First Aid to the Injured 30th edition 1916

BONES.

seventh} Cervical Vertebra .-----l (clavicle) J

Bone Breast} (sternum) Arm Bone (humerus)

4th Lumbar _ Vertebra HaUnCh} Bone (pelvis)

Metacarpus - \ phalanges _ •..

Thigh Bone (femur)

Knee Cap (patella)

Shin Bone (tibia)

Brooch Bone (fibula) Tarsus M-etatarsus _

ARTERIES. TI

Ooolpital. Tamporal.

Fee al. Carotid•. belavlan. - "Killer".

eh,ItI.D glt I or Tourcnlqu I) ' Aorta. - - Br "hlDt (FleK on). lime.

encem611t of POpliteal.

o"lilea' •• k'on).

AS COMPANIONS TO THIS BOOK-

CATECHISM ON FIRST AlD."

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

Price 6d., post free.

"PROBLEMS

IN FIRST AlD."

BY

L. M. FRANK CHRISTIAN. M.B., AND W. R. EDWARDS, A.C.A.

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FIRsrr AID TO THE INJURED

ARRA:-IGED ACCORDING TO THE REVISED SYLLABUS OF THE FIRST AID COURSE OF THE

ST. JOlIN ASSOCL-\TION.

BY

Jr\:\IES CANTLIE, [\I.A., [\1:.B., F.R.C.S., Knight 0./ Grace 0./ the Order of St. Iohn. /loJlonllY Li./e Jlt!lIlber of, and Lectltrer and E,l:<lmilLer to. the rl ssociatiolL.

\Vith a CHAPTER on Stretcher Transport," revised from that originally written b.v Sir JOHN FURLEv. C.B .. Knight of.Jltstice 0./ the Order 0./ St. john. in accorJance wilh the Arm.v Stretcher Exercises. Also a CHAPTER (belllg" the Filth Lectllre tor Females only). by E. l\IAcDowEL COSGRA\'F., M.D.• F.R.C.P.!., f(lIt:f?ltt 0./ Grace 0./ the Order 0./ St. fohlL, I-fOlLorary Li.fe .'!-fell/ber of, alLd Lectllrer altd Examiner to, the Association.

THIR1 IETH E:J1TION, 1,440,000 to 1 ,490,000.

(This pdit ' on is simil" r to Lite eirdilepnth, i/t edition malty of the "Ultstratiolts were ,'e -dr"wlt; ofher'lvise it differs bitt little frOIll the eleveltth to the sf!veltleeltth editiolts.)

Price in Cloth, Is. po t free.

LONDON:

TlIE ST. JOIl:\! fDIGUL.-\:\! CE A. ST. JOIIN 'S G.\TE. E.C.

\'\'. H. & L.c. SO,()()() 7/ 19 1().

Ube (l;tantl \prior)? of ttbe of tbe 'lbospital of St. 50lm of 5etll5alem in JEnglantl.

SOVEREIGN HEAD AND HIS MOST GRACIOUS MAJESTY THE KING.

GRAND PRIOR: H.R.H. THE DUKE OF CONNAUGHT, K.G.

SUB-PRIOR: THE :EARL OF PLYMOUTH, C.B.

BAILIFF OF EGLE: COLO}lE-L SIR HERBER [ C. PERROTT,

EXECUTIYE OFFICERS: [Bt., C. B.

PRELATE.-The Archbishop of York.

CHA;-';CELLOR.-Col. Sir Herbert Jekyll, K.C.M.G.

SECRETARY-GENERAL.-Evelyn Cecil, M.P.

RECEIYER-GENERAL.-Edwin Fr e hfield, LL. D.

DIRECTOR OF THE DEPARL\[ENT.-The Earl of Ranfurly, G. c. M. G.

CHAIRMAN OF THE BRITISH OPHTHALMIC HOSPITAL, )

ALMONER.-Sir Dyce Duckworlh, Bt., M.D., f. R.C. P., LL. D. Fraser.

REGISTRAR.-The Earl of Ranfurly, G.C.M.G.

GENEALOGIST. -Sir Alfred Scott Scott-Gatty, K. C. V. O. (Garter).

DIRECTOl't OF CEREMONIES.-Sir Alfred Scott Scott-Gattv, R.C.V.O. (Garter).

ASSISTANT EXECUTIVE OFFICERS:

ASSISTANT RECEIYER-GENERAL.-Edwin H. Freshfield.

HONORARY SECRETARY OF TIdE BRITISH OPHTHAUIIC HOSPITAL, JERUSALEM.-Col. Thomas H. Hendley, G. r. E., 1\1.

ASSISTANT HONORARY SECRETARY (FOR SCOTLAND) OF THE BRITISH OPHTHALMIC HOSPITAL, JERCSALEM.-Johll Horll\:! Stevenson (Unicorn Pit rs It iv{l. It t).

R. Euw<tl-ds, A.C."".

ASSISTA:>IT SECRETARY.-Dullcall G. l\Ionteith.

AUDITORS.-Price, \Vaterhouse & Co.

BA:\KERs.-The London County & \Veslminster Bank, Ltd., Lothbury, London, E. C.

CHA"\CERY: St. John's Gate, Clerkenwell, London, E.C. Telegraphic Address: .. Eirstaid. London. " Telephone: Central 903.

THE CHAPTER-GENERAL:

The Chapter-General consists of the Grand Prior.. the Sub-Prior. tho other Knights of Justice. the Prelate and the SI1b- Prelates. de iure ; the Officiating Chaplains: all members of the Council; not more than ten Knights of Grace and not more than six Esqllires appointed by the Grand Prior.

KNIGIITS OF JUSTICE:

IllS :\lOST GRACIOUS :\L\JESTY THE KING (Sove reign Head and Patron).

f"IELD-:\IARSHAL ILR.II. THE DUI{E OF CONNAUGHT. K.G.. K. T., K.P P.C Etc. (Grand Prior).

GENERAL II.R.II. PRINCE CHRISTIAN OF SCHLESWIG-HOLSTEIN, K.G .. P.C., G.C. \'.0.

H.n. PRI:-ICE ALBERT OF SCHLESWIG-HOLSTEIN. G.C.B.• G.C.V.O.

COLO:-lEL H.B. THE J)lTKE OF TECK. G.C.B.. G.C. \'.0.• C.)t.G.

ADMIRAL II.S.H. PRINCE LOUIS OF BATTEYBERG, G.C.B .• G.C.v.O., K.C.III.G .• R.N.

I-T.:\I. BAAKON VII .• KIN G OF NORWAY. K.G .. G.C.B .. G.C.V.O.

LIEUT.-COL. H.S.II. PRINCE ALEXANDER OF TECK. G.C.B G.C.V.O.• D.S.O.

MAJOR II.R.II. PRINCE ARTHUR OF CON:-;.\UGIIT. K.G .• K. T., P.C., G.C.V.O C.B.

H.II. PRINCE ALEXANDER OF BATTENBERG. G.C.V.O.

Sir John Fur1ey, C.B. (Honorary The Earl o f Mealh. K.P.• P.C. Bailiff). A. E. Fraser.

Sir T. N. Dick-Lauder. Bt. The Lord Mostyn. 1Ilaj. Sir A. Lamb. Bt. The ;\larquess of Breadalbane, Col. Sir II. C. Perrott. Bt.. C.B. K.G .. P.e. (Bailiff of Egle). The Duke of Portland, K.G., P.C., Col. Sir J. Gildea. K.C.V.O .• C.B. G.C.V.O.

H. J. Loftus. R. B. Carter. F.R .C.S. (Honorary Col. B. ;\1. D awes. [R.E. C0mmander·).

Gen. Sir C. \Varren G.C.M.G., K.C.B ., Col. C. \V H. Bawdier. c. B. ;\laj.-Gen. J. C. Dalton. ( II onorary Commilnder).

Lieut.-Gen. Sir A. G. Hunter- Lieut.-Col. A. C. Yate. \Vestonof IIunterston, K.C.B.. Maj.-Gen. A. F. Terry. n.s.o. The Earl of Plymoulh, P C.B. Col. The Lord \Villiam Cecil. c. V.o. (Sub-Pri0r).

E. Freshfield. LL.D. (IIonorary E. II. Freshfield. Bailiff). Lieut.-Col. The Earl of Ellesmere. The Earl Brassey. G.c.n. 111.\'.0. (Commander. Ellesmere The Viscollnt Templelown. Comm andery).

R. :\1. :\lacLean. Liellt.-Col. Sir R. C. Temple. Bt..

A. F . G. Leveson Gower. C.B .• C.I.E.

Col. F. A. H. Lambert. Sir J\ S. Scott-Gatty, K.C.V.O.

Col. Sir C. \V. :\Iurray. C.R. (Garter Principal King of The Earl 0fRanfur1y. P.C.. G.C.;\I.G. Arms).

The Lord Sandhurst. P.C.. G.C.V.O.. Col. 'ir II. Jekyll. I<.C.;\I.G.

G C. ".T G.C.I.E The Lord Is lington. P.C G.C..M.O., Sir H. A. Blake. G.C.III.G. D.S O.

KNIGHTS OF' Ju TICE.-continueJ.

Col. Sir]' R. A. Clark. Bt.. C.B.. John Horne Stevenson (Unicorn F. R.C.S. E. Pursui\"ant).

