse is the liability t o s u dde n relapse after a temporary Im proveme nt , and the ut most care a nd watch f ul ness must therefore be exe rcised to mai n · tai n the heat of th e body and t o guard against failu re of the heart and lungs.

TRIXI \JEXT.

I. - Remove the Cause by arresting htemorrha re, atlenLiing to mjunes, loosening all tight clo thing, especially about the cbest and abdomen, remov in from a close or CrQ\\ ded room, using encouraging \\ orcls, etc,

2. - Lay the patient on the back, w ith the head low. Raise the lower lim hs; \\ hen the patient 1-; In bed this is best clone by raising the foot of the bedstead.

3. - Provide for a free circulation of fresh air.

4·- If hcemorrhage has been severe and the patient is collaped, firmly bandage the limbs from the toes to t he hip, and from the fingers to the armpits.

5·- To stimu late the action of the heart, sal volatile and \\ atel may be gn'en if the can s\\'allo\\', or smnllmg salts may be held to the nostrils .

6. - It is of the utmost importance to use every means of preventing a fall of temperature below the normal point. To accomplish thi c over t he patient wi t h ex.tra clothing, o r by placing

136

rugs or blankets over him; get him to bed in a warm but well-ventilated rool11 as soon as possible. Apply warmth to the fe et and to the pit of the stomach by hot water bottles or hot flannels. (T est the heat of wIth the e lbow before ap ply ing them.) If the p atIent can swallow, give hot d r inks, such as milk, .or coffee. I t is well to add sugar, as it aids in ralsll1 g the temperature of the body . cannot be discerned, apply artIfi.clal respIration.

8. - If want of nourishment has been the cause of fain ting or collapse, gi ye food sparingly at first.

SUNSTROKE A i D HEAT-. TROKE.

'Wh en exposed to great heat, as in the stoke-hole of a steamer, in tropics, or to the rays of th e sun dUrIng a march 111 very hot \"eather \\ hen persons may de\'e!op sickness, glddll1ess, and difficulty in breathing. The patient cOl11plains of thirst, the skin becomes "d ry and burning, the face very flushed, the pulse qUick and

.. A very temperature, stertorous (snorll1g) breathll1g, and ll1sensibility may ensue.

I.-Undo all tight clothing.

2.-Remove the patient to a cool, shady spot. , .

137

J' trip rhe patient to the \\aist.

4.-Lay the patient do\\n, \\ith rhe head and trunk \\ell raised.

5.- Procure as fr ee a circulation as possible of fresh mr, and fan the patient vigorously.

6.-Apply ice bags or cold \\ater freely tu the head, neck, and spll1e, and maintain this treatment until tht symp tom subSide.

7.-0n return to consciousness, the patient may have \\ater to tl.rink.

CONVULSION IN CHILDREN.

Teething or stomach tJ oubles are the commonest causes of this ailment.

IG:\S.

pasm of the muscles of the lim bs and trunk, blueness of the face, insen ibility, mort or less complete, and occasionally quinting, su pended re piration, and froth at the mouth are the prominent signs.

1

1.- upport the child in a \\arm bath slightly above the temperature of the bo dy (98 degree , ), so that the water reaches to th e middle of the trun k.

2.- Place a sponge dipped in cold water on the top of the head.

A PHYXI A.

"VI: en, owing to want of air, the blood is not \\:I th oxygen the patient becomes insensible, and IS saId to asphyxiated . This condition may be bro ught about as follo\\'s : -

I. Obstruction of the air passages.

(a) By DROWNING.

(b) By PR.ES URE FRO.\f OUTSIDE: trangubtio n, hangmg, smothering.

(c) By A FOREfGN BODY IN THE THROAT: Choking.

(d) By S "ELLING OF THE TISSUES OF THE TH.ROA.T : InflammatIOn, scald of the throat, pOISOnll1g by a corrosive.

II. In.haling poisonous gases. By coal gas (as us ed 111 the house), producer, or water, gas, smoke, f from a charcoal or coke fire, se\\'er gas, limekIln gas, carbonic acid gas.

III. Pressure on the chest as" hen crushed by sand or or by a crowd. '

IV. N affections, as the result of narcotic and certall1 ?ther. poisons, collapse, electric shock or stroke by lIghtnll1g. '

G ENERAL TREAT.\fENT.

In all cases of Asphyxia attem pts must be made to remove the cause, to remove the patient from the cause. "Vhen tbls has been done artificial

respiration must be applied, taking care tllat the aIr passages are not ob tructed, and that there is abundance of fresh ai r.

DRO\\ NI -G.

Persons completely immersed in \\ ater for even ten or fifteen minutes ha\'e be n restored by artificial means. Th erefore, if the body is recowred wIthin a rea onable time, absence of sign. of Me is not to deter immediate attempts to re tore animation.

The first th Illg to do when the body is reco\'ered is to get rid of the wattr and froth obstructing the air and then artJil(ially to n :5tore breathing. This is best accompbshed either by proceeding at once to perform artIficial respIratIOn by 'chMer 's method, or a follo\\'s:-

I.-As qUIckly as po. sible loosen the clothing, and clear the mouth and the back of the throat.

'2.-Turn tIle patlC'nt face dO\\,I1\\arc1., \\'ith a pad below the chest, and with the forehead upon the right forearm.

3.-\\,hilst in thi . position apply pr sure by the hands to the patIent's back oyer the 10\\ er ribs, and keep the pre sure up for three econds .

4.- Turn the patient on the right side, maintaining that position 801. 0 for tIne second . .

5.- R epeat these movement alternately as long as froth and \\ atLl' issue from the mouth.

These operations ( fur hall Hall's method) in themtend to promote respiration, but \\ hen the alr passages are clear of froth and water ilve ter's method of artificial respiration may be used by itself or \yith HOlyard's method in conjunction.

'Vhil e performing these operations send someone t o the nearest house to procure blanket and dry clothing, hot \Yater bottles, etc., and to fetch a doctor.

STRANGULATION.

Cut and remove the band constricting the throat. Apply artificial respiration.

HANGING.

Do not wait for a policeman: grasp the lower limbs and raise the body to take the tension off the rope; cut the rope, free the neck; apply artificial respiratioll.

Remove \\'hatever is smothering the patient: apply artificial respiration.

CHOKING.

Open the mouth, forcibly if need be j pass the right to the back of the throat and attempt to dIslodge the foreign body j if vomiting results, so much the better. If unsuccessful, thump the back hard whilsl the head is bent fOf\\ard. Apply artificial respiration.

I-t[

S \ ELL!. G OF T1S ' UES OF THK THROAr.

'Vheth er the s'vYelling is caused by inflammation by swallowing. very hot water, as not infrequently happens to children attempting to drink from the spout of a kett.le, or by the effect of a corrosi \'e poison, the treatment IS as follo\\'s :-

I.-Apply a sponge, piece of flannel or other clot\ \Yrung out of very hot \\'ater, to the front of the neck fro:11 the chin to the top of the breast-bone . 7

2.- et the patient before the fire.

3·-Give Ice to suck if it can be had' if not gi\'e cold \\ater to drink. "

4.-:-Give animal or vegetable oil, a dessertspoonful at ,a tllne, to soothe the scalded throat and ease the pam.

. S·-If breathing has ceased apply artificial respiratIon.

UFFOCATIO , UY ' .\JOKE OR GASE

.

I.-Remove the patient into the fresh air. Before entering a building full of smoke tie a handkerchief. \\ et if possible, round the head so as to cover nose and mouth. . It is ,,:ell ,to move slo\\ 11', keeping or even era\\ Ill1g, \\ hllst 111 a room full of smoke

111 sear.ch o,r a suffo ated person. Every opportunity of lettlllg 111 fresh aIr by openilF doors or \\ indo\\ s should be seized.

0

2.-A p ply artificial respi ration.

3 - In th e case of prod u cer or \\'ater gas, inhalatio n of oxyge n will a lso be necessary .

ELECTRIC HOCK.

Electric cur rent is conveyed by a cable, wire, rai l, or bar, called the "Positive," and returns to the source of supply by another cable, \\"ire, rail, or bar, called the" Negatiye," or tbrough the earth. In the case of an electric railway, the current is generally com'eyed by an insulated rail the third rail, and returns through the running rails or an insulated rail called the fourth rail, and in the case of an electric t ramway it is frequently conveyed by an overhead conductor or trolley wire, and returned through the running rails.

Through contact with a " positiYe II the shock may be so severe as to cau e insensibility, and the sufferer \\"ill be unable to extrIcate himself, and 111 ust be liberated with all possible peed. As it is genen.,.1ly impossible or inexpedient to switch off the current some other method must usually be adopted; but precautions must be taken or else the person rendering assistance wi ll himself receive a shock.

To liberate the sufferer from contact-

I. - Insulate yourself from the earth by standing on a n "i ns u lator " or " n on-conductor," that i , a body wh ich resists the current. Amongst such bodies

143

J.re in dia ru bber , dry glass , dry bricks, dr y silk, d ry cloth, d ry wood a nd dry hay o r straw .

2. - Protect your hands from contact with the the electric medium by covering them v:lth an lI1sulu.tor. Althouf;h incl larubber is probably the best insulator, do not wa te time in running for indiarubber glo"es, but use dry articles of clothing; an indiaruober tobacco pouch or cap, or folded ne\\ paper, \\ ould sen'e to proted the hands 111 an emergency. 1£ no means of insulatmg the hands are at hand an attempt may be Illade to drag the sufferer away by means of a loop of dry rope or a crooked stick; an umbrella is not safe because the metal ribs would act as conductor * of electricity and it is not infrequently the case that the" stick" ;i the umbrella is a metal tube .

3· - Pull the sufferer away from contact. Care hould be taken to ayoid touching with naked hands the sufferer 's hallds, wet clothing, or boots if th e soles are nailed . The armpits should be avoided as per pi ration usually makes tl'e clothing damp there .

' Vhen the sufferer is removed from contact-

I. - Apply the g e neral treatment for insen -

* A conductor is a body through which electricily readily pa se. Amongsl such bodies are copper, iron, 111visture and one\' u\\ n lJOoy.

144 sibility (loosen clothing, procure free circulation of air and place in a recumbent position).

2. - Dip a towel in cold water and attempt to arouse him by sharply flicking the face and chest.

3. - Commence artificial respiration if othe·r methods fail to restore animation. "Laborde's II method (see page 126) has been found to be very s ucce·ssful.

4.-Treat burns if there are any (see pa.ges 103, 10-t).

EFFECT OF LIGHTNING ,

A person struck by lightning: is usually mor-e or less deprived of consciousness. The treatment is the same as that for electric shock, of course, that the instructions for the patient from contact with the electric medium do n ot apply. 145

Q"CESTIO?\ ON CHAPTER V.

TIle numerals indicate tIle pafr!s where Ille answers may be found.

\Vhat ;Lre the two systems of nerye ?

Of what is the cere bro -sp inal system made up? ...

What is the spinal cord?

'Vhat are nerves like?

Explain the system

the respiratory system

In what system of artificial respiration is the patient laid back upwards?

In what systems is he laid on his back? ..

what _ystem is he laid on his back or side?

)w long should artificial respiration be pers e vered \\

the various forms of insensibility

Stale the general rules for lreatment of insensibility 12 to 131

'Would you examine the patient to see if any bones were broken?

V-hat wrong opinion may be formed when the patient smells of drink? collapse from drink a serious condition?

hlt is conctlssion of the brain? ...

What danger accompanie injury lo the head?

'What caution should be given to a ratient who lost consciousness, even for a moment, after an Injury to the head? ... . .. . ..

\Vhat are the cau ses of compre'sion of the brain?

In what aged people does apoplexy usually occur?

\Vhat are the signs and symptom6 of compressIOn and apoplexy? ...

... ":. . ..

Slate the rules for treatment of the e condllIOns ...

\Vhat dang!" r is there in applying hot w,:ler cot tIes to insensible persons, ancl what precautIOns should be

taken? '" 132

Describe a case of epilepsy 132, 133

\Vhat special care must be taken in treating a case of epilepsy? ... 130,132

Descri be a hysterical fit 133

IIow would you treat a hysterical fit ? ... ... 133

\Vh at are the commonest physical causes of shock? 134

What may produce shock. 01 ... ... 134

\\11at conditions do certain pOIsons hnng about? J 34

Wbat may bring about .fainling or col'apse?... ... 134-

How would you recogmse the general conditIOn of shock? 134

\Vhat special precaution must be taken in the ca e of collapse? ... ... 135

State the treatment for shock, faintlllg (syncopl) aT d collapse... ... ... '" 135, 1]6

'''hat is the effect of sugar on the temperature of the body? ...

'Vhat are the causes of sunstroke and heat·stroke ?

State the treatment for sunstroke and heat·stroke

\Vhat are the causes of convulsions in children?

\Vhat are the signs of con\'Ubions in children? .. .

State the treatment for cOlwubions in children . . .

State fully the causes of asphyxia ...

Wh at two things have to be done in all cases of asphyxi<t? ... ... '" ': '. .... 138, 139

W hat two things must he seen to before It IS pOSSible for artificial to do any good ?.. . 139

I s artificial respiration likely to du any good if the air passages are obstructed, or if there is not abundance uffrcshair?

139

\Ylnt is the first thing to do in a ca"e of drowning?.. . 139

By what method may artifIcial respiration be perfurmed without laking any previous step ? .... 139

What steps must be taken before procee<llllg "ith S method? ...

139 What should be done while artificial respiration is being performed?

the treatment for strangulatIon

140

State the treatment for choking 140

lI ow maya swelling of the tis ues of the throat be cau:;ed?

State the treatment for swelling of the tis:;ues of the throat ...

