First Aid to the Injured 16th edition 1910

BONES.

SEVENTH} CERVICAL VKRTE8RA

COLI.AH} BONE (clavicle)

BREAST} BONE (sternum)

ARM BONE (humerus)

4TH VKR1'EBRA • HAUNCH} BONE (pelvis)

PHALANGF.5 -.

TIIIGH BONE (femllr)

KNlm CAl' (pal.,lIa)

SHiN BONE (tiLia)

BIWOCH BONE (fibula)

FIRST

AID TO THE INJURED·

AR R ANGED TO THE REVISED SYLLABUS OF 111b: ['IRS!' AID COURSE

01' THE ST. JOHN AMBUL AN CE AS SOCIATIO N. BY

C.\:\"TLIE, .\l.A., .\1.1.;': F.R.L ... , Honoran' Asso,'ialL' ('/ tlte 0/ lohll, i/ollonuy Ltji: .11&J//i>o- allci LCdIlH'7 "lIti i, l'anl/ncr 10, lite J ssoc ""!iO ".

" rith a CIIAPTER on" tretcher lralbport," re,·i eJ frolll that originall) Wl'illen by jOHS FURl-ii", A""ir:ltt O//UStICC 0.1 ill< Urdcr 0/ St .Jolrn HI accorJance with the c\rl11\' 'tretcher Also a CIIAl'rEf< (bt!ing the Fifth Lecture, for I only). by E. \lACl)O\\,EL COSGRAVi':, M.D. , F.R.C.P.I., A-nir:ht ii' (,race oftlte urtle, 0/ Sf. jolm. Honorar), Life .11&111(>'101, a n d Lccturer tu,d ExamlILc1- to, tlte AssoClatiolL.

SIXTEENTH EDITION, 680,00,) to 780.000 (Tllis EdItion is similar 10 tlte de·l'e1ttlt. twelfth, tltirtuntlt. /ourtulltll and .li/teentl,), P rice in C loth, IS. net; by post. 1 s zd. In Morocco, 2$ cd,; by post. SJ.

TO UE A1

·T. J OIli\ ' S GATE, CLLR K. E WELL, L . C. \V.H .&: L. C. 50,000-1110.

Wl)t

8ranb of tbe ®rbcr of tbr 311o%pttal

of cSt. .3J oba of J rru.5alrm in ngIanb.

an<!l -:patron of Or<!lu.

His Most Gracious Majesty King George V.

(!';ran<!l -:prior.

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

Sub--:prlor.

The Right Honble . the Viscount Knutsford , G. C M. G.

Y.lalliff of

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

0fflc¢rs .

Cluz1lcelloy - C olonel Sir HERIlEIn' JEKYLL, K.C.;\I.G., R F:

Secretary·GuLCral-Colonel Sir HERllERT C. PERROTT, Ih., C.B.

Rece iver·General-EO\\IN FIIESHEIEI.O, E"q ., LL D.

ALm olLer-The Rev. Canon DUCKWORTH. C.V.O., D.D .

Reg istrar-i\ I ajor·Genernl the Lord K.C V.O.

Genealog-ist--Sir ,\LF RED SCOT I COTT·GATTY, C. V. O. (Garter).

Director of tltt: Ambulance Dej>a"/me lL /-The i\lost Hon. the l'Ibrques, of BHEADALBA:-';F., K.G.

Libran all -Lieur.·Col. HOLBECHE . R. El)IL\I<l)S. Esq ., A.C.A.

Cilair11lalt 0/ rhc_ O/,lztlzahlllc I/os/'ilal jerusalem-The Right Hon. the Earl of PIYllIolllh, C. n.

Clziif Sccreta , y 0/ tite A Dej>a, !men/-Colonel Sir HERBERT C. PI::RROTT . Hr. . C. n. :t\sslstant Offlcus.

A sS/rla"t 0/ the rJ JIIllII/ana V,,/aJtllluzt-Lieut Co)onel SiJ

RICIIAIW C. Hr., C.I.E., Assl ,""''' Recel7.'er·Gclleral-EllwIN H. [, I<l·SIIFIEJ.O, I<..sq. r/SSls/mlt LIbraria n -CYRIL DAI'ENI'"'' I. 1-. sq. !lOll. St'c1elary 0/ tlte B,i/islz UplzLltalllllc Hospital, jeru!alemColonel T. H. HE:-IIlLIl:Y, C.l. F:. , . . Assi,I'/(wt HOltOlary SrcrctalY (for Scotland) 0/ Ilze Bntlslt Ofilultal",,' Hospilal,}cl1tsa/elll J.lIOR:-':ESTEI'E:-':SON , E q. (UllIcorn Pursltl1'allt.) ZSl,¢ (touncll.

The Council of th e Sub·Prll)r, <l'i President e ,-·officio. the Executive Officers, and the follu\\'ing

StrjOH:-> FURtFY,C.n. I i-lajor.Gcneral J. C. DAI.TO:-';, H..A.

The Right Hon. the Earl of l' A:-':' ::,ir RICIL\Rn IJOt:CI.AS Pow F. !.!., Ih" :'Il.l).

FUR!.Y , G.c.;\1.G.

Col. C. \Y. HO\\,IlLI::R, C. B.

Sir J A E S D 1 C K, K. C . B . , R.N.

Colonel Sir CII\RLES :'IL \VA 1S0:-':, K C.l\l.G" C.B, R.E. Sir DI'CE DUCKWORTH, Er., LL.D., M ll.

1> Oil 1:::->, 1.1.. D., F.R.C.S.

Lieut.·Colont:1 Sir HICHAIW C. fE \l!'1 I" , ilt-, C.Lh-. D. JA\lES, F,q., C.V.O.

The Right Hon. the Lord 1'.01<'1'1-'COTE, G.C.:'IU;., G .l.I.l<.. .• c.u.

The RIght Hon. Ihe Earl of BFSSB·'Rl.)\;CH, C.V.O ,C.H. I nspeclor·G eneral TIELto R A , ' E 1'\1:-'::-':15, :'11.]).,

The Chapler l'on,i.;ts of Ihe "f Jlbtlee and d,' ; the l-.xt:Cllli,e Officers; the \Ielllhers of Couned ; and tllt: followmg Officiating <r:I,aplalns .

The Rev. Canon SHEPPARD. C. \ 0 lJ. I J ..... ulo.l>ean of the Chapels Royal). The Re\,. PAUL \\'. \\'\Art. A:-';I>

A ;:; of (!;rac¢ an<!l -"EsquIre s .

Surgeon.( ,eIH::Jal Si r \ Y TA\LtlR, Th: 1,lg ',t Hon. the 1·.",r1 of ' K.C.I;, ;\1.0 KIDI "I'\-\' .

The RIght Hon. Lord Cl.AUD Culonel T. H. HI·;.;nl FY, C.1.E. Lh,. !-l Oll. [ A\lh \fcL .-\/lI::;oI

The Righl lIon Earl CAWDClR S'lll H, :'I1:btc:r of Gray

}< 1'\\'1:-': liANSlIN I ,q. C. R. HAMll.TO:-':. E'q., C.:'I [ G. C,I. Sir Clement :'If. Ro),(h, C.B. Lleul ·Colonel hOI{ PHll.II'J'S. Ll.-Col. Kmlm:o l\f. \\'11.501". C.B , D. '.0., :'11.1'.

C ;\1.(;., D 0., R __ Cnlonc:l F. ST CLAIR

Lt.,Col. Sir LEES K:-.:o\\ I.I'.S, Hr., A 'STRU'I HER, \'.0 ., D.S.O. C.V.O. Em\'!" DAllES. J<:'q

The RighI H on. the Lord DI"s- Hr: :-':l(Y T. JOH1' HOPE, Esq. IlI)RUUGH, K.C.V .O. B 2

following "J\ nlgl,ts of :J :

H R H. P r ince CH Rbll AN ov SCH LES WIG·Ho LSTElN , K.G.

JI.:'>L KI Nl. HAAK ON OF - OR W.\ Y, K G , G. C.B., G .C Y. O

11.11. Prince A LI.;ERl" OF SCl IL ES. \\I G .H oL!:)rEi:-O, G C.B , G .C.V.O.

II.S.Il. Th e D u ke of T ECK, G. C.V.O. , C.;\ U ;

Rc ar·"\ d mi ra l ILS .H l 'rillLe LOUIS liF BATTE:\IlERl.. , G.C e., K C. 1\I. G.

1l. S. 1r. Prince \ 1.1''' \,\OLl, CeOR(,E OF TECK, C . C . \ ' .0., If .R. II. Prince . \ RTIIUR Cu:\. NAt:GIIT, K .G.

' ir J UIIX FUI<Lb\, C.I:. (Iloll B a iLiff) ·

l'he Rt . H on . Lord G.C . l\ l. G . . ir :X. l)1Cl-':.[,AUUI:.R, llt.

'l ajor Sir A IlCII II.; \1 I) LU!R, Dt .

Col. H Elwun C. PI:.RIWTT, Bl., C .D.

J he H.l. Hon. Earl Fl- RI{[-RS. Co l. J . GII .I>I:..\, h. .C . \ '.0 ., C.B

JOHX LOI'TU';, Colonel Ih;TIIEI :\ l 1'1:'> 1> \\\

Gen. . il CHAItII- ' \\'.\lll,eX, "-.CI\., R. lc :\ l aj.·C;en. JA\ILS C. LJ .\I TtlX , R .,\. Col. GuUll) au:. rEIl· \\' E!:)TOX, }{. J, . CoJonei Tht! R t. HOIl . Lord CeCIl., C.\· O, 11)11'1'1 L ' ll., LL LJ (1 / OIL. Sai/ijr).

11 is Grace th e D uke of FIFe, K:l .

'1 lIt! Rt. H on . Lord l:hC\S"Ev,G . C.B.

The Rt. H on \" bcuUnt '1 E',II LE. TOWN .

The R t. H on. \" bCOUlll K :\UTSFOIW. G.C. 1II. C (Sub · Prio r ).

follOWing

The Lo rd Bhhop of S

The B ishop in J

Th e B is h op Or-OISBY . I

R. MACLEAN MAcLEAI', E.;q .

A. F. G . LE VESON GO\\ I':sq .

Lie ut C o I.F.A.H E YGATE !.-\\ IUC-In" .

C o l. Si r C. :'l lJl<I-c-\ \

C.B. '

The Rt. H o n. th e Ea rl of R AI'.

I'l.iNLY, G .C. l\ L G.

Tile [{ t. H o n . L o rd SANO llUllST.

G.C .S. r. , G. C . I. E .

Sir ll r:;;\RY . \. BLAKE, G . c.;\ I. G .

The R t !-f Oil tbe Earl o f :'llc\ 1"11

K. I'. '

\. 1'. 1J:l1l;:'>1) FII -\S I R, Esq.

I lie Rt. I [on Lord 1II usI'Y".

1 he :'10'1 lI on the M arqlle,s of J:REAl>AI flA:-IE, K. G .

His (;raLe Ih<! Duke of K.G . , C.C . V . O . '

I· :'1 the Rt. Hon the: F.ul

K.G., K . p.,r.1!:' ,<:1 ' .

}{UBEnT BNUUE:-;EI L CARTLl1, E'lj., F R.C.S. (1IolL Co m malLd,r)

::,'0101.-\:-1 ll.-\y FUIWES, (l!:dill . ).

Colonel C \Y. BUWUI.LI, C.I: (1IolL. Co mm a lL der)

Lleul.·Col..\ . C . \.-\TE.

\lajor·Gelleral ASTI.EY F . J'EIO<\·.

l'he Rt. Hon the of 1'1 \ . .\IOl' TH C.I:.

The }{t. lion. the Earl of SA '\ I)' \lICII, K.C \'.0.

The Rl. Hon. the Lord " ORr-II. COTE,C; C. \ I.(;.,G.C .I.I·" Col:.

Tile Rl. 11.)1) Ihe Earl of I:. 1 E'· \IEI< I-. II A'\SO'; FI<E!:)lII'IFLIJ, I' -" t-. !\L\ .

rhe Rt. Hon. Vj!:)count BUA ' 1 , 1 1:.\ .\L V.O.

F.·:'>!. tile Rt. H on Viscounl K IT. K lIARTOU\I.( ,.C.I:., 0. \1. , G.C .:' U,., G C I. I _

tl,e Sub.-.prelates:

The Bi,llUJ.l of CIURALr,\IC

The Bi,hop o f /) UNeD IN (Pri m a!e 0/ N ew Z ca / att .i.)

BEING THE AMB U LA 'e F. O F (ffi-nnb' of ibe ®rber of tbe of .st. loiJ" of in lJatr-on.

HIS MOST GRACIOUS MAJESTY KING GEORGE V. (SOVEREH,N IIF -\Il .'\1'0 J' ATRO:'> roF ·IIIF OROER )

FIELD MARSHAL HIS ROYAL HIGHNESS THE DUKE OF CONNAUGHT, K.G . ((,R \:\1 ' 1-1<1'1 01' -I liE UR ll EH. ) <tommlttca . COllsi.;t illg excl11si\-dr uf \ Iemll"" and '\s-ociale-; of Ihe Order.

D,ra!o1' o/tlu AIII/'lIltln c /' n/'l'm!nlt' Jlt and Clurirllla1l "/ COJllmiftuThe ;\ 1os t H OIl. the :'>1.11"'111"" of Illn·; ,OAI.B, .·F. K.(,.

A_\-Jis!altt Direcfo' au.! fl'·I' II '.' Cltall IIII1Jl-Lieul.·Colo nei ir RICIIARt> C. 'J UIII.I', Ill .. c.l.l..

.1 0 1:'> Ft-f(l!.\·, c . n. (Life 1c ni:t:r Oflh" COIllmittee 110 ItO) is CaliS" ) , .1/01.' ·-t!rs.

:\rajor.Gent!ral J. C. IhITO·. R. \ .

Colonel C. \\'. Bo \\ l>1 C I: Lieut.·Colonel ,\ C. Y.\ rr .

The Rev T. \\'. \ \ ·( )I) I).

\\',\".'\:11 \1' T>I,\() ,\ I' ,,\. :\lajor G. 1£ . \ \'\"1'';1111,:'1 :'II \1 Fl.

Colonel Sir J . \\'. OITilY. h..C . ! E ., R.F.

I nspe,:tor·General I :'IJ n . I'.X

(;EORGE FowI. r,ll, 1'. , '1

Surgeon.:\lajor l;. H. IIAl<WI:-O, \I D. S. 1':11.1;;,.0'<. 1-:,'1 ., . .

l _ieul.·Colonel C. J. TRI\lfll E, (. . \1.(;., L. R.C.P.

Colonel Sir CI E\JFN r :'II. /{ l' \ B

Captain T. \\'. ,I I' I:, ,\\ I'll.

lIAI 'O I I)' Bot-! f"UX , Esq .. ;\1.\' .0.

l:..mll:.·J) OWI-:-O, 1.' '1 I I.. D I· R.C.S.

<!:ltntra\ tXltcuUVIt <!:ommltt lt2.-coJltillued.

The Lord Cl.AUD HA:lllI.TON. Sir jf)l!1' L. Ht.

The lIon. Sir JOHN A. COCKBURN, K C.:'ILG., :'ICD. Sir ARTHUR C,)NAN DOYLE, ;\LD.

The Right lion. J. L. W HARTON, P.c:.

Surgeon.General Sir }\L FRfW KEOGH, " c.n., F.R.C.S E. & I. SYDNEY \Y \ [ AI.h:lN, E'q.

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

Surgeon.General Sir BEN]AWN FRA.·Kl.lN, K.C.l.l.

JOHN GRIFFITlIS. l\I.R.C.S.

Lieut.-Colonel JOliN AR"A1.I.l' JONES. ;\1 D. Sir \\"ILI.IA\1 LEI\' IS, IlL, K.C. \'.0.

The Hon. THO\l.\S A. BRASSEY.

The Right Hon. the Earl of C.V.(). C B.

Lieut.·Colonel (;EORG.: E. T\\,ISs. F.R.C.S.I.

Colonel TA:>IES C\ , ·TlIF. F.R.C.S.

Colonel'r H. HENllll·Y. C .l. E.

J. H :\[Ollr.AN, Esq., C. ' -.O., v.R.C.S.

S u rgeon-\[ajor t; ..\. HVrTol\.

Surgeon·General Sir ClI·\RLES !\TCDOIWUGII CUFFE, K.C.B., F.R.C.SK :\1. CO.\1°ES, l\l.D., R.N. FRANCIS IZ. Esq., :'ILl>.

A. THEonoRE IlllANIl. l':sq., :\1.1>.

J. ASTLEY IlI.OX\\I, Fsq., F.H.C ... FRANC[S ?'J' . £1.1.[5, K:q ]\[ajor E. \VEST-S"'Il£S, \f.D. \\'ILLL\\l 1:. . ,\t·UL.·\NP, , :\T.R.C S. r: ,' ·Oflio,' ,1follbers oj Committee.

Colonel Sir HERUEI<T C. PERROTT, nt., C. D. (Secretary·General of the Order).

EOW[N FRESlIFIEI.D, Esq., LL.D. (Recciyer·General of the Order).

The Ri.l;ht H0!l. the tarl of PLY\IOUTH, C. H. (ChairIl11!l, British Ophthalmic Ho<;pital) <.t:l)lef Sltcrda ,l'.

Colonel Sir HERIn- RT C. l'J'.]{ROTT, I\!., C.B. (Se c ld:J.ly.C;eneral of the Order).

of Stores anO -:2\ccoulttant.

\\ I LL I A],[ R. A.C.'\' (Secn:(/l])' 0/ !Iz, Orde'}.

\V II.LI,\\! H. ;\[UIH;.\N, Esq. (""pc>-intel/do", Im·,d'd r,alLspor( Corps).

REVI SED 1908

REF ERENCE No. 58 19Q8.

FIRST AID TO THE INJURED .

SYLLABUS OF INSTRUCTIO N.

FIRST

A. Principles of Fir-..t Aid.

B. A Lricf De:;cripllon uf the Human Skeleton and of the Iu_ cles.

e. Fractures-Causes, \'arielies, signs and symptoms.

IJ. Treatment of Fractures -C;eneral Rule.

E. The Triangular Bandage and its application. LEcruRE.

A. Treat ment of Fractures (continued). Details of t reat mcn\.

B. Di,lucations, Sprains, Strains-Signs, symptoms and t re atment.

C. The Heart and Blood Ve:;els. The Circulation of the Blood.

D, II <emorrhage and wouncls. General rules fo r treatment.

E. The Triangular Bandage and its application.

THIRD LECTURE.

A . and wounds (continued). Details or treatm ent.

B. [ntemal IIzemorrhage -S igns, symptoms and arrest.

C. [hemorrhage from Special Regions. -S igns, symptoms and arrest.

D. Bruises, Burn and calds, Bites and Stings, Frost-bite.

E. Foreign bodie in the Eye, Xose and Ear.

F. The Triangular Bandage and its application.

FOURTH LECTURE.

A. The N er\'(IUS

B. The and l\Iechani m of Respiration-Artificia l Respiration.

C. Insensibility.

D. Poironing.

FIFTH LECTURE (fur :\Iales only).

A. Improvi eel methods of lifting and carrying the sick or injured.

B. Meth ods of lifting and carrying the sick or injured on stretchers.

C. The conveyance of such hy rail o r in country carts.

FIFTH LECTURE (for Females only'.

A. Preparation for recep tion of accident cases.

B. Means of lifting and carrying.

C. Preparati on of beel.

D. Removing the clothes.

E. Preparations for surgeon . 9

NOTE I.-The subject of poisons should be trealed in it general manner; the common poisons classified, and only their general symptoms, effects and treatment taught.

NOTE lr.-Th e last half-hour of each lecture should bt devoted to practical work, such as the application of and splirlts, lifting and carrying wounded on stretchers.

NOTE IlL-There should be an interval of a week between each lecture. A candidate for examination must attend at least four out o f the five lectures.

NOTE lV.-Male c1as es must pass in that system of stretcher exercise most suitable for the locality.

NOTE V.-As little time as possible is to be spent on instruction in anatomical and physiological details. Lecturers and examiners are particularly requested to remember that it is " First Aid" that has to be taught and tested, and not anatomy and physiology,

fI'.:ad classes of /liCll and women are on no account permitted.

PUPILS U:-IDER SIXTEEN YEARS OF AGE CA:-I ONLY ATTKNC

THE. "JUNIOR" C0URSE (SECTION A, SYLLABUS 40 ).

Lecturers instructing a First AId class, and Local Secretaries, can obtain further particulars on application to the Chief Secretary for II Paper Reference No. 80."

No Ledurer may examine Ilis own Class for Ce,-tificates.

ro

CH.\l'TER 1.

of First Aid

E:{planatory

Questions on Chapter

CH.\l' fER II.

The Human Skeleton . Skull, spine, ribs and brea tbone, upper liml)s (collar-bone, shoulder-blade, armbone, hones of. the foreal:m, carpus, melacarpus, phalanges), pelns, 10\\ cr 11I11"S (thigh-bone, kneetarsus, metatarsus, phalanges) ... . ..

Joints ...

Muscles. \'olunlaryand inyoluntary

Fractures. Cause5, yarietie. ,sign and !:ymptoms

Apparatus for treatment of Fractures ..

General Rules to be observed in the treatment of . Fractures

Special Fractures. Cranium, lower jaw, spine, ribs, breast-bone, collar-bone, shoulder-blade, arm-bone or bones c.lose .to the elbow j Jinl, forearm, crushed hand, pelns, th igh-bone, knee-cap, leg, crushed foot

II

CH_\f'lLR Ill.

Circulation of the Blood . Organs; general (systemic) and pulmonary circulatiuns .

Hremorrhage or Bleeding. .\.rterial, venous, c,lpI11ary

Arterial Hremorrhage . Principle,., of arrest

Wounds with Arterial Hremorrhage .. ,

Course of the Main Arteries and Pressure Points. Aorta, arteries of the head and neck, of the upper liml'5, of the lower limbs

Venous Hremorrhage and Varicose Veins

Wounds with Venous Hremorrhage

Capillary Hremo rrhage

Internal Hremorrhage

Hremorrhage from S pecial Regions

Questions on Chapter CHAPTER IV

Miscellaneous Injuries . Bruise, burns and scalds, bites of snakes and rabid animals and by pili,;, lIled weapons, stings of plams and.animals, frust bite neeJk eml..lt:clcled under the skll1, fih hook eml;edded in the skin, injuries to joints, foreign h 1dv in the eye, ear passage and nose, wuund in the fron't \\all of the abdomen, injurie to the organs '" ithin the abdomen and pelyis

Questions on Chapter

CH,\PTER V.

The Nervous System. Cerebra·spinal, sympathetic ...

The Respiratory System

Artificial Respiration. chafer'S, Sih'ester's, Howard's combined with Si lves te r's, Laborde's and )1 a rshall Hall's methods ...

Insensibility. general rules for treatment, concussion of the brain, compress ion of the brain, apoplexy, epil epsy, hy te ri a, shock, fainting and collapse, sunstroke and heat-stroke, connllsions in children, asphyxia

Electric Shock and Effects of Lightning

Questions on Chapter

CHAP'!"] ' R Yl.

Poisoning. General rules for treatment, ,-pecial pUlsons

Questions on Chapter

CHAPTER YII.

Bandaging. Bandages for the scalp , foreheall, etc., shoulde r, hip, hand, fOOL, chest, back, knee, e1 bo\\, fingers and toes ...

CHAPTl.R YIII.

Methods of Carrying. Four, two, and three handed seats, fireman's lift, fore and aft method. improvised stretchers, to cross a ditch or wall, to load or unload a wagon ..

CHAP 'l ER IX.

Stretcher Transport . Stretchers, stn:tcher exercises, litters

CHAPTER X.

The Fifth Lecture (for Females only ). Preparation for reception of accident cases, choice ancl preparation of a room, lifting and carrying, preparation of bed, remO\ing the clothes, preparation for surgeon ...

Questions on Chapter

LVT

keleton sh owing position of main arte rie s

Skull and vertebral column

Vertebra

Bone s of the left upper lim b

Bones of the right lower limb

Shoulder Joint

Ankle ...

Rectus Muscle

Triangular bandage spr ead out and folded

Large arm sling

Small arm

Reef knot

Gra nny knot ...

Loop knot

Bandage fOl' fracture of lower ja\\ ..

Bandages for simple fracture of ribs "'t. John sling

Bandages for fracture of both ",,1bu bones

Bandage for fracture of shol11 (lLr h1aue

Treatment of fracture of arm

Angular splint

Treatment of fracture of forearm

Treatment of crushed hanel ...

Treatment of fracture of thigh hone

Treatment of fracture of thigh bone ( \\'oman )

Fracture of knee cap

Treatment of fracture of knee cap

Treatment of fracture of leg ( man and \\"0l11an)

Treatment of crushed foot

Diagram of the heart, lungs and air passages

14

Diagram of the of I he blood

Digital pressure on car?lld artery ...

Digital pressure on faCIal artery

Digital pressure on artery

DigiL.' \ pressure on OCCIpItal arrery '" ..

Pad am. bandage to arrest from temple

Ring pad

Digital pressure on subclavian artery . ... .

Pad and bandages to apply pres ure on axillary artery ...

Digital pressure on brachial artery (two met ds)

Flexion at el bow

Digital pressure on radial and ulnar arterie", '"

Pad and bandage to arre t from palm

Digital pressure on femoral artery .. .

Tourniquet on femoral artery

Flexion at knee

Oraans of the chest and abdo·nen ... lungs and bronchial tube,; '"

. chMer's method of artificial respiration ...

. il\'ester's method of artificial re piration

'ih'e::ite r's and Howard's meth ods of artificil-ll re opiration combined

Bandage for the head

Bandage for the shoulder

Bandage for the hip .. .

Bandage [or 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 fo r two-handed seats ...

Carrying by two-handed seat

Grip for seat ...

Supporting patIent ... .. ..

Fore and aft metho? of carrylOg

Carrying on impro\'lsed seat

Improvised stretcher ...

Furley 'T" :, Fall in .)

Stretcher exercI.e, ::-\0: I.

Ditto, ready to h.ft patient ...

Ditto lifting pauent... . .

Ditto: placing stretcher .... .

Ditto, preparing to lower pallent ..

Ditto "Lower" ... ... ....

Ditto' No. II. Ready to lift pallclll

Ditto: patient lifted ..

Ditto o. I\'. First puslllUn

Ditto: second position ... .... "1"

Diagrams illu strating Army stretcher dl! I .

Ditto ... ... ..

Bed cradle ... ..

PREFACE.

AI' the request of the Central E\:ecutive C ommittee

I ha ye the manual written by myself in 19 0 I, a" the official handbook of the t. Tohn Ambulance -

Tbroughollt the reyision an endeavour has been made to implify the ·tudy of FIrst l\ id to the I njured hy dra\\lJ1g up a numher of general rules for the of accidents and sudden illness. and by the omISSIon of all detail \\ hich not absolutely to (:;nahle the to acquire an intelli"ent kno\\'ledge of the subject.

I

\\ ish to express m)' thanks to Profes 'or E. A. chafer for fUl:I:is.hing for performing a method of artlhC1a1 respIratIon, to Dr. L. F. fo r many' aluable and to the MedICal of the Central Executiye Committee, especially Surgeoll<\Iajor (;. H. Darwin, M.D. and pr. F. R. Cassidi, for peru . iog the proof sheets and tor a number of useful additions to the \\ork.

I cannot omit also to offer Ill\' best ackno\\ ledllm ents to ?\Ir. IV. R. Ed\\'alds, tl;e Accountant atUl ,'tmekeeper of the :' for hIS im-a luable co-operation.

]A \fL C\NTLIE.

FIRST AID T O THE I N JURED.

'H.\PTER 1.

The t. J oh n Ambulance Association has n.o\\" com p lete d t hirty years of its existence, and dunng that period hundreds of thousands .of men and women have been taught at its classes, ll1 parts of the world ho\\' to help their injured

Fi;st Aid to the Injured is a speCIal branch of practical medicine and surgery, by a of which trained per. are enabled to afford .skllled assistance in ca es of accident .Illness. The instruction begins and ends WIth First Aid, and the subject is taught simply but thoroughly exhaustively. The duty of the ambulance pupIls ends ",here the and the.re ought to be no oyerlapping or clashing of duty or lllteresb.

PRL CIPLE -, OF FIR .' T AID

.

1. The Fir t . \ icl studenL should be-

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

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

. Signs are whal may be percei,·ed. I are whal the palienl can tell you. . . :;: m ean" the circum lances allcnclmg the aCcloent 01 urlclt'l1

(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 "hat can best be left for the patient or the bystanders to do.

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

3· Severe must receive the first attention, no matter what are the other injuries.

4· The. patient must be in a position in whIch breatl1111g IS possible i the air passages must be free from obstruction; if bre<1 thing l1a. ceased prompt measur es must be taken to restore it.

5· 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 Ii 111 bs.

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

7· When the skin is broken the wound

19

should be promptly covered with.a clean dressing. Should the \\ ound be pOlsoned, IS most important immediately to prevent the pOlson permeating the 5) StClll. .

8. Poisons S\\ allowed shoul? be got rId of, or when that is inexpedi nt. neutralised.

9. The best of mllst _ be studied, and provlslOn made for plOper care "hen the patJent is brought to sbelter.

ro. Removal of should not be taken off unnccessarily, but wnen 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 necessary, slit up the seam of the sleeve on the injured side.

SHIRT A:\D VEST: lit down the front and remove as the coat.

TROUSERS: lit up the outer seam-

BOOT: Slit the back seam and undo the laces.

SOCK: Cut off.

II. Stimulants. - It is inco.rreet to suppose that alcohol is the only form of stllTIulant, and far .too frequent use of spirits is. to restore a patient aftrr an accident, often With senous re ults; the safest rule, therefore, is to defer the <1o.minislrallOn of <i:1cohol until the arrival of a doctor. 'When the patient IS able to swallov,', strong tea or coffee, or milk, as hot as can

be dr u nk , or a.. small quantity of sal volatile in wat el ma y be given. Smell ing salts may be held to the nose. Sprinkling the face with cold and h ot watel alt ernately, warmth applied to the pit of the st omach and over the heart, and vigorous friction of the limb s u pwards have a stimulating effect . I2. Throughout his work the First Aid student must on no account take upon himself the duties and responsibilities of a Medical man. At times an apparently slight injury is accomp a n ied by graye danger and may actually caus e loss of life. 'When sending for a doctor, state the n ature of the casE' , and remember that written parti c ulars are safer than a verbal message.

