First Aid to the Injured 22nd edition 1913

BY J. M. CARVELL. M.R.C.S., L.S.A.

Price 6d. poat free . "PROBLEMS

IN FIRST AID."

BY

L. M. FRANK CHRISTIAN. M.B., j,ND

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AID TO THE INJURED

ARRAN '>ED ACCORDT:-<G TO THE REVISED SYLLABl.:S OF THE FIRST AID COURSE OF THE

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1ES C\NTLIE,

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\Vith ,a CIlAPTER on" lretcher Transport," revisl"d from that originally written by Sir JOliN FURLEY, C. B .• ofJIlStice of the Ol'der of .':>/. Johl/, in accordance with the Army tretcher Exerci es. Also a CHAPTER (being the Fifth Lecture f,)r Female only), by E. l\IACDowEL CO GR.\\ E, M,D F.R.C.P.I K'":l(ld of Grace of the Order of 51. Johll. HOl/ol'llt:;' Life Jlember of, and Lel'lllrer E:.:amiller to, the .·issoc/atioll .

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LADY CO:lIMANDANT -IN-CHIEF OF ST. JOHN \\TOMEN'S V . A . DETACHMENTS : Lady Perrott.

ECRETARY: P . G. Darvil-Smith. R EVISED 1903.

REFERENCE

FIRST AID TO THE INJURED.

SYLLABUS OF INSTRUCTION

. FIRST LECTURE.

A. Principles of First Aid .

B. A brief Description of the Human Skeleton and of Muscles.

C. Fractures-Causes, varieties, signs and symptoms.

D. Treatment of Fractures-General Rules.

E. The Triangular Bandage and its application. SECO:-lD LECTURE.

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

E. Dislo ca.tions, Sprains, Strains-Signs, symptoms and treatment.

C. The l1eart and Blood Vessels. The Circulation of the Blood.

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

E. T he Triangular Bandage and its application .

8

TllIRD LECT URE.

A. H x:norrhage anJ wJunds (continued) . Details o f treatment.

B. Int ernal Hxmorrhage - igns, symptoms a nd arrest.

C. I from Special Regions.-Signs, symptoms and arrest.

D. Bruises, Burns and Scald, Bites and Stings, Frost·bite.

E. Fo reirrn bodies in the Eye, and Ea r.

F. The Triangula r Bandage and its application.

F OURT H LECTURE.

A. Th e Nervous Sy ·tem.

B. Th e Organs and of Respiration-Artificial R espiration.

C. I nsensibility.

D. Poi,oning.

FIFTI[ LECTURE (for :-.rales only) .

A. I mprovised method s of lifting ano carrying the sick or injured.

B. Meth ods of lifting and c<urying the sick or injured on stretchers.

C. The conveyance of such by rail or in count ry carts.

FIFTIl LFCTURE (for Females (lnly ).

A. Preparati on fur reception of acciJent cases.

B. M eans of lifting and carrying ..

C. Preparatio!l of bed.

D. Rem oving the clothes.

E. Preparations for surgeon .

N OTE I.-Th e subject of pois ons should be treated in a manner ; the common poisons classified, and only thei r general symptoms, effects and treatment taught.

N on: n.-The last half·hour of each lecture should be elevoted to pract ical work, suc h as the "pp'ication o f banda ae s and splil,t , lifting and carrying wounded on stretche rs. '"

NOTE lIr.-Th e re .,hould be an intervJ.I of a week between eac h lecture. A candidate for examination must attend at least fuur out o f th e five lectures.

O!E IV.-i\!ale classes must pass in that system of stretcher exercIse most sUItable for the locality.

NO.fE :r.-As little time a ., possible is to be spent on inst ructIOn In anatomica l and L1hysi ological detail. Lecturers an d examiners are particularly reque ted to remember that it is lC First Aid" that has to be taught and tested , and not anatomy and phy siology.

illixed classes oj men and women are Oil no aCColmt lermitted.

PUPILS UNDER SIXTEEN YEARS OF AGE CAN ONLY ATTEND

TilE" JUNIOR" 00URSE (SECTJON A, SYLLI'BUS 40) .

Lecturers instructing a First Aid class, and Local Secretaries can obtain further particulars on application to the Chi e f Secretary fur ,. Paper Rt:ference No. 80."

/\' 0 L,'dllre7' may exalli/Ite his OWIZ Class for Certiji mles.

SUMMARY OF CONTENTS.

CH APTER 1.

of First Aid

Explanatory

Questions on Chapter

CH APTE R II.

The Human Skeleton. Skull, spine, ribs and breastbon e, upper limbs (collar-b one , shoulder-blade, armbone bone s of th e forearm, carpus, metacarpus, pelvis, lower limbs (thigh-bone, kneecap, tarsus, metatarsus, phalanges)... . ..

Joints ...

Muscles. foluntary and involuntary

Fractures. Causes, varieties, signs and £ymptoms

Apparatus for treatment of Fractures ... ."

General Rules to be observed in the treatment of Fractures

Special Fractures. Cranium, lower j:lW, spine, ribs, breast-bone, colhr-bone, shoulder-blade, arm-bone or bones close to the el bow j lint, forearm, crushed hand, pelvis, thigh-bone, knee-cap, leg, crushed foo t

Dislocations

Sprains

Sprains and Ruptured Muscles .. ,

CHAPTER III.

C;rculation of the Blood. Organs; general (systemic) and pulmonary circulations

Hremorrhage or Bleeding. Arterial, venous, ca pillary

Arterial Hremorrhage. Principles of :lrrest

Wounds with Arterial Hremorrhage ...

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

Venous Hremorrhage and Varicose Veins

Wounds with Venous Hremorrhage

Capillary Hremorrhage

Internal Hcemorrhage

Hremorrhage from Special Regions

Questions on Chapter

CHAPTER IV.

Miscellaneous Injuries. Bruises, burns and scalds, bites of snakes and rabid animals and b) poisoned weap ons, stings of plants and animals, frost bite, needle emb edded under the skin, fish hook embedded in the skin, injuries to joints, foreign b ody in the eye, ear passage and nose, wound in the front wall of the abdomen, injuries to the organs within the abd omen and pelvis

Questions on Chapter ... . . .

CHAPTER V.

The Nervous System. Cerebro-spinal, sympath et ic . ..

The Respiratory System

Artificial Respiration. Schafer's, Silvester's, H oward'! c ombined with Silvester's, Laborde's and Marshall Hall's methods ...

Insensibility. Cause s, rules treatment, cus sion of the bram, compre ssIO n of the bram, apoplexy , epilepsy, hyst eria, shock, collapse, mnstroke and beat-str oke , convulsIOns m children, asphyxia

Electric Shock and Effects of Lightning

Questions on Chapter

CHAPTER VI.

Poisoning. Gene ral rules for treatment , spe cial pois')ns

Questions on Chapter

CH APTER VII.

Bandaging. Bandages for the sc alp , forehead, et c., shoulder, hip, hand , foot , chest, back, knee, elbow , finge rs and toes . ..

CHAPTER VIII.

Methods of Carrying. Four, two, and thr.ee.ha n?ed seats, fi reman' s lift, fore and aft method, Impronsed stretchers, to cross a ditch or wall, to load or unload a wagon

CH APTER IX.

Stretcher Transport. Stretchers, stretche r exercis es, li tte rs

CHAPTER X.

The Fifth Lecture (for Females only). Preparation for rec eption of accident cases, and lion of a room, lifting and carryll1&, preparatIOn of bed, rem oving th e clothes, preparatIon for surgeon ...

Questions on Chapter

Skeleton showing position of main arteries

Skull and vertebral column

Vertebra ...

Bone3 of the left upper limb

Bones of the right lower limb

Shoulder Joint

Ankle ...

Rectus :\Iuscle ... ... ... '"

Triangular bandage spread out and folded

Large arm sling

Small a rm sling

Reef knot

G ra. nny knot . . .

Loop knot , " .. .

Bandage for fracture of lower jaw .. .

Bandages for simDle fracture of ri bs

St. John sling

Bandnges for fral-lure of both collar bones

Bandage for fracture of shuulder blade

Treatment of fr& ,ture of arm

Angular splint .,.

Treatment of fracture of forearm

Treatment of crushed hand... . .. .. .

Treatment of fracture of thigh bone .. .

Treatme nt of fracture of thigh bone (woman)

Fracture of knee cap ... ' "

Treatment of fracture or' knee cap ...

Treatme.lt of fracture of leg (01'tn and wuman)

Treatment of cru shed foot ... ... '"

Diagra m of the heart, lungs and air

14

Diagram of the cir-ulation of the blood

Digital pressure on carotid artery .. .

Digital on facial artery .. .

Digital pressure on temporal artery

Digital pres>ure on occipital artery... . ..

Pad and bandage to arrest hcemorrhage from temple

Ring pad

Pigi tal pressure on su bclavian artery

Pad and bandages to ap ply pressure on axillary artery

Digital pressure on brachial artery (two methods)

Flexion at el bow

Digital pressure on radial and ulnar arteries

Pad and bandage to arrest hcemorrhage from palm

Digital pressure on femoral artery...

T ourniquet on femoral artery

Flexion at knee ... ... '"

Organs of the chest and abdomen .. .

The lungs and bronchial tubes

Schafer's method of artificial respiration

Silvester' s method of artificial respirati on

Silvester's and Howard's me th ods of artificb,l re spi

combined

Bandage for the head

Bandage for the

Bandage for the hip ...

Bandage for the hand

Bandage for the foot

Bandage for the ch est

Ban dage for the knee

Bandage for the elb ow

Grip for four-handed seat ...

Lifting by two-handed seat...

Grips for two-handed seats ...

Carryi ng by two-handed seat

Grip for three-handed seat ...

Supporting patient ... IS

lFore and aft method of carrying

Carrying on improvised seat

lImprovised stretcher

Wurley stretchers

Stretcher exercise, No. I. " Fall in"

Di tto, ready to lift patient

Ditto, lifting patient. .. itto, placing stretcher

Ditto, preparing to lower patient...

Ditto, "Lower"

Ditto, No. II. Ready to lift patient

lDitto, patient lifted ...

Ditto, No. IV. First position

DAtto, second position

lDiagrams illustrating Army stretcher drill

Ditto ...

)Sed cradle ...

l1mproVl ed bed cradles

PREFACE.

AT the request of the Central Executive Committee

I have revised the manual written by myself in 1901, as the official handbook of the St. John Ambulance Association.

Throughout the revision an endeavour has been made to simplify the study of First Aid to the Injured by drawing up a number of general rules for the t reatment of accidents and sudden illness, and by the omission of all detail \\"hich is not absolutely necessary to enable the student to acquire an intelligent knowledge of the subject.

I wish to express my thanks to Professor E. A. Schafer for furnishin g instructions for performing a method of artificial respiration, to Dr. L. M. F. Christian for many valuable suggestions, and to the Medical Members of the Central Executive Committee, especially Surgeon-Major G. H. Darwin, :M.D. and Dr. F. R. Cassidi, for perusing the proof sheets and for a number of useful additions to the work

I cannot omit also to offer my best acknow ledgments to Mr. ,V. R. Edwards, the Ac countant and Storekeeper of the S.J.A.A., for his invaluable co-operation.

JAllIES CANTLIE.

FIRS/f AID TO THE INJURED.

CHAPTER I.

The St. John Ambulance Association has now completed thirty years of its existence, and during that period hundreds of thousands of men and women have been taught at its classes, in all parts of the world, how to help their injured neigllbours.

First Aid to the Injured is a special branch of practical medicine and surgery, by a of which trained persons are enabled to afford skdled assistance in cases of accident and sudden illness. The instruction begins and ends with First Aid, and the subject js taught simply but thoroughly ar: d exhaustively. The duty of the ambulance pllplls ends where the doctor's commences, and there ought t') be no overlapping or clashing of duty or interests.

PRINCIPLES OF FIRST AID.

!. The First Aid student should be-

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

(b) Tactful, that he may without questlOns learn the symptoms, and hlStoryt of the case. -----------------------

* Signs are what may be perceiYed.

t Symptoms are what the patient can tell you. .

t History means the circumstances attending the acclnent 0-': surlclr.n illness.

(c) Resourceful, that he may use to the best advantage whatever is at hand to prevent further damage and to assist Nature's efforts t o repair the mischief already done.

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

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

2. Remove the cause of injury or danger when eyer possible.

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

4. Air. - The patient must be in a position in 'which breathin s is possible; the air passages must be free from obstruction; if breathing has ceased prompt measures must be taken to restore it.

. ' S. Rest.r---A restful position of the body will assist th e vital functions; support of the injured part \\ ill help to prevent further damage , and is essential i.:: the case of fractures of limbs .

6. Warmth.-After every accident keep the pJtient warm so as to pre\'ent the fall of temperature below the nOTnial point.

7. When the skin is broken the wound

should be promptly covered with,a clean dressing. Should the \\'ound be pOIsoned, IS most important immediately to prevent the pOIson permeating the s) stern. ,

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

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

10. Removal of Clothing. -Clothes should not be taken off unnecessarily, but whcn 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: Slit down the front and remove as the coat.

TROUSERS: Slit up the outer seam .

BOOT: Slit the back seam and undo the laces.

SOCK: Cut off.

II. Stimulants.-It is incorrect to suppuse that alcohol is the only form of stimulant, and far too frequent use of spirits is made to restore a patient after an accident, often with serious results; the safest rule, therefore, is to defer the administration of alcohol until the arrival of a doctor, \Vhen the patient is able to swallow, strong tea or coffee, or milk, as hot as can

be drunk, or a small quantity of sal volati1e in water may be given . Sm e lling sallS may be held to the nose. Sprinkling the face with cold and hot water altei-nately, warmth applied to the pit of the stomach and oyer the heart, and vigorous friction of the limbs up\\'ards haye a stimulating effect.

12. 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 accompanied by grave danger and may actually cause loss of life. When sending for a doctor, state the nature of the case, and remember that written particulars are safer than a verbal message.

QUESTIONS

It is necessary that something should be known of the structure of the body anatomy), and of the functions of some of the more important organs and systems (elementary physiology). A short description of the neces!3ary anatomical and physiological points is therefore gi\-en as the several subjects are disc u :;sed . For purposes of description the human body is supposed to be erect, with the arms hanging by the side and the palms of the hands directed forwards. The" middle linE:" of the body runs vertically from the top of the to a point bet\\-een the feet. 2!

Wh3.t is First Aid to the injured ?...

\Yhat qualities should the First Aid student possess?

\Yhat are signs?

\Yhat are symptoms?

\Yhat is the history of a case?

'Yhat is often the first thing to do in an accident?

"What result of injury must receive the first attention?

CHAPTER II.

FRACTURES, DISLOCATIONS, SPRAINS AND STRAINS.

THE SKELETON.

T he human body is moulded upon a bony framework (the skeleton) which serves-

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

2.- To afford attachment to the muscles.

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

THE SKULL.

T he Bon es of th e Sku ll are arranged in two groups, those of the brain case or cranium, and those of the face.

The B ou n da ries of t h e Cra niu m are the vault or dome, the rounded portion forming the top of the head; the front or brow j the back of the head, where the greatest extent of brain exists, and where therefore the cranium is\\"idest and deepest; the sides or temples. The base of the cranium is hidden from view by the bones of the face and of the vertebral column; in it are numerous perforations for the passage of blood vessels and nerves j through the largest opening the brain and spinal cord are continuous.

The Bo nes of t he Face with the exception of 23

the lo,ver j:lW are firmly jointed together, so that movement between them is impossible. The ca vities of the nose and of the eye sockets (orbits) are formed by the bones of the cranium and of the face conjointly The mouth cavity is formed between the 'J pper and lower jaws, the being the bony r0.of of the mouth which separates It from the nasal cavIty above.

The Lower Jaw consists of :-

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

(b) Vertical portions term inati ng on either sidl· at the joint between the lower ja \\' and the base of the cranium , situated immediately in front of the ear.

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

T HE BACK-BONE, SPINE, OR VERTEBRAL COLUMN.

The Vertebral Column (Fig. I) is composed of bones called ver t ebrce , each of which consists of-

I.-A body or bo ny mass in front.

projecting bac k wards, which enclose a c.anal for the spinal cord - the spinal canal.

3·- Two transverse processes, twelve pairs of which suppor t the r ib s.

SKULL AND VERTEBRAL COLUMN.

Showing left ribs and portion o f breast .bone . The right ribs are removed.

SPINOUS PROCESS.

CANAL FOR SPI N AL C O RD.

BODY OF VERTE BRA

FIG. 2A.

S URFACES

SUPPO RTING

O F RIBS.

FIG. 2f ,

TRANS\ ER S Ir P ROCESS.

SPINOUS PROCESS

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

The Vertebrce, ..,.:i;3 in all, are grouped into regions, in each of whIch they are known by numbers, counting downwards :-

I.-In the n eck 7 Cervical verte'brre. The first vertebra, th e atlas, forms a joint with the base of the skull, at which the nodding movement of the head takes place; the second, tlze axis, by the joint between it and the atlas, allolVs of the side-to -side movements of the head.

2.-1n the back 12 Dorsal vertebrre.

3·-In the loin 5 Lumbar \'ertebrre.

4·-The rump-bone, or Sacrum, consists of 5 Sacral vertebrre united in adults as a solid mass.

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

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

a heiaht on the fee t ) . The ",hole spine is strapped to gether by ligaments reaching its entire length.

THE RIBS AND BREAST-BONE.

The Ribs consist of twelve pai rs of curved bones extending from the dorsal vertebrre to the front of the body, and are known by numbers-first, second, etc., c ommencing from above . The are bony throughout their entire length, but at a short dIstance from the front the bony material ends, and cartilage takes it s place. T he upper seven pai s, named the true r ibs, are attached by their cartilages to t he Breast-bone (sternum), a dagger shaped bone 'with the point dO\\'llwards , just oyer the pit of the stomach. The lower five pairs are termed the false ribs, as t heir cartilages fall of the middle line. The eleventh and twelfth paIrs are termed the floating ribs, as their ends are free in front. The ribs enclose the chest and sen'e to protect the lungs, heart, liver, stomach, spleen, etc.

THE UPPER LUIBS.

The Shoulder-bones are the C ollar-bone ( da'lJZde) and the Shoulder-blade (scatula).

The Collar-bone can be felt on either side beneath the ski n at the lo,ver and front part of the neck as a na rr ow curved rod about the thickness of a finger. I ts inner end rests on the upper part of the

ARM

RADIUS

BONES {ULN A OF RADIUS --++-li-\

WRIST

METACARPUS

PHALANGES

FIG. 3A

B ONES OF THE LEFT UPPER LD1B .

F I G. 3B .

SnOWING THE POSITION OF THE RADIUS AND WHEN THE THUMB IS TURNED INWARDS .

Compare Fig. 3A, in which th e thumb is turned outwards .

PART OF COLLAK BOl\E SHOULDER BLADE (SCAPULA)

BONE (HUMERU , )

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

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 (Izumerus) reaches 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 inn er, or little finger side. Both bones reach from the elbow to the wrist, and they change th eir relative position with every turn of the hand (Figs. 3A and 3B).

The Hand is composed of-

l.-The bones of the wrist, or carpus, eight in number, arranged in two ro'vvs of four.

2.-The mdacarpus (the frame\vork of the palm) ; five bones which form the knuckles and support the bones of the fingers.

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

THE PELVIS AND LOWER LIMBS.

The Pelvis.-The lat:ge basin-like mass of bone attached to the lower part of the spine is composed of the two haunch-bones and the sacrum. The haunchbones meet in front (at the pubes) in the middle line, only a small piece of cartilage intervening, but behind, the sacrum is placed between them. The pelvis

4.

B O :,\ES OF THE RIGHT LOWER LnIB, SH O W IN G WITH THE PELVIS AT THE HIP.

FIG.

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

The Thigh-bone (femur) reaches from tte hip to the knee joint. Its shaft is stout, rounded, and arched forwards; the upper end presents a rounded head, supported on a neck "yhich projects inwards, to fit into the socket of the hip joint.

The Knee-cap (patella) is a triangular bone :Ting with its base up\yards in front of the knee joint immediately beneath the skin.

The bones of the Leg are the Shin-bone (tt"bz'a) and the Brooch-bone (fibula). The Shin-bone extends from the knee to the ankle, in both of \\ hich joints it plays an important part; its sharp edge, tltt sh£n, can be felt immediately beneath the skin of the front of the leg. The Brooch-bone lies on the outer side of the tibia. It does not enter into the formation of the knee joint, but its lower end forms the outer boundary of the ankle joint.

The Foot is composed of--

1.-The tarsus, a group of seven irregular bones at the instep. The largest is tbe heel-bone, and the uppermost (the ankle-bone) forms. the lower part of the ankle joint.

1.- The metatarsus, the five long bones in front of the tarsus which support the toes:

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

31 JOINTS.

A Joint is formed at the junction of two or more bones. In moveable joints such as the hip knee etc., surfaces of the bones are b; cartlhge, whIch lessens friction and the shock of a

5. Compare Fig. 4, Page 29.

Lhubricatin g the joint is a clear, rather sticky

Ul t e " .. t OJ /) ° , }om 01, or sYllovia, enclosed within a capsule. Tymg the bones together but allo\\'in a of movenlent are a b f b d ' . 0 '0 G num er 0 an s or ligaments.

To explall1 the formation of limb joints, the

FIG. 6.

LEFT ANKLE.

FIG.

t E NDON NERVE

ARTERY

MUSCULAR TISSUE

TENDON OR LIGAMENT OF PATELLA

FIG . 7.

DIAGRAM SHOWING RECTUS MUSCLE OF THIGH, WITH !\RTERY, VEIN AND NERVE.

following examples are given :-

T he Shoulder, a balland-socke t joint, consists of a shall ow socket on the ou ter angle of the shoul der-blade, and of the h ead of the arm-bone (Fig. 5). 0\\ ing to the shallo\\"ness of the sod et the arm-bor..; is very prone to escape fr( m its socket (dislocate ). .

The Ankle, a h1l1ge joint, is fOl:Tlfd at the junction of three bones, shin -bo ne abO\'e and on t he inner side, the bro ochbone on the outer side, and the ankle-bone belm,,, (Fig . 6) .

THE M U SCLES.

The Muscles of tIle body are classified into t\\ a groups-voluntary and z"71volmllar)' .

T he Voluntary muscles are met " 'i th in the limbs the h ead and n eck, and the surface of the tru n k: Their e n ds are atta"ched to different bones, and as they pass from one to anothtr they cross a joint, and, being endowed with the power of contraction and relaxation, cause the movements of the body, As a muscle crosses a joint, it as a rule a fibrous cord or tendon . Blood-vessels traverse and supply the muscles, and the nerves entering them bring them under the direct control o f the brain and spinal cord .

The Involuntary muscles are met with in the walls of the stomach and intestines, in the nir passages, and in mos t of the internal organs and blood-vE.ssels, also, in a special form, in the heart. They are not under the influence of the will, but continue their v\ ork during the hours of sleep j their functions are regulated by a separate set of nerves (see Sympathetic System, page II 8).

FRACTURES AND THEIR TREATMENT.

' Vhen a bo n e breaks a Fractme is said to occur.

C AUSES OF FRACTURE.

I. Direct Violence.-\Vhe n from a severe blow, impact of a b ullet, crush of a wheel, etc., a bone breaks a t the !'pot where the force is appJied th e fracture is termed direct.

2. Indirect Violence.- \Vhen the bone breaks at some from the spot "here the force is applied the fracture is termed indirect. Alighting on the feet and fracturing the thigh- bone or the bones of the leg, or falling on the hand and breaking the radius or the collar-bone, are examples.

3. Muscular Action.- The kn ee-cap and the arm-bone are occasionally broken by a vlOlent con , traction of the muscles attached to them.

VARIETIES OF FRACTURES.

Fractures are classified according to the condition of the tissues adjacent to th.e bone as f0.1lo\\'s :- . v. . I. im ,k.- The IS broken WIth but slIght to t e surroundmg parts. ,

2. Com ound.-The bone is broken and the nd tissues are punctured or torn, thus allowmg disease-producing germs to obtain entrance to the seat of fracture. The fractured ends may protrude through the skin, or (for example, 'w hen a bone is broken by a bullet) the wound may lead do\\'n to the fracture.

X3· Com licated.,-:The bone i.s broken and in addition there IS an mJury to some mternal organ (for example, the.,brain, spinal cord, lung, etc.) or to some important blood-vessel or nerve.

A fracture may be compound or complicated as 'tthe immediate result of the injury j or a fracture,

originally simple, may be converted int o a coml?o und or complicated fr.i.cture-

(a ) By careless m ovemen t on t he part o f the \ patien t.

)

\ (b) By or ignorance on the part of one rendenng first aid.

. Special varieties of fractures may be classified accordll1g to the injury to the bone itself as follows:-

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

2. Green-stick. -In children, OWil1 O' to the softer of the b?ny tissues, a bone may and crack vVlthout breakmg completely across.

. 3· Impacted. - The broken ends of the u'lne arc dnven one into the other.

GENERAL SIGNS AND SVMPTOMS ,,'HICH ?lL\ V BE P RESENT .

(A fracture of the femur, humerus, or both bones of the forearm or leg, affords the most complete example .' .

I. Pain at or near the seat of fract ·e.

2. Loss of Power in the lim b.

3· Swefling about the se.:tt of fracture. SweI1in O' frequently renders it difficult to percel\'e other of and c.:tre must th erefore be t.:tken to mIstakE: a fracture for a less serious injury,

4· Deformity of the limb.-The lim b assumes an

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

S. Irregularity of the bone.-If the bone 1S close to the skin the fracture may be felt, and If compound it may be seen.

6. Unnatural Mobility. -.\Iovement may be made out at the seat of fracture.

7. Crepitu.s, or bony grating, may be felt or heard when the broken ends move one upon the other.

The last two signs SiLOu/d 0171, be sough! b)' a Several of the above sIgns are absent 111 green-stIck and impacted fractures.

.

In addition to the signs and symptoms the patIent or the bystanders may be able to the of the injury, and marks on the clothmg or skm should be noted, as they may serve to locate the The snap of the bone may have been heard or ielt.

ApPARATUS FOR TREAT:\[E1\T OF FRACT"G"RES.