I-t1

State the treatment for suffocation by smoke or gases I-tL q2

IJ ow i:; electricity cOIn'eyed ? ... ... ... '" 142

II ow would you liberate a sufferer from contact with an elecLric medium? 14 2 , 143

,Vhat would you do ,"hen the utTerer was remon:d from contact? " ,.. ... I.t3

What \\oo1d you do in the case of a lightning stroke? ... I-t4

CHAPTER VI.

PO

I SON I NG.

Poisons may be cla sified according to their treatment under two heads :-

1.-Those which do not stain the mou t h, and in the treatment of which an emetic is to be given. Amongst these are :-

(a) Arsenic, Phosphorus (contained in rat and lucifer matche), Tartar emetic and Corrosive 'ubllmate, \\ hich cau e a metallic taste in the mouth and a burning pain in the mo u th, throat and stomach.

(b) Strychnine, Prussic Acid, Belladonna (deadly nightshade plant) and seyeral other vaneties of plants, such as laburnum seeds, etc.; these give rise to convulsion, delirium, failure of re piration and collapse.

(c) Poisonous meat, fish and fungi (often mistaken for mushrooms). uspicion of these poisons should be directed to cases "here several persons who have partaken of the same food develop similar signs ancI symptoms.

(d) Alcohol, which may cause collapse.

(e) Opium and its preparations,

J49

Laudanum, Paregoric, Ch]orodyne, yrup of P?ppie . an I various soothing drinks and cordIals; the"e cause 11 tendency to go to sleep, which ontinues until sleep becomes deep and breathing sterotorus . the pupils of the eyes become minutely contracted '-Plllhe1.d pupils). \

2. - Those which burn or stain the mouth and in the treatment of which no emetic is b e g iven . The e are of t\\O classe :-

(a) Acids, such as Nitric Acid (Aqua fortis), Acid (Oil of Yitriol), HydrochloriC, or Acid ( pirits of alt). arboli Acid (Phenol), Oxalic Acid, \\ hlch is contained in oxalate of potash, s1lts of sorrel, .-tIts of lemon and ome pO'lishing paste .

(b) Alkalis, such as Caustic Potash, Caustic oda and Ammonia.

OF SIIIIPLE DIRECTIONS FOR THE TR EA DfENT OF PG'! ONI, c.

I. - Send for a doctor at once, stating what has occurred and if possible the name of the po ison.

2. - Except when the lips and mouth are stained or burned by an acid or alkali,

ISO

promptly give an emetic- that is , make the patient vomit as follows : -

(a ) Tickle tlze back of tile till-oat with the finger or with a featber.

(b ) Mustard - a dessert-spoonful in a tum blerful of luke-\-yarm \\ ater.

(c) Salt-a table-spoonful in a tumblerful of luke-warm water.

(d ) TT ine-for a young ehJ1d, a teaspoonful repeated at intcn'als of fifteen minutes.

3. - I n all cases when the patient is not insensible, give Milk, Raw Eggs beaten up with milk or water, Cream and Flour beaten up together, Animal or Vegetable Oil (except in phosphorus poisoning) , and Tea.

O live, alad, and Cod-li\ er oil, or Oll su h as that in . \\"hieh sardines are preseryed, may bc giyen; mmeral l1iachine oils and raraffin are unsuitable.

O il is soothing, and i tberefore esreeially llScful in poiso n ing by Acids, Alkalis and . uch sut tan es as Ar senic and Co rr osive ub limate. Demulcent drinks, such as barley water or thin gruel, act in tbe same mann e r, and are free from danger in cases of ph sp h o ru s poiso n ing.

Tbese may be given either before or after the emeti c if t he poison calls for o n e.

S tr o ng T ea ac ts as a neutraliser of many po iso n s,

1 51

anJ is always sJJe. A handful of tea should be thrown into a kettle anJ boiled.

4. - If the lips and mouth are stained cr burned give no emetic, but( a) If an is kno,\' n to be the poison give an Alkalt at once. First wash the mouth out freely \\"ith lil11e water or other alkaline mi\':ture, such as soda chalk \\"hitino- CJI" . "b' ma611esla or \\'all pIa ter in \\"ater, and afterwards let the patient sip a little of it. ,'oda and potash are not to be gi"en in the case of pOIsoning by oxalic acid.

(/I) If .a Alkali is known to be the poison glre an aCId at once. \\'ash the mouth frecly with lemon juice or yinegar dIluted \\ Ith an eq ual quantity of \Yater, and afterwards let the patient sip a little uf it.

In both cases gi\'e oil (Rule 3).

5·- Wh en a person has swallowed poison and to go to sleep , keep him awake by hun about and slapping his face, neck and t wIth \vet to\\ el. Strong bla ck coffee may be gIven to .dnnk. lapping the sales of the feet may a1 a be trIed.

6. - If the throat is so swollen as to threaten ob stru ction to air passage, apply hot flannels or poultIces to the front of the neck and give frequent sips of cold drinks.

7. - Apply artificial respiration if breathing cannot be discerned.

8. - Treat shock and collapse.

9. - Preserve any vomited matter, food, or other substance, suspected of being the poison. Do not wash vessels \yhich lllay have contained the poison, and carefully guard them.

Certain poisons require special treatment, and a few of the commoner of these are mentioned below with their treatment.

CARBOLIC ACID.

The odour of the breath \yill aid in the detection of this poison ; the lips and mouth are usually stained white, and several nervOUS symptoms come on.

TREAT:\lE\,T.

1.- GiYe milk, to a pint of \\hich half an ounce of Epsom Salts has been added.

2. - Treat accorJing to the gene ral rules.

PRUSSIC ACID.

The action of this poison is extremely rapiu. Giddiness, staggering, insensibility accomranied , by panting respiration, profound collapse .and convulsions are the general signs, and 111 addltlOn a smell of bitter is often present.

TREATJ\[ENT .

I. - Place the patient in the open air. 153

2.-D ,lSh cold water on the head and spine contJlluou.,lr.

3.-:\pply artificial resp iration.

4.-H ol d s nelling salts to the nostrils.

5.-Treat shock and collapse. ('ee page 135·)

P OISO)l'OUS E.\ T, FISH AND FUNGI.

Th e sig ns and symptom . are vomitin g and purging (d ia rrh eet), colic, headache, great \yeakness, ra i ed tcrnpe,'ature and a quick pulse.

TREAT:\IENT.

I.-Giv e an emetic,

2 - \\Tben the emetic has acted, give castor oil.

3 -Treat collapse. (ee page 135. )

TRYCHNINE.

The igns and sympto '11S are a feeling of suffocn,tion, 1l\'id features, and convulslOn. Th e patient re ts on hi') head tnd feet, and the hody is arched.

TREAT,\fENT.

I. -Gi\'e an emetic.

2.-Apply artificial respiration.

ALCOHOL.

1.- Give an emetic if the patient can swallow

2. - Tr eat collap e by k eepi ng the patient \\arm , etc . (ee page 135 )

QUEST I ON ON CHAPTER YI.

The! ?11f1l1e?'als indicate the pa,[[er where tlte answers m ay be fOll lld.

CHAPTER VII. BANDAGING.

\Yhat are the symptoms of poi oning by arsenic?

\Vhat olher poi ons lise lo the same symptoms?

Under what two heads may poisons be classified? PAI;E I4 , 149 14

\Vhat poisons give ri e to convulsion, delirium, failure of re piratiol1 and collapse? ... .. 148

If several people " oho had partaken of the same food cleyelopecl similar signs and symptoms, by \I hal would you suspec l they had been poisoned? . . Lt

\ Vhat condition may re ull from poi oning by alcohul ? LtS

\Yhat are the effects of uch poisons a - opium?.. LtS, Ltc)

\\'hat two classes of poison burn or tain the mouth? .. . 149

\\'ould you giYe an emetic for such poi ons? 149

Name some of the principal acids J 49

Name some of the principal alkalis Lt9

Slate the general rules for the treatment of ing ... Lt9 to 152

State the best methods of making a person "omit ISO

How would you treat a case of acici poisoning? ... 151

How would you treat a case of poisoning by an alkali? 151

State the signs, symptoms and treatment of carbolic acid poisoning ... 15 2

State the signs, symptoms and treatment of poisoning by Prussic Acid 152, 153

State the signs, ympt011ls and treatment ( f poisoning by poisonous food ...

Esmarch 's Tri angular Bandage has bee n d escr ibed jn Chapter II. I t may be applied to keep a dressillg on a \\ound, burn or s aid of any part of the body, or for an injury of a joint.

For

the Scalp (Fig. 62). Fold a hem abo u t It F IG. 62. inches deep along the base of a bandage; place the bandage o n the head so that the hem lies o n the forehead close down to the eyebrows, and the point hangs down at the back; carry the two ends round the head above the ears and tIe them on the forehead; dr3.w the point first do \Yl1\Yards, and then turn it up and pin it o n to the ba n dage on the top of the head .

For the Forehead, Side of the Head

,

Eye,

State the signs, symptoms and treatment of poisoning by Strychnine ... ... ... ... ... ... 153

What would you do in the case of alcoholic poisoning? 153 153

Cheek , and for any part of the body that is round (as the arm or thigh , etc. ) the narrO\\' bandage should be used, its centre being placed o ver t he

dressing, and the ends b ei ng carried round the head

o r limb, as the case may be, and tied over the wound. For the Shoulder ( Fi g. 63) ' Pl ace the ce n tre

o f a band age on the shoulder, \\'ith the point running

FIG. 63.

FIG, 6'1-.

up the sid e of the neck; fold a hem along the base; carry the ends round the middle of the arm and tie them. Place one e nd of a broad bandage over the point of the first bandage and sling the arm by carrying the other end over the sound shoulder and tying the ends at the side of the neck; turn CO" n the point of the filst bandage, draw it tight and pi n it.

157

For the Hip (Fig. 6-1-). Tie a narrow bandage round th e body above the haunch bones, with the knot on the injured side. Fold a hem according to the size of the patient alollg the base of a seco n d bandage; place its centre over the dressing, carry the ends round the thigh and tie them; then carry the point up under the

FIG. 65.

FIG. 66. first bandage, turn it down over the knot and pin it.

For the Hand when the fi n gers are extended (Fig. 65) a hem along the base of a bandage; place the 'Hlst on the hem with the fino-ers towards the point; then bring the point over wrist, pass the ends round the \\ rist, cross and tie them' bring the point O\'er the knot and pin it to bandage on the hand.

IS

For the Foot (Fig. 66). Place the foot on the centre of the bal1:da ge with the toes towards the point; draw up the pomt over the instep, bring the ends fOf\yard and cross them; now pass the ends round the instep and tie them at the back of the ankle.

FIG. 67b.

Draw the point forward and pin it to the bandage on the instep .

. F the Back. The bandage lS applied as the foregoing, except that it is begun at the back.

For the Knee. Fold a narro\\' hem along the base of a bandage; lay the point on the thigh and the middle of the ba'e just belo\\ the knee-cap; cross the ends first behind the knee, then oyer the thigh, and tie them. Dring the pomt do\\ n and pin it to the base (Fig. 68).

For the E lb ow. Fold a F1G. 6S. narrow hem along the base of a bandarre ,: lay the point on the back of the arm and the middle of the base on the back of the forearm; cross the ends first in front of the elbow, then oyer the arm and lie them 111 front (Fig. 69) .

For the Fingers and Toes wrap a strip of calico or lin e n round and round the part· plit the free end, and secure it round the wrist or ankle.

For the Front of the Chest (Figs. 67((' and 67b). Place the middle of the bandaae over the dressing with the point over the shoulder the same side; carry the ends round the waist and tie them .) 159 then draw the point over the shoulder and tie it to one of the ends.

CHAPTER VIII.

METHOD OF CARRYI G.

THE FOUR-HANDED SEAT.

This seat is used when the patient can assist the bearers and use his arms. ,

1.-T\\ 0 bearers face each other behind the patient and grasp their left forearm \yith their right hands and

FIG. 70.

ea.ch other's right forearm with their left hands (Fig. 70 ), and stoop down.

2.-The patient sits on the hands and places Olle arm round the neck of each bearer.

3.-The bearers rise together and step off, the bearer on the right hand side of the patient with the right foot, and the left-hand bearer with the left foot.

THE EAT.

This seat may be used to carry a helpless patient.

FIG. 7I.

r ,-T,yo bearers face eacil other and stoop, one on each side of the patient. L ach be:uer passe his forearm n eares t to the patient's head under his back just G

below the shoulders, and, if possible, takes hold of his clothing. They slightly raise the patient's back, and then pass their other forearms under the middle of his thighs ( Fig. 7 I), and clasp their hands by one of the methods shown in Figs. 7 2 and 73. A handkerchief should be held in the hands if the first grip is used.

2.-The bearers rise together and step off, the right-hand bearer with the right foot, and the left-hand bearer with the left foot (Fig. 7-+)·

THE EAT.

This seat is u seful for carrying a patient and supporting either of his lower limbs, when he is able to use his upp er limb.

I.-Two bearers face each other behind tbe patient. For supporting the left limb the bearer to the patient' · right grasps his own left \Hist with his right hand and the other bearer's right wrist \\'ith his left hand. The bearer to the left grasps the fir:,t bearer' - right wrist with his right hand (Fig. 75)· This leaves his

74.

FIG. 72. FIG . 73.

left hand free to support the patient's left leg. For the patient's right lo\yer limb follow the same directions, substituting "right" for" left" and" left" for " right." The bearers stoop down.

2.-The patient places one arm round the neck of each bearer and sits on their hands.

3,-The bearers rise together and step off, the

FIG. 75· right-hand bearer with the right foot, and the lefthand bearer with the left foot.

THE FIRE:'IAN'S LIFT.

(To be attempted only by a strong man.)

Turn the patient face dO\\,l1\yards; place yourself at his head, stoop down, slightly raise his head and FIG 76.

166

shoulders and take hold of him close under his armpits, locking your hands on hIS back. Raise his body and rest it on your left knee; shift your arms and, taking him round his waist, lift him until his head rests on your left shoulder. Throw his left arm over your head, stoop down and place your left arm between his thighs, letting his body fall across your shoulders. Rise to an upright position; hold the patient's left wrist "ith your left hand and leave your right hand free.