It is necessary that something should be known 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 several 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 lin e " of the body runs vertically from the top of the head to a point between the feet

QUEST IO NS

\\That is First Aid to the injured?..

What qualities should the First Aid student possess?

\\'hat are signs?

'What are symptoms?

What is the history of a ? .:.

\"hat is often the first IhlI1g to do m an accldent ..

What result of injury must receive the first ...

What three things are ab olutely necessary to an lI1Jured

hould clothing always be How would you remove when nece ary?

Explain the use and abuse of ::;tll11ulants ...

What must the First Aid tudent not do

CHAPTER II.

FRA CTURES, DISLOCATIONS, SPRA INS AND STRAINS.

THE SKELETON.

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

1.- To giye shape and firmness to the body.

2.- To afford attachment to the muscles.

3·-To protect important organs, as In the sk uD, chest, and abdomen.

THE SKULL.

The Bones of Skull are arranged in t\\ 0 group s, those of the brall1 case or cranium, and those of the face.

The Boundaries of the Cranium are the vault or dome, the rounded portlon forming the top of the head; the front or brow; the back of the head, where the greates.t eX.tent of brain exists, and where therefore the cranIUm lS \\idest and deepest; the sides or temples . The base of the cranIUm is hidden from view bones of the face and of the vertebral col umn; In It are numerous perforations for the passage of blood and. nerves; through the largest ope!1ing the brall1 and spmal cord are continuous.

The Bones of the Face with the exceptIOn of

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 ca\'ity is formed between the upper and lower ja \\s, the p<lb.te being the bony roof of the which separates Il 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 terminating 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 \'ertical portions.

THE BACK-BO:\E, pnE, OR VERTEBRAL

The Vertebral Column (Fig. 1) is composed of bones called vertebrre, each of which consists ofI.-A body or bony mass in front.

2. -Processes projecting backwards, which enclose a canal for the spinal co rd - the spinal canal.

3.-Two transverse processes , twelve pairs of which support the ribs.

D. n

SKULL AND VERTEBRAL COLUIIIN.

Showing left rib and portion of bruit bone. The right rib5 a.re removed.

SPINOUS PIlOCllSS. TRANSVRRsa f PROCRSSItS.

'. CANAl. !'Olt . SPINAL CORD Bony OF VERTEBRA. FIG. 2A.

•••. TRANSV!:RS. PROCESS.

; , SURJI·ACES SUPPORTING HEADS 01' RIBS.

•• - SPINOUS PROCES S FIG. 211. 25

4.-A spinous process. The spinous processes of the vertebrce 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 vertebrce. The first vertebra, Ille atlas, forms a joint with the base of the skull, at which the nodding movement of the head takes place; the second, lIlt! ax/s, by the j oint between it and the atlas, allows of the side-to-side movements of the head.

2.-1n the back 12 Dorsal vertebrce.

3·-1n the loin 5 Lumbar vertebrce.

4.- The rump-bone, or aerum, consists of 5 acral vertebrre united in adults as a solid mass.

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

Bet\\ een the bodies of the , -ertebrre, in the upper three regions, are interposed thick piece of cartilage (gristle), which, \\ hile they bind the bones together, allow of free movement to the column as a \\ hole, and help to break the shock of any sudden force applied to the spine ( for example \\hen falling from

a hei g ht o n the feet) . The \\hole spi n e is st rap ped tog e th e r by ligaments reaching its entire length .

THE RIBS AND BREAST-BONE.

The Ribs consist of twelve pairs of curved bone s . e xtending from the dorsal vertebrce to the front of th e b ody, and are known by numbers-first, second, etc., commencing from above. The ribs are not bony t hr o ughout their entire length, but at a short distance f rom the front the bony material ends, and cartilage takes its place . The upper se\"en pairs, named (he true ribs, are attached by their cartllages to the Breast-bone (sternum), a dagger-shaped bone with the point downwards, just m'er the pit of the st omach . The lower five pairs are termed tIle false ribs, as their cartilages fall short of the middle line. The eleventh and twelfth pairs are termed the floatmg r ibs, as their ends are free in front. TIle ribs enclose the chest, and serve to protect the lungs, heart, liver, stomach, spleen, etc.

THE UPPER LIMBS.

The Shoulder - bones are the Collar-bon e (clavzde) and the Shoulder-blade (scapula).

The Collar-bone can be felt on either side ben eath the skin at the lower and front part of the neck as a narrow cun'ed rod about the thickness of a fin ger. I ts inn er end r ests on the upper part of th e

" ..00

{ "C'1.NA OP"

RAuIUS --ttl-\

FIG. 3A.

BONES OF THE LEFT UP PEP. LnIB .

FTr.. 3B.

SH()\\,!:\G THE POSITIO!" OF THE RADIUS AND ULN4. \\"HE); THE ;rr!U:-rB

TUR:\ED Il\;\\"ARDS.

Compare Fig. 3A, in which the thumb is turned out-

P ART OF COLLAR BONE

SHOULOF:R BLAOE (SCAPULA)

BONE

(HU"E RUS)

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

The Shoulder-blade lies at the upper and outer part of the back of the chest, and forms joints with the collar-bone and the bone of the arm. '

The bone of the Arm (lzu?JIerus) r eac hes from the shoulder to the elbow.

In the Forearm are two bones, the Radius on the outer, or thumb side, and the Ulna on the inner or littl e finger side. Both bones reach from the elbow to the wrist, and they change their relative positi on with every turn of the band (Figs. 3A and 3 B).

The Hand is composed of-

I.-The bones of the wrist, or ra?p"S, eight in numb er, arranaed in two 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 t\\' O in the thumb.

TH E PELVIS A TD Lo\\ ER LIMBS.

Th e Pelvis.-The large basin-llke mass of bone attached to the lower part of the spme is composed of the two haunch-bones and the sac rum . The haunch bones meet in front (at the pubes) in the middle line, only a small piece of cartilage intervening, but behmd, the sacrum is placed between them. The' pelvis

1)0:--1.'-; OF TIrE RfCHT LO\\'ER LI!,:B, "HOW, I "r, JOI."!' \\'!'III TilE PEl.\"!S \[' TilE IlI I',

FIG, 4.

P ELVI S, " , Tlllt,1I BOSE: (FE:MU R).

KNPE CAl (P ATE LLA)

.., I\I<(lOCII 130SE (FIBUL A). , - SillS BOKE (T IBIA),

" TARSUS, ..•..

supports the abdomen and its contents, and provides the deep sockets for the thigh-bones-the hip joints.

_ The Thigh-bone (femur) reaches from the hip to the knee joint. Its shaft is stout, rounded, and arched forwards; the upper end presents a rounded supported on a neck \\ hich projects il1\\ ards, to fit mto the socket of the hip joint .

. Knee-cap (patella) is a triangular bone l) ing :"'lth base up" ards in front of the knee joint lmmedlately beneath the skin.

The bones of the Leg are the Shin-bone (tibia) and the Brooch-bone (fibula). The Shin-bone extends from the knee to the ankle, in both of" hich it plays an important part; its sharp edge, shzn, can be felt im mediately beneath the skin of the front of the Jeg. 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 forms the outer boundary of the ankle joint.

The Foot is composed of--

1.-The tarslts, a group of se\ en Jrregular bones at the ll1step. The largest is the heel-bone, and the uppermost (the ankle-bone) forms the lower part of the ankle joint.

2.-The metatarsl(s, the five long bones in front of the tarsus \\ h ich support the toes.

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

3 1 JOINTS.

A Joint is formed at the junction of two or more bones. In moveable joints such as the hip, knee, elbow, etc., the surfaces of the bones are covered by cartilage, which lessens friction and the shock of FTC. 6.

LEFT ANKLE.

FI C·5· Compare Fig. 4, Page 29· fall. Lubncatmg the joint is a clear, rather sticky fluid, the " joint oil," or S),II07.'/a, enclosed within a capsule. Tying the bones to;ether, but allowing of movement, are a number of bands or fio ·aments. To explain the formation 'Jf limb joints, the

FIG. 7.

32 following 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 from 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 below. (Fig. 6).

THE MUSCLES.

The Muscles of the body are classified into two groups - volunta ry and t'nvoluntary.

33

The Voluntary muscles are met \\ith in the limbs the head and n ec k, and the surface of the trunk: Their e nds are atta·ched to different bones, and as they pass from one to another they cross a joint, and, being endowed \\ ith the power of contrac tion anu relaxatlOn, cause the morements of the body. .t\..s a muscle cro ses a joint, it as a rule becomes a fibrous cord or tendon. Blooel-\'essels trayerse and supply the muscles, and the nenes entering them bring them under the direct control of the brain and spinal cord.

The Involuntary muscles are met with in the \\alls of the stomach and lI1testines, in the air passages, and in most of the internal organs and blood-YE els, also, in a special form, in the heart. The\' are not under the influence of the will, but continue their \\ork during the hours of sleep' their functions are regulated by a separate set of nerves (see ympathetic ystem, page I 18).

FR \CTURE AND THEIR TREATMENT.

"h en a bone breaks a Fracture is said to occur.

CAU ES OF FRACTURE.

I. Direct Violence. -"\Vhen from a severe blow, impact of a bullet, crush of a wheel, etc., a bone breaks at the where the force is appJied the fracture i termed direct. c

2. Indirect Violence. -W h en the bone breaks at some di3tance from the spot where the force is applied the fracture is termed indirect. Alighting on the feet and fracturing the thigh-bone o r the bones of the leg, or falling on the hand and breaking the radius or the collar-bone, are examples.

3. Muscular Action.-The knee-cap and the urn-bone are occasionally broken by a violent CODtraction of the muscles attached to them.

VARIETIES OF FRACTURES.

Fractures are classified according to the condition of the tissues adjacent to the bone as follows :-

I. Simple. - The bone is broken with but slight injury to the surroundin g parts.

2. Compound.-The bone is broken and the skin ..nd tissues are punctured or torn, thus allowing disease-producing germs to obtain entrance to the seat of fr a cture. The fractured ends may protrude through the skin, or (for example, 'wh e n a b one is broken by a bull e t) the wound may lead down to the fracture .

3. Complicated. - Th e bon e is b ro ke n and in addition there is an injur y t o so me int e rnal orga n ( for example, the brain, sp ina l c or d , lung , e tc .) or t o som e important blo od -vesse l or ne rve .

A fracture may be com p o und or c om p licat ed as the immediate res ult of th e inj ury j o r a frac ture ,

ori gi na lly simp le , may be co n ve r ted in to a co m pound or c o mp lica ted fractu re-

( a ) By careless m O\'ellle llt on the pa rt of the pa t ient.

(b) By careless n ess o r 19 n ora n ce o n the pa r t o f o ne re n dering first aid.

pecial varietIes offractures may be clas lfied acco rding to the injury to the hone it elf as follo\\s :-

I. Comminuted. - The bone is broken in to se\'eral pieces.

2. Green-stick. - I n children, o\\'ing to the softe r stlte of the bon)' ti sues, a bone may bend and c rack \\ithllllt breaki ng completely across .

3. Impacted. - Thl: hroken ends of the bone a re elm'e n one lllto the otber.

'[G:\'s A,\D :'nfPTO\l'3 \\HICH \L-\Y BE PRI , !:.:". L

(A fracture of the fem ur, humeru , or both bones of the forearm or leg, affords the rna t com plete e\ampk).

I. Pain at or near the. eat of fracture.

2. Loss of Power in the limb.

3· Swelling about the seat of frac ture. Swelling freiluently renders it difficult to r;erceiYe oth er ians of fracture, and care must therefore be taken to mistake a fracture for a less erious injun.

4. Deformity of the Illnb . - T he lllu b a SS tl ll1f;: S a r:

unnatural position and is mis-shapen at the eat of fracture. The contracting 111 uscles may cause the broken ends of the bone to override, thereby producing shorte ning.

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

6. Unnatural Mobility. -l\Iovement may be made o u t at the seat of fracture.

7. Crepitus, or bony grating, may be felt or heard whe n the broken ends move one upon the other.

Tlze las t two signs SILOlIld 0711)' be sougilt a doctor . eve ral of the above signs are absent in green-stick a n d impacted fractures.

I n addition to the signs and symptoms the patient or the bystanders may be able to give the hi tory of the i n jury, and marks on the clothing or skin should be n oted, as they may sen'e to locate the fra tUrf'. The sna p of the bone may have been heard or felt.

ApPARATUS FOR OF

Spli n ts a n d ba n dages for First Aid frequently ha\"c t o be imp r ovised .

A Splint may be improvised from a walkillg stick, umbrella, b ill iar d cue, broom or brush handle, policeman ' s trun cheo n , rifle, folded coat, piece of \,"ood, cardboard, paper fi r mly folded, a rolled-up map, or, in fact, anytlzing that z's firm alld 10l/g enOl/gil to keep , 37

t he joiJlts £mmediately above alld below the fractured bom at rest. , Yhen the above appliances are r: ot available, the upper limb, if fractured, may be to the trunk, and in all cases a fractured lower limb should be bandaged to its fello\\'. .

Bandages may be imprcn'ised from 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 .lmen or .calico about forty inches square dIagonally II1to two pieces ..

The broad banda g e is made by bnnglng pOint down to the base (Fig . 9), and then foldlllg mto two (Fig. 10). .

The na rrow banda g e is made by foldmg the broad bandage once (Fig. I I). . .

T he m edium banda g e is made by brmgmg the point down to the base and then into three. (Fig. 12). This bandage may be used I11stead of .the broad or the narro\\' bandage \\ hen it is better SUIted to the proportions of the patient. .

IL is sometimes adnsable to halve the sIze of the bandage by bringing the t \\ a ends before folding it into the broad, narrow, or medlUm bandage. When not in use, the triangu hr bandage should be folded narro\\,' the t\\ 0 ends should be turned to the centre and the bandage then folded into four, reducin rr it to a packet inches by inches. b M

FIG. 9. BANDAGE ONCE FOL nh))

FIG. 10 BROAD BANDAGE. ,

12. -'1 HE DOl"! El:) LINES SHOW I'll E FOLDS OF TilE L \1 BANDAGE.

3)

Large arm-sling (FIg. 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 front of the che. t; carry the point behind the cH)o\., of the injured limb, and bend the forearm

FIG. 13. FIG. 14.

over the middle of the bandage; then carry the econd end up to the first and lie them; bring the point fon\ ard, and secure \\ ilh t\\ 0 pins to the front of the bandage.

S mall arm-sli ng (Fig. q).-Place one end of a

FIG.

40 broad bandage over the sh o ulder on the sound side, pass it r ound the n eck so that it app ears over th e should e r of the injured sid e ; pl ac e th e forearm over the middle of the band age ; th e n bring th e second end up to the first, and ti e th e m . Thi s sli,ng is used in cases of fr ac tur e d hum e rus, and occa sIO n a lly wh e n the la rge slin g wo uld b e too c onspicu o u s . Slings may be impr ov ise d in many simpl e way s, s uc h

F I G. IS . -REE F KN OT . FIG , 16.-GR A NNY KNOT.

as pinn ing th e sleeve to t h e turning u p the tail of th e coa t , p assing the h and ll1 sIde the b u ttoned coat or wais tc oat, etc .

R eef K nots (F ig. I S) are to b e u sed . Avoid granny knot s (Fi g . ] 6).

4 1 G ENE R AL R ULES TO BE OBSERVED IN TH E TREATMENT OF FRACTURES.

The object of First Aid or Fractures is to guard against further mIschIef, especially to prevent, a simple fro,m becommg compound or complIcated. To attam thIS end :-

I, Attend to the fracture on the spot. No matter how crO\\ ded the thoroughfare, or how sh ort the distance to a more convenient or comfo r tab le place, no attempt must be made to mO,ve the patIe n t until the limb has been rendered as Immovable as possible by splints or other restraining appa ra t us.

2 , Steady and support the injured limb at once, so that its further movement on the pa r t of either the patient or the bystander is prevented.

3· Straighten the limb with great care , a nd if shortel1lng is ob en'ed in the case of a fracture of a bone of the lo\\er limb, pull upon the foot un til the limb regains a more normal length. ,\Vhe n the shape of the limb is improved, on no account le t go until it is secured in positio n by splints, ot her wise there is great danger of the fracture becoming com o p ou nd or complicated.

4· Apply splints (when practicable) and bandages as follo\\'s :-

(0) The splints must be fir m, and long enough to keep the joi n ts im mediately above a n d

b,=low the fractured bone at rest They should, if pra cti able, be padded to fit accurately to the limb and be applJed over the clothing.

(b) The bandages must be applied firmly, but not so tightly as to constrict the circulation of blood in the lim b. \Vhen the patient is in the recumbent position double the bandage over a splint to pass it under the trunk or lower limb. As a general rule: -

For the trunk the broad bandage should be used. Pass it once round the trunk and fasten It by tying the ends, or with two or three safety pins on the side opposite to the fract ure, but if to secure a splint for a broken thigh, over the splint.

For the arm or .forwrm the narrow bandage should be used. Pass it twice round the limb, and tie the ends over the outer splint.

For the thigh or leg the narrow or medium bandage may be used. It is frequently convenient to double the banda ge at the centre, pass it under the limb, bnng the loop over the limb, pass both ends o f th e bandage through it in opposite duections, and tie them over the outer splint (Fig. 17 )· in applying bandages near a fracture the upper one be £ecured first.

43

5· .Wh en accompanies a fr a ct u re It must be attended to first, and the \Voun e.! covered by a clean dressing .

G. 1-0 attempt must: be made to remove a patient suffering from a fracture of the pelvis, or thigh, except in a recumbent p031tlOn, prderLlbly UpO!l :l. ...,tretcher.

7· In case of fracture it is necessary to cover the patient to keep him warm, LLncl SU les . en the effects of the SHOCK of the accident.

8. In all doubtful cases, tre:l.t :l.S a fracture.

'I'ECL\L FR \C ITRF .

Fracture of the Cranium. -. \ fracture of the upper pLnt IS usu:l.lly cau. eel by direct violence - fo:example, a blo\\" on the head. "..\ fracture of the ba e IS caused by indirect yiolenc e, throu gh a f:l.ll on the

44

head, a fall on the feet or lower part of tbe spine, or a severe blo\\' on the lower jaw. If tile 11/,/0 part is jradllred, the signs are s\\ elling, and frequently insensibility, either im medIate .or coming on gradually. If tile base t's fradllred 111senslbillty ma) come on

YIG. inlmediately, blood or a clear fluid may issue fr0111 the ear channel, blood may escape from the nose, or it may pass do\\ n to the stomacb, whence it may be vomited; the fracture may involve the orbit, causing a blood-shot eye.

TREATl\lE:\T.

Injury to the brain is the great danger attending a fracture of the cranium. For treatment see "Concussion and Compression of the Brain," pages 13 1 , T3 2 .

Fracture of the Lower Jaw .-Pain, of power (inability to speak and to move the ja\\ freely), irregularity of the teeth, crepitus and bleeding fram the gum are the usual signs and symptoms.

4)

TREAT:\lE:-.1T.

1. - Place the palm of the hand below the injured bone and press it gently against the upper jaw. z.-Apply the centre of a narro\\' handage under the chin, carry one end over the head, cra s the ends at the angle of the jaw, carry the long end across the chin, and tie the ends on the ide (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 uneven surface is an exam pIe of direct fracture, and a fall on the head, causing a broken neck, is an e'{ample of indirect violence. \Vhat is (ommul11y regarded as a broken hack consists of a fr,lcturc of one G)f more of the yertebrc:e mth dis placement of the fragments, wherehy the spinal cord and the nerves issuing from it may he torn, causmg cumplete or partial parLd) sis of the parts belo\\' the fracture. Pain IS pre ent at the seat of injury.

TREAT'!F 'T.

I.-Pre\-ent all 11l()yement on the part of the patient.

2.- oyer the patlent warmly.

3. -To remove the patIent, place him on a stretcher or shutter as follows: -

(a) Turn up the colb.r of his coat: roll up a . stick or umbrelb in each side of the coat

so that the ends are level with the top. of his head; pass a broad bandaae or hamlkerchief under the head and it tll the sticks. If no coat is worn, or doubt as to its strength and length exists, pa -" a of bandages under the patient to serve lI1-,tead of, or in addition to, the coat.

(b) A be;Her on each side grasps the H,lled coat with his .hands well a third the clothll1g on both Sides on a le\'cl "ith the hips; a fourth bearer takes harge of the legs .

(c) On the \\'ord being given, all lift torrethcr and carry the patient by short Side bpaces over the stretcher and carefully lo\\'er him on to it. If a fifth bearer is <iyadable the should be passed under the patient I11stead of carrying him over it.

4 . - 0n arrival at shelter nothing further is to be attempted tHe arrival of a doctor, except to gl've the pa.tlent water, tea, etc., if he is consclou . Fr.actured Ribs. -The ribs usually fractured are the Sixth, seventh, eighth, and ninth, and generLllly the fracture is mid "vay bet\\ een the breast-bone and the spine. The fracture may be caused by indirect violence, driving the fractured ends of the hone outwards, or by direct Ylolence, driving the fractured e n ds of the bone inwards and sometimes injuring the 47

lungs or other internal organ. If the lower nbs or. the ri6ht side are broken, the liver may be injured and a of the lower left ribs may wou n d the spleen. EVIdence of the fracture is afforded by pain . especially on attemptll1g to take a deep breath, a n d by short and shallow breathing. If the lungs are injured blood, frothy anJ bright red, may be coughed up and torated. If the liver or spleen is wounded internal hcemorrhage (see page 95) may occur.

TR EA

. (a) JJ?zen the/raclun 1S not mmphcated bl' an z'njllry to all organ :I.-Apply two broad bandages round the chest . ufficiently firmly to

FIG. 19. comfort, \\ ith the centre of the first Immediately above and that of the second immediately below the fracture. The lower bandage should overlap the upper to half Its

48

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

2.-Place the arm on the injured side 111 a large sling. (Fig. 19)·

(b) TT'hen all z"nterlla! organ l'S z"lljured-

I.-Do not apply bandages round the chest.

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

3.-Loosen the clothing, give i e to suck, and place an ice bag oyer the seat of injury. Treat as for internal hremorrhage (see page 95) .

4 .-Place the ann on the injured side in a large sling.

Fracture of the Breast-bo ne (sltr)/um).-

\Vhen this fracture can be felt or IS suspected undo all tight clothin g, and keep the patient quiet in an easy position until the arrival of a doctor.

FRACTURE OF THE OF THE UPPER LIMB.

Fracture of the Co ll ar-bon e (clavicle }.-This fracture is frequently caused by a fall on the hand or shoulder.-The arm on the injured side is partially

49

helpless, and the patient usually supports it at the elbow \\ ith his hand, and inclines his head towards the injured side. The fractured ends can generally be felt to overlap, the outer fragment being the lo\\·er.

The general sIgns and symptoms of fracture are mostl) pre ent.

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

2. - Place a pad about t\\ 0 inches thick and four mche'S 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. John J) ling, made as fo 110\\"s :-

(£1) La) an unfolded bandage acro s the che t oyer the injured limb \\ ith one end on the uninjured shoulder and the point beyond the elbow on the injured side. (Fig. 20).

(b) Pass the 10\\ er end of the bandaae under the injured limb, across the back,oand tie the ends some\\ hat loosely in the hollo\\' in front of the sound shoulder.

(c) Fold the point oYer the elbo\\ of th e injured lim b and secure it by one or t\\·o pins (FIgs. 2 I and 22).

2

(Body handage om Itted to shr)\\ nl"tails of S ling.)

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

5· - No\\ tighten the ling . \rhLn both collar - bones are broken keep the

:> t1Oulders back by narro\\' bandages tied round each arm, close to the shoulder, passed across the back, oyer the opposite arm and tied together in front. The forearms shoulu be raised and supporteu by the bandages (FIgs. 23A and 23 B ).

Fracture of the Shoulder-blade (scapula).Apply the centre of a broad bandage in the armpit of

FIG.

1.

he. 23 A.

FIG. 23 B.

the injured side, cross the ends m'er the unin jured shoulder and tie them u n der the armpit. S uppor t the limb in a St. John sling ( F ig.

Fracture of the Arm

(hztmerus).- The bone may be broken :-(a) Close up to the shoulder; (b) near the FIG. 24. middle of the shaft; (c) close to the elbow.

All the general signs and symptoms of fracture are u sually present.

TREATMENT .

lVhen the Fracture is close to tlze Sho1l1der-

I.-Apply a broad bandage with its centre above the middle of the arm round the limb and body, tying it on the opposite side.

2.-Support the forearm by a small arm sling When the Fracture is mar the lI11ddle of the Shaft-

I.-Bend the forearm at a right 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 and back ellso. The front splint

53

must on no account be so long as to press upon the blood-vessels at the elbow joint.

3.- ccure the splll1ts by bandages above and below the fracture. If splints are not available, secure the arm to the side by two broad bandages.

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

Fractures invo l ving the elbow joint, whether of the arm or forearm, are attended \\ ith so much swelling, and it is so difficult to ascertain the exact nature of the injury, that \\ hen the aCC1dent occurs indoors the limb should be laid upon a pillo\\' 10 F1G. 25. the most comfortable position; ice or cold water dressings sho uld be applied to the injured part, but no further treatment should be attempted pending the arrival of a doctor

TVlten the ace/dent occurs out of doo r s-

1. - T ake two pieces of thin flat wood, one 10nO" enough to reach from the arm pit to below the elbow, the oth e r long enough to reach from above the elbow to the finger tips; tie them tog e ther to form a right angle. . 26).

2. - .\pply th e anFIG 26 . gula.r splint so made on the inner side of the flex c c1Iimh.

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

4.-Support the limb by a large arm sling.

5.-0n arrival a t hOll.e remoye the splint, :ll1d treat the injury as if it had occurred indoors.

Fracture of the Forearm. - ,Vhen b et h hon es (th e Radius and VIna) are broken, the generaJ and symptoms of fracture are usually present. ,Yh e n one of the bones only is broken the signs and symptoms are as a rule pain, loss of pO\\'er, a nd irregularity. An impacted fracture of the Radius

just above the \\'fist is a common result of a fall on the hand . This is the same, \\ hether the fracture is o f one b one or of both.

I .-Bend the forearm at right angles to the arm,

FIG . 27. FIG. 28.

k eeping the thumb up\\ards, and the palm of the hand towards the body.

·2. - Apply broad splints on the inner and outer sI des from the elbow to the fingers.

3·-A pply bandages, em bracing both splmt., im'll cciiately aboye and belo\\' the fracture and round t he hand (Fig. 27).

4 · •\ pply a large arm-sling . Crushed hand (fracture of the bones of t he l.1rpUS, metacarpus, or fingers).

TREATMJ<JNT.

1. Apply a carefully padded plint to the front of the hand, rea hing from well aboye the wrist to b e) ond the tips of the fingers .

2.-To secure the splint apply a narro\\' bandage crossed in the manner of the figure 8 to the wrist and hand (Fig. 28).

3.-Apply a large arm-sling.

Fracture of the Pelvis. - \Vhen, after a severe injury in the neighbourhood of the there is no sign of damage to the lower lImbs, but the patient is unable to stand or e,'en to the lower limbs without great difficulty and pam, a fracture of the pelvis may be assumed to have occurred. TIYe blood-vessels and organs, especially the bladder, the pelvis are in danger of being \\ ounded.

TREADIENT.

I.-Lay the patient in \\'hateyer position is found to give .the greatest ease, and flex or straighten the lower limbs as the patient desires.

2.-Apply a broad bandage round the hips tight enough to support the parts, not so tight as to press the broken bone further l11\\·ards.

3.-To remove the patient place him on stretcher, acting on the same principle as that deSCrIbed under " Fracture of the Spine II (see page ..J.5).

FRACTURE OF THE BONES OF THE LOWER LIMB.

Fracture of the Thigh-bone (femur).- TI:e thigh bone may be broken at its neck, anywhere Il1 the shaft, or close to the knee. A fracture at the

neck IS likely to occur in old people from very slight injury, and is often difficult to distinguish from a severe bruise of the hip, but it may be assumed that when, after an injury near the hip joint, the patient cannot, when lying on the back, raise the heel from the ground, the bone is broken. All the genend sIgn and symptoms of fracture are usually present, and a prominent sign is the position of the foot,

29.

" 'hich, as a rule lies on its outer side. may , 'ary from one-half to three inches . horten im;

I. - Steady the limb by bolding tIle ankle f?ot.

2. - Gentlv draw down the foot and bring It 1l1to line with its 'fello\\,. " ' hen two or three assistants arc at llanc1, it is one person's duty to hold the foot in position until the are secured.

3·-A pply a splint on the outer side from the armpi t to beyond the foot.

FIG.

4 -Apply a splint on the inner side from the top of the thigh (the fork) to the knee. . -S the splints by bandages as follows .( )5R' chest J'ust below the armpits, (b) round a oun h' . , t (\ bove the pelvis on a level \\"ith the Ip Jom s, c, a

FIG. 30.

the fracture, (d) below the fracture, (e) the leg, (f) round both ankles and feet, and tIed bel?w the feet ( 0-) a broad bandage round both knees (FIg. 29)· , 0 \Vh en single-handed, or wher: the patient is a woman, it is. expE?dlen.t, after extension cf the lImb, to tIe the feet together, dispense with the inner splint and pass the bandages round both\mbs (Fig. 30).

Fracture of the Knee-cap

(patella).-The knee-cap may be broken by fallin a on ll;e knee

FIG. 3r. (direct but more . :requently it is broken by muscular actIon, as follo\\s.-

59

\Vhen the fo ot slips 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. 3 I).

Pain, loss of pJwer (the limb will be quite helpless ) , and irregularity (a gap may be felt between the broken fr::tgments of bone) accompany this injury.

TREATl\fENT.

I.-L:ty the patient on his back, raise well and support the head and shoulders, straighten and raise the limb.

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

3·- Apply a narrow bandage with its centre imme-

diately above the ross the c.nds behind over the splint, tie in front below the broken bone. To ensure firmness apply a second bandage in a similar way, but commenced bela\\' and tied above the broken bone.

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

5.- Support the foot well off the ground by a pillow, roll of clothing, etc., or if none of these are at hand by resting it on it fello\\' (Fig. 3 2 )-

6.-Apply an ice bag or a cold \\ ater urcs ing oyer the fracture.

Fracture of the Leg (tib/a and ji/lllla).-One or both of the bones may be broken. \Vhen hoth 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 lo\\er end IS frequently mIstaken for a sprain and sometimes for a dislocation of the ankle.

TREATMENT.

1.- teady the limb by holding the ankle and foot.