Splints and bandages for First Aid frequenLly have to be improvised.

A Splint may be improvised from a walk1l1g stI.ck, umbrella, billiarci cue, broom or brush handle, polIceman's truncheon, rifle, folded coat, piece of wood, cardboard, paper firmly folded, a rolled-up map, Of, in fact, anything that is firm and long enough to keep 37

the Jomts immedz'ately above and below the fractuntl bone at rest. \Vhen the above appliances are not available, the upper limb, if fractured, may be tied to the trunk, and in all cases a fractured lower lim b should be bandaged to its fellow.

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

Esmarch's Triangular Bandages (Fig. 8) arc. made by -:utting a piece of linen or calico fo rty inches square diagonally into two pieces.

The broad bandage is made by bringing th E point down to the base (Fig. 9), and then into hyo (Fig_ 10).

The narrow bandage is made by folding broad bandage once (Fi.s- II).

The medium bandage is made by bringmg th e point down to the base, and then folding into three _ (Fig. 12). This bandage may be used instead of th broad or the narro\\' bandage when it is better "uited to the proportions of the patient.

It is sometimes advisable to halve the size of th bandage by bringing the t\\·o ends together before folding it into the broad, narrow, or medium bandage , \Vh en not in use, the triangular bandage should b e;' folded narro\-v; the two ends should be turned t the centre, and the bandage then folded into fout l reducm g It to a packet about 6t inches by 31

FIG. 8. SPREAD OUT.

BANDAGE ONCE FOLDED.

FIG. 10 BROAD BANDAGE. 4·

FIG. II. NARROW BANDAGE.

FIG. I2.-THE DOTTED LINES SHOW THE FOLDS OF THE MEDIUM BANDAGE.

Large arm-sling (Fig. 13).-Spread out a bandage, put one end over the shoulder on the sound 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 chest; carry the point behind the elbow of the injured limb, and bend the forearm

FIG. 13. FIG. 14.

over the middle of the bandage; then carry the second end up to the first and tie them; bring the point forward, and secure with two pins to the front of the bandage.

Small arm-sling (Fig. 14).-Place one end of a

broad b andage over the shoulde r on the soun d side, it roun d the n eck so t ha t it appears ove r the shoulder of the in j ured side ; plac e t he forearm ove r the middle of the ba nd age; then b rin g th e second end up to th e first, and tie the m. This sli n g is used in case s of fr act ured hu me ru s, an d oc casio nally whe n th e la rge sli ng would be too c onspicuous . Slings may be im provised in ma ny si m p le ways , su c h

as pinni ng th e sl eeve to the clothing, turn ing u p th e t ail of t he coat, pass ing t he h a nd inside the huttoned c oat o r waistcoa t, et c.

eef Knots (F ig. IS ) a re t o be us e d. A voi d granny kn ots (Fig. 16).

IGENER,\L RULES TO BE OBSERVED IN THE TREATOF FRACTURES .

The object of First Aid Q! E ctures IS to auard aaainst further mIschIef and pre\'ent. a imp e trac ur.e fro.m hecom!.!2g comj2oun or comphcated. To attall1 thIS end :-

I. Attend to the fracture on the s ot. ..:.£ matter 110w crowded the thorouahfare or hoI\' short the distance to a more convenient or comfortable p ace, no attempt must e made tQ the patient until the limb ha b. n rendered as Immovable as possibl e b"Y splints or oth.e r

2 . Steady and sup po rt the injured limb at once so that its furth er movement on the part of the patient or the bystander is prevented.

3. Straighten the lim b w ith gre a t ca re, and if shortenin a is obsen'ed in the case of a fracture of a bone of d1e lower limb, pull upon the foot until the limb regains a more n ormal length. Wben the shape of the limb is impro\'ed on n o .account let go until it is secured in po ition by splll1ts, there is great danger of the fracture l)ecoming compound or complicated .

4. Ap p ly s Qlints (when practic a b le) and ba nd a O"es as follo\\'s :(a tTbe S) 'nts mu t be firm, a?d lon a enough ta keep the jOlrl ts Immediately above an

F IG. I5 . -R EEF KNOT. FIG. 16. - GRANNY KNOT.

below the fractured bone aL-r.e.s.t. They should, if practicable, be to fit accurately to the limb and be applted over the clothing.

(b) The bandaaes must be applied firmly, but not so as to constrict the circll.latio.n

0 - 100d in the Ii When the patlent lS in the recumbent positioll 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 but if to secure a splint for a broken thlgh, over the splint.

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

For tlte 'thigh or leg the narrow. or medium bandage may be used. It lS frequently convenient to double the bandage at the centre, pass it under the limb, bring the loop over the limb, pass both ends of the bandage through it in opposite directions, and tie them over the outer splint (Fig. 17).

In applying bandages near a fracture the upper one should be secured first.

5· When accompanies a fracture it must be attended to first, and the wound covered by a clean dressing.

FIG. 17.

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

7· In every case of fracture it is necessary to cover the patient to keep him warm, and so lessen the effects of the SHOCK of the accident.

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

SPECIAL FRACTURES.

Fracture of the Cranium.-A fracture of thupp er part is usually caused by direct violence-fOl example, a blow on the head. A fracture of the base is caused by indirect violence, through a fall on the

44

head, a fa ll on the or lower pa rt of the spme, or a severe bl ow on t he lower jaw. If tile uppel' pa r t i s fractured , the signs ar e swelling, irregularity> and freq u en tly insensibility, either immediate or c om ing on If the base £s fractured insensibility may come on immediately, blood or a clear fluid may issue from the ear blood may escape from the nose, or it may pass down to the whence it may be \"Om11.ed; the f racture may involve the orbit, causing a bloo d-shot eye.

In j ury to the bram 1 the great d anger attend-

FIG . 18. ing a fr act ure of the cra n iu m . For treatme nt see " Conc ussion a n d

Co mp ression of the Brain," pages 131, 13 2 •

Fra cture of the Lower Jaw.-Pai n , loss ot po wer (inabi lity to speak and to move th e jaw free Ly), irr egulari ty of the teeth, crepit us a nd b leedi n g fro m the gum are the usual sig ns a nd symptom s.

4S

TRl!.ATl\IEP;'T.

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

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

Fracture of t he S p in e . - The vertebral col umn may be broken either by direct or indirect yiolence. F::tlling from a height on the back across a bar or upon an uneven surface is an example of direct fracture, and a fall on the head, cau ing a broken neck, is an example of indirect violence . ' Vhat is commonly regarded as a broken back consists of a fracture of one or more of the vertebrre \\"ith displacement of the fragments, whereby the spinal cord J.nd the nerves issuing from it may be torn, causing com plete or partial paralysis of the parts below the fracture. Pain is present at the seat of injury .

TREATMENT.

I.-Prevent all rnoyement on the part of the patient.

2.- Cover the patient warmly.

3.- To remove the patient, place him on a stretcher or shutter as f01l0\\"s

(a) Turn up the collar of his coat; roll up a stick or umbrella in each side of the coat

so that the ends are level with the top og his head; pass a br Jad bandage or handkerchief under the head and secure it t the sticks. If no coat is \Yom, or d o ubt as to its strength and length exists, pass a number of bandages under the patient to serve instead of, or in addition to, the coat.

(b) A bearer on each side grasps the wiled coat with his hands well apart; a third grasps the clothing on both sides on a level with the hips; a fourth bearer takes charge of the legs.

(c) On the word being given, all lift together and carry the patient by short side paces over the stretcher and carefully lower him on to it. If a fifth bearer is available the stretcher should be passed under the patient instead of carrying him over it.

4·-0n arrival at shelter nothing further is to be attempted until the arrival of a doctor, except to give the patient water, tea, etc., if he is conscious.

Fractured Ribs.- The ribs usually fractured are t he sixth, seventh, eighth, and ninth, and generally the fracture is midway between the breast-bone and the spine. The fracture may be caused by inrlirect violence, driving the fractured ends of tht. Jone iOutwards, or by direct violence, driving the fractured tends of the bone inwards and sometimes injuring the

lungs or other internal organ. If the lower on the ri Gh t sIde are broken, the liver may be and a O fracture of the lower left ribs may wound spleen. Evidence the fmcture is afforded by pam 9 especially on attemptmg to take a deep breath, and by short and shallow breathmg. If the lungs are injured blood, frothy and bri ght red, may be cou ghed up and expectorated. If the liver or is wounded internal hcemorrhage page 95) may occur.

TREATMENT.

(a) TTilen till? fracture is not complicated b)' an injury to an internal organ :-

two broad bandages round the chest suffi-

FIG. IQ. ciently firmly to . a fford comfort, with the centre of the flrst immediately above and that of the second immediately below the fracture. The low.er bandage should overlap the upper to half Its

48

extent. The knots are to be tied rather to the front on the opposite side of the body. Another good plan is to apply a strong towel, folded about eight inches wide, tightly round t0e chest, securing it with three or four safety pms.

:I.-Place the arm on the injured side in a large sling. (Fig. 19).

(b) When an inferllal organ is z"n.Jured-

I.-Do not apply bandages round the chest.

2.-Lay the patient down, inclined a littl e towards the injured side.

3·-Loosen the clothing, give ice to SUCk and place an ice bag over the seat of Treat as for internal hcemorrhage (see page 95).

4·-Place the arm on the injured side in a large sling. of the Breast-bone (sternum).-

Whe.n thIS can be felt or is suspected undo all tIght clothmg, and keep the patient quiet in an easy position until the arrival of a doctor.

FRACTURE OF THE BONES OF THE UPPER LIMB

Fracture of the Collar-bone (davlde ) .-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 pati ent usually supports it at the elbow with his hand, and inclines his head towards the injured side. The fractured ends can generally be fel t to overlap, the outer fragment being the lower. Th e general signs and symptoms of fracture are mostly present.

TREABfE;,{T.

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

2.-Place a pad about two inches thick and four inches across in the armpit.

3.-Gently bend the forearm well up, keeping the shoulder as far back as practicable, and support it in a " St. John" sling, made as fo \lows: -

(a) Lay an unfolded bandage across the chest over the injured limb \\"ith one end on the uninjured shoulder and the point beyond the elb8w en the injured side. (Fig. 20).

(b) Pass the lo\\'er end of the bandage under tbe injured limb, across the back, and tie the ends somewhat loosely in the hollow in front of the sound should er.

( /) Fold the point over the elbow ot the injured limb and secure it by One or two pins (Figs. 21 and 22).

4.-Tightly secure the injured limb to the side by a broad bandage passed round the elbow and as to lever out the shoulder, the pad forming the u1crum.

S.-Now tighten the sling. When both collar-bones are broken keep th

FIe 2 1. (Body bandage omitted to show details of Sling.)

FI G. 23A. FIG. 23B. shoulders back by narrow bandages tied round each arm, close to the shoulder, passed across the back9 over the opposite arm and tied together in fronto The forearms should be raised and supported by the bandages. (Figs. 23A and 23B).

Fracture of the Shoulder-blade (scapula).-

Apply the centre of a broad bandage in the armpit

the injured side, cross the ends over the uninjured shoulder and tie them under the armpit. Support the limb in a St. J ohn sling (Fig 24)·

Fractu re of the Arm (lzumerzts) . - The bone may be broken :-(a) Close up t the shoulder; (b) near thE" middle of the shaft; (c) close FIG. 24· to the elbo\\'.

All the general signs and symptoms of fracture are itlsually present.

TREATMENT .

J¥lzen the Fracture Z"S close to the Slzoulder-

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 tlze Fracture z's near the Mz'ddle of tIle S haft-

I.-12end the forearm at a r ight 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 also. The front splmt 53

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

3·-Secure the splints by bandages above and below the fracture . If splints are not a\'ailable, secure the arm to the side by two broad bandages.

4.-S11pport the forearm by a small arm sling. (Fig. 25).

Fractures in volving the el bo w joint, \"hether of the arm or iorearm, are attended \\ ith so much s\\ elling, and it is so difficult to ascertain the exact nature of the injury, that when the accident occurs indoors the lim b shou Id be laid upon a pillow in the most comfortable position; ice or cold water dressings should be applied to the injured part, but no further treatment should be attem pted pend ing arrival of a doctor.

FIG . 25.

54

.When the accident occurs out of doors-

.1. Take two pieces of thin flat wood, one long enough to reach from the armpit to below the elbow , the other long enough to reach from above the elbow to the fi nger ti ps ; tie them togeth e r to form a right angle. (Fig. 26).

2.-Apply the angular splint so made FIG. 26 on the inner side of the fl exed limb.

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

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

5·- On arrival at home remove the splint, and treat the injury as if it had occurred indoors.

Fracture of the Forearm.- 'Vh en both b ones (the Radius and Ulna) are broken, the ge neral signs and symptoms of fracture are usually present. 'Vhen one of the bon es only is broken the signs and sympt oms are as a rule pain, loss of po\\"er, swellin g, and irregularity. An impacted fracture of the Radius

55

just above the wrist is a common result of a fall on the hand .

TREATMENT.

This is the same, whether the fracture is of one bone or of both.

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

FIG. 27·

FIG. 28. keeping the thumb upwards, and the palm of the hand to\\"ards the body.

2.-Apply broad splints on the inner and outer sides from the elbows to the fingers. ..

3.- A pply bandages, embracing both splmts, Immediately above and below the fracture and round the hand (Fig. 27)·

4.- A pply a large arm -sling. Crushed Hand (fracture of the bones of the ca rpus, metacarpus, or fingers).

TREATMENT.

I.-Apply a carefully padded splint to the front of the hand, reaching from well above the wrist to beyond the tips of the fingers.

2 - T o secure the splint apply a narrow bandag e crossed in the manner of the figure 8 to the wri st and hand (Fig. 28).

3.-Apply a large arm-sling.

Fracture of the Pelvis." 'hen, afte r a severe injury in the neighbourhood of the haunch-bone, there is no sign of damage to the lower limbs, but the patient is unable to stand or even to move the IO'v\'er limbs without great difficulty and pain, a fracture of the pelvis may be assumed to have occurred . The blood-vessels and organs, especially the bladder, within the pe lvis are in dang er of being wounded.

T REATMENT.

I.-Lay the patient in wnatever position is fou n d to give the greatest ease, and flex or straighten the 10\\ er limbs as the patient desires.

2.-Apply a broad bandage round the hips tight enougil :0 support the parts, but not so tight as to press the broken bone further inwards.

3.-To remove the patient place him on a stretcher, acting on the same principle as that described under " Fracture of the Spine" (see page 4 5).

FRACTUR E OF THE BONES OF THE LOWER LIMB.

Fractu re of t h e Thi g h -bone C!emllr) . - The thigh bone may be broken at its neck, an)'\\ here in the shaft, or close to the knee . A fracture at the

57

neck is likely to occur in Old peop1e 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 general signs and symptoms of fracture are usually present and a prominent sign is the position of the foot, f

which, as a rule, lies on its outer side. Shortening may vary from one-half to three inches .

TREAnfENT .

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

2.-Gently draw down the foot and bring it into line with its fellow. When two or three assistants are at hand, it is one person's duty to hold the foot position until the splints are secured.

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

58

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

5.-Secure the splints by bandages as follows :(a) Round the chest just below the armpits, (b) round the pelvis on a level with the hip joints, (c) above the fracture, (d) below the fracture, (e) round the leg, (/) round both ankles and feet, and tied below the feet, ( 0) a broad bandage round both knees (Fig. 29).

FIG. 30.

\Vhen single-handed, or when the patient is a woman, it is expedient, after extension of the limb, to tie the fee t together, dispense with the inner splint, and pass the bandage£ round b oth limbs (Fig . 30).

Fracture

of the Knee-cap ( patella) -The knee-cap may be FIG. 3 I. broken by falling on the knee (direct violence), but more frequently it is broken by muscular action, as follows:-

59

\Vhen the foot 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 [).

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

TREAT:'1ENT.

l..-Lay the patient on 1...;" back, raise \\'ell and

FIG. 32.

support the head and shoulders, straighten and raise the limb. .:

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

3·-A pply a narrow bandage with its centre imme-

60

diately above the knee-cap, cross the ends behind over the splint, and tie in front below the broken bone. To ensure firmness apply a second bandage in a similar way, but commenced below and tied above the broken bone.

4.-Further secure the splint by bandages 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 its fellow (Fig. 3 2 ).

6.-Apply an ice bag 01 a cold \\ater dressing over the fracture.

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

TREATMENT.

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

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

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

61

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

4.-Secure the splints by bandages (a) aboye, (b) below the fracture, (c) immediately above the kneel

33.

34.

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

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

FIG.

FIG.

) f2

woman, after extending the limb tie both feet together, dispense with the inner splint, ani P1SS the b:mdacres round both limbs (Fig. 34). 'Yhen no splint IS available tying the legs, ankles, and knees together is o f great service.

Crushed Foot (fracture of the tarsus, metatarsus and toes).-This accident is commonly caused by the passage of a heavy weight ove r the foot, and may be recognised by pain, swelling, and loss of power.

TREATME T.

I.-Remove the boot (see page 19),

z.-Apply a wellpadded splint to the sole of the foot, reachingfrom the heel to the toes.

3.-Apply a bandage FIG. 35. cr o ssed after the manner of the figure 8 (Fig. 35) .

4·-Support the foot in a slightly raised position.

DISLOCATIONS.

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

The joints most requentl dislocated are of the shoulder, elbow, thum , fingers, and lower jaw.

AND OF DISLOCATION.

1.- Pain of a severe sickening charac t er at or near joint.

2.-Loss of power in the limb.

3. - Numbness of the parts below the seat of dislocation.

4. - Swelling about and below the joint.

s.-Fixity of the joint.-The limb cannot be moved at the joint by either the pltient or others.

6.-Deformity of the limb.-The limb assume s an unnatural position, and is mis -shapen at the joint.

TREATMENT.

No attempt should be made by anyone except a. do cto r to reduce a dislocation. Pending his arrival :-

(a) J,VlleJl tile ace/de Ilt ocCltrs ou t of doorsSupport th e limb in whatever position gives most ease to the patient, bearing in mind the necessity of lessening the effect s of jolting during transport.

(b) lVlleJl the patient is t'ndoors-

I. - Remo ve the clothing from the limb .

2. - Pl ace the patient on a couch or bed.

3.-Rest the limb on pillows in the most comfortable position.

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

s.-'Vhen cold ceases to give comfort apply

'warmth (flannels or to'tyels wrung out of h0t water)

6.- Treat shock (see page 135).

SPRAINS.

'Vh en, by a sudden wrench;; twist, the ligaments and around a joint are stretched and torn the ]OI.nt IS said to be sprained. "Going over" tli.eankre IS a common example.

SIGNS AND SYMPTOMS.

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

2.-InabIhty to use the joint.

3·-Swelling and discoloration.

TREATMENT OF SPRAINED ANKLE.

TVhen O[(t of doors-

I -Apply a bandage tightly over the boot, bes;mnmg on the sole at the instep, crossing It on the front of the ankle and carrvin a . d 'J 0 It roun and round the ankle where it is to be firmly tied. '

2.- 'Vet the bandage after application; it is thereby tightened.

After reaclzz'ng shelter_

i.-Remove the .boot stocking (see page 19). the lImb Jt1 the most comfortable posltlOn; usually that i:, well raised.

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

4.-'Vhen cold fails to give comfort, apply hot fomentations.

'Vhen other joints are sprained , treat them as if dislocated.

When in doubt as to the: nature of the injury, treJ.t as a fracture.

STRAINS

AND RUPTURED MUSCLES.

'Vhen, during severe exertion, muscles or tend ons are over-stretched they are said to be strained, if they are actually torn they are described as ruptured.

SlG:\TS AND

r .-A sudden sharp pain.

2.-When the muscles of a limb are strained they may s\yell and caus e severe cramp.

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

TREATr.'lE T.

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

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

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

QUESTIONS ON CHAPTER II.

Tlu nume1 -als illdz'catt tIle pages whe1't tIlt allswers may be found.

What is the skeleton, and what purposes are served' by it?

R ow are the bones of the skull arranged?

'Yhat are the bonndaries of the cranium?

22 22 22

Describe the bones of the face 22, 23

Describe the lower jaw

What is the angle of the jaw?

'Yhat other names has the back-bone? is a vertebra?..

How many vertebrre are there in the spine?

\\' bat are the regions of the spine, and how verte brre are there in each?.. ...

lIow is the spine endowed '" ith free movement?

What is a rib?

How many pairs of ribs are there?

What is the breast-bone?

'Yhat are the bones of the upper limbs?

'''hat is the pelvis?

What is the hip j oint?

\Vhat are the bones of the lower lim bs?

What is a joint?

Describe a moveable joint ...

Describe the shoulder joint

Describe the ankle joint ...

How are muscles classified

Describe voluntary muscles

Describe involuntary muscles

\Yhat is a fracture? ...

\Yhat are the causes of fracture?

\Vhere does a bone break when direct vi olence is the

cause of fracture?

\Vhere rioes a bone break when indirect violence is the cause of fracture? ...

How maya fracture be caused hy action?

In what two ways may fractures be classified? . ..

What is a simple fracture? ..

\Vhat is a compound fracture?

\Vhat is a complicated fracture?

\Vhat is a comminuted fracture?

\Vhat

In making up your mind whether a had occ.urred or not, what points should you take ll1to consldera· tion beyond the signs and symptoms?

":hat may caus.e a fracture of the base of the cranium? 43, 44

\\ hat are. the? sIgns of fracture of the uppe r part of the cranIum.

...... 44

\Yhat are the signs of fracture of the base of the cranium?

\Yhat is the treatment for fracture of the cranium ?

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

How maya fractured spine be caused? ...

":hat is commonly regarded as a broken back?

\\ hat are the symptoms of a fractured spine?

How may ribs be fractured?

How may fracture of ribs be complicated?

State the sIgns and symptoms of a simple and of a complicated fracture or ribs

is a frequent cause of fractured collar-bone?

\\ hat are the signs and symptoms of fractured collar-

bone?

State the treatment of other sprains

\\'hen not sure whether the injury is a sprain or fracture h ow would you treat it?

II')w may muscles be strained or rup t ured?

State the signs and symptoms of strains

St,lte the treat ment of strains

First Aid Stud ents should practise impro\'ising materinl, folding bandages, tying knots, making sl ings , and the treatment of the fullowing injUli cs.

sp'ints

48, 49

A t what POInts the bone of the arm be broken? ... 52

Are the sIgns and symptoms of a fracture al ways present In a broken forearm? .

State the cause of a common of ...

How would you recognise a fracture of the pelvis?

A; what points may the thigh-bone be broken?

hat are the signs and symptoms of

thigh-bone?

\\ . hat are the of fracture of the knee-cap?

of the

58, 59

\\ hat a r e the sIgns and symptoms of fracture of the kneecap?

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

\Yhat mistake may easily be made when the fibula is broken near its lower end?

\\"hat is a di slocation?

59

Knot for applying splint to lower limb

Fractures - Lower jaw, 44. Spine, 45, 46. Ri h (simple and complicated fractures), 46 to 48. Breastbone, 48 . Collar-b one, 48 to 51. Both collarbones, 51. Arm, close up to shoulder, 52. Arm, near middle of shaft, 52. Arm or for ea rm wh cn the elbow is i nvolved, 53 . Forearm, 55· Crushed hand, 55, 56 . Pelvis, 56 . Thigh (man), 57, 58 . Thigh (woman, or man when single-handed), 58. Kn eecap, 59, 60. Leg (man), 60, 61. Leg (woma.n, o r man when single-handed), 62. Crushed foot, 62.

Dislocations-Out of doors and indoors .. . 63, 64

Sprained ankle 6-1Strains and rup tured musclLs 6,

C HAPTER III.

THE O RGANS OF C I RC

ULATION.

THE organs concerned in the cir culation of the blood. are the Heart, the Arteries, the Vei ns, and _ the Capillaries.

The Heart is situated in the chest behind the breast-bone and rib cartilages, between the lungs and immediately above the diaphragm; it lies obliquely with a quarter of its bulk to the right and the remaining three-quarters to the left of the middle line of the body . Its beat may be felt just below and to the inner side of the left ni pple. The heart bas four cavities, two on either side of a central partition . The two upper cavities are named the right and left auricles, the two lo\yer the right and left ventricles.

Arteries are vessels ·which. convey blood from the heart. Veins carry blood to the heart. Capillaries connect the arteries a n d veins.

In the general (systemic ) circulation arterial blood is driven from the left ventricle of the heart 1l1to the aorta (the main artery of the body). From the aorta branch arteries are given off to all parts of the body . These divide and s ub-divide, and become so small u.s to assume mic roscopic dimensio ns, they are termed capillaries .

L. Larynx (voice box); T. Trachea (wind-pipe); R.L. Right Lung; L. L L e ft Lung (the lungs are d.ra \\'n to expose the heart and hlood .vessels) ; y.. A. Rl rht Aunc}e ; L.A. Left Auricle; R.V. RIght Ventncle; L '. Le!t \ tricle; P.A . Pulmonary Artery; Ao. Aorta; , .\ .C. Superior vena caya (the large vein carrying blood from th e up pe r part of the body to t h e heart); LV.C . Inferior vena cava (the large vein carrying blood f rom the lower part of the body the heart). T he four pulmonary veins cannot be sho .... n 111 th e diagram .

In the capillaries an interchange of gases and fluids t:1kes place, whereby the nourishment and maintenance of the tissues and organs of the body are provided for, and the blo od becomes dark and impure.

Venous blood pass es from the capillaries to the veins, which convey it towards the h eart, getting larger and larger as they proceed by being joi ned by neighbouring veins until they finally, as two large Yessels, reach the right auricle of the heart. The veins, especially in the limbs, are provided with valves at frequent intervals, which prevent the backward fl)w of th e blood .

The pulmonary system of blood vessels is concerned in carrying th e blood throu g h the lungs. From the right auricle the blood passes to the right ventricle, and is carried to the lungs, where it is by contact with air, and becomes scarlet in colour; it is th en conveyeJ to the left auricle of the heart and passe3 into the left ventricle, thus corn pleting 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 lyin g to the sitting or to the standing position; hence the importance of ad j usting the patient's position in cases of hcemorrhat;e. At every contraction of the left ventricle blood is forced into the arteries, caus in g the pulse, which rna,y be felt wherever the finger can 8e

Exp 1anatz'o71. -In the middl e of the diagram is the heart 'with its (our Above the heart is shown the lung (pulmonary) circulation. The lower part rep resents the general (systemic) circulation. Vessels containing impure (venous) blood 'are shown black, while those containing (arterial) blood are shown white. The connecting vessels represent the capillaries. The arrows show the of the flow of blood.

placed on an arte ry as it passes over a bone. In the veins no pulse is to be fo und.