S.r H.obert IIan·ey. Col. Francis \Villiam Pixley. Col. 1 he Lord Sydenha11l of Combe. Inspector-Gen. Belgrave Ninnis.

J .. E.

Sir \V . \V. Portal. Ht. II.s Excellency The Lord ChclmsThe Duke of Somerset. [LL.D. ford. G.C.M .G. Sir D. Duckworth. Bt.. 1\1. D • F.R.C.P.. Evclyn Cecil. M.P. E. Houlton. C.v.O. Arthur E. G. Rhodes.

] he , 'Sl'Ollllt E"her. G.C. B .• G.C. v.o. The Earl of Derby. K.G.

Fielu-l\larshal The Lord Kicholson. Sir Owen C. Philipps. K.C.M.G. G.C. R. The Lord Claud Hamilton. M. V.O., Lieut.-Col. The Lord Herbert Scott. M.P. .• D.S.O.

PRELATE: The Archbishop of York.

SUfl-l'.n:1.ATEs:

The Rishop I The Bishop of Southwark. The Bishop of Dunedin (Primate The Bishop or Gihraltar. 01 New Zealand). The Bishop of Peterborough.

OFFICIAT.="G CHAPLAINS:

The Re,·. Canon E. Sheppard. I The Venerable Ernest E. Holmes, IC c." .0.• n.o. B. n. (Archdeacon of London) .

KNIGIITS OF GRACE APPO.NTE)") BY TilE GRAND PRIOR:

Col. Sir J. \\' Ottley. K.C.I.E., R.E'I J. II. Morgan. C.\·.O F.R.C.S.

J. 1\ Jamcs. M.V.O. Sir \V. II. St. J. lIope. LlTT.n.,

J. S. M.R.C.S. I'.C.L.

Lt.-Col. George E. Twiss. F.R.C.S.\. F. H. Cool;:. C.I.E. R. A. M.D. The Lord 1 orrcys. ESQUIRES APPOINTED BY TilE GRA:-ID PRIOR: C;. R. IIamilton. C.M.G. I Lieut.-Col. Sir :'II. D. Murray, L. Dawes. K.C.V.O .. C.B. Col. \V. G. Carter.

THE COUNCIL:

The Council consists of the Grand Prior, the Sub-Prior. the Executive Officers of the Order, the Commanders of existing Commanderies. and not more than fifteen mcmbers of the Grades or Knight of Justice. Chaplain, Knight of Grace and Esquire appointed by the Grand Prior.

l\IEMBERS APPOI:-lTED BY TilE GRA:-In PRIOR: Sir J. Furley. C.R. I In spector-Gen. Belgrave Ninnis.

i\Iajor-Gen. J. c. Dalton. lc v.o. C.V.O. R.!\". bl.p.

C?lonel The Lord \ Villiam Cecil. The Lord Claud lJamilton, M.\'.O.•

SIr lIenry Arthur Blake. G.C.M.G. The of SOllthwark.

E. H. Freshfield. [C.B.. C.I.E. Sir \Villiam H. Bennett. K.C.V.O .• Li eut.-Col. Sir C. Temple. Bl.. · F.R.C.S.

Col. Sir James R. A Clark. Rt Col. T. II. Hendley. C.1.E f\T.R.C.S. C.B., C.M.G .• F.R.C.S.E. Sir Mackenzie D . Chalmers.K.c.B..

Francis \V. Pixlcy. Esq . C.S.I.

Ube Granb IPrior)2 of \tbe @rber of tbe 'U)ospital of 5t. 30bn of 3erusalem in JEnglanb.

DEPARTlIlENT.

"U()e St. 3-o()n :ambulance :association.

PATRON:

IllS l\IAJ ESTY TIlE KING, Sovereign Head and Patron of the Order.

PRESIDENT:

FIELD-l\IARSHAL H.R.II. THE DLJKE OF CONNACGIlf, K.G., Grand Prior of the Order.

CENTRAL EXECUTIVE COi'lIl\lITTEE: Consisting exclusively of l\lembers and Associates of the Order.

CllAIRMAN.-The Earl of Ranfurly, P. C. (I.), G.C. :\l.G. (Director of the Department).

DEPUTY CIIAlRi\L\N.- ir John Furley, C.B., Life I.\Iember of the Committee, Honoris Causa.

EX-OFFICIO :'IIl£lIIBERS:

Col. Sir II. C. Perrott, Bt.. C.B. (Bailiff of Eglel.

The Secretary-General of the Ord er

The Recei"er-Ge neral of the Order.

The Chairman of the British Ophthalmic IIosp.ta l.

J\IEMBERS:

:'IIaj.-Gen. J. C. Dalton.

The Lord Islington. G.C.M.G., n.s.o.

Col. Sir J. R. A. Clark. IH C.B G.i\['G F.R .C E.

Col. The Lord Sydenham, G.C.S.I .. G.C.M.G., G.C.I.'·:.

Capt. II . E. Boulton. C.v.O.

Lieut.-Col. The Lord I [erbert Scott. C.M.G., )).5.0

Inspector-General B. innis. c .v.o .. M.n.• R.:-I.

The Lord Claud H amilton. ::\l.v.O.• M.P.

The Rev. T. C. Elsdon.

i\Iaj. G. H. Darwin, M.n.

Col. G. S. Elliston, C.B .. "'.R.C.S.

Col. C. J. Trimble, C.1\1.G., L.R.C.P.!!.

Sir J. L. Langn1:ln. Bt.

S. W. Malkin. Esq.

C. Colton. F.R .C.P.E.,

CENTRAL EXECUTIVE COMMITTEE-continued.

C. B. Palmer.

Lieut.-Col. G. E. Twiss. F.R.C.S.I.

Col. T. H. Hendley, C.I.E•• M.R.C.S.

J. H. l\Iorgan, C.V.O F.R.C.S.

Col. Sir Trevredyn R. \Vynne. K.C.S . I.. K .C.l.E.

Major E. H. T. Parsons.

Brig.-Gen. H. R. Mends, C.B.

Lieut.-Col. A. D. Acland. y.4); •• Col. E. D. Browo-Synge-Hutchinson, c. B.

J. A. Blaxam, F ....C.S.

Lieut.-CoI. Sir R. \V. Inglis.

Surg.-Gen. H. R. 'Vbitehead, C.B., F.R.C.S.

The Viscount Acheson.

T. H. 'Voolston.

CoL C. R. Tyrrell. lI!. R.C.S. Col. The Lord Bolton.

Surg.-Gen. Sir A. 'V. May, K.C.B., F.R .C.S., K H P R N.

F. N. Ellis.

"V. E. Audland, M.R.C.S.

A. H. Johnston. lIt R.C.S.

E.. A. Richards.

J. M. Carvell, lI>!.R.C.S.

CHIEF SECRETARY: Major \V. O. Prichard.

ACCOUNTANT: \V. R. Edwards, A.C.A.

DIRECTOR OF STORES: \ \'. H. l\1organ.

ASSISTANT SECRETARY: D. G. l\Ionteith.

TERRITORIAL BRAl'\CH.

CONTROLLER-IN-CHIEF :-Vacant.

SECRETARY: P. G. Darvil -Smit b.

HEAD OFFICES:

St. Johu's Gc'i.te, Cle l kenwell, Lond on, E. C.

BANK&Rs:

London County and \ Vestm inste r Bank, Limit ed, Lothbury, E.C.

REFER SNCF; No. 58. 1908 -

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 the 1\1 uscles.

C. Fractures-Causes, varieties, signs and sympt oms.

D . Treatment of Fractures-General Rules.

E. The Triangular Bandage and its application. SECO:'<D LECTURE.

A . Treatment of Fractures (continued). Details of treatm e nt.

B. Dislocations, Sprains, Strains-Signs, symptoms and treatment.

C. The and Blood Vesse ls. The Circulation ';If the Blood.

D. Hc.emorrhage awl wounds. General rules for treatment.

E. The Triangular Bandage and ils application .

TIIlRD LECTURE.

A. IJremorrhage and wounds (continued). treatment. Details of i;terna\H remo rrhag:-S.igns. symptoms and arrest. and age from SpecIal Regions. -S igns, symptoms

FBruis.es, Scalds, Bites and Slings, Frost-bite . bodIes 111 the Eye, ose and Ea;. .

F. The Tnangul a r Bandage and its application.

FOURTH LECTURE.

A. The Nervous System.

R

B .. Organs and Mechanism of Respiration-Artificial esplratlOn.

C. 1nsensi bilily

D. Poi >on ing.

FIFTH LECTURE (for Maies only).

. .A. d1mprovised m ethods of lifting and carrying the sick or Injure .

B. Meth ods of lifLing and c .nrving the sick " d str-etch ers. J or Injure on

C. The conveyance {\f such by rail or in counlry carts.

F1FTH LrCTI1RE (for Females only).

A. Preparatio? reception of accident cases.

B. Means of hftmg and carrying.

C Preparation of bed.

D. Rem oving the clothes.

E. Preparations for surgeon.

9

NOTE 1.-The subject of poisons should be treated in a general manner; the common poisons classified, and only their general symptoms, 'effects and treatment taught.

NOTE 1I.-The last half-hour of each lecture should be devoted to practical work, suc h as the "pplication of bandages and splints, lifting and carrying wounded on stretchers.

:N aTE III. -There c;hould be an interval of a week between each lecture. A candIdate for examination must attend at least fuur out of the five lectures . aTE classes must pass in that system of stretcher exercise mosL suitable for the locality.