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

3.-Apply splints on the outer and inner sides of the leg, reachinlS from above the knee to beyond the

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

4 · - 'ecure the splints by bandages (a) above, (b) below the fracture, (c) immediately above the knee,

34.

(d) round both ankles, (e) a broad bandage round both knees (Fig. 33).

\Vhen single-handed, or when the patient is a

FIG.

woman, after extending the limb tie both feet together, dispense with the inner .s plint, and pass the round both limbs (FIg. 34 ). \ Vhen no splmt IS available tying the legs, ankles: and knees together IS of great service.

Crushed Foot (fracture o f the tarsus, metatarsus and toes) . - This accident IS commonly caused by the passage of a hea.vy \\ O\'er tl1e fcot, and may be recognised by pam s\\"ellmg, and luss of PO\\ er.

I.-RemO\·c the boot (see page 19).

2.-.\pply a \\ cllpadded spl111t to the sole of the foot, naching from the heel to tl-:c tuts.

3.-Apply a bandage after the manner

FIG. 35· o f the figure 8 (Fig. 35)'

4.-Support the foot 111 a slIghtly raIsed positIOn.

D1 ·LUC.\.TIO

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

The joints most frequently dislocated are those o f the shoulder, elbow, thumb, fingers, and lower jaw.

63 AND OF iJISLOCATlON.

1 .- Pain of a severe sickening character at or near the joint.

2.- Loss of power in the limb.

3. -Numbness of the parts below the seat o f dIslocation.

4.- Swelling about and below the joint.

5.- Fixity of the joint.-The limb cannot be moved at the jOll1t by eIther the p ltient or others.

6.- Deformity of the 11mb. The limb an unnatural position, and IS mls-shapen at the JOll1t.

TR EA

No attempt should bE' made by anyone except a doctor to red uce a dislocation. Pending his arrival ;.-

(a) TVIleJZ the accident oCClIrs out of . . Support the limb in whate\'er POSItIon gl\'es most ease to the patient, bearing in mind the necessity of lessening the effects of jolting during transport.

(b) IT'lzeJl tile patient z's z'Jldoors- .

I. - Removc the clothll1g from the limb.

2. - Pla.ce the pal1ent a cOllch or bed.

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

4·-Apply cold (ice or cold water) dressings to the j01l1t.

5·-\Vhen cold ceases to giye comfort apply

warmth (flannels or towels wrung out of hot "vater).

6.-Treat shock (see page J 35)·

SPRAINS.

When, by a sudden wrench or twist, the ligamenrs and the parls around a joint are stretched and torn the joint is said to be sprained. "Going over 1/ the ankle is a common example.

lG(I;S AND SV:'I[PTO:'l[S.

I.-Pain at the joint after a twist or wrench.

2.-Inability to use the joint.

3.-S\\'elling and discoloration.

OF SPRAI ED A TKLE.

TT7zen out of doors-

I.-Apply a bandage tightly oyer the boot, beginning on the sole at 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.-\Vet the bandage after applicaton; it is thereby tightened.

After l'eadzz'ng sltelter-

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

2.-Place the limb in the most comfortable position; usually that is we11 raised.

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

4.- When cold falls 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.

TRAINS AND RUPTURED MU CLES.

"When, during severe exertion, muscles or tendons are over-stretched they are said to be strained, if they are actually torn they are described as ruptured.

SIG(I;S AND SV:\fPTmrs.

I.-A sudden sharp pain.

2.-\Vhen the muscles of a limb are strained they may swell and cau e severe cram p.

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.

TREATMENT.

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

2.-Apply hot water bottles 01 hot fomentations when the pain is very severe.

A so-called strain in the groin (hernia) is an injury of a totally different nature (see page J I4).

D

Q"lJE TIONS ON CHAPTER II.

The 1lltlll era ls indicate tlu pages 7.ulzere Ilu al/ swers I/Iay be lOllI/d.

\\'h at i the skel eton, and \\ hat purposc are sc n red by it?

TI ow are the bones o f the skull arranged?

\\' hat are the boundaries of the cranium?

Describe the bone . uf the face

D escrihe the lo\\'e r jail'

\\'ha t i the angle uf the ja\\'?

\\'hat othe r name . has the back·bone ?

What is a yc rtebra ?,'

1l ow many yertebrze are therc in the spine?

What are the regions of the spine, and how many yeneb rze are there in eac h ? ..

1l o w is the end()\1 eel \\ ith free 111 0YCment?

What is a rib?

H ow many pairs of ri bs are thcIe?

What is the breasl·oune? ..

\\'hat are the bones o f the upper limhs? ..

\ \'hat is the pelyi:- ? .. '

\\'hat is the hip joint?

\\'hat are the bones of the lOll er lind);,? .,

Wh at is a joint?

D esc rib e a 111 0ycalJle joint, ..

De sc rib e the sh oulde r joint

D esc ribe the ankle joint

How are muscles clas"ified ?

Describ e voluntary mu . cles

De sc ribe iIwoluntary muscks

\"hat is a frac ture? ..

\"ha t are the causes of fractur e?

22

\Vhere does a bone break when (lirect violence the

cau. e of fracture?

\\'here a bonl> b reak wh en iI;('lirect' is the

cause o f fracture? ... .. ... ...

Ilow maya fracture be caused hy action?

In II hat two ways may fractures he cla '. ified? ...

What is a simple fra cture ?... . ..

\"hat i, a compound fracture?

\\ hat is a complicated fracture?

\\'hat i a com minu ted fracture?

What is a green·stick fractlIle?

State the g:neral igns and symptoms that may be • present In a_case of fracture .. ... .. J), 36

\\ hat. fra ctures affurd the most cumplete example of the SIgn and, ymptum,,? .. , . . ... ..

In making up your mind \\ hether a fracture had occurred or nnt, what points should you take into considera· tion beyond the signs and symptoms? ...

apparatu' may be neces 'a ry for the

impnll'isecl?

oe improvised?

De ... cribe Esmarch's tri.angular bandage... 37,3 (Fig. 8)

In II hat ways the t nang\llar bandage he folded for use? 37

lIow many kmds of arm-slIngs arc there, antI what are

they

40, 49

\\ hat knot IS to be tied, and what knot a\'o ided? ... 40

What is the object of first aid treatment of fractures? 4T C;il'e the general rule , for the treatment of fractures ..p

IIm\ should splints be applied? ... .. ..p, 42

I Tow should bandages be applied? 4 2 , 43

\\'hat may cause a fractnre of the upper part of the cranium? 43 C

What may cause a fracture of the base of the cranium? 43, 44

What are the signs of fracture of the upper part of the cranium? ...

What are the signs of fracture of the base o f the cranium? ...

What is the treatment for fracture of the cranium?

What are the signs of frac t ure of the lowe r ja\', ?

How maya fractured spine be caused? .

What is c om mo nly regarded as a broken ?ack? .. .

What are the symptoms of a fractu r ed _p1Oe? .. .

How may ri bs be fra ctur ed?

How maya fracture of ribs be compl.icated? .. . ...

State the signs and symptoms of a SImple and of a complicated fractur e o f ri bs .. ,

\\That is a frequent cause o f fractured colJar-bone? ..

\Vbat are the signs and symptoms of fractured collar?

48 , 49

At whJ." points may the bone o f the arm be broken? ... 52

Are the general signs and symptoms of a fracture always present in a broken forearm?

State the cause of a common fracture of the rad.ius

How would you recognise a fracture of the pelVIS?

At what points may the thigh-bone be broken? .,.

What are the signs and symptoms of fracture of the

thigh-bone?

What are the causes of frac tu re of t h e knee-cap? ... 58, 59

Wha t are the signs and symptoms of fracture of the kneecap?

Are the general s ign s and symptoms always present 10 a fractur e of the leg?

What mistak e may easily be made when the fibula 18 broken near its loyver end?

What is a dislocation?

the

Aid tudents should practise impw\ ising material, folding bandages, tying knots, making slings, and the treatment of the following injuries.

Fractures -Lo wer jaw, 44. 45, 46. Ribs (sill1ple ami complicated fractures), 46to 48. Breastbone, 48. Collar-bone, 48 to 5I. Both collarbones, 5I. Arm, close up to shoulder, 52. Arm, near middle of shaft, 52. Arm or forearm when the elbow is involved, 53. Voreann, 55. Crushed hand, 55, 56. Pelvis, 56. Thigh (man), 57, 58. Thigh (woman, or man when single-handed), 58. Kneecap, 59, 60. Leg (man), 60, 6I. Leg (woman, o r man when single-handed), 62. Crushed foot, 62.

C HAPTER III.

THE ORGAN S OF CIR CULAT IO N.

TH E orga ns concern ed in the circulation of t h2 blood are the Heart , the Arteries, the Veins, and th e Capillaries.

The Heart is situated in the chest behind th e bre:tst-bone and rib cartilages, betw een the lungs a n d immediately above the diaphragm; it li es obliquely with a quarter of its bulk to the right and t he remaini ng three-quarters to the left of the middle of the body. I ts beat may be felt just below a n d to t he inner side of the left nipple. The h eart has fo ur cavities, two on either side of a central partition. T he tw o upper caviti es are named th e right and left auricles , the two lower the right and left ventricles.

Ar teries are \'ess els which COllyey blood from th e hea r t. Veins carry blood to the heart. Capillaries co n nect the art e ries and veins.

In the general (systemic ) circulation arteria l blood is driven from the left ventricle of th e heart into the aorta (the main a r tery of the body). Fro m t h e aorta b ranch arteries are gi \'en off to all parts o f the body. These divide and sub-divide, and become so small as to assume mi c ros copic dimensions, when t hey a re termed capillaries. .

. 36.

L. L a rynx (v o ice b ox ) ; T. Trach ea (wind Pl] Jl) ; R.L. Right Lung; L.L. Left Lung (the lungs are drawn back to expos e the heart and bl ood vess e ls ) ; R .A . Right Auricle; L.A. Left A uri c le; R . V. Right V e ntricle; L V Left Ventricle: P .A. Pulmonary Artery; Ao. A o rta; S . V. c. Superi o r vena cava (the large vein c a rrying bl ood from the upp e r part o f b ody t.o the heart ) ; LV. C. Inferior vena cava ( th e large vem carrymg blo od from the lo we r part of the b ody to the heart ). T he fou r pulmonary veins cannot be sh o wn in the diag ram.

FIG

In the capillaries an interchange of gases and flu id s tak es place, whereby the nourishment and maintenance of the tissues and organs of the body are provided for, and the blood becomes dark and impure .

Venous blood passes from the capillaries to the veins, which convey it towards the heart, getting larger and larger as they proceed by being joined by n eighbouring veins until they finally, as two large vessels, reach the right auricle of the heart. The veins, especially in the limbs, are provided with valves at fr equent intervals, which prevent the backward fl ow of the blood.

The pulmonary system of blood vessels is in carrying the blood through the lun gs . From the right auricle the blood passes to the right ventr icle, and is thence carried to the lungs, where it is purified b y contact with air, and becomes scarlet in colour; it is then conveyed to the left auricle of the heart and passe s into the left ventFicle, thus compl eting the circulation .

The heart contracts in adults at an average rate of seventy-two times a minute, but the rate varies, increasing as th e position is changed from the lying to the sitting or to the standing position; hence the importance of ad.iusting the patient's position in cases of hremorrhage. At every cont raction of the left ventricle bl ood is forced into the arteries, caus ing the pulse, which may be felt wherever the finger can be

Explanatiol1.- In the middle of the diagram is the heart with , it four chambers. A bove the 't heart is shown the lung (pulmonary) circulation. The lower part represen ts the general (systemic) cireulation. Vessels CODtaining impure (venous) blood are shown black, while those

DIAGRAM OF THE C IRCULATION OF THE BLOOD. containing pu re (arterial) b lood are shown white. The connecting \"e sels represent the capilla ries. The arrows show the direction of tht flow of blood.

FIG. 3i·

placed on an artery as it passes over a bone. In the veins no pulse is to be found .

H.£i\IORRHAGE.

Hremorrhage, or bleeding, is of three kinds:r. Arterial. 2. Venous. 3. Capillary.

ART E RI AL H IE \{ O RR HAGE.

I. - Blood from an artery is scarlet. .

2. - If the wounded artery is near the skm the blood spurts out in jets corresp onding to t h e pu lsat ion of the hear t.

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

A RRE T OF ARTI:.RIAL HJE:\[ORRHAGF: .

A rte r ial hcemorrhage is, when practicable, to be <Jupsted by p ressure, positio n of the body, and e levat iot'"' of the bleeding part.

Pressure may be :-

I. - Digital -that is, applied ,,·ith the thumh or fin'Ters a.nd may be (a) on the wound: (brat . pot calle'd the pressure point The pressure puints are indicated by dots on the frontispiece.

2. - Bya pad and bandage (tourniquet) (a) 0. the wound: (/I) on the pressure POll1t .

3.- By flexion.

To apply a pad and bandage to the wound , p lace a piece of lint or linen or a clean. chief folded into a h ard pad, on the bleedmg- POlllt. and secure it by a bandage tightly tice round t he injured part. To fold the handke rchief, bring t he four corners t o the centre, :md re) at the proces::. until a hard p.1.d is formed. The smooth surbce i'> .. " I.)

placed on th e wo u nd, and, to prevent the pad from :111 folding, t he puck red surface may be stItched or fixed by a safety pm. A hard substance, su h as a stone may be el1 10. ed in the entre of the pad.

A Tourniquet may consIst of a fad to be pbct d on the pressure point, a strap, cord, or to en( ircle the lim b pad, and a arrmlKe?nod, _ uch as a sti! k ('r other means of t\\lStll1g the t and to tighten it.

T o improvise and apply a tourniquet: -

I -Apply a firm paJ on the pre sure POll1t.

::!.- Enci rcle the limb by a narro\\ 1 andage \\ ith lIs centre over the pad.

3.-TIe the ends of the bandage in a half knot on the opposJte ')Ide to the pad.

4·-Lay the t\\ lstmg stick on the half knot, and oyer it tie a reef knot.

5·-'1'\\ 1st the st Ick to tighten the bandac;e, thereby prcs:'l11g the pDd ulon the artery, :md arre t Il1g the flo\\ of blood.

6.- Lock the in position hy the ends of the band:lgc :llready applied, or by another ba n dage p:lsc:,ed round the stick and 11mb.

The pad of tbe tournIquet must be accurately I1.lIl'd upon the pressure point so as completely to compress the artery; othen' ise arterial blood \\ III be allowed to pass along the lim b, and the vell1S, being com pressed by the tourniquet, '\ III not allow the

blood to return through them to the heart, and the result will be dangeruus swelling and congestion.

Should a suitable pad n ot be at hand, a knot may be made in the ce ntre of the bandage, and when available, a stone, cork , etc ., enclosed in it to give it firmness and bulk. ee that the bulging and n ot the flat side of the knot is next the skin.

An elastic bandage passed tightly round the limb, immediately abo\'e the seat of arterial hremorrhage, will arrest bleeding. The si m plest prepared form of this bandage is a strip of elastic webbing, twenty-five to thirty inches long and two inches wide, with a piece of tape se\\"n at each end. An elast ic belt or brace \Yill serve the same purpose. Except when part of a limb is torn off, it is not advisable to us e an elastic cord or bandage if other apparatus can be had, as it cuts off all circulatIon in the limb.

Flexion consists of the application of a pad on the pressure point at the knee or elbow joint, flexing the limb to make pressure, and securing the lIlnb In the fl exed position by a bandage crossed like the figur e 8.

RULE S FOR OF A Acco:YrPANIED BY fERL\L

1. Stop b leeding.

II. Prevent injurious germs [rom getting into the wound.

'7

To attain thes e ends :-

1. Place the patient in a suitable position, bearin g 111 mind that th e blood escapes with less force when the patient sits, and is still more checked when he lies down.

2. Elevate the bleeding part, as thereby l ess bluud finds Its \\ay into it.

3. Expose the wound, removing whatever clothlllg IS neces ary. (ee Rule 8, a.)

4. Apply digital pressure.

(a) If the wound I small on the bleeding spot.

(b) If the wound IS large on the pres ' ure POll1t next to the wound on the heart SIde. The nearest pI pomt is chosen 1Il order to avoid cutting off the circulatIOn from as much of the part as pos. Ible, but sometimes it IS nec e· ary to apply pressure still nearer to the heart.

S. Remove foreign bodies, such as broken glass ) bits of clothll1g, haIr, etc., seen ll1 the \\ound; do not search for foreign bociJcs 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 absorbent cotton wuol, lint, or gauze, or a clean piece of 1ll1en \\'Ill anS\\'Lr the purpose. houlc1 any doubt be entertamec1 as to the of tile dre sing, a clean pIece of unprinted paper, such as the inside of an

envelope, should be placed next the wound before applying the pad. (Compare pages 75 and 76 .)

7. Bandage tightly over the pad unless :-

(a) Foreign bodies are suspected to be left unseen in the wound.

(b) There is danger of causing injury to a fractur e. I n these cases a light dressing only should be applied.

8. Apply a pad and bandage or flexion o n the pressure point (see Rule 4, b ), but only i n the following cases :-

(a) As a temporary measure while the wound is being exposed , examined and covered.

(b) As a more permanent m eas ure when bleed1l1g cannot be stopped by the pad and bandage on the wound, or \\'hen, in acco rd ance \\ Ith Rul e 7, the tight bandage has not been apphed.

9. Afford support to the injured part.

'Vh en part of a limb has been torn off o r the wound is lacerat e d (for example by the claw of an animal or by machinery) hremorrhage frequently does not come on at once, but as there is a danger of seyere h remorrhage later, mea n s for its arrest should be applied to the limb, but not tightened unless nec essa ry . Do not disturb a clot of blood formed O\'er a \\ ound. No attempt should be made to cleanse a \\'ound except with sterilised water (that is previously boiled

and aIJowed to cool I, and experien ce, especia ll)' 111 I ecent wars, has shown that th ose wounds \\ hlch \\ ere pro\'l.lo n al l)' treated with a dry dressll1g and subdresed by a s urgeon \\ lth proper appliances dl(l best.

tudents practisll1g arre t of arten,lt hremorrbalTe - hould feel the pulse to see wben the current of blo;u

1I1 the artery has been '>topped, ::l11d hOllld then llnme.dlately relax the pressure made on the arten. In thiS way the importa.nce of the accurate application of prt''>ure ,,-Ill be realised, and the amount of furce l1eces ::1.1')' will be ascertained.

THI... CUUR 1-'2 OF '1'111', .\hlx 'flU: OF H .E\IORRHACE.

(The numbers of the prlS!)lIre points refer to those III the FrontispIece.)

THE L\RCE ARTERIL..., \VlJHI"N THL CHIC T ,\:\1> , ABDO\! FX.

Tl:e _-1.orta is t.he central or trunk artery of the boo). at the left yentricle It forms an beh1l1cl the upper part of the breast-bone. the arch are gIven off the large branches whIch carry the blood to eIther SIde of the head anu neck and the upper lImb ' . Th e Aorta pa se down on the . left ?f tl:e spi n e to jut below the l1a \'el, \\ here It dl\'ldes ll1to tw o rrreat branches (th ilIacs)

which conve) the blood to the organs m the pelns and to the lower limbs.

"'Wounds of these arteries are one cause of internal hremorrhage (see page 96).

ARTERIES OF THE HEAD AND NECK.

The Carot id Ar te ries (right and left) leave the upper part of the chest and pass up on either side of the windpIpe and, just below the level of the of the lower jaw, divide mto the Internal and External Carotid Arteries. The Internal Carotid Artery ascends deeply in the neck, and enters the cranium to supply the bram WIth blood. The External Carotid Artery gives off a number of branches; to the front the artery of the tongue (Lingual), the arlery to the face (Facial); to the back the OCCIpItal; the artery itself is continued upwards in front of the ear, where It changes its name to the Temporal, and supplies the scalp in the neighbourhood of the temples.

When a Carotid Artery i·s wounded , as in the case of a cut throat, apply the thumb of one h and o n the artery at pressure point I, pressmg b ackwards agai n st the backbone and taking care to avoid the wi n dpipe. It may also be necessary to apply pressure with the other thumb above the wound for two reasons: (a) To arrest' the fio\\" of blood from the main ( jugular) vein in the neck, which runs

8r

alongside of the carotid artery and is usually \\"ounded at the same time; (/7) To check the flow of blood from the upper end of the carotid artery itself, \\ hicb is often considerable owing to communication between the branches of this artery and those of its

felkw. Digital pressure must be m.aintnined, by Ielays of assistant if necessary, until the doctor arrives (Fig. 38). . .

The Facial Artery crosses the lower JaW 111 a sli o" ht hollow t\\"O fingers' breadth in front of the angle f and sends to the chin, bps, cheek, and

FIG. 38. FIG. 39.

outside of the nose. Hremorrha ge from wounds of the face below the level of the eye is to be arrested by:-

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

(b) Grasping the lips or cheek on both sides of the wound by the finger inside -and the thumb outside the mouth or 'l.'/ce ve r sa.

:<IG. 40.

FIG. 4r.

The Temporal Artery may be felt pulsating 111 front of the upp er part of the ear. Hcemorrhage from the region L>f the temple may be arrested by pressure applied at pressure point 3 (Fig. 40).

The Occipital Artery supplies branches to the

83

region of the scalp from hehllld the ear to the back o( the head. from this regIOn may be arrested by digital pressure on pressure point .4, four fingers' breadth behind the ear (FIg. 41). This pom! i. difficult to find, and it is u sually sufficient to apply pres ure immediately below the wounu. from the Forehead or anywhere in the Scalp may be arrested by applyll1g a sma II fi rill pad un the bleeding point and securing it by a narrow bandage \\ Ith lts ce l'.tre laid on the pad, the Lllds carried round the heJd 111 the dIre lion most cOl1Yenient, and tied tightly O\er the pad (FIg. 42)

Wh e n a \\ ounel of the forehead or scalp IS asso clated WIth a fra ture, th e n c . .12. be ·t plan i to apply a rIng pad around the s at of injury. To nuke a nng pad, pass one end of a narro\\" bandage round your fingers; pass the other E.nd the the rinl! thus formed and (ontll1ue to pass It thloubh and untIl the whole of the bandage IS used and a nng as sho\\ 11 in FIg. 43 i.s formed .

ARTERIES OF THE UPPER LIMBS.

The Subclavian Artery passes from a point b ehi n d the in ner end of the collar-bone across the firs t ri b to the armpit.

FIG. 43· FIG. 44.

To apply digital pressule :-

I.-Bare the neck and upper of the chest

2.-Place the patient's arm against the bod} 0 as to depress the shoulder, and cause him to incline his head to\\ ards the injured sidf'.

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 thf" collar-bone in the hollo\\' between the muscles attached to the bone (pressme point 5).

85

s·-Press the thumb deeply dO\'t'lYards and backwards against the first rib, which is beneath the collar-bone at this spot (Fig. 44).

The Axillary Artery, which is a continuation of the suhclavlan, keeps close to the shoulder joint. and can be felt pulsating when the fingers are deeply pres ed into the armpit. Digital pressure is difficultto apply to thi artery.

To apply a pad anG bandage:-

1.- Place a hard pad the Sl/e of a billiard ball 111 th armpit (prc ' sure point 6).

2.-.l\pply the centre of a narrow bandage on the pad; cross the bandage on

FIG. 45. the shoulder; pull the ends tight and tie them under the oppo ite armpit, taking care that the pad doe not slip.

3.-.l"lex the forearm and tie the limb tightly to the trunk with a broad bandage, applied on a level \\ the elbow (Fig. 45).

The Brachial Artery is a continuation of the Axillary, and runs dO\YIl the arm on thp inner sid of the biceps muscle, gradually pas ing forward until it reaches the middle of the front of the elbow. The inner seam of the coat abm'e the elbow roughly illlhcates its course.

DIgital or instrumental pressure may be applied at or near pressure point 7·

FIG. 47.

To apply digital pressure extenJ the 11mb at rigbt angles to the body, palm of the hand upwards. 'tan 1 behmJ the lImb) and pass lhe fingers under the back 87

of the arm over the seam of the coat or the greove on the insi.de of the bi eps muscle. Press the pulps (not the tIpS) on the artery (Fig. 46). orne prefer to pass the hand oyer the front of the muscle (FIg. 47). A slight turn of the hand ouh\ ards ::IS it grasps the arm ",ill better ensure compression of the artery.

The Brachial artery mar be compressed at the

49.

FIG. 4 . elbow (pressure point 8) by fl exion. The pad be a folded handkerchief with a small tone o r a cork wrapped up in it, but when no pad is a \'ailable the coat sleeve rolled or gathered up will serve instead {FIg. 48).

FIG.

88

Just below the elbow the Brachial artery dIvides into the Radial and Ulnar arteries, which run along the front of the forearm on the outer and inner sides respectively. The pre sure points (9 and 10) are about one inch above the WrJst and about half an inch from the outer and inner sides of forearm, where the arteries may be felt pulsating Branches of these arteries join to form the Palmar Arches in the hand. The arteries run along on either side of the fingers to the tip.

Pressure may be applied to the Radial and Ulnar arteries at pressure points 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 sid e of one half on the Radial, and of the other half on the Ulnar artery.

3.-Secure them by a tight band age.

To arrest hremorrhage from the palm of the hand :-

I.-Apply a firm pad, and make the patient 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 bandages fold the point over the knuckles and wrist, pass the two ends round the wrist, make the

89

patient pull on the point of the bandage, cross the ends over the fingers t\.vice and tie them as firmly as possible. Bring the point ( A) down to the knuckles and fasten with a pin at B (Fig. 50 ).

3·- Elevate the forearm and support it with a " t. John" sl ing ( ee page 49 / .

Art e rial hremorrhage fr om the fingersmaybe arrested by applYIn g a small pad o n th e " ound, and securing it firmly "lth a strip of ta pe, linen or plaster.

ART E RIES OF THE LO\\ ER LIMBS.

The Femoral Artery, a contin ua ti on of the iliac, FIG. 50. e nt e rs the thigh in the ce ntre of the fold of the groin, where it may be felt pulsating immediately below the skin. The course of the artery may be indicated by a line dra\\ n fr om the centre of the groin to the inner SIde of the back part of the knee. After traversing two-thirds of this line, the femoral artery passes behind the thigh bone to the back of the knee jo int as the Popliteal artery.

Digital pressure may be applied to the Femoral artery at the groin (pressur 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 \.U the thigh; the fold in the clothing at the top of the thigh will indicate the groin

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

5.-Press firmly against the brim of the pelvIs

As there is 1I1\11ledlate danger of death it IS Important not to waste tIme in removing the trousers.

'When the Femoral artery is wounded in the upper third of its course, pressure must be maintained at the grnin. No really satisfactory tourni que t has reen

FIG. 51 devised for at this point, :!nd relays of assistants be employed to keep up the pressure until the doctor arrives; each fresh assistant places his thumbs over thos e of his predecessor, who slips his away from beneath, and thus gushes of blood are during the change.

Application of a tourniquet to the Femoral artery (pre. ure point 12) :When practising compr essio n of this artery, it is a

FIG. $2

g ood p la n to dra w a c halk line fr om the cent re of the groin to th e in ner side of t h e back of the k nee ; place the pa d of t h e tournique t o n this line as high up as the ba ndage can be applied. The pad shou ld be the size of a lawn tennis ball ( Fig . 52) . Pressure may be applied to the Popliteal ar tery by flexion at the knee (pressure point 13); the pad should

FIG. 53.

be the size of a lawn tennis ball, or if no pad is available the trouser leg may be rolled or gathered up to serve instead . It is not necessary to take off the clothing (Fig. 53) .

Just below and behind the knee joint the artery divides into the Anterior (front) and Posten or (back) Tl bial arteries.

The Posterior Tibial Artery passes down th e 93

b a ck of th e leg t o the in n er side of th e ankle. I t is a t fir st deep ly placed be twee n th e ?1us c1es of t h e calf, bu t it app roac h es the sur fa ce a s lt p r oceeds, so t hat it ca n be felt pul satin g b ehind th e large bone a t the inne r side of the a nkl e. I t ent e rs th e sole as the Plantar Arteries, wh ich run forward amongst the muscles to supply the foot a n d toes.

The Anterior Tibial Artery, on leaving the Popliteal, at once passe fon\ ard bet" eEn the leg bones, and, deeply placed amongst the muscles, runs down the leg to the centre of the front of the ankle. This artery is continued as the Dorsal Artery of the Foot, which, passing fon\ard oyer the tarsus, dips do\\"n to the sole bet ,,'een the first and second metatarsal bones . Here it forms "ith the Plantar arteries what is known [IS the Plantar Arch. At the ankle (pressure points 14 and IS) pressure may be applied by the nngers or by pads and bandages.

V ENOUS HADIOR RHAGE.

I. - Blood from a vein is dark red.

2. - It flows in a slow continuous stream.

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

4. - In the case of a wound of a varicose vein it flows also from the side of the " 'ound nearer to the heart, especially if the patient is kept standing.

Varicose Ve i ns .-The veins of the leg are specially apt to varicose. varicose vell1 is dilateJ, winding, and with bead-like (varicose) projections along its course. A vein becomes "aricose from several causec;, such as long standing or tight garters. The first effect is to throw extra \\'ork upon the valves, and the bead-like projections are cau ed by the bloJ::l accumula.ting in the pockets behind the valves. In time the vein becomes so dilated that the valves can no longer span it.

GE:-;'ERAL RULES FOR OF ,\ \\'ou:-m BY VENOUS

I

.- Place the patient in a suitable posit ion , bearIng in mind that the blood escapes \\ ith lef's force when the patient sits and is still more c.hecked a s he lies do\\'n.

. the part, as thereby less blood tinds Its way mto It.

3.-Expose the wound, removing \\ hate\'er clothin,:!; is nece:;sary.

4.- Remove any constrictions , such as the collar or garters, from the he:!.rt side of the \\ ountl.

S·-Apply digital pressure on the wound until you can apply a pad and tight bandage. If that does not stop the bleeding, make pressure near th \\ ollnd on the side away from the heart. In the case of a ",'ound of a varicose vein it may also be necessary to

apply a pad and bandage to the \'ein the \\'ound, especIal!) if the limb cannot be mamtained 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.

CAPILL\RY

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 . \ slight amount of \\ III suffice to arrest ulJlIllary

I:\TERx.-\L H/E:\IORRH.\GE.

Wounds of the hlood "ess Is \\ithin the trunk C1U c kBlTIorrhage into the ca\ity of the cheq or of the abdomen.

.\:\D OF IXTERi\:\.L H/E:\lORRHAGE.

1.- Rapid los of strength, g-iddiness and faintnt especlall)' \\ hen the upright po 'ition is assllmed.