E.

Hrem or rhage, or bleeding, is of three k inds :1. Art erial. 2. Venous. 3. Capill ary.

FIG. 37. DIAGRAM OF THE C .RC ULATI ON OF THE BLOOD.

ARTERIAL HlEMORRHAGE.

I.-Blood from an artery is scarlet.

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

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

ARREST

OF ARTERIAL HlEMORRHAGE.

Arterial hcemorrhage is, when practicable, to be arrested by pressure, posltion of the body, and elevation of the bleeding part.

Pressure may be :-

I.-Digital-that is, applied with the thumb or fingers, and may be (a) on the wound; (b) at a spot called the pressure point. The pressure points are indicated by numbered dots on the frontispiece.

2.--Bya pad and bandage (tourniquet) (a) on the wound; (b) on the pressure point.

3.-By flexion.

To apply a pad and bandage to the wound, place a piece of lint or linen or a clean handkerchief folded into a hard pad, on the bleeding point, and secure it by a bandage tightly tied round the injured part. To fold the handkerchief, bring the four corners to the centre, and repeat the process until a hard pad is formed. The smooth surface is 75

placed on the wound, and, to prevent the pad from unfolding, the puckered surfa::e may be stitched or fixed by a safety pin. A hard substance, such a stone, may be enclosed in the centre of the pad.

A Tourniquet may consist of a pad to be placed on the pressure point, a strap, cord, or bandage to encircle the limb and pad, and a tightening arrangement, such as a stick or other means of t'vvisting the band to tighten it.

To improvise and apply a tourniquet :-

I.-Apply a firm pad on the pressure point.

2.-Encircle the limb by a narrow bandage with its centre over the pad. Tie the ends of the bandage in a half Knot on the opposite side to the pad.

4·-Lay the twisting stick on the half knotT and over it tie a reef knot.

5·-Twist the stick to tighten the bandage, thereby pressing the pad uron the artery, and arresting the flow of blood.

the stick in position by the ends of the bandage already applied, or by another bandage passed round the stick and limb.

The pad of the toumiquet must be accurately placed upon the pressure point so as completely to compress the artery; other",ise arterial blood will be allowed to pass along the limb, and the veins, being compressed by the tourniquet, will not allow the

blood to return through them to the he:lrt, and the result will be dangerous swelling and congestion.

Should a suitable pad not be at hand, a knot may be made in the centre of the bandage, and when avaihble, a stone, cork, etc., enclosed in it to give it firmness and bulk. See that the bulging and not the fht side of the knot is nex.t the skin.

An elastic bandage passed tightly round the limb, immediately above the seat of arterial hremorrhage, will arrest bleeding. The simplest prepared form of this bandage is a strip of elastic webbing, twenty-five to thirty inches long and two inches wide, with (..-piece of tape sewn at each end. An elastic belt or brace .\,ill serve the S:lme purpose. Except when p:ut of a limb is torn off, it is not advisable to use 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, fl ex.ing the limb to make pressure, and securing the limb in the flexed position by a bandage crossed like the figure 8.

GENERAL RULES FQR TREATMENT OF A 'VOUND ACCOMPANIED BY ARTERIAL H.lEM ORRHAGE.

1. ' Stop bleeding.

II. Prevent i.lJjurious germs from getting into the wound.

To attain these ends :- . . .

I. Place the patient in a sUltabl.e pOSition, bearing in mind that the blood. escapes \\'lih less force when the patient sits, and is still more checked when he lies down.

2. Elevate the bleeding part, as thereby less blood finds its \yay into it. .

3. Expose the wound, remOVJl1g v\'hatever clothing is necessary. (See Rule 8, a.)

4. Apply digital I?ressure. .

(a) If the wound IS small on the bleedmg s·pot:

(b) If the wound is large on the POlllt next to the wound on the he art sIde. The nearest pI essure point is chosen in ord er to avoid cutting off the circulation fron: as much of the part as possible, but S?met1l11eS it is necessary to apply pressure stIll nearer to the heart.

5. Remove foreign bodies, as broken glass, bits of clothing, hair, etc., seen In the wound; do not search for foreign bodies you cannot see. .

6. Cover the wound with a clean and flrt? absorbent dressing. A hard dry pad of boracIc gauze or lint is to be preferred, but. wool, lint, or gauze, or a clean pIece of l1l1en ,,11. answer the purpose. Should any be entertained as to the cleanliness of the dress1l1g, 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 fra cture. In these cases a light dressing only should be applied.

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

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

(b) As a more permanent measure \\ hen bleeding cannot be stopped by the pad and bandage on the wound, or when, in accordance with Rule 7, the tight bandage has not been applied.

9· Afford support to the injured part.

When part of a limb has been torn off or the wound is lacerated (for example by the claw of an animal or by machinery) hcemorrhage frequently does n ot come on at once, but as there is a dan ge r of severe hcemorrhage later, means for its arrest should be applied to the lim b, but not tightened unless r.ecessary. Do not disturb a clot of blood formed over a wound. No attempt should be made to cl ea nse a wound except with sterilised water (that is previously boiled

and allowed to euo!), anJ ex[)erience, especially in recent wars, has shown that those "'ounds which were provisionally treated with a dry dressing and subseauently dressed by a surgeon with proper appliances did best.

Students plactising arrest of arterial hremorrbage should feel the pulse to see when the current of blood 111 the artery has been stopped, and should then immediately relax the pressure made on the artery. In this way the importance of the accurate application of pressure will be realised, and the amount of fMce necessary will be ascertained.

THE COURSE OF THE MAIN ARTERIES, AXD THE ARREST OF H}E}lORRHAGE.

(The numbers of the pressure points refer to those 011 the Frontispiece.)

THE L.\RGE ARTERlE 'VITHIN THE CHEST AND ABDO:\IEN.

The Aorta is the central or trunk artery of the body. Commencing at the left ventricle it forms an arch behind the upper part of the breast-bone. From the arch are given off the large branches which carry the blood to either side of the head and neck and to the upper limbs. The Aorta passes down on the left of the spine to just below the navel, where it divides into two great branches (the iliacs)

80 which convey the blood to the organs 111 the pelvis and to the lower limbs.

"\Vounds of these arteries are one cause of internal hcemorrhage (see page 96).

ARTER rES OF THE HEAD AND NECK.

The Carotid Arteries (right and left) leave the upper part of the chest and pass up on either side of the \\ indpipe and, just below ' the level of the angle of the lower jaw, divide into the Internal and External Carotid Arteries. The Internal Carotid Artery ascends deeply in the neck, and enters the cranium to supply the brain with blood. The External Carotid Artery gives off a number of branches; to the front the artery of the tongue (Lingual), the artery 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 hand on the artery at pressure point I, pressing backwards agai nst the backbone and taking care to avoid the windpipe. It may also be necessary to apply pressure with the other thumb above the wound for t\\'O reasons: (a) To arrest'the flo\\' of blood from the main (jugu1:1.r) vein in the neck, which runs

81

alongsid e of the carotid artery and is usually wounded at the same time; (b) To check the flow of blood from the upper end of the carotid artery itself, 'which is often considerable owing to communication between the branches of this artery and those of its

FIG. 38. FIG, 39·

fellow. Digital pressure must be by relays of assistants if necessary, untll the doctor arrives (Fig. 38). . .

The Facial Artery crosses the lower ]J.W 111 a sliaht hollow two finaers' breadth in front of the angle, and sends to the chin, lips, cheek, and

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

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

(b) Grasping the lips or cheek on both sides of the wound by the finger inside and the thumb outside the mouth or V/C ' ,{)I! rsa.

40. FIG .p

. The Temporal Arte ry may be felt pulsating m front o f the upper part of the ear. from the of the temple may be arrested by pressure app]le.d at pressure point 3 (Fig. 4 0 ).

The OCCIpItal Artery supplies branches to the

region of the scalp from behind the ear to the back of the head. Heemorrhage from this rEgion may be arrested by digital pressure on pressure point 4, four fingers' breadth behind the ear (Fig. 41). This point is difficult to find, and it is usu::t1ly sufficient to apply

pressure immediately below the \\ ound.

Hce mo rrha g e f[ om the Fo rehe ad or anywh ere in the Sca lp may be arrested by applying a small firm pad on the bleedingpoint and securing it by a narro\V bandage with its centre laid on the pad, the ends carried round the head in the direction most convenient, and tied tightly oyer the pad (Fig. 42).

When a wound of the forehead or scalp is associated with a fracture, the best plan is to apply a ring

FIG. 42.

pad around the seat of injury. To make a ring pad, pass one end of a nan-ow bandage round your fingers; pass the other end of the bandage through the ring thus formed and continue to pass it through and through until the whole of the bandage is u sed and a ring as shown in Fig. 43 is formed.

FIG.

ARTERIES OF THE UPPER LL\rBs.

The Subclavian Artery passes from a point behind the inner end of the collar-bone across the first rib to the armpit.

FIG. 43. FIG. 44.

To apply digital pressure:-

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

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

3. - Take your stand opposite the shoulder.

4. - Using the left hand for the right artery, anu vice versa, grasp the neck low do\Vn, placing the fingers behind the shoulder and the thumb immediately aboye the centre of the collar-bone in the hollow between the 111 uscles attached to the bone (pressure point 5).

5.-Press the thumb an.d backwards against the hrst nb, whIch IS beneath the collar bone at this spot (Fig. 44)·

The Axillary Artery , which is a continuation of the subclavian, keeps close to the shouluer joint, and can be felt pu lsating when the fingers are deeply pressed into the armpit. Digital pressure is difficult to apply to this artery.

To apply a pad and bandage :-

I. --Place a hard pad the size of a billiard ball in the armpit (pressure point 6) .

2. -Apply the centre of a narrow bandage on the pad; crosS the bandage on the shoulder; pull the ends tight tie them under the opposite armpit, taking care that the pad does not slip.

3. - Flex the forearm and tie the limb to the trunk with a broad bandage, applIed on a Lvel with the elbow (Fig. 45)·

The Brachial Artery is a continuation of the Axillary, and runs down the arm on the inner side of the biceps muscle, gradually passing forward until it reaches the middle of the front of the elbow. The inner seam of the coat sleeve above the elbow roughly indicates its course.

Digital or instrumental pressure may be applied at or near pressure point 7.

FIG. 47,

To apply digital pressure extend the limb at right angles to the body, palm of the hand up".. ards. Stand behind the limb, and pass the fingers und er the back

of the arm over the seam of the coot or the groove on the inside of the biceps muscle. Press the pulps (not the tips) on the artery (Fig. 46). Some prefer to pass the hand over the front of the muscle (Fig. 47). A slight turn of the hand outwa:-ds as it grasps the arm will better ensure compressIon of the artery .

The Brachial artery may be compressed at the

FIG . 49.

FIG·4t;, elbow (pressure point 8) by flexion. The pad may be a folded handkerchief with a small stone or a cork wrapped up in it, but when no is the coat sleeve rolled or gathered up WIll serve mstead (Fig. 4'8).

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 pressure points (9 and 10) are about one inch above the wrist and about half an inch from the outer and inner sides of the forearm, where the arteries may be felt pulsating. Branches of 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 ]Joints 9 and 10, by the thumbs (Fig. 49) or as follows :-

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

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

j.-Secure them by a tight bandage.

To arrest hremorrhage from the palm of the hanrl :-

j .-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 pa.tient's hand on the centre of the bandage, fold the point over the knuckles and wrist, pass the two ends round the \\"fist, make the

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

3.-Elevate the forearm and support it mth a " t. John" sling (see page 49)·

Arterial hcemorrhage from the fingers may be by applying a small prJd on the and it firmly "nth a stnp of tape, linen or plaster.

ARTERIES OF THE LOWER LniBs.

The Femoral Artery, a continuation of the iliac, FIG. 50. enters the thigh in the centre 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 drawn from 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 joint as the Popliteal artery.

Digital pressure may be applied to the artery at the groin (pressure point r r) as follows :-

r. -Lay the patient on his back.

2.-Kneel beside the patient.

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

4·-Pbce the thumbs one on the other upon the pressure point, grasping the thigh \\ ith the hands (FIg 51).

5·-Pr ess firmly against the brim of the pelvis.

As there is immediate danger of death it is important not to waste time in removing the trousers.

\Vhell the Femoral artery is wounded in the upper third of its course, pressure must be maintained at the groin. No really satisfactory tourniquet has been FIG . 51. devised for compression ?t this point, and relays of assistants should be employed to keep up the pressure until the doctor arrives; each f resh assistant places his thumbs over those of his predecessor, who slips his away from beneath, and thus gushes of blood are p revented during the change.

Application of a tourniquet to the Femoral artery (pressure point J 2) ;-

\ Vhen practising compression of this artery, It is a

52

good plan to draw a chalk line from the centre of the groin to the inner side of the back of the knee; place the pad of the tourniquet on this line as high up as the bandage can be applied. The pad should be the size of a lawn tennis ball (Fig. 52).

Pressure may be applied to the Popliteal artery by flexion at the knee (pressure point 13); the pad

FIG. 53.

should 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 Popliteal artery divides into the Anterior (front) and Posterior (back) Tibial arteries.

The Posterior Tibial Artery passes down the

93

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

The Anterior Tibial Artery, on leaving the Popliteal, at once passes forward between 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 forward over the tarsus, dips down to the sole between the first and second metatarsal bones. Here it forms with the Plantar arteries what is known as the Plantar Arch. At the ankle (pressure points I4 and IS) pressure may be applied by the fingers or by pads and bandages.

I. - Blood from a vein is dark red.

2. - It flows in a slow continuous stream .

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

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

VENOUS H ..'E:.\lORRH.-\GE.

Varicose Veins. -The veins of the leg are sp eclally ap t to become .varicose. . A var.icose yein is dilated, vvindin g, and wIth bead-hke (vancose). projections alon a its course. A vein becomes van cose from severalocauses, such as long standing or tight aarte rs. The first effect is to throw extra work u pon the valves, and the bead-like projections are cau sed by the bl ood in the behind the valves . In time the vem becomes so d Ilated that the valves can no longer span it.

G l!:NERA L RULES F OR TREATM EN T OF A 'WOUND " ACCOMPAN IED BY VENOUS HlEl\lORRHAGE.

1.- Place the patient in a suitable b eari n a in mind that the blood escape s wIth less force the patient and is still more checked as he lies down.

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

3.-Expose the wou.nd, removing whateveI cloth ing is n ecessary.

4. - R emove any constrictions, such as the coll ar or gart ers, from the heart side of the wound ..

5. -Apply digital pressure on the wound untIl you can apply a pad and tight bandage, If that does n ot stop the bleeding, make pressure nedr the wound on th e side away from the heart. In the case of a wound of a varicose vein it may also be necessary to

apply a paa and bandage to the vein immediately abuve the wound, especially if the limb cannot be maintained in an elevated position.

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

7. -Affo rd support to the injured part.

CAPILLARY HtE:.\lORRHAGE.

I.- The blood is red.

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

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

A slight amount of pressure \",ill suffice to arrest capillary hremorrhage.

INTERNAL HlE:.\lORRHAGE.

IVounds of the blood vessels . within the trunk cause hremorrhage into the cavity of the chest or of the abdomen.

SIGNS AND SY:\lPTOiIIS OF INTERNAL HlEMORRHAGE .

I.-Rapid loss of strength, giddiness and faintness, especially when the upright position is assumed.

2.-Pallor of the face and lips.

3·-Breathing hurried and laboured, and ac c ompanied by yawning and sighing.

4·-The pulse fails, and may altogether disappear at the wrist.

$.-The patient thro\\ s his arms about) tugs at the clothing round the neck, and calls for air.

6.-Finally the patient may become totally uncon· scious.

TREATMENT.

I.-K eep the patient in a recumbent position.

2.-Undo all tight clothing about the neck.

3.-Provide for free circulation of air; fan the patient.

4.-Sprinkle cold water on the face j hold sn lelling salts to the nostrils; avoid other forms of stimulants, at all events until the hcemorrhage has been controlled .

5.-Give ice to suck or cold water to drink; if the seat of the hcemorrhage is known, apply an ice bag over the regi on.

6.-Should the patient he reduced to a state of collapse, rais e the feet and bandage the limbs firmly from the toes to the hips and from the fingers to the shoulders.

H1E!\IORRHAGE FROM THE NOSE (NOSTRILS).

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

2.- Undo all tight clothing around the n eck and chest.

3.-Apply cold )ce, a cold sponge or Luncl" of

keys ) over the nose and also the spine at the level of the collar; place the feet in hot \-\atel'.

4. - Cause the patient to ke ep the mouth open, and so avoid breathing through the nose.

Blood issuing from the mouth may come flOm the tongu e, th e gums, the socket of a tooth aft er extraction, tr,c thlOat, the lungs, or the stomach.

HAOIORRHAGE FRmf THE TOr\ GUE, THE GUMS, THE SOCKET OF A TOOTH, OR THE THROAT.

T .- G lye ice to suck or cold \yater to hold in the mouth. If this is not successful give water as bot as can be borne to hold in the mouth.

2.-If n ecessary make pressure on the carotid at leries.

3.-If bleeding from the front part of the ton gue 1.3 excessive compress the part by a piece of clean lmt held bet\\een the fiIJger and thumb.

4.-If the bleedmg IS from the socket of a tooth, plug the socket with a piece of clean lint or cutton \\001; over this place a small cork or other substance of suitable size, and instruct the patJent to bite en it.

HJE:\IORRHAGE FRO:\! THE LUNGS.

Blood from the lungs is coughed up and is scadet and frothy in appearance.

Treat as for Internal Hcemorrhage (see pag e 95).

HIE:vtORRHAGE FR O M THE ST 0:lIACH.

Blood from the sto mac h is vomited j it is of a dark colour and has the app ea rance of coffee grounds; it may be mixed with food.

Treat as for Intern:!! Hce mo rrhage (see page 95 ), e xcept that nothing is to be g i\'e n by the mouth.

Blood issuing from the Ear Channel, whi ch gen e rally indlcates a f ract ure of the base of the cran iu m, must be wiped away as it issues j no attempt is to be made to plug the ear.

99

QUESTIONS ON CHAPTER lll.

Tll.: numerals indicate the pages where (lte a1iSwers lIIa)' be found.

" 'hat org:ms a re concerned in the circulation of the ulood? . . .

uluod through the ue-dy and lungs

the heart contract on the

is the effect of the patient's position on the rate at which the heart contracts?

\\ould you know a case uf artc]ial

is accuracy necessary 111 placmg the pad of a tournig uet

' Yhen mayan elastic bandage be used instead of a tourniquet?

is flexion?

StaLe the general rules for treatment of a wound accompanied by arterial hremorrhage ... ... . .. 77, 78

If part of a lim b had been torn off, but ther e was not much bleeding, how would you act ?

Should blood clots be disturbed ?...

I s it wise for an unskilled person to attempt to cleanse a wound?

Describe the arteries of the head and neck

80

\Vhy is it sometimes necessary to compress the carotid artery both. below and above the wound? ... 80, 81

What is a ring pad, and what is its use? ... 84

Describe the arterie s of the upper limbs... 84 to 89

Describe the arteries of the lowe r limbs... 89 to 93

How would you know a case of venous hremorrhage? 93

What is a varicose vein? ... 94

How maya vein becc me varicose? 94

State the general rules for treatment of a wound accompanied by venom. h::emorrhage? ... 94, 95

How would you know a case of capillary hremorrhage ? 95

How would you stop capillary h::emorrhage ? ... ... 95

What is internal hremorrhage? ... ... ... ... 95

What would lead you to suspect internal hremorrhage? 95, 96

Stale the. treatment for int erna l hremorrhage? ... 96

How would you arrest h::emorrhage from the nose? ... 96, 97

vVhere may blood issuing from the mouth come from ?... 97

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

What else would you do if the longue were bleeding? ... 97

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

How would you distinguish between bleeding from the lungs and from the stomach? ... ... ... ... 97

And what would be the difference in the treatment? .. . 97

Of what is bleeding from the ear channel generally a sign? 98

The Student should practise placing supposed patients in a proper positi on for the arrest of hremorrhage (se e pages 72, 77 and 94), folding firm pads (74 and 75), tying hard knots in bandages to form a tourniquet (76 ), and the application of pressure at all the pressure points shown in the frontispiece, at various points on the forehead and scalp, and on the palm of the hand. Pressure should be digital, by pad a.nd bandage, or flexion, as directed in the text.

Pressure points - Carotid artery, 80. Fac,iaJ, 82. Temporal, 82. Occipital, 83. Subc1aVlan, 84 . Axillary, 85. Brachial (by pad and bandage, pressure being made against humerus and by flexion at the elbow), 86. Radial Ulnar, . 87 . Femoral at the groi n, 90. Femoral m .the 92. Popliteal, 92. Anterial and postenor TJ blal arteries, 93.

Hremorrhage from the forehead or scalp . ..

IIremorrhage from the palm of the hand.. ....

Venous hremorrhage fr om a varicose or other Yem

IV. BRUISES.

A blow anywhere on the surface of the body may ca use extensIve h;:emorrhacre beneath the skin, \\ ithit-a" bbck is an instance. The lllJury IS accomp ::mied by discoloration and swelling.

T.\IENT.

ice or cold water dressings. A piece of lint soaked 111 extract of witch hazel may be placed on the affected part.

BURNS AND SCALDS.

A burn is caased-

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

(b) By a rail.' wIre or dynamo charged with a bigh pressure electriC current.

(c) 13y a corrosi,'e acid, such as oil of vitriol.

(d) a alkali, such as camtic soda a1111110111a, or qUIcklIme. '

. (e) By caused, for example, by contClct WIth a wheel. (Brllsh burn.)

103

of the body may be charred and. clothing may adhere to the burnt skm, and Its is impossible without detnment to the U1Jurec: part. The great danger IS Shock.

TREAT:\rF.NT

I .- Carefully rem ov e the over th e inju red part. If stuck to the. sk1l1, . the adherent clothing must be cut around wlth SClssors, soaked with oil, and left to come away subsequently.

2. - Do not break blisters.

0

A !S cClused by moist beat, such as boilinO" water, hot 011 or tar.

.The effect may be a mere reddening of the skin; hlrsters may be formed; or even the deeper tissues

3. - Immediat e ly cover up part. m smear pieces of Imt or llllen WIth OJl? or vaselllle, lanolme, or cold cream; a small quantIty of boraCIC powder added to these \\"Jll be of benefit. The inside of a raw potato scraped out and spread on lint makes a soothing aprlIcation . 'When the injured surface is extensive do not cover it \yith one large sheet of lmt, but with strips about the breadth of the hand; this is advisable as they fit better on the part, and during subsequent dress1l1gs. one strip can be removed at a time, and a fresh dress1l1g applIed before the jacent strip is taken off. The shock to the system lS t hereby less than if the whole of the burnt surface were laid bare to the air by the removal of all the dressincrs . at one time. 'When covered by the oily dressing envelop the part in cotton wool or a piece of flannel and a pply a ba n dage.

When the face is burnt, cut a mask out of lint or linen, leaving holes for the eyes, n o se and mouth. Dip this in oil or smear it with vaseline and apply it to the face and cover it with cotton wool leayin a openings to corr espo nd with the holes' in mask.

\Vhen possible place the injured pa rt in water at the of the body (9 8 degrees) unt il suitable ?res.smgs can be prepared. A dessert spo onfu l of soda added to a pint of the wa rm water wIll make a soothi ng lotio n.

As it is imp or tant not to leave the part exposed to the air., it is duty of the bystanders to prepa re the dressm gs whlle the clothing is being remm'ed .

4·-Treat Shock.- This is pa rti cularly n eces sar y in the case or eve ry burn or scald of a n y considerable extent (see page 135) . Be very apprehensive of dan O'e r \Q the cas e o f even slight burns of the ne ck . 0 the burn is caused by a corrosive aCId, bathe the part with a weak alkaline lotion, such as soda, baking soda (bicarbom.te of soda), magnesIa, or sl a ked li me in warm \yat er before appl yi n g the dressings.

6.-:If the burn is caused by a corrosive alkah, bathe the part with a weak acid lotion such le mon juice or vinegar diluted "ilh an equal qu a ntlty of water. CauHon.-Before usinO' \\ater brush off any lime that remains on the part. 0

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

(a) Lay the woman fbt on the floor at once, so that the flames are uppermost; that is to say, if the front of the dress is on fire lay h e r on her back, and if the back of the dress is burning, pbce her face down\\ards. The reason for this is that fl:lmes ascend, so that if the upright position is assumed, the fia i11es \\'ill quickly reach and burn the boJy, neck, anu face; or if the wom an lies wlth the fl .lmes undermost, they will, if unextinguished, pass o\'er and burn the limbs, and set fire to the rest of the dress .

(b) As soon as the woman is laid flat, smother the flames with anything at hand, such as a rug, co!.t, blanket, or table cover; if made wet so much the better.

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

(d) If a woman's dress catches fire when nobody is by, she should lie flat, fl ame s uppermost, s mother the flames wit h a nything handy , and call for assistance, or crawl to th e bell-pull and ring ; on no account sh ould she rush into the open air.

The use of fire guards would prevent many calam i ties.

BITES OF SNAKE S AND RA BID A "

A ND ' VO U ND S BY POI SON E D "WEAP ON S.

H ydrop hobi a is caused by t he bite of a n animal , such as a dog, cat, fox, \yo lf, or deer suffering from rabies. The special poiso n s in troduced into wounds camed by yenomous snakes and poisoned \\ enpcns cause immediate danger to life .

1. - Immediately place a constriction between the wound and the heart so as to prevent the venous b lood from carrying t he poison through the body. If, for example, a finger is bitten it should be encircled on the side of the wound nearest to the heart, with the finger and thum b, and as soon as possible a ligature (a string, piece of tape, or strip of handkerchief) should be placed tightly round the root of the fing e r. \\'ith the fi nge r and thumb must not be relaxed until the ligature has been applied. Additional ligatures may , with adyantage, be applied at intervals up the limb.