N aTE V. -As littl e time as possible is to be spen t on instruction in anaLomical and physiological deLails. Lecturers and examiners are particularly requested to remembe r that it is " First Aid" that has to lJe Laught and Lested, and not anatomy and physiology.

llIixed classes 01 melt and WJme ll are Oil no aCCOltll l'ermitleJ.

PUPILS UNDER SIXTEE YEARS OF AGE CAr ONLY ATTEND THE" JUNIOR" G.JURSE (:)ECT,ON A, SYLLABUS 4°)·

Lecturers instructing a First Aid class, and Local Secr"tarie5. can obtalO further particulltrs on application to Chief Secretary for .. Paper Reference No. 80."

No Lecturer may examine liis own Class for Certiji,ales.

SUMMARY OF CONTENTS

.

CHAPTER 1.

Principles. of First Aid

Explanatory

Questions on Chapter

CHAPTER II.

The Human Skeleton. Skull, spine, ribs and breastbone, upper limbs (collar- bone, shou ld er-blade, a rmbone, bones of. the carpus, metacarpus, phalanges), pelvIs, lower limbs (thigh-bone, kneecap, tarsus, metatarsus, phalanges)

Joints .. .

Muscles. Voluntary 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 jaw, spine, Tibs, breast-bone, collar-bone, sho uld er· blade, arm-bone or bones close to th e elbow joint, forearm crushed hand, pelvis, thigh-bone, knee-cap, l<:;g, foot

Dislocations

Sprains

Sprains and Ruptured Muscles ...

CHAPTER III.

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

Hc:emorrhage or Bleeding. Arterial, venous, ca.pillary

Arterial Hc:emorrhage. Plinciples of arrest

Wounds with Arter ial Hc:emorrhage ...

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

Venous Hcemorrhage and Varicose Veins

Wounds with V enous Hc:emorrhage

Capillary Hc:emorrhage

Tnternal Hc:emorrhage

Hc:emorrhage from Special Regions

Qt1estions on Chapter

CHAPTER IV.

Miscellaneous Injuries. Bruises, burns and scalds, hites of snakes and rabid animals and wounds by poisoned weapons, stings of plants and. animals, frost bite needle em bedded unda the skm, fish hook embedded in the skin, injuries to joints, body in the eye, ear passage and nose, wound m the front wall of the abdomen, injuries to the organs within the abdomen and pelvi,

Questions on Chapter

CHAPTER V.

The Nervous System. Cerebro-spinal, sympathetic ...

The Respiratory System

Artificial Respiration. Schafer's, Silvester's, Howard's combined with Silvester's, Laborde's and nIarshall Hall s methods ...

12

lnsensibility. Causes, general rules for treatment, concussion of the brain, compression of the brain, apoplexy, epilepsy, hysteria, shock, fainting and collapse, sunstroke and hea.t-stroke, convulsions in children, asphyxia

Electric Shock and Effects of Lightning

Questions on Cha ?ter

CHAPTER VI.

Poisoning. General rules for treatment, special poisons

Questions on Chapter

CHAPTER VII.

Bandaging. Bandages fur the scalp, forehead, etc., shoulder, hip, hand, foot, chest, back, knee, elbow, fingers and toes ...

CHAPTER VIII.

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

CHAPTER IX.

Stretcher Transport. Stretchers, stretcher exercises, litters

CHAPTER X.

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

Questions on Chapter

Skeleton showing position of main arteries

Skull and vertebral column ." .. .

Vertebra

Bones of the left upper 1m:\)

Bones of the right lower 11mb

Shoulder Joint

Ankle .. ,

Rectus Muscle ...

d d"

Triangular spread out and fol e ...

Large arm shng .. , ...

Small arm sling

Reef knot

Granny knot .. ,

Loop knot

Bandage for fracture of lower Jaw.....

Bandages for simple fracture of nb,

St John sling

for fracture of both collar bones

Bandage for fracture of shoulder blade .. ,

Treatment of fracture of arm

Angular splint

Treatment of fracture of forearm

Treatmtnt of crush ed hand:.. .,. ..,

Treatment of fracture of thigh bone ( "')

Treatment of fracture of thigh bone woman

Fracture of knee cap ......

Treatment of fracLure Off llwe(e cap nd

Treatment of fracLure 0 eg man a

TreaLment of crushed foot... :. . . ..

Diagram of the heart. lungs and air passages

Diagram of the circulation of the blood

Digital pressure on carotid artery .. .

Digital preosure on facial artery .. .

DigItal pressure on temporal artery

Digital pres -ure on occipital artery ... '"

Pad and bandage to arrest h::emorrhage from temple

Ring pad ... ... ... ...

Digital pressure on subclavian artery '" ... '"

Pad and bandages to apply pressure on axi llary artery .. .

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

Flexion at elbow ......

Di gita l pressure on radial and ulnar arteries ...

Pad and bandage to a rrest h::emorrhage from palm

Digital pressure on femoral artery... .. . ...

Tourniqu et on femoral artery

Flexion at knee .... ..

Organs of the chest and abJo:nen .. .

Th e lungs and uronchial tubes method of artificial respirati on ...

Silvester's method of artificial respiration ... '"

Silvester's and Howard 's methods of artifici .1 re spiration , combined

Bandage for the head

Bandage for the shoulder

Bandage for the hip ...

Bandage for the hand

Bandage for the foot

Bandage for th e chest

Bandage for the knee

Bandage for the elbow

Grip for four-handed seat

Lifting by two-handed scat .. .

Grips for two-handed seats .. .

Carrying by two-handecl seat

Grip for three-banded seat .. .

Supporting patient ... . ...

Fore and aft method of carrY1l1g

Carrying on improvis ed sea·t

Improvised stretcher

Furley stretcher.s ... . Fall in "

Stretcher exerCIse, o. 1.

Ditto, ready to li.ft pati ent

Ditto, lifting patIent. ..

Ditto, placing stretcher ... . .. .

Ditto, to lower patIent . . .

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

Ditto, No. II. Ready to lift patIent

Ditto, patient lifted... ..

Ditto No. IV. First pOSlllOn

Ditto' second position .. , .. . . ...

Diag;ams illu strat ing Army stretcher dnll

Ditto ... .. ..

Bed cradle

)mprovised bed cradles

PREFACE.

AT the re9uest of the Central Executive Committee

I have revIsed the manual written by myself in 1901 as handbook of the St. John Am AssocIatIOn.

the revision nn endeavour has been to the study of FIrst Aid to the Injured y drawmg up.a number of general rul es for the of accIdents a.nd sudden illness, and by the cml lSSIOn of all detaIl which is not absolutely necessary to enable the st u dent to acquire an intelligent k:-lOwledge of the subject.

no I .. wlsh to exp:es.s my thanks to Professor E. A. for fur.ms!1ll1g instructions for performing a met?o.d of artIficIal respiration, to Dr. L. M. F . for many valuable suggestions, and to the .edlcal Me:nbers of the Central Ex ec utive CommIttee, espeCIally Surgeon-Major G . H. Darwin M D and D F R C ' d' , .. , r. . . assl 1, for perusing the proof sheets and for a of useful additions to the ,yor k.

I cannot omIt also to offer my best acknow ledflto Mr. '.V. R . Edwards, the Accountant and of the S .J .A.A., for his inval u ab le co-operatIO n.

J AMES CANTLIE .

F IRST A ID TO TH E I NJURED . CHAPTE R 1.

The St J ohn Ambulance Association has now completed thirty years of its existe n ce, and during that period hund r eds of thousands of men and women have bee n taught at its classes, in ' all parts of the world, how to help th eir injured neighbours .

First Aid to the Injured is a special branch of practical medicine and surgery, by a knowledge of which trained persons are enabled to afford skilled assistance in cases of accident and sudden illness. The instruction begins and ends with First Aid, and tbe subject is taught simply but thoroughly and exhaustively. The duty of the ambulance purils <;nds where the doctor 's commences, and there ougbt to be no overlapping or clashing of duty or interests.

PR I I CIPLES OF FIRST AID .

1. The First Aid student sh o uld be-

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

(b) Tactful, that he may without tbou gbtless questions le..'1.rn the symptoms t and history! of the case.

". Signs are what may be perceived.

t S\' mpt oms are what the patient can tell you .

t History means the circumstances attending the ac cident o r sudden illness.

(c ) Resourceful , that he may use to the best a d vantage whatever is at hand to prevent further damage and to assist Nature 's efforts to rep.ai: the mischie f a lready done.

( d) that he may give clear instructIOns to the p.:ttient or the bystanders how best to assist him.

(e) Discriminating, that he may decide which of several in juries 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 danaer whenever possible.

3· Severe hc:emorrhage must receive the .attention, no matt er what are th e ot her lllJunes.

4· patient must be in a position in whl h breathll1g IS. the air passages must be free from obstructIOn; If breathing has ceased prompt measures l1lust be taken to restore it.

5· .Rest .-A restful position of the body will assist the VItal functIOns; Support of the injured part will help to prevent further damage, and is essential in the case of fractures of lim bs.

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

7· When the skin is broken the wound

19

s hould be promptly covered with clean dressing. Should the wou n d be pOlson ed, IS most important immediately to prevent the pOlson permeating the system. .