2.-Pallor of tllC face and lip.

3·-Breathing hurned and laboured, and accom· panled hy ya\\ning and icrhin cr .

-1-.- pulse '-fails, altogether di-;appear at the wnst.

5.-The patient throws his arms about, tu g s at the clothing round the n e ck, and calls for air.

6.-Finally the patient may become totally unconscious.

I. - Keep the patient in a rec umb e nt position.

2. - Undo all ti ght cloth in g about th e n ec k .

3.-Provide for fr ee circulati o n of ai r; fa n the pati e nt.

4.-Sprinkle c old water on the face; hold smelling salts t o the nostrils; avoid oth e r forms o f s timulant s , at all ev e nts until the hremorrh age has b e en contr oll ed.

5.-Give ice to suck or c old wat e r to drink; if the se a t of the hremorrhage is known, appl y an ic e bag over the region.

6.-Should the pati e nt be r e du ced to a stat e of coll a pse, raise the fe e t and b a nd age th e li mbs fir mly from the toes to th e hips a nd fr o m th e fin ge rs t o th e shoulders.

HADIORRHAGE FR m I TH E NOS E (N OST RIL S)

I. - Place the pati e nt in a sittin g position in a current of air b efor e an ope n wind o w, with the h ea d thro wn sli g htly back and th e h a nds ra ised abo ve th e head.

2.-Undo all ti ght clothing around the n e ck and chest.

3.-A pply cold (ic e , a cold sponge or bunch of 97

keys) the nO"l' and <1ls() thl t tLe 1L \'el uf tht' collar; place the fu." t in hot \\atel .

-I. Calise the patient to kClp the l1'outh open, and :;u a \ old through the no,>e.

Blood issuing from the mouth 11l8Y conic flom the thl' gUI1l"-, the' socket of a tooth aftu l'\tl.1ction, the thlOat, the lun!-!", or the stomach.

H .£:'IfORRHACI·. FRO;\f THE TONGL'E, 'I HF

J HI· :(lCKF 1 OF ,\ TOOTH, OR TH} THRO:\T

1 .- (; I\'l' icc to suck or cold \Yater to hold in the mouth. If thl' i'> not su(cLssful gin; \\ater as hot a can be horne to hold in t he mouth.

,., If l1l'ces.-ar\, make pres me on the carotid a l lenes.

:). If bleeding from the fr ont of the to ngue IS l \ Ce Ive comp l ss t he pal t by a piece of clean lint hlld hd\\'een thE' finger and thum h.

-l- If the bleedlllg is' from the ocket of a tooth, the so ket " ith a piece of clean IlI1t or rotton \\oul; over t his pla -e a small rork or uther . ucslancc of sUlIab le size, and in:,truct the patient to bite on it.

FROII T H E Ll) '\ (.s.

Blood from t hc lu n g IS coughed up and 1S scarlet an d frothy in appeara n ce.

T reat as for I nte rn a l ( ee page 95)· 1-:

HlE.\[ORRHAGE FRO:\[ THE TOl\fACH.

Blood from the stomach is vomited; It IS of a dark colour and has the appearance of coffee grounds; it may be mixed with food.

Treat as for Internal Hcemorrhage (see page 95), except that nothing is to be given by the mouth.

Blood issuing from the Ear Channel, which generally indicates a f ract ure of the base of the cranium, must be wiped away as it issues; no attempt is to be made to plug the ear.

The: 11lflllerais indicate the: pages wiler,; Ihe aJlswers may be found. \\'hat organ. a r e concerned in the circulation of the

blood? ...

the heart

the circulation of the blood through the body and lungs 70 It)

IIow many times a minute does the hLart contract on the a\'erage?

"hat \\ ay should arterial ha:I1lOl rhage he cuntroll to?

is meant by " pressure point " ?

What is fle:-.ion ?

:-;tate the general rules for treatment ofa \\ound accompanied hy arte rial ... 77, 78

If part of a lim b had been torn ofT, bUl there \\ c1.S not much bleeding, ho\\' wuuld yuu act?

Is it \\ie for an persun tu attempt to cleanc a \\ ound ?

D escribe the arterie of the he:ld and neck

' Yhy is it ometime nece<;sary to compre<;s the carotid

artery hoth below and ahu\'e the wound?

\\That is a ring pad, and what is its u, e?

Describe the arterie of the upper lim bs L'..j. tl) 89

Describe the arteries of the lower limbs "

lIow would you know a case of yenuus h:.\!J11orrhage ?

\\'hat is a yaricose nin? ... ...

IIo\\' maya yein hecome yaricose ? .. ..

State the general rules for treatment of a wound accom-

panied by yenUliS h <-e morrhage ..

How woult! you know a ca::;e uf capilhry ? 05

If 011' would you stop capillary ..

'Yh at is internal h,-el11orrhagc? ..... os

'Yh at lI'ould lead you to suspect internal h::emorrhagc? 95 , 96

State the treatment for internal hxmnrrhage?'" . ()6

Hall' would you arrest h,emorrhage from the nos('? ·.91), 97

\\'here may 1100d issuing from the mouth come from?... ()7 would you treat bleeding frnm the gums or throat? ()7

\\ hat else would you do if the tongue \yere hkctling?.. ()7

And if the bleeding were from the socket of the too'th? 97

H ow would you di"tinguish het\1 een bleeding frum the lung and from the stomach ?.. ... ... .. .

And Il'hat Il'ould he the difference in the trealment? .. .

Of what is bleeding from the ear channel generally a sign?

The . 'ludent should practise placing supposed patients in a proper position fur the arrest of hremorrhage (see pafe" .... 2, 77 and 94), folding firm pads (74 and 75 ), tying hard knots in bandages to form a t0urniquel (76), and the application of pres ure at"all the pressure points shown in the frontispiece, at "arious points on the foreh ead and scalp, and on the palm of the hand. Pressure should be digital, by pad and bandage, or flexion, as directed in the text.

101

Pres.,ure ';,oint - Carotid arlery, 80. Facial, 2. 2. Occipital 3. ubcla\'ian, 4. ..-\ ,illar)', .5. Brachial. (by pad and bandage, pressure bemg macle agamsl the humeru'i ancl by flexion al the e lb o,,), 86. Raclial and Ulnar, 7. Femoral at the groin, 90. Femoral in the thigh, 9 2 ,Popliteal, 92. . \ nlerial and poslerior Ti bial artenes, 93.

ITxmorrhage ft0111 the furehead or scalp ...

llamorrhage from the palm of the hand .. . ..

Yenous hxmorrhage frum a yancoe or olher 'lin

4

87 to 9 ... 91, 94

CHAPTER I V.

BRU I ES.

A blow anywhere on the surface of the body may cause extensIve hcemorrhage beneath the sk in \\ ithout breakmg It -a " black eye 1/ is an instance. The injury is accompanied by discoloration and S\\ elling.

TREA'l :\fE.:-:T.

Apply ice or cold water dressings. A piece of lint soaked in extract of \\ itch hazel may be placed on the affected part.

AND .... CALD .

A burn is caused-·

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

(b) By a rall, wire or dynamo charged \\ lth a high pressure electric current.

(c) By a corrosive acid, such as oil of \ itriol.

(d) By a corrosive alkali, such as caustic soda, am monia, or quicklime.

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

A scald is caused by moist heat, such as boiling water, hot oil or tar.

The effect may be a mere reddening of the skin ; bliste rs may be formed ; o r even the deeper (issues

103 of body may be charred and blackened. T he adhere to the burnt sk1l1, and its remova l IS ble Without further detriment to the injured part I be great danger is hock.

TRF \T\IF,\,T.

. !. - Carefully remove the clothing over the part. If stuck to the skin, the adherent clothu:g OlU t be cut around With SCissors, soaked WIth oIl. and left to come away subsequently.

2. - Do not break blisters.

3· cover up the part. Soak or sme::tr piece of lint or IlJ1en \\"ilh 011, or vaselll1e, lanolme or cold cream; a small quantity of boracIc p0\:' der addeJ to the e \\ III he of fit. The 111 Ide of a raw p.ota to out and spread on lillt a apl,licatlon. When the IIljureel surface IS exten ' I\'e do not cover It with one larae sheet of IlJ1t, but \\ ith strip about the hreadth of th; hand' thl . IS ad"isable as they fit better on the part, and ubseqUE'nt dresslIlgs one stnp can he remo\'cd a tnne, al:cJ a fresh dres.;;ing applIed h fore the .:tel , jacent stnp IS t3ken off. The shock to the system 15 t hereby. less than jf the whole of the burnt surface were . laid bare to the air by the re mon.! of all the !CIre at one time . , Vhen covered by the olly dre I11g enyelop the part In cotton \\ 001 or a piece of flannel a n d apply a ba n dage.

'W hen the face is burnt , cut a mas k out o f lmt or m e n, leaving holes for the eyes, n ose, and mouth. D ip t his in oil or smear it \\ith vaseline and apply it t o the face and cover it \yith cotton wool, leaving openi ngs to correspond \\ ilh the holes in the mas k . 'When possible place the injured parl in water at the temperature of the body (98 degrees) until suitable d ressings can be prepared. A dessert-spoonful of baking soda added to a ba inful of the \\ arm \yater wlll make a soothing lotion. As it is important not to leave the part exposed t o the air, it is the duty of the bystanders to prepare the dressings \\ hile the clothing is being removed.

4. - Treat Shock. - This is particularly necessary In the case of eyer)' burn or scald of any considerable extent (see page 135). Be very apprehensive of danger n the case of even sligh t burns of the neck.

5. - If the burn is caused by a corrosive acid, bathe the part with a weak alkaline lotion, such as washing soda, baking soda (bicarbonate of soda), magnesia, or slaked lime in \\arm \\ater 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 vinegar diluted with all equal qua n tity of water. Caution .-Before using watel brush off any lime that r em ains on the part.

7.-When a woman 's dress catches fire(0) L1Y the \\oman tllt on the floor at once so that .the names are uppermost; thal is to say If thc front of the dress i on fire lay her on her hack, and if thc back of the 9,ress is burning, place her face dO\\"D\\ ards.

1 he for. th is is that fl<lmes as end, so that If the upnJ:ht is assumed, the fl .lIl1es \\ ill qUIckly reach and burn the ho 1)", neck, .mel face ' or if the woman lIes \nth the fhmes undermo t they will If pas ' O\'cr and bu'rn Ii m hs, and set fire to the rest of the drcss.

(/7) as tl:e \\'oman js laid flat, smother the flames With anything at band, such as a coat, blanket, or table coyer; if made \vet so much the beller.

( r) .\ \\ oman rendering a .. should hold a rug or blankL!L in front of her elf whcn approaching the flames.

( d) If a woman 's dress catches fire when nobody IS by, she should lie flat flames uppermo t, smother the flames with anything handy, and :lll fO.r ass istance, or crawl to the beil-pull 1 rmg ; on no account should she rush mto the open air.

T he . use o f fi r e guards would prevent ma ny cala m i ll es.

BITE OF NAKE AND RABID A TUf.AL I AND \VOUND BY POI ONED \VEAPOi\ .

Hydrophobia is caused by the bite of an animal, such as a dog, cat, fox, \\"olf, or deer suf!ering from rabies. The special poisons mto wounds camed by venomous snakes and pOIsoned \\ eapons cause immediate danger to life.

T R E;-' 1.

I.-Immediatelyplace a constriction between the wound and the heart so as tu prey ent the venous blood from carrying tbe pOlson through the body. If, for example, a finger IS bItten it should be encircled on the side of the wound nearest tc the heart, wIth the finaer and thum b, ar:d as soon as pOSSIble a lIgature (a ;tring, piece tape, or strip of handkerchief) should be placed tIghtly round the root of the finger. Compres ion \\'ith the finger and thumb n:ust not be relaxed until the ligature has been Additional ligatures may, \\"Ith adyantage, be applIed at mtervals up the limb.

2. - Encourage bleeding for a time :-

(a) By batbing the w!th warm \\ater.

(b) By keeping the lI1Jured lImb 10\\; the upper limb should be allo\\ed to bang do\\ n, and in the case of the lo\\'er limb the patient should be seated \\ ith the foot on the ground.

Iv7

3. - Cauterise the wound, if it is quite Impossible to obtain the services of a doctor. T his is best done by burning with a fluid caustic, such as caustic potash, pure carboliC acid, or nitric acid, or if these are not at hand, \\ itb a red hot wire or a fusee.

The usual s)1 IJ C:ltl . tic IS insufficient. as It does not reach the bottom of the \\ound, where the poison is.

To ensure the caustIC reaching the bottom of the wound, it should be applied on a piece of wood, such as a match cut to a point. When tbe caustic has been thoroughly applied, but not till then, the ligature may be removeu.

4. - Cover the wound, afte r a ",hile, with a clean dressing

S. - Afford support to the injured part.

6 - Treat shock if it occurs (see page 135)'

7· - In the case of a bite by a venomous snake, rub in powdered permanganate of potash and inject under the skin in the neighbourhood of the wound a solutio n of permanganate of potash.

STINGS OF PLANT' . \.ND AN IMAL

These give rise to serious incol1Yenience. and 111 some cases graye sympt0111s de\'elop.

TREAT\lE:\T.

I - Extract the sting If left in.

2 - Mop the part freely with dilute ammoma

ro8 or spirits. A paste of bicarbonate of soda and sal volatile is an efficient application. A solution of washin g soda or potash or the application of the blue bag \yill relieve pain .

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

FRO T BITE.

D uring exposure to severe cold, parts of the body, u uall)' the feet, fingers , nose, or ears, lose sens.ltion and become first \\ ax)' \\ hite and aften\ ard:, congested and of a purple appearance. As sensation is lost in the part, it is often only by the remarks of h) standel's that the frost-bitlen person is made a\mre of his condItion.

TRE"\T..\IENT.

I. - Do not bring the patient into a warm room until, by friction of the hand or by rubbll1g with soft snow, sensation and circulation in the affected p arts are restored. NeITlect of this precaution may lead to death of the of the frost-bitten part.

2. - When circulation is restored, leep the p at ient in a room at a t em perature of 60 degrees.

NEEDLE EMBEDDE D UNDER THE K1

" Then a n eed le br eaks o ff after penetrating the skin and disappears, take th e patient to a doctor at once. If the wound is near a joint, keep the limb at rest on a splint. 109

FI H -HOOK THE KIN .

Do not attempt to ",ithdraw the fish-hook by the way it went in, but cut off the dres ing of the ho o k, so that only the metal is left, and then force the point onwards through the skin untIl the hook can be pulled out.

INJU RIE TO JOINT .

'Vh en a joint is Il1 jured by a bullet, stab, or other cause-

I. - Wrap the part in cotton wool.

2. - Afford rest and support to the injured limb; If the upper limb, In a flexed positlOn by a sling ; If the lo\\er limb, in a position by a spll11t.

FOREIGN BODY THE EY E.

I. - Prevent the patient rubbing the eye, tying do\\ n a child /s hancls if nece sary .

2. - Pull down the lower eyelid, when, if tbe foreign body is seen, it can readily be remoyed \\ ith a camelIs hair brush, or \\ itb the corner of <1 handkerchIef twirled up and wClled.

3. - Wh en the foreign body is beneath the upper eyelid lift the lid forward, pu ' h ur the lo,,-er lid beneath it and let go . The hair of the lower bel hru<;hes the inner surface of the upper one, and may <..lIsloc1ge the body. '"' hould the fir . t atlcmrt be, unsucce sful, repeal It e\'eral times if necessary. It

t he foreign body is not dislodge d call the sen-'i( es of a doc t o r as soo n a. po sible. When, however, skilled help cannot be had, proceed as fo ll o\\"s :-

(a) Seat the patient so as to face th e light, and sta n d behind him , stead ying h is head agai n st your chest .

(b) P lace a small rod, such as a match or bodkin, on the upper eyelid, half-an-inch above the e dge, press ing it back wards as far as p o slUe.

(c) Pull the upper eye-lashes up\\ards mer the rod, and thereby the eyelid .

(d) R emm'e the foreign body.

4. - When a piece of steel is embedded in the eyeball drop a little olive or castor oil on the after pullll1g down the 10\\ er eyelId, 10 e the lIds, apply a soft pad of rotton \\ 001 and It b) a bandage tied sufficiently firmly to keep the e) cball steady; take the patIent to a doctor.

5. - When quick-lime is in the eye brush a\\ayas much of it as possihle ; bathe the eye \\ Ith vinegar and \\'arm water, and treat as for a piece of steel embedded in the eyeball.

FORE I GN BO DY I:';- THE EAR P.\S '.\ GE .

.As a rule make no alt el 11]>t to treat a patient ,,,ilh a foreign body in the ear if the services of a doctor an iJo sibl)' be had: any atl e mpts to rel11o\'c the n body may lead to fatal conseauences. If a child I II

cannot be induced to ke e p the fingers from the ear, tIe his hands do\\"n or cowr up the ear. If an insect IS in the ear-p:lss'1.ge, fill the ear \\ 1th olive oil, when the insect will float and may be remoyed. Never 5yringe or the ear.

BODY L THE XO ·E.

Induce sneezing by pepper or snuff. the patient to blow his nose violently. atter the nostril. There IS no ImmedIate danger from a foreign body in the no . e.

THE

The abdomen is boun led above by the diaphragm; belo\\; by the pelvis; behind by the 1um bar yertebrre; and In front an I at the sides by muscular \\alls. (Fig . 54·)

T[[E ORG:\ S GF T HE ABDQ:\fEX.

The Stomach lies immediately below the" plt of the slo:nach " just below the brea t-bone.

The Liver 'lies in the upper part of the abdomen , where 1l I mo . tty co\"cred by the right lo\\er ribs

The Spleen lies beneath the ribs at uppe part of the left side of the abdomen.

The Intestines occupy the greater part of the ca\"ily of the abdomen.

The Kidneys lie at the back, in th'J r egion of the 10111.

The Bladder lles 111 the pel\"is .

FIG. 54.

WOUND IN THE FRONT 'VALL OF THE ABDOMEN . .

When the intestines 01 other organs protrude through the wound, whether vertical or transverse, bend the knees, raise the shoulders, and apply lint, a towel, or cotton wool wrapped in soft linen, and keep th e

I 13

patie n t war m until the doctor arrives. ' Vhen there is no protrusion of organs, if the wound is vertical, lay the patien t fi a t on the back with the lower lim bs straight ; if the wound is transverse , bend the k n ees a nd raise the shoulders.

INJ UR IES

TO THE

O RGA S \VITHIN THE A BDO M EN AND PELVIS.

Injuries of the Stomach are attende d by extreme collapse and sometimes by vomiting of dar k blood like coffee-grounds. For treatment see " Hremorrhage from the Stomach " (page 98).

Injuries of the Liver , Spleen and Intestines may be caused by a blow, a stab or a bullet; the liver or spleen may be injured by a fracture of the lower ribs. The Signs and ymptoms are those of internal hremorrhage accompanied by pain and swelling at the seat of injury, and the treatment is as for that condition (see page 95).

The K idneys may be injured by a fracture of the eleventh or twelfth ribs, also by a crush, blow, stab or bullet. Blood may escape with the urine, and there may be pair 1 and s\\'elling over the injured kidney.

The B la dde r may be injured by a fracture of the pelvis. The signs and symptoms are either inability to pass water, or if a little is pas-sed it is tinged with blood.

Iq

OF I:\Jl:RY 10 THE KID;\EYS OR BLADDER.

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

2. - Apply hot fomentations over the painful or inj ured part.

Rupture (hernia) consist of a protrusion of an internal organ, usually the bo\\ el, through the muscular \yall of the abdomen, most frequently at the groin. Should a sudden s\\ eUing accompanied by pain and sickness take place in that region

I.-Send for a doctor instantly.

2.-Lay the patient down \"ith the buttocks raised.

3.-Apply ice or cold ,Yater dres. ings to the affected part.

QUE TIO),T.: 0:\ CHAPTER IV.

Th Illtlllerais int'-m', th e pages 'Where the answer s /IIIl) ' be found.

\\'ould you do if a piece of ;tecl were embedded in

IIO\." WQula you lry to remO\-e an insect fr0111 the ear ):lssage?..

Would you try to re-move any other form of foreign body from the ear passage? ... 110, III

How would you remove a for eign b ody from the nose? I I I

State the boundaries of the abdom en and its contents 1 I I

State the treatment for wounds of the abdomen 112, I 13

How may injuries to the liv e r, spl ee n and intestines be caused? .. , (13

What is the difference between treatment of injuries to the stomach and of injuries to the liver, spleen and intestines? '" .. , .. 1 13

State the treatment of injuri es to the kidneys or bladder 114

State the treatment of hernia 11#

C HAPTER V.

TH E TERVOU' y

T\\ 0 ystems of nerye s, the Cerebro-spmal and. the .'ympathetic regulate the moyements and fun tlOn Clf the body . _

The Cerebro-spinal System IS made up 01 the Brain, the pm:d Cord and i\er\'es, and through its arrenc\' -'en atlons are receIved and the ,yill cau es action of the \'oluntar\' muscles . For e'\amplc, when a part is injured a 'sen:ation of pain IS conyevctl to the brain by the nerye, thus affording an indication of the seat of II1jury or a warning of a possible danger of further damage. On attention bell1g directed to the injury, an attempt j. instantly made to ease the pain or to mO\'e the injured part from danger. .

The Brain i situated within the craniulll, and IS di"ided in the middle lllle, so that, \vith the exception of some con n ecting bands, the right and left sides are separate.

The Spinal Cord i the long cord of neryous matter lying "ithin the. pinal canal (see Vertebral Column, page 23)' It lea\'es the brain through an opening in the ba e of th e cranium and extends co th e upper lumbar y er tebrre .

TIS

The Nerves proceed from the brain and spina cord 111 pairs a pearly-white trunks, ami their branches can be traced throughout the tissues of th e body. ' Vhen a nerve is torn through there is pa ralysis of motion and sensation in the region in wh ich its branches are distributed .

The Sympathetic System extends as a nervous c hain on each side of the front of the spinal column a long its entire length, and sends branches to all the organs of the chest and abdomen to control the mvoluntary muscles, and thereby regulate the ntal f u n ctions . This system is not under the control of t he \\ ill, and acts alike during sleep and activit),.

THE RE PIRATORY ,·Y ' TEM

.

The air reaches the lungs by \\a)' of the (or mouth), the throat, the \\ md-pipe, and the bronc h ial tubes. The conyey it to the back of t he throat, \\ hence it enters the \\ ind-plpe by an o pe n ing guarded by a sort of trap-door or vah e, so t hat in health air, but not solids or ftl1lcb, may enter.

D uri n g insensibility, ho\\ e,'er, the \ ah e fails to act, s· that should solids or iluids he given by the mouth, t hey may enter the \\ind-pipe and cau 'e

The \\ ind -pipe ext e nds to two inches below the top of t he breast - bone, \\here it divides into the ri£ht and left bronchial tube. Each bronchial tube enters a lung and divides into small and still smaller t uhes, until

FIG. 55. THE A:\D TU B ES.

A. Trachea, or Wind-pipe. B. L e ft Bronchus. C. Right Bronchus. D. Bronchial Tubes.

the ultimate recesses of the lung-the air cells or aIr snA.ces-are reached.

fhe Lungs, Right and Left, occupy the greater of the chest; they lie immediately within the rIbs, and practically wherever a rib IS felt, whether front, back or sides, there is lung beneath. Each lun.g is enveloped in a fine membrane (the pleura) \\'hlch allows it to move within the chest durinobreathIng without friction. b

Respiration , or breathing, consists of t\yO acts, Inspi r at ion , an expansion of the during which air .is drawn into the lungs, and Exp ir ati on , a contractIon of the chest, during which air leaves the lungs. A pause follows the act of expiration . In health fifteen to eighteen breaths are taken p r minute, and at each inspiration about 20 to 30 cubiC' inches of air enter the lungs, and a similar quantity 15 expelled at each expiration.

The expansion and contraction of the chest are effected partly by the muscles of respiration attached to the ribs, but chiefly by the Diaphrag m , the large arched muscular partition which separates the chest from the abdomen. In inspiration, which is chiefly a muscular act , the ribs are raised, and the arch of the diaphragm falls and becomes flattened thus increasing the capacity of the chest and the air to enter. In expiration, an act performed almost without effort, the ribs fall and the arch o f the

121

diaphragm rises; this Ie . sens the capaclly of the chest and forces air /)ul. The rnecham m of re piratlon 15 some\\hd.t lIke that of ordmary household hello\\!', hut \\ Ithout a valve; the nbs may be compared to the boards of the bello\\s, \\hIle the dIaphragm corre"pol1ds to the leather, the air passagts bemg tqul\'alent to the nozzle .

.i\'i the blood depends upon the air for its pUrIfication ,1l1d the oxygen necessary to m::untain ltfe, Jl1ter[Lrence \\ith yerr . oon may produce a dangerous state called asphy--.:ia, examples of \\ h1Ch are afforded by dro\\ nIng, suffocation, choklllg, etc.

ARTIFICL\.L RESPIRATION.

PROFF OR , CH:\FER'

1.- Waste no time Jl1 loosening or in remoying

2. Lay the patient in a prone position (I.t' ., ha( k upward.;) with hIS heacl turned tu une SIde, 0 to keep his no .- e and mouth away from the ground.

0 pad is to he pbc e d under the patient, nor need tile be c1ra \\ n out. :1S it will fall 11:1 rurally.

3. Kneel at one side facing the patient's head, and pLlce the palm ' of your hanc1s un It , Icm l'c,t nbs, one :-It eae h side, the thumb . touching one another in the small of the h:1(,h Leaning your baLly forward, slo\\ ly apply firm but

not violent pressure straJght downwards upon the back and lower part of the chest, thus dri\'ing air out and producing expiratio n (Fig. 56). Draw back

1 2 3 your body s0J11ewhat 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\\'aymg back\\ards and forwards of your body, twelve to fifteen times a minute, persevering until respiration IS restored, or a doctor pronounces life to be extinct

DR. ILVESTER' ).iETHOD.

I . Adjust the patient's position. -\Vithout W3.stlllg a moment place the patient on his back on a fiat surface, inclined if possible from the feet up\\ards. Remo\'e all tight clothing from about the neck and chest, and bare the front of the body as far a the pit of the stomach; unfasten the braces and the top button of trousers in men, and the corsets in women. Raise and support the shoulders on a small, firm cushion or folded article of dress placed under the shoulder-blades.

2 . Maintain a free entrance of air into the windpipe. -Cleanse the lips and nostrils' open and wipe the mouth; an assistant must draw forward the patient 's tongue as far as possible, and keep it in that positio n .

3. - Imitate the movements of breathing. IndNce IJlspz'ratt'oll.-Kneel at a conven ient distance behind the patient 's head, and, grasping his forearms just below the elbow, draw the arms

rIG. 56. EXPIRATION

FIG. 57.

FIG. 58. INSPIRATION.

FIC. 59. EXPIRATION'.

upwards, outwards, and towards you, with a sweepmg movement, making the elbo\\ s touch the ground

FIG. 6r. EXPIRATIO.

(Fig. 58). The cavity of the chest is thus enlarged, :and air IS drawn into the lungs.

Induce explratio1Z.-Bring the patient's flexed arms slowly forward, downwards and inwards, press the arms and elbows firmly on the chest on either side of the breast-bone (Fig 59)' By this means air is expelled from the lungs.

Repeat these movements alternately, deliberately, and perseveringly about fifteen times a minute. When a sufficient number of assistants are present, Howard's method may be combined with ih'ester's, as follo\\'s :-

The additional assistant kneels astride the patient's hips with the balls of the thum bs on either side of the pit of the stomach, and the fingers grasping the adjacent parts of the chest. Using his knees as a pivot, he presses forward on his hands. Then suddenly, with a final he springs back and remains erect on his knees while he slo\\ ly counts I, 2, 3. These motions are to be repeated to correspond with those being perfor med by ilvester's method, pressure on the chest btlllg made Simultaneously by those per.forming the t\\ 0 methods (Figs. 60 and 6 I).

LABORDE's METHOD.

When from any cause the above methods cannot be carried out, Laborde's method of artificial respiration should be tried. It is especially useful in suffocated children and when the ribs are broken.

1 2 7

The patient i placed on. his back or side; the cleared; the. tongue I seized-using a handkerchIef or somethll1g to prevent it slipping from the fingers-the lower jaw depressed; the tongue is pu Ile.d forward and held for two seconds in that pOSItIon, then allowed to recede into the mouth. These should be repeated about fifteen time a mll1ute.

. Artlficiai respiration must be continued until IS established, or until a doctor arnves. ?reathing com mences, regulate the artl ficlal respl ratIOn to correspond with It. uccess may resu It e\'en after two hours' time.

. 'Whilst artificial respiration IS bema other. useful steps may be employed, such as applymg smellIng salts or snuff to the nostrils and fllck1l1g the chest with a dam} to\yel. '

Ind:uce circulation and warmth after natural has been \\Trap the patient in dry or other coverIn', and rub the limbs energetically towards the heart. Promote warmth by hot flanneL, hot-."ater bottles, or hot bricks ,(wrapped in applIed to the feet, to the limbs and body. "hen the PO\\ er of s\rallo\\ ing has returned give hot tea or or meat extract. The patient should be kept 111 bed and encouracyed to ao to sleep Large poultices or fomentationsO applied to the

front and back of the chest ",ill serve to assIst breathmg. . Watch the patient carefully for some t see that the breath ing does not fall; should .a ny slgns of failure appear, at once beg1l1 artificial respIratIon

IN EN IBILITY.

Unconsciousness or Insensibility may anse as follows :-

Injury to the Head. -Concussion and Compression of the brain.

Disease of the Brain. -Apoplexy Epilepsy) Hysteria. . .

Various Causes. - hock, Fmntmg (Syncope), Collapse, Alcoholic other po!soning, and Heat-stroke, Infantlle ConvulSIOns, AsphYXIa .

GENERAL RULE FOR TREATMENT OF IN EN IBILITY.

I. - If a person appears abou.t to lose sciousness, prevent him from falllDg, and lay hIm gently down.

2. - Arrest Hcemorrh3.ge when. apparent j attending to minor injuripc- is less Important than treating the unconscious ... .

3.- Lay the patient in the poslti<?n In which breathing is most easy-usually thIS WIll be on the back, or inclined to one side. As a general rule

12 9

raise the head and shoulders sliglztl)' when the face is flushed, and keep the head lo\\' \\ hen the face IS pale.