2. - Encourage bleeding for a time :-

(a) By bathi n g the wound with \\'arm water.

(b) By keeping the injured limb lo\\'; the upper limb should be allo\\'ed to hang down, and in the case of the lo\\"ei limb the patient should be scated \yith the foot on the ground.

Y07

3. - Cauterise the wound, if it is q uite impossible to obtain the services of a doctor . This is best done by burning \\ ith a fluid caustic, such as caustic potash, pure carbolic acid, or nitric acid, or if these are not at h:ll1d, with ared hot \\ ire or a fusee. The usual solid cn ustic is insufficient , ns it do es not reach the bottom of tl1e wound, \\ here the poison is.

To ensure the cau tiC reaching the bottom of the \\ol1l1d , It should be applied on a piece of wood, such as a match cut to a point. ' Vhen the caustic has been thoroughly applied , but not till then, the ligatures rna)' be removed.

4. - Cover the wound, after a while, ",ith a clean dressing .

5. - Afford su p port to th e injured par t.

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

7.- In the case of a bite by a venomous s 1ake , rub in powdered permanganate of potash and inject under the sk in in the neighbourhood of the wound a solution of perl11anganate of potash .

ST I NG OF P L ANTS A N D AN I MALS.

These give rise to serious in convenien ce, and m some cases grave symptoms develop.

TREA T MENT.

I. - Extract the sting if left in.

z. - Mop the part freely with dilute ammonia

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

3.-Treat collapse if it occurs (see page I3S)·

FROST BITE.

During exposure to severe cold, parts of the bo?y, usually the feet, fingers, nose, or ears, lose sensatIOn and become first \\axy white and afterwards c ongested and of a purple appearance. As sensation is lost in the part, it is often only by the remarks of bysta nders that the frost -bitten person is made aware of his condition.

TREATM ENT .

I.-Do not bring the patient into a room uBtil, by friction of the hand or by rubbll1g with soft snow, sensation and circula.tion in the. affected parts are restored. Neglect of this precautIOn may lead to death of the of the frost-bitten part.

2.-When circulation is restored, keep the patient in a room at a temperature of 60 degrees.

NEEDLE EMBEDDED UNDER THE SKIN

'When a ne edle breaks off after penetrating the skin and disappears, take the pati.ent to a doctor at once. If the wound is near a joint, keep the limb at rest on a splint.

109

FISH-HOOK EMBEDDED IN THE SKIN.

Do not attempt to withdraw the fish-hook by the way it went in, but cut the dressing of the hook, so that only the metal IS left, and then force the point onwards through the skin until the hook can be pulled out.

INJURIES TO JOINTS.

\Vhen a joint is injured by a bullet, stab, or other cal1se-

I.-Wrap the part in cotton wool. ..

2. - Afford rest and support to the lnJured limb; if the upper limb, in a by sling; if the lower limb, in a straight positIOn by a splll1t.

FOREIGN BODY IN THE EYE.

I.-Prevent the patient rubbing the eye, tying down a child's hands if necessary.

2.-Pull down the lower eyelid, \"h en, if t.he foreign body is seen, it can readily be removed Wlth a camel 's hair brush, or with the corner of a handkerchief twirled up and wetted.

3. - When the foreign body is beneath the upper eyelid lift the lid forward, push up the lid beneath it and let go . The hair of the lower lId brushes the inner surface of the upper one, and may dislodae the body. . hould the first attempt be repeat it several times if necessary. If

the foreign body is not dislodged call the services of a doctor as soon as possible. When however skilled help cannot be had, proceed follows

(a) Seat the so as to face the light, and stand behmd him, steadying his against your chest.

(b) Plac e a small rod, such as a match or bodkin on the upper eyelid, half-an-inch above edge, pressing it backwards as far as p ossible .

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

(d) Remove the foreign body.

4.- When a piece of steel is embedded in the eyeball drop a little olive or castor oil on the after pulling do\\'n the lower eyelid, close the lrds, apply a soft pad of cotton \\'001 and [ecure it by a bandage tied sufficiently firmly to keep the eyeball stead y j take the patient to a doctor.

5.-When qll.ick-lime . is in the eye brush as much of It as possIble; bathe the eye \,ith vmegar and warm water, and treat as for a piece of steel embedded in the eyeball.

FOREIGN BODY IN THE EAR PASSAGE.

A,s a rule n:ake no attempt to treat a patient with a forelgn body m the ear if the services of a doctor can possibly be had j any attempts to r emove the foreio:rn bo dy may lead to fatal consequences. If a child

cannot be induced to keep the lingers from the ear, tie his hands down or cover up the ear. If an insect is in the fill the ear \\'ith olive oil, when the insect will and may be removed. Never syringe or probe the ear.

FOREIG N BODY IN THE KOSE.

In duce sneeling by pepper or snuff. Cause the patient to blow his nose violently after closing the un1.ffected nostril. There is no immediate danger from a foreign boJy in the nose.

TIlE ABDO).lEN.

The abdomen is bounded above by the diaphragm; below by the pelvis; behind by thelumbaryertebrce; and in front and at the sides by muscular walls . (Fig. 54·)

THE ORGA I S OF THE ABDOME T.

The Stomach lies immediately below the" pit of the stomach " just below the breast-bone.

The Liver lies in the upper part of the abdomen, where it is mostly covered by the right 10\\ er ribs.

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

The Intestines occupy the greater part of the cavity of the abdomen .

.The Kidneys lie at the back, in the region of the 10m.

The Bladder lies in the pelvis.

FIG, 54.

'WOUND IN THE FRONT 'VALL OF THE ABDOMEN.

lllhen the z'ntestz'nes or other organs protrude through the \-vound, whether vertical or transverse, bend the knees, raise the shoulders, and apply lint, a towel, or cotton wool wrapped in soft linen, and keep. the

113

patient warm until the doctor arrives. 'When there is no protrusion of organs, if the wound z's vertical, lay the patient fiat on the back with the lower limbs straight; if the wound is transverse, bend the knees and raise the shoulders.

INJURIES TO THE ORGANS \VITHli'l' THE ABDOMEN AND PELVIS.

Inj uries of t h e Stomach are attended by extreme collapse and sometimes by vomiting of dark blood like coffee-grounds . For treatment see " Hc:emorrhage fro;n the Stomach" (page 98).

Injuries of the Liver, Spleen a nd Intestines may be caused by a blow, a stab or a buliet; the liver or spleen may be injured by a fracture of the lower ribs. The Signs and Symptoms are those of internal hc:emorrhage accom panied by pain and swelling at the seat of injury, and the treatment is as for that condition (see page 95).

T h e 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 pain and swelling over the injured kidney.

The Bladd e r may be injured by a fracture of the pelvis. The signs ana symptoms are either inability to pass water, or if a little is passed it is tinged with blood.

TREAT::-.rEXT OF I NJURY TO THE KmXEYS OR BLADDER.

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

2. - Apply hot fomentations ov e r the painful or injured part. .

Rupture (hernia) consists of a protruslOn of an internal organ, usually the bowel, through the muscular wall of the abdomen, most frequently at the groin. Should a sudden accompanied by pam and sickness take place m that regIOn

1.- Sen d for a doctor instantly .

2.-Lay the patient dO'v\'n with the buttocks raised .

3.-A pply ice or cold water dressings to the affected part.

Jllllllera/s £Ild.·ca f e the pages 'Wh ere the answers may be .fOUl/d.

corrosive alkali? 10-+ \Yhat steps should be taken v\ hen a woman's dress catches fire?

the general rules for lreatment of wounds caused by p ois onous biles or weap ons... 106, 107 \Yhat special treatment is requirrd for the bite of a ven o mous snake?

would you treat a sLing?

107, lOS State the signs, symptoms and treatment of frost·bite ... IUS \\ 'ould yo u attempt t·o remove a needle embedded under the skin? ' .

lOS How w ould you extract a fish hook em bee d ed in the skin?

the treatment for injuries to joints

S tate the general rules [or removing a foreign body (rom the eye ..

109, 110 What would you do i[ a piece ot steel were embedded in the eyeball?..

And when quick.lime is in the eye?

How w ould y uu 11 Y to remove an insect [rom the ear passage? ... I II

\Vould you try to remove any other form of foreign body from the ear passage? ... ... ... ... 110, I I I

How would you remove a foreign body from the nose? I II

State the bound aries of the aLd omen and its contc:nts ? III

State the treatment for wounds of the abdomen 112, I J 3

How may injuries to the liver, spleen and int est ines be caused?

'What is the difference between treatment of injuries to the stomach and of injuries to the liver, spleen and intestin es ?

113

II 3

State the treatment of injuries to the kidneys or bladder 114

State the treatment of hernia ... .., ... ... 114

THE NERVOUS SYSTRM.

Two systems of nerves, the C erebro-spi nal and the Sympathetic, regulate the movements and functions of the body.

The Cerebro-spinal System is made up of the Brain, the Spinal Cord and Nerves, and through its agency sensations are received and the will causes the action of the voluntary muscles. For example, when a part is injured a sensation of pain is conveyed to the brain by the nerve, thus affording an indication of the seat of injury, or a warning of a possible danger of further damage. On attention being directed 1.0 the injury, an attempt is instantly made to ease the pain or to move the injured part from danger.

The Brain is situated within the cranium, and is divided in the middle line, so that, with the exception of some connecting bands, the right and left sides are separate.

The Spinal Cord is the long cord of nervous matter lying \\'ithin the spinal canal (see Vertebral Column, page 23). It leaves the brain through an opening in the base of the cranium and extends to the upper lumbar vertebrce.

IIS

The Nerves proceed from the brain and spinal c ord in pairs as pearly-\\ hite trunks, and their branches can be traced throughout the tissues of the body. "When a nerve is torn through there is paralysis of motion and sensation in the region in which its branches are distributed.

The Sympathetic System extends as a n'ervous ch ain on each side of the front of the spinal column along its entire length, and sends branches to all the organs of the chest and abdomen to control the in voluntary muscles, and thereby regulate the vit al functi ons . This system is not under the control of th e will , and acts alike during sleep and activity.

THE RESPIRATORY SYSTEM .

The air reaches the lungs by way of the nostrils (or mouth), the throat, the wind-pipe, and the bronchial tubes. The nostrils convey it to the back of the throat, whence it enters the \\'ind -pipe by an opening guarded by a sort of trap-door or valve, so that in health air, but nnt solids or fluids, may enter. During ins ensibility, however, the valve fails to act, so that should solids or fluids be given by the mouth, they may enter the wind-pipe and cause asphyxia. The wind-l-' ipe extends to two inches below the top of the breast-bone, where it divides into the li ight and left bronchial Each bronchial tube e n ters a lung and divides into small and still smaller tubes, until

Fl c . 55. THE L UNGS AND BRONCHIAL TUBES. r

A. Trachea, or Wind-pipe. B. Left Bronchus. C. Rlght Brvilchus. D. Smaller Bronchial Tubes.

the ultimate recesses of the lung-the air cells or ai r spaces-are r eached.

The Lungs, Right and L,:ft, occupy the greater part of the chest; they lie immediately within the ribs, and practically 'vvherever a rib is felt, whether (ront, back or sides, there is lung beneath. Each lung is enveloped in a fine membrane (the pleura) which allows it to move within the chest during breathing without friction.

Respiration, or breathing, consists of two acts , lnspiration, an expansion of the chest, during which air is drawn into the lungs, and Expiration, 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 per minute, and at each inspiration about 20 to 3 0 cubic inches of air enter the lungs, and a similar quantity is 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 Diaphragm, the large arched muscular partition which separates the chest f!0-!l1 t he abdomen. In inspiration, which is chiefly a muscular the ribs are raised, and the arch of the diaphragm falls and becomes flattened, thus inc reasing the capacity of the chest and causing the air to enter. I n expiration, an act performed almost without effort, ribs fall and the arch of the

]21

diaphragm rises;. tIlis lessens the capacity of the c.hest .and fOl'ces aIr ?ut. The mechanism of respiration IS some what lIke that of ordinary household bellows, but without a valve ; the ribs may be c?mpared to the boards of the bellows, while the cor.responds to the leather, the air passages bemg eqUIvalent to the nozzle.

. As the blood depends upon the air for its purificatIOn and the oxygen necessary to maintain life interference with breathing very soon may prod uce a dangerous state called asphyxia, examples of which are afforded by drowning, suffocation, choking, etc.

ARTIFICIAL RESPIRATION .

SCHAFER'S METHOD .

I.- Make no attempt to loosen or remove clothing.

2. - Lay the in a prone position (z'.e. , Jack upwards) WIth hIS head turned to one side so as to his nose and mouth away from the pad IS to be placed under the patient, nor need the be drawn out, as it will fall naturally.

3· - Kneel at one side facing the patient's and place the palms of your hands on his loms, one at each sid"" the thumbs nearly touchinoone an.other in the small of back, and the extendmg o.ver lowest nbs. Leaning your body for\\'ard,let Its weIght press straight do\\'u\\'ard upon the

loins and lower part of the back, compressing the abdomen against the ground and alI out of the chest. This produces expiration (FIg 56). Draw back

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

DR. SrLVESlri:R'S METHOD.

I. Adjust the patient's position.-IVithout wlsting a 11l01l1E'nt place the patient on his back on a flat surfac,-, inclined If possible from the feet upwards. Remove all tight clothing from about the neck and chest, and bare the front of the body as far as the pit of the stomach; unfasten the braces and the top button of trousers in men, and the corsets in \yomen. Raise and support the shoulders on a small, firm cushion or folded article of dress pbced under the shoulder-blades.

2. Maintain a free entrance of air into the windpipe.-Cl eanse the lips nnd nostrils; open and wipe the mouth; an assistant 111 ust dra\v forward the patient's tongue as far as possible, and keep it in that position.

3.-Imitate the movements of breathing. Indllce IllSp/rat/oll.-Kneel at a convenient distance behind th e patient 's head, and, grasping his forearms just below the elbow, draw the arm s

FIG. 58. INSPIRATION.

FIG. 59. EXPIRATION.

upwards, outwards, and towards you, with a sweeping moverr.ent, making the elbows tOllch the ground

FIG. 61. EXPIRATION.

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

Induce ex}zratio71.-Bring the patient's flexed arms slO\Y1y forward, downwards and inwards, press arms and elbows firmly on the ch es t on either SIde of the breast-bone (FIg. 59)' By this means air is expelled from the lun gs . .

Repeat these movements altern a t ely, dehberately, and perseverin gly about fifteen times a minut.e.

When a suffici e nt number of assistants are present, Howard's method may be combined with Silvester's, as f ol1o\\'s :-

The additional assistant kneels astride the pati e nt's hips with the balls of the thumbs resting on either side of the pit of the stomach, and the firwers grasping the adjacent parts of the chest. .Using his knees as a pivot, he presses forward on hIS hands. Then suddenly, \yith a final push, he springs back and remains erect on his knees while he slowly counts I, 2, 3. These motions are to be repeated to correspond • '"vith those being perfor med by Silvester's method, pressure on the chest being made simultaneously by those performing the two metho ds (Figs. 60 and 6 r).

LABORDE'S METHOD.

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

The patient i pbced on his back or side' the cleared; the. tongue is seized-using a handkerchIef or to prevent it slipping from th e fingers-the l?\yer Jaw depressed; the tongue is forwara and held for two seconds in that posItIon, th en allowed to recede into the mouth. shou ld be r epeated about fifteen tltllES a mmute.

respiration must be continued until IS established, or until a doctor arrives. \\ ?reathi ng commences, regulate the artIficIal respIratIOn to correspond \yith It. Success may result even after two h ours ' time.

. E?C cite 'Whilst artificial respiration IS bemg other. useful steps may be employed, such smelllllg salts or sn uff to the nostrils and filCk111g the chest \\ ith a damp towel. '

Ind.uce circulation and ,,'armth after natural breath111g has been restured \Vr ap the t' t' d bl 1-. .' < pa len 111 ry \.cts or other and rub the limbs energel1cally to\\ ards the h eart. Promote warmth by hot flannels, hot-\\ ater bottles or hot b . I ( d . flanneJ\ applied to the to (Sb \HuPdPeb dill \\'h ,1m s an 0 y. I en the of s,,-allowing has returned g-iYe tea or or meat extract. The patient ould be 1l1. bed encouraged to go to sleep. Larg e poultIces or fomentations applied to the

f ront ani back of the chest will serve to as ist breat h ing. . Watch the patient carefully for some tllne to see that the breathing does not fail; shou ld .any. sIgns of failure appear, at once begin artificia l respmltlOn.

I TSE .-·IBI L I TY .

U nC0nsciousn e ss or Insensibility may arise as follows ;-

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

Disease of the Brain. -Apoplexy , Epilepsy, Hysteria . Various Causes. -Shock, Fainting (Syncope), Collapse, Alcoholic and other poisoning, and H eat-stroke, In fantile COlwulsions, AsphyxIa.

G ENE R A L RULE FOR TREAT 1fENT OF I N 'ENS I BILI TY

.

r.. -- If a person appears abou.t to lose c0!lsciousness, preven t him from fall mg, and by hun gent ly down .

2. - Arrest Hcemorrhage when apparent; atte ndi ng to minor in juries is less important tha n treati ng the u nconscious slate. .., .

3. - Lay the patient in the posib<?n WhiCh breathing is most easy-usually thIs wIll be on the back, or incli ned to one side . As a general rule

raise the head and shoulders sligh I!)' when tbe face is fl ushed, and keep the head low when the face is pale.

4. - Undo all tight clothing round the neck , chest and waist, unfastening tbe braces and top b utton of the trousers in men, and the corsets in women, th e object being to relieve pressure on the air passages, lungs , heart and abdominal organs. Be sure that there is no obstruction to the air pas ages by the tongue or by a foreign body in the throat. The possibility of false teeth obstructing breathing must be considered.

5·- Provide for a suffic iency of fresh air by opening doors and windows , and by keeping back a c ro\\"d .

6. - When breathing cannot be d iscerned apply artificial respiration .

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

8. - Unless unavoid a ble, n eve r le ave the patient until you have placed h i m i n charge of a responsible person.

9·- Give no food or fluids what eve r by the mouth while the patient is insensible.

IO. - Should the spine or an important bone of the upper or of the lower limb be fr acture d it must be steadied and maintained at rest as Soon Should the unconsciousness be prolonged, the may be removed in a recumbent po ition

to shelter, provided that the broken bone is adequately supported .

I1.-When the patient is in a state of convulsion, support his head, and after wrapping a piece of wood or any other hard material in a handkerchief, hold it in his mouth to prevent biting of the tongue. Do not forcibly restrain his limbs j prevent him from hurting himself by pulling him away from a source of danger, such as machinery, a wall, or fireplace ; light pieces of furniture should be pushed out of the way.

12.-0n return to consciousness ,yater may be given to drink. If the pulse is feeble give \-\'arm tea or coffee, provided hremorrha ge , either internal or external, is not present. A desire to sleep should be encouraged , in cases of opium poisoning, a condition tbat may generally be recognised by the history of the cas e, and . also by the pupils of the eyes (the black openings in the grey, blue brown iris) being minutely contracted (pin-head pupIls) .

13.-It must not be assumed that a person is insensible as the result of drink merely because the breath smells of alcohol; frequently when people are feeling ill they take or are given alcoholiC; stimulants, after which they may become insensible , not from the drink, but from the cause that induced them to take it, for example, ins ens ibIlity coming OIl, effects of poisoning, etc. Even if

13 1

drink is beli eve d to be the actual cause of insensi· bility it must be borne in mind that the patient is in a ve;y dang erous state, and he must be treated for Collapse by being cover ed up and kept

The above general rules will enable ald. t? .be rendered efficiently in most cases of although the exact form from which the patlent IS suffering is unknown.

OF THE BRAIN.

The patient may be stunned by a blow or fall on the head, or by a fall on the feet or lower part of t,he spine. He may quickly regain consciousness, or 111sensibility , more or less complete, may be prolonged.

TREAT:\lENT.

1. - Apply the general rules for the treatment of Insensibility.

2.-Be very apprehensive of in all cases of injury to the head. The patIent may be stunned and after a short interval may recover some of consciousness, or even the brain may apparently have escaped injury; yet in both there is a grave risk that a structure mth111 ' the cranium has been injured, and that a serious state of insensibility may develop later. (See Fracture of the Cranium , page 43). A caution should therefore be given to a patient who has lost consciousn ess even

D 2

for only a after an injury to the head not to resume physJcal or mental activity without the con sent uf a doctor.

C011PRES ION OF THE BRAIN

APOPLEXY. '

Compression of the Brain may result from the same. as produce Concussion; in fact, CompressIOn IS freq preceded by Concllssion . . usually in elderly people, and no SIgns of 111Jury are necessanly present.

In .both conditions the face is flushed' the stertorous; one side of the body be more lImp than the otber, and the pupil of one eye may be brger that of the other; the tem perature cf the body IS generally raised.

TREAT:\IENT.

1. - Apply the general rules for treatment of Ins ensibility.

2. Promote warmth in the lower part of the body by the application of hot water bottles to the abdomen and lower limbs. Care mu t be taken not to burn the patient with the bottles which be wrapped in fl2.. nn el, and their heat' tested \nth the elbow.

EPILEPSY.

Epilepsy occur in persons of any age, but usually occurs 111 young adults. The patiellt 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 Rules, especially Rule 11.

HYSTERICAL FITS (HYSTERIA).

SIGNS AND SV:\IPTO:\lS.

The patient, usually a young girl, in consequence of mental excitement, suddenly loses command of her feelings and actions. She subsides on a couch or in some comfortable position, throws herself about, grinding 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 opened and shut rapidly. At times froth appears at the lips, and other irregular symptoms may develop.

TREAT:\fENT.

I.-Avoid sympathy with the patient: and speak firmly to her.

2.-Threaten her with a cold water douche, and if she persists in her "fit," sprinkle her with cold water.

3.-Apply a mustard leaf at the back of the neck.

l\'IeJical treatment is necessary to cure the condition of mind and body which gives rise to hysterical attacks.

SHOCK, (SYNCOPE), COLLAPSE.

CAUSES.

I.-Injury in the region of the abdomen, extensive wounds and burns, fractures, lacerated wounds, and severe crush are some of the more frequent physical causes of shock.

2.- Fright, anticipation of injury, and sudden bad news, or sometimes sudden removal of fear and anxiety after prolonged suspense, produce shock or fainting.

3.-Some poisons cause shock, while others, such as alcohol, so depress the nervous system that collapse ensues.

4.-Heemorrhage or heart weakness, a close or crowded room, tight clothing, fatigue, or want of food may bring on fainting or collapse.

SIGNS AND SYMPTO;\IS.

The general condition of shock may be recognised by extreme pallor, a feeling of cold, clammy skin, feeble pulse, and shallow breathing accompanied, if heemorrhage has been severe, by yawning and sighing. The term "collapse" signifier - a very serious condition in which the life of the patient is in the greatest danger; the temperature of the body falls below the normal, and one great object of treatment is to prevent it sinking to a point at which life is impossible. An attendant danger of the condition of

collapse is the liability to sudden relapse after a temporary improvement, and the care '\yatchfulness must therefore be exerclsed to mamtain the heat of the body and to guard against failure of the heart and lungs.

I.-Remove the cause by arrestin.g heemorrbage, attending to injuries, loosening all tlght clothing especially about the chest and a?domen, rem.oving from a close or cro\vded room, usmg encouragll1g words, etc. .

2.-Lay the patient on the back, With head low. Raise the lower limbs; when the patIent is in bed this is best done by raising the foot of the bedstead.

3.-Provide for a free circulation of fresh air.

4.- If hcemorrhage has been se,:ere the patient is collapsed, firmly bandage the ltm bs from. the toes to the hips, and from the to the armpIts.

5.-To stimulate the .of the sal volatile and water may be gIven If the patIent c?n swallow, or smelling salts may be held to the nostnL

6.-It is of the utmost importance to use every means of preventing a fall of ture below the normal point. To accomphsh thIS cover the patient with extra clothing, or by placing

13 6

rugs or blankets over him get him to bed in a warm but well-ventilated roo n as soon as possible. Apply warm th to the feet and to the pit of the stomach by hot water bottles or hot flannels. (Test the heat of with the elbow before applymg them.) If the p3.tIent can swallow, give hot drinks, such as milk, .or coffee. It is well to add sugar, as it aids in ralSll1g the temperature of the body.

cannot be discerned, apply artIficIal respiratIOn.

8.-If want of nourishment has been the cause of fainting or collapse, give food sparingly at first.

SUNSTROKE AND HEAT-STROK-E.

'Vhen exposed to great heat, as in the stoke-hole of a steamer, especially in the tropics, or to the rays of the during a march in very hot weather \\"hen persons may develop sickness, giddl.ness, and difficulty in breathing. The patle?-t COlllplall1S of thirst, the skin becomes dry and burnll1.g, the face very flushed, the pulse quick and .. A very high temperature, stertorous (snorIng) breathIng, and insensibIlity may ensue.

TREATME T.

I.-Undo all tight clothing.

2.-Remove the patient to a cool, shady spot.

137

3.-Strip the patient to the waist.

4.-Lay the patient down, with the head and trunk well raised.

s.-Procure as free a circulation as possible of fresh air, and fan the patient vigorously.

6.-Apply ice bags or cold water freely to the head, neck, and spine, and maintain this treatment until the sympt oms subside.

7.-0n return to consciousness, the patient may have water to drink.

VULSIO S IN CHILDREN.

Teething or stomach troubles are the commonest causes of this ailment.

SIG:\'S.

Spasm of the muscles of the limbs and trunk, blueness of the face, insensibility, more or less com, plete, and occasionally squinting, suspended Iespiration, and froth at the mouth are the prominent signs.

TREAT:\IENT.

I.-Support the child in a warm bath slightly above the temperature of tbe body (98 degrees), so that the water reaches to the middle of the trunk.

2.-Place a sponge dipped in cold water on the top of the head.

ASPfl Y XI A.