Assistance may be given to an injured pers on by supporting him in the manner shown in Fig. 76.

The plan of carryZ?w tile patl'ent by the arms and leo's witlt the face doul?lwards, called the" fr o../{s' marciz," must ?lever be used, as deatll may ensue' from "la's treatmellt.

bIPRO\'l ED STRETCHER.

A stretcher may be improvi ed as follow s :-

1.-Turn the sleeves of a coat inside out; pass two strong poles through them; button the coat. Th e patient sits on the back of the coat and rests again st the back of the front bearer (Fig. 78). If a longer stretcher is required two or three coats m u t be treated in the same manner. The poles may b e k ept apart by strips of wood lashed to the poles at both ends of the bed formed by the coats (FIg. 79).

167

THE F ORE A:-'-D AFT METHOD.

Thi plan of carrying is useful when space does not permit of a hand seat.

FIG. 77.

2 holes in the bottom corners of one or two sacks and pass stout poles through them.

3.- pread out a large piece of carpet, sacking, tarpaulin, or a strong blanket, and roll two stout poles up in the sides. Two bearers stand on each side and grasp the middle of thc pole with one hand, and near the end with the other. They walk sideways .

4.-A hurdle, broad piece of wood, or shutter may be used as a stretcher; ome straw, hay, or clothing should be placed on it, and covered \yith a piece of stout cloth or sacking; the latter is useful in taking the patient off the stretcher.

Always test an improyised stretcher before usc.

Stretchers must be carried, and the patient placed on them, as laid dm\"!1 in the 'c tretcher Exercises."

As a general rule carry thc patient feet foremost.

The exceptions are :-

(a) ,'"hen going up hill with a patient \rho e lo\\"er limbs are not injured.

(b) \\Then going down hill \\"ith a patient whose lowcr limbs are injurt:d .

A\"oid lifting the oyer ditches or \\alls, but where these cannot be the stretcher must be carried in the follo\\ing \\"ays :-

To CROSS A DITCH.

In crossing a dItch, the stretcher houlcl be 10\\ ered with Its foot one pace from the edge of the ditch.

Nos. I and 2*' bearers then descend. The stretcher, with the patient upon it, is afterwards advanced, N os . I and 2 in the ditch supporting the front end wh ile its other end rests on the edge of the ground above . N o. 3 nmv descends . All the Nos. now carry the stretcher to the opposite side, and the foot of the stretcher is made to rest on the edge of the grou n d, while the head is supported by No. 3 in the ditch. No . I climbs out, No . 2 remaining in the ditch to assist NO . 3. The stretcher is lifted forward on the ground above, and rests there while Nos . 2 and 3 climb up .

To C ROSS A "\VALL .

The stretcher is lo\vered with the foot about one pace from the wall. TOS. I and 2 bearers then take hold of the foot of the stretcher, and 0.3 of the head; the stretcher is raised till the foot is placed on the wall. No. I then climbs over the wall and takes hold of the foot of the stretcher, while Nos. 2 and 3 support the head j the stretcher is then carried forward till the head rests on the wall, No . I supporting the foot. Nos. 2 and 3 then climb over the wall and take hold of the head of the stretcher, which is then slo\dy lifted off the wall on to the ground, and the bearers take their usual places .

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

T o L OAD A "\VAGON .

The stretcher is lowered with the foot one pa ce from the end of the \\'ago n. N os . I an d 2 take hold of the foot of the stretche r, No . 3 the head. The stretcher is t hen raised and carried forward till the front wheels rest on the floor of the wagon. No. I then jumps into the wagon, while No.2 goes to the head of the stretcher and helps NO.3 . The stretcher 1S then pushed slowly into the wagon . If the tailboard cannot be shut, the stretcher must be lashed firmly to the ides of the \\agon.

To UNLOAD A "\V

Nos . 2 and 3 take hold of the head of the stretcher, while o. I gets into the \\'agon ; the stretcher is then gradually drawn out till the foot-wheels rest on the edge of the wagon. Ko. I jumps out of the wagon, and with No.2 take hold of the foot of the stretcher, NO,3 supporting the head. The stretcher IS now gently dra\\ n away one pace and lowered. "\Vith four bearers Nos. I and 2 would lift the foot of the stretcher, while Nos. 3 and 4 lift the head. ThIS applies to cro ing a ditch or \\'all, as well as to loading and unloading a wagon.

CH APTER IX.

STRETCHER TRAN SPORT.

T he " Furley " S tretchers ( Model r899) a re of thre e pa tt e rns, viz., "Ordinar y," "Telescopic-handl ed, /I and "P olic e." In ge nera l pri nci ple they are a lik e, the component parts being designated the poles,

Fig. 8r.-T ELESC OPIC - HA NDL E D S TRETC HER - O PE N.

handl es, jointed trave rs e bars, foo t wh eels , bed , pi llow sack and slin gs.

Th e Ordina ry Stre tch er (F ig . 80), is 7 fee t 9 in ches m leng th, a nd I foo t TO inch es wid e. Th e be d is 6 fee t in leng th, a nd th e han d les ro t in ches. The h eight is sf inches. At the h ead of th e stre tc h er is a canvas overl ay (th e pi ll ow sac k) which can b e filled with stra,,- , hay, cl o th ing, etc ., to form a pillow_ The joi nted traverse bars a re provided wi th joints, 173

for openi ng or closi ng the stretcher. T he Telescopich a n dled pattern (Fig . 8r) is very similar, but the h andles can be slid underneath the poles , th us red u cing the length to 6 feet. This arrangeme n t is of great value when working in confined spaces, or \"hen a patient has to be taken up or down a narrow staircase with sharp turns. The PolIce stretcher is SImilar to the O rdmary pattern, but is more strongly made, and has, in additIOn, straps for securIng a refractory patient.

, Vhen closed, the poles of the stretcher lie close together, the traverse bars being bent in\\ards, the canvas bed neatly folded on the top of the poles an d held in position by the sli ngs \yhich are laid along the canvas, a n d secured by a strap, placed transversely at the end of each slIng, being passed through the large loop of the other, and round the pole and bed .

I n closing a stretcher care should be taken to raise the ce ntre of the canvas when pushing in the traverse bar, as it is otherwise liable to get caught.

To prepare, or open a stretcher, unbuckle the transverse straps of each sling j remo,-e the slings from the stretcher; separate the poles; take hold of each traverse bar and dla \\' it fo[\\ ard. The slings \\ III then be folded to half then length, one being laid neatly over the handles at each end of the stretcher .

•\. a general rule, the tretcher \\ ill he prepared by .;\ 0 ;:,. I and 3 bearers in Exercises I., II ., and III. ;

Fig. 80 - 0RDINAR Y STRET CHER - CLOSED.

and by No. 2 in Exercise IV. These bearers will, however, if required, assist the other bearers in attending to the patient's injuries.

Note . - The various movements detailed in the following Exercises should be carried out steadily, the bearers working in unison, hurrying being carefully avoided, and every attention being paid to the bearer who gives the words of command.

STRETCHER EXERCISES,

Oriainally drawn up by ir John Furley, and revised in to accord with the drills adopted by the Royal Army Medical Corps :-

EXERCI E No. 1.

FOR F01:R nEARERS.

1.-The Instructor selects the bearers and numbers them-I, 2, 3, 4 at his discretion. hould one man be taller and stronger than the others, he should be styled NO.3, as he will have to bear the heavier part of the burden.";\< All order will be given by No. -to 2 .-" Fall i n ."-Nos. I, 2, and 3 take position on the left side of and facing the patient. No. I places himself at the patient's knees, No. 2 at the hips, NO.3 at the patient's shoulders. At the same

* Bearers should, however, be taught to take any of the positions named in the following Exerci es, whether that of No. I, 2,3, or 4 bearer.

175

time No. 4 places the prepared stretcher on the ground by the right side of the patient about two

FIG. 82.

pace away from hI111, and then takes position opposite to and facing NO.2. (Fig. 82).

3·-" R ·eady. " - Th e bearers kneel down o n the knee 3nd take h old of the patient, No. I passing his and fore-arms be neath the patient's legs, hands wide apart. No s. 2 a n d 4 pass th ei r hands

FIG. 83 . and forearms beneath the patient 's hips and loins, and grasp each ot her's Innds. NO.3 paes hi::; leit hand across the patient's chest and under the rig-ht shoulder, and. his right hand beneath the left shoulder (Fig. 83).

4. - " Lift."- O n the word "Lift, U the bearers raise the patient gently and rest him on th e knees of N os. I , 2 , and 3 bea rers (Fig. 84) ; as soon as he

FrG. 84.

is . ecure ly rested, Ko. 4 disengages hands with No. z, runs round by the head of the-stretc her and places It the patient, close to the other bearen/ fee t,

178

being careful that the pillow is immediately under the patient's head (Fig. 85); he then down and locks his hands with those of No.2 (FIg. 86). .

5. -" Lower. "-The place patIent on the stretcher (Fig. 87), dIsengage theIr hands, and then stand up.

FIG. 85.

6.-" Stand to Stretcher. "-No. I goes the foot of the stretcher, with his back to . the patIent ; No. 3 to the head with face to the patIent; Nos. 2 and 4 remain on each sIde of the stretcher. . .

7.-" Ready." -Nos. I and 3 place the (If used ) oyer their shoulders, stoop down, and shp the

179

loops of the slings on to the handles of the stretcher, which they then grasp.

As soon as all is right the word is given :-

8. -" Lift Stretcher. "-Nos. I and 3 bearers raise the stretcher steadily together and stand up.

No/e.-Nos. 2 and 4 will now adjust the slings on the shoulder of N os. I and 3. taking care that each is well below the le\'el of the collar and lies accurately in the holJow of the shoulder in front. Th ey will also lengthen or shorten the lings, ha\'ing regard to the patient's injuries and the rela tive heights of the bearers.

FIG 86.

9. -" March. "- The bearers move off :-Nos. I, 2, and 4 stepping off \\ith their left foot, and NO.3

with his right foot (Fig. 87). The step sho uld be a short one of b\"enty inches, and taken with bent knees and no spring from the fore part of the foot.

10. - " Halt. " - T h e b earers remain steady.

FIG. 87.

11.-" Lower Stretcher."-The bearers place t he stretcher gently on the ground, slip the loops of th e slings off the handles of the stretcher, remO'i'e the slings from the shoulders, and then stand up.

lSI

12.- " Unload Stretcher - Ready. " - The bearers prepare to take the patient off the stretcher, as at Orders 2 and 3.

13.- " Lift. "-The bearers raise the patient as at O rder 4 (Fig. 86) ; NO.4, in this case, disengages hands from NO.2, remO\'es the stretcher (Fig. 85), and resumes his former position. If necessary, the bearers will then steadily rise together, and carefully carry the patient Lo the bed, or other place to which it has been arranged to com'ey him.

14.-"Lower. " -The patient is carefully lowe red.

EXERCI'E No. II.

FOR THREE BEARERS .

I.- N umber the bearers I, 2, 3 .

All orders will be gi\'en by NO.2, ",ho will look after the injured part of the patient ' s body or limbs to see that no bandages or splints become displaced; and also that No . I bearer, in lifting or carrying the stretcher , does not touch the patien t's feet.

2. - " the:: Stretcher. "-No. 3 places the stretcher 111 a hr:e WIth the patient 's body, the foot of the stretcher bemg close to his head .

3. - " Fall In. "-No. I places himself on the left side of the patient in a line \\ith his knees, TO. 2 on the left side just below the patient 's shoulders and No ..) at the right side, and faces K o. 2. '

4.-"Ready. "-All kne el on the le ft knee. No. I places his hands, . well u nderneath t he lo wer li mbs, alway s tak mg ca re, In case of a to have one ha nd on eac h side of the seat of 111 Jury.

N os. 2 and 3 grasp each oth.er's und er th e should ers a nd thi ghs of th e pa tl ent (Fl g. 88) .

FI G. 88.

5.-" Lift. " - b earers. keeping the patie n t in a honzontal posItIOn (Fl g. 89 )·

6.-" March. "-All tak e sh ort sid e-p aces , ca rr yi ng th e oy er th e str etch e-r until his head is immedi a tely above the pillow.

7.-" Halt. "-T he bearers re main steady.

8.-" Lower."-Th e bearers stoop d ow n, ge ntly place th e pa tient on t he str et cher, di sengage their h a n ds, an d th en sta n el up.

G

9 . -" Fall In . "-No . I places himsel f t he foot of the stretcher with his bac k to the patlent, No.2 pbces himself at the left ide of the patient, an d N o. 3 at the head , wilh hIS face to \mrds the patie nt.

FI

10. - " Ready. "-Nos. r and 3 place the slings (if u sed) over t h eir shoulders , stoop down, and slip the loops of the slings on to the handles of t he stretcher, which th ey then grasp.

As soo n as all is right the ,yord is give n-

11. - " Lift Stretcher. "-Nos. I a n d 3 bearers raise the stretcher steadily together and sta n d up.

No. 2 will now adjust the slings on the shoulders of Nos. I and 3, taking care that each is well below the le\'el of the collar, and lies accurately in the hollow of the shoulder in front. He \\ ill also lengthen or shorten the slings, ha\'ing regard to the patient's injuries and the relati\-e heights of the bearers,

12. - " March."-Nos. I and 2 step off with the left foot , and No. 3 with the right. The step should be a shor t one of 20 inches, and taken \\ ith bent knees , and no spring from the fore part of the foot.

13. - " Halt. n-The bearers remain steady.

14. - " Lower Stretcher. "-The bearers place t he stretcher gently on the ground, slip the loops of the slings off the handles of the stretcher, rLI11O\'e t he slings from the shoulders, and then stand up.