4. - Undo all tight clothing round the nec k , chest and waist, unfastening the bra es and top button of the trousers in men, and the corsets in women, the object being to relieve pres ure on the air pas ages, lungs, heart and abdominal organs. Be sur.e that there i no obstru tion to the air PC] age by the tonuue or by a foreign body in the throat. The possibiltty of fal e teeth obstructing breathing mu t be considered.

5. - Provide for a sufficiency of fresh air by doors and windows, and by k e ping back a cro\\d.

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

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

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

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

lO. - Should the spine 0r an important bone of the upper or of the lower limb be fractured, it must hp. steadied and maintained at rest as oon as possible. hould the unconsciousness be prolonged, the patient may be removed in a recumbent position "

13° to shelter, provided that the broken bone is adequately supp rted,

n .-Wh e n th e p a t ie n t is in a s t ate of ,convuls i on ) suppJrt his he:ld, and ;lfter \:'fapp1l1g a piece of wood or ?lher hard mate rial In a handkerchi ef hold It 111 hiS mouth to pr e \'e nt bltll1g of the tonz'ue. Do not forcibly restrain his lil11?s; prevent him fro :11 hurtJn"; himself by h1l11 :1\\'(1.Y f rom a source of such as machin e ry, a \\ all, or #i repbce; light pi eces of furnitur e should be out of the way,

12. - On return to consc ious n es s \\ ;l t e r may be given to drink . If the is giv,e \\'arm te::t or pr ov ided elth r ll1ternal or extern3.1, is not present. A deSire to sleep sho,uld be encoura...;ed, except in cas es of opium a conditio l; that may generally be recognised by the history of the cas e, and also by the pupils of tbe eyes ( the black openings in the blue or bro\\!1 iris) minutely contracted (pm,head pupils),

13. - It must no t be assume d a pers on is insensible as th e re su lt o f d n n k me r ely because t he b reath s mells o f alcohol; frcquemly \\'hen peopl e are feeling ill t,hey take or are give n alcoholic stimulants, after ,\ hlch they may become in e nsible, not from the drink, but from the cause th:tt induced them to take it, for e,ample, insensibility coming on, effects of poisonll1g, etc. Even if

13 1

dri n k is belteved to be the actual cause of insensibIlity, it must be borne in mmd that the patient is In :1 very dangerous state, and he must be treated for '011 apse by bemg covered up and kept \\'arm.

The above general rul e s \\ ill enable first aid to be rendered efficiently 1I1 most cas s of insensibility, although the exact form from \\ hich the patient IS su ffering i unknown.

C O.\'CUS ' ION OF THE RRAIN.

The patient may be stunned by a blo\\' or fall o n the head, or oya fallon the feet or lo\\er part of the He may qui< kly regam consciousne s, or ])1sen lolllty, more or complete, may be prolonged.

'l'RFADlr, NT

I . - Apply the general rules for the treatment of In ,l' n Ibtllty

2.- Be ye.ry apprehensive of danger in all cases of injury to the head . Th e patient may be tunned, and after a short interval may reco\-e r Some degree of consciousness, or e\'en the iJrall1 may apparently have e scaped injury j yet in both in tances there is a grave risk that a structure \\ithm the cranium has been il1 ;ured and that a s [Jous slate of II1sen Ibility may develop later. (ee Fracture of the <;:ral1lum, page 43.) A cautio n should therefore be gIven to a patI e nt \\ ho has lost consciousne seven

D2

[3 2

for only a moment after an injury to the head not to resume physical or mental activity without the consent of a doctor.

COMPRESSION OF THE BRAIt-J", APOPLEXY.

Compress"ion of the Brain may result from the same causes as produce Concussion; in fact, Compression is frequ ently 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 body may be more limp than the other, and the pupil of one eye may be larger than that of the other; the temperature of the body is generally raised.

TREATMENT.

I. - Apply the general rules for treatment of Ins ensibi lity .

2. - Promote warmth in the lower part of the body by the application of hot \\ a ter bottles to the abdomen and lower limbs. C are must be taken not to burn the patient \\'ith the bottles, which should be \\'rapped in flannel, and their heat tested with the elbow.

EPILEPSY.

Epilepsy may occur in persons of any age, but usually occurs in young adults. The patient falls to

the ground, sometimes with a scream, and passes into a state of convulsion, throwing his limbs about. The treatment is according to the General especially Rule I I.

HYSTERICAL FITS (HY STER IA)

SIG S AND SYMPTOMS.

The patient,. usually a young girl, in consequenceof eXCItement, suddenly loses command of her feelmgs and actions. She subsides on a couch or in comfortable position, throws herself about, her teeth, clenching her fists, shaking her haIr loose; she clutches at anyone or anything near her, kicks, cries and laughs alternately The eyeballs may be turned upwards, and the eyelids and shut rapidly. At times froth appears at the lIps, and other irregular symptoms may develop

TRE ATMENT.

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.

a mustard leaf at the back of the necK ,

. MedIcal treatment is necessary to cure the cond itIOn of mind and hody which gives rise to hysterical attacks .

SHOCK,

FAINTING (SY NCOPE), COLLAPSE.

CAUSES

I. -·In jury in the region of the abdome n, extensive wound s a n d burns, fractures , lacerated \\ ounds, and sev ere crush a re some of the more fr equent ph) ical cau ses of shock .

2.-Fright, anticipation of injury, and sudden bad ne\\ s, or sometimes sudden remoYal of fear and anxiety after prolo n ged suspense, produce shock or faintmg.

3.- 'ome poi sons cause shock, \\ hile others, such as alcohol, so depress tile nervous system that collapse ensues .

4.-Hremorrha ge or heart \\ eakness, a lose or crow ded room, tight fatigue, or \\ ant of food may bring on famting or collaps e.

A:--.'D

Th e ae neral condition of shock may be r ecognise d by pallo r , a feeling of clammy feeble pulse and shallow breatl1lng :lccompal1led, If h as been severe, by ya\\ning and sighing. The term "collapse " sigmiie·. a serious condition in which the life of the patient IS m the greatest danger; the ttm perature of the body falls b elow the normal, and one great obj ect of treatment is t o prevent it sinking to a point at \\ hleb. IS Imp0ssible. An attendant danger of the c ondit ion of

135

collapse is the li ab ility m suddei1 relapse after a temporary Improveme nt, and the utmost care and watchfulne ss mu t therefore be e xe rcised to main tam the heat of the body and to guard a gai nst failur e of the heart and lungs.

TRI' .-\T\fE XT.

I. - Remove the Cause by arrestmg hremo rrhag e, to mjuri es, loosenin.g- all tight cloth 111';, especially about the chest and abdomen, lc.mov m, from a close or crowded roOlll, using encouraging \\ ords, etc.

2. - Lay the patient on the back, with the ?ead low. Ra.isc the lo \\er limbs: \\hen the patient I Ii1 bed th IS IS best done by ralsm a the ioot of th e bedsteacl. v

3. - Provide for a free circulation of fresh air.

4· - If has been severe and the is coll apsed, firmly nancl::H!e the 11m bs from the toes to the hips, and fron-1 the fingers to the armpits.

5·-:-To stimulate the action of the heart, sal vobtil e and \\ater may be gl\'en if thl! ratient C3t1 s\\"alJo\\, or smolling "aIL mar be held to the nostrils.

6. - It is of the utmost importanc e to u se every means of preventing a fall of temperature below the normal POJl1t. To accompli h thl£ coYer th e pabent with extra clothin g, or by placing

136

tugs or blank e ts over him; get him to bed in a warm but well-v e nt ila t e d ro o m as soo n as possib le. Ap ply warmth to th e fe e t a n d to the p it of th e stomach by hot water b ottles or hot flannels . (T est the heat of these with the elbo w before ap plyin g them. ) If the pat ient can s wallow, give hot d r inks, such as mil k , tea or co ffee. It is well to add sugar, as it aids in ra ising the temperature of the body.

7. - If breathing cannot be discerned , appl y art ificial respiration.

8. - If want of nourishment has been the cause Qf fainting or collapse, give food sparingly at first.

SUN TROKE AND HEAT-. TROK'E.

\Vhen exposed to great heat, as in the stoke-hole of a steamer, especially in the tropics, or to the rays of th e sun during a march in "ery hot \\ eather \\ hen heavily burdened, persons may develop Sickness, faintness, giddiness, and difficulty in breathing. The patient complains of thirst, the skin becomes dry and burning, the face very flushed, the pulse qUIck and bo un ding . A very high temperature, stertorous (snorm g) breathing , and insensibility may ensue.

I. - Un do all tight clothing.

2.-Re mov e the patient to a cool, sh a dy spot.

137

3·-Stri p the patient to the waist. the patient down, with the head and t k well raIsed. run

, 5'-dProcure as fr,ee a as possible of fresh aJr6an fan patient vIgorously.

k · Apply I,ce bags or cold water freely' to the head nec - and spme and ' , , , th ' ' , mamtam thiS treatment until e symptoms subSide.

7·-0n return to consciousness the t' t have water to drink. ,pa len may

CONVUL ION IN CH I LDREN.

Teething or stomach troubles are the commonest causes of this ailment.

SIGN.

pasm of the muscles of the limbs and tr k blueness of the ,face, insensibility, more or Ie and occasIOnally qUinting, suspended Ie iratIOn, and froth at the mouth are the prominent

TREAT:\JE T.

I.- upport the child in a warm bath sli 1 ' above tht temperature of the bod 7 ( 8 deO' g 1tl) that the water reaches to the of th b rees ), so

2 Place d' e trunk. top 'Of Ipped in cold water on the

13 8

A PHYXIA.

\V hen, owing to want of air, the blo?o IS not sup plied with oxygen the patient and is said to be asphyxiated. This conditlOn may be b rought about as follo\\'s : -

I. Obstruction of the air passages .

(a) By DROWNI:"\G.

(b) By PRE URE FRO:\I OUTSIDE: trangulatlOn, hangin g, smothering.

(c ) By A FOREIG . BODY IN THE THROAT: hoking.

(d) By S IYELLIXG OF THE Tl UES OF THE TH ROAT: Inf1 a m matlOn, scald of the throat, poisoning by a corrosive.

II. Inhaling poisonous gases. By coal gas (as u sed in the house), producer, or water, gas, sm?ke, f u mes from a charcoal or coke fire, se\\ er gas, limek il n gas, carbonic acid gas.

III. Pressure on the c4est, as \\hen crushed b y sand or debris, or by a crowd.

IV. Nervous affections , as the result of narcotic a n d certain olher p oisons, collapse, electric shock, or stroke by lightni118·

GElI.·ERAL TREADlE T.

In all cases of ..:\sphyxia attempts must be made to r emove the cause or to remJve the patient from the caus e . \Vhen 'this bas been done art ific ia l

respiration must be applied, taking care that the [.l\r pas ages are not obst r ucted , a n d that there is abunda n ce of fresh ai r.

D RO\\' 'I G

Persons com pletely immersed in water for even te n' or fifteen minutes have been restored by artificial means. Th e refore, if the boJy is recovered within a reasonable time, absence of igns of life is not to deter Immediate attempts to r tore animation.

The first thing to do when the body is recovered is to get rid of the \\ater and froth obstructing the air pas. ages, and then artificially to restore breathing. This is b est a compli . hed either by proceeding at on e to perform arti ficial respiration by chiifer 's method, or as follo\\'s :-

I. - As quickly as possible loosen the clothing, and clear th ' mouth and the back of the throat.

2. - TlIrn the patient bee downwards, with a pad below the chest, and ,,·ith the forehead upon the right forearm.

3." ' hi 1st in this position apply pres ure by the hands to the patient'. ba k over the lo\\er ribs, and keep the pressure up for three seconds.

4.- TlIrn the patient on the right ide , maintaining that position also for three seconds.

5.-Repeat these movements alternately as long as froth and \\ ater issu e from th e mouth .

These operations ( Iarshall Hall's method) in 'themselves tend to promote respiration, but \\ .hen th,e air passages are clear of and water llvester s method of artificial respiratIOn may be used by itself or with Howard's method in conjunction. While performing these operations send someone to the nearest house to procure blankets and dry clothing, hot water bottles, etc., and to fetch a doctor.

TRA ' GULATlON.

Cut and remove the band constricting the throat. Apply artificial respiration.

HA l GlNG.

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 reSplratloll.

M0THERING.

Remove whatever is smothering the patient: apply artificial respiration.

CHOKI ' G.

Open the mouth, forcibly if need be; pass the forefinger right to the back of attempt to dislodge the foreign body; If vomltll1g results, so much the better. If unsuccessful, thump the hard \\"hilst the head is bent fOf\\ard. Apply artificial respiration.

141

SWELLING OF THE TISSUE OF THE THROAT.

'Vhether the swelling is caused by inflammation by swallowing very hot water, as not infrequently happens to children attempting to drink from the spout of a kettle, or by the effect of a corrosive poison, the treatment is as follo\\"s :-

I.-Apply a sponge, piece of flannel or other cloth, wrung out of very hot water, to the front of the neCK, from the chin to the top of the breast-bone.

2.- et the patient before the fire.

3·-Give Ice to suck if it can be had; if not, give cold water to drink.

4·- Give animal or vegetable oil, a dessertspoonful at a time, to soothe the scalded throat and ease the pain.

5·-If breathing has ceased apply artificial respira tion.

UFFOCATIOi'{ BY :\lOKE OR GASES.

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 the nose and mouth. It is \\' 11 to move slowly, keeping low, or even crawling, whilst in a room full of smoke in search of a suffocated person. Every opportunity of letting in fresh air by opening doors or windows should be seized.

2.-Apply artificial respiration. .

3.-In the case producer or water gas, mhalatIOn of oxygen will also be necessary.

ELECTRIC HOCK.

Electric current is conveyed by a cable, wire, rail, or bar, called the "PositiYe," and to the source of supply by another cable, \\ Ire, raIl, or bar, called the" l'\egatiYe," or through the In the case of an electric railway, the current gel:erally conveyed by an insulated rail called the rall, and returns throuah th lunning rails or an lllsulated raIl called the rail, 2..l1d in the case of an electnc tramway it is frequently conveyed by an Q\'erhead con· ductor or trolley wire, and returned through the running rails. . .." _

Through contact \\ Ith .a the shock may be so severe as to cause insensIbIlity, and the sufferer vill be unable to extncate himself, and must be Iberated with all possible speed. As it is generally mpossible or inexpedient to s\\itch off the current orne other method must usually be adopted; but precautions must be taken or the person ing assistance will himself receIve a shock.

To liberate the from contactI.-Insulate yourself from the by ng on an " insulatf,)r " or " non-cond uctor, that a lody which resists the current. Amongst such bodIes

f43

ll1diarubber, dry glass, dry bricks, dry silk, dry clotb, dry wood and dry hay or straw.

2. - Protect your hands from contact with the the electric medium by covering them \'. Jth an Illsulator. .Although indlaru bber is the best insulator, do not wa te time III for indi.aru.bbc; gloves, but use dry articles ot clothll1g ; an mdwrulJber tobacco pOlich or ap, or nc\\ spaper, would sen'c to protect the hands

In an emeraency. If no means of Il1sulatinlT the ha.nds are at hand an atlempt may be made to;:' draa the a\\'ay by means of a loop of dry rope or crooked stIck; an umbrella is not safe because the metal nbs would act as cOllductors* of electricity :l11d it is not infrequently the case that the" stick 1I ;t the umbrella is a metal tube.

3·-Pull the sufferer away from contact.

CLue should be taken to a\oid touchin a with naked hands the ufferer's hallds, wet clothing, or boots if the sules are. nailed. The armpits should be avoided as perspIratIon usually makes the clothing damp there.

When the sufferer is removed from contact-

I. - Apply the general treatment for insen.

.\ conductor is a bod): through which electricity readily passes. Amongst such bOtltcs are copper, bras, iron, mois'ure ar.d one's own body.

144 sibility (loosen clothing, procure free circ ulati o n of air and place in a r ec u mbent 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" method (see p>age 126) has been found to be very successful.

4. - Treat burns if there are any (see pages 10 3 , (4) ,

E-FFECTS OF LIGHTNJNG.

A lJerson struck by lightning is us-uall) more 01 Ie s deprived of consciousness. The treatment IS the same as that for electric shock, e\.cept, of course that the instructions for Lhe patJent from contact with the electric medium d0 oot apply.

QUESTION ON CHAPTER V.

TIle 111t171e1-als indicate the ja,g-es where tlte answers may be found.

\Vhat are the two systems of nen es ? '" ..

Of what is the cere bro-spinal system made up? ...

What is the spinal cord?

\Vhat are nerves like? ...

\he sympathetic system

the respiratory system 1

the acts or respiration .

How are the expstnsion and contraction of the chest effected?

In \\ hat system of artificial respiration is the paticnt laid bac·k upwards? ... ... ...

In \\ hat sy terns is he laid on his back? 00. 123, 126

In what system is he laid on his back or side? 00. 12 7 h \\ hat system is he rolled alternatel" on his side and face downwards? ...

How long should artificial rc piration be perscvercd with? I27 What is exciting respiration? I27 \Yhat is inducing circulation? ... ... 127, 128 \Yhy is it necessary to watch the patient? 128 How may insensil.Jility ari. e? ... ...... 128

State the various forms of insen ibility ... ... I28

State the general rules for treatment of insensibility 12 ' to 13 1

\Vould YOll examine the patient to see if any bones were broken?

\Vhat \-\ ron g opinion may be (ormed \\ hen the patient smells of drink? 12 9

Is collapse from drink a seriOll condition?

is concussion of the brain? ... . .. State the rules for treatment of concussion

'What danger accompanie. injury to the head?

What caution hould be given to a patient who ha lost consciousness, even for a moment, after an injury to the head? ... . ..

" 'hat are the cau es of comprecsion of the brain?

I n what aged people does apoplexy usually occur?

' Vhat are the signs and symptom.:; of compressIOn and apoplexy? ...

State the rules for treatment of these conditions .. ,

\Yhat danger is there in applying hot water cOLtles to insensi ble persons, and what precautions should be

taken?

Describe a case of epilepsy 132, 133

\ Yhat special care must be taken in treating a C:1se of epilepsy? '" 130, 13 2

Describe a hysterical fit 133

How would you treat a hystelical fit?

\\'hat are the commonest physical cau e of shock?

\\'hat may produce shock 01 fainting?... . ..

\\'hat conditions do certain poisons bring about?

What may bring about fainl ing or collapse? ... ..,

How would yuu recognise the general condition of slwck ?

\\'hat special precaution must he taken in the case of

collapse?

State the treatment for shock, faintIng (syncope) arc! collapse... ..' ... 135, I3 6

\Yhat is the effect of sugar on the temperature of the body? ,., ,.. ' .' ,,' ,.. ..,

\\' hat are the causes of sunstroke and heat ·stroke ?

State the treatment for sunstroke and heat·stroke

\\'hat are the causes of convulsions in children?

\\'hat are the signs o f conntlsions in children? ...

State the treatment fo r connJision<; in children .. ,

State fully the causes of asph)'Xia ...

What two things have to be done lD all cases of asphyxia? ,., ... ... ,.. . .. . 138, 139'

What two things mu L be seen to befo re It 15 posSIble fo

artificial respiration to do any good ?

Is artificial respiration likely to do any good if the passages are obstructed, or if there is not abundance of fresh air?

What is the first thing to du in a case of drowni ng? ... I

By what method may artificial respiration be performed without taking any pre\'iou ste ps? . 1"

\\'hat ste ps must be taker. before proceedlOg \vith ilvester's method? r 3

\\nat should be done while artificial respiratIOn is being performed? .. ' ... ... I4L tate the treatment for strangulation 14 State lhe treatment for hanging 14( tate the treatment for mothering 14C

How may a swelling of the tis ues of the throat be caused? ... ,., ... 14tate the treatmen t for swelling of the tissues of the throat .. 141 tate the treatment for suffocation by make or gase 141. 142 H o w IS electricity conveyed? ... ..,... 1.12

How would you liberate a suiferer from contact with an electnc medium?, ,,142. 14:'

:\.That would you .10 when the sufferer was removed from (.ontact? .. . .. 4 hat wOI.lJd you do in [be case of a lightning stroke? ,

CH APTER VI. POISONING.

Poisons may be classified according to their treat· ment under two heads :-

I. - Those which do not stain the mouth , and in the treatment of which an emetic is to be given. Amongst these are :-

(a) Arsenic, Phosphorus (contained in rat poison and lucifer matches), Tartar emetic and Corrosive ubllInate, which cause a metallic taste in the mouth and a burning pain in the mouth, 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 convulsions, delirium, failure of respiration and collapse.

(

c) Poisonous meat, fish and fungi (often mistaken for mushrooms). Suspicion of these poisons should be directed to cases where several persons \\'ho have partaken of the same food develop similar signs and symptoms.

(d) Alcohol, which may cause collapse.

(e) Opium and its prepa rations, M orphi a , 149

Laudan u m, Paregoric, Chl o rodyne, yrup of Poppies and yarious soothi ng drinks and cordials; these cause a tendency to go to leep, which continues until sleep becomes deep and br eathing sterotorus j the pu pils of the eyes become minutely contracted (pinhead pupJls).

2. - Those which burn or stain the mouth and in the treatment of which no emetic is be given. These are of two classes:

(a) "cid, Nitric Acid (Aqua fortis), ulphurlc ACId (Oil of Vitriol), Hydrochloric, or Muriatic, Acid ( ' pirit of 'a It), strong Car bolic Acid (Phenol), Oxalic Acid, which is contained in oxalate of potash, alts of sorrel, salts of lemon and some poli hina- pastes.

(b ) . \ lkalis, such a - Caustic Potash, Caustic ' oda and Ammonia.

SU\DIARY OF C\1PLE DJRECTIO ' S FOR THE OF POI O i I ' G.

I . - Send for a d?ctor at once, stating what occurred and If possible the name of the p Olson.

2 . - Except when the lips and mouth are s tained or burned by an acid or alkali,

promptly give an emetic- that is, make the patient vomit as follows :- .

(a) Tickle til e back of tile throat with the finger or with a feather.

(b) Mustard-a dessert-spoonful in a tumblerful of luke-warm water.

(c) Salt-a table-spoonful in a tumblerful of luke-warm \\ater.

(d) Ip eCat1faniza U 'z'ne- f or a young child, a teaspoonful repeated at intervals of fifteen minutes.

3. - In 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.

Oli ve, alad, and Cod-liver oil, or oil such as that in \,,'hich sardines are prEserved, may be given; mineral nlachine oils and paraffin are unsuitable. Oil is soothing, and is therefore especially useful in poisonin g by A cid, Alkalis and such as Arsenic and Corrosive ublim ate. Demulcent dnnks, such as barley water or thin gruel, act in the same mann e r, and are fr ee from danger in cases of phos phoru s poisoning.

These may b e given either before or after the emetic if the poison calls for one,

Strong Tea acts as a neutraliser of many pOisons, IS!

and is always s.lfe . ,,\ 11.lndful of tea should be thro\\ n into; kettl<.: and boded.

4. - If the lips and mouth are stained or burned give no emetic, but -

( a) If an ACid 15 kno\\ n to be the pOIson give an Alkali at once. FH ' r \\a h the mouth out freely with lillIe ,yater or other alkalll1e mi\ture, such a ' soda, chalk, \\ hiting, or maglle ILl or wall pia ter in \yater, and after· wards let the patient SIp a little of It. .'oda and potash are not to be gi';en in the cae of pOlsonll1g by oxalIC aCid.

(/I) If a strong . AlkalI J. knO\\"l1 to be the poison gl\'e an aCid at once. Fir. t \\'a h the mouth fre<.:ly with kmon juice or vinegar <-Ji.luted \\llh an equ.ti quantity of \\ater, and afrerward Id the patient sip a ltttle of ie.

In both cases gl\'e oil (Rule 3).

5. - When a person has swallowed poison and to go to sleep, keep him awake by him ab o ut and slapPll1g- face, neck and chest \\'Ith a wet to\\ el. trong black coffee mav be given to drink. Slapping the of the feet also be tried.

6, - If the throat is so swollen as to threaten obstruction to the air passaO'e apply hot fla nnels or poultices to the fro;t the neck and give frequent sips of cold drinks.

IS2

,.-Apply artificial respiration if breathing cannot be discerned.

8. - Treat shock and collapse.

9. - Prs;serve any vomited matter, food, or other substance, suspected of being the poison. Do not wash vessel which may 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 will aid in the detection of this poison; the lips and mouth are usually stained white, and several nervouS symptoms come 011.

TREATME'T.

1.- GiYe milk, to a pint of \\ hlch half an oun ce of Epsom . alts has been added.

2.- Treat according to the general rules.

PRUSSIC ACID.

The action of this poison is cxtrcmcly rapid. Giddiness, staggering, insensibilIty accompanied by panting respiration, profound collapse and possibly convulsions are the general signs, and in addItIOn a smell of bitter almonds is ofte n present.

TREAT\TENT.

I.-Place the patient in the 0pen air.

J

2.-Dash cold water on the head and spine contll1uously.

3.-Apply artificial respiration.

4.-Hold sl1elling salts to the nostrils.

5·-Treat shock and collapse. (ee page I35.)

FISH AND FU l GI.

( !he sIgns an? symptoms are yomiting and purging dlarrhcea), colIc, headache, great weakness raised temperature and a quick pul e. '

TREAD1ENT.

I.-Give an emetic.

2.-'Vhen the emetic has acted, give castor oil.

3 -Treat collapse. (ec page 135 .)

TRYCHNINE.

Tdh; sIgns and symptoms, are a feeling of suffocation IVI leatures a d I . ' h h d ,n convu slons. The patient rests on IS ea and feet, and the body is arched.

TREAT:.\IENT.

I.-Give an emetic.

2.-Apply artificial respiration.

ALCOHOL.

I.-Give an emetic if the patient can swallow t

2.-(Treat collapse by keeping the patient e c. See page I35.) ,

QUE 'TION' ON HAPTER VI.

Tilt lIulJlcra!s iJld/cate thl' fa"rel' when: the anJ1uers may be found.

['A(,F

Under "haL t\\'o may poisons be ? 14· , q9

\Yhat are the )'mptoms of poisoning by arsenic? .. q,'

\Yhal other poisons gi\'e rise to the same ? 14

\Yhat poi ons give rise to con\'ulsion , delIrIum, faIlure of respiration and collapse? ... .. .. , ... q

If everal people who had partaken uf the same f<l od developed similar sign. and I;y \\ hat would you suspeci they had . q .

\Vhat condition may result from pOlsonln.g iJ); alcuhol? J.t)

\Yhat are the effects of such poisons as opIUm ... , q8, qC)

\Yhat two cia es of poison burn o r the mouth? qC)

\Yuuld you gi,'e an for pOlson:-;? 149

'ame some of the pnn c lpal aCids ... LtC)

Tame some of the principal alkalis qC) the general rules fo r the treatment of puison, ing ... ... "','" ... .... Lt9 to 15 2

late the bet methods of making a person " omit 150

How would you treat a case of acid. ? ... .,'; 151

lI o w would you treat a case o f p OlsOl1lng by an alkalI.. 15 1

State the signs, symp toms and treatment o f carbolIc acid poisoning ... ... .., ... ." . .. 15 2

State the signs, symptoms and treatment of pUlsol11ng by Prussic Acid ..

... ... ... ... 15 2 , 153

State the Signs, symptoms and treatment L f poisoning by poisonous food ...

.. . ... 153

tate the signs, symptoms and treatm e nt uf p Ulsonlng hy Strychnine ... ... 153

What would yo u d o in the case of alcoholic poisoning? 153

5'

\. HAPTER VIl

BAN D AG I NG .

E s ma rc h 's Tri a ngular Ba n dage has bee n descr ibed m Chapte r II. I t may be applied to keep a d ressing on a \\'ouI?d: burn or. of any part of the body. (·r for an Il1Jury of a Jomt.

For the Scalp (Fig. Fold a hem abo u t It mches deep along the base of a bandage; place the bandage on the head so that the hem lies o n the forehead close down to the eyebrows, and the point hangs d o wn at the back; carry the t\\'o ends round the head above th{> ears and tie them on the forehead; dr3.w the point first downwards, and then turn it up and pin it on to F IG. 62. the ba n dage on the top of the head.

For the Forehead, Side of the Head

Eyp Cheek, and for any part of the body that r ound (as the or thigh, etc.) the narrow ban dage hnuld be used, Its centre being placed o ve r th e

dressing, and the ends being earned round the head or limb, as the case may be, and tied over th wound.

For the Shoulder ( F ig. 63)' Place the ce tre of a band age on the shoulder, with the pomt runnUlg

FIG. 63. FIG. 64.

up the side of the neck; fold a hem along th e carry the ends round the middle of the arm d tIe them. Place one end of a broad bandage 0 el the point of the first bandage and sling the arm by carrying the other end over the sound shou lder and tying the ends at the side of the turn d own the point of the first bandage, draw It tIght and pm t

For the Hip (Fig. 6-.t). Tie a narro\\' bandage round the 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 second bandage; place its centre over the dressing, carry the e n ds round the thigh and tie them; then carry the point up under the

FIG. 65. FIC. 66. first bandage, turn it UO\\11 over the knot and pin it.

For the Hand when the fingers are xtended (Fig. 65). a hem along the base of a bandage i place Wflst on the hem with the fingers towards the pOl11t; then bring the point oyer the wrist, pass the ends round the wrist cross and tie them' brin<Y the point oyer the knot and pin it to bandage on the hand.

For the Foot (Fi g. 66) . Place the foot on the centre €)f the with the toe s towards th e point; draw up the POInt over the instep, bring the ends forward and cros s them ; now pass th e end s round

F I G. 67a .

the and ti e th e m. Draw th e point forward and pIn It to th e ba nd age o n th e in s t ep.

For the Front of the Chest ( Fi os. 67a and 67b). Place th e m id d le of the ov e r the dressing with the point ove r th e shoulder the same Ii de ; carry the ends round the waist and tie them;

the n draw the point oyer the shoukler and tie it to one of the e n ds.

For the Back. The bandage is applied a!-) the foregoi n g. except that it is begun at the bac k.

For the Knee. Fold a narro\\ hem along the base of a bandage; by the POlllt on the thigh and the mIddle of the base jLlst belo\\' the knee-cap; cros , the fir:,t behll1d the knee. then over the thIgh ancl tIe them. llring the poin t do\\'n and pin it to the oL1se (FIg . 68).

For the Elbow. Fold a FIG. () , narro\\' hem along the base o f a bandage ; lay the point on the back of the arm and the mIddle of the oa e on the back of the forearm; cross t he cnds first 111 front of the e lbow, t hen ove r t he ar m and tie the m, draw dow n a n d pi n poi n t ( FIg . 69) ·

For the Fingers and Toes \\rap

a strip of calico or linen round and rounu the part; split thc frec' end, and secure It round the \\ rist or ankle , 00.