'When, owing to want of air , th e blood is n ot supplied wi h oxygen the patient becomes insensible , and is said to be asphyxia ted . This condition may be brough t about as follows : -

1. Obstruction of the air passages.

(a) By DRO\\' 1 'G .

(b) By PRESSUR E FROM OUTSIDE : Stranguiation , hanging, smothering.

(c) By AFOREIGN BODY IN THE THROAT: Choking.

(d) By SWELLING OF THE TISSUES OF THE

THROAT : I nflammatio n , scald of the throat, poisoning by a corrosive .

II. Inhaling poisonous gases. By coal gas (as used in the house), producer, or water, gas, smoke, fumes from a charcoal or coke fire, sewer gas, limekiln gas, carbonic acid gas.

I II. Pressure on the chest, as when crushed by sand or debris, or hy a crowd,

I V . Nervou s a ffe c ti o n s, as the result of narcotic and certain other poisons, collapse , electric shock, or stroke by lightning.

G ENERAL T REATMEN T.

In all cases of Asphyxia atte m pts mus t be made to remove the cause, or to remove the patient from the cause. ' Vhen this h as been done artificial 139

respiration must be applied, taking care that the air passages not obstructed , a n d that there is abundance of fresh air.

DROWNING .

Persons completely immersed in \yater for even ten or fifteen min utes haye been restored by artificial means. Therefore, if the body is recovered within a reasonable time, absence of signs of Me is not to de'.cr immediate attempts to restore animation.

The first thing to do when the booy is recovered is to get rid of the \\-ater and froth obstructing the air passages, and then artificially to restore breathing. ThlS is best accomplished either by proceeding at once to perform artificial respiration by Schafer's method, or as follows :-

I.-As quickly as possible loosen the clothing, and clear the mouth and the back of the throat.

2.-Turn the patient face downwards, with a pad below the chest, and with the forehead upo n the nght forearm .

3--\ Yhi lst in th is position apply pressure by the hands to the patient's back over the lower ribs, and keep- the p r essure u p for three seconds .

4.-Turn the patient on the right side) maintaining that position also for three secon ds.

5.-Repeat these movements alternately as long as froth an d \yater iss u e from the l1l.outh.

These op erations (Marshall Hall's method) in themselves tend to promote respiration, but ",.hen th,e air passages are clear of froth and water Sllvester 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.

STRANGULATION.

Cut and remove the band constricting the throat. Apply artificial respiration.

HANGING.

Do not wait for a policeman: grasp the lower limbs and raise the body to take the tension off the rope; cut the rope, free the neck. Apply artificial respiration.

R emove whatever is smothering the patient. Apply artificIal respiration.

CHOKING.

Open the mouth, forcibly if need be; pass the forefinger right to the back of t?e and attempt to dislodge the foreign body; If vomltmg results, so much the better. If unsuccessful, thump the back hard whilst the head is bent forward. Apply artificial respiration.

I4I

S .YELLI0:G OF THE TISSUES OF THE THROAT.

'Whether the swelling is caused by in flam mation 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 cl oth, 'Hung out of yery hot \Yater, to the front of the neck, fro:11 the chi n to the top of the breast-bone.

2.- et the patient before the fire.

3.-Giye Ice to suck if it can be had; if not, give cold water to drink.

4.-Give animal or oil, dessertspoonful at a time, to soothe the scalded throat and ease the pam.

5.- If has ceased apply artificial respiration.

SUFFOCATlON BY S:\lOKE OR GAS ES.

I.-Remove th e patient into the fresh air. Before entering a building full of smoke ti e a handkerchief, wet if possible, round the head so as to cover the nose and m o uth. It is well to l1lov e slowly, keeping low, or even crawling, "hilst in a room full of smoke in search of a suffocated p e rs on. Every opportunity of letting in fresh air by opening doors or windows should be seized.

2.-Apply artificial respiration.

3.-1n the case of producer or water gas, rnhalation of oxygen will also be necessary.

ELECTRIC SHOCK.

Electric current is conveyed by a cable, wire, ran, or bar called the U Positive, U and returns to the source 'of su pply by another cable, 'wire, rail, or bar, called the" Negative," or through the earth. In the case of an electric railway, the current is generally conveyed by an insulated rail caWed the third rail, returns through the running rails or an insulated called the fourth rail, and in the case of an electnc tramway it is conveyed by an oyerhead conductor or trolley wire, and returned through the running rails.

Through contact with a "positive" the shock may be so severe as to cause insensibility, and the sufferer will be unable to extrIcate himself, and must be liberated 'with all possible speed. As it is generally impossible or inexpedient to switch off the current some other method must usually be adopted; but precautions must be taken or else the person rendering assistance will himself receive a shock.

To liberate the sufferer from contact-

I.-Insulate yourself from the earth by standing on an " insulator" or " non-cond uctor," that is? a body which resists the current. Amongst such bodies

143

are indiarubber, dry glass, dry bricks, dry silk, dry cloth, dry wood and dry hay or straw. lIS

2.-Protect your hands from contact with the sufferer or the electric medium by covering them with an insulator. Although indiarubber is probably the best insulator, do not waste time 'in running for indiarubber gloves, but use dry articles of clothing; an indiarubbe" tobac co pouch or cap, or fold ed newspaper, would serve to protect the hands in an emergency. If no of insulating the hands are at hand an attempt may be made to drag the sufferer away by means of a loop of dry rope or a crooked stick; an umbrella is not safe because the metal ribs would act as conductors*' of electricity, and it is not infreq uently the case that the" stick" of the umbrella is a metal tube.

3.-Pull the sufferer away from contact. Care should be taken to avoid touching with naked hands the sufferer's hands, wet clothing, or boots if the soles 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-

.. A conrluctor is a b ody through which electrici ty r ead ily passes. Am ongst such bodies are copper, brass, iron, moisture and one's own body.

144 sibility (loosen clothing, procure free circulation of air and place in a recumbent position).

2. - Dip a towel in cold water and atte m p t to arouse him by sharply flicking the face and chest.

3. - Comme n ce a rti ficial resp ira t ion if other methods fail to restore animation. "Laborde's 1/ method (see page 126) has been found to be very succe·ssful.

4.- Treat burns if there are any (see pages 103, 10-+) .

EFFECTS OF LIGHTNI 'G.

A person struck by lightning: is us-ually more or less deprived of consciousness. The treatment is the same as that for electric shock, e\:cept, of course, that the instructions for the patient from contact with the electric medium do not apply.

145

QUESTIONS ON CHAPTER V.

Tile numerals indicate the pagl!s wlure tile allsweJ s lIIay be found.

"That are the two systems of nerves? ... '"

Of what is the cere bro-spinal system made up ? ...

What is the spinal cord? \Vhat are nerves like?

the sympathetic system

are the expansion

In

hat system of artificial respiration is the patient

what systems is he laid on his back?

In what system is he rolled alternately on his side and face downwards?

IIow long should artificial respiration be perse\'ered

Would you examine the patient Lo see if any bunes were

wrong opinion may be formed when the' patient smells of

collapse from drink a serious condition?

""hat danger accompanies injury to the head?

\Yhat caution should be given to a patient who has lost consciousness, even for a moment, after an injury to the head? .•.

\Vhat are the causes of compre.sion of the brain?

In what aged people does apoplexy usually occur?

\Vhat are the signs and symptoms of compression and apoplexy?

State the rules for treatment of these conditions ...

\Vh3.t danger is there in applying hot water bottles to insensible persons, and what precautions should be

Describe a Case of epilepsy 132, 133

\Vhat special care must be taken in treating a case of epilepsy? 130, 132

Describe a hysterical fit... . ..

How would you treat a hysterical fit ?

What are the commonest physical causes of shock?

What may produce shock or fainting?

What conditions do certain poisons bring a bout?

What may bring about fainting or coJlapse?

How would you recognise the general condition of sh ock? 134

\Yhat special precaution must be taken in the case of collapse?

State the treatment for shock, fainting (syncope) ard collapse ... 135, 136 135

'What is the effect of sugar on the temperature of the body?

\Yhat are the causes of sunstroke and heat-stroke?

State the treatment for sunstroke and heat-stroke

\Vhat are the causes of convul sions in children?

\Vhat are the signs of convubi ons in children ? ...

State the treatment for convulsions in children

State fully the causes of asphyxia ...

'What two things have to be done in all cases of asphyxia?

'What t\\'o thing5 must be seen to before It IS pOSSl ble for artificial respiration to do any good? :..

Is artificial r espirat ion likely to do any good If the aIr passages are obstru cted, or if there is not abundance of fr esh air ?

What is the first thing to do in a case of drown ing ?..

By what method may artificial respiration be performed without taking any previous steps? .

Wh at steps must be taken before proc eedmg with Silvester's method?..

"That should be done while artificial respira tion is being performed?

State the treatment [or strangulation qo

State the treatment for hanging qo

State the treatment for smothering qo

Slate the treatment for choking qo

How may a swelling of the tissues of the throat be caus ed ?

State the treatmen t for swelling of the tissues of the throat...

the treatmznt for suffocation by sm ok e or gases

How would you liberate a sufTerer from contact WIth an electric medium?

\Vhal would you do when the sufferer was removed fr om contrlct ?

What would you do in the case of a ligh tning stroke?

CH APTER VI.

PO I SONI G .

Poisons may be classified according to their treatment under t\\'o heads :-

1.- Those which do not stain the mouth, and in the treatment of which an eme tic is to be given. Amongst these are:-

(a) Arsenic, Phosphorus (contained in rat and lucifer matches), Tartar emetic and Corrosive Sublimate, \\ hich cause a m tallic ta ste in the mouth and a burning pain in the mouth, throat and stomach.

(b) Strychnine, Prussic Acid, Belladonna (aeadly nightshade plant) 2nd seyeral other ,-aneties of plants, such as laburnum seeds, etc.; these give rise to cOlwulsiGns, deliriul11, failure of respiration and collar se .

(c, Poisonous meat, fish and fungi (often mistaken for mushrooms). Suspicion of these poisons shou ld be directed to cases \\ bere several persons \\'ho baye partaken of the same food develop similar signs and symptoms.

(d) Alcohol, \\'hich may cau e collapse.

(e) O pium and its preparations,

149

Laudanum, Paregoric, Syr u p of Poppies and various sGothmg dn nk s a n d cordials; these cause a tendency to go to sleep, which continues until sleep becc:mes deep and breathing stertorous; the pupJls.of the eyes become minutely contracted (pmhead pupil )_ .

2. - Those wh ich bu rn or s t am the a nd in t he trea t men t o f w h ich no emetic IS to be gi ven . These are of t\\.-o _classes :- .

(a) Acids, as. ACId fortIS), SulphUrIC ACId ( 011 Hydrochloric, or Muriatic, ACId (SPll'lts of al_t), stron J Carbolic Acid (Phenol), Oxalic ACId, which is contained in oxalate of potash, salts of sorrel, salts of lemon and some polishing pastes. .

(b) Alkalies, such as CaustIc Potash, Caustic Soda and Ammonia .

OF SIMPLE DIRECTIONS FOR THE T RE)"DIENT

OF

I. - Send for a doctor at once, stating what has occurred and if possible the name of the poison. .

2. - Except when the hps ar:d mouth stained or burned by an aCId or alkah,

promptly give an emetic-that is, make the patient vomit as follows :-

(a) Tickle tlze back of tlze tlzroat with the finger or with a feather.

(b) lJ,fustard-a dessert-spoonful in a tumblerful of luke-warm water.

(c) Salt-a table-spoonful in a tumblerful of luke-warm water.

(d) Ipecacuanlza a young child, a teaspoonful repeated at inlervals 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.

Olive, Salad, and Cod-liver oil, or oil such as that in which sardines are preserved, may be given; mineral machine oils and paraffin are unsuitable. Oil is soothing, and is therefore especially useful in poisoning by Acids, Alkalies and such substances as Arsenic and Corrosive Sublimate. Demulcent drinks, such as barley water or thin gruel, act in the same manner, and are free from danger in cases of phos· phorus poisoning.

These may be given either before or after the emetic if the poison calls for one. .

Strong Tea acts as a neutraliser of many poisons,

151 and is always s::tfe. A handful of tea should be thrown into a kettle and boiled. .

4.-If the lips and mouth are stamed or burned give no emetic, but- . ' .

(a) If an Acid is known to be the pOlson gIve an Alkali at once. First wash the mouth out freely with lime water or other .<l:lkaline mixture, such as soda, chalk, whltmg, or maallesia or wall plaster in water, and afterwa:ds let the patient sip a little of it. Soda and potash are not to be giyen in the case of poisoning by oxalic acid. .

( b) If a stron a Alkali is known to be (he pOlson give an at once. Firs.t :\'ash the I?outh out fr eely with lemon JUlce or vl11egar diluted "ith an equal quantity of water, and afterwards let the patient sip a little of it.

In both cases give oil (Rule 3)'

5 -When a person has swallowed poison and threatens to go to sleep, keep him awake by walking him about and slapping his face, neck and ch est with a wet towel. Strong black coffee may be g iven to drink. Slapping the soles of the feet may also be tried.

6. - If the throat is so swollen as to threaten obstruction to the air passage, apply hot flannels or poultices to the fron! of the neck and give frequent sips of cold drinks.

7.- Apply artificial respiration if breathing cannot be discerned.

8.-Treat shock and collapse.

9.- Preserve any vomited matter, food, or other substance, suspected of being the poison. Do not wash vessels which may haye C011tained 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 on.

TREATMENT.

1.- Give milk, to a pint of 'which half an ounce of Epsom Salts has been added.

2.- Treat according to the general rules.

PRUSSIC ACID.

The action of this poison is extremely rapid. Giddiness, staggedng, insensibility accompanied. by panting respiration, profound collapse and posslbly convulsions are the general signs, and in addition a smell of bitter almonds is often present.

TREAD1ENT.

I.-Place the patient in the 0pen air.

2.-D.lsh cold water on the head and spine continuou sly.

3.-Apply artificial respiration.

{.-Hold s:nelling salts to the no strils.

5.-Treat shock and collapse. (See page 135.)

POISONOUS MEAT, FISH AND FUNGI.

The signs and symptoms are vomiting and purging (diarrhrea), colic, headache, great weakness, raised temperature and a quick pulse.

TREATMENT.

I.-Give an emetic.

2.- 'When the emetic has acted, give castor oil.

3 -Treat collapse. (See page 135.)

STR YCHNINE.

T he signs and sympto ;n s are a feeling of suffocation, livid features, and convulsions. The patient rests on his head and feet, and the body is arched.

TREATMENT.

1. -Give an emetic.

2. -Apply artificial respiration.

ALCOHOL.

I.-Give an emetic if the patient can swallow.

2. - Treat collapse by keeping the patient warm, etc. (See page 135.)

QUESTIONS ON CHAPTER VI.

Th( 'numerals itldicate the pages 'Wltere the answtn may be found.

Under what two heads may poisons be classified?

What are the symptoms of poisoning by arsenic?

hat other poisons give rise to the same symptoms? ...

149 148

What poisons give rise to convulsions, delirium, failure of respiration and collapse? ... I4f

Kf several people who had partaken of the same food developed similar signs and symptoms, by what would you suspecl they had been poisoned? ... 14

":-Yhat condition may result from poisoning by alcohol? 14

What are the effects of such poisons as opium?... 148, 149

What two classes of poison burn or stain the mouth? , ..

Would you give an emetic for such poisons?

Name some of the principal acids

Name some of the principal alkalis

State the general rules for the treatment of poison-

ing

State the best methods of making a person vomit

How would you treat a case of acid poisoning? ...

How would you treat a case of poisoning by an alkali?

State the signs, symptoms and treatment of carbolic acid poisoning ...

State the signs, symptoms and treatment of poisoning by Prussic Acid 15 2 , 15 3

State the signs, symptoms and treatment vf poisoning by poisonous food

State the signs, symptoms and treatment of poisoning b)

What would you do in the case of alcoholic poisoning?

CHAPTER VII. BANDAG ING.

Esmarch's Triangular Bandage has been described in Chapter II. It may be a pplied to keep a dressing on a wound, burn or scald of any part of the body, or for an injury of a joint.

For the Scalp (Fig . 62). Fold a hem about dinches deep along the of a bandage; place the bandage on the head so that the hem li es on the forehead close down to the eyebrows, and the point hangs down at the back ; carry the t\\ 0 ends round the head above the ears and tie them on the forehead ; draw the point first dO\\,l1\yards, and then turn it up and pin it on to the bandage on the top of the head.

FIG. 62.

For

the

Forehead, Side the Head,

Eye, Cheek, and for any part of the body that is round (as the arm or thigh, etc.), the narrow bandage should be used, its centre being placed over the

dressing, and the ends being carried round the head or limb, as the case may be, and tied over the wound. For the Shou lder (Fig. 63). Place the centre of a bandage on the shoulder, with the ooint running

FIG. FIG. 64.

up the side of the neck; fold a hem along the base j carry the ends round the middle of the arm and tie them. Place one end of a broad bandage over the point of the first bandage and sling the arm by carrying the other end over the sound shoulder and tying the ends at the side of the ; turn d.ow.n the point of the first bandage, draw It tIght and pm It.

157

Fo r the Hi p (Fig 64). Tie a narrow bandage round the body above the haunch bones, with the knot on the injured side. Fold a hem according to

FIG. 65. the size of the patient along the base of a second bandage; place its centre over the dressing, carry the ends round the thigh and tie them; th e n carry the point up under the

66.

first bandage, turn it down over the knot and pin it. F or the H and when the fingers are extended (Fig. 65). Fold a hem along the base of a bandage; place the wrist on the hem with the fingers towards the point; then bring the point over the wrist, pass the ends round the wrist, cross and tie them j bring the point over the knot and pin it to the bandage on the hand.

FIG.

158

For the Foot (Fig. 66). Place the foot on the centre of the bandage with the toes towards the point; Elraw up the point over the instep, pass the ends round the ankle and cross them in front; now pass the ends round the instep and tie them. Draw the ' 1"

FIG. 67a. FIG. 67b. point forward and pin it to the bandage on the instep.

For the Front of the Chest (Figs. 67a and 67b). Place the middle of the bandage over the dressing with the point over the shoulder on the same side j carry the ends round the waist and tie them;

159

toen draw the point over the shoulder and tie it to one of the ends.

F or the Back. The bandage is applied as the foregoing, except that it is begun at the back.

For the Knee. Fold a narrow hem along the base of a bandage; lay the point on the thigh and the middle of the base j ust below the knee-cap; cross the ends first behind the knee, then oyer the thigh and tie them. Bring the point down and pin it to the base (Fig. 68).

FIG. 6S. For the Elbow. Fold a narrow hem along the base of a bandage; lay the point on the back of the arm and the middle of the base on the back of the forearm; cross the ends first in front of the elbow, then oyer the arm and tie them in front (Fig. 69).

For the Fingers and Toes wrap a strip of calico or linen round and round the part; split the freeend, and secure it round the wrist or ankle.

FIG. 69

CHAPTER VIII.

METHODS OF CARRYING.

THE SEAT.

This seat is used when the patient can assist the bearers and use his arms.

I.-Two bearers face each other behind the patit.:nt and grasp their left forearm with their right hands and

FIG. 70. each other's 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.

161

3.-The bearers rise together and step off, the bearer on the right hand side of the patient with the right foot, and the left hand bearer with the left foot

THE Two-HANDED SEAT.

This seat may be used to carry a helpless patient.

7r.

T.- Two bearers face 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 G

FIG.

below the shoulders, and, if possible, takes hold of his clothing. They slightly raise the patient's back, and then pass their other forearms under the middle of his thighs (Fig. 7 I ), an d clasp their hands by one of the ll1ethodssho\\n in Figs. 72 and 73. A handkerchief s,lOuld be held in the hands if the first grip is used.

FIG. 72. FIG. 73.

2.-The bearers rise t06ether and step off, the right-hand bearer ·with the right foot, and the left-hand bearer with the left foot (Fig. 74).

THE THRhE-HAXDED SEAT.

This seat is useful for carrying a patient and su pporting either of his lower limbs, when he is able to use his upper limbs.

1.-Two bearers face each other behind the patient. For supporting the left limb the bearer to the patiEnt's right grasps his own left 'v\Tist \yith his right hand, an.d the other bearer's right wrist with his left hand. Tbe bearer to the left grasps the bearer's right wrist \yith his right hand (Flg. 75). This leaves his

left hand free to support the patient's left leg. For patient's right low er limb foll ow the same directions, substituting" right" for" left" and" left" for "right." The bearers stoop down.

2.-The patient places one arm round the n eck of e:tch bearer and sits on their hand.

3· - The bearers rise together and step off) the FIG. 75.

right-hand bearer with the right foot, and the leftband bearer with the left foot.

THE FIRIT.."\IAX'S LIFT.

(To be attempted only by a strong mai1) .

Turn the ratient face do\\ n wards; place yourself at his head, stoop down, slightly raise his head and

shoulders and take hold of him close under his arm . pits, locking your hands on his back. Raise his body and rest it on your left knee; shift your arms and, taking him round his waist, lift him until his head rests on your left shoulder. Throw his left arm oyer 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 patie nt's left wrist with your left hand and Ie aye your right hand free.

Assistp.nce may be given to an injur ed person by supporting him in the manner shown in Fig. 76.

Tlte plan of carrying tlt e patieJlt by lite anm and legs witlz tlte face dowmvards, C071t III OJl (I , called tlte "frogs> march," mllst llever be used, as deatll may ellsue from th i s treatm ell!.

blPROVISED STRETCHERS.

A scretcher may be improvised as follows:-

I.-Turn the sleeves of a coat inside out; pass two strong poles through them; button the coat. The sits 011 the back of the coat and rests against the back of the front bearer (Fig. 78). If a 10[lger stretcher is required byo or three 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)

THE FORE AFT METHOD.

This plan of carrying is useful when space doeSl not permit of a hand seat.

FIG. 77.

.FIG. 78,

FIG. 79.

2.-Make holes in the bottom corners of one Of wo sacks and pass stout poles through them.

3.-S pread out a large piece of carpet, sacking ; tarpauli n, or a strong blanket, and roll two stout polt:s tlp in the sides. Two bearers stand on each side and grasp the middle of the pole with one halld, and near the end with the other. They walk sideways.

4.- A hurdle, broad piece of wood, or shutter ma} be used as a stretcher; some straw, hay, or clothing should be placed on it, and cm'ered \yith a piece G stout cloth or sacking; the latter is useful in t;:tkin a the patient off the stretcher.

Always test an improvised stretcher before use.

Stretchers must be carried, and the pati ent placed 'on them, as laid down in the "Stretcher Exercises."

As a general rule carry the patient feet foremost.

The exceptions are :-

(a) When going up hill with a patient y,.hose lmyer limbs are not injured.

(b) When goibg do\\n hill with a patient whos lower limbs are injured.

Avoid lifting the stretcher over ditches or 'walls, but . here these cannot be avoided the stretcher must b lC arried in the following ways ;.-

To CROSS A DITCH.

In crossing a ditch, the stretcher should be lowered with its foot one pace from the edge of the ditch ,

Nos. I and 2*' bearers then descend. The stretcher \\'lth the patient upon it, is afterwards advanced' N os. a nd 2 in the ditch supporting the front end while Its other end rests on the edge of the groun d above . No. 3 now descends. All the Nos. now carry the stretcher to the opposite side, and the foot of the stret,cher is made to r est on the edge of the whIle the .head is supported by TO. 3 in the ditch. No. I ch mbs out, No. 2 r emamIng in the ditch to assist NO.3. The stretcher is lifte d forward on the gro un d above, and rests there while N os . 2 and 3 climb up.

To C ROSS A 'V ALL.

The stretcher is lo\\'ered with the foot ab out one p ace from the wall. os . I and 2 bearers then t ake h old of the foot of the stretcher, and IO. 3 of the head; the stretcher is raIsed till the foot is placed on the ,mI l. No. I then climbs over the \\'all and takes hold of the foot of the stretcher, while Nos. 2 and 3 support the held; the stretcher is then carried forwar d tll1 the head rests on the wall, No. I supporting th e foot. Nos. 2 and 3 then climb over the wall and take hold 0,[ the h ead of the stretcher, which is then slowly lifted off the wall on to the gro und and the bearers t :tke th eir usual places. '

* The se numbers are explained later in the deta.!ed "Stretcher Ex.cccis s."

To LOAD A 'V AGON.

The stretcher is lower ed ,,,ith the foo t one pace fr0111 the end of the wagon. N os . I and 2 take hold of the foot of the stretcher, No. 3 the head. The stretcher is then r aised and carri ed fonyard till the front \\ heels rest on the floor of the wagon. No. I then jumps into the \\'agon , "hile No.2 goes to the head of the stretcher and helps TO . 3. The stretch e r is then pushed slowly into the wagon . If the tailboard cannot be shut, the stretcher must be lashed firmly to the sides of the wagon.

T o UNLOAD A IV AGON.

Nos. 2 and 3 take hold of the head of the stretcher, \\'hile No. I gets into the wagon; the stretcher is then gradually drawn out till the foo t-wh eels rest o n the 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 away one pace and lo\\'ered.

'Vi th four bearers Nos. I a nd 2 \\'ould lift the foot of the stretcher, \\ hile Nos. 3 and 4 lift the head. This applies to crossing a ditch or \\'all, as 'well a s to loading and unloading a wagon.

CHAPTER IX.

STRETCHER TRAN ,-- PORT.

The II Stret.chers (Model ] 899) are of three,patte.rns;,Ylz ," and Pollce. In general prll1clple they are alike the component parts being designated the poles:

FlG. fO. -ORDIK .-\RY STRETCHER-CLOSED .

FIG. 81.- TELESCOPIC-HANDLED STRETCHER - OPE:-;-. handles, jointed traverse bars foot \\ heels bed pillo\\' k d . ' " sac an sllllgs.

. The Ordinary tretcher (Fig. 80) is 7 feet 9 in.ches 111 len.g th, and r foot 10 inches \\'ide. The bed is 6 111. length, and the handles inches The h e1ght 1S Sf inches . At the head of the stretcher is a overlay (the pillow sack) \\'hich can be filled WIth .3t.raw, hay, clothing, etc., to form a pillow. The Jomted traverse bars are provided \yith joints,

173

for opening or closing the stretcher . The Telescopichandled pattern ( Fig. 8r) is yery similar, but the bandIes can be slid underneath tbe poles, tbus reducing the length to 6 feet. This arrangement is of great value when working in confined spaces, or \vhen a patient has to be taken up or down a narrow staircase wit!l sharp turns. The Police stretcher is similar to the Ordinary pattern, but is more stron gly made, and in addition, straps for securing a refractory pat1ent.