15. - " Unload Stretcher - Ready. " - The bearers prepare to take the patient off the stretcher, as at Orders 3 and 4 (Fig. 88),

16.-" Lift. "-The bearers raise the patient, as at Order 5, and carry him by short Side steps, clear of t he stretcher, to the bed, or other place to whIch It h as been arranged to conyey him (FIg. 89).

I SS

17.-" Lower."-The patient is carefully lowered .

EXERCI E .L TO. III.

' YHEN ONLY THREE BEARERS ARE AVAILABLE AND THE STRETCHER CANNOT BE PLACED AS IN EXERCISE II.

I.-The I nstructor numbers the bearers-I, 2, 3. All orders will be gi,'en by TO. 2.

2. - " Place the Stretcher. "-::\'o. I taking the foot of the stretcher, and No. 3 the head, place it on the ground by the side of the patient, and as close to him as practicable.

3.-" Fall In ."-The three bearers the same positions on one side of the patient, as bid down 111 E\:ercise No. 1.

4.-" R e ady. "-Xos I, 2, and 3 kneel do\\'o on the left knee, pbcll1g them eh'es as clo-e to the patient as they com'eniently can, and then take hold of him as directed in Excrci:,e :\0. 1.

5.-" Lift."- T os. I, 2 and 3 raise the patiel:t as di rertccl in Exerci"e :\0, I. and tht. n move 111 a kneeling po ition up to thetretch e r.

6.-" Lo w e r."-The bearer bend forward. fullY lower the on to the tretcher, and disengage hands.

I 6

7·- " Stand to Stretcher. "-All the bearers stand up; 1 o. I goes to the foot, No. 2 remains in position at the side, and No. 3 goes to the head 0\ the tretcher.

8.-" I and 3 place the slings (if used) over the,lr houlders, toop down, anrJ. slip the loops of the slmgs on to the handles of the stretcher which they then grasp. '

,9.-" Lift Stretcher."-Nos. I and 3 bearers raise the s,teadily together and stand up.

No.2 WIll now adjust the sling on the hould e rs of N os. I and 3. taking care that each is well below the level uf the collar, and lies accurately in the hollow of the in. front. He \\ill also lengthen or , ho rten the slIngs, hanng regard to the patient 's injuries and th e relative heights of the bearers.

10. -" March. "-Nos. I and 2 step off with the left foot, and No. 3 with the right . The step should be a short one of 20 inches, and taken with bent knee, and no spring from the fore part of the foot.

II. -" Halt." -The bearers remain steady.

12. -" Lower Stretcher."-The bearers place the gently on the ground, slip the loops of the slmgs off the handles of the stretcher remove the lings from the shoulders, and then sta;1d up.

Unload Stretcher-Ready. "- Ko. I places on the left side of the patient, and in a lme \\'lth hiS knees, No. 2 on the left side just below the patient's shoulders, and No. 3 at the right

187

side, and faces NO.2. All kneel on the left knee. No. I places his hand, well apart, underneath the lower limbs, always taking care, in case of a fracture, to have one hand on each side of the seat of injury. Nos. 2 and 3 grasp each other's hands under the shoulders and thigh of the patient.

14.-" Lift ." -The bearers rise together to their feet, keeping the patient in a horizontal position, and carry him by short id e steps, clear of the stretcher, to the bed, or other place to which it has been arranged to convey him.

15·-" Lower. "- The patient is carefully lowered.

EXERCI ' E TO. IV.

FOR USE IN AXD TARRo\\' CCTTI;\GS WHERE T\\ a O;\L Y CA;\ BE Ei'iGAGED.

No . I and 2 will carefully place the stretcher in a lm e \\ ith the injured man': body, the foot of the stretcher being, if po ible,;;' close to hi head.

0, I traddles acros the patient's legs, placing hiS right foot, with the toe turned outwards, a little below the patient' knees, and with the toe of the left foot clo e to the heel of No.2; he then stoops down, pas es the left hand under the patient's thighs and

• It is n ot ach ' isable to b e too parti c ular as to the head or foot of a tretcher in a mine, as it would probably be quite impossible to reverse it.

the right hand across and under the patient 's calves. NO.2 places his feet one 011 each side of the patient bet\\"een his body and arms, the toe of each foot as near the armpits as possible. He then SlOOps down and passes his hands bet\reen the sides of the chest and the arms underneath the shoulders, and locks

FI G. go.

the fingers (Fig. 90). If the patient's arnlS are uninjured he may put them round the neck of No.2, and by this means greatly assist him in lifting.

I 9

"Then both are ready, TO. I will give the order " Lift and move forward ." The patient is then to be slowly lifted, just sufficient to allow his body to clear the stretcher. . Both bearers will slowly and gradually move the patIent forward, TO. 2 by very short steps. No. I by bending his body fOf\yard as much as he can 'wititout 1Jlovz";zg his fiet (Fig. 91). I no\\" gives the orger " Halt " NO.2 remains steady, and o. I advances hIS nght foot to his left, and

FIG. 91 again advances his left foot till the toe touches the heel of 2. :t\o. I then gives the order " Advance '" when the patient will again be moved forward. These 1l100'ements :lrc to be repeated untIl

the pa tient is over the stretcher, when he is to be ge n tly lowered.

The following Stretcher Exercise is adapted by permissio n from the Royal Army "Medical C orps l\Ianual, 1908.

All orders will be given by NO·4·

1. "Fall in. "- 'ix bearers fall In behind each other.

2 . "Number. "-The bearers number from front to rear.

3. "No.3 Bearer, right (or left ) turn - supply stretcher-quick march."-l o. 3 bearer \Yill march to the stretcher, stoop, lay hold of it and place it on his right shoulder at the slope, holding it by the lower foot wheels, wheels to the front. As soon a. the bearer is provided \yith a stretcher, he will tu rn about and rejoin his squad in quick time, halting as he arrives in his place. He turns to the front, and, passing the lower end forward, places the stretcher on the ground to the right of the squad, \\ heels to the right, fro n t end of the poles in line " 'ith the toes of No. I a n d rises.

4. "Stand to Stretcher. "-No. I places himself with his toes in line with the front ends of the poles . NO,3 with his heels in line with the rear ends of the poles, close to and touching the stretcher with

94.

I9 2

his riaht foot. 1 O. 2, -t, 5 and 6 take up their positiobns one pace and off the bearer in front of them (Flg . 92 \.

5. "Lift Stretcher. " - 1 os . I and. 3 sloop, gra.sp both handles of the poles with the nght hand, nse, together holding the stretcher at the full extent of the arm, wheels to the right.

6. "Collect Wounded · - Advance. " - .The squad doubles by the shortest route to the patlent, and halts \\"ithout further word of pace from the head of and in a line with the patlent (Fl g ·93)·

7. "Lower Stretcher. "-Nos. I and 3 place the stretcher quietly on the ground, and nse smartly together.

8. "Prepare Stretcher." - .1. os. I and 3 turn to the riaht kneel on the left knee, unbuckle the tran vel's; and place the slings on tl:e ground be ide them, separate the poles, and stralghten the trayerses.

T'wo . On the \\"o rd two each takes a sling, doubles it on itself, slips the loop thus formed on the near handle, and places the free ends over opposite handle, buckle uppermost. They then nse and turn to their left together.

"While the stretcher is being prepareJ iJy J\ os. I "11d ,., the disel1 Lr a u ed bearers \\"ill advance and cl J' b b. b render to the patient such asslstance as may e required (Fig. 9-+).

I93

The necessary assista n ce having been rendered, NO·4 \\"ill give the command-

9· "Load Stretcher. " - The bearers place themselves as follo\\'s :-Nos. I, 2 and 3 on tIle left, Nos. 4, 5 and 6 on the right of the patient; Jos. I and 4 at the knees, 2 and 5 at the hips, 3 and 6 at the shoulders, the whole kneeling on the left knee.

os. I and -+ pass their hands beneath the patient's knees, 2 and 5 be neath the hips, 3 and 6 beneath the shoulders, care being taken of- the injured part, one of the bearers being detailed for this purpose (Fig. 95).

10. (( Lift. "-The \\hole \\"ill carefully lift the patient on to the knees of X os . I, 2 and 3.

Two. No. -+, 5 and 6 will then disengage, rise; )/0 . -+ and 6 step b<lck one pa e. X o. 5 turns to his left, double- to the stretcher, takes hold of and rai es it, left hand acro . s, the near pole re tlllg on the left hip; carrying the stretcher, he return - to his place bet\\een -+ and 6, and places it beneath the patient.

Tlm!c. TOS. -+ and 6 tep forward one pace, and together with TO. 5 kneel do\\ n on the left knee, and prepare to assist in 10\yering the patient (Fig. 9 6).

II. "Lower. "-The patient is lo\\"ered slo\\'ly and gently on to the centre of the canvas (specia l care being taken of the injured part).

1100. The bearers disengage, rise; Nos. I, 2, 3 and 6 turn to the left) K os. 4 and 5 to the right ; H

No. -I- places himself three paces in of t h No 6 havincy collected the kit and arms stre c er. " < 0 f of the patient, places himself three III rear 0 the stretcher, Nos. 2 and 5 opposite the cent.re of the stretcher. The ",hole are now ready to lift stretcher and move off (Fig. 97) .

Fig. 97. Fig. 98

195

12. Ie Lift Stretcher. "-Nos . I and 3 stoop, grasp the doubled sling mid\\ay between the poles with the forefinger and thumb of the right hand , sweep it off the handles, rise, holding the sling at the full extent of the arm, buckle to the front, take a side pace to the front between the handles, and place the sling over the houlders dividing it equally, buckle to the riCYht. The slings should be placed so that they lie well below the collar of the coat behind and in the hollow of the shoulders in front. In the event of the slings req uiring to be adjusted, either as regards length or for the greater comfort of the bearers, o. 4 ",ill detail a bearer to carry this out, the length of the slings being adjusted, when necessary, by means of the buckles.

T,wo. Nos. I and 3 stoop, slip the loops oYer the handles, commencing with the left, and grasp the handles firmly.

Three. 1 0 . I and 3 rise slo\\'ly together, TO. 3 conforming closely to the movements of 0Jo. 1.

13· (( Advance."-Nos. I, 2, -1-, 5 and 6 step off with the left foot, TO. 3 with the right, stepping short, knees bent, feet rai ' ed as little as po.sslble.

14 · " Halt. "-The whole halt.

IS · " Unload Stretcher. "- The bearers place them elves in the ame position at the tretcher as described for Loading (Order 9).

16. (( Lift. "_.1S described for Loading (Order 10), I;I2

196 except that the stretcher is carried forward three paces clear of the patient's feet.

17. "Lower." - The patient is gently lowered to the ground. The bearers disengage, rise; Nos. I, 2 and 3 turn to the left, 4, 5 and 6 to the right, and the whole step off to their places at the stretcher, as at Order " tand to 'tretcher /I (Fig. 98).

The Ashford Litter is made up of either of the Furley stretchers on pages 17 2 and 17 3, a wheeled l!nder-carnage and a waterproof hood and apron, or, If preferred, a light wet-resisting canva cover. The stretcher is kept in position on the under-carriaae by the foot-\yheels, which fit into slots in the sides the an? it can be removed at pleasure. under-carnage IS fitted with a cranked axle, \"hlch allows the bearers to pass with the stretcher between the wheels instead of lifting it m-er them. At both en d s a re two legs which may be turned up as \"he n " 'heeli ng the litter. The hood and apron fi t sockets screwed to the stretcher. In wheeling the care be taken to keep the patient in a honzonta l it be necessary, two bearer s ca n eaSI ly 11ft the lItter and patient.

. The Litter, introduced in I904, IS used 111 a SimIlar manner. and one model of it is fitted with pneumatic tyres, which add immen ely to the comfort of the patient and to the ease of propulsion.

19 7

CHAPTER X.

(BeiJlg the Ftfth Lecture for Females on!y, ill accordance witiz Syl!alilts 58.)

BY E. MACDOWELL COSGRAVE, M.D., F.R.C.P.I.

FOR OF ACClDE!\T CASES.

"THEN ne\\s of an accident comes, preparations should at once be made so as to ha \'e everything read y before the injured person is brought in. Of course the preparations needful \\ ill vary according to the nature and extent of the injury, but the follo\ying are the chief things which may ha\-e to be done.

CHOICE PREPARATIOl OF RomI.

A room must be chosen. In a bad case this should be one easily reached, as it is dIfficult to cany an injured person through narnw passages and up-stairs. Unle s there is some such reason against it, the injured person 's own room is best.

The way to the room must be cleared, projecting furniture and loose mats in the hall or in lobbies should be removed. If the injured person is carried on a door, shutter, or stretcher, two strong chairs should be placed ready to support it the bearers \\ould be likely to require rest.

Useless furniture should be rel11m-ed from the bedroom. The bed should be drawn out from the \\"all

I9 8

so that both sides can be approached, and the clothes turned back to one side to their full length. A hot bottle should be got ready. If there is much several hot bottles and hot blankets may be required; COYE;r the hot bottles with flannel.

If the injury is yery severe, if .mud-stai!1ed clothes have to be removed, or if extensive dressmgs have to be applied, it may be necessary to have another bed, a couch or a table placed near thE; bed to lay the sufferer on in the fir t instance. Thi should be so arrano-ed that soiling may do no harm; old sheets, waterp oof materials, thin oIlcl?ths, or cycn l1e\\Spaper, may be used as a protectIon.

LIFTING AND CAR R YING.

If present at the place where the it will be necessary to see that the patient IS carefully lifted after proper "First Aid" ha been rend ered.

The fo11owino- rules should be remembered:- elect the proper numober. of perso.ns to assist, and do not let them lift the patient until they thoroughly understand how they are to do it.

For ordinary cases, \\ here the injured person has to be lifted a very short distance, three are sufficient. Two (\\'ho should be. as far as o f equal height) are to bear the weight, the third IS. t? support and take charge of the injured part. ThiS IS

199

best done by a person who has been through a "First Aid" course. If the injured person is insensible, another helper should support his head.