CHAPTER VIII.

METHODS OF CARRYING .

THE FOUR-HANDED SEAT.

This seat is used when the patient can assIst th ' bearers and use his arms. .

1.-Two bearers face each other behind the patIent and grasp their left forearm with their right hands and

FIG. 70. each other' right forearm with their left hands (Fig. 70), and stoop down.

2.-The patient sits on the hands and places one arm round the neck of each bearer.

3·-The rise together and step off, the On the nght hand sIde of the patient with the nght foot, and the left-hand bearer with the left foot.

THE Two-HANDED SEAT.

This seat may be used to carry a helpless pati( nt .

FIG. 71.

1.-:Two bearers each other and stoop, one on each SIde of the patIent. Each bearer passes his forearm nearest to the patient's head under his back just co

below the shoulders, and, if possible, takes hold of hi'; clothing. They slightly raise the patient's back, and then pass their other forearms under the middle of his thighs ( FIg. 7 I), and cbs[J their hands by Ol1L of tbe methods shown in Figs. 7 2 and 73· .\ hi.U1dkerchld should be held in the hands if the first grip IS used.

FIG. 73.

72.

2.-The bearers rise together and step off, tht; right-hand be::ner \\-i th the rwht foot, and the left-band beart;r \yith the left foot (Fig. 74-)·

THE THREE-H.\XDED E.\T.

ThiS seat is u eful for carr)'lllg a patIent and supporting either of his 10\\ er limbs, '.\ hen be is abk to use his upper limbs.

I.-Two b ea rers face each other behind the patient. For supporting the left 11mb the beart;r to the patient's right grasps his own left \\ ri t with hi ' right hand, and the other bearer's rIght wrist \\ ith his left band. The bearer to the left grasps the first bearer's right wrist with his right hand (Fig 75). Tbis leaves his

FIG. 74.

FIG.

left hand free to support the patient's left leg. For the patient's right lower limb follow the same diretions, substituting" right" for" left" and" left" for " right." The bearers stoop do\\ n.

2.-The patient places one arm round the neck of each );)earer and sits on their hands.

3.-The bearers rise together and step off, the

FIe;. is.

right-hand bearer with the right foot, and th e lefthand bearer with the left foot.

THE FiREMAN'S LlFT.

(To be attempted only by a strong man.)

Turn the patient face downwards; place yourself at his head: stoop down, slightly raise his head and FIG 76.

shoulders and take hold of birn close under his armpits, locking your hands on hIS back. Raise his body and rest it on your left knee; sbift your arms and, taking him round his waist, lifl 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 with your left hand and leave your right hand free.

Assistance may be given to an injured person by supporting him in the manner shown in Fig. 76 .

The plan of carryillg tIle patient b)' tlze arms and legs witlz the face do,zetll7.f 1ards, called tlze "frogs' fnarcll, " 1JlIISt never be used, as dealll may ellsue from this treatment.

bIPROVISED STRETCHERS.

A stretcher may be improvised as fo11o\\s :-

I.-Turn the sleeves ofa coat inside out; pass two strong poles through them; button tbe coat. The patient sits on the back of the coat and rests against the back of the front bearer (Fig. 78). If a longer stretcher is required two or thr ee coats must be treated in the same manner. The poles may be kept apart by strips of wood lashed to the poles at both ends of the bed formed by the coats (Fig. 79)'

rrG. 77.

THE FORE AND AFT METHOD.

This J)l f . an a carryIng is useful wben space does not p rl11ll of a band seat.

2 holes in the bottom c orners of one or two sacks and pa s stout poles through them .

3·-S 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 ach side and grasp the middle of the pole \\'ith one halld, and \lear the end with the other. They walk sideways .

{ . - \. hurdle, broad piece of wood, or sh utter may be used as a stretcher' some straw, hay, or clotbing should be placed on it, and coyered \\ ith a piece of stout cloth or sacking; the latter is useful in the patient off the stretcher.

..:\l\\'ays test an impro\·i. ed stretcher before use.

'tretchers mut be carried, and the patient placed on them, a laid down in the " Exercises./I .\s a gent:ral rule carr} the patient feet foremost. The exceptions are ;-

(a) \\'hen gUlIlg up bill with a patient \;ho 'c 10\\ er limbs are not injured.

(I)) \\ Then going do\\ 11 hill \rith a I,atient \\ ho c 10\\ er limbs are injured .

• \ \ Old lifting the :trctcber over ditches or wall, but \\ here these cannot be a\'oided the stretcher m u t be earned in the follo\\ing \\uys ;._

To RO A DITCH.

In crossing a ditch, the stretcher hould be lowered \\ ith its foot one pace from the edge of the ditch .

I70

Nos. I and 2* bearers then descend. Th e stretcher, with the patient upon It, is aftenyards advanced, Nos. I and 2 in the ditl h supporting the front end " ' hile its other end rest:> on the edge of the ground above . No. 3 no\\' descends. All the Nos. now carry the stretcher to the opposite side, and the foot of the stretcher is mack to rest on the edge of the ground, while the bead i- supported by _ TO. 3 in the ditch. No. I climbs out, TO . 2 renlaJI1l11g in the ditch to assist 1\0. 3. The stretcher is lifted fOT\\J.rcl on the ground above, and rests there \\ hIle Nos. 2 and 3 climb up.

To eRO;:,.') .\ IV.\LL.

The stretcher is 10\\ cred \yith the foot about one pace from the \vall. 0-', I and 2 bearers then take hold of th e foot of the stretcher, and 1\0. 3 of the head; the stretcher is raised till the foot IS placed on the w<"tll.

1 o . I then climbs O\'er the \\::tll a nd takes hold of the foot of the stretcher, \\"hile Nos. 2 a n d 3 support the head; the stretcher is then carried forward till the head rests on the wall, No. I supporting th e foot. Nos. 2 a nd 3 th e n climb o yer the \\"all and take hold . of th e head of the stretcher, \\'hich is th e n slo\\ ly lifted off the wall on to the ground, and th e bearers t a ke th e ir usual places .

'" These num bers are explained later in the detailed "Stretcher Exer cises . "

171

To LOAD A \VAG ON .

The stretcher is lo\yered with the foo t one pact. from the e nd of the \\ ago n. N os. I and 2 take hold of the foot of the stretc her, No. 3 the head. The stretch er IS then r aised and c arried forward till the front wheels rest on the floor of th e wagon. No. I th en ju mps into the wagon, \\hile No.2 goes to the head of the stretcher and helps NO.3. The stretche J is then pushed slowly in to the wagon. If the tall board cannot be sh ut, th e stretcher must be lashed firmly to the sides of the \\agon.

To 1JxLO.\ D A W AGO:-l'.

Nos. 2 and 3 take hold of the head of the stretcher, while No. I gets into the \\agon; the stretcher is th en gradually dra\\ n out lIll the foot-wheels rest o n th e edge of the wagon. No. I jumps out of the wagon, and with NO.2 takes hold of the foot of the stretcher, NO.3 supporting the head . The stretcher is now gently dra\\n a\\ay one pace and 10\yered.

\Vith four bearers Nos. I and 2 would lift the foot of the stretcher, \\ hile Tos. 3 and 4 lift the head . ThIS applies to crossing a ditch or walL as well 25 to loading and unloading a wagon.

CHAPT ER IX.

STRETCHER TRANSPORT.

The "Fudey" Stretchers (Model are three patterns viz "Ordinary,""

d In aeneral principle they are abkc, an b b· d · ted the poles the compon ent parts emg eSlgna

Fig. 80.-0RDINARY STRETCHER-CLOSED.

F · 81 - TELESCOPIC-HANDLED STRETCHER-OPEN. Ig. . handles, traverse bars, foot \\ heels, bed, pillow sack and slings. . f . h

The Ordinary (Fi g. 8<:», is 7 eet S m length, and I foot TO lllch es mde. ,!,he e feet in length, and th e handles Jot mches. . e . h' 3' ches At the head of the stretcher IS a helg t IS S"4 m . . b fill d canvas overlay (the pillow sack) which can e' 11 e with 3traw, hay, clothing, etc., form. a ow. The jointed traverse bars are provIded wIth Jomts.

for opening or closing the stretcher. The Telescoplchandled pattern (Fig. 8r) is very similar, but the handles can be slid underneath the poles, thus red ucing the length to 6 feet. This arrangement is of great value ,yhen working in confined spaces, or when a patient has to be taken up or down a narrow stairca e 'nth sharp turns. The Police stretcher is similar to the Ordll1ary pattern, but is more strongly made, and has, Il1 audition, straps for secllrlng a refractory patient.

,Vhen closed, the poles of the stretcher lie clo e together, the tra, erse bars being bent im\arcls, the cam'as beel neatly folJed on the top of the poles nnd held 111 position by the slings \\ hich are laid along the cam'as, and ecured ;'.' a trap, pla< ed transversely at the enu of each sling, being through the large loop of the other, and rounu the I ole ::lIld bed.

In closing a stretcher care hould Lc taken to raise the centre of the canvas \\ hen pu hing in the traverse bar, as it is otherwise liahle to get caugbt.

To prepare, or open a stretcher, unbuckle the trans\ crse straps of each sling: remm'e the slings from the stretcher; separate the poles; take bold of each traverse bar and draw it for\\ard. The slings will then be folded to half theIr length, one being laid ne.otly over the handles at each end of the stretcher.

As a general rule, the stretcher \\ ill be prepared by Nus. I and bearers 111 Exercises 1., II ., and III. ;

and by No. 2 in Exercise IV. These bearers will, however, if required, assist the other hearers in attending to the patient 's injuries.

Note.- The various mo\'ements detailed in the following E:..:erci es 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 EXERCI

O riginally drawn up by ir John Furley, and revised in I90-l- to accord ",ith the drills adopted by the Royal Army Medical Corps :-

EXERCI E No . 1.

FOR FOUR BEARERS.

1.-The I nstructor selects the bearers and num bers them-I, 2, 3, -l- at his discretion. hould one man be taller and stronger than the others, he should he styled 3, as he will have to bear the hea\ ier part of the burden .'''< All orders will be given by No. -l-.

2. - " Fall in. "-Nos. I, 2, and 3 take positiol'l on the left side of and fa ing the patient. No . I places himself at the patient'S knees, ?\o. 2 at the hips, NO.3 at the patient ' s shoulders. At the same

'" Bearers should, however, be taught to take any of the yositions named in the following Exercisec;, whelher that of No. I, 2,3, or 4 bearer.

[75

t ime No. 4 places the prepared stretcher on th e gro u nd by the right side of the patient abcut two

FIG. 82.

paces away from him, and then takes position opposite to and facing NO.2 . (Fig. 82).

3. - " Ready. "-The bearers kneel down on the left knee and take hold of the patient, No. I passing his bands and fore-arms beneath the patient's le gs , Lands wide apart. Nos. 2 and 4 pass their hands

FIG. 83. and forearms beneath the patient's hips and loins, and grasp each other's hands. No. 3 pas es bis left hand across the patient 's chest and under the right shoulder, and his right hand beneath the left shoulder (Fig 83) '

4.- " Lift. "-On the word " Lift, " the bearers raise the patient gently and rest him on the knees of Nos. I, 2, and 3 bearers (Fig. 84) ; as soon as be

FIG.

is securely rested, NO.4 disengnges hands with No. runs round by the head of the stretcher and places It under the patient, close to the other bearers' feet,

8

bemg careful that the pillow is immediately under the patient 's head 85); he then kneels down and loc k s his hands with those of No.2 (F ig. 86) .

5.-" Lower."- The bearers place the patient on the stretcher (Fig. 87), disengage their hands, and stand up.

F[c. 5.

6. - " Stand t o Stretcher. "-No. I goes to th ,foot of the' \\.lth his back to the patIent ; l O. 3 to the head \\ Ith hIS face to the patient· Nos ] and 4 remain on each side of the stretcher . '

7·-" Ready. "-Nos. I and 3 place the slmg If used) over their shoulders, stoop down, and slip the

179

loops of the ling on to the handles of the stretcher, which they then gra 'p.

As soon as all [s right the "'ord is given :-

8 .-" Lift Stretcher. "-Nos. I and 3 bearers raise the stretcher teadily together and stand up.

Nole.-Xos. 2 and 4 will now adjust the slings on the shoulders of J. as. I ant\.1, taking care that each is well belm\ the leyel of the collar and lies accurately in the holl()\\ of t he shoulder in front. They \\ ill also lenglhen or h o rten the . lings, haying regard to lhe patient' injUrIes and the relatiye height.; of the bearers.

FIC 86.

9.-" M a rch ."-The bearers moye off:- TO . I, 2, and 4- steppino- off \\ltlt theIr left foot, and NO·3

J 0

with his right toot (Fig . 87). T he step should be a short one of twenty inches, and taken with bent knees and no spnng from the fore part of the foot.

10. - " Halt. "- The bearers remain steady.

FIG. 87.

11. -" Lower Stretcher. "-The bearers place the gently on the ground, slip the loops of the slll1gs off the handles of the stretcher remo, e the slings fr0111 the shoulders, and then up.

12. - " Unload Stretcher - Ready." - The bearers prepare to take the patIent off the stretcher, as at Orders 2 and 3.

13. -" Lift ."-Tbe bearers the patient as at Order 4- (Fig. 86); NO .4, in this ase, disengages h:l11d.., ftom No.2 remm es the stretcher (Fig. 85), :111d reSllmes his former po Ition. If necessan', the bearer. will then teadil) rise together, and (a;efully ::1.1"ry the patient to the bed or other place to which It has been a rra nged to ('ol1\'ey him.

14. -" Lower. " The patient is carefully lowered .

EXER 'bE ?\o. II.

FOR THREI' BEARERS.

I.-Number the bearer'> I, 2, 3.

orders will he gl\'en by :';0. 2, \\ho will look after the injured part of the patient's body or limbs, to ee that no bandage or !:>pl111ts become displaced, and al'o that :-Jo. I hearer. 111 lifting or carrying the stretcher does not touch the patient's f, et.

2.-" Place the Stretcher."-No. 3 places the stretcher in a line with the patient's body, the foot of the "tretcher being close to his had. .

J 3 .-" Fall In. "-No. I places him elf on the left side of the patient in a line \\ ith his knee, TO. 2 on the left side just belm\' the patient's shoulders a n d NO.3 at the right side, and faces NO.2. '

4. - "Ready. " - All kneel on the left knee. No. I p laces his hands, well a part, underneath the 10\\ er limbs, alw ays taking care, in case of a fracture , to have one hand o n each sid e of the seat of injury. Nos. 2 and 3 grasp ea ch oth e r 's h a nd s und e r the should e r a nd thi gh s of th e pa ti ent (Fig. 8 8) .

FI r; 88.

5. - " Lift. " - Th e b ea rers rise tog ether, keeping the patient in a hori zont a l position (Fig. 89) .

6. - " March. " - AII ta ke sho rt sid e- pace s, ca rryin g t he pati ent over th e str e lc her until his h ead is immed iately above the pillow. I 3

7·-" Hal t." - T he be.He rs remaJ l1 stea dy .

8 " L ., '1'1 I . - ow.er. - 1C )carer..., SLOOp do\\' n, ge ntly place t he pa(Je n l o n thc ' tretcher, di engage t hei r ha n a n d t he n sla n U up.

F IG. Rq .

9. - "Fall In. "-No. I pbc es himself at the foot of the tretch e r with hi back to the patient TO. 2 plac es at the le ft sid e of the patient, and No. 3 at the head , with his face towards the patient .

I 4

10. - " Ready."-Nos . I and 3 place the slings (if u sed) over their shoulders, stoop down, and slip the lo ops of the slings on to the ha nd les of the st retcher, wh ich they then grasp.

As soon as all is right the "'ord is gi\'en-

II. - " Lift Stretcher. "-Nos . I and 3 bearers raise the stretcher steadIly together and stand up.

TO. 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. lle will also lengthen or shorten the slings, having regard to the injuries and the relative heights of lhe bearers.

12. - " March. "- os . I and 2 step off with the left foot, and TO. 3 with the right. The tep should be a short one of 20 inch s, and taken \\ ith bent knees, and no spring from the fore part of the foot.

13. - " Halt. "--The bearers remain steady .

14. - " Lower Stretcher. "--The b arers place the stretcher gently on the ground, slip the loops of the slings off the handles of the stretcher, remO\ L' the slings from the shoulders, and then stand up .

IS. - " Unload Stretcher - Ready." - The bearers prepare to take the patie nt off the stretcher, as at Orders 3 and 4 (Fig . 88),

16.- " Lift." - The bearers raise the patient, as at O rde r 5, a nd carry him by sh or t side steps, clear of th e stret ch e r, to the bed , or othe r place to whIch it has bee n a rrange d to co nvey h im (F ig. 8 9).

18 5

17. - " Lower."- The patient IS car efully lower ed, EXERCI E No . II I.

WHE:-l' O:-l'LY THREE BEARERS ARE AVAILABLE AND THE TRETCHER CA . _ OT BE PLACED AS IN EXERCISE II.

I.-The In tructor numbers the bearers-I 2 3 All orders will be given by NO.2 . ' ,

2 .-" Pl a ce the Stretcher. "-No. 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 take the same positions on one side of the patient, as laid down in ExerCIse No. I.

4·-" Ready. "-l os. I, 2, and 3 kneel down on the left knee, placing themselves as close to the patient as they conveniently can, and then take hold of him as directed in Exercise o. I.

5·- " Lift. "-Nos. I, 2, and 3 rai e the patient as dIrected in Exercise No. I, and then move in a kneeling position up to the stretcher.

6. - " Lower. "-The bearers bend forward, carefully lower the patient on to the stretcher, an d d isengage hands.

I 6

7. - " Stand to Stretcher." -All the bearers stand up; No. I goes to the foot, o. 2 remains In position at the side, and 1 o. 3 goes to the head o{ the stretcher.

8. - " Ready." - Nos. I and 3 place the slings (i f used) oyer their hould ers, stoop do \\"l1 , anrl sl.p the loops of the slings on to the handles of the stretcher, which they then grasp .

9.-" Lift Stretcher. " -. -os. rand 3 bearers raIse the stretcher steadily together and stand up.

NO.2 will now atljust the sling,- 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 110110\\ of the shoulder in front. II e will also l engthen or shorten the slings, haying regard to the patient" injuries and the relati\'e heights of the hearers.

10. - " rand 2 step off \YJth the ieft foot, and X o. 3 with the TIght. The step should be a short one of 20 inches and taken wIth bent n ees, and no spring from the fore part of the foot.

11. - " Halt." -The bearer remain steady.

12. - " Lower Stretcher." -The bearers place t he stretcher gently on the ground, slip the loops of the slings off the handles of the stretcher, remo"e he slings from the shoulders, and then stand up.

13.--" Unload Stretcher- Ready." - No. J places himself on the left side of the patient, and in ta. lme with his knees, No. 2 on the left side just below the patient's shoulders, and NO.3 at t he right I 7

ide, and faces 1 o. 2. kneel on the left knee. o. I place, hi h,1l1ds, \\ e ll apart, underneath the lo\\'er limb;', al\\ ays taking carc, III case of a fracture, to hayc one hand on each side of the seat of lOS. 2 and 3 gra P each other" hands under the "ihouldcrs and thIghs of the patient.

14.-" Lift ." - The together to theIr fed, keeplllg the patient in a horizontal poitlOn, and c.nry h1111 by short side steps, clear of the stretcher, to the bed or other place to which it has been arranged to conn;y him.

15 ·-" Lower." - Th e patient i" carefully lo\yered.

EXERCI 'E Xo. I\'.

F OR 1:Sf L .\i'\IJ 1\ARROil' CUTTI:\GS II H.l:.RE

TIl 0 0;\,1 \' C.\X BE EXGAGED.

?\ 0 . I and :2 \\'jll carefully place the stretcher in 8. lltle \\ ith the injured man's body, the foot of th e stret her bell1g, jf possible, -.l,< close to hi head.

N'o. rtraddle . acros the p8.tient 's legs, placing hlS right toot, WIth the toe turned outwards, a little below the patIent's knees, and "'ith the toe of the left foot close to the heel of No.2; he th 11 :,toop down, pa scs the left hand under the patient's thIghs and

• It is not a<l\' i able to lie too particular a to the head or !nut a stretcher a mine, a i t would probably be quite llnpossd.lle tu re\'er"e It.

th e right hand across and under patient 's N O.2 places his feet one 011 each sIde of the patlen t bet ween his body and arms, the toe of each foot as near the armpits as possible. He then sto ops down and passes his hands between the sides of the chest and the arms underneath tr.e shoulders, and locks

90.

the fingers (Fig. 90). If the patient 's arn1S are umnjured he may put them of No.2, and by this means greatly assIst hIm 111 lrftmg.

'Vhen both are ready, NO.1 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, o. 2 by very short steps. NO.1 by bending his body forward as much as he can without 71107}/llg his fiet (Fig. 91). NO.1 now gives the order" Halt " whereupon TO. 2 remains steady, and No. I ad,-ances his nght foot to his left, and

91.

ad"ances his left foot till the toe to u ches the heel of NO.2. No. 1 then gives the ord e r " Advance, " when the patient will again be moved forward. These movements are to be repeated u ntll

FIG.

FIG.

the patient is over the stretcher, wh en he is to be gently lowered.

The following Stretcher Exercise i adapted by permission from the R oyal Army C orps ual, 190 8.

All ord ers will be gi\'en by )\0. -to

I. "Fall in."' ix bearers fall 111 behind each other.

2. "Number." -The bearers number from front to rear.

3. "No.3 Bearer, right (or left) turn - supply stretcher- quick march."-No . 3 bearer will march to the stretcher, stoop, lay hold of it and place it on his right shoulder at the slope, holding it by the lower fool wheels, wheels to the front. soon as the bearer is provided with a stretcher, he will turn 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, front end of the poles in lin e \\ ith the toes of No. f a nd 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 01 the poles, close to and touching the stretcher WIth

FIG. 93.

FIG. 9-+.

FIG. 96.

his righ t foot . Nos. 2, 4, 5 and 6 take up their positio n s one pace behind and covering off the bearer in fro n t of them (Fig . 92).

S. "Lift Stretcher. " -1 os. 1 and 3 stoop, grasp both handles of the poles "ith the right hand, rise 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 \yithout further \\'ord of command one pace from the head of and in a lme with the patient (Fig·93)·

7. "Lower Stretcher. " - os. 1 and 3 stoop, place the stretcher quietly on the ground, and rise smartly together.

8. "Prepare Stretcher. " -.1. os. I and 3 turn to the right, kneel on the left knee, unbuckle the transverse straps, and place the slings on the ground beside them, separate the poles, and straighten the traverses.

Two . On the word two each takes a sling, doubles it on itself, slips the loop thus formed on the handle, and places the free ends o\'er opposite handle, buckle uppermost. They then nsc and turn to their left together.

, Vhile the stretcher is being prepared by Tos. I and 3, the disengaged bearers. will advance and r ender to the patien t such assIstance as may be req u ired (Fig . 9 4). 193

The necessary assistance having been rendered, No . 4 will give the com mand-

9· "Load Stretcher. II - The bearers place themselves as fo11o\\s :-Nos. I, 2 and 3 on the left, Nos. 4, 5 and 6 on the right of the patient; Nos . I and 4 at the knees, 2 and 5 at the hipS, 3 and 6 at the shoulder ' , the y, hole kneeling on the left knee.

Nos. 1 and 4- pass their hand::; beneath the patIent's knees 2 and 5 beneath the hIPS, 3 and 6 beneath the care bemg taken of the injured part, one of the bearers beIng detaded for this purpose (FIg. 95).

1.0' " Lift. "-Thc whole ",ill carefully lift the patIent on to the knees of Nos . I 2 and 3.

Two. • os. 4, 5 and 6 will then disengage, rise j Nos. 4- and 6 step back one pace. X o. 5 turns to hIS left, to the ·trctcher, takes hold of and raIses It, left hand across, the near pole re.tll1g on the left hlp; carrying the stretcher, he returns to hIS place between 4- and 6, and place it beneath the patient.

Tlzree. .Nos. 4 and 6 step fOr\\ard one pace, and together \\ lth NO.5 kneel down on the left knee, and prepare to assist 111 lowering the patient (Fig. 96 ).

II . " Lower. "- The patient is lowered .10\\ ly and ge?t1y on to the cent re of the canvas (specIal care bemg taken of the injured part).

Two. The bearers disengage, rise; Nos. J, 2, 3 and 6 turn t o the left j Nos. 4- and 5 to the right ; H

19-1

N o laces himself three paces in of . 4h P No 6 havintr collected the kIt and arms st retc er. . ,' b e of o f the patient, places himself three p<l:ces 111 r ar 1 . 2 and 5 opposite the centre th e stretc leI, os. LIt l'ft of the stretcher. The \\ .hole are no\\' real Y 0 I stretcher and move off (Fig. 97)·

Fig. 97. Fig. 98 .

12. "Lift Stretcher. "- os. 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, nse, holding the sling at the full extent of the arl1l, buckle to the front, take a side pace to the front between the lundles, and place the slmg oyer the shoulders dl\'iding It equally, buckle to the riaht. The slmgs shuuld be placed so that they lIe well bela\\' the collar uf the coat behind and in the hollo\\' of the shoulder IJ1 front. In the event of the slmgs requiring to be adjusted, either as regards length or for the greater comfort of the bearers, No. 4 \\ III Jetati a bearer to Gur) this out, the length of the sling being aclju teel, \"hen necessary, by means of the buckles.

T,wo. Nos. I and 3 stoop, slIp the loops oYer the handle, commencind \\ Ith the left, and grasp the handles firmly.

Tlzree. Nos. I and 3 rise slo\\ I)' together, No. 3 conformmg closely to the 1110\ ements of Xo. 1.

13· "Advance."-Nos. I, 2 4, 5 and 6 step off with the left foot, No. 3 with the right, stepping short, knees bent, feet raised as little as possible.

14· " Halt. "- The whole halt.

IS · " Unload Stretcher. "- The bearers place themselves in the same position at the stretcher as described for Loading (Order 9) .

16. "Lift. " -As described for Loading (Order 10), HZ

196 except that the stretcher is carried forward three paces clear of the patient's feet.

17. "Lower."-The pa.tient is to the ground. The bearers dIsengage, nse; . os. T, 2 and 3 turn to the left, 4, 5 a nd 6 to the nght, and the whole step off to their at. the tretcher, as at Order " tand to .'tretcher (FIg . 98).

The Ashford Litter IS made up of either of the Furley stretchers mentioned on pages J 72 and 173, a wheeled under-carriage and a hood apro n, or, if light \\:c t-reslst1l1g canvas The stretcher IS kept 111 pOSltlOn on the b the foot·wheels, \\'hich Ilt into slots 111 the sIdes Gf under-carriage, and it can be :emo\'c u at plcasure. The under-carriage i!-> fitted \nth cranked aXl:: which allows the bearer . to pa.: the !->tretchcl between the wheels 1I1stead of llft1l1g It o\'er them. At both en ds are two legs which may be turned up as handles ",hen wheeling the litter. The hood and fit into sockets screwed to the stretcher. In wl-:eelll1g the litter care should be taken keep the patlcnt 111 a position. hould It be .ne essary two bearers can easily lift the litter and patJent.

The Rea-Edwards Litter, introduced in is used in a similar manner. and one .model of It IS fitted with pneumatic tyres, which add to the comfort of the patient and to the ease of propulslOn.

197

CHAPTER X.

(Be/JIg the Ftfth Lec/llre for Females only, in accordance wt'th S..1'!!ablls 58.)

BY E. :\IACDO\\,ELL CO GRAVE, :\I.D., F.R.C.P.I .

PR EPARATIO. FOR RECEPTIOX OF ACClDE.XT CASES.

\VHEN ne\\ s of an accident comes, preparations should at once be made so as to ba\'e eyer) thinO' ready before the injured person is brougbt in. Of course the preparations needful \\ill vary according to the nature and extent of the injury hut the following are the chief things which may ha\'e to be done.

CHOlCF "\\'D PREP,\RATlOX OF

.\ room must be chosen, In a bad case this should be one ea il)' reached, as it i' chfficult to carry an injured person through nar[')w passages and up-stairs Unles . there is some such reason against it5 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 \\ herever the bearers would be likely to require rest.

Useless furniture should be removed from the bedroom. The bed should be drawn out from the wall

19S

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 j cow;r the hot bottles with flannel.

If the injury is very severe, if mud-stained clothes have to be removed, or if extensive dressings have t 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 first instance. This should be so arranged that soiling may do no harm j old sheets, waterpoof materials, thin OIlcloths, or eyen ne\\ spaper, may be used as a protection.

AND CARRYING.

If present at the place where the accident occurred, it will be necessary to see that the patient is carefully lifted after proper (( Fir t Aid" has been rendered.

The followin g rules should be remembered:- elect the proper number of persons to assist, and do not let them lift the patient until they thoroughly understand how they :ire to do it.

For ordinary cases, \\ here the injured person has to be lifted a very short distance, three helpers are sufficient. Two (\\ ho should be as far as possible of equal height) are to bear the weight, the third is to support and take charge of the injured part. This

199

,?on e by a person has been through a " First AId course. If the I11Jured per on is insensIb le another helper should support hIS head. '

The lifters, one at each side, should kneel on one knee, and pass their hands under the patient's back at the lo\\ er part of the shoulder-blades, and under the hIps, cJasplllg c:lch his nght hand In the other 's left. rhe injured p:lti ' nt ,>hould, jf practicable, place his arms round the necks of the bearer ' ,

The thIrd :-;holl.lcl :lttend to the . C::lt of injury; If thIS IS a tractured 11mb, he llOuld support it by plaCIl1g- the p:llms of hIS h:lJ1cls under the limb one above :lJ1d one belu\\' the SC::lt of the inJ'un' t fi It' l ' -, b b I 1r111)' Hlt ::tYOIC Illg unnecessary pre<;:-;ure.

The helpers should remain tIm' until the order ,I Lift" is giycn, th.en they should all lift slo\\ Iy a.nd "teaddy, ayoldlllg prs, atten pts to change positIOn of hands, etc.

H the per 'on is to be placed on a stretcher or hutter, thIS should be preyiou '1\ placed with the bottom end at his bead; the beai'ers hould then move, one at each side of it, until the patient is oyer It.. The word II Lo\\'er " should then be giYen, and the lDJured person shou1d then be s1myl), lowered. A pillow or folded-up should be ready, and a the sufferer IS lowered thIS should be placed under hi head. *

• Full directions are gi\-en in Chapter IX.