8. Poisons swallowed should. be got nd of; or when that is inexpedient, neutralIsed.

9. The best me a ns of transpo rt must be studied, and provision made for proper care wilen the patient is brought to shelter.

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

COAT: Remove from the sound side first, and, if necessary, slit up the seam of the sleeve un the injured side .

SHIRT AND 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 suppose that alcoho l is the only form of stimulant, and far .too frequent use of spirits is made to restore patlent after an accident, often with serious results; tl1e safest rule therefore is to defer the administration of alcohol unt/I the of a ooctor. "When the patient is able to swallow, strong tea or coffee, or milk, as hot as

be drunk, or a small quantity of sal volatile in water may be given . Smelling salts may be held to the nose. Sprinkling the face with cold and hot water alternatciy, warmth applied to the pit of the stomach and over the heart, and vigorous friction of the limbs upwards have a stimulating e ffect . 12. Throughout his work the First Aid student must on no account t3.ke upon himself the duties and responsibilities of a Medical man. At timts an apparently slight injury is accompanied by grave danger and may Dctually cause loss of life. When sending for a d oc tor, state the nature of the case, and remem ber that \\Tltten rarticulars are safer thJ.11 J. verbal message.

It is l,ecessary that semething should be known of the structure of the body (e]ementary anatomy), and of the functions of some of the more important organs and systems (elementary physiology). A description of the necessary anatomical and physiological points is therefore f:,iven as the several subjects are discussed. For purposes of description the human body is supposed to be erect, \\ith th e arms hanging by the side and th e palms of the hands directed fel'wards .. Tl: e "middle line" of the body runs vertically fr om the top of the head to J. point between the feet.

'What is First Aid to the injured ?.. .., ...

"What qualities should the First Aid student possess?

\Yhat are signs?

\Vhal are

What is often the first thing t o ?o m an accIdent : ?'"

\Yhat result of injury mnst receIve the first .

IJow mu st poisoning be treated? ...

What steps mus ' be taken beyond th.e actual treatment of injut1.es? ... ..,

Should clothing always be ? ... "'?

1low would you r emove clothJ11g when necessary.

Explain the use and abuse of stimulants...

\Vhat must the First Aiel sLudent not do

is

For purposes of description how IS the human body supposed .to be ,Placed?

What is the mIddle IJ!1e of the body?

CHAPTER II.

fRACTURES, DISLOCATIONS, SPRAINS AND STRAINS.

TH E SKELETON.

The 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 imp ortant organs, as in the skull, chest, and abdomen.

THE SKULL.

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

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

T he Bones o f the F ac e with the exception of

23

. firml J'ointed together, so that the lower Jaw are y.. ' bl The cavities t between them IS Impossl e.

m?vhemen and of the eye sockets (orbits) are formed ot t e nose . d of the face con- b the bones of the Cr.1nlUm an h . Y h mouth cavity is formed between t e JOlt1tly. dTI e . 's the palate being the bony roof upper an howeh r .Ph\\ ;ep:uates it from the nasal cavity of the mout w IC c above. . f

The Lower Jaw consists 0 :-:-- k

(a) A horizontal portion in which are the soc ets for the teeth. . h .d

(!J) Vertical portions terminating on. en er Sl e at the joint between lower Jaw an? the base of the cranium, Situated 1111lTIedlately in front of the ear. .' f h

The angle of the ja \V the Junction 0 t e horizontal and the vertical portions.

THE BACK-BONE, SPlNE, OR VERTEBRAL COLUMN.

The Vertebral Column (Fig. is of bones called vertebrre, each of :vhlch consists of-

I.-A body or bony .mass m front. . n-

2 -Processes projectmg e h

. close a canal for the spmal cor -t e spinal canal. twelve palfs of 3.- Two transverse processes, which support the ribs.

D.12

Co. 4 FIG I

SKULL AND VERTEBRAL

CCLUl\IN

Showing left ribs and' . breast bone. The removed.

T SPINOUS PI,OCESS RANSVERS!<; • PROCI£SSES. !

CANAL FOR SJ'INAL CORD.

BOD.Y OF VERTEBRA.

FIG. 2A.

SURFACES SUPPORTING HEADS OF RIBS.

FIG. 2 11 .

TRANSVERSB' PROCESS.

SPINOUS PROCESS. -J

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

T he Vertebrce , 33 in all, are grouped into re. gions, in each of which they are known by nu ,nbers, counting downwards :-

I.-In the neck 7 Cervical vertebrce. The first vertebra, atlas, forms a joint with the base of the skull, at which tlte nodding moveme n t of the head takes place; the second, tlze axis, by the joint between it and the atlas, allows of the side-to side move· ments of the head.

2.--In the back 12 Dorsal vertebrre .

3 -In the loin 5 Lumbar vertebrre.

4.-The rump-bone, or Sacrum, consists of 5 Sacral vertebne united in ad ults as a solid mass.

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

Between the bodies of the vertebrce, 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 of any sudden force applied to the spine (for example, when falling from

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

THE RIBS AND 'BREAST-BONE .

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

THE UPPER LIMBS.

The Shoulder-bones are the Collar-bone and the Shoulder-blade (scatula).

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

PART OF COLLAR BONE

_ r

3A.

BO!'<ES OF THE LEFT UPPER LIMB.

FIG. 3B.

SHOWING THE POSITICY:'< OF THE RADIUS AND ULNA WIlE)! THE TnUMB IS TUR:\ED INWARDS

Compare Fig. 3'\, in which the thumb is turned out· wards.

FIG.

breast-bo n e, and its outer end joins with the shoulde rblade.

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

The bone of the A rm (/tztmerllS) reaches from the shoulde r to the elbow.

I n the Forearm are two bones, the Radius on the outer, or thumb side, and the Ulna Qn the inner, or little finger side . Both bones reach from the elcow to the wrist, and they change their relative position with every turn of the hand (Figs . 3A and 3 B ).

The Hand is composed of-

r.- The bones of the wrist, or cal pus, eight in number, arranged in two rows of four.

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

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

THI:!: PELVIS AND LmVER LIMBS

The Pelvis. - The large basin-like mass of bo n e attached to the lower part of the spine is composed of the two ha un ch-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 , t h e sacrum is placed between them . The pelvis

FIG. 4.

BONES OF THE RIGHT LOWER LIMB, SHOW· ING JOINT WITH THE PELVIS AT THE HIP.

DONE (FIBULA).

BONE (TIBI A).

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

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

The Knee-cap (patella) is a triangular bone lying with its base upwards in front of the knee joint immediately beneath the skin.

The bones of the Leg are the Shin-bone (tibia) ar.d the Brooch-bone (jibula). The Shin-bone extends from the knee to the ankle, in both of which joints it plays an important part; its sharp edge, the sllin, 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 the heel-bone, and the uppermost (the ankle-bone) forms the lower part of the ankle joint.

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

3·-The plzalanges, or toe-bones, t.wo in the big toe, and three in each of the other toes. ,

31

JOINTS.

A Joint is formed at the junction vf two. or ·more bones. In moveable joints such as the hlP, knee, elbow etc. the smfaces of the bones are fb Y lessens friction and the s oc 0 a

Compare Fig. 4, Page 29· fall. Lubricating the joint is clear, rather. st.icky fl. . d the "joint oil IJ or synovza, enclosed a Tying the' bones together, allo/wm g of movement, are a number of bands or. s. h T I · the formation of 11m )omts, t e o exp am '

FIG. 6.

LEFT ANKLE.

FIG·5·

VEI N

MUSCULAR TISSUE

PATELLA

TENDO N OR OF PATELLA

FIG. 7.

The Muscles of the DIAGRAM SHOWING RECTUS body are classified into two MUSCLE OF THIGH, WITH g I A .roups-vo 1t1ttary and RTERY, VEIN AND NERVE. znvoluntar) ' . 33

J2

examples are given :-

The Shoulder a balland-socket jOint,' consists of a sklllow socket on the outer angle of the should er-blade , and of the of the arm-bone (FI g . 5). 01\ in g to the shallown ess of the socket the arm-bone is very prone to. escape from its socket (dIslocate).

.. Ankl e, a hinge J?mt, 1S formed at the junctIO.n of three bones , the above and on the Il1n er side, the broochbone on the outer side the ankle-bone belo; (FIg. THE MUSCLES.

The Voluntary muscles are met with in the lim bs . the head and neck, a nd the surbce of the trunk. Their ends are attached to different bones, and as th ey pass from one to another thev cross a joint, and, endowed with the power of contraction and relaxatio n, cause the mO\'ements of the body. As a muscle crosses a joint. it as a rule becomes a fibrous cord or tendon. Blood-vessels traverse and supply the muscles, and the nerves entering them bring them un der the direct cont rol of the br ai n and spinell co rd.

The Invo luntar y m u scle s are met with in the walls of the stomach and intestines, in the ai r passages, and ill most of the internal organs and blood vessels, als'o, in a special form, in the heart. They are n ot un de r th e influence of the will, b ut comi nu e their work during the hour s of sleep; thei r functions are regu ated by a separate set of nerves (s ee Sympatb efic System, page 118).

FRACTURES AND THEIR

\ Vh en a bone breaks a Fracture is said to occ ur.

CAUS ES OF FR ACTURE .