The lifters, one at each side, should kneel on one knee, and pass their hands under th e patient's back at the lo\\'er part of the shoulder-blades, and under the hips, clasping each his right hand in the otber 's left. The injured patient should, if practicable, place his arms round the necks of the bearers.

The tbird helper should attend to the seat of injury; if this is a fro. tured limb, he should support it by placmg the palms of hi' bands under the limb, one above and one below the seat of the injury, grasping it firmly but avoiding unnecessary pressure.

Th e helpers should remain thus until the order " Lift" is given, and then they should all lift slo\\' ly and steadily, avoiding jars, attempts to change position of hands, etc .

H the injured person is to be placed on a stretcher or butter, this should be previously placed with the bottom end at his head; the bearers should then move, one at each side of it, until the patient is over it. The word " Lo\\ er " should then be given, and the injured person should then be slowly lmyered. A pillow or folded-up coat should be re2.dy, and a the . ufferer is lowered this should be placed under hi -. head. *

* Full di r ections are gi\'en in Chapter IX.

MEANS OF CARRYlL G.

Besides a stretcher, and substitutes such as a gate, or a door, other means of carrying can be Improvi sed .

In slight injuries, where the injured person is unable to walk, two bearers can carry him by forming a fourhanded, three-handed, or two-handed seat.

A four-handed seat is formed as described on page 160.

A three-handed seat is made as described on page 162.

The two -handed seat is made as described on page 161.

201 C.\RRYli-:G UP TAlRS.

In carrying a stretcher up stairs the head should go first, and an extra helper should assist at the lower end, so as to raise it and keep the stretcher nearly horizontal.

'rhe t\\ 0, three, or four-handed seat mav be used for carrying up stairs; or a trong chair, the patient being carried up backward' . In the latter case cne should walk after the chair and help to support It, and to pre\'e nt the injured person slipping out.

LIFTIXG lNTO BED.

b

A single helper can lift by supporting with one arm the two knee, and with the other the back. The arms must be pa sed well under before commencin a to lift.

A single helper can give support by putting his round the waist, grasping the hip and placing the Injured person's arm round his own neck holdin a the hand.with his o\\'n hand (Fig. 76, page' 16 s). 0

A capItal stretcher can be improvised out of a strong sheet and two broom handles or other short poles. Each side of the sheet is wound up on a broom handle until there is just room for a person to lie between. This requires four bearers, t\\·o at each side, to prevent the sheet slipping.

If the bed is narro\\ and there IS room the stretcher should be placed on the floor with the head close to the foot of the beel. The injured per on should then be lift ed oyer the foot and placed on the bed. If the bed i too \\ ide to admit of this, the stretcher should be placed beside it, and t\\'o helpers should stand at the far ide of the stretcher. One helper passes one arm beneath the shoulders and one beneath the middle of the back, the other helper placing hIS under the lower part of the back and under the knees. The injured person is then lifted another helper pull away th stretcher, and after a single step forward the burden is placed on the bed.

PREPARATION OF BED.

A firm mattress, not a feather bed, should be selected. If there is much injury, or if dressings have to be applied, a draw-sheet ought to be placed on the bed. It should be of four or more thicknesses, extend across the bed, and reach from the middle of the patient's back to the knees. A piece of waterproof sheeting or of thin oil-cloth should be placed under the draw-sheet. As the draw-sheet becomes soiled, the soiled portion should be rolled and a clean part drawn smoothly under the patient.

In fracture of the leg or thigh, sprained ankle and some other cases, a "cradle" (Fig. 99) should be improvised. The use of a " cradle I, is to support the bed-clothes and keep them from pressing on the limb.

A band-box (Fig. 100), three-Iegcred stool (Fig. 101), or hoop sawn across and the two halves secured together (Fig. 102), may be used. A corkscrew passed through the bed-clothes, with its point guarded by a cork, and tied by string to the bed or a nail in the wall, \\'i11 relieve the pressure of the bed-clothes effectuall y.

THE CLOTHE.

In taking clothes off an injured person a few ruleshould be borne in mind.

In serious cases it is much better to sacrifice the clothes than to run any risk of increasing the injury.

FIG. 100.

FI G . 101.

In removing a coat, etc .. in a case of fractured arm the uninjured arm should be drawn out first.

In putting on a coat or shirt the injured arm should be pu t in first.

In burns and scalds notbing should ever be dragged off. A slzm'} pair of scissors should be used and everything not adhering should be cut If anything adheres it should be left until medic;l aid

FIG. 102.

can be obtained. The clothing adhering may, with advantage, be soaked with oil. To remove the trousers from a severely injured limb, the outsz"de seam should be ripped up.

PREPARATIONS FOR SURGEON.

As soon as the injured person has been attended to, preparation should be made for the surgeon's visit.

205

The preparations needful will depend upon the nature of the case. The following hints may be of use :-

A fire in the room helps ventilation, even in summer. There should be plenty of water, hot, cold, and also boiling, also several basins, plenty of clean towels and soap. There should be something to empty water into; a foot-bath does well. The basins should be placed on a table, covered with a clean white cloth; a large to\\ el makes a suitable cloth; the towels, folded up, should be placed on the same table, and the hot and cold water should be within easy reach. The foot-bath should be under the table or close at hand.

In the case of a burn, absorbent cotton wool, soft cloths, old linen, oil, and baking soda, should be ready, and materials hould be torn up for bandages.

In the case of hremorrhage, plenty of \yater should be boiled and allowed to cool, and pads of absorbent cotton wool should be baked 111 a tin box in the oven, and at least t\\"o basins should be ready.

In the case of a per on rescued from drowning the sheets should be taken off the bed, plenty of blankets should be heated before the fire, and several hot bottles should be ready.

If poultices are likely to be required boiling water, linseed meal, mustard, a loaf of stale bread, a small basin, a large spoon, sweet oil, and to\\, flannel or handkerchiefs may be required.

. For fomentation, haye hoiling water, flannel, a. kItchen rolier, and two sticks, or a brae to\\"cl.

'When summoning a. medi 'al man to all accident always let him k!10W by a. written 111 ssage what kind of case is required to treat, so that he may bring whateyer lS needful. By this means valuable time may be saved.

QUE TION. 0 T CHAPTER X.

The numerals iJl d/tale tile pages where the allswl"n may be jouJld.

'What points would you consider when choosing a sick r oom?

... 197

How would you clear the way to the sick room? 197

What means of r esting would you provide for those carrying a patient on a stretcher?

How would you place and arrange a bed for an accident case?

197

197, 198

Are h ot bottles nece sa ry, and how would you prepare them?

'What is often necessary to lay the sufferer on in the first instance?

'"

198

198

How would you protect this from gelling soiled? 198

How w<;)U!d you see to the proper lifting an d carrying of an lDJured person?

... 198, 199

\Vhat substitutes for a regular stretche r can you suggest? 200

How is the four-handed seat made? 160 161

For what cases is this seat u. tful ?.. ' 160

How is the three-handed seat made? 162, 164

207

For what cases is this seat useful? ..

H ow is the two-handed seat made?

For what cases is this seat useful ? ..

How can a single helper lift?

How can a single helper give SUppOlt?

How would you improvise a stretcher? ...

How many bearers are required for this stretcher?

How should a stretcher be carried upstairs?

How would you carry a patient upstairs on a chair?

lIow would you lift a patient frol11 a stretcher to a hed?

How should a bed be prepared for an injured person? .. .

lIow should a elraw shl;et he made?

\ Vhat would you place under the dra\\ sheet? ..

\Vhat should be done with the soiled part of a draw sheet?

\Vh at is the use of a " cradle "? ..

In what \\ays maya cradk he impro\ised?

lIow would you remuve a coat or shirt in the case of a fractured arl11? .. ,

lIow "ould you put on a coat or "hirt if the arm \\ert:! injured? .. ,

In the case of a bad hum, what \\ould yOll do with clothing that adhered to the patient?

IIow \\ ould you remove trouser ' from a se\'erely injured limb?

\Yhat preparations would you make for the surgeon'>; ?

"\ hat \\ ould you gel ready in the case of a burn?

And \\ hal in the case of hxmorrhage ?

And what in the case ofa personresclled from dro\\ning? '.

\\' hat \\oulcl you get ready for making poultices? . A nd for fomentations?

\Vhat sort of a me ,,' age \lould you send t o 'ummon a doctor? ...

INDEX

.

Abdomen " wound of II2

Accident case, preparation for 197

Acids, poisoning by 149, 151

Air, always neces ary ... 18

Alcohol, caution as to smell of 130

Alcohol, poisoning by 134, 153

Alkalis, poisoning by 149,151

Ammonia, poisoning by 149

Anatomy (elementary) 20

Ankle 30, 32

" sprained... 64

Anterior tibial artery 93

Aorta 79

Apoplexy 13 2

Apparently drowned, to restore ...

Arm, bone of " fracture of Arm-slings

Artery, brachial... " carotid ... dorsal of foot facial femoral ... iliac occipital plantar ... popliteal radial subclavian tibial temporal " ulnar

Artificial re opiration

A phyxia Alia 121, 129,

Page

Biles of rabid animals 106

Bladder ... II I, II]

Brachial artery ... 86

Brain 117 compression of 132 " concussion of 13 1

Brea. t-bone 26 " fracture of 48

Broad bandage 37

Broken bone , see Fracture.

Bronchial tubes ... . .. lI8

Brooch-bone 30

Bruises 102 Burns 102

sion of the brain Concussion of the urain

Capillaries ... Capillary hremorrhage

Cap ule ... 70, 72 95 3 1

Arsenic, poisoning by Arterial hremorrhage, 139 28 52 39,49 148 arrest of 74 " practising arrest of 79 ., Arteries signs of 74 " course of main 70 79 85

Auricles ...

Axillary artery Axi

Back, bandage for Backbone

Bandage, to apply to fold 136, " to impro\'ise ...

Bandaging

Artery, axillary ...

Bed, lifting into . .. " preparation of Belladonna, poi oning by

Carbolic acid, poioning by 15 2 80

Carotid arterie " hremorrhage from Carpus ... . ..

Carrying, means of " upstairs

Cartilage

Cerebra-spinal system Cen-ical ,"eIte brre

Dress, woman's, on fire . . . 105

Drowning 139

Ear .channel, blood issuing from Ear-passage, foreign body in Elbow, bandage for joint fracture inyolving I lO 159 53

Electric shock

Emetic

Epilepsy ...

Esmarch's 14 2 148, 149, ISO 13 2 bandage

Expiration triangular

External carotid artery .. .

Eye, bandage for .. . foreign body in

Face, bones of

Facial artery

Fainting ...

Femoral artery " "digital pressure at groin ...

Femoral arte r y, tourniquet fo r

Femur fracture of " fracture of Fingers, bandage for " fracture of

Fireman's lift

Fir t aid, meaning of " student

Fish-hook, embedded

Flexion ... at elbow " at knee ...

Food, poisoning by

Foot, bandage for bones of .. , " crushed

Forearm, bones of " fracture of ... Forehead, bandage for. .. " hremorrhage from Foreign body in the earpa sage .. , in the eye " "in the nose

Four-handed seat

Fracture, apparatus fur treatment of causes of definition of general rules for treatment inyoh'ing elGow joint of arm . .. of breast- bone of carpus of collar - Gone of cranium of finger

Fracture of forearm Pagt 54 58 60 " of knee-cap of leg ... of lower jaw of metacarpus uf metatarsus .. . of pelyis o f ri bs . .. of spine of tarsu of thigh-bone ... of toes " signs and symptoms of

62 56 62 " \"urieti es of 35 34 lO8 prost-bite Fungi, poi'>oning by 153

circulation 70 Granny knot 40 Green-stick fracture 35, 36 Gum, h::emorrhage from 97 H::emorrhage, arterial 74 capillary... 95 fr0111 gum . 97 from head and neck 0 from lower limbs ... 9 from lungs 97 from nO ' e 96 from stomach 98

frol11

bandage for ISS " injury to ... 128, 131 " side of, bandage for ISS

bandage for .. . 15 7

History. meaning of ... 17

Howard's method of artificial respiration

IIumerus , fracture of Hydrophobia

lIysterical fits

Pagl

In ensibility, general rules for treatment ... 128 212

Inspiration 120

Instep 30

Insulator... 142

Internal carotid artery ... 80

Internal hremorrhage 95

Intestines, injury of 113

Involuntary muscles 33

Jaw, angle of 23 " lower 23 " "fracture of 44

J oint, definition of 3 I " injuries to... 109

Jugular yein 80

Kidneys ... I I I " injury of II3

Knee, bandage for 159

Knee-cap 30 " fracture of 58

Knot for bandage of lower lim b 42

Knot, reef and granny 40

Laborde's method of artificial respiration 126

Laburnum seeds, poisoningby... J48

Lacerated wound 78

Large arm-sling 39

Laudanum, poisoning by 149

Leg, bones of ... 30

Leg, fracture of Lifting and carrying " into bed

Ligaments

Lightning, effects of Limbs, lower " upper

Lime in the eye

Lips, bleeding from Litters

Liver " injury of

Lower limbs

Lumbar yertebrx

Lungs hremorrhage

Iarshall Hall's method of artificial respiration 140 Iedium bandage 37 :r-Ietacarpus 28 " fracture of... 55 l'.Ietatarsu 30 " fracture of ... 62 :r-liddle line of body 20 :r-routh, blood i suing from 97 3 2 "ruptured 65 Muscular action... 34 arrow bandage 37 1\ eedle, embedded 10 1\erves 1I8

Pagl!

ervous sy tem ... 117

Nose, foreign body in III hremorrhage from 96

Occipital artery... 2

Opium, poisoning by 148

Pad, ring .. " to folel

Palm, hxmorrhage from Palmar arches ...