MEA:,\ OF CARR\"I 'G.

Besides a stretcher, and substitutes such as a gate, a shutter, or a door, other means of carrying :tn b improvised .

In slicrht injuries, where the injured per 'on is unable to walk o two bearers can carry him by forming a fourkmded: three-handed, or two-handecf scat.

A four-handed seat is formed as described on page 160

A three.handed seat is made as descri bed on page 162

The two-handed seat is made as described on page 161.

A single helper can lift by supporting wllh one arm the two knees, and with the other the back. The arms must be passed well under before commencing to lift.

A single helper can give support by putting his arm round the waist, grasping the hip and placing the mjured person's arm round his own neck, holding the hand with his own hand (Fig. 76 , page r65)·

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 \yound up on a brool:' handle until there is just room for a person to be between. This requires four bearers, t\\O at each side, to prevent the sheet slipping.

201 CARRYI ' G UP STAIRS.

_ In carrying a stretcher up stairs the head should go mst, and an extra helper should assist at the lower end, so as to raise it and keep the stretcher nearly horizontal.

The three, four-handed seat may be used up tans; or a strong chair, the patient be1l1g carned up backwards. In the latter case one helper should walk .the chair and help to support It, and to prevent the Injured person slipping out.

LIFTI ' G INTO BED.

If the bed is n:trro\\, and there is room the stretcher should be placed on the floor \\ith the head close to the foot of the bed. The injured person should then be lifted over the foot and placed on the bed If the bed is too \\ ide to admit of this, the stretcher should be placed beside it, and two helpers should stand at the far side 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 The injured person is then lifted, helper pulls away the stretcher, and after a single step forward the burden is placed on the bed . .

PREPAR.\TJO'\ OF BED

A firm mattress, not a feather bed, shou1d be selecteu. If there IS much injury, or if dressings ha\ e to be applied, a dra\y-sheet ought to be placed un the bed. It should be of four or more thicknesses, extend across the bed, and reach frum the mIddle 01 the paLJent's back to lhe knee ' . .\ picce of water proof or of thll1 od cloth . hould be placed Ullier the dra\\'-sheet. .\s the dra\\-sheet becul11L.:s soiled, the '()dell porllull ."hould be rolled anc1 a cleall part dr:1\\'n smu()lhly ul1l1er the patient.

In fracture of the leg or sprained ankle and sumL.: other cases, a "cradic" (Fig. 99) should be improvised, The use of ,1 .. cradle" is to ,>upporl the beel-clothes and keep them from IJressing on lhe limb. A l>anLl-ho.\. (Fi er , 100), three-legged stool 101). or hoop S,l\\ n aero..;:; and the t\\'() hal\es '>et ured together 102 \, may be used. _\ c rkc;cre\\' passed through the bed-clothe'>, \\ ith its point guarded by a cork, and tied by string to the beel or a nail in tIll' wall, \\ ill ) the pressnre ()f thl: b d- 'lothes

RE.\lO\"l'\G THE CLOTHE',

I n taking clothes off an injured person a few rules should be borne in mind,

In seriolls cases it is much better to acrifice the clothes than to run any risk of increasing the injur) ,

2 0 3 FIG, lo t .

In remoying a coat, et c .. in a case of fractured arm the uninjured arm should be drawn out first.

In putting on a coa t or shirt the injured arm should be put in first .

In burns and scald s nothing should ev e r b e dragge d off. A sharp p a ir of sc isso rs sh o uld b e use d, a nd e ve rything n o t a dh ering sho uld b e c ut aw ay . If a nything a dh e res it sh o uld b e le ft until me di cal ai d

FI G 102.

can b e obta in ed. The clothin g a dh e rin g may, with advantage, be soaked with oil. To remove the trousers from a sever ely injured limb, the outside seam should be ripp e d up.

PREPAR ATIONS F OR SURG E O .

As soon a s the injured person has bee n atte nd e d to, preparation should be made for the surgeon ' s yi s it.

205

Th ep re parat io n n eed ful will depen d upo n th e nature of th e ase . Th e foll owing hints may be of use :-

A Ere in th e room helps ventila ti o n , even in u mm e r. T he r e sho uld be pl en ty of water, hot, cold, and a lso boi li ng, also severa l basins, plenty of c lean towels and soap . There sho ul d be something to empty w;lter into; a fo o t-bath does welL Th baSinS should be placed on a table, covered \\ith a clean whIte cloth: a large to\\el make!'> <l 'iult<lble cloth; the to\\T!ls, folded up, should be plol.ced on the same table, and the hot an d cold water should he \\ ithll1 eas\' reel ' h . The foot-bath should be under the table or close at band .

111 the case of a burn, absorben t cotton \\"001, !)oft old 1ll1en, ad, and bakll1g soela, should be read), and materials ..,hould be torn up for bandages,

I n the case of hremorrhagc, plent) of \\ater 'hould be boiled and allo\\ eel to cool, and pads of absorbent cotton wool should be baked in a tin box in the o\'en, and at lea t two basi n s should be ready .

I n t he case of a p er on rescued from d r owni ng the sh ee t s sho u ld be t a k en off the bed , ple nt y of blankets ho uld be h ea te d be fore th e fi re, and several hot bot tl es sh o ul d be ready.

If p oult ices a re like ly to be required , boili ng water, lin see d m ea l, mu sta rd , a loaf of stale br ead, a sm all ba sin, a la rge sp oo n, s \\ ee t oil, a n d to w, flann el or handkerchiefs may b e req uired .

For fomentation, have boiling water, flann el, a kitchen rolier, and two sticks, or a large towel.

"When summoning a medical man to all accident ah\ays let him know by a written message "hat kind of case he is reqlllred to treat, so that he may bring whatever is needful. By this means valuable time may be saved.

QUESTION' OX CHAPTER X.

Tlze 111lmera/s illdimtt! tilt' pages 'wllt're lite allswers ilia)' be foulld.

What points w ould you consider when choosing a sick room? '"

JIow would you clear the way to the sick room?

\\'hat means of re ting would you pro\·ide for those carrying a patient on a stretcher? 197 197 197

IIow would you place and arrange a bed for an accident case? 197. 198

Are hot bottles necessary, and hO\l \\ ould you prepare them?

\Yhal is often necessary to lay the sufferer on in the first instance?

How would you protect this from getting soiled?

lIo\\' would you ee to the proper lifting and carrying of an injured person?

19 ' I()Q

\Vhat suhstitutes for a regular stletcher can you" uggcst?

lIo\\" is the four-handed seat made? 160, 200 16r

For what cases is this seat useful? ..

160

How is the three-handed seat made? 162, 164

For what cases is this seat useful ? ..

110\\ is the two-handed seat made?

For \\ hat ca.,es is this seat useful ? ..

How can a ingle helper lift? ...

lIo\\ can a single helper giveuppolt?

IIo\\" \\oult! you irnprO\' ise a stretcher? ..

lIow many bearer an.: required for thi .. stretclwl :'

How shnulrl a stretcher IJe carried upstairs?

1[0\\ wuuld you a p:llient upstairs on a chan?

j ll)\v wlluld you lIft a pat!em frnm a stretcher til a l Ie d)

I I 11\1 -.h o ule! a hed he prepared for an injured per li n? .

110\\ sh"lllld a. clra\\ 1,(, made? .

\\ hat would you place under th e dra\\' sheet? .:.

\Yhat "hould be clone lIith the -. (,il L' 1 part '1f a (h a ll sheet?

\Yhat is the use of a .. cradle" ?

In \\ hat II ays maya cradle h e i11lprlllis('c'l ?

I [0\\ \I "ult! y"u rem(J\'e a coat n r shirt in tl1l' ca e nf a fmct u rLd arm? ... . ..

1111\\. \\(, ult! you put on a cClat III' ,.,hin ir the arm \\ ere lllJured?

In the case of a bad bl.rn. what \\(Juld you " do clothing that adhered tu the patient?. .

J 10\\ would yuu rel11ll\' e from a e\'crel\" injured lim!>? ... '" ... ' " ... .

\\'hal preparations I\ould you make for the ''':uflTtOn's visit?

\Yhat \\uuld you get ready in the case ofa hurn'?'

And 1\ hat !n the ca e of hXl11orrhage? . .

And \\hat 111 the case ofa per"'.ll rescued frpm d'''\\llin<T?

\\ hat \I ould you get ready fOf making poulllces? :::>

And for fomentationc:?

\\-hat sort of a message \InuIt! senci' t .. \;;"mon a doctor? '"

208

INDEX.

Abd om en III wound of 112

Ac ci'dent case, preparation for 197

Acids, poisoning by 149, 151

Air, always necessary . .. 18

A lcohol, caution as to smell of 130

Alcohol, poisoning by 134, 153

Alkalis, poisoning by 149, 151

Ammonia, poisoning by 149

A natomy (elementary) 20

Ankl e 30, 32 " sprained... 64

Anterior tibial artery 93

Aorta 79

Apoplexy 132

Apparently drowned, to restore ...

Arm, bone of " fracture of Ar m-slings

Arsenic, poisoning by

Artery, brachial. . . " carotid dorsal of fout facial fem oral ... iliac occipital plantar ... p opliteal radial subclavian tibial temporal " ulnar

Artificial respiration

Atlas 121, 129,

Bite" o f rallid animal,; 106

Blanner III,II3

Rrachial artery '6

Brain 117 cOlllpression of 13 2 of 13 1 26 " fracture of 4

Broad handnge .. 37

Broken bone ,', StY Fradlfrt. Rrnnchi:t1 tulJe. 209

Bmoch·I)()ne 30

Bruises 102 Burns 102

Circulation of t he hlood, Pa/{! organs of 70 CirculaLion of the hlood, La induce .. 127 '!a\'icle 26 " fracture of 4 Clothes, remO\'al of 19, 202 ncc)'x 25 Collapse. . 138 Collar-hone 26

of the brain

Capillaries 70, 72 ('apillar)" h:"l'l1lorrhage.. 05 t 'apsule ... 3 [ Carbolic acid hy 152

143

Ar teries

" course of main

Artery, axillary ...

Art erial hremorrhage, 139 28 52 39,49 141) a rre t of 74 " practising arrest of 79 74 70 79 85 ., signs of

Auricle s ...

Axillary artery Axis

Back, bandage for 159

BackGone 23

Bandage, to apply 42 to fold 37 " to improvise.. . 37

Bandaging 155

Bed, lifting into ... 201 " preparation of 202

Belladonna, poisoning by 148

Carotid arteries... h::emorrhage from So L'arpus .. ,., 2

Carrying, means of 160, 200 upstairs 201 Cartilage 25 erehro- pinal system I I 7

Cer\"ical vertebra: 25

Cheek, bleeding from .. 1)2

Chest, bandage for IS '

Chloroclyne, poi oning hy 140 Choking ... qo

in children J 37 Cradle, hed 202 ... "),. fracture of 43 Crcpilu,; 36 Cru heel hand 55 fooL 62 Diaphragm 120 Digital prc,;,;urL' 7-1Direct violence.. 33 Dislocation 62 Ditch, to \\ iLh J 69

Dor. al arter) of fout 93 25

D r es , woman's, on fire ... 105

D r owning 139

Ea r·channel. blood issuing from Ear-passage, foreign body in 98 110 159

Elbow, bandage fur joint, fracture in-

Emetic

Epilep y . .• 14 bandage

Yoh-ing 53 14 2 149, ISO 13 2 lectric

Expiration tliangular

External carotid arten' ..

Eye, uandage fpr foreign body in

i'ace, bones of

Facial artery

Fainting

Femoral artery " "digilal pressure at groin ...

Femoral artery , tourniquet fo r

Femur fractu r e (If " . fracture of Fi ngers, bandage for " fracture of 37 120 bo 155 109 22 SI I34 89 S9 90 30 56 30 60 159 55

Fireman' lift

First aid, meaning of " student embedded

FleXIOn . . . at elbow " at knee ...

Fuod. poisoning by Foot, bandage for bones uf ...

crushed . Forearm, bones

fmctun: uf ..

Furehead, bandagl.: fnr.. " hXl110rrhag e from Foreign budy in the larpassab't: . .. in the eye " "in the r.ose

Fuur-handed seat

Fracture, apparatus for treatmeJ.t of ... causes of definition of ... general rules " fDr treatment inyoh'ing el bow joint of arm .. of ureast - bone of carpus of collar - bone of cranium of finger

21 (

Fracture ()f forearm of knee·cap of leg. 5 60 uf lo\\cr jaw ... 44 uf metacarpu" 55 of melatar. lb. 62 of pel\i" 56 ()f rib... 46 of spine 45 of t::usu" 62 llfthigh-bone... 56 of toes .. 62 ign . and symploms of " varieties of 35 3i F rost-bite 10

Fungi, pui<;oning by 153

General circulation 70 Granny kn()t 40

Creen-stick fracture 35,36 l; U1l1S, h,1.:1l1orrhage frum 97

artlli,ll.. 74 capillary.. ()S from gum.., 97 fflnn heat! and neck 0 from l{)\\ er limus... 'q frulll lung., 0i frum nlhl.: C)b from stumach 98

from throat 9 7 from tongue 97 from tooth socket... 97 frum upper limbs " internal ... 95 kinds of .. 73 "enolb I land, bandage f()r bune of ... I ranging. I launch-bones . ,.

Ilt:adand nl.:ck,arlerie,;of lIeaJ bandage for injury to 128, side of, handage for Heart

, rate ()f contraclion of

J leal-stroke

lIernia I I4

II ip. bandage for 15 7

History. meaning of 17

IIoward' method of artificial re . pi ration I rlImerns fracture of lIydrophobia

IIysterical flts

Iliac arteries ... lmp.lc tct! fracture

Indirect \'io!ence Insen ibility I26 2 52 lob .. 133 79 35, 36 .H 12

Pllt'l

Insensi bility, general rules for treatment 128

Inspirati on 120

Instep 30

Insulator ... 142

Internal carotid artery ... 80

Internal h remorrhage 95

Intestines, injury of 113 lnyoluntary muscle:; 33

Jaw,angle of 2j

" lower 23 " "fracture of ... 44

Joint, definition of 31 " injuries to... 109

Jugular vein So

Kidneys ... III "injuryof 113

Knee, bandage for 159

Knee-cap 30 " fracture of 58

Knot for bandage of lower lim b 42

Knots, reef and granny 40

Laborde's method of artificial respiration 126

Laburnum seeds, poisoning by ...

Lacerat ed wound 7 .;

Large arm-sling 39

Laudanum, poisoning by 149

Leg, bones of ... 30 211

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 vertebrre Lungs hremorrhage

l\Iarshall Hall's method of artificial respiration

Medium bandage l\Ietacarpus :\1 fracture of ... " fracture of ...

Middle line of body

louth, blood i suing from

Muscles " ruptured uscular action ...

?\ en'ou system ... e, foreign body in hrcmorrhage from

Occipital artery ..

Opium, pois un ing by

Pad. ring .. " to fold

Palm, from Palmar arche.

Paregoric, Patella ... fracture uf hy 149 30 5., fractur e of Phalanges of foot .. of hand ... Ph o-.pho rus, puisoning I»), 14 ,

Ph}".iology (elementary)

Plantar arch '" ... " artery

Plants, Yarious, poisoning by ... Pleura

Poi son e d

wound . hy

Poisoning

Popliteal artery

Posterior ti uiai

l'n.:s ,ure, digitaL .. point ...

Principle ' of First aid

Prusic acid, poisoning I,), Puhe. . ... I

chuice

f'afft:

Rupture (hernia) 114

Ruptured mu cles 65

Sacral \'erte brre ...

Sacrum ... 25 25, 2)

Scalds calp, bandage for " hremorrhage from Scapula ... . ..

" fracture of Schafer's method of artificial respiration

Seat, four-handed three-handed " two-handed

Shin-bone

Shock " electric

Shoulder, IJandage for ... " blade ., ,. flacture of bones

" joint..:

Sick r oom, choIce and preparati on of. ..

Signs, meaning of . Silvester's method of arl!ficial reo pi ration

Simple fracture ...

Skeleton ...

Skull " fracture o f

Slings, arm

43 39, 40, 49

mall arm ling ... mothering -'nake bite

Soda, poisoning by pleen " injuryof ... pinal canal

" cord 2],

Spine

" fracture uf

Spirits of :-alt, poi 'oning by Splint, angular Splints, rules fur apply ing " to imprO\i e . ... " fracture of Stimulants

Sting of plants and animals

Stomach ... hremorrhage from " injury of ...

Strains

Strangulation

Stretcher exercise, Army

tretchers, to carry " to improvise Pa£,e 169 166 153 qr 13 6

's \'isit, preparation for 204poisoning by Subclavian artery ' .. troke

yllabus of instruction... <

Sympathetic ... 1 I

Symptoms, meaning of .. 17 yncope ... , yno\'ia

Systemic circulation

Temporal artery .. . 134 3 1 70 30 '2

Thigh-bone 30 " fracture uf ... 56

Three-handed seal ... 162

Thruat, hL'Cmorrhage from 97 .. swelling of sue of .. . Tibia " fracture of qr 30 60

Toe:;, bandage for 159

Tongue, hremorrhage fronl 97

Tooth socket, hrem orrhage from 97 Tourniq uet 75

Transyer e wound of abdomen

Two-handed seat r 13 r6r 21 5

Ulna

" fract ure of ..

Ulnar artery

U nconsciou5n eS5

Upper limu5

Yaricose veins

Veins

\- CI10US blood " h:emorrhage

Yentricle5 ... \" ertebra ...

Ycrtehr::e... '" \- ertebral culumn

Yertical wuund uf alxlomen .. .

Yitriol, burn oy .. . \-ulllnlary lllu.cles

\\'agon, to load or unload

Wall, to cross with stretcher

\Yannlh, necessity for " to promole

Wind-pipe

" 'oman's on fin:

\ \' ou nd by pui::.oned

" accompanied by arterial hremorrhage

\Vounds accompanied by venou hremorrhage

\Vound , lacerated \\' ri<;t

HORSE AMBULANCE CARRIAGES & WAGONS.

$t. 30bn Bnlbulance Bssociation.

GENERAL PRICE LIST.

INTRODUCTION.

This Price List, which is subject to revision from time to time, has been compiled with a view to assist members of the Association and others in the purchase of the necessary equipment for corps and divisions of the Brigade, ambulance stations, classes and first aid and nursing work generally.

A complete and reliable Ambulance Equipment is an actual necessity. and experience has proved that employers of labour and others interested in the district readily subscribe for the purchase of such appliances. Collecting cards, stating the purposes for which subscriptions are required, will be sup' plied gratuitously on application to the IIead Office of the Association, where also any information with regard to its work can be obtained.

Stores of the value of lOS. or upwards will be sent carriage paid to any part of the United Kingdom.

Owing to fluctuations in market prices it is impossible to guarantee that the quotations herein can be adhered to.

Quotations will be furnished for articles relating to Am bu· lance Nursing and Hygiene, not mentioned in this list.

Orders and correspondence should be addressed to the t. John Ambulance Association, St. John's Gate, Clerkenwell, London, E. C.

,Remittances should be made payable to the St. Jobn Ambuance Association, and crossed "London County and 'Vestminster Bank, Lothbury."

Registered de ign 418,030.

_\ number of improved design for Ambulance Carriages have recently heen perfected, and several specimens can usually be seen at St. John's Gate, varying from a light vehicle to be drn.wn by two men or by a pony, costing with india-rubber tyres to wheels £32 lOS., to a ln.rge ingle or pair-horse wagon capable of accommodating three patients in a recumbent po ition and :tn attendant inside. A fully illustrated price list will be 'jent on application .

7' ;J ,

With Iron Tyres to Whet:\-;. IWllhlndiaRuhherTyrestoWheels

Without Covt:r or Hood and Apron. With I Cover. I With I!oot! amI Apron. Zs:tL1 J, s. J.

Without Cover or I With II ood and Co\,er. Apron. With Hood and Aprun.

Under-carriage (no

Ltlter complete with OrdinaryStretcher*

Ditto with Telescopic handled

Ditto with Police Stretcheri...

* Prices quoted for Litter wtlh Ordinary Stretcher include \Vide \1/ ebbing Slings but no Chest Strap. Leathel, of Wtbbing Slings, 55. 6d. extra; Chest S trap. IS. 6d. extra. If SlIpplit:d without any Slings. 45. allowed.

t quoted for Lttter with Telescopic-handled Stretcher include Wide Webbing Slings and rh"st Strap. Leather. of 'Webbing Slings, 5S. 6d. extra. If supplied without any 4'. allowed; and if without Chest Strap, IS. 6d. allowed

t Prices quoted for Litter with Police Stretcher include Wide \Vehbing and Leather Straps for securing a refractory patient. Leather, instead of Webbing Slings, 5" 6d. extra. llood and Apron, complete (state pattern of Stretcher) £2 IO 0

Extra Sockets and Studs, per set 0 I 6

Water proo f Sheet (washable) to be laid on the strelcher bed... 0 10 6

Crates (returnable) charged 4S. 6d for each Litler,

THE "REA=EDW ARDS" LITTER.

THE H R EA -l!..DW ARDS" LITTj!:R, with wooden \\ heels showi ng method of l oading; also first aid box fitLed to

T he under-carriage or wheeled portion of this Liller is of a n en tirely new design, and is adapted to carry either of "Furley " or "Clemetson" Pattern Stretchers in p r ecisely the same manne r as the "Ashford" Litter. I t is fi tted eithe r _ bicycle wheels and extra strong pneumatic _ or. With lIght strong wooden wheel, either with solId Il1dla-rubber or Iron tyres. Owing to the reduction in th e height of the wheels it is easy to lift a loaded stretche r fRICE LIST. 6

o\-er them, and the cranked axle has, therefore, been replaced by a straight one con ·trucled of tubular teel.

" REA - } DWARDS" LITTER, fitted with pneumatic tyred wheels, howing the "Clemeton" Stretcher.

Ball bearings are fitte d to the wheels, both cycle pattern and wooden , and the hubs are so arranged that the wheels can be r emove d from the axle without disturbi ng the bearings. In place of the four legs made to raise as handle, two fixed legs filled with small wheels or rollers are placed at the foot end, whIle a combined leg and handle Jitted \\ ith a crossbar and capable of being raised or 10\\ is u ed at the he3;d end . \ Vhen rai ed as a handle It may be locked Il1 one of two and when lowered it i locked in a ye rtical position. The adYantage: .cl.aimed for .thi ment arc implicity, and rapidIty of mal1lpUiatlO11 and

7 I'RIlE LlST.

the facility afforded by the two fixed legs for raising the liller, if necessary, on to the pavement. The question uf balance has been carefully studied, and the stretcher is shifted forward so that the middle of it is inches ill front of the axle, a perfect balance when the sLreLcher is loaded and in a horizontal position being- thus obtained, and consequently there is no weight on the hands of the peron propelling the litter.

The pneumatic Lyred wheels are sLrongly recommended in cases where the small amount of care neces 'ary to keep Lhem inflated can be gi\'en, as the comfort LO the patient and case in propulsion are increased beyond all compari..,on with any jitter yet produced. It \\ ill be noted that the prices are considerably lower than those of the , .. \shfurd·' Litter, and the following are gi\en as examples, but 0\\ ing to the ntst number of comhinations that can be made \\Jlh the different stretchers and cO\'erings, it is impossibk within reasonable limits to set out q uOlations for the \\hole of them, but these may be calculaled by adding together the prices Of the under-carriage, stretcher selected, and houd alld apron or coyer, see page 4 and to I I.

SPECIMEN PRICES.

Under-carnage only, either with pneumatic tyred cycle \\ heels or solid rubher tyred wooden wheel", £lO.

Litter complete with ordinary stretcher (no slings or chest strap) and hood and apron, £14 3s. 6d.

Ditto with Telescopic lhndled (with chest strap) and hood and apron, .£14 llS.

If wiLh iron tyred \\ heels prices are £2 less.

The lowest priced litter complete i fitted \\ith iron tyred wooden wheels. ordinary stretcher (no slings or chest strap) and cover. Price'£10 8s. 6d.

lIand brake, which acts aUlomaticaIly ,,\hen the litter is at rest, extra £, [ lOS.

" -hen plea e state which wheels are required.

" CLE:'IIETSQX" STRETCHER, with back raised, also showing extending legs.

On lhi" stretcher the patient can be moy-ed a desired, from the recumbent to the silting po ilion. There is no complicated mechanim to get out of order, and the adjustment depends simply on the balance of the patient's body. The stretcher will fit either the" A -hfo rd " or the " Rea-Edward - " UnderCarriage . Price £3 3s. ; with extt'nding legs, £4 3

H ood and Apron, Y entilated, £2 IS S.

9

ADJUSTABLE LEGS FOR STRETCHERS .

Primarily these legs, which a re independent of and additio na I to the ordinary foot wheel, a re intended to facilitate the carriage of a stretcher in a railway compa rtm ent, in whi c h case two on one side would be luwered and aclju. ted by a telescopic arrangement to the prop er height, so that the foot wheels on one side would rest on the seat, and the adjustable legs on the other side would re5t on the flour. Th e four legs may be u ed to raise the stretcher as required. 'Yhen not in use they are folded up immediatLly under the poles of the stretcher.

Price per set of four, £ 1.

FIRST AID BOX .

To be carried below the axle of the" Rea-Edwards" Litter, from which it is easily detachab le.

Contents of Splin ts, 12 Triangular Bandages, 12 Roller Bandages, 2 i- lb. packets each Colton \\' 001 and Bori c Lint, Adhesiye Plaster, Pair of Knife, 2 oz. each Olivt" Oil , Tinct. Eucalyptus B.P.C., .'al Volatile, and Spirits Ether Comp., Graduated :'Il easure Glass, KidneyDressing Basin, 6 Tampons for washing wounds

Tourniquet Pins, Safety Pin, Ne ed les, Thread and Tape. l'ric e £2.

" FURLEY" STRETCHERS WITH THE LATEST IMPROVEMENTS , 1899 MODELS .

ORDJ);,AR \'

The impro\' el11enh in all p<lllLrnil of the •. Furtey" Stretcher, 1 '99 :'II"dd, are nUl1h:rou". The cumfurt to the patient i" increased; the stretcher i" strunger, 1110re rigid, and lighter, lt fold up mure closely, ant! its handles are mure comfurtable to hold amI afford greater prutection tu the hands uf the bearer" in passing through narn)\\ dOllr\\ays ur pas ages. Shuuld it Ile necessary to reduce the \I idth uf a loaded strdcher in order, for e).amplc. to carry il into a railway carriage, this can Ill' done. either \I hen it is resting- Ull the ground or supported hy the hearers, \\ilhout 1I0uIJle and without the slightest jar to the patient. The priCe uf the stretche rs is Im\ creel. . \11 minor puints ha\ e heen must carefully considered. and thl' stretcher are cunfide ntly recummended a thoroughly effic ient in e\ e ry \\ ay.

These st retchers are adapted for use alone or a part of the " . \ hfonl " or ,. Rea-Ed\\ards" Liller. and the cO\er, hood alltl ;"\'pron. army rug, and waterlJroof sheet decribed thi" list are slIila hie fur wi th them.

TJo..LESCOPIC lIA"'I>LE.D 51 RE·lCIH

PRICES OF THE "FURLEY" STRETCHERS, WITH THE LATEST IMPROVEMENTS (1899 MODELS ).

N.B.-The prices of the Standard Models are shown in heavy type. \ W ' h With Wille With Wide With I With SI lt Ollt W ebbing W"I Jlllllg Leather L.callter , ci gs or SLing, Sltngs Slings Slings and I (n.o c'hl:st (noChesl \ \ ebbing

Stl.lp). Sll:tp Slr::tP)·ICht,tSlrap.

Ordinary Stretche r , fo r General .l s. d.1 ;:, 5.

and Brigade lise, laking the

place of both the old o rdinal) and military patterns ...

Tel escopic - handled Stretcher for workinginconfined

P olice Str etche r, very st rong, with Ash 1J ul(;s, and pn)\i<led \\

Leather St raps to secure a refractory patient-

Complete, with Wi

Slings , Wi de Webbing

Do. Leather

(o r if purchased with the Stretcher instead of Webbing Slings, 5/6 extra)

Cover (awning) for Stretcher (when ordering please state pattelll uf Stretcher)

Superiur (I ood and Apron (see illustration, page 3)

Spare Bed for Stretcher

Army Rug to cover Patient on Stretcher ...

Pill ow for Stretcher, stuffed hair '"

Chest Strap

"LOWMOOR JACKET."

For use in mines, ships' holds, eLc., to ecure a patient on l\ stretcher (see illustration), which can then be placed in 'an uprigh t p 0 sition. Price £r 5s.

WATER BOTTLE.

Copper tinned, with carrying strap.

Price lOS. 0d.

Enamelled Iron \Va te r Bottle

Cloth cove red, with Strap, 5s:

LAMP.

This is filled with a socket, by which to fix it to a Litter, or it can be convenientl y carried by hand, or attached to a belt or the clothing.

Price complete, 55. 6d.

Dressing Basin, kidney shaped, made of enamelled iron.

Price IS. 3d.

Ambulance Station Plate , Iron, 35 . 6d. each.

Stretcher Depot Plate , Enamelled Irun, 3s. 6d. each.

Carrying Sheet for carrying patients up and clown stairs or othen, ise aboul a house. Designed by J. C. Derham, Esq., Blackpool, and Mrs. Alfred Paine, Bedford. The sheet is fiLLed with rope handles and detachable bamboo poles, and may be placed on a stretcher without disturbing the patient.

Price complete, ISS.

1 Set of Cane plints.

1 Elastic Band Tourniclut.:l.

lb. Carbolic ")

lb. Boric Lint

Cotton Wool ... LIn Tin ... J lase.

I Roll Adht.:si,·e Plaster.

20 Roller Bandages, assortt:d.

1 doz. Triangular Bandage.

3 Pieces Tape.

4 oz. Sal Volatile.

4 oz. Bicarblmate uf

4 oz. of Olive Oil.

4 oz. pirit Ether Compo

i lb. Tin PO\\ dtl'ed Bl)ric Acid.

4 oz. Tincture Eucalyptus B.P.C.

I pair Pean's Forceps.

I pair Scissors.

I Knife.

12 • urgeon's Needles.

I packet each and Plain Pins.

oz. Carbolised Chinese T\\ist.

b uZ. \\ Of 111 G ul.

I reel each Black and :ewing Threat!.

I K1Jne) -shaped Basin.

I Loosener.

I Graduated :\Ieasure.

I cake 20 per cent Carbolic oap.