I. Direct Violence. - 'Wh e n from a severe blow, impact of a bull et, crush of a wheel, etc ., a bone breaks at t 11e spot where the force is applied the fracture is tenYJed dir ect. c

2. Indirect Violen ceo - "\ rhen the bone breaks at so me d istance from the spot "her e the force is applied the fracture is termed indirect. Alighting on the feet a n d fractu ring the t high -h one or the bones of .I the leg, or falling o n the ha n d and breakine; the radius or the collar-bone, are examples,

3 · Muscular Action . - The knee-cap and the arm-bone are occasionally broken by a vIolent contraction of the muscles attached to them.

VARIETIES OF FRACTURES.

Fractures a r e classified according to the condition of the tissues adjacent to the bone as fo11o\\ s :-

1. Simple. - The bone is broken with but slight injury to the surrounding parts .

2 . Compound. - The bone is broken and the skin and tissues are punctured or torn, thus allowing disease-producing germs to obtain entrance to the seat of fracture . The fractured ends may protrude through the skin, or (for example, when a bone is broken by a bullet) the wound may lead down to the fracture .

3· Complicated , - The bone is broken and in addition the re is an injury to some internal organ (for examp le, the brain, spinal cord, lung, etc .) or to some important blood-vessel or nerve .

A fracture may be compou n'd or c omplicated as the immediate result of the injury; or a fracture,

35 . ' I ,be converted into a compound origmally simp e, ma).

or complicated fractute-. t on the part of the (a) By ,careless movernen patient. , n the part of (b) By or Ig:1orance 0 one rendenng first ald. I 'fled accord-

Special varieties of fractures, rna l Y f :_ h " to the bone Itse [t ing to t e d T1 bone is broken 1l1to 1. Commmute ,- 1e

several pieces. . I h'ld n o",inO' to the softer 2. Green-stl ck:.- n c Ib re e 'may bbend and crack state of the bony tissues, a on.

without breaking completely of the bone are 3. Impacte d. - The brvken en s dnven one into the other.

G L SIG ' s SY::\IPTO::\IS WHICH :\L\ Y BE 1, PRESEI T.

f humeru'" or both bones (A fracture of the complete of the forea.rm or example . h t of fracture.

I Pam at or near t e sea , . f wer in the 11mb. . 2. Lo s s .o po h t of fracture. Swellmg 3 Swel hng about t e sea . other sims . d 't difficult to perceive 0 frequently ren ers I 1 f e be taken not of fracture, and care must t or , . f t for a less senou-s m Jury. to mistake a me l" b -The limb assumes an 4. Deformlty of the I.TI

unnatura l posItIon, and is mis-shapen at the seat of fractur e. The contracting muscles may cause the ends the bone to override, thereby producmg shortenmg.

5· of the bone .-If the bone is close th e skll1 the fracture \ nay be felt, and if compound It may be seen.

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

7· Crepitus, or bony may be felt or heard when th e broken ends move one upon the other.

The last two signs only be sougld by a doctor.

Se:vera1 of the above signs are absent in green-stick and Impacted fractures.

. In addition to the signs and symptoms the patient 01 bystanders may be able to give the history of the l11Jury, and marks on the clothing or skin should be noted, a s they may serve to locate the fracture. The snap of the bone may h::n-e been heard or felt.

ApPARATUS FOR TR EAT:\IENT OF FRACTURES.

Spli,nts bandaQ'es for First Aiel frequently have to be Impronsed.

A be Impr ovised from a walking stick umbrella, blllJard cue, broom or brush handle l ' ' rna I t h 'f! ' po Ice n s runc eon, f1 e, folded coat, piece of \\'ood ::atdboard, paper firmly folded a rolled Ul) , , f: ' ,- map, or 111 act, anytlung that z's firm and long eno1lglz to k eep :7

tlze Joints above and below. flu fractured bone at rest. 'When the above applIances are avai lable, the upper limb, if fractured, may be to the trunk, and in all cases a fractured lowe r 11mb should be bandaged to its fellow . ,

Bandages may be improvised from belts, straps, braces, neckties, or any pIece of lmen, calico strina or cord that comes to hand,

Triangular Bandages (Fig. 8) are made by cutting a piece of, linen or about forty inches square diagonally mto two

The broad bandage is made by brmgll1g point down to the base (Fig. 9)3 and then fold m g into two (Fig . IO). .

The narrow bandage is made foldmg the broad bandage once (Fig . II).. . '

The medium bandage IS made by bnngmg the point down to the base, and then foldil:g ..into three. (Fig. 12 ). This bandage J11ay be of ,the broad or the na!:row bandage when It IS sUited to the proportions of the patierlt. ".

It is so metimes advisable to halve t L-:z Size of the bandage by bringing the two ends before "oIdin g it into the broad, narro w, or m edIum bandage.

.When n ot in u. e, the triangular bandage sho uld be folded narro\\' ; the two ends shou1d be turn ed to the c ent re, an d the bandage then folded four, reducing it to a packet s:.bout in ches by mches.

IO BROAD BANDAGE.

FIe:. 12. DOTTED LINES SHOW THE FOLDS OF I\IEDIUlIJ: BANDAGE. THE

39

Large arm-sling (Fig. 13).-Spread out a bandage, put Oile end over the shoulder on the sound side, pass it round the neck so that appears over the shoulder of the injurej sid,:, 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

FIG.

40

broad. bandage over the shoulder on the sound side, pass It round the neck so that it appears over the of the injured side; place the forearm over t he mIddle of the bandage; then bring the seco n d end up to the first, and tie them. This sling is used in cases of h u merus, and occasionally whe n t he I.arge slll1g would be too conspic uous. Slmgs may be improvised in many simple ways, s uch

FIG IS - REEF KNOT

F IG. r 6.- GRAW'iY KNOT .

a s pi n ning the sleeve to t he tail of the coat, passing the coat or waistcoat , etc.

. Reef Knots ( Fig . IS ) granny knots (Fig. 16).

clothi ng, t u mi ng up the hand inside the b uttone d are to be used . A voi d

GENE R AL RULE S T O BE OBSER VED IN THE TREATl\1ENT OF FRACTU RES.

The object of First Aid Treatment of Fract ures is to g uar d against further mischief, and especially to preven t a simple fracture from becoming compound or c omplicated. To attain this end :-

I. Attend to the fracture on th e spot. No matter how crowded the thoroughfare, or how short the dis'ance t o a more c onve nient or comfortable place, no attempt m ust be made to move the patient until the limb has bee n rendere d as immovable as possible by splints or other restraining apparatus .

2 . Steady and support the inju r ed limb at once, so that its furthe r movement on the part of either the p:ltient or the bystander is prevented .

3. Straighten the limb with great care, and if shortening is observed in the case of a fracture of a bone of the lower limb, pull upon the foot until the limb regaIns a more normal length . When the shape of the limb is imp roved, on no account let go until it is secured in positio n by splints, otherwise there is great da nger of the fracture beco:lling compound or comp licated .

4. Apply splints (when practicable) and ban::lages as fo ll ows :-

(a) The spli n ts m ust be fi r m, and long enough to keep the joints im m e d iately above and

below the fractured bone at rest. They should, if practicable, be padded to fil accurately to the limb and he applied over the clothing.

(b) The ban?ages must be applied firmly, but not so tIghtly as to constrict the circulation ?f blood in the limb. When the patient is In the recumbent position double the bandage over a splint to pass it under the trunk or lower limb. As a general rule :_

For the trunk the broad bandage should be used . Pass it once round the trunk <md fasten it b? tying the ends, or with two or three safety pms on the side opposite to the fracture, but Jf to secure a splint for a broken thigh. oYer the splint.

For the arm or .forearm the narrow should be used. Pass it twice round the limb, a?c1 tie the ends over the outer splint.

For the Ihz<fh or It'g the narrow or medium may be used. It is frequently convenIent double the bandage at the centre, pass It under the limb, bring the loop over the limb, pass both ends of the band. a.ge through it in opposite directions, and them over the outer splint (Fig. I 7).

In applymg bandages near a fracture the upper one should be secured first . 43

When hcemorrhage accompanies a fracit must be attended to fnst , and the wound covered by a clean dressing.

1'7.

6. No attempt must be made to remove a auent suffering from a of the sprue, pelvis, or thigh, except a recumbent position, preferably upon a stretcheI. . .

7 In every case of fracture It necessar . to cover the patient to keep hlm w .arm, d y I the effects of the SHOCK of the aCCIdent. an so essen f F. In all doubtful cases, treat as a facture.

SPECIAL FRACTURES.

Fracture of the of the upper part is usually caused by dIrect VIOlence-for exam Ie, a blow on the head. A fracture of the base is caJsed by indirect violence, through a fall on the

FIG.

44

head, a fall on the feet or lower part of th ' or a severe blow on the lower J'aw rf the spme, p ,t 'fi ' . .1../ e upper aJ zs ract7lred, sIgns are swellin a irrerrularit and, frequently JJ1sensibility either y, conllng 0 d 11 ' ' or n gra ua y. if tile base z's fractured inmay come on Immediately, blood or a clear fluid may issue :rom the ear channel blood may escape the nose, or it may pass d ,)\yn to the stomach \\'hence it may be the fracture may the orbit, causmg a blood-shot eye.

TREATl\IENT.