Paregoric, poisoning by Patella fracture of " fracture of Phalanges of foot " of hand ...

Pho phorus, poisoning by 148,

Phy iology (elementary)

Plantar arch " artery

Plants, various, poi ons... .) 74 88 8 149 30 58 28 56 30 2 20 93 93 ing by... T4

Pleura ......

Poi 0 ned w e a p 0 n 5, wounds by... ...

Poisoning .. ,

Popliteal artery ...

Posterior ti bial artery ... cau.tic, poisonmg by...

Pres ure, digital... " point ... Principles of First aid ... Pru 'sic acid, poisoning by Pubes ... ... .. .

Pulmonary circulation . . . Pul.e

Pupils of eyes

Rabid animals, bites of. .. Radial artery

Radius .. , " fracture of Reef knot

Respiration artificial 121, 129, n6, " to excite

Respiratory system

Rest, nece sit)' for Ribs " fracture of:::

Room, choice and preparation of

Rupture (hernia) 114

Ruptured muscles 65

Sacral yerte brre ...

Sacrum ...

Scalds

Scalp, bandage for 25 25, 28 102 155 " hremorrhage from Scapula... .. , " fracture of Schafer' method of artificial respiration

Seat, four-handed three-handed two-handed

Sh'j'n-bone

Shock " electric ... .. .

Sh oulder, Lanclage for .. . " blade ... " fra ct ure of bones . .. " joint..:

Sick room, cholCe and preparation of. ..

Signs, meaning of . Silvester's method of artIficial respiration

Simple fracture ...

Skeleton ...

Skull " fracture of

Slings, arm .

Smothering

Snake bites

Soda, caustic, poi oning by

Spleen " injury of

pinal canal cord ,pine ... " fracture of 23,

Spirits of salt, poisoning by

Splint, angular .,.

Splints, rules for apply ing to improyise

Spr;'ins

Sternum ... " fracture of Stimulants

Stings of plants and animu.ls tomach ... hremorrhage from , injury of ..

Strains

Strangulation , tretcher exercise, ,\rmy

Stretchers, to carry " to improyise

Strychnine, poisoning by S ubelayian artery

Suffocation

SunstroKe

Surgeon' . preparation for 'yllabus of instruction ... . 'ympathetic system

Symptom , meaning of ... 'yncope . .,

Syno\'ia

Sy temic circulation

Tarsus

Temporal artery.,_ Thigh-bone " fracture of ...

Three-handed eat Throat, hXl11 0 rrhage from " swelling of tisue of ... Tibia fracture of Toes, bandage for Tongue, hremorrhage from T ooth .0c Ket, hremorrhage from Tourniquet

Tran..,verse wound of abdomen

Tw o·handed seat

tretchers, Furley

39, 40 , 49 mall arm sling ...

Ulna " fracture of.. .

Ulnar artery

Unconsciousness

Upper limbs

Varicose veins

Veins

Venous blood " hremorrhage

Ventricles

Vertebra .. .

Vertebrre . . .

Vertebral column

Vertical wound of abdomen

Vitriol, burn by ...

Voluntary muscles

\Yagon, to load or unload

\Yall, to cross with stretcher

\Yarmth, necessity for " to promote Wind-pipe

\Yoman's dres on fire

\Y ounds by poisoned weapons " accompanied by arterial hremorrhage ... \Vounds accompanied hy \'enous hremorrhage

\\' ound , lacerated Wri t

AMBULANCE CARRIAGES « WAGONS.

St. 30bn Bnlbulance Bssociation.

GENERAL PRICE LIST. INTRODUCTION.

Thi Price List, which is subject to revision from time to time, has been compiled with a ,-iew to as. ist members of the Association anu others in the purchase of the necessary equipment for corps and divIsions of the Brigade, amhulance stations, classes and first aid and nursing work generally.

A complete ami reliable Amhulance Equipment i!S an actual necessity, and experience has pro,-ed that employers of labour anu othas interested in the district readily sub cribe for the purchase of such appliances. Collecting cards, stating the purposes for which suhscriptions are required, will be supplied gratuitously on application to the Head Office of the As!Sociation, where also :lony information with regard to its work can be obtained.

Stores of the yalue of lOS. or upwards will be sent c ar riage paid to any part of the United Kingdom.

Owing to fluctuations in market prices it is impos ible to guarantee that the quotations herein can be adhered to.

Quotations will be furnished for articles relating to Ambulance Nursing and Hygiene, not mentioned in this list.

Orders and correspondence should be addre ed to the t. John Ambulance Association, St. J ohn'5 Gate, Clerkenwell, London, E.C.

Remittances should be made payable to the t. John Ambulance Association and crossed ., London and \\' est minster Bank, Lothbury."

Registered design 4 18,030.

A numbe r of improved designs for Ambulance Carriages ha"e rece ntly been perfected, and several specimens can usually be seen at t. John'.; Gate, varying from a light vehicle to be drawn by two men or by a pony, costing with india-rubber tyres to wheels £32 lOS., to a large single or pair-horse wagon capable of accommodating three patients in a recumbent position and an attendant in ide. A fully illustrated price list will be sent on application.

,....,.... n 0 """'0 ft ft ... 5': ft

:J g ft ft

n (1) - ::rCIQ (1)Cll::r _0.._ ;.. I" g

f.1'<cr'0..::r I" :3 c o..en

t:l Cll Cll:;: ;:;.::rCll.., Cll::r

s:; ==' r- ::s 0 .- ro ";1 0'

rT g- ,.... ::rCIQ g, a

f;; ;. en ;. I" en-::' ::

3. Cll E O'!!. Cll i3 ch

5' 3 5- I" 8

Cll .., '"d rT n 0 (b Cll b.. e; &

o 5. en ::r (b .;-: p ......,:::: 9 (t) en e..:::-:;.\O ft] CIa 5. ft :; !!.:3

:: ro· .... 0 cr' 0.. I" ::-: 8"I'j;:;' g ....... g- ::i C n -g. !!.

c·CfQcr,.-cn'"1 '1:J9n_ ::r'<::r (l) ni I" ro '< :::: r ci en g ::::r g :!.:; 0 :::.;!l. 1? Cll g .... ::;--,-. ;r :f' 8Q;; C E5' en Jg 5 S, . 3 0"'Q (1) 3. c. p (b r-. Cll v Cll n

PRICES OF THE IMPROVED ASHFORD

LITTER,

Under-carriage (no Slretcher)

Liller complele with Ordinary Stretcher·

Ditt o with Telescopic handled Stretcher!

Ditto \\ ith Pulice

* Prices quotetl for Litter with Ortlinary Stretcher include \Vitl e \V chbing Slings but no Chest Strap. Leather, instead of W ebbing Slings, 5S. 6d. extra ; Chest S t rap , 6d. extra. If supplied without any Slingb, 4S. allowed.

t Prices quotetl for Liller wi th Tde,copic.handled Stretcher inclucle Wide \\'ehbing Slings anti Strap Leatht:r, instead of Wehbing Slings, 55.60. extra If without any Slings, " s. allowed; anti if without Chest Strap, IS. 6d. allowetl.

t Prices quotetl for Liller with Police Stretcher inclutle \Vide \\'ebbing Slings :mcl Leather Straps for securing a refractory patient. Leather, of Webbing Slings, 5S. 6d extra Ho od and Apron, complete £2 10 0

Extra Sockets and Studs, per set ... ... 0 I b

Waterproof Sheet (washable) to be laid on the stretcher bed... 0 10 6 Crates (returnable) charged 45. 6d. for each Litter.

THE "REA. EDW ARDS" LITTER .

TH E " R EA-EDWARDS" LITTER, \\' ith \\ ooden \\ heels, showi ng method of loading; also first aiel box fitted to axle,

T he or \\ heel,eel portion of this Litter is of an e,?l!,rel,r n,;\\' and adapted to carry of FUlley or Clemetson Pattern Stretchers 111 precIsely the same manner as the "Ashford" Liller. It is fitted either, bicycle wheels and extra strong pneumatic , o r, with hght but strong wooden wheels, either with sohd or iron tyres , Owing to the reduction in th e he Ight of the wheels it is easy to lift a loadeu stretche r

ove r t h em, and th e c ran k ed axle has, the r efo re, bee n replaced lly a st raight one constructed of tub ula r ste el.

" REA-EDWARDS" LIT lER, tilted wi[h pneumatic ty red wheels, showing the" Clemetso n " I tretche r.

Ball bearings are fitted to the wheels, both cycle pattern and wooden , and the hubs are so arranged that the wheels cap. be removed from the axle without disturbing the bearings. I n place of the fou r legs made to rais e as handles, two fixetl legs filled with small india- r ubbe r w h eels or rollers a re placed at the foot end, while a combined leg and handle fitted with a crossba r and capable of being raised or lowered is used at the head end. ' ''hen raised as a handle it may be locked in one of t\\'o positions, antI when lowered it is locked in a vertical position, The admntagcs claimed for this arrangement are implicity, ease and rapidity of manipUlation and

the facility afforded by the two fixed legs for raising the litter, if necessary, on to the pa\'ement. The question of balance has been carefully studied, and the stretcher is shifted forward so that the middle of it is several inches in front of the axle, a perfect balance when the stretcher is in a horizontal po. ition being thus obtained, and consequently there is no weight on the hands of the person propelling the litter.

The pneumatic tyred wheels are strongly recommended in cases where the mall amount of care necessary to keep them inflated can be given, as the comfort to the patient and ease in propulsion are increased beyond all comparison with any litter yet produced. It will be noted that the prices are considerably lower than those of the "Ashford" Litter, and the following are gi\'en as examples, but owing to the vast number of combinations that can be made with the diflerent stretchers and coverings, it is impossible within reasonable limits to set out quotations for the whole of them, but these may be calculated by adding toget her the prices of the under·carriage, tretcher selected, and hood and apron or cover, see page 4 and 8 to I I.

SPECIMEN PRICES .

Under·carriage only, either with pneumatic tyred cycle wheels or solid rubber tyred wooden wheel, £10.

Litter complete with ordinary stretcher (no slings or chest strap) and hood and apron, £14 3s. 6d.

Ditto with Telescopic Handled Stretcher (with chest strap) and hood and apron, £I.t I IS.

H with iron tyred wheels prices are £2 less.

The lowest priced litter complete is filled with iron t)'red wooden wheels, ordinary stretcher (no slings or chest strap) and conr. Price £10 8s. 6d.

'Vhen ordering please state which wheels are required.

PRICE LI T.

THE ,. CLEMETSON" STRETCHER.

TRETCHER, with back raised, also sho\dng extending leg.

On this stretcher the patient can he moved a de. ired,. from the recumbent to the sitting position. There is no comphcated mechanism to get out of order, amI the adjustment depends simply on the balance of the patient's body. The stretcher will fit either the" Ashford" or the "Rea·Edwards" UnderCarriage. Price £3 3s. ; with extt'nding legs, £4·

Hood anJ Apron, Yentilated, £2 I5 s .

9 PRI CE LIST.

ADJUSTABLE LEGS FOR STRETCHERS .

Primarily these l egs , whi c h a re indep e ndent of and ndditiona l to the ordinary foo t wh eels, ar e intend ed to facilitat e th e carriage of a stret c h e r in a ra ilway co mpartment, in whi c h case two on on e side woul d be lo wer ed a nd adj ust ed by a t e lesco pic a rra nge men t to th e proper h eig h t , so th a t th e foot whe els on one side w oul d res t on th e seat , and the adju st able legs on the oth e r side would r est on t h e fl oor.

Th e fou r legs may be usecl to raise th e st r e t che r as r eq u ired .

Wh e n not in nse t h ey arc folded up im med iately unde r the poles of t h e str e t c h e r.

Pri ce pe r set o f fo ur, 17s.

FIRST AID BOX .

T o be fixed be low the ax le of t h e " Re a -Edwards" or " Ashfurd " Litte r.

T his is intended to be kept permanent ly attac h ed to th e litte r, and is no t designed to h:m g in a stat ion or to be ca rri ed by ha nd .

Con te nts :-S et of Splint s, 12 Tri a ng ul a r Ba nd age s, 12 R oller Ba nd age , 2 i- lb. pa ckels eac h Co tton \Y oo l and Bori c Lint, Adhesi ve P lasl er, Pair of Scissors, Knife, 2 oz. each Olive Oil, Tin ct. Eu calypt us B. P. c., Sa l V olatil e , a nd

Spirits Eth e r Comp. , Gra duated Measure Gl a ss, Kidn eyshap ed Dres sing Basin, 6 T a mpo ns for was hing wounds, T ourniqu e t Pi n s, Safet y Pins, eed les , Thread and Tape. .Pric e £2.

STRETCHERS WITH THE LATEST IMPROVEMENTS, 1899 MODELS.

L ESCOPIC HANDLED STRETC H ER - OPEN .

OR[) I NARY STRETC H ER - CLOSED .

S The improyements in all patterns of the "F urley " 1 99 Model, a r e Ilumerous . T he comfort to th e pallen,t IS ll1creased ; the stretcher is st ronge r, mor e rigid, and hghter, It folds up more clnsel)', and its handles a re more comfortable to hole! and affllrd g reater protection to the hands of the bearers in passing through na rrow doo rur P3S ages. it be necessary to r educe the :\ Illth of:: luaded stretcher order, fIr example, to ca rry it In to, a rall\\'ay carriage, thIS can he done, either wh en it is r estlllg on the ,grouud o r supported I)y the lJea re rs withou t and \\ 1lhout the. slightest ja r to the pat ie'nl. Th e pl lce of the st retche rs IS I,fm e red, AIl mino r points have most carefully conSIdered, and the stretchers a re cunltdt,; n tly recommenued as thoroughly efficient in eve ry ,\ ay ,

These stretchers a re adapted for use alone or as par t of the ""\ hfurJ " or "Rea-Edward " Litte r, and the coyer, hood an,J a,r lll), rug, and wate rp roof shee t desc ribed in th l lIst a r ellltable fu r usc \\ ilh them .