,\Vben closed, the poles of the stretcher lie cl os e together, the traverse bars being bent imrards, the canvas bed neatly folded on tbe top of the poles and held in position by the slings which are laid along the canvas, and secured by a strap, placed transversely at the end of each sling, being pass ed through the large loop of the other, and round tbe poles and bed.

In closing a stretcher care should be tak en to raise the centre of the cam-as when pushing in the traverse bar, as it is otherwise liable to get caught.

To prepare, or open a stretcher, unbuckle the transverse straps of each sling; remove the slings from the stretcher; separate the poles; take bold of each traverse bar and draw it forward. The slings will then be folded to balf their length, one being laid ne atly over the handles at each end of the stretcher.

As a general rule, the stretcher will be prepared b y Nos. I and 3 bearers in Exercises 1., 11., and Ill.;

174 and by No. 2 in Exercise IV. These belrers will, however, if required, assist the other bearers in attending to the patient 's injuri es .

Nole . - The various movements detaIled III the following Exercis es should be carried out steadily, the bearers working in unison , hurrying being carefully avoided, and eve ry attention beind paid to the bearer who gives the words of comnund.

STRETCH

ER EXERCISES, Originally drawn up by Sir Jo hn Furley) and revised in r 904 to accord with the drills adopted by the Royal Army Medi ca l Corps :-

EXERCISE No. I.

FOR FOUR BEARERS.

1.-The Instructor selects the bearers a nd numiJers them-I, 2, 3, 4 at his discretion. Should one man be taller and stron6er than the others, he sho uld be styled NO.3, as he will have to bear th e heavier part of the burden. *" All orders will be given by NO.4.

2. -" Fall in." - Nos. I, 2, and 3 take position on the left side of and facin g the patient. No. I places himself at the patient's knees, No. 2 at the hips, NO.3 at the p:ltienL's shoulders. At the same

It Bearers should, h(\w e vcr, be taught to take any of the pusitions named in the following Exercises, whether that of N O.1, 2, 3, or 4 bearer.

175

time No. 4 places the prepared stretcher on the ground by the ri ght side of the patient about two

FIG. 82.

paces away from him, then takes position opposite to and facing NO.2. (Flg. 82).

3· - (( Ready. "-The bearers kneel down on the knee and take hold of the patient, No. I passing illS hand.s and fore-arms beneath the patient's legs, hands wJde apart. Nos . 2 and 4 pass their hands

FIG. 83.

I and forearms be!leath the patient's hips and loins and grasp each other's hands. NO.3 passes his hand across the patient's chest and und e r the ricrht shoulder, and his right hand beneath the left shoulder (Fig. 83).

177

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 he

is securely rested, NO.4 disengages hands with No.2, runs round by the head of the stretcher and places it under the patient, close to the other bearers' feet,

178

being careful that the pillow is immediately under the patient's head (Fig. 85); he then kneels do\\ nand locks his hands with those of No.2 (Fi g. 86).

5.-" Lower."-The bearers place the patient on the stretcher (Fig. 87), disengage th eir hands, and then stand up.

FIG. 85.

6.-" Stand to Stretcher. " - No. I goes to the foot of the stretcher, with his back to the patient; NO·3 to the head with his face to the patient; Nos. 2 and 4 remain on ea ch side of the stretcher.

7·-" Ready."-N os . I and 3 place the slings (if used) over their shoulders, stoop dO 'v\'n, and slip the

179

loops of the slings on to the handles of the stretcher, \\"hich they then grasp . . .

As soon as all is right the wo rd IS given :-.

8.-"Lift Stretcher."-Nos. I and 3 bearers raise the stretcher steadily together and stand up.

Note -i\ os. 2 and 4 will now adjust the slings the of N ;)s. I and 3, tak ing care Lhat each well below the level of the collar and lies III the hollow of the shoulder in front.. Th ey wIll alhso h 1· - ha VlOO' reo-a,rd to t e len o-then or shorten L e SlOg::>, 1:>. b f h pJ.tient's injuri es and the relativ'" heIghts 0 t e bearers.

FIG. 86.

9.-" March." - move off I, 2, and 4 stepping off with th ei r left foot, and No. 3

with his rIght foot (Fig. 87). The step should be a short one of twenty inches, and taken with b ent knees and no spring from the fore part of the foot.

ro.-" Halt."-The bearers remain steady .

rr.-" Lower Stretcher."-The bearers place the stretcher gently on the ground, slip the loops of the off the handles of the stretcher, remove the slmgs from the shoulders, and then stand up.

12.-11 Unload Stretcher - Ready." - T he be arers prepare to take the patient off the stretcher, as at Orders 2 and 3.

I3.-" Lift."-The bearers raise the patient as at Order 4 (Fig. 86); NO.4, in this case, disengages hands frOl.l No.2, removes the stretcher (Fig. 85), and resumes his former position. If necessary, the bearers will then steadily rise together, and carefully C1.rry the patient Lo the bed, or bther place to which it has been arranged to convey him.

14.-"Lower."-The patient is carefully lowered.

EXERCISE No. II.

FOR THREE BEARERS.

I.-Number the bearers I, 2, 3.

All orders will be given by No.2, who will look after the injured part of the patient's body or limbs, to see that no bandages or splints become displaced, and also that TO . I bearer, in lifting or carrying the stretcher, does n ot touch the patient's feet.

2.-" Place the Stretcher."- TO. 3 places the stretcher in a line with the patient's body, the foot 0:$ the stretcher being close to his. head.

3. - " Fall In."-No. I places himself on the left ciide of the patient in a line with his knees, No.2 on the left side just below the patient's shoulders, and No. 3 t the right side, and faces NO.2.

4.-" Ready. " - All kneel on the left knee. No. t pla c es his hands, well apart, underneath the lowe r limbs, al ways taking care, in case of a fracture, to h av e one hand 011 each side of the seat of inj ury. Nos. 2 and 3 grasp each other's hands under the shoulders and thighs of the patient (Fig . 88).

s·-".

Lift."--:- The bearers rise together, keeping the patIent In a hOrIzonta l positio n ( Fig . 89). .\)

6.-'.' March. " -All take short side-paces, carrying , h e patIe n t over the stretcher unti l his head is immedi ately above th e pillow;

183

7·-" Halt "- The bearers remain stea dy.

8.-" Lowt::r." -The bearers stoop down, gently place the patient on the stretcher , disengage thei r hands, and then stand up.

9.-" Fall In. "-No. r places himself at the foo t of the with his back to the patient, No .2 places himself at the lefl side of the patient, an d No. 3 at the head, with his face towards the patient.

10. - " Ready."-Nos. 1 and 3 place the slings (if used) ove r their shoulders, stoop down, and slip the loops of the slings on t o the handles of the stretcher, which they then grasp .

As soon as all is right the word is given-

11. - " Lift Stretcher. "-Nos. I and 3 bearers raise the stretcher steadily together and stand up.

No. 2 will now adjust the slings on the shoulders of Nos. I and 3, taking care that each is well below the level of the collar, and lies accurately in the hollow of the shoulder in front. He will also lengthen or shorten the slings, ha\'ing regard to the patient's injuries and the relative heights of the bearers.

12.- " March ."- Nos. 1 and 2 step off ,yith the left foot , and No. 3 with the right. The step should be a shor t one of 20 inches, and taken \\"ith bent knees, and no spring from the fore part of the foot .

13.-" Halt. "--The bearers remain steady.

14.-" Lower Stretcher. "--The bearers place the stretcher gently on the ground, slip the loops of the slings off the handles of the stretcher, remove the slings from the shoulders, and then stand up .

IS. - " Unload Stretcher - Ready. " -. The bearers prepare to take the patient off the stretcher, as at Orders 3 and 4 (Fig. 88),

16. - " Lift. "-The bearers raise the patient, as at Orde r 5, and carry him by short side steps, clear of the stretcher, to the bed, or other place to whIch it h as been arranged to convey him (Fig. 89).

185

17.-" Lower."-The patie nt is carefully lowere d.

EXERC I SE No . III .

WHEN ONLY THREE BEA R E R S ARE AVAILABLE AND THE STRETCHER CANNOT BE PLACED AS IN EXERCISE II.

I.-The Instructor numbers the bearers -1, 2, 3. All orders will be given by NO.2.

2 .-" P l ace 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 practi.cable.

3.-" Fall I n."-The three bearers take the same positions on one side of the patient, as laid down in Exercise No. I.

4.-" Ready."-Nos. I, 2, and 3 kneel down on the left knee, placing themselves as close to the patient as they com'eniently can, and then take hold of him as directed in Exercise No. I.

S. -" Lift ."-Nos. I, 2, and 3 raise the patient a s 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, and di s- ' engage hands.

7. - " Stand to Stretcher. "-.-\ll the bearers stand up; No. I goes to the foot, No. 2 remains 111 position at the side, and No . 3 goes to the head of the stretcher.

8. - " Read y ."-Nos. I and 3 place the slings (if used) over their shoulders, stoop dO\\'l1, anri sl p the loops of the slings on to the handles of the tretcher, whIch they then grasp .

9·-" Lift I and 3 bearers raise the stretcher steadily together and stand up.

No.2 will now adjust the sling on the shoulclers of 1\os. I and 3. taking care that each is well below the le\'cl uf the collar, and lics accurately in the hollow of the shoulder in front. lIe will also lengthen or shorten the slings, having regard to the patient's injuries and the relati\'e heights of thc bearers.

10. - " March. "-Nos. I and 2 step off with the left foot, and NO.3 with the right The step should be a short one of 20 inches, and taken with bent knees, and no spring from the fore part of the foot .

1I.-" Halt." -The bearers remain steady .

12. - " Lower Stretcher. "-The bearers place the stretcher gently on the ground, lip the loops of the slings off the handles of the stretcher remove the slings from tIle shoulders, and then up.

13·-- " Unload Stretcher - Ready." - No. I places himself on the left side of the patient, and in a Ime with his knees, o . 2 on the left" side just below the patie nt's shoulders, and NO . 3 at the n ght

187

ide, and faces NO.2. All kneel on the left knee. No. I places his hands, \yell apart, underneath the lower limbs, always taking care, in case of a fracture, o have one han 1 on each side of the seat of injury. Nos. 2 and 3 grasp each other 's hands under the shoulders and thighs of the patient.

14.-" L i ft ." - The bearers rise together to then feet, keeping tIle patient in a horizontal position, and carry him by short side steps, clear of the stretcher, to the bed, or other place to which it has been arranged to cotwey him.

15·-" Lowcf."- The patient is carefully lowered.

EXERCISE No. IV.

FOR USE IN MIXES AXD NARROW "'HERE T\\ 0 l\IEx OXLY BE ENGAGED.

Nos. I and 2 will carefully place the stretcher in a Ime ",ith the injured man 's body, the foot of the stretcher being, if pos -ible,* close to his head.

No. I straddles across the patient's legs, placing his right foot, 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 TO. 2; he then stoops down, p:tsses the left hand under the patient's thighs an d

• It is not ad\'isable to be too particula r as to the head or foot of a stretcher in a mine , as i t would probably be quit e impossible to reverse it .

188

t he right hand. across and under the patient's calves. No.2 places his feet one on each side of the patient between his body and arms, the toe of each foot as near the armpits as possible. He then stoo;:-s down and passes his hands between the sides of the chest and the arms undel neath the shoulders, and locks

FIG. 90.

the fingers (Fig. 90 ). If the patient 's arms are uninjured he may put them round the neck of No.2 , an d by chis means greatly assist him in lifting.

189

vVhen both are ready , TO. I will give the order " Lift and move fo rward ." The patient is then to be slowly lifted, just sufficient to allow his body to clear the stretcher. Both bearers will slowly and gradually move the patient forward, TO. 2 by very short steps, No. I by bending his body forward as much as he can 'witlzout moving Ius feet (Fig. 9T). No. I now gi\-es the order" Hal t," \yhereupon NO.2 remains steady, and N o. I adyances his right foot to his left , and

FIG. 9I.

again advances his left foot till the toe touches the heel of NO . 2. 1'\ O. I then gives the order " A dva nce," when the patient ",ill again be moved forward. These movements are to be repeated until

I90

the patient is over the stretcher, "'hen he is to be gently lowered.

The followin g Stretcher Exercise is adapted hy permission from the Royal Army 1Iedical C orps .:\Ian ual, 1908.

All orders will be given by NO.4.

I. "Fall in."-Six bearers fall 111 behind each o:her.

2. "Number."-The bearers number from front to r ea r.

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 foot wheels, wheels to the front. As 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 low e r end forward, places the stretcher on the ground to the right of the squad, "heels to the right, front end of the poles in line with the toes of No. I and rises.

4.: .-, Stand to Stretcher. "-No. I places himself with his to es in line with the front ends of the poles. No. 3 with his heels in line with the rear eno s of the poles, close to and touching the stretcher with

FIG. 93.

FIG. 94.

FIG. 96

FIG·Sl2.

hi s right foot. Nos. 2, 4, 5 and 6 take up their positio n s one pace behind and covering off the bearer in front of them (Fig. 9 2 ).

5. "Lift Stretcher." - Nos . I and 3 stoop, grasp both handles of the poles with 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 patient, and halts without further word of command one pace from the head of and in a line with the patient. (Fig·93)·

7. "Lower Stretcher. "-N os. I and 3 stoop, place the stretcher quietly on the ground, and rise smartly together.

8. "Prepare Stretcher. " - Nos. 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. O n the word two each takes a sling, doubles it on itself, slips the loop thus formed on the near handle , a n d places the free ends over the opposite handle, buckle uppermost. They then rise and turn to their left together.

\ Vhile the stretcher is being prepared by Nos. I and 3, the disengaged bearers will advance and render to the patient such assistance as may be required (Fig. 94). 193

T he nec ess a ry assistance having bee n r en de red N O.4 wi ll give the command- '

9. "Load Stretcher." - The bearers place themselves as follo\\'s :-Nos. I, 2 a n d 3 on the left, N os. 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 shoulders , the y;hole kn ee ling on the left knee.

Nos . I and 4 pass their hands ben ea th the patient's knees, 2 and 5 beneath the hips, 3 and 6 beneath the shoulders, care being taken of the injured part, one of the beacrs being detailed for this purpose (Fig. 95) .

1.0' "Lift. "- The wh ole will carefully lift t he pal1ent on to the knees of Nos I, 2 and 3.

Two. Nos . 4, 5 and 6 will then disenaaae rise' N d b b , os. 4 an 6 st ep back one pace. No. 5 turns to doubles to the stretcher, takes hold of and raises. It, left across, the near pole resting on the left hlp; carrymg the stretche r, he retu rn s to his place between 4 and 6, and places it beneath the patient.

T h r ee . . N os. 4 and 6 step fonya r d one pace, and tosether wit h NO.5 kneel down on the left knee and prepare, to assist in lowering the patient (Fig. 96).

II 'Lower. "-The patient is lowe red slowly and ge ? tly on to the centre of the canvas (special care bemg taken of the injured pnrt).

TWJ. The bearers disengage, rise ; Nos . J , 2, 3 a n d 6 hun to the left; Nos . 4 and 5 to the riaht · b , H

No. 4 places himself three paces in fr.ont of the stretcher. No.6, having collected the kIt .and arms of the pati ent , places himself three m rear of the stretcher, Nos. 2 and 5 opposite the of the stretcher. The whole are now ready to hft stretcher and move off (Fig. 97).

I95

12. "Lift Stretcher." -N os. I and 3 stooP7 grasp the doubled sling midway between the poles with the forefinger and thumb of the right hand, sweep it off the handles, rise, holding the sling at t he full ext ent of the arm, buckle to the front, take a side pace to the fr on t bet ween the handles, and place the sling over the shoulders dividing it equally, uckle to the right. The slings should be placed so t hat they lie well below the collar of the coat behind and in the hollow of the shoulders in front. In the event of the slings requiring to be adjusted, either as regards length or for the greater comfort of the !bearers, NO.4 will detail a bearer to carry this out, the length of the slings being adjusted, when necessary: by means of the buckles.

Two. Nos. I and 3 stoop, slip the loops over the andles, commencing with the left, and grasp the hand les firmly.

Three. Nos. I and 3 rise slowly together, No. .3 c onforming closely to the moyements of No. I.

I3· "Advance."-Nos . I, 2, 4, 5 and 6 step oft with the left foot, NO.3 with the right, stepping short g knees bent, feet raised as little as possible.

I4. "Halt. " -The whole halt.

IS. Ie Unload Stretcher." - The bearers place in the same position at the stretcher as! tdlesc ribed for Loading (Order 9).

"Lift."-As described for Loading (Order- 10),

FIG 97

FIG. 98.

except that the stretcher is carried forward three paces clear of the patient's feet.

17. "Lower." - The patient is gently low ered to the ground The bearers disengage, rise; Nos. I, 2 and 3 turn to the left, 4, 5 and 6 to the right, and the whole step off to their places at the stretcher, as at Order "Stand to Stretcher II (Fig. 98).

The Ashford Litter is made up of either of the Furley stretchers mentioned on pages r 7 2 and 173, a wheeled under-carriage and a waterproof hood and apron, or, if preferred, a light wet-resisting canvas c0.ver. The stretcher is kept in position on the under-carnage by the foot-wheels, which fit into slots in the sides Gf the under-carriage, and it can be removed at pleasure. The under-carriage is fitted with a cranked axle, which allows the bearers to pass with the stretcher between the wheels instead of lifting it over them. At both ends are two legs which may be turned up as handles when wheeling the litter. The hood and apron fit into sockets screwed to the stretcher. In wheeling the litter, care should be taken to keep the patient in a hori zontal position. Should it be necessary, two bearers can easily lift the litter and patient.

The Rea-Edwards Litter, introduced in 1904, is used in a similar manner. and one model of it is fitted with pneumatic tyres, which add immensely to the comfort of the patient and to the ease of propulsiono

197

CHAPTER X.

(Being the Fifth Lecture for Females ollly, z"1l accordance zmilt S)'llalills 58.)

BY E. :'IIACDO-.\ ELL cose :\1 D., F R C P.I.

PREPARATION FOR RECEPTIO:s' OF ACClDENT CASES .

,\THE • ne\ys of an accident preparati ons houlJ at once be made so as to bave everything ready before the injured person is brought in. Of course the prepcU"ations needful \\ill yary according to the nature and extent of the injury, but the following are the chief things which may ha\"e to be done .

CHOICE AND PREPARATION OF RomI.

A room must be cho en. In a bad case this should be one easily reachecl, as it is difficult to carry an Illjured person through narrow pas ages up:stairs. Unless there is some such reas on agalllst It, the Il1jured person's own room is best.

The way to the room must be cleared, .rrojecti.ng 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, t\\'o strong chairs shoulu be placed ready to support it whereyer the be::trers would be likely to require rest.

Useless furniture should be ren)Qved from the bedroom. The bed should be drawn out from the \\-all

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 collapse several hot bottles and ,hot blankets may be required; cover the hot bottles wIth flannel.

If the injury is very severe, if mud-staIned clothes have to be removed, or if extensive dressinas have to be applied, it may be n ecessary to have an;ther bed, a couch or, a table placed near the bed to lay the sufferer on 111 the first instance. This should be so arranged that soiling may do no harm; old sheets waterpoof materials, thin oilcloths, or even paper, may be us ed as a protection.

LIFTING AND CARRYING.

If present at the place where the accident occurred it will, be necessary to see that the patient is fully lifted after proper "First Aid" has be en rend ered .

The following rules should be remem bered :- Select the proper number of persons to assist and do not let them lift the patient until they tho'roughly understand how they are to do it.

For ,ordinary cases, 'whe re the injured person has to be, lIfted a very short distance, three helpers are T\yo (who should be as far as possible of equal he Ight) are to bear the wei gh t, the third is to support and take charge of the in jured part. This is 199

best done by a person who has been throuah a "First Aid" course. If the injured person is b insensible, 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 10 \\'e r part of the should e r-blades, and und er the hips, clasping each his right hand in the other's left.

The injured patient should, if practicable, place his ar ms round the necks of the bearers.

. helper shou.ld nttend to the seat of injury; If IS a fractured h, he should support it by placmg the palms of hIs hands under the limb, one above and one below the seat of the injury, QTasping it firmly bu t avoiding unnecessary pressure. b Th e helpers should rem ain thus until the order " Lift /I is given, and then they should all lift slowly and steadily, avoiding jars , attempts to change position of hands, etc.

H the injured person is to be placed on 11 stretcher or sbutter, tbis should be previously placed with the bottom end at his head; the bearers should tben move, one at each side of it, until the patient is oye r The word " Low er " should then be give n, and the mJured person should then be slowly lowered. A pillow ?r folded-up coat should be ready, and as the sufferer IS lowered this should be placed under his head.*

• Full directi ons ar e given in Chapter IX.

201

MEANS

OF CARRYING.

Besides a stretcher, and substitutes such as a gate, a shutter, or a door, other means of carrying can be im provised .

In slight injuries, where the injured person is unable to \yalk, two bearers can carry him by forming a fourhanded, three-handed, or two-handed seat.

A four-handed seat is formed as described on page 160.

A three-handed seat is made as described on page 162.

The two-handed seat is made as described on page 161.

CARRYIKG UP STAIRS.

In carrying a stretcher up stairs the head should go first, and an extra helper should assist at the lower end, so as to raise it and keep the stretcher n early horizontal.

The tw o, three, or four-handed seat may be used up stairs; or a strong chair, the patient bemg carned up backwards. In the latter case one should walk after the chair and help to support tt, and to the injured person slipping out.

LIFTI TG INTO BED.

A single helper can lift by supporting with one arm the two knees, and with the other the back. The arms must be passed well und e r before comrnencin cy to lift.

-

b

A single helper can give support by putting his arm round the waist, grasping the hip and placing the injured person's arm round his own neck, holdincy the hand with his own hand (Fig. 76, page 16 5). b

A capital stretcher can be improvised out of a strong sheet and two broom handles or other short poles. Each side of the sheet is wound up on a broom handle until there is just room for a person to lie between. This requires four bearers, two at each side, to prevent the sheet slipping.

If the bed is narro\\' and there is room the stretcher sh ould be placed on the floor with the head close to the foot of the bed. The injured person should then be lift ed over the foot and placed on the bed. If the bed is too wide to admit of this, the stretcher should be placed beside it, and t\yO 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 knees . r The injured person is then lifted, another helper pulls away the stretcher, and after a single step f Jrwa rd the burden is placed on the bed.

20 3

P REPARATION OF BED.

A fi rm mattress, not a feather bed, should be s elected . If there is much injury, or if dressings have to be applied, a draw-sheet ought to be placed 0n the bed . It should be of four or more thicknesses, extend across the bed, and reach from the middle of the patient 's back to the knees. A piece of waterproof sheeting or of thin oil-cloth should be placed unler the draw-sheet. As the draw-sheet becomes soiled, the solled portion should be rolled and a clean part drawn smoothly under the patient.

In fracture of the leg or thi,gll, sprain e d ankle and some other cases, a "cradle" (Fig, 99) should be improvised . The use of a " cradle " is to support the bed-clothes and keep them from pressing on the limb.

A b ::l.l1d-box (Fig. 100), three-legged stool (Fig, 101), or hoop Sa\\'D across and the two halves secured together (Fig. 102" may be used . A corkscrew passed through the bed-clothes, with its point guarded by a cork, and tied by string to the bed or a nail in the wall, \"ill relieve the pressure of the bed-clothes effectually.

REMOVING THE CLOTHES.

I n taking clothes off an injured person a few rules should be borne in mind .

I n serious cases it is much better to sacrifice the -:lothes than to run any risk of increasing the injury.

I.

FIG. 99.

FIG, 100.

FIG. rO

In removing a coat, etc., in a case of fractured arm th e uninjured arm should be drawn out first.

In putting on a coat or shirt the injured arm should be put in first.

In burns and scalds nothing should ever be dragged off. A sharp pair of scissors should be used, and e\' erythillg not adhering should be If anything adheres it should be left untIl medIcal aid /

FIG. 102 .

can be obtained. Th e clothing adhering may, \\'ith advantage, be soaked with oil. .To remove trous ers from a severely injured lrmb, the outszde seam should be ripped up.

PREPARATIONS FOR SURGEON.

As soon as the injured person has been c.ttended to, preparation should be made for the surgevn's visit.

205

Thepreparations needful will depend upon the nature of the case. The follomng hints may be of use :-

A fire in the room helps ventilation, even in summer. There should be plenty of water, hot, cold, and also boiling, also several basins, plenty of clean towels and soap. There should be something to empty water into; a foot-bath does well. The basins should be placed on a table, covered with a clean white cloth; a large towel makes a suitable cloth; the towels, folded up, should be placed on the same table, and the hot and cold water should be within easy reach. The foot-bath should be under the table or close at hand.

In the case of a burn, absorbent cotton wool, soft cloths, old linen, oil, and baking soda, should be ready, and materials should be torn up for bandages.

In the case of hcem o rrhage, plenty of water should be boiled and allowed to cool, and pads of absorbent cotton wool should be baked in a tin box in the oven, and at least two basins should be ready.

In the case of a person resc ued from drowning the sheets should be taken off the bed, plenty of blankets should be heated b efore the fire, and several hot bottles should be ready.

If poultices are likely to be required, boiling water, linseed meal, mustard, a loaf of stale bread, a small basin • a large spoon, sweet oil, and tow, flannel or handkerchiefs may be required.

For fomentation, have boiling water, flannel, a kitchen roller, and two sticks, or a large towel.

'When summoning a medical man to all accident always let him know by a \uitten message what kind of case he is required to treat, so that he may bring whatever is needful. By this means valuable time may be saved.

QUESTIONS ON CHAPTER X.

Tht 11Unw'als il1dicatt tht pages whtre tht answers may be found.

For what cases is this seat useful? ..

How is the two-handed seat made?

For what cases is this seat useful? ..