Injury to the brain is great danger attendFIG, 18 mg a fracture of the cranium. For treatment

C. see "Concussion and ornpresslon of the Brain," paocs 131 I" 2

Fracture of the Lowe; Jaw J i>: 1 f

P , (' b" ,-.I. am, oss 0 , .0\\ er l Jr:a lllty to speak and to move the jaw freely) anty of the teeth, crepitus and bleeding e gum are the usual signs and symptoms.

45

TREAT?lIENT.

I.-Place the palm of the hand belm\' the inju:;:ed bone and press it gently against the uppe-r jaw.

2.-Apply the centre of a narrow bandage under the chin, carry one end o\'er the head, crosS the ends at the angle of the ja \\', carry the long end across the chin, and tie the ends on the side (Flg, IS).

Fracture of the Spine. -The vertebral column may be broken either by direct or indirect violence. 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. 'Vh at is commonly regarded as a broken back consists of a fracture of one or n1.ore of the vertebne "with displacement of the fragments, whereby the spinal cord and 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 movement on the part of the patient.

2.-Cover the patient warmly.

3.-To remove the patient, place him on a stretcher cr shutter as fo11o\\"s :-

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

s<? that ,the ends are level with the top or hIS pass a broad bandage or handkerchl.ef under the head and secure it to stIcks. If no coat is worn, or doubt as LO Its strength and length exists, pass a of bandages under the patie:lt to , serve Instead of, or in addition to, the coat.

(

b) A. bear.er on each side grasps the rolled coat mth hIS .hands well apart; a third grasps the cl.othmg on both sides on a level with the hIps; a four th bearer takes charae of the legs.

(c) On ,word beil?g given, :lll lift together cany the patI ent by short side paces over t.he stretcher and carefully lo\\"er him on to It. If a fifth bearer is available the should. be passed under the patient of carrymg hml over it.

4.-0n arn,:al at shd.ter nothing further is to be the ann'al of a doctor, except to gIve the patIent tea. etc., if he is conscious .

Rlbs:-The ribs usually fractured are the SIxth, se,:enth? eighth, and ninth, and generally the IS 11l1dway between the breast-bone and spll1e. !?e fract ure may be cauc;ed by indirect the end·,. of tl:e bone out\\alds, or (IIrect VIOlence drivin2" Llle f -,.. ... d . d fib ' '''' L 1m.. c Ule eil sot le one It1wards and sometimes injuring the

lunas or other internal organ. If the lower ribs on the °riaht side are broken, the liver may be injured, and aOfracture of the lower left ribs may wound the spleen . Evidence of the fracture is afforded by pain, especially on attempting to take a deep breath, and by short and shallow breathing. If the lungs are injured blood, frothy and brigh t red, may be coughed up and expectorated . If the liver or splee n is wounded internal hcemorrhage page 95) may occur.

(a) TUzell tlu fracture is not comphcated by an hljmy to an internal or;an :-

J .-Apply two broad bandages round the chest suffi-

FIG. rg. ciently firmly to afford comfort, with the centre of the first immediately above and that of the :;econd immediately below the fracture. The lower bandage should overlap the upper to half its

48 extent. The k t the front on s are. to ?e tied rather to Another aood OpposIte sIde of the body. folded to a strong to\vel, the he",.t wIde, tightly round c est, secunn a It 'tl h safet' '" \\ 1 1 tree or four y pms.

2. - Place the arm on the in' ." brae slin er (F ' ) Jured SIde 111 8. '" ", ' 19. 19 .

(b) TVhen all internal . " d D <.'> • zs IJ1jltre -

0 not bandage.s rouod the chest. mclined a little towards

3·-Loosen the clothina 1 b' give ice to sllck,' and p aCe an ice ba b a over h r t t e seat of inJ·ury. rea as for internal h page 9S). cemorrhage (see

4 · -Place the arm on the . . . large sling. l11Jured SIde in a

Fracture of the B

" Then this fracture can (sternllm).all tIght clothin a and k e1t or lS. suspecteJ undo easy position unt'/l th t le patIent quiet in 8.n e arnva of a doctor.

FR,\CTURE OF THE B F t o:-ms OF THE UPPER LIMP.

rac ure of the CoIl b '-'. fracture i frequentl ar- one (clo'l)icle).- This or a: caused ?y. a fall. on. the hand m on the 1I1Jured SIde IS partially

4)

helpless, ani the patient USU8.lIy supports it at the elbow with his hand, and inclines his head tow8.rds the injured ide. The fractureJ e n ds can generally be felt to overlap, the outer fragment being the lower. The general signs and symptoms of fracture are mostly present.

TREATi\IEt\T.

I.-Remove the coat (see pt1ge 19), and as much more of the clothing as is expedient.

2.-Place a pad about two inches thick and four inch(::;s across in the armpit.

3.-Gently bend the forearm well up, keeping the s110 u ldtr as far back as practicable, and support it in a "St. John" sling, made as follows :-

(a) Lay an unfolded bandage across the chest over the injured limb with one end on the uninjured shoulder and the point beyond th e elbow on the injured side. (Fig. 20).

(b) Pass the lower end of the bandage under the injured limb, across the back, and tie the ends somewhat lo osely in the holl ow in front of the sound shoulder.

(c) Fold the point over the elbow of the injured Ii 111 b and secure it by one or two pins (Figs. 2I and 22).

4.- Tightly secure the injured limb to the side by a broad bandage passed round the elbow and. trunk, so as to lever out the shoulder, the pad formll1 g the fulcrum.

S.-No\\' tighten the sling.

\ Vben both collar-bones are keep the

FIG 21. (Body bandage omitted tc show details of Sling.)

A

shoulders back by narrow bandages tied round each arm close to the shoulder, passed ac ross the back, ove; the opposite arm and tied together in front. The forearms should be raised and supported by the b:ll1dages . (Figs . 23 A and 23 B).

Fracture of the Shoulder-blade ( ({ajll/a).Apply the ce ntr e of a broad ba n dage in the armpit of

FIG. 23

FIG. 23B.

the injured side, cross the ends over the uninjured shoulder and tie them und er the armpit. Support the li m b in a St. John sling (Fig, 24).

Fracture of the Arm

(lzumerus) , - The bone may be broken :-(a) Close up to the shoulder; (b) near the midd le of the shaft; (c) close FIG 24, to the elb o\\".

All the general signs and symptoms of fracture are usu a lly present.

T REATMEN T.

When the Fracture z's close to the Sh oulder-

I.-Ap ply a broad bandage with its centre abO\'e the middle of the arm round the limb and body, tying it on th e opposite side.

2.--Support the forearm by a small arm sling.

lV/zen t he Fracture is ma r the Mzddle of tile Shaft-

1.- Pend th e forea rm at a right angle to the arm.

2.-Apply splints, reaching from th e shoulder to the elbow on the outer and inner sides of the arm, and, if eno ugh can be procured, to the front a nd back also. The front splint 53

mus t 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 ayailable, secure the arm to the side by two broad bandages.

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

Fractures involthe elbow j oint, whether of the ann or forearm, 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 limb sh,ould be laid upon a pillow in the most comfortable position; ice or cold water dr essings should be applied to the injured par,l, but no treatment should be attempted pendll1g the arrl\'al of a doctor.

FIG. 25·

TVhen the accz'dent occurs out o.f doors-

1.-Take two pIeces of thin flat \yood one lon o , enough to reJch from the armpit to below the elbow, the other long enough to reach from above the elbow to the finger tip ; tie them together to form == a right angle. (Fig. 26).

FIG. 26

3·-Secure by fracture.

2.-Apply the angula r splint so made on tIle inner side of the flexed limb. bandages above and below the

4·- the limb by a large arm sling.

5·-0n arrIval a.t ?ome remove the splint, and the Il1Jury as if it had occurred mdoors.

Fract:ure of the Forearm.-Wh en both bones (the RadIUs and Ulna) are broken, the ge neral signs a nd symptoms of 2.re usually present. \Vhen one of the bones only IS broken the signs and symptoms. are as. a rule pain, loss of power, swelling, and uregubnty. An impacteri. fractureof the Radius

5S

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

TREATMENT.

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

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

FIG. ':7 ·

FrG. 28. keeping the thumb upwards, and the palm of the hand towards the body.

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

3.- A pply bandages, embracing both splints, 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 carpus, metacarpus, or firigers).

TREATl\IE TT .

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

2.--To secure the splint apply a narrow bandage c rossed in the manner of the figure 8 to the \vri st and hand (Fig. 28).

3·-A pply a large arm-sling.

Fr a cture of the Pelvis.-When, after a se vere injury in the nei g hb c urho o d of th e haunch-bone, the re is no sign of damage to the lower limbs, but the patient is unable to stand or even to move the lower limbs without great difficulty and pain, a fracture o f the pelvis may be assumed to have occurred. TIOle blood-vessels and organs, especially the bladd er, withi n the pelvis are in danger of being wounded.

TREAT;\[ENT.

I.-Lay the patient in whatever position is found to give the greatest ease, and fl ex or straighten the lower limbs as the patient desires.

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

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 45) .

FRACTURE OF THE BONES OF THE Lo -.rER LIMB.

Fracture of the Thigh-borte (femur) . - The thigh-bone may be broken at its neck, a n ywhere in the shaft, or close to the knee. A fracture at the

57 . old people from very slight k 's likely to occur m . ' h f a nec 1 d"ffi It to dlstm uuls rom injury, and IS often . I it may be that severe brUlse of the hlp, l" int the patient" when, after an nt1ar tbhe the heel from I n h 'm o" on t le ac, " I cannot, \\' 1e ) b b ken All the uenera the ground, the bone _ a're usually present si a ns and symptoms at ra " " f the foot b " "is the pOSitIOn 0 , and a prol11ment sIgn

29·

h · h as a rule lies on its outer side. Shortening W IC, L, " h may vary from one-half to three mc es.