PRICES OF THE "FURLEY" STRETCHERS, WITH ... THE LATEST IMPROVEMENTS (1899 MODELS ).

N.B.-The prices of the Standard Models are shown in heavy type.

f With \ With Leather Leath er Without With Wide Slings or Webbing Chest Slings Strap. (no Chest Strap).

Ordinary Stretcher, for General £ s. d. £

and Brigade use, taking the place of uoth the old ordinary and military patterns .. . ...... I 13 6 1 17 6

Telescopic - handled Stretcher for workinginconfined spaces I

With Wide Webbing Slings and Chest Strap.

Slings Slings and (no Chest Webbing Strap). Che,tStrap.

police Stretcher, very strong, With Ash Poles, and provided with Leather Straps to secure a refractory patient-

Complete, with Wide Webbing Slings

" "Leather Slings

Slings, Wide Webbing

Do. Leather per pair

(or if purchased with the Stretcher instead of We bbing Slings, 5/6 extra)

Cover for Stretcher

Superior llood and Apron (see illustration, page 3)

Spare Bed for Stretcher Army Rug to cover Patient on Stretcher Pillow for Stretcher, stuffed hair Chest

" LOWMOOR JACKET."

For use in mines, ships' hold, etc., to secure a patient on a stretcher (see illustration), which can then oe placed in an upright position. Price £1 5·.

WATER BOTTLE.

Copper tinned, with carrying strap .

Price lOS. od.

Enamelled Iron \Yater Bottle, Ji Cloth covered, with Strap, 5s. 6d.

LAMP.

This is filled with a socket, by which to fix it to a Litter, or it ean be conveniently carried by hand, or attached to a belt or the clothing.

Price complete, 58. 6d.

Dressing Basin, l..idnl)· sh1ped, made of enamelled iron.

Price IS. 3(1.

Knife \I ilh strong olade Pair of Scissors ...

each 9d. ; per doz. 8s. each I . ; per doz. lOS.

Carrying Sheets fur carrying patients lip and do\\"n stairs

or other\\jse aholll a h{)use. Des!gned by J. c. Derham, Esq., Blackp(lIll, and ':\Irs. ..:\Ifrecl P:une, Bedford. The heet is fitted with rope haDdles and detachable l)a1111>00 pules, and may be placed 011 a streLcher \\ ithuut disturoing the patient. Price cumplete, 15 .

THE IJA;\I PER CO:-nAINS

I Set of Cane Spl in ts .

I Elastic Band T ournirluct.

it lb. Carholic ')

lb. Boric Lint

Cotton \Yool ... LIn Tin ... JCases.

I Roll Adhesi\'e Plaster.

20 RoJler Bandages, a sorted .

I doz. Tr.iangu1ar Bandages.

3 Pieces Tape.

4 oz. Sal Volatile.

4 oz. Bicarbonate of Soda.

4 oz. of Olive Oil.

4 oz. Spirit Ether Compo

i lb. Tin Powdered Boric Acid.

4 oz. Tincture Eucalyptus

B.P.C.

I pair Pean's Forceps.

1 pai r Scisso rs.

1 Knife.

12 Su rgeon's Needles.

I packet each Safety and Plain Pins.

oz. Carbo lised Chinese T\\ist.

2 oz. . 'il kw orm Gut.

I reel each Black and '''h ite ew in g Thread.

I Kidney·shaped Basin .

I " lopper Loosen er.

1 Graduated

I cake 20 per cent Carbolic Soap.

I Nail Brush.

3 Empty 8 oz. Bott les.

P rice complete, £4

For contents see next page.

SMALL AMBULANCE HAMPER.

\ Vith waterproof cover and strap, for use in factories, collieries, stations, and large works, as well as for parochial and domestic use .

CC:'-. lAI:'-.I:\(J

Set Splints I Elastic Tourniquet. 3 Tampons, fO.r washing wounds. 2 Packets Lint. 4 Roller Bandages (\\ Ide and narrow). 4 Triangular Bandages.

Cotton Wool... ... 1 In Tin Cases. Boric Wool ... ... r , pool of Adhesiye Plaster. . Knife, Scissors. Thread, Tape, eedles, and PillS. \Yeight complete, lbs. Length, 1ft. 6 in. Depth, 5 in. Width, 7 in. Price £1 I IS. 6d.

hrPROVED P fitted with a lin, so arranged that any article can be taken out without disturhing the rest of the contents.

Contents: r et of SplintR, 6 Triangular Bandages. 6 Roller Bandages (wide and narrow), Callan. Boric in ti:l cases I Roll Adhesiye Plaster, I Prill' clssors, I kmre, 2 oz. Olive' Oil, 2 oz. Tinct. Eucalyptus B. P.e.. 2 oz. .'al Volatile, 2 oz. pirils Ether amp., I Graduated Glass )[easure, I Elastic Band Tourniquet, Pins, Xeedles and Threall. Price £1 lIS. 6d. \Vhite Linen H.aliun Havl!rsac:;, IS. 9d. each.

NURSES' WALLETS .

ORDIl ARY PADLOCK SHAPK.

\Vilhout instruments, 4S. 3d.

Fitted complete, contaming Bow

Dressing Forcep, Spatula, Probe, 2 pairs Scissors (round and sharp poinled), Clinical Thermome'.er, and Knife.

Adyanced price ros.

ST. JOHN'S PATTERN, as illus· trated, but impro\'ed by the addition of flaps to prolect the instruments.

\Vilhout instrumenls, 7s. 9el •

Fitted complete, conlaining Bow

Dressing Forceps, Artery Forceps (also useful for dressing) , Spatula, Probe, Direclor wilh

Ear Scoop, 2 pairs Scissors (round and sharp pointed), Clinical (minute, round), Knife, Pencil, and Safely Pins.

Price £ 1 I S.

FIRST AID BOX FOR " ASHFORD" L I TTER OR AMBULANCE STATION .

.This is primadly designed to be placed on the" A shford" LItter (1899 Model), but it is furlher adapted to be hung up on a wall. A detachable leather handle is also filted for carrying purposes.

Fer contents see next page.

2 1

PRICE LIST .

OF F I RST A I D BOX.

(I llustrated on previous page . )

Set of Wooden Splints; I Elastic Band Tourniqu et; Carbolic W ool, Boric Lint, in tin cases; I Roll Adh esi,'e Plaster; 12 Roller Bandages, a sorted; 6 Triangular Bandage ; 3 Pieces of Tape; I Pair Scissors; I K nife; 1 Kid ney- shaped Basin; I Graduated Measure; 2 oz. Oli\-e Oil; 2 oz. Tinct. Eucalyptlls B.P .C.; 2 oz. Sal Yolatile; 2 oz. Spirits Ether C ompo ; 8 oz. Carron Oil; Pins, Safety Pins, Thread _ PRICE £2 lOS .

Tourniquet, Elaslic

Tourniquet, Fie ld

Splints, W ooden, per sel, 2/6 ; Cane .. per et

Greatly impro\'ed \ ',"ooden plints, with g r oo\'ed joints and angle piece, strongly recommended ...

Tow, fo r splint padd ing ... ...pe r lb.

First Field Dressing (A rmy Hegulal ion Pattern),

o 6 6 Price ... each

Jaconette, 44 i nches wide ...

Carbolized or :Styptic

Wound Pad.- This consils of a pad of cotton w oo l a n d gauze, to which a bandage is attached . By a cleve r c ontrivance the mrface o f t h e pad coming in contact wit h the wou nd is not to uched by the hand of the pe rson ap p lying the p:1d. P rice 4d . each.

SAFETY PINS.

AIJ fasten o r unfasten on either ide.

Facile No. S 600 or ' 602 per 3 doz. 0 6 " "S 603 ,, 0 8

D uchess Duplex, N o.2... pe r doz. 0 2 " Assorted

Blanket. afel), Pin s, 3 in.

" " " in. 6

Ambulance Station Plate, Enamelled Iron, 3s. 6d. each.

Stretcher Depot Plate, Enamelled Iron, 3s. 6d. each .

LIST . 22

Nursing Chart, designed by I nderwick, eac h .

Temperature Chart, each .

Registers. Class Attenclance , 2S . 6cl. Ce rtificates, 4s . 6d. C ase Report., I S.

Large Physiological Diagrams. For Lecturer:;' use. Comprising: T he Human Skeleton, the :\I uscular, Arterial and Ve nous ystems, the IIeart and Circulation of the Blood

Simple F racture, Compound Fracture, Dilocations.

P rice per set of ix, I5s . These may be hired for a course o f " Aid" lectu r es, gi\-en under the aut.,pices of the ASSOCIatIOn, for a fee of 5s., or with the addition of Splints

T ourniquet, an.d plain Triangular Bandages, for a fee of lOS:

Boxes of StatlOnery for the u<.;e of Class Secretaries and othe r s connected with the Association, containing twelve sh e ets of high·class paper, suitably headed, and twelve e nve lopes beanng the de\'ice of the .\ ssocialion. Price 6d., by 9d .. that quantit)" p!lce IS., by post IS. 3d. Issued 111 acc?rdance with special regulations, for whIch see leaflet L o. I!: ii n' to he had on application. Coinage Bronze, 2S. ; 7"'. 6d. ; Gold, £2 lOS. ; including e ng raving na m e and number on back. :\[orocco \elvetli ned case, 25.

Labels! to J:>e for each sllbsequentyear's ex am1l1atlOn Issued 111 accordance \\ ith reguhtion , as per paper

Coinage Bronze, 60. ; ,'iher, IS. 6<1. ; Guld, I2s. 6d.

NURSING INSTRUMENTS.

Dow Dressing Forceps, full si;;e, IS. 3<1.; small, extra well finished, I . 6(1.

Scissors, round-puinte(l , I!.'l. 3(1. ; sharp-pointed, for delicate work, IS. 3(1.; small round-pointed, blades take apart for cleaning IS. 9d.

Spatu la, 9<1. Probe , 9(1. D irec tor , w ith Ear Scoop, IS. 9d . A r tery Forceps . 2S. -td. Kn ife, very thin , ivory handle, tw o hlades, IS. 9d.

23 PRICE LIST.

CLINICAL THERMOMETERS.

Reduced Prices .

Ro u nd . Ordinary, IS. ; minute, IS. 3d.; half-minute, IS. 6d. Flat. trongly recommended as they will not roll. Ordinary, IS. 6d. ; rapid (specially selected and reserved for the Association), with very open scale, 3s.

Lens Fronted . When held in the proper position the column of mercury i - magnified, and so easily read. A little practice is required to ascertain the correct position in which to hold the in trument. Price, ordinary, IS. 6d. ; minute, IS. 9d.; half-minute, 2 . 3d.

Kew Certificates (to order), IS. 3d. each . N.B.-These certifica.les either state thal the instrument is correct or point out any slight error there may be; they are not usua.lly considered nece!:isary.

N.B.-MinuLe and half·minute in trumenls will only register in the time stated under favourable circumstances.

BATH THERMOMETERS .

To Dr. Forbes' specification. Japanned with zinc scale, 2S. 3d. ; Clinical Thermometer size, in case, IS. 6d. iVO liability is taken for breakage 0/ Tlze?'IJlOmeters in transit.

TEXT BOOKS. &c.

FIRST AID TO THE INJURED." By James Cantlie, M.B., F. R. C. S. The authorised Text Book of the First Aid Course. IS.; by post, IS. 2d. ." CATECIlIS;\f OF FIRST AlD." Compiled from Dr. Cantlie's Manual. By J. Brown, L.R.C.P., L.R.C.S., and J. M. Carvell, i\LR.C.S., L.S.A. Price 6d. ; by post 7d.

"HINTS A:-';D HELPS FOR IfO:\IE URSING AND HYGIENE."

By E. Cosgraye, M.D., illustrated, with chapter on the applIcatIOn of the roller bandage, by R. J. M.D. The authorised Text Book for the Nursing Course. IS. ; by post IS. 2d.

PRICE LIST. 24

TEXT BOOKS

.

"HOME HYGIENE." By John F. J. Sykes, D.S.c. (Public Health), M. D., &c. Illustrated. The authonsed Text Book for the Home Hygiene Course. IS.; by post, IS. 2d. " CATECHISM ON HOME NURSING" (based on Dr. Cosgraye's Text Book). By J. Brown, L.R.S;.P., L.R.C.S., and J. Carvell, M.R.C.S., L.S.A. Pnce 6d. : by post, 7d.

" QUESTIONS AND ANSWERS UPOI' AilIBULA:,CE WORK."

John W. Martin, LD., and John MartlD, F.R.C.S. Ed. IS.; by post, IS. Id. "T "QUESTIONS A:-;D i\I'S\\,ERS NURSI:\C. By John \\. lartin, 1.D. IS. 6(1. ; by post, I . Sd. " "FIRST AID TO THE INJURED (Six Amhulance Lectures). By Professor Frederich Translated from the German by H. R. H. Princess ChnstJan. 2S.; by post, 2S. 2d. " ELE [ENTARY BANDAGING AND SURGICAL DRESSING." By Walter Pye, F.R.C.S. 2S.; by post, 2S. 2d.

DR. G. H. DARWIN'S" FIRST AIVS," heing a card to hang up, giving treatment of \'arious accidents. 2d.; bY,post; Sci. .

"To RESTORE THE ApPARENTLY DROWNED, pnnted In large Type with two Diagrams. Unmounted, each; by post, 3d . Mour,ted, with reel border, and \'arnlshed to hang up 6d.· po t free, packed, IS. . ACT WHEN CLOTJl1NG TAKES FIRE." By J. E. H. Mackinlay, M.R.C.. U.nmounted, 2d.; by po.st, 3d . Mounted on card and varI1lsheel, 4d.; by post, packed, 7d .