I Nail Brush.

3 Empty oz. Bottles.

Price complete, £4

For contents see n ext page.

PRICE lIST.

SMALL AMBULANCE HAMPER.

\Vith waterproof c()yer and strap, for use in factories, collieries, stations, and large \\ork J as well as for parochial and domestic use.

C",\,T\I,\,IXG

Set Splints. I Elastic Tourniquet. 3 Tampon, for wasl;, ing wounds. 2 Packets Lint. 4 Roller Blnclages (wide and narrow). 4 Tliangular Bandages.

;Vool ... ... } In Tin Cases. Bone" 001

Spool of Adhesive Plaster.

Knife, . cissors, Thread, Tape, Needles, and Pins, Weight complete, Ibs. Length, I ft. 6in. Depth, "in. Width,7in. Price £1 lIS. 6rl.

PRICE LhT.

SUR GICAL HA VERSAC.

[\IJ'R()\'EI' ".\1 HR:'>. flllLd linn a tin, so that any lrticle call bL' taken out \\ ithuUl (l!sturIJing the rest uf the cllntenh.

('ontent,: I "et IIf Splint,;, 6 Triangular Bandages. 6 Roller Bandages (1\ ide and narrcJ\\ 1, Cotton \\'001. Boric Lint. in tin l'.\ses, I 1\011 .\dhe<;i\ e I I'air Scissor", I 1-:' nirt.>. 2 Ill.

Oil. 2 oz. Tinct. ll. P.t' .. 2 oz. \·lIlatile. 2 oz. Spirih ( · ()JllP.' 1 l;rnt!u<1ted (;!as., lEla lic lJand TIIlIIlliIIUt't, Pins. :'\ ceclle" and Thread. l'li"e £1 If';, 6cl.

\\ hite Linen R.t . illl) 11:1\' er,,<\(',. r,. 9d. each.

FIRST RID '

iVRFSSINGS AND BANDAGES COMPRESSED •. SI- 7Cbd R$S«liJ!J;m,

Is. 6d.

6alt. B P t J 8" O:rktDtlJtl/. fJtI(lon. t.e. ) os u.

FIRST AID COMPRESSED KIT.

The Lox is made of W(hJd CUI'creel II it h (bmp resisting marerial, and is filted Ilith a lock and key. It contams a num ber of practical ambulance appliances ::trranged so that any a"ticle can be v.ilhdrawn or replaced wilhout disturbing the remainder. Being fitted \Iith a handle it is portable. and the lid , when let down, can be used as a tahle. All bandages and dre sings are compressed. Size-Length 16i in. ; width in. ; height cl in. without handle.

Contents: 4 Triangular Bandages, 6 Roller Bandageq, 4 First Aid Dressings, 6 Small Pflcketq of Cotton Wool, 6 Small Packets of Boric Lint, Elastic Band Tourni'luet, I ;\[easure Glas-;, I tin Lox containing a Roll of Plaster, BOric Lint Patches, Sci,sors and Pins, I tray containing 3 (Sal Volatile, Tincture of Eucalyptus and Olive Oil) and a Dredger of Boric Acid, 1 'et of improved Splints, with angle piece, g Splint Straps (sufficient for a fractured thigh).

Pric e £1 I IS. 6d. Each article is priced separately (Stt Index).

Size by 31 hy Ii inches. Suitable for the pocket.

1. Triangubr Bandage. 2 1· irst .·\id Drl'. sing. 3 Cotton \Y oo!. 4. '1'1\ 0 5 "\dhe!--il'e PIa"tll' 6 Per· mallgallaLc.: uf l'otn h. 7. LanuJinl'. 13l1ric Lint 9· and l'lain }'in<,.

Price, each 1:. oLi. By l'u t Is. d. Per c1.)z. 17 ' 6d, caniage paid. No. I 4d. 2 2d. 3 Id.

2d.

5 ld. each o r 3'9 per duz. " 2 a ,. lad. per strap tll J 9., per box ur lcd. " ;\0.

6 II!. per box or lOci pc r doz.

7 [t d. pcr tin or I/4 " , 1(1. per pac kct L,r loci.

9 Jd. loci.

Not less one supplied 3.t d0zen prices.

FIRST AID BOX FOR "ASHFORD"

LITTER OR AMBULANCE STATION.

.Tbi s is primarily designed to be placl'd on the cc Ashflml " Lllt e r ( 1899 "\10del), but it is further adapled to be up on R. wall. A detachable leather handle is al so filled for carrymg purposes.

For contents see next page.

PRICE LIST. 2 2

CO T ENTS or FIR T AID BOX. ( l llLl>trated on page.)

Set of Wooden ,plints; 1 Elastic. Band Tourniquet ; Carbolic W ool, Bone Lin t , in tin cases; I Roll Adhesive Plaster; I'2 Roller Bandages, as<orted; 6 Triangular Bandages; 3 Pieces of Tape; I Pair Scissors;

1 K nife ; 1 K id ney.shaped Bru.in; I Graduated l\leasure; '2 oz. Oli,'e Oil ; '2 oz. Tinct. Eucalrptus H.P.C.; 2 oz. Sal Volatile; '2 UZ. Spirits Eth er Compo ; 801 . Carroll Oil; Pins, 'afe ty Pins, Needles, Threild .

PRICE CO:,\!PLETE £2 l OS .

POUCH FITTINGS,

specially selected fur the Sl. John Ambulance Brigade , clll1-.i-.ting of :-

2 Triangular Bandages, one of \\ hich is sealed up in v.axed paper. The other may lH:! used for practice, but should be kept as clean a" po" Ible.

2 Bandages (3 in. and I in. ).

t Packet of Cyanide Gauze ( I yd . com pressed ).

I Pair Scissors.

6 Safety Pins .

i Small Bottle of strong Smelling Salts. Piece of strong Cane, for tightening improyied Tourniquets.

Price, 2s. Sci. each. 6 doz. or more, 2 . 7d. each .

Packets of Cyanide Gauze (1 yd. compressed) . Price per dnz., 2S. St!.

Buttles strong , alt . Price per doz., 55. 6d.

SAFETY PINS.

All fasten or unfasten on either sitle .

Facile No. S 600 or 602 per 3 doz.

" ,.' 603 ... "

Duchess Duplex, No.2 .. pe r doz.

., .\ ,;s'lrleLl

pecial Blanket .'arel), Pins, 3 in. in.

23

PR Cn: LIST.

Tourniquet, Tourniquet, Field

Splints, ,Vooden, per .et, 2/6; Cane .. . . .. pcr <;ct

Greally improved ,Yooden Splints, with grooyccl joints and angle piece, strongly recommendeu ... . ..

Tow, for splint padding '" ... per Ih.

First Field Dressing ( ...... rmy Regulation Pattern),

Price ... each 0 9

Jaconette, 44 inches wide per yard 2 3

Tow, Carbolized or Stypti c ... . .. per lb. () 9

Wound Pad.-A pad of c"tton wool and gauze, to II hich a bandage is attached. The wrface of the pad coming in contact with the wound is not touched hy the hand of the person applying the p It!. Price 4<1. each.

First Aid Dressing, of a small compn:s. eel packet of boric lint, a compressed roller bandage, and a s:tfety pin. Price 2d. each.

Dredger, containing boric acid powder, IS. 4d.

Measure Glass , 2tl.

Knife I\·ith strong j,lude each 9<1. ; pcr duz.

Pair of Scissors each IS. : per dot.. 10'1.

Splint Straps, ,Yebbing, and suilable Buckle..;. Pcr eet of 12 yards of strong 2-inch ""ebbing and IS Rudles, 2<;. 6d.

These '11uke very compact :lr3.ps for carrying- in the Pouch. The \Vebbing should be cut to meet local requir 'mcnts.

Buckles only, IS. 3d. per dozen. ,Vebbing only, IS. 3d. per dozen yards.

It is unnecessary to <;ew the Buckle,> The "pikes c;hould be passed through the webhing, and the shon end of th e webbing should lie ol1lwards.

PR!CE LIST.

PLASTERS.

Leicestel Adhe"i\c Plastcr on Cambric, in.tin::; uf yard, 6 inches \\Jut!

6d.

The Adhcsiyp }' ilJbuns, in tin 6 yards long. inch II I inch II ide

National Rubhcr 1'laslc.:r t·\nl1seplic), on -.p\)oL.

S 10 L inch Ilide 9\1. h. IS. I (xl. :! IS. 9(l. 2:-\. 3<1.

Ditto in card ho', i 1. Ililk, 'i: yd - lung ... \ in I 3 !, 5 -} ., 5 ., Cou R 1 PLASI ER, TRICOLOR. Lare,e 'izf:', 9<1. ; diul11. Sd. ; ')111:1.11, 3d .

PRll b l.l<;T.

NURSES' WALLETS .

Chnr:\.\RY PADLOCK SHAPE.

\Yithout in trument , 4. 3d .

Filled complete, con laming Spring Dressing Forcep'i, Spat ula, Prohe, 2 pair Sci "ore; (round and sharp pointed), CI inical Thermometer, and Knife.

Ach'anced price TOs.

Sr. ]O][:\'s 1',\11 a-; illus. trated, lmt illlpro\ed by the addition of Hap" t() protect the instillments.

\\' ithout inqtrumenh, 7s. 9c1 .

Filted complete, containing, pring Dressing Forceps, Artery Forceps (also useful for dressing), Spatula, Prohe, Director with Ear Scoop, 2 pair (round and sharp pointed), C:inical T hermometer (minute, round), Knife, Pencil, and 'afety Pin.

ROLLER BANDAGES in Assortment.

Fa>=h packet contains 6 hanclages:1. follows:6 yard long-one 6 inch, two

long-l \\'0 inch.

Plain Triangular Bandages, ench (Special quotations fo r large quantities . )

Dittu Compressed (thinner quality), each 4d . ; per doz. 3s. 9d.

Ill ustrated Tliangular Banclages (after E march) sll0wing 25 applications of the Triangular B a ndage, with p rinted instructions ... each

ROLLER. BANDAGE MACHINE.

Designed IJY

Dr. .\. C. Tlln:itall.

Price 2,.,. Gd.

Forceps , dressing, full size or small as desired, IS. ; bow dre .,ing, 5 in. locked joint, IS. 6 d.; l'ean's Artery, 5 in. locked joint, I . 3d.

Scissors, round-pointed, IS.; sharp-pointed, for dl.licate work, IS. 3d. small round-pointed blade. . locked joint, or 5 in., IS. 6d.; round-pointed cun'ed blades, locked joint, IS. 6d.; sharp-pointed curyed blades, locked juint, IS. 9d . The locKed joint allow the blades to be taken apart for cleaning.

Spatula, 9d. Probe . 6(1. D irec to r, with Ear S c oop , IS. 9d. Knife , yer)' thin, i\'ory hanclk, t\\'o blades, IS.9d. Nursing Chart, desi,;ncd by '\liss Inder\\'ick, each. Temperature Char t , each.

CLINICAL TH E RMOMETERS . l' ed uced Prices.

Round. Ordinary, IS. ; minute IS. 3d.; half-minute, IS. 6d . Flat. Strongly recommended as they will not roll. Ordinary, IS. 6d. ; rapid ( pecially stlected and resclTecl for the Association), with very open scale, 3s.

CLINICAL THERMOMETERS -(l'olltl1llled.)

W ith Magni fy i n g L ens. I'ncc, ordinary, I . 6d. : minute, I. 9d.: half-illlnllte, 2<; • .)d.

T B.-.\finutc ancl half·minute in truments I\ill only regi ter ill the time stated under fa\'ourahl e circum<,tances.

/1/(1 Ilabilll)' IS tal.:ol /01' 0/ TlzerJllometers ill tral/sr'!.

BATH THERMOMETERS.

To Dr. Forhes' specificatIOn. Japanned with zinc scale, 2S. 3d. ; Clinical Thermometer size. in ca-;e. IS. oll.

'Vo liabililJl is !d.-ol fiJI 0.1 ThermOllle/ers ill transit.

COTTON WOOL.

P lain, I oz., 2d. : 2 oz , 3(1. ;..j. oz., 4(\. ; lb., 7d.; I lb., IS.; small packet lei.

M edica t ed, Boracic, ±lb., 6(1. ; I lb., IS. 6J.; Carbolic, pe r lb., IS. Stl. ; Alembmth, per Ih., IS. 6J.; Double Cyanide, per lb., 2<;. 6J. LINT.

P lain, I oz. , 2d. ; 2 oz., 3d. ; 4 oz., 6d. ; lb. Iod.; I lb I 6t!.

B oracic, 4 OZ" 6d. : I lb., IS. 6d. j Equare foot packet, 2d. ; small packel (Compres"cti), Ill.

GAUZES.

These are supplied in 6 yarc! lengths, width alJout 36 inches

Unmerlicated white

Alcmbl'oth

Dnuble Cy:l.llide

B<H:Jcic

GAUZE TISSUE.

A layer of ab orbent colton wool between two sheets of gauze, good quality, per lb., IS. 6d.

PRICb LIST,

TEXT BOOKS, &c.

.. FIRST AID TO L JURED," By Jame Cantlie, M.B., F . R . C. S. The authurised Text Book of the First Aid Course. 1::;.; by pust, h. 2d. c. CATECHIS.\! 01' FIR'T AID." Cumpiled from Dr. Cantlie's :'Ianual. By J. :'1. Carvell, M R.C.S., L.S.A. Price 6d. by pust id.

c'l1l1\1's A:\U lIELI'S lOR lIo\!!!; KURSI:\(; ANI> I By E. :.racDu\\ ell L'(lsgraYe, 7\1. D., illu"trated. \\ ilh chapter un the applicatlun uf the wIler I)anuage, \), 1', J. Cr)llie, :\I.D. The authuri'>ed Text Buuk fur the Course. IS. ; by pust h. 2d.

"CAl'EClIIS:'II U:\ TL'RsI'\(." (lmsed ()n Dr. Cusgnl\e' Text Buuk). Dy J. Dru\\n, L.K.C.l'., L.H.. L.S., anu J. :'1. Carvell, M.l-:'.C.S., Price 6d. ; by post, 7d. llYl;IEi\E." Dy Juhn F. J. .ykcs, D.Sc. (Public llealth), ...\L D., ·C. Illu strated. The Te:\t Duuk fur the J lume lIygiene (',)urse. h.: hy post, Is. 2d. " (-2UES'lIO:--;S A:-'U , \:\ S\\ERS l'I'U'\ !\:'IIHLLA'iCE \\'()Rh.." By John \\'. :'1.0., amI J(lhn F.R.C. '. Etl. I.:i. ; by pust, h. 1(1.

" QUESIIO:--;S A:\[) ,\ '\s\\ ERS CI'():\ By Juhn \\'. Martin, D. Is. uti. : I,y pust. b. Sd. "FIRST AI[) TO I;-.IIl/REt) (!-Ii\. ,\mlJlllance Lectun;s)." By Prufe"sur Frederich j·:slllarch. Translated from the German by II. R. 1L L'nllcess Christian. 2S.; by post, 2 . 2d. "ELELIlE,,'lARY BA:-'I)A(.I:--il; SURCICAL DRES S INC. " By \-ValLer l'yc:, IJ) post, 2s. 2d.

DR. G. II. DAR\\"[:--;'S" 1'lRsr AIDS," being a card to hang up, givll1g treatmeI1l uf \'anous accident:,. 2d.; by post, Sci. "To l<.EsrORE TilE ApPARENrLY DROWNED," printetl in large Type with two Diagrams. Unmounted, 2d. each; by post, 3d. l\I ourcted, \\ ilh red bonier, and \'arnished to hang up, 6d. ; post free, packed, Is.

PRW[· 1 hT. 30

TEXT BOOKS, &c .-(rontilllled).

"Trn\\' ['n :\CT "'HE" Cr nTIlI',; '!.-\KES Ill' T l ' rI M k' I . " , ... . . ac ' 111 ay, :'f.I\.C.<.;. t:nll11ll1llll'd. 2,1.: by·p·()... t. .:;.1. ;\Inl1nred nn card and 1:1rt1I hl'd. 4d . Iw parl'eel _(I .\I[) f'RI'\T[P[ E .. " ('ar.]" ,,;' ·c<ll;ci ·' :1\ rt:'cti:Jll s' each: -101. per ,]nz. qU()latiol1s fllr 1,1rge

EXA\[I'IATln I API I-:<;. , \id. Xllr<;ing an(1 . I Iygiene Courses." 3d.: Ly )lr)<;[ -III.

:-;\IAI.1. \ DI·\ .KA \1. lhl' human I'ele, tOil, . ll1aln artcne .... and p"illh \\ III re prcure should he applied to ane<;t ::?f.: I I' PI)q, )d.

A"Tn 1111 I'E j')I{\IIf)";1[' I'E,,:n'<;S['I'FF.RT:---; 1,•. LJ:C'TRI' "II" CK. L:tJ'Q"l' I rint. pfister <;i7e. 3d, t,leh . hy pn t. '-J.d. : fir ::?<;. 6d. pt'l d,)zen.

:'TE\[nTRF:. ()11 cardhnard, in lil1en linea ennln]1c, fnr the r:>C!.;:et. I1y .the late . P. !-Ihepherd. Cnntrlll1ll1g useful hmts for FIrst . \i,j trJ the Injured. 'd.' hy POq ..J.d. .) .

GF:;'I1:R-\T :\'nTE n." FIR<;T \J[) rn PF. I' [ "TlEREI ) 1:\ ( ,\";F., nl. 1,"1 n'INr;. By \Iilne llt·). \[ .\., I lice 2(1. : hy po<;t, 311.

" , \ \IIW[ ,\NCF. T\RI ETS.'· By I'artridgl'. :'T. D. Price Is. : hy pnc;[, IS . lel. n'l' \TII ITAR\" By Lt. ,Co lon el I r. p. c.

" ,R .. \. \LC , ' 6d. : hy pnSl 7<1.

\ for rcference, (Yil'in(Y Ilhtructlon<;: to hang nn \\'al1. in' :thrlllt Price 3<;. 6rl. : hy pmt. 3<;.

AII1S 10 FOR FIRST , \ 111 Il'nE" I";. Revised til !I,lte . \<I<llLIOn'11 II lust ration, RI' L. \1. Fr:tnl ' Chrl·r" .lll \f n -:.[ f' r . \. . . , : •. , ',t In. 6ti. per eory : hy P0St, 7d.

Rc L:S fo'OR CORl's A:\'n DI\'lSln'l'5, :t. John Ambulance nrrgade. 3d. per copy.

3 1

LIST .

TEXT BOOKS, &c. -{fon ti l//( cd) .

A History of the Order of the Hospital of St. John of Jerusalem. By the late Rev. W. R. BEOF01W, A., a nd L ieut.-Culonel 1'. II . llOLBECIlE . Price 5s ; by p ost 55. 4d .

The Knights Hospitallers in Scotland and their Priory at Torphichen. By TILO\I-\S Bc.ArSO\, L.B.

Price 25. 6d . , post flee, 25. Sd.

Registers . CIa 5 Altendance, 2S. 6d. Certificates, 45. 6d. Ca ' e Rcport, IS.

St. John Amb ulanc e Brigad e Cash Book, M inu te Book and Occurren ce Book. Set uf three, 7s. uti. R eceipt Book, 6d.

Large Physiological Diagrams. For Lecturer;;' use. Comprising: The U uman Skeleton, the Muscular, Arterial ancl Venous Systems, the H eart and Circulation of the Bluud, Simple Fracture, Compound Fracture, Dislocations. Price p er set of si x, 155. These 111 a) be hired fur a cuurse of " First Aid" lectures, given under the au. pices uf lhe A ssociation, fur a fee of 55., or \\ilh the additiull uf Splints, T ourniquet, and plain Triangular Bandages, for a fce uf lOS.

Boxes of Stationery fur the use of CIa S Secretaries anti othe r s connected "ith the Association, containing twehe sheets of high-class pape r , suitably headed, and l wehe e n velopes bearing the de\'ice of the Assoc iation . Price Gd., by po t 9d . T wice that quantity, p ri ce I S., by pust I S. 3d. Medallions, i.5s ued only i n accordance \\ ith pape r 1\0. 62, to b e had on appli cat ion. Coinage Bronze 2S.; Silve r, 7s. 6d . ; G old , £2 105. ; i ncl ud i ng eng rav ing na me and I ul11ue r on back. l\I orocco ve lvet- lined case, 2s.

Labels, to be placed above for each su b equentyear' examination, issued on ly in a cco rdance pa pe r 62 . Coin.lge Bronze, 6d.; Silver, IS . 6d. ; Go ld, 12S. 6d .

Arm Badges , \\ it h th e device, jcsued under. the authority of the Central Executive Committee, havwg ueen Ii : t approved by H. R. I I. the Grand Prior as the s.o le offiCia l and r ecognised Badge of the Association and Bngade. lV B. - This design is prot£cterf

N o. I, fo r the use of individua l ce r tificated pllpl1s - fl d . In German Silver, La rge ize...

Small Size fo r button hole

In Electro Plate , La rge Size

Small, ize ditto

Small Size fo r button h ole

In Enamel fo r button hole

" hrooch

In C lot h and Si lk ...

In Clot h and S il\Tef (Reg iste r ed Num be r, 35 22)

In C lot h and W orsted , ma ll Cell uloid Bad ge, for b utton hole or brooch

,\Vhite a tin A rml et , wit h woven Badge

Bl a ck Silk Ar mlet, wi t h prin te d Badge ...

N.B. - Tluse Badgu art! lI(lt to be W(lr " as

6

PRIer:: LIST

BADGES

. Xo. 2.

N o. for members o f the, St. John .. Brigatle.:, ha vmg the. name. of the .Corps or Dl\ l SW!1 annexed on a la b el , or. ly Issued In quantIlies-

I n Ge r ma n Si lver, fi rst doz . , £ 1 ; subsequent dozs., 125

In E lectr o P late, first doz ., £ 1 12S. ; subsequent duz ., £ 14s.

In C lot h and S il k, pe r doz . , 1 25.

In Clot h and S il \'e r, pe r doz., £ 1 105 .

All t he above may he worn by me mbe rs of the St. John Ambul a nce not wearing unifor m.

BR

I

GADE UNIFORM BADGES

Officers. Cap Badge (Reg. TO . Culla r Badges ( " Pou c h Badge (

. e t c.

Sergeants . Cap Badge ( " Collar Badges ( I OI} 10 3) 3,657) 102) 104) each p e r pai r each pe r pair

Corporals and Privates . Cap Badge (Reg. TO. 102) .. . each O\'e rcoat Badge( " 1,5 2 ) ... "

Shoulder Tllle.:. , ' .J.A.B., \\ ith numeral, pe r pair

'houkle r ' traps, fitted with title and numeral... .. . . .. "

Lady Officers of Nursing Divisions.

Supe r inl endent's Clnak Badge (Reg . N o . 3,65 8)

Supe rintendent's 1\r 111 Bauge ( " 3.659)

Other Xursing Alcer's 'loak Rldge (" 3·555)

Othe r N ursing Office r's Arm Badge (" 3,65 6 )

Nursing Sisters . .A rm Badge ( 3 ,522 ) " Cloak Bauge ( " 3,5 21 )

Honorary Surgeo n ' s 'ilver \ Yire Cross (pattern B) ..

Superintendent's Silver \ \,ire Sta r (pattern A)

Medallion Badge (pattern 1)) .. ,

Nursing Badge (pattern E)

Satin Badge to r 1. ursing Si t r's Pin Cushion

Bugler's Badge 4 0 Bugler 's Cord

Honorary Secretary' s Badge ...

Whistle and Chain .. . ea ch

Private' s Brown Waist Belt and Pouch "

White Piping , per packet of 71 ya rd, enough fo r 3 pai rs of t rou,;er (packets cannol be broken)

Lace, Sih'er pe r yard Black ... ... " (. \ Cap Band generally nlns about 24 inche .)

BUTTONS FOR THE UNIFORM OF THE ST. JOHN AMBULANCE BRIGADE .

I ssued only r,)r the use of Officer and M emhers of Corps and Di\-i",ions wea tin g the presclibecl unifunn

Electro Plate, large sinall cap

German Silye r , large small cap

Black lIorn, large small

ELECTROTYPES OF THE ST . J O HN AMBULANCE DEVICE.

1. For Cards. Tickeh, &" .... a a For ::'\ ole Paper ... mall Circula rs, &c, a 3 , 3. For Quarto and Fool cap Letterpaper, Circular:>, &c.

4-. For Snull PoJsters...

,,5. For L arge Posters...

Complete Se ri es

['rints of lhe abo \' e Electrot ypes ( I to 3' appear 011 the follo wing page. i\ o. -+ is 011 p:tge 32. The diamete r of 3"- i", 3 in., and of 5 B \\ ithout scro ll.

PRICE LIST.

ELEC T ROTYPES

.

For prices c;ee page 35.

Flags bearing A ociation de\'icc -12 feet by 6 feeL 7 6

5 fcel by 3 fe\.:L 0 12 6 Brigade -+ flo I in. by 3 ft. 0 J2 0

l'RILl': Lb'l'.

UNIFORMS FOR AMBULANCE UNITS OF THE 8.J.A.B.

These may be obtain ed d ireel fre)1)1 :\ 1 Ie b bert and Co" .35. Bethnal Green Road, L Tekphone Xo. 909, London \\ 'a ll. Telegraphic Address: .• Other\\'i e, London , ,.

lllll' F '-il' I{\;K()::\\ '\1) 1Io:,\ORARY <':;URGI:.":\',

SWAGGER STICKS

for the use of Officers and Members of the St. John Ambulan ce Brigade.

Ebonised Cane, German Sih'cr bearing the Brigadc ice.

PRICE IS, EAClI,

Officers' 'pecia! \\ ilh ,'lLrlIng Sih'cr :'I[ounts,

PIZlCE i. EACH,

All Orders for the foregoing Stores should be given to the Local Secretary. or to the Stores Department,

St. John Ambulance Association, St. John's Gate, Clerkenwell, London, E.C.

C r C\,;s-hell, " 'hite Patent Leathe r and Bbc\.; Pouch (Badge extra) ...

Forage C:tp (Badge ext ra)

G

39 PRICE LIST.

ilIESS DRESS FOR OFFIceR.

Jacket (Badges eXlra)

\'est ...

1ST SERGEANT.

Patrol Jackel (Badges exIra)

Chenon, 4 1)ars, . 'iln:r, 35 -+el., \\'orslcd

Trousers

Forage Cap (Badge exIra) ..

Cross-belt and Pouch (Badge L' Ira)

Buckskin G loyes

Collon

Leg-gings

Great Coat (Chenon and lhdge exlra)

SERGEA:-\TS, CORPORALS, A:-;n RA:-\K A:\lJ

Palrol Jackel, Black Tanan I Rtdges extra)

Trousers, Black Tarlan

Forage Cap (Badge extra) ...

\\'aist-uelt and Pouch

Greal Coat (Chenon where required and Badge extra)

Gloves

Leggings

Sergeant's CheYl6n , 31.11', Slh er.2s 6d., \\' Olsled

Corporal's 2 b Sd. lE;\,DENT.

Patro l Jacket (Badges extra)

Cap (Badge extra) ...

B reeches: (3rey Se rge

Cross Belt and Pouch (Badge extra)

Gloves

{Jalters

H ose ...

G reaL Coat (Badges extra) .. .

Jacket (Badge5 extra) ...

Cap (Badge extra)

Breeche,, : Grey. erge.

Belt

Gloye,>

Gaiter'>

Carriage out of L Llndon extra.

UNIFORM FOR NURSING UNITS OF THE S.J.A.B

These may ue obtained frem E. & R. Garrould, 150 to 160, Edgware Road, Hyde Park, \Y .

Telephune,,: 5320 and 5321 Paddington, and 3751 Mayfair.

Telegrams: ,( Garrould. Londun."

Cloak (Badge c\.lra) Bonnet

Dress, made to :\f easure (Badge extra) ollars

uffs

ap. ,. Si"lcr Dura"

Apron

and

I 8 and 2;; . 6d.

Carriage paid on all orders oYer ten shilliIlgs in mluf'.

All Badge to be obtained fr0111 't o John's Gute.

If the Corps or DiYblon is out of London, measu r ements to be supplied to contracto r free of charge.

IND EX TO PR I CE LIST.

Ambulance Hampers '5 to '7

... Station Plate 3 2 to

Bandage Rolling l\Iachine.. 27

Bandagps .. 26

Rasin, Dressing '4

Bed, I} " Camp

Books ., 29 to 3'

Bottles (Water) "

Button 35

Carriages (Horse Ambulance) 2

Carrying Sheet q

Cash Book -:;,

Cotton \"'nol ... ... 28

Cover for Stretcher or Littc:r

Diagrams, Large ,I "Small 30

Dredger (Boric Acid) 23

Dressing Basin Ii

Drowlllng Tackle 12

Electroty-pes .. .. 35, 36

Emergency Book 30

First Aid Hox.. ... 9,21,22 " Companion.. 20 " "Compresst!d Kit IQ

First Field 23 37

Forceps 27

Gauze. .. 28

Gauze Tis.ue 28

Hampers ( Ambul ance) 15 to 17

Haversacs ... . ... 18

Hood and pron for Litter... 4

Instruments (various) =7

Jaconette ...... 23 Knife 23

Labels.. 31

Lace for Cap ', &c 34

Lamp... '4

Lint .. ... 28

Litter (Ash ford) 3, 4

Litter(Rea·Edward,)

Lowmoor Jacket

.. 5 to 7 ?II easure Glass ... ;\1 edallions ;\Itnute Book ),' ur-es' Wallet-; :\ Charh

Occurrenc.e Dook

Pdlow ... PIa ters

Pouch Fittings Rt!ceipt Hook Registers Roller Bandage ;\Iadlln<: Rug .. Rules for Corp' or 1li \'Isions ] niln Ambulanct! Brigade Safety PIns... .. .. 13 23 3' 3 1 3' 30 22

Scissors '" 23, 27 hngs, Stretcher Splint Padl!Jng 23 ,plint traps .. 23 :plints .. 23 . tationery . . . 3'

. tretcher Depot Plate 14

Stretchers .. ... 8 to 1 I ,. Adjustable Legs for 9 wagger tick.. 37

Temperature Chart 27

Text Books ... 29 to 31

Thermometers.. ... 27, 28

Tourniquets 23

Tow, carbolized 23 " plain . . 23

Uniform Sundries 34

Uniforms .. .. 18 to 40

\Vagon' (Horse Ambulance)

\Vater Bottle, \Vaterproof Sheet

Whistle ant.! Chain

W oo l (Cotton)

Wound Pad