How can a single helper lift? PAC. 162 161, 162161

How can a single helper give support?

How would you improvise a stretcher?

How many bearers are required for this stretcher?

How should a stretcher be carried upstairs?

How would you carry a patient upstairs on a chair?

How would you lift a patient from a stretcher to a bed?

How should a bed be prepared for an injured person? ...

How sheuld a draw sheet be made?

vVhat would you place under the draw sheet? .. .

What should be done with the soiled part of a draw sheet?

What is the use of a " cradle"? ...

In what ways maya cradle be imprO\'ised ?

197

What points would you consider when choosing a sick PAGE room? ...

How would you clear the way to the sick room? 197

\Vhat means of r esting would you provide for those carrying a patient on a stretcher?... ... ... 197

How would you place and arrange a bed for an accident case? 197, 198

Are hot bottles necessary, and how would you prepare them?... ... 198

vVhat is often necessary to lay the sufferer on in the first instance? 198

How would you protect this from getting soiled? 198

How would you see to the proper lifting and carrying of an inj ured person? ... ... ... '" 198, 199

vVhat substitutes for a regular stretcher can you suggest? 200

How is the four-handed seat made? 160, 161

For what cases is this seat useful ?.. 160

How is the three-handed seat made? 162, 164

How would you remove a coat or shirt in the case of a fractured arm?

How would you put on a coat or shirt if the arm were injured?

In the case of a bad burn, what would you do with clothing that adhered to the patient?

How would you remove trousers from a severely injured limb? ... . ..

vVhat preparations would you make for the surgeon's risit?

What would you get ready in the case of a burn?

And what in the case of hremorrhage ?

And what in the case of a person rescued from drowning?

\Vhat would you get ready for making poultices?

And for fomentations?

What sort of a message would you send to summon a doctor?

INDEX.

Abdom en Page III wound of 112

Ac ciden t case , preparation for 197

A cids, poisoning by 149, 151

Air, always necessary... 18

Alc ohol, caution as to smell of 130

Alcohol, poisoning by 134, 153

Alkali s, poisoning by 149, 151

Amm on ia, poison ing by 14 9

Anat omy (elementary ) ... 20

Ankle 30 , 32

" sprain ed ... 64

Anteri or tibial artery 93

A orta 79

Ap oplexy 13 2

Appa rently drowned , to restore . ..

Arm, bon e of 139 28

Arm -slings

" fracture of 52 39,49 ... 148

Arseni c, poisoning by Arterial h remo rrhage , " arrest of 74 " practising arres t of 79 signs of 74 , , course of main .. ,

Art e ry, axillary ... 70 79 85

Artery, brachial. .. " car oti d d orsal of foot " facial " " " femoral ..• ilia c occipital plantar ... popliteal rad ia l subclavian " ti bial

" t empora l " ulnar

Artificial respiration 121, 129, A phyxia Atlas

Auricl es ... A xilla ry artery A xis

Back, bandage for 159

Backbone 23

Bandage , to apply 42 to fold 37 " to improvise... 37

Bandaging ISS

Bed, lifting into . .,. 201 " preparation of 202

Bellad onna, p oison ing by 148

Pag e

Bites of rabid animals ... 106

Bladder ... I II , 113

Brachial a rt ery ... 86

Brain I I 7 c ompression of 132 " concussion of 131

Breast- bone 26 " fracture . of 48

Broad bandage ... 37

Broken bones,

Carpus 28

Carrying, means of 160, 200 " uDstairs

Cartilage Cerebro-spmal system Cervical vertebrre

bandage for

poisonin g by

Circulation of the blood, organs of . .

Circulation of the blood , to induce

Cla\"icle ... " fracture of Clothes, removal ot Coccyx

Collapse ... Lollar-bone I"), 202

Ditch, to cross with st retche r 169

Dorsal artery of foot 93 verte brre... 25

2TO Page

Dress, woman's, on fire ... 105

Drowning 139

Ear·channel, blood issuing from

Fireman's lift

First aid, meaning of " stud ent

Fish-hook, embed ded

Flexion

Electric shock

Emetic

Epilepsy ...

Ear-passage, foreign body in Elb ow, bandage for • ... " joint, fracture in110 159 53 14 2 148, 149, 150 13 2

Esmarch's bandage triangular

Expiration ... . ..

External carotid artery .. .

Eye, bandage for .. . foreign body in 37 120 80 155 109

Fac e, bones of 22

Facial artery 81

Fainting... 134 89

" " digital pnssure at groin ... ... 89

Femoral artery, to' p'niquet for ... ... 90

F emu r 30

" fracture of 56

Fibula 30

" fracture of 60

Fingers, bandage for 159

" fracture of 55

" at elbow

" at knee ...

Food, poisoning by Foot, bandage for b ones of .. . " crush ed .. .

Forearm, bones of " fracture of .. .

Forehead, bandage for .. . " hremorrhage from Foreign body in the earpassage .,. in the eye

" "in the nose F ou r-handed seat

Fracture, apparatus for treatment of '" caus es of '" definition of ... gen eral rul es 110 T09 III 160 36 33 33 " for treatment 4 I involving elbow " j oint 53 of arm ... 52 of br east-bone 48 of carpus ... 55 of collar - bone of cranium 43 55 of finger 211 Pag-!

Fracture of forearm 54 58 60 " " of knee·cap of leg ... of lower jaw ... of metacarpus of metatarsus ... of pelvis of rib ... of spine of tarsus of thigh-bone ... of toes .. signs and symptoms of 44 55 62 56 46 45 62 56 62 " varieties of 35 34

poisoning by 153

circulation 70 G ranny knot 40 Green-stick fracture 35, 36 Gums, hremorrhage from 97 Hremorrhage, arterial ... 74capillary... 95 from gums 97 from head " and neck 80 from lowe r limbs ... 89 from lungs 97 fr om nose 96 from st omac h 98

neck, arteries of

H ead bandage for 155 injury to ... 128, 131 " side of, bandage for 155 Heart 70 . , rate of contraction of 72 Heat-stroke 136 Hernia II<lHip, bandage for 157 History, meaning of 17 Howard 's method of artificial respiration Humerus " fracture of Hydrophobia Hysterical fits

Page

(nsensibility, general 1 ules for treatment 128

Inspiration 120

Instep 30

Insulator... '" ... 14 2

Internal carotid artery... fo

Internal hremorrhage ... 95

Intestines, injury of 113

Involuntary muscl e5 33

Jaw, angle of 23 " lower 23 " "fracture of 44

Joint, definition of 3 1 " injuries to... 109

Tugular vein 80 ...

I " injury of I 13

Knee, bandage for J 59

Knee-cap ')0 " 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, poisoningby...... 148

Lacerated wound 78

Large arm-sling ... 39

Laudanum, poisoning by J 49

Leg, bones of ... '" 30

Leg, fracture of Lifting and carrying " into bed

Ligaments ...

Lightning, effects of Limbs,

up;

in the eye

Lip5, bleeding from

\'ertebr::e

Marshall H all's method of artificial respiration

Medium bandage ... 11 etacarpus fracture of ... " fracture of ... Middle line of body

Mouth, blood i suing from Muscles " ruptur ed 11 uscular action ...

Narrow bandage Needle, emuedded Ten'es

Nervous system

Nose, foreign body in hcemorrhage from

Occipital artery ...

Opium, poisoning by Pad, ring ... " to fold Palm, h::emorrhage from Palmar arches ...

Paregoric, poisoning by Patella fracture of

fracture of Phalanges of foot

of hand

poisoning by 148,

(elementary)

artery

various, poisoning by

0 i son e d w e a p 0 n s, wounds by Poisoning

Popliteal artery

Posterior tibial artery Potash, caustic, poisoning by

Respiratory system

Pact:

Rupture (hernia) 114 uptured muscles 65

Sacral verte brce .. . acrum ...

S calds

Scalp, bandage for " hcemorrhage capula .. , " fracture of 25 25, 28 102 155 from 83 26 51

Schafer's method of artificial respiration 121 160 162 r6I

S eat, four-handed " three-handed " two-handed

S hin-bone

S h ock

" electric

:S houlder, bandage for ... , blade ...

" fra cture of bones .. . " joint .. .

§iick ro om , choice and preparation of. ..

Signs, meaning of Silveste r's method of arti· ficial respiration

Simple fracture ...

. Ekeleton '" 30 134 142 156 28 51 26 32 197 17 12 3 34 22

Skull " fracture of Slings, arm 22 43 39, 40 , 49 214

Small arm sling ...

Smothering

Snake bites

S oda, caus tic, p oiso ning by .. 149

Spleen I I '

" injury of ... I n

Spinal canal 2 j

" cord 2], I I,

Spine 21

" fracture of .. 4

Spirits of salt, poisoning by

Splint, angular . ..

Splints, rules for apply . ing to impro\'i se

Sternum ."

" fracture of Stimulants

Stings of plants and animals

Stomach ... hcemorrhage fr om

" injury of. ..

Strains

Strangulation

Stretch er exercise, Army No. I. No. II No. III. " "No. IV.

Stretchers, Furley 2 4 Iq, 21 5

Pag-t:

Stretch ers, to carry 169 " t o impro\'ise 166

Strychnine, poisor!ing by 153

Subclavian art ery

Suffocatio:1 141

Sunstroke 136

Surge on's \'i"it, prepa ration for 204

Syllabus of instructi)I1... 7

Sympathelic system 118

Symptom , of... 17

Syncope... 134

Synovia ... 31

Systemic circulation 70

Tarsus 3)

T emporal a rtery. 82

Thigh -bone ?O " fracture of... 56

Three-ha nded seat 1 6 2

Throat, hcemorrhage frol11 97 " swelling of tissues of... 141

Tibia 30

" fracture o f 60

Toes, bandage for I59

Tongue, fr om 97

Tooth so cket, heem orrhage from 97

T ourniquet 75

Transv e rse wound of abdomen I I3

Two -handed seat 16 1

Ulna " fr acture of .. Ulnar arlery

U nconsciousn ess

Upper limbs

Varicose ve ins \ Teins

Venous blood "

Ventricles

Vertebra ...

Vertebrce .. .

Vertebral column

Vertical wound of abdomen

\Ti t ri ol, burn by ...

Voluntary muscles

\Vagon, to load or unloall

\Vall, to cross with stretcher

\Varmth, ncces it)' for " to promote

Wind-pipe "r

oman's dress on fi re W ounds by P?isoned weapons " accompamed uy arterial hcem orrhage ...

\Vounds accompanied 1y venous hremorrhage

\V ounds, lacerated

Wrist

St. 30bn Bnlbl1Iance BBSOcifttloJl.

Carriage Paid on all Orders in the Un ited Kingdom, " ASHFORD" LITTER.

GENERAL PRICE LIST.

A complete and reliable Ambulance Equipment is an actual n ecessity, and experience ha proved that employers of labour and othe rs interested in the district readily subscribe for the purchase of such appliances. Collecting card, stating the purposes for which subscriptions are reyuirec1, will be supplied to approved persons gratuitously on application to the H ead Office of the A sociation, where also any information with regard ,to it s work can ue obtained.

All stores will be sent carriage paid to any par t of the United Kingdom. Returns may be sent carriage forward . If carriage is prepaid it will be allowed .

Owing to fluctuations in market prices it is impossible to guarantee that the quotations herein can be adhered to.

Quotations will he furnished for Ambulance Carriages and othe r articles relating to Ambulance, I\'ursing and Ilygiene , n ot mentioned in this list.

Orders and correspondence shou ld he addressed to the St. J ohn Ambulance Association, Sl. John's Gate, Clerkenwell, L ondon , E. C.

Remittances should be made payable to the St. John Ambulanc e Association, and crossed "London County and \Vestn.inst er Bank, L othbury."

Th e "Ashfo rd II Litter (1899 model) consists of a twowheeleu under-carriage filled "ith elliptical springs, and eithe r of the "Furley" stretchers, " ith a coyer so arranged on a jointed frame that it can be folded up inside the st r etcher, or with a hood and apron (as shown above). The undercarriage, having a cranked axle, the beare rs can pass between the wheel with the stretcher, and thus avoid lifling It oYer them. When travelling, the legs of the under-carriage are raised, and thus fo rm the handles by whi ch to propel it. Should it be necessary to pass over r ough ground, t" 0 bearers can easily lift the litter and patient. The" Clemetson " stretcher can be used in stead of the" Furley " pattern.

PRICES OF THE IMPROVED ASHFORD LITTER, 1899 MODEL

With Iron Tyres to Wheels. With IneliaRubuerTyresto Wheels o \Vitholll Co\er or H ood a nd Apron. With Cover. With Hood and Apron. Without Cover or Hooel and Apron. With' Cover. With Hood and iii' Apron, as (JQ illustrated. (I)

Under-carriage (no Stretcher) ... . .. I 8

Liller complele with Ordinary SlreLcher*

Dittowilh Telescopic handled Slretched'

Dilto with Police

Stretchert

,. Prices quoted for Litter with Ordinary Stretcher in clude \Vide \V ebbing Slings hut no Chest c: Slrap. Leather, instead of Slings, 55. 6d. extra; Chest Strap, 6d. extra. If sup· :s piled without any Slings, 45. allowed. ;:;:

t P, ices quoted for Litter with Telescopic·handled Stretcher include \Viele \Vebbin g' Slings and Chest Strap. Leather, in<teael of \Vebbing Slings, 5S 6d. extra. j f supplied without any Slings, 4S. allowed; and if without Chest Strap, '5. 6d. allowed

t Prices quoted for Litter with Police Stretcher include \Viele \Vebhin g Slings and Leather Straps for securing a refractory patient. Leather, imtead of Webbing Slings, 5S. 6d extra. r. IIo od and Apron, comp lete (state pattern of Stretcher) £2 IO 0 3

'Extra Sockets and Studs, per set 0 lb' Waterproof S heet (washable) to be laid on thestretcherbed... 0 10 6 Crates (returnable) charged 4S. 6d. for each Litter.

5 Carriage Paid on all Orders in the United Kingdom.

over them, and the cranked axle has, therefore, been replaced by a straight one constructed of tubular steel.

"REA-E DWARDS" LITTER, fitteo with pneumatic tyred wheels, showing the "Clemetson" Stretcher.

Ball bearings are fitted to the wheels, both cycle pattern and wooden , and the hubs are so arranged that the wheels can be removed from the axle without disturbing the bearings. In place of the flmr legs made to raise as handles, two fixed legs fitted wilh small india-rubber wheels or rollers are place<l at the foot end, while a combined leg and han<lie fiLted wilh a crossbar and capable of being raised or lowered is used at the head end . \Vh en rai sed as a handle it may he locked in one of two positions. and when lowered it is locked in a vertica l po ition . The aCl\rantages claimed for this arrangement are simplicity, ease and rapidity of manipulaLion and

Carr;age Paid on all Orders in th e United Kingdom. the facility afforded by the two fixed legs for raising the liner, if necessary, on La the pavement. The question of ualance bas ueen carefully and the is shifteci: so that the midJle of it is several inches in frullt uf the axle, a perfect balance when the slretcher is loaded and in a horizontal position being thu obtained, and cunsequently there no weight on the hands of the person pwpelling the lilter.

The pneumatic tyred wheels are strongly recommended in cases where the small amount of care necessary to keep them infbted can ue gi\-en, a, the comfort to the patient and ea e in propulsion are increaecl beyond all comparisun with any jitter yet produced. It will be noted that the prices are considerably lower than those of the "Ashforll" Litter, and the following are gi\'en as examples, but owing to the vast number of comhinations that can be made \\ith the different suetcbers anJ coverings, it is impussiule within reasonalJle limits to et out quutations for the whole of thenl, but tbe e may be calculated by adding together the prices of the under-carriage, stretcher selected , and hood and apron or cover, see pages 4 and 8 to 10.

SPECIMEN PRICES.

Under-carnage only, either with pneumatic tyred cycle \\ heels or solid rnuber tyred wooden \\ heels, £10.

Litter complete with ordinary stretcher (no slings or ches t strap) and hood and apron, a illu trated, £q 3s. 6d .

Ditto with Telescopic Handled Str etche r (with ch es t strap) and hood and apron, £14 I IS.

H with iron tyred wheels prices are £2 less.

The lowest priced litter complete is fitted with iron tyre d wooden wheels. ordina ry stretche r (no slings or chest strap) and cover. Price £10 8s. 6d.

Hand brake , which acts automatically when the litter is at r est, extra £1 lOS

'Vhen o rd ering please state which wheels are requir ed.

7 Carriage Paid on all Orders in the Un:ted Kingdom.

THE" CLEMETSON" STRETCHER .

H CL EMETSON " S TRETCHER, with back raised, also showing exte n ding legs.

On thi s stretche r th e pat ient can be moved as desired , from th e rec umbe nt to the sitting posilio n. The re is no complicated mechan ism to get out of orde r, and the adjustment depends simply on th e bala nc e o f the patient's body. Th e stretche r will fi t eith er the" Ash fo rd" or the " Rea-Edwards" Unde rCarriage . Pri ce £ 3 3s. ; wit h ex tending legs, £4 3.<;·

Hood a nd Apron, V e ntilated , £ 2 IS S.

Caniage Paid on all Orders in the United Kingdom.

ADJUSTABLE LEGS FOR STRETCHERS.

Prima rily these legs, \\ hich a re independent of and ndditional to the ordinary foot wheels, are intended to facilitate the carriage of a stretcher in a railw:1y compartment, in which case two on one side would be lo\yered and adjusted by a teleocopic arrangement to the proper height, so that the fuot wheels on one side would rest on the seat, al.d the adjustable legs on the other ide wonlcl rest on the floor. The fuur legs may be to rai e the stretcher as required. \Yhen not in use they are folded up immediately unde r the poles of the stretcher.

Price per set of [our, £ 1.

FIRST AID BOX.

To be c ll'ried below the axle of the" Rea-Edwards" Lille r, frum which it i· easily detachable .

Contents: - 'et of Splin's, 1 2 Triangular Bandages, 1 2 J\. L ' lIer Bandages, 2 i lb . packets each Cotlon \Yool and Boric Lint, Adhesi\'e Plaster, Pair of Scissors , Knife, 2 oz. each Olive Oil, Tinct. I odine B.P.C. , Sal Vo]atile, and Spirits Ether Comp., Graduated Kidneyrhaped Dres5ing Basin, 6 Tampons fo r washing wounds, Tourniquet Pins , Safel y Pins, Needles, T h read and Tape . l'rice £2 .

9 Carriage Paid on all Orders in the United Kingdom.

"F0RLEY" STRETCHERS WITH THE LATEST IMPROVEMENTS, 1899 MODELS.

TELESCOPIC HANDLED STRETCHER-OPEN .

ORDINARY STRETCHER-CLOSED.

The improvements in all patterns of the "F urley" Stretcher, 1899 Model, are Th e comfort to the patient is increas ed ; the stretcher is stronger, more rigid, and lighter, it folds up more closely, and its handles ::Ire more comfurtable to hold and affo rd g reater protection to the hands of the bear ers in passing through narrow doorways or passages. Should it be necessary to r educe the width of a loaded stretcher in order, f,n examp le, to carry it into a railway carr age, thi') can be done, eithe r wh en it is re5ting on the ground or supported by the beare r'), without trouble and without the sli,;htest jar to the pati ent. The price of the stretche rs is lowe red. All minor p oints have h een most carefully cons id e red, and the 't retchers are c on fidently r ecommended as thoroughly f:ffic ient in e\'ery W 3.y

These stretc hers a re adapted for use alone or as part of the " Ashford" or " Rea-Ed wards" Lit te r, an:l the co\'e r, hood and ap ron, a rmy rug, and wa te rproof sllf:!et described in thi s list a re suitahle for use with them,

Carriage Paid on all Orders in the United Kingdom.

"LOWMOOR JACKET ."

For use in min es, ships' holds, etc., to secure a patient on a stretcher (see illustralion), which can then be placed in an upright pos ition. Price £1 55.

WATER BOTTLE..

Copper tinned, with carrying strap.

Price lOS.

Enamelled Iron \Yate r Bottle, Cloth covered, with Strap and Carrier. Price 48. zd.

Carri-lge Paid on all Orders in the United Kingdom, 12

LAMP.

This is filted wilh a sockel, by which to fix it to a Lilter, or it can be conveniently carried by hand, or attached to a belt or the clothing.

Price complete, 5,;. 6d .

D ressing Basin , kiJney shaped, made of enamelled iron.

Price I S. 3d.

Ambuiance Station Plate, Enamelled Iron, 35. 6d. eac h. Stretcher Depot Plate, Enamelled Iron, 3s . 6d. each. Carrying Sheet for carrying patients up and down stairs or olherwise ahout a house. Designed by the late J. C. Derham, Esq ., Blackpool, and Mrs. Alfred Paine, Bedford . T he sheet is fitted with rope handles and detachable bamboo poles, and may be placed on a st retcher without disturbing the pati ent. Price complete , 15 s.

13 Carriage Paid 0t1 all Orders in the United King dom.

POUCH FITTINGS,

specially selected fQr the St. John Ambulance Brigade , consisting uf :-

2 Triangular Bandages, one of which is sealed lip in waxe,l paper. The other may be lIsed for nraclice, but shou ld be kept as clean as po ·sible.

2 Roller Bandages (3 in . and r in.) .

Packet of Cyanide G au z e (r yd. compressell) .

I Pair Scissors .

6 Safety Pins .

Small Bottle of stron g Smelling S alts.

Piece of str on g Can e, for tightening improvi sed Tourniquets.

Price , 2S Sci. each. 6 doz . or more, 2S 7d. each .

Packets of Cyanide Gau ze (r yd. compressecl),

d oz., 2S . 8d.

S .na11 B ottl es strong Smelling Salls, p e r dJz., 53. 6ll.

SAFETY PINS.

All fasten or unfasten on either side. s. d .

Facile No . S 600 or S 602 per 3 doz . 0 6

" "S 603 ... ,,0 8

D uch ess Duplex, N G 2 .. . per doz. 0 2

" "Assorted a 3

Special Blanket Safety Pins, 3 in. a " 3!in . 6

Pocket Cork Line and Drag, with 80 feet o f line, in case; for r ecovering a drowning person from the wate r. l'lice complete , with instructi ons for use, 6s. 6d.

Pocket Reel and Ice Line for use in ice accidents, with 80 fee t of line in case . Price complete, with instruction" fo r u se, 6s. 6d.

t:arriage , r!ai"d on all Orders in.the Unite d Kingdom 14

LARGE HAMPER FOR AMBULANCE STATION AND RAILWAY PURPOSES.

For cont en ts see next page.

15

Carriage Pai d 011 all Orders in the United K ingtiom.

TH E HAl\l PE R CO N T A IN S

1 Set of Cane Spl ints .

I S t. J ohn T ourn iq uet.

Ca r r i age Paid on all Orders in the United K ingdo m . 16

SMALL AMBULANCE HAMPER .

'Wi t h waterproof cover and st rap, fo r use in factories, colli eri es , stat ions, and la rge works, a s well as for pa rochia l and domestic use.

1 K ni fe.

12 Surgeo n' s N eedle s.

.. . lI n T in

lb. Carboli c Cotlo n Woo l .. . J Case . . lb . Bori c Li nt

1 Ro ll Adh esive Plaste r.

2 0 Ro ll er Ba ndages , asso rted .

1 d·oz. Tri angu 'ar Bandages.

3 pieces T ape .

4 oz. Sa l Volat il e.

4 oz. Bica rbo nate of Soda..

4 oz. of Olive Oi l.

4 oz. Sp iri t Ethe r Comp o

i Ib. Tin P o wde red Bo ri c A cid.

4 oz. Tin cture Iodi ne.

1 pair Pea n's Forceps.

I pa ir Sc isso rs.

I pac k et eac h a fety an d Plain Pi ns .

i oz . Ca rbo liseu Chinese Tw ist.

1 oz. S ilkwor m Gu t.

1 ree l each an d \Vhit e Se win g T hread .

I K id ney-shap ed Bas in. top per L oosene r.

1 Graduated :'II easure .

1 cake 2 0 per cent. Ca r b oli c Soa p_

I Na il Br us h.

3 E mpt y 8 oz. BoLL les .

3 Sau cers.

3 Camel II ai r Brushes.

Pri ce cumplete, £ i-

CONTAINING

Set Spli nts. I St. J ohn T ourniquet. 3 T ampons, for \yas hi ng wound s 2 Packets Li nt. 4 Rolle r Bandages (wide and nar row). 4 Triangular Bandages.

Cotton W ool . .. .. . } I T ' C ses Doric \ Vool . .. ... n m a .

Spool of A dhesive P Ia tel'.

K nife, S cisso rs , Th read, T ape, N eedles, and P ins.

We ig ht com plete , lbs.

L ength, I ft . 6in. Depth, S in. Wid th,7in. Price £t lIS. 6d.

I'] Carr:age Paid on all Orders in t he United Kin g dom.

SURGICAL HAVERSAC

.

hlPROVED PATTERN, filted with a tin, so arranged that any article can be taken out without distUTbing the of the contents.

Contents: 1 Set of Spl ints, 6 T riangular Bandages, 6 Rolle r Bandages (wide and narrow), Cotton Wool, Boric Lint, in tin cases, I Roll Adhesive Plaster, 1 Pair Scissors, I Knife, 2 oz. Olive Oil, 2 oz. T inct. I odine, 2 oz. Sal Volatile, 2 oz. pirit

Ether Cam p. , 1 Graduated Glass Measu re, 1 t. John T ourniquet, P ins , Needles and T h read, 3 Saucers, 3 Camel

Hair Brus hes. Price £ 1 lI S. 6d.

White Ration Haversacs, IS. 9d each.

Carrie ge Paid on all Orde rs in th e United King do m .

FIRST AID CO M PRESSED K

IT .

Th e box i made of wood cO\'e red with damp-resisting material, and is filted 'v\'ith 'a lock and key. I t contains a nun. ber of pract ical am bulallce appliances arranged so that any article can be withc1rawn or replac ed with out disturbing the Being filted \l'ith a handle it is porlable, and the liel , when let down, can ue used a a lahle. All bandages and dressings arc compressed. Size-Length 16} in. ; width in. ; height in. without handl e .