"FIRST AID PRJ CJPtES." ards of conci e . for waistcoat pocket, each; 4d. per doz. peclal quotatIOns for large quantities. .

"SP KCn.lEN EXAilllNATION PAPERS, Flfst Aid, Nursing and Hygiene Cour es.' 3e1.; by po t ,4d ..

SMALL ANATOMICAL ,howmg the human skele· ton, main arterie , pOInts where pre ' nre should be applied to arrest bleedtng. 2d.; by po t, 3d .

PRICE LIST.

TEXT BOOKS,

DIRECTIONS AS TO THr-; RESTORATIO OF PERSONS SUFFERING FROil1 ELECTRIC SHOCK. Larse print, poster size. 3 d . each; by p os t, 4d. ; or 25. 6d. p e r dozen.

AIDE MEMOIRE. On cardboard, in li nen- li ned envelope, fo r the pocket. By the late Surgeon-Majo r P. Shepherd. Containing useful hints for First Aid to the I nju red. 3d.; by post 4d.

!GENKRAL NOTES FIRST AID TO RE RENDERED I ' CASES OF POI SONI NG. By Miln es l1 c)" LA., 1\I.R.C. -_ , L.R .C.P. Price zcl. ; by post, 3d . " A:'IIRULANCE TABLE 1"5." By 'ydney Partridge, 1\1. D. Plice I S. ; by post, I . Id.

NOTES l\IILlTARY SANITATION. By Lt.-C olone l H. P. G. Elkington, R.A.l\I.C. hice 6c1 . ; by post 7d . .. , EMERGENCY BOOK," (or in tantaneous r efe rence, givin g (;oncise instructions; to hang o n wall. about one foot quare. Price 2S. 6d. ; by po. t, 3s.

AIDS TO MEMORY. By L. Frank Christian, LB.C.M., Edin. 6d. per copy; by post, 7d. FoR C ORPS AND DIYISIONS, St. J o hn Ambulance Brigade. 2d. pe r copy.

A History of the Order of the Hospital of St. John of Jerusalem . By the Rev. W. K. R. BEDFORD, r.A., Geneal ogist of t h e Order, and Lieut.-C olo nel R. H. HOLBECHE, Librarian of the Order. In one Yol., D emy 8vo., 230 pp. Profusely Price 5s.; by post 55. 40.

The Knights Hospitallers in Scotland and their Priory at Torphichen. By GEORGF. THOMAS BEATSON, 1.D., C.B. \Vith IS pages of illustrations. Price 25. 6d., bound in cloth; p ost fl ee, 2S. 8d.

ROLLER BANDAGES.

ROLLER BANDAGES in Assortment.

Each packet contains 6 bandage as follows :6 yards lon g-one 6 inch, two 3 inch,

long-two inch.

Special quotations for la rg e quantiti es.

Illustrated Triangular Banoa.£!'c. (after Esmarch) sho\\ ing 21 applications of the Triangular

ROLLER BANDAGE MACHINE.

Designed by Dr. A. C. Tunstall. Price 2S. 6d. COTTON WOOL.

\Yhite absorbent, good, I oz. packet, 2d. ; 2 oz. packet, 3d . ;

4 oz. packet, 4d .. lb. 7d.; I lb.!.. AN l'ISEP'! Ic-Boracic, lib. packets, 6d. each; per lb., IS. 6d.; Carbolic, per lb., IS. Bd. ; Alembroth, per lb., IS. 6d.; Double Cyanide, per lb., 25. 6d. LINT.

:'Iedium quality, I oz. packet, 2d.; 2 oz. packet, 3d .; 4 oz. packet, 6d.; 11b. packet, Iod.; I lb. packet, IS. 6d. ; Boracic, I lb. packet, IS. 6cl.; 4 oz. packet, 6d. GAUZES.

These are. upplied in 6 yard lengths,

Unmedicated white Alembroth

PLASTERS'.

Manufactured by Messrs. A. De St. Dalmas & Co.

Leicester Adhesive Plaster on Cam bric in tins of f yard 6 inches wide ... ... ... ' ... . .. .l .' 6d.

The Leicester Adhesi\'e Ribbons, in tin boxes, 6 yards long. inch wide 1 inch wide

National Rubber Adhesive Plaster (Antiseptic), on spools.

Double Cyanide width about 36 inches

Boracic GAUZE TISSUE.

d. per length

A layer of absorLent collon wool bet ween two sheets of gauze, good quality, per lb., IS. 6d.

5 yds. 10 yds. ! inch wide 9d . I . IS. IS. 6<1. 2 IS. 9d . 2s. 3d .

Ditto in card box, in. wiele, i yds. long .. . " tin "I " " .. . " 3 .l. S i " s " " COURT PLAS j ER, TRICOLOR.

Large Size, 9<1. : Medium, Sd.; ' mall, 3d . 6d. Sd. Id. 3d . 3d . 6d. 9d •

Pr ices much

Reduced in many cases.

Arm Badges, with the device, issued under. the authority of the Central Executive Comm ittee, havmg been first approved by H. R. II. the Grand Prior as the sole official and recognised Badge of the Association

N. B.- TiLis dt!Sign is protect.:d, and must be! obtamed dIrect from tlte Celt1ralOffice.

.

N o. 1, for the use of indiyidual certificated puplls- s. d.

In German Silyer, Large Size

Small Size ditto

mall Size for button hole

In Electro Plate, Large Size

Small Size ditto

Small Size for button hole

In Cloth and Silk ...

In Cloth and Silver (Registered Num ber, 35 22 )

In Cloth and 'Vorsted

Small Celluloid Badge, for button hole, arm or brooch ... '.. ...

'Vhite Satin Armlet, \\'ith woven Badge

Black ilk Armlet, with printed Badge .. ,

N .B.-These Badges are 1Iot to be worll as dccorat:olls,

H

6

6

1\0. 2.

No. for members of the St. John . \1l1 bulance Brigade, haVlng the name of the Corps or Diyision annexed on a lab el, orlly issued in quantities-

In German Silver, first doz., £r ; subsequent dozs., 125

In Electro Plate, first doz., £ 1 125.; 5UUSC(!uent c!ozs., £r 45.

In Cloth and Silk, per doz., 12S.

In Cloth and Silver, per doz., £ r 105.

All the above may he worn by members of the St. John Ambulance Brigade, not \\ earing uniform, and the German Silver and Electro Plated may be worn as the . \r111 Badge for alJ ranks on the Brigade Uniform. .

BRIGADE UNIFORM BADGES, etc.

Officers. Collar Badges (Reg. No. 3,524) per pair

" Pouch Badge ( " 3,657) each Sergeants. Cap Badge ( 3 52 0 )

" Arm Badge ( ,,3 ,523) "

Fatigue Cap Badge for Officers and Sergeants

(Reg. No. 3,558) Corporals and Privates.

Cap Badge (Reg. No. 3,521) .. .

Arm Badge ( 3, 54 2 )

Field Service Cap Badge for all ran ks

Lady Officers of Nursing Divisions.

OYercoat Badge( " 1.582) . . . each "

'upe rintendent's Cloak Badge (Reg. No. 3,658)

Superintendent's A r m Badge ( " 3,659)

Other Nursing Officer 's Cloak Badge (" 3,5 55)

Othe r TULing Officer's Arm Badge (" 3,656)

Nursing Sisters. Arm Badge ( " 3,522)

" Cloak Badge ( " 3,521)

Honorary Surgeon's Silver Wire Cross (pattern B) ...

Superintendent's ilver Wire Star (pattern A)

Medallion Badge (pattern D) .. .

Nursing Badge (pallern E) ...

Satin Badge for Xursing Si ter's Pin Cushion

Bugler 's Badge 4 0 Bugler's Cord

Honorary Secretary's Badge ...

Whistle and Chain each

Field Service Cap , complete ...

Private's Brown Waist Belt and Pouch ... "

White Piping, per packet of yard, enough for 3 pairs of tr ousers (pack ets cannot be broken)

Lace, Sih-er per yard

(A Cap

runs about 24 inches.)

BUTTONS FOR THE UNIFORM OF THE ST. JOHN AMBULANCE BRIGADE.

Issue d on ly for the use of Office rs and Members of Corps and Di'/isions wearing the presc ribed uniform.

large

ELECTROTYPES

OF THE ST. JOHN AMBULANCE DEVICE. N o. I. 2. For Cards, Tickets, &:c.... For Note Paper, SmalI Circulars, &c.

",J' Fo r Quarto and Foolscap Letterpaper, Circulars, &c .

,,4. For Small Poster...

,,5. For Large Posters...

Prints of the above Electrotypes, with the exception of No. 4A, which is sho wn on page 29, and No. 5B, appear on the following page.

PRICE LIST

.

POUCH FITTINGS.

specially selected [or the 'to John Ambulance Brigade, consisting o[ ;-

2 Triangular Bandages, one of whic h is sealed up in waxed paper. The other may he used fo r practice, but shoulcl be kept a. clean as pos ible.

2 Rol br Bandages (3 in. and I in.) .

I Packet of Cyanide Gauze (1 yd. compressed) .

I Pair Scissors.

6 Safety Pins.

I Small Bottle of strong Smelli ng Salts.

I Piece of strang Cane, [or tightening improyised Tourniquets.

Price, 2S. 8d. each. 6 doz. or more, 2S. 7el. each.

Packets o[ Cyanide Gauze (1 yd. compressed). Price per doz ., 2S. 8el.

mall Bottles strong Smelling, aIls. Price per doz., 5 . 6d.

Splint Ties, ·Webbing, and suitable Buckles. Per set of 12 ya rds of strong 1-inch \\'ebbing and 15 Buckles, 2S. 6d.

These make very compact Ties for carrying in the Pouch .

T he \ Vebbing should 1:e cut to meet loca l requirements.

Buckles only, IS. 3d. per dozen.

\Vebbing only, IS. 3d . per dozen yards.

I t is unnecessary to sew the Buckles. T he spikes should be passed th rough the webhing, and the sho rt end of th e webbing should lie outwards.

SWAGGER STICKS

for the use of Officers and Members of th e St. John Ambulance Brigade.

Ebonised Canes, German Sih'er :'Iounts bearing the Brigade De\'ice.

These may Le obtained direct from Me rs. IIebbert and Co., 35, Bethnal G r een lZoad, E. TO 909,., London \ \ ' all. Telegraphic Addre ss : "OtherWIse, Londun

Crus '-he lt, \Yhite Patent Leather and Black l\lorocco Pouch (Badge extra) ...

Cap and Co\'er

or

LIST.

l\IESS DRESS FOR OFFIceR.

Jacket (Badges extra)

Vest ...

1ST CLASS SERGEANT.

Patrol Jacket (Badges extra)

Chevron, 4 liars, Silver, 3s. 6d., \\'orsted Trousers

Forage Cap (Badge extra) ...

Cross- belt and Pouch (Badge extra)

Field Cap (Badge extra)

Buckskin Gloves

Cotton

Leggings

Great Coat (Chevron and Badge extra)

SERGEANTS, CORPORALS, AND RANK ANlJ

Patrol Jacket, mack Tartan (Badges extra)

T rousers, Black

Forage Cap (Badge extra) ...

Cover for Cap

\Vaist-belt and Pouch

Field Cap (Badge extra)

Great Coat (Badge extra)

Gloves (per pair)

Leggings (per pair) ...

Sergeant's Chenon , 3 bars, Silver,2 6d., \\'orsted

Corporal \ " 2" "I s. d. " CYCLISTS-S UPERINTEN DENT.

Patrol Jacket (Badges extra)

Cap (Badge extra) ...

Breeches : Grey Serge

Shoulder Belt and Pouch

J acket (Badges extm) ...

Cap (Badge ext ra) .. .

Breeche : Grey Serge .. .

Shoulder Belt

Gloves (per pair)

Gaiters (per pair)

All Badges to be obtained by the Corps or DiYision from St. John's Gate.

If the Corps or Di\'ision is out of London, measurements t o be supplied to contractors free of charge.

Carriage out of London extra.

IND E X TO P RI CE LI T.

A ids to M emory

A mbulance H amp ers .. " S tation Plate

Badges...

Bandage Rolling :\lachine

Bandagf'S ... Basin Dressing

B ed, Equipoise " Camp Books... ...

Bottles (\Yater)

Button s . 23, 25 13 3 2

Carriages (Horse Ambulance)

Carrying Shed

Cotton Wool... ... ...

CO\'er for Stretcher or LitleI'

D iagrams, Large " Small

Dressing Basin

Drowning: Tackle

Electrot}:'pes ... 33, 34. 35

Emergency Rook 25

First Aid Hox ... ... 10, 20,21

First Field Dre sings.. "1

Flags... ...... 37

Gauzes... ... 27

Gauze Tissues ... ... 27

Hampers (Ambulance) ... 15, 17

H a\ ersacs ... ... ... 18

H ood and A pron for Litter... 4

J aconette 2 ( Knife 14 Labels 22

L itter (Ashford)... 3, 4

Litter (Rea-Edwards) 5, 7

L owmoor Jack et 13

Medallions ...

Nur. es ' \ Yallets

Nursing Charts " ] nstrUIl1<:nts ...

Pillows ...

Plasters.. ... Fittings

RegIsters ... ...

Roller Bandage :\Inchine

Rug for Corps or Di\'isions

St. John Ambulance Brigade

Safety Pins

Scissors... ... Slings, • tretcher plint Padding Ties

" Adjustable Legs felr :;)\\,agger Stick . Temperature Chart

Text Books ... Thermomet ers

Tourniquets .. Tow, carbolized

.. 23, 2oj. 23 21 " plain 21

Uniform Sundries ... ... 29, 31

Uniforms 38, 39, 40

Wagons ( H orse Aml;lulance) 2 \ Yater Bottles ... 13 \ Vaterproof Lint 21

\ \'lIterproof Sheet

W histle and Chain

W ool (Cotton) \\'ound Pad