TREATMENT.

d the limb by holding the f?ot . I.-Stea y d ' the foot and brmg It mto Gently draw 0\\ n G.

2.--:

. When two or three assIstants are line with .fellow. I d ty to hold the foot in t hand It IS one person s u a .. ' "1 th plints are secured. pOSItIOn untl e s. h ter side from the arm-

3.- A pply a splmt on t e ou pit to beyond the foot.

FIG.

,)8

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

5·-Sec ure the splints by bandages as follow'::> ._

. (a) Round the chest just below the armpits, (b) round the p elvis on a level with the hip joints, (c) above the fracture, (d) below the fracture, (e) round the leg, (.I) round both ankles and feet, and tied below the feet, (g) a broad bandage round both knees (Fig. 29).

FIG. 30.

vVhen Single-handed, or when the patient is a woman, it is expedient, after extension of the limb, to tie the feet together, dispense with the inner splint, and pass the bandages round both limbs (Fig. 30 ).

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

59

. . the attempt to prevent a fall \Vhen the shps f the thigh act with s uch the muscles 111 the front o. (F''' r) the knee-cap 111 two Ig. J . force as to snap (the limb will be quite helpPain, loss of be felt bet\\'een the ) d . ulant\7 (a cr ap may less, an lrreg , J "t"> , this injury . broken fragments of bone) ac compan)

TREAT:\IENT.

On his back, raise \yell and I.-Lay the pat.ient

FIG. 32 •

t the head and shoulders, straighLen and raise suppor ' the limb. . 1 the back ')f the limb, 2.-Apply a a beyond the heel. reaching from the uttobc d ge with its centre immc3.- A pply a nCHrow an a

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

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

S·-Support the foot well off the ground by a pnlow, roll of clothing, etc ., or if none of these are at hand by resting it on its fellow (Fig. 3 2 ).

G.-Apply an ice bag or a cold water dressing over the fracture.

Fracture of the Leg (Hbia and fibltZa).-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

foot. If only one splint is available place it on the outer side. () b ' (b)

-Secure the splints by bandages a a me, the fracture, (c) immediately above the knee,

d) round b oth ankles, (e) a broad bandage round both knees (Fig. 33). . 'Wh en single-handecl, or \\ hen the patient IS a

FIG. 33.

FIG. 34.

62

w.oman, after extendin o the lili. b . dl pense with the inn;r ]"_ 1 tIe both feet together, both limbs and pass the ban.dages available tyina- the 1 ( g kJI-J.) · "\Vhen no splmt is b egs, an es and k ot I5Teat service. ,nees together is

Crushed Foo t f and toes) .-This the tarsus, metatarsus the passage of a heav . ' hIS commonly caused by b ' Y \\ eJU t over th f e recognised by pain . 1--'1' e oot, and may , s\, e lllg, and loss of power.

TREATMENT.

I.-Remove the boot (see page I9).

'2.-Apply a wellpadded splint to the sole of the foot, reaching from the heel to the toes

FIG. 35. 3· -Apply a bandaa-e crossed after the

4.-Support the foot in a 8 35) · b Y raIse posItIOn.

. DI SLO CATIONS.

A dIslocation is the d is )lac the bones at a joint. I ement of one or more of Th " e Jomts most frequentl d' 1 of the shoulder elbo tl b y IS ocated are those , w, 1um , finaers and 1 . b, ower jaW.

SIGN S AND SYMPTOMS OF D lSLOCATION .

1. - Pain of a severe sickening character at or near the2.joint.

- Loss of power in the limb .

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

4.- Swelling about and below the joint.

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

6.- Deformity of the limb . - The limb assumes an unnatura l position, and is mis-shapen at the joint.

TREATl\,[ENT.

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

(

a) TVhen the accident occurs out of doorsSupport the limb in whatever position gives most ease to the patient, bearing in mind the necessity of lessening the effects of jolting during transport .

(b) Hilzen the patient Z"S z"ndoors-

I.-Remove the clothing from the limb .

2.-Place the patient on a couch or bed.

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

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

S. - When cold ceases to give comfort apply

64

wa rmth (flannels o r tow els 'iyrun O' out of hot \\ ater).

6.- Treat shock (see page I35).

SPRAINS.

"When, by a sudden wrench o r twist, the liO'aments and the parts around a joint are stretched torn the is said to s:jrained. " Going over" the ankle IS a common examp le.

SIGNS AND SY:\[PTOMS.

r. - Pain at the joint after a twist or wr ench.

2.- Inability to use the joint.

3·-S \,\elIing and discoloration .

TREAT1IlENT OF SPRAINED ANKLE

J,Vhen out o.f doors-

a bandage tightly over the boot, beon the sole at the instep, crossing 1.t on the front of the ankle, and carrying It round and round the ankle, where it is to be firmly tied.

2.- \Ve t the bandage after applicr'.tion; it is thereby tightened.

A./ter reaching she!ter-

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

2.-Place the lImb ll1 the most comfortable position; usually that is well raised.

65

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

-t.- When cold fails to give comfort, apply hot fomentations.

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

Wh e n in doubt as to th e nature of the injury, treat as a fracture.

STRAI1'-TS AND RUPTURED MUSe LE .

"When, during severe exertion, muscles. or are over-stretched they are said to be strall1ed, If they are actually torn th ey are described as ruptured.

SIGNS AND SYMPTOMS.

I.-A sudden sharp pain .

2.- When the muscles of a limb are strained th ey may swell and cause .

3.-Further exertion IS dIfficult or. ImpossIble; for example, if the strain has occurred the back the patient may be unable to stand upnght.

TREATMENT.

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

2.-Apply hot \Yater bottles or hot fomentatIOns when the pain is very severe .

A so-called strain in the groin (hernia) is an injury of a totally differ ent nature (see page I14)· D

QUESTIONS ON CHAPTER II .

Tlu n u merals in d£ca t e t h e pag u w here the m ay ge .louna. a ns wers

'Yhabt the skeleton, and what purposes y It?

are served

How are tho b f h ......

\Vl • - ones 0 t e skull ",rrana-ed ?

D llt .are the boundaries of the ; be the bones of the face .

Drescn.be the lower jaw ...

\" hat IS the angle of the jaw? :::

\\hat ?ther names has the back· bone ?

\\ hat IS a verte bra?...

many vertebrre a re in li';e ? at are the regions or the spine h brre are there in each? ow many

HoW' IS the spine end d 'h' ... ... ...

\Vhat is a ri b ? owe wIt free movement?

pa'irs of;i'bs are"t'here?"

T a r IS the breast·bone?

\\ hat are 'the b f h ...... Wh' ones 0 t c upper limbs?

T at the pelvis? ... .

'\hat IS the hip joint? ... ... bones uf the lower limbs? .. . atlsajo1l1t?

D escl!be a moveable joint ::: the shoulder joint

Descnbe the ank le joint ...

IIow muscles classified? :,olulltary musc les

D7escn.be 1l1 vo'untary muscles

" hat IS a fract ur e?

\\'hat are the

Where does a bone break when direct violence is the

cause of fracture?

How maya fracture be caused by muscular action?

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

What is a simple fracture? . .

\Vhat is a compound fracture?

Whll.t is a complicated fracture?

\Vhat is a comminuted fracture?

\Vhat is an impacted fracture?

State the general signs and symptoms that may be present in a case of fracture ..

\Vhat. fractures afford the most complete example of the

In making up your mind whether a fracture had occurred or not, what points should you take into consideiation beyond the signs and symptoms?

\Vhat apparatus may be necessary for the treatment of fractures?

Describe Esmarch's triangular bandage .. , 37, 38 (Fig. 8)

In what waysmay thetriangl1larbandage be folded for use? 37

IIow many kinds of arm-slings are there, and vvhat are they called?

4c. 49

\ Vhat knot is to be tied, and what knot avoided? -to

\ Vhat is the object of fi rst aid treatment of fractures? 4 I

Give the ge n eral ru les for the treatment of fractures 41 lIow should splints be applied?

How should bandages be appli.::u?

\Vhat may cause a fractnre of the upper part of the cranium?

, 42, 43

What may a fracture of the base of the craniUFl1? 43, 44

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

\Vhat are the signs of fracture of the base of the cranium? 44

What i the treatment for fracture of the cranium? 44

\Vhat are the signs of fracture of the lower jaw? 44

How maya fractured spine be caused? 45

'''hat is commonly regarded as a broken back? ... 45

'Vhat are the symptoms of a fractured spine? 45

How may ribs be fractured? 46

IIow maya fracture of rihs be complicated? 47

State the signs and symptoms of a simple and of a complicated fracture of ribs 47

'Vhat is a frequent cause of fractured collar-bone? 48

'Yhat are the signs and symptoms of fractured collarbone? . , 48, 49

At what points may the bone of the arm be broken? ... 52

Are the general signs and symptoms of a fracture always present in a hroken forearm? ... 54

State the cause of a common fracture of the radius 55

How would YOll recognise a f;a.cture of the pelvi ? 56

At what points may the thigh-bone be broken? ... 57

" That are the signs and symptoms of fracture of the thigh-bone? 57

'''hat are the causes of fracture of the knee-cap? ... 58, 59

'Vhat are the signs and symptoms of fracture of the kneecap? 59

Are the general signs and symptoms always present in a fracture of the leg? 60

What mistake may easily be made when the fibula is broken near its lower end? 60

What is a dislocation?

the

the treatment of a ankle ... 6" 65

State the treatment of other sprains .... "f.

not sure whether injury IS a spraJl1 or lacture how would you treat It? ... "'? ".