Contents: 4 Triangular Bandage,. 6 Roller Bandages, 4 Fi:st Dressing..;, 6 Small Packets of Cottoil '\\'001, 6 Small Packet:; of Bone LlI1t, St. John Tourniquet, r Measure tin l.oox containing a Roll of Plaster, Boric Lint Patches, cissors and PillS, tray containing 313ottle5 (Sal Volatile, Tincture of I oJine and Olive Oil) ann a Dredger of Boric Acid, I of improved Splints, with angle piece, g Splint Straps (sufficient for a frartured thigh), 2 Saucer" 3 Camel Hai r Brushes .

Pric e £1 I IS. 6d.

19 Carriage Paid on all Orders in the United Kingdom.

FIRS T

. r. AND BANI{ApFS C<?MPRESSED).

Price Is. 6 d. IJy Post Is. Sa.

Siz e 4l by 3! by Ii inches. Suitable for the pccket.

CONTE TS.

I. T liangular Bandage. 2. First Aid Dressing. 3. Colton Wool. 4. Two Splint Straps . 5. Adhesive Plaster 6 Per· manganate of Potash. 7. Lanoline. 8. Boric Lint Patches.

9· Safety and Plain Pins.

frice, each LS. 6el. Packed [or Post I S. 8el. Per doz . 17s, 6j.

ARTICLE S.

No.

r dd . each or 3/9 pe r doz .

2 2ci. ,,2/0

3 rd. " "Jod. "

4 2d. per strap or J/9"

5 rd. per box or rod. " "

No.

6 rel. per box or rod. per doz .

7 r per Lin or 1/4 "

8 rd. per p3.cket or IOd.

9 rd. rod .

Nbt less than one dozen supplied at dozen plices.

Carri<\ge Paid on all Orders in the United Kingdom 20

FIRST AID BOX FOR USE IN MINES.

CONTENTS.

Set of Im proved \\Tooden Splints; St John Tourniquet; Cotton \Vo<?l; Lint; 12 Compressed Roller Dandage.s, ; 6 Triangul ar Bandages 10 paper; Adhesive Plaster ; Prur SCIssors; Spatula ; Graduate? .lI;eas,!re, 2 oz. Sal Volatile; 2 oz. Spirit Ether Comp.; 8 oz . J?oraclc \ aseiI:,e; 8 oz. Tinct. Iodine ; 3 3 Camel Hair Brushes; Plos; Safety PillS.

PRICE COMPLETE £2 ros.

A somewhat similar box can be supplieu for carrying o n the" Ashford II Litter, or for banging up in a factory .

2 1 Carl lage Paid on all Orders in the United King.tJom

SMALL FIRST AID OUTFIT .

\Yhen can be carried by a Strap-hanJle. Dln1 nSlOlls-9i uy 7i by inches.

2 Tri::lnglllar Rand:lges, I St. John Tourniquet, 8 S lillt (for s.ecuring ill lieu ,uf Ihndag<:s), 2 oz. Cotton \Vool, 1 PaIr of SCIs-ors, 4 Roller I,andage', 2 2-il1. Roller Handages, 1 2-0Z. Bottle Sal Volaull" , [ 2-0Z. Dutlle TInc ture Iodine B.P.C., 2 oz. Plain Lint, I 2-0Z . l\[easure Glass, 2 China Sau ers, and 2 Camel Hair Brushes to be used when applying Tiilclure of Iodine.

Price:

\Vooden Box, covered with Damp Resisting Material, IS S. Stout Cardboard Box, Cloth Covered, 105. 6d .

FOLDING CAMP BED.

T his can be folded in a very small compass and can be readily set up to form a comfo rtable bed. Price, £1 5s.; case for same , when folded, fitled with carrying strap, 55. 6d .

Carriage Paid on all Orders in the United Kingdom. 22

The St. John Tourniquet, as supplied to the Admiraltv, wi Lh clirecLion for use ... 0 9 (:,pecial quotations for large quantities)

S plints, "-noll en, per set, 2/6; Cane ... ...per set

Greatly improved Wooden Splines, with grooved joint. 'and angle piece, stroagly recommended ...

Tow, for splint padding... ...pe r lb.

Firs t Field Dressing (Army Pattern)

Jaconette, H inches wide

Tow, Ca rb o li zed or Styptic per yard ... pe r lb.

First Aid D ress ing, consi ting of a smal l compressed packet of boric lint, a compressed roller bandage, and a s::tfety pin

r )redger, containing boric acid powder

'Measure Glass ...

Knife with strong Llade

P air of S ciss o r s each 9d. ; per doz. 3. each IS. ; per doz. lOS.

Splint Straps , and _ ui:alJle Buckles. Per et of 12 yards of st rong 2-inch Webbing and IS Buckles, 2S. 6d.

These make very compacL SLraps for carrying in the Pouch .

The \ YebLing hould be culto meet local r equi rem ents.

Buckles only, IS. 3d. per dozen.

\\-ebbing only, IS. 3d . per dozen yards.

It is unnece, :;ary to sew the Buckles. The spikes should. be pas ed through the webbing, and the sho r t end of the webbl11g lie outwards.

23 Carriage Paid on all Orders in the Ur1ited Kingdom. PLASTERS.

Leicester Adhesive Plaster on Cambric, in tins of yard, 6 inches wide 6d.

T he L e ic(:<;te r Adhesive

Ribbons, in tin boxes, 6 yards lon g .

N ational Rubber Adhesive

Plaster (Anti septic) on spoo ls.

S yd . 10 yds. inch wide 9(1. IS . od. IS. od . I . 6d.

2 " IS. 9 d 25. 3d .

Ditto in card box, in . wide, yds . {in I it

in ch wide I inc h wide long ...

COURT PLA STER, T RICOLOR.

Large Size, 9d. ; t.l ed iu111, Sd . ; Small, 3d.

Carriage Paid on all Orders in the United Kingdom. 24

NURSES' WALLETS.

ORDINARY PA DLOCK SHAPE.

"With out instrum ents, 4S. 3d.

Fitted complete , containing Sp ri ng Dresing Forceps, Spatula, Probe, 2 pairs cissors (round and sharp pointed), Clinical Th ermomete r , and Price lOS.

ST. J OIlN'S PATTER", as illu strated, but improyed by tbe addition of flap to p rotect the in struments.

"Without instruments, 75. 9d.

Fitted complcte, containing Spring Forceps, Artery Forceps (also useful for dressing), Spatula, Probe , Director wi th Ear Scoop, 2 pairs Scissors (rounel and sharp pointed), Clinical Th erm ometer (minute, round), Knife, Pencil, an, Safety Pins.

Price 18s .

'25 Carriage Paid on all Orders in the United Kin'gdom.

ROLLER BANDAGES. (6 yards long. )

Grey Superior Be. t quality, Superior Grey Open "-hite Calico. Wove. 0 White, with White Open e1 \Vo" en \Vove

Per \\' o'·e. Edges. Compressed.

d .

.

ROLLER BANDAGES in Assortment.

Pack.ed in neat Cardboard Box.

RECO)lMENDED FOR CLASS PRACTICE.

Two 3 in. ; two in . ; one I in.; each 6 yards long.

Grey Calico

Plain Tri angular B.tndages, each (Special quotalions for large quanlilies.)

Dilto Compressed (Lhinner qualily), each 4d. ; per doz . 3s. 9d .

Illustrated (after Esmarch) showing 25. appl.lcatlOns of the fnangu la r Bandage, with pnntecl Jl1structions .. _ each per doz. s. d . a 6 4 6

Carriage Paid on all Ordars. in theUrnted. KingdOOl

ROLLER BANDAGE MACHINE. Designed by Dr. A. C . Tun stall. Price 2S. 6d.

Forceps, sprin!?; dressing, full size or small as desired, IS., bow dressing, 5 in. locked joint, IS . 6d.; Pean's Artery; S in. locked joint, IS. 3d. . .

Scissors, round-poinled, IS.; sharp-poJl1ted, fOr- del.Ic,ate work , LS. 3d .; small round-poinled blades, locked jomt, or 5 in., IS. 6d.; round-pointed cun'ed blades, joint, IS. 6d.; sharp-pointed curved hlades, locked jOlnt, IS. 9d . The locked joint allows the blades lo be laken apart [or cleaning. ._

Spatula, 9d. Probe, 6d. DIrector, w ith Ear Scoop, IS. 9d. Knife, vcry thin, ivory handle, two blad,es, I S. 9d. Nursing Chart, designed by :'liss I nderwIck, each.

Temperature Chart, each .

CLINICAL THERMOMETERS.

Round. -Ordinary , IS.; minule, I S. 3d. ; half-minute, IS.

Flat.- Strongly recommenrltd, as lhey WII! not roll. OrdInary, IS 6d.; rapid (specially elecled and reserved for the Association), with very open scale, 35•

" Carriage Paid on a ll Orders in the United Kingdom .

CLINICAL THERMOMETERS -(c"lltilluea').

With Magnifying L e ns . Price , ordinary. I S. 6d.;

I S. gd . ; half-minute, 2S. 3d.

N B. -':"' Minute and half-minute instruments will only registe r in the time stated under favourable circumstances.

N o liability is taken.forbreaka,,:e of Tlurlllollle/ers in trallsit.

• BATH THERMOMETERS.

T o Dr. Forbes' specification. Japanned with zinc scale, 2S. 1d . ; Clinical Thermometer size. in case, IS. 6d.

No liability is taken for breakage of Tlurllloilleters ill tram it.

COTTON WOOL.

Plain, r oz., 2d. ; 2 oz., 3d . ; 4 oz., 4d. ; 1Ib., 7d.; I lb., IS.; small packet (Compressed), Id.

Medicate d, Boracic, i lb., 6d. ; I lb., I S. 6<1.; Carbolic, per lb., IS. Sd.; Alembroth, per lb. , 13. 6cl. ; Double Cyanide, per lb ., 2S. 6d.

LINT.

Pl a in, I oz. , 2d. ; 2 oz., 3d. ; 4 oz., 6J. ; lb., lad. ; I tb., IS. 6d .

Boracic, 4 oz., 6d. ; I lb., IS. 6c.1. ; square foot packet, 2d. ; small packet (Compres cd), Id.

GAUZ E S.

These are supplied in 6 yard lengths, width ahout 36 inches.

U nmedicated white Alembroth

Double Cyanide

Boracic

GAUZE TISSUE.

s. d . per length

TEXT BOOKS,

&c.

"First Aid to the Injured. " By James Cantlie, M. B. , F. R. C. S. T he authorised T ext Book of the First Aid Course . I S.

" A Catechism of First Aid." Compiled from Dr. Cantlie's Manual. By J. 1\1. Carvell , M.R.C.S . , L.S.A . 6d.

" Problems in First Aid. " A companion to t he authorized Text Book of the St. John Ambulance Association "First Aid to the I njured." By L. .\J. F . Christian, 1\1. B., c.l-I., Ed., and W. R. Edwardc;, A.C.A. 6d .

"Hints and Helps for Home Nurs ing and Hygiene. " By E . :\lacDowell Cosgrave, :\1. D., illustrated, with chapter on the application of the roller bandage, by Sir R. J. Collie, M . D. The authorised Text Book for the l\ursing Cou rse . IS.

"A Catechism of Home Nursing " (based on Dr. Cosgrave's T ext Book) . By J. Brown, L. R.C.P., L.R.C . S., and J . M. Carvell, :\I.R . C. ., L.S._-\. . 6d.

"Home Hygien e. " By John F. J . Syke, D .• c. (Public Health), .\1. D ., &c . Illustrated. The authorised Text Book for the Home Hygiene Course. IS.

., A Catechism of Hom e Hygiene " (based on Dr. Sykes' T ext Book). By J. M. Carvell, 1\I.R.c. " L. S.A. 6d .

"Questions and Answers upon Ambulance Work." By John \ V. Marlin, M. D., and John {arlin, F . R.C.S., Ed. IS . "Questions and Answer'" upon Nursing. " By John W. Martin, :\I.D . I S. 6d .

"First Aid to the Injur ed " (Six Ambulance Lectures). By Profe'sor Frederich Esmarch . Tr::tnslated from the German by II. R . H. Princess Chri tian . 2S.

A layer of absorbent cotton wool bet ween two sheets of gauze , good quality, per lb., I S. 6d. Carriage Paid on all Orders In the United Kingdom . 2e

"Elementary Bandaging and Surgical Dressing. " By Walter Pye, F.R.C.S . 2S .

'Coarrlage pam ·,on.all Otders tn the l Unittro KingdAm.

TEXT BOOKS, &o.-( conhmed).

"To Restore the Apparently Drowned," printer} in Jarge TYIlle with two Diagrams. 2c1.

Dr. G. H. Darwin ' s" First Aids," being a card to hang up, giving tl'eatrnent of vari ous acciJents. 2d.; P lcked for post,4d .

l' 'Manual of Drill and Camping for the St. John Ambulance Brig-ade." 5d.

I. Manual for St. John Voluntary Aid By Lieut.-Col. G. E. Twiss, H..A.M.C. (Retired Pay). 6d.

"How to Act when Glothing takes Fire." By J. E. II. Mackinlay, M.R.C.S. 2d.

Aid Principles." Cards of concise c1 irection for waistcoat pocket, each; 4d. per doz. quotations for large quantities.

", Specimen Examination Papers, First Aid, Nursing and Hygiene Courses." 3d.

Small Anatomical Diagram. Showing the human skeleton, main arteries, and points where pres ure should be applied to arrest bleeding. zd.

Directions as to the Restoration "Of Persons suffering from Electric Shock. Large print, poste r size. 3d. each; or 2S. 6d. per dozen.

General Notes on First Aid to be Rendered in Cases of POlsoning, !3y Milnes H ey, M.A., M. R.C. S. , L. R.C. P. 2d.

"Ambulance Tablets." By Sydney Partridge, 1\I. D. I S.

Notes on Military Sanitation. By Lieut.-C ol. II. P. G. Elkington, R.A. 6d.

Carrlage Paid on all Orders In the United 30

TEXT BOOKS, &c. -(contillued)

B.ook," for instantaot>ous reference, giving concIse II1structlons ; to hang on wall. Size about one foot square. 2S. 6d. j packed for post, 2S. 8d.

A ids to Memory for First Aid Students. Revised to date . Additional IIlu <;tratiofL . By L. }1. Frank Christian ilLB., c.:\1., Edin. 6d. '

General Regulations for the St. John Ambulance Brigade, 19 1 3. 3d.

Rules for Corps and Dlyisions, St. J ohn AmbulCLl1ce Brigade. 2d.

A History of the Order of the Hospital of St. John of Jerusalem. By the late Rev. \V. K. R. BedfOJd, M.A., and Lieut.-Colonel R. II. Holbeche. 5S.

R egisters. Class Attendance, 2S. 6d. Certificates, 45. 6d. Case Report, IS.

St. John Ambulance Brigade Cash Book, Minute 'l:::sook and Occurrence Book. Set of three, 7s. 6d. Receipt Book, 6d.

Large Physiological Diagrams. For Lecturen' use. Compri ing : . The IIuman Skeleton, the }Iuscular, Arterial and Venous System, the IIeart and Circulation of the Blood imple Fracture, Compound'Fracture, Dislocations. per set of six, ISS. These may be hired for a course of "First Aid" lectu res, given und er the auspices of the As oci.ation , for a of 5.s., or with the addition of Splints, T ourOlquet, and plalO Tnangular Bandages, for a fee of 105.

Boxes oL ,Stationery fo r the use of Class Secretaries and others connected with the Association, containing twelve sheets of high-class pape r, sui tably headed, and twelve envelopes bearing the device of the Association. 6d. TwiCe that quantity, IS.

Arm Badges, with the device, issuec ..1nder the authority of the Central Executi\'e Committee, having be e n first approved by H. R. H. the Grand Prior as the sole officia l and rec0 7 nis ed Rtdge of the Association and Brigade.

1:> N. B.- Tltis design is jrotected.

No. For the use of indi\'idual certificated pupils-

I. In G:!rman Silver, Large Size ...

2 Small Size ditlO

3. mall Size for button h ole

4 In Electro Plate, Large Size

5. Small Size dItto

6. Small Size for butto n hole

7. In Enamel for button hole

8. '" brooch

9. In Cloth and Silk ...

10. In Cloth and Silver (Registered Numb er, 3522)

I I. In Clot h and Cotton ...

12 . Small Ce llul oid Badge, tor buUon hole or brooch 0 2

13. Whi te Satin Armlet, with woven Badge 0 U.B.-These Badges are not to be as decoratiolls.

Carriage Paid on all Orders in the United Kingdom.

For members of the St. John Ambulance Brigade', having the name of the Corps or Di\'isiol1 annexed on label, ol:l y issued in quantities-

No. IS. In German Silver, fir t doz., £r; subseq uent doz s., I2 S

16. In Electro Plate, first doz., £ 1 J 25.; subsequent clozs., £r 45.

" J7. I n Cloth and Silk, per doz., 1 25

" I S. I n Cloth and Silver, per doz., £ r 105.

Al! the above may be worn by members of the St. J ohn Am bulance Bri;,ade, not wearing uniform.

33

Paid on all Orders in Uw Un:ted KingCcm.

BRIGADE UNIFORM BADGES, etc. s. d.

Officers, Cap Badge (Reg. Ko. roil 0 8

Collar Badges ( " ro3) per pair

" Pouch Badge ( " 3,657)

Sergeants , Corporals and Privates. 2 o 3 6 6

Cap Badge (Reg. No. 102) ••

Collar Badges ( 104) ... per pair 0 101

OverCQat Badge ( " 1.582 ) . .. . .. ...

Titl es, S.J.A.B., w,ith perplir 0 6

Shoulder Straps, filled wllh tItle and num eral ... ... ... ... per p3.ir 3

Lady Officers of Nursing Divisions.

Superintendent's Cloak Badge (,Re cy • I o. 3,65 8) 4 6 Superintendent's Arm Badge ( i:> " 3,6j9) 3 9

O the r Nursing Officer's Cloak Badge (, 3,55j) 4 0

Other Nursing Officer's Arm Barlge (,,' 3 3 'Y hite !30x Cloth Backs, for Badges.. . per paIr 0 3

Nursmg Slsters. Arm Badge (Reg . N o. 3,5 22 ) 2 0 '.' Cloak Badge: ( " 3,5

Black Sllk Armlet for Arm Badge, Superinlendent

Honorary Surgeon's Crosses (pallern B) per pai r

Superil!ten dent 's Stars (pallern A) per pair 0 6

Medal hon Badge (pattern D)

Nursing Badge (pattern E).. .

Satin Badge for Nursin a Sisler's Pin Cushion Badge ... 4S. Bugler's Cord

DIV. Secretary and Sergeant's Badge ... Whistle and Chain .

Private ' s Brown Vlaist Belt and Pouch ...

White Piping, per packet of 7)., yards enOtl"h for 3 pairs of trousers (packets ca-nnot brok;n)

Lace, pcr yard, Silver, I IS. ; Black

St. John Voluntary Aid Detachments.

Cap Badge ... 6d. Officer.:;' Stars

Paid on all Orde rs 1n the United

BUTTONS.

Issued only fur the use of Officers and :'Iembers wearing the prescribed uniform

John Ambulance Brigad

Sih'er, No. I (large) per

St. John Voluntary Aid Detachments.

No.

1. For Ca rds, Tickets, &c. " For I ote Paper, Small Circul:us, &c.

For Association u-;e . For Brigade use .

3. For Quarto and Foolscap Letter-paper, CirSeries eric; A . AH.

culars, &c . ... 0

4. For Small Posters 6

5. For Large POSlers 9 I 9 Complete Se ries 3

Prints of the above Electrotypes (I to 3) Series A and B , and ( I) Series AH and BII, appear on page 35· No. 4A is shown on p:{ge 31. The diameter of SA and 5I3 is inches.

35 Carriage Paid on all Orders in the United Kingdom, ELECTROTYPES. NJ . I A. No.2 A. NO . 3 A .

Ubc (!IrantJ J)rtorl1 of u 6e I»lrOcr of tbe b osptral of Sr. 30bn of 3er usalem In .EnglanO.

.,.; • Ar>fBt lANtt. riEPAATM'l'<lT

\t he $t. 30hll tlmblll ll llcC ti sso.cill tion.

No . I All.

Ubi: J)rtorll of Ubc I»lrOer of tbe lbospltal of SI. 30bn- of 3erusalem In IEnglanO

AMBULANCE on \RTMEST ithe $t. ) ofm Bmbulall ce

N o. I BI I.

Carriage Paid on all Orders in the United Kingdom

Flags bearing A ssociation cleyice-I2

SWAGGER STICKS

for the use of Officers a nd M emb ers of th e St. ] ohn Ambu lance Brigade.

Ebonised Canes, German ,ih'e r :-I ounts bearing the Brigade Deyice.

PRICE IS. E'\CH.

Officers' Canes, with Sterling Silve r :-I ounts.

PRI CE i s. EACH.

BEARER'S DRESSING CASE.

Pl{[CE 12S. 6d.

All Orders for the foregoing Stores should be given to the Local Secretary, 01' sent direct to The st. John Ambulance Associatioll, St. John's Gate, Clerkenwetl, London , E .C.

37

Contractors' L1.st. Ca r ria g e out LoRd!}n Extra.

PRICE LIST.

UNIFORMS FOR AMBULANCE UNITS OF THE S.J.A.B.

T hese may be obtained from Hazel & Co. (sale proplietor, D . IIazel, for many years associated with the late firm of Hebbert & Co., Ltd . , as Director), Clothing and Equipment Manufacturers, 65, East Road, City Road, Landon, E. C. ; and at 6, York Place, Leeds; 69, Piccadilly, Manchester; an d 8, Cadogan Street, Glasgow. Telephone: 5678 London ' Vall. Telegrams: "Hazelism, Land 1n." 'Vhere two prices are given for an article they are for first and second qualities.

A II Badges, a nd carria e outside London al'ea, fxt ra. Measu r ements to be m}p/ied free of charge.

CORPS S URGEON AND DIVISIONAL SURGEON.

T unic, Superfine Black Cl oth

Trousers, Superfine Black Does.kin (if Silver Lace Stripe, extra)

Cross Belt and Pouch, Plain, 20/-; Sih'e

Superfine Black

Patrol Jacket, Superfine Black Cloth...

Trousers, Super.fine Black Doeskin

Cross Belt and Pouch ...

Gloves, 4/6 ; Leggings, 8/6

Great Coat, Grey Cloth '"

Cap-District Superintencrent '"

" Corps 0 fficer

Cross B elt and Pouch .

Gloves, 4/ 6; Leggings, 8/6

Black VIcuna Serge

Black

Cap, 2/9 ; Gloyes, Buckskin, 4/6; Gloves, Cotton, 8d. Lerrging Black or Brown Leath r ......

Great Coat, Dark Grey ;,Ie1ton

CORPORALS Al\D PRIVATES.

Patrol Jack et, black Tart an CheHons, ilver. ..

Trouser, Black Tartan

\Vaist Belt and Pouch, Brown Leather

Cap, 2/9; Gloves, Colton, 8d.

L eggings, Black L eathe r ... .., T "',

'Vater Botlle and Carrier, 3/9; Haversack, \\ hlte Duck 0 1 6

Great Coat. Dark Grey Mellon 16/- and 0 14 0

DRAB SER GE

Jacket, Drab Mixture Serge

Trousers

39

Contractors' List. Carriage Paid on all Drapery Orders.

UNIFORM FOR NURSING UNITS OF THE S.J . A.B.

S erge Cloak (Badge extra)

Special ·Waterproof Serge, extra

Serge Dress, to measure

Better quality do.

Cotton Dresses, complete to measure

Cotten Dress L engths, 8 yards

Don net ...

D o. , for lady office rs

C ollars sit!. each; p e r doz.

Cuffs to ma tch 6ld . per pair; per d oz . pairs

Cap, "Sister D ora" ... 81 (1. each; per doz .

Cambric Strings for above, tu cke d ends

3td· per pair; per doz.

N urses ' Sl eeves , elast ic band and lJUtton a t wri st

Stiff Linen Belt

'" each; per

Nurs e 's AIl ·L inen Apron, in white ... each

D o. , Cheaper, 'Yhi te Uni on, each IS. I and

Stra w Hats p er doz., 155. 6d . ; each

flnlZs sent free Oil request .

U i\ 1)1)04iT'\S lTD RI CHARD BURBIDGE, T TT'\ON SW 'U '.J.j M anaging Director. --' '1 '.

T e'egrams: "Everything Harrocs, L ondon," Telephone: Western One (80 lines) .

l)JDEX TO PRICE LI T .

(For General I n.1ex see pages 20 3. 21 5.)

Ambulance H amper« .. " S tation Plate

Bandage :\bch1l1c ... Sa,in, s Case Bed (Camp)

Delt and Pouch ILob... ...

Dottles (Water) Rutton" ... Sheet

Cash Book .. . Cotton W ool...

Coyer for Stretcher or Litkr

Diagrams, Large

Dre(iger (Boric Acitl)

Dressing Basin

Drowning Tackle

Electrotypes .. . Emergency Book Aid Box... ... " Companion " .. Compre.ssetl Kit

First Fi eld Dress1I1g, .. Flag, Forceps

G;tuze<

Gauze Tis<;ue ... .. Hamper< (,\ mbulance)

H aversacs

H ood ;tnd \ pron for Litter

I nstru:nent5 (variou-;)

Tacond te Knife...

Litter !,-\,hiord) ... " !Rea·E,lwards)

Lown10or Jac:kl'!t

Gb<;<; .. :\Iinute n.)ok X \\. allets

ursing Charts D·)ok

Pillow ... PLbter<; . Pouch Fittinc:s

Receipt Dook .. Ret!:isters ...

C:t. J.'hn l, mbulance Brigade . afety Pins

Sci-;sors.. Slings (. tretcher) Splint Padtling ., Straps .. "plints ... Stati'JI1erv ...

,. .-1. lill,table Legs for Swagger Stick .. Tempemture Ch:ut Tl'!xt Boo!,s

Thermometers .. . Tourniquet .. T ow (carboli/ed) " (plain)

Uniforrn Uniforms ... \Vater Bottle, ... \\';tterproof Sheet

W hi<;tle anti Ch:.in W hite Piping ". W ool (Cotlon) ...