How may muscles be strained or rup.tured .

State the signs and of strams .,.

State the treatment of s'la!l1S ... F' t A'd Students should pLlctise lfS f ld l b dages tying knots makIng shngs, an o l11g an, .' . . the treatment of the follOWing 111Jl1nes.

Knot for applying splint to lower "45, 46.'

Fractures-Lower jaw. 44· p, 6 8 Breast(simple and complicated fractules). 4 to; collarb e 8 Collar-bone, 48 to 51 0 on , 4· AIm close up to shoulder, 52. Arm, bones, .5 I. f h' ft 52 Arm or forearm when the near mIddle 0 sa, . Crushed band elbow is involved, 53· F<?rearm, 55) 58 Thiah 5- 56 Peh'is 56. ThIgh (man, 57, . r b or 111a'n when single-handed), 58. \.neew '60 Leg (man), 60, 61. Leg (woman. or r lP, 591, '. I -banded) 62. Crushed foot, 62 . man \V len smg e , . 6"', 64

Dislocations-Out of doors al1 fl 1I1r1oorS . . . . ..) 6-1ankle ", ", .. , 00 " 65

Strains and ruptured muscles

CHAPTER III.

TrIE ORGANS OF CIRCULATION.

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

The Heart is situated in the chest behind the breast-bone and rib cartilages, between the lungs and immediateiy above the diaphragm; it lies obliquely with a quarter of its bulk to the ri ght and the remaining three-quarters to the left of the middle lin e of the body. Its beat may be felt just below and to the inner sid e of the left nipple. The heart has four cavities, two on either side of a central partition. The two upper cavities are named the right and left auricles, the two lower the right and left ventricles.

Arteries !lre vessels which convey blood from the heart. Veins carry blood to the heart. Capillaries connect the arteries and veins.

In the general (systemic) circulation arterial blood is driven from the left ventricle of the heart into 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 sub-divide, and become so small as to assume microscopic dimensions, wh e n they are termed capillaries.

36. . ). T Tra chea (wind-pipe): R . L. L. Larynx (vOlce L . (the lungs are drawn back to Right. Lung; L. L Le tung ). R A Right f'. uricl e ; expose the hea.rt L V Left

L.A. Left Auncle , R. . . Ao Aorta; S.V.C. Supen or tricle; P.A. Pulmonary A from the uptJer part of yena cava (the large ve)m vena cava (the large the body to the heart ; . h' 1 . part of the body to the ve in ca rrying blood from t e cannot be shown in the heart). The four pulm onary vems

FIG.

In the capillaries an intercl1ange of gases and fluids takes place, whereby the nourishment and maintenance of the tissues and organs of the body are provided for, and the blood becomes dark and impure.

Venous blood pass es from the capillaries to the veins, which convey it towards the heart, getting larger and larger as they proceed by being joined by n eigh bouring veins until they finally, as two large vess e ls, reach the right auricle of the heart. The vein s , especially in th e limbs, are provided with valves at frequent intervals, which prevent the backward fl ow of the blood.

The pulmonary system of blood vessels is concerned in carrying the blood through the lungs. From the right auricle the blood pass es to the right ve ntricle, and is thence carried to th e lungs, where it is purified by contact with air, and becomes scarlet in colour; it is then conveyed to the left auricle of th e h eart ani passes into the left ventricle, thus completing the circulation.

The heart contracts in adults at an average rate of seve nty-two times a minute, but the rate varies, incr easing as the position is changed from the lying to the sitting or to the standing position; hence th e importance of adjusting the patient's position in cases of hremorrhage. At every contraction ()f the left ventricle blood is forced into the arteries, causing the pulse. which may be felt wherever the finger can be

E x planat ion. - In the middle of th e diagram is the heart with ilS four chambers. Ab ove the heart is sh own the lung (pulmonary) circulalion. The lower part represents the gen eral (systemic ) circulation. V essels containing impure (venous) bloodare shown black, while those containing pure (arterial) blood are shown white. The connecting vessels represent the ca:)i,laries. The arrows show th..:: ..Iirection of the flow of blood.

37.

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

HLEMORRHAGE.

Hremorrhage, or bleeding, is of three k.inds:I. Arterial. 2. Venous. 3. CapIllary.

FIG.

DIAGRAM G:'i' THE CIRCULATION OF THE BLOOD.

ARTERIAL HiE:\lORRHAGE.

r. · - Bl ood from an artery is scarlet.

2. - If the wcunded artery is near the skin the blood spurts out in jets corresp ondin o- to t he pulsation of the h eart. U

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

ARREST OF ARTERIAL HiE:\IORRHAGE.

Art erial hrem orrhage is, when practicabl e, to be by pressure,. positi on of the body, and elevation of the bleedmg 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. th e pressure point. The pressure pomts are indicated by num bered dots on the frontispiece.

2. a pad and ba n dage (tourniquet) (a ) o n the j (b) on tbe pressure point.

3 . - By fleXIOn.

To a and bandage to the wound, a piece of l Int or linen or a clean handkercbJef folded i!lto a hard pad, on the bleeding point, and , It bv a b::1.l1dage tigbtly tied round the mJ ured par t. To fold the handkerchief brin othe four corners to the centre, and repeat the untIl a hard pad is formed . T he smooth surface is

75

plac ed on the wounJ, and, to prevent the pad from unfolding, the puckered surface may be stitched 01 fix ed by a safety pin . A hard substance, such as a st one, may be enclosed in t?e centre of the pad.

A Tourniquet may conSIst of a pad to be placed on the p ressure poi n t, a strap, cord, or. bandage to e ncircle the limb and pad, and a tlghte7ttng , a:rangement, such as a stick or other means of tWlstmg the band to tighten it. .

To improvise and apply a tourn1quet. :-

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

2.-Encirc1e the lim':J by a narrow ba n dage WIth its centre over t he pad .

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

...j..-Lay the twisting stick on the half knot, and over it tie a reef knot.

5.-Twist the stick to tighten the thereby pressing t h e pad upon the artery, and arresting the flow of blood.

6.-Lock the stick in position by the ends ot the bandao-e alreldy applied, or by anothe r bandage round t he stick and limb.

The pad of the tourniquet must be ao:urately placed upon the pressu re point so as to compress the artery j otherwise arterial bloo.d wIll. be allowed to pass alo ng the limb, and the vems, bemg co mpressed by the tourniq u et, wi ll not allow the

Dlood to return through them to th e heart, and the. result wil l be dangerous swelling and congestion .

Should suitab le pad not be at hand, a knot may be ,made 111 th e cent re of the bandage, and when avaIlable, a ston e, cork, etc, enclosed in it to aive it firmr:ess and bulk. .See that the bulging and the fI. It SIde of the knot IS next the skin.

, An . elast,ic bandage tightly round the 11 mb, above the seat of arterial hcemorrhage, WIll, arrest The simplest prepared form of thIS IS a strip of elastic webbing, to thirty lt1ches long and t\\'o inches wide, wIth a pIece of tape sew n at eac h end . A n elastic belt or brace wi.'! se,rve the purpose. Except when part a 11mb IS torn off, It IS not adv isable to use an elas,t Ic cord or bandage if other apparatus can be had, It cuts off all circnlation in the limb.

FlexlOn co?sists o f the application of a pad on the POll1t at the knee or elbol\' joint, flexing the Illnb to pressure, and ser urmg the limb in the fl exed pOSItion by a bandage crossed like the figure 8.

GENERAL RULES F() R TR;!'ATMENT OF A 'WOUND

ACCO.\lP.-\:\'lED BY ARTERIAL HiE:\JORRHAGE.

1. Stop bleeding.

U. Prevent injurious germs from getting into the wound.

77

To attain these e n ds :-

I. Place the patient in a suitable position, bearing in mind that the blood escapes with less forc e when the patient sits, and is sti ll more checked \\'hen he li es down.

2. Illevate the bleeding part, as thereby less blood finds its \\ av into it.

3. Expose the wound, removing whatever clothing is necessary. (See Rule 8, a.)

4. Apply digital pressure. . (a) If the wound is small o n the bleedmg spot., (b) If the wound is large on the pressure pom t next to the wound on the beart side. The n earest pressure point is chosen in o rder to avoid cutting off the cir culation fron:- as much of the part as possible, but sometImes it is necessary to apply pressure still nearer to the heart.

5. Remove foreign bodies, such as broken glass , bits of clothin a hair, etc, seen in the wound j Jc, not search for fureign bodies you cannot see.

6. Cover the wound with a clean and firm absorbent dressing. A hard dry pad of boracic aaUle or lint is to be preferred, but absQrbent cotton lint, or g lu ze, or a clean piece of linE'n wili.

answer the purpos e . Should any doubt be entertained as to the cleanliness of the dressing, a clean piece of unprinted pa per, such as the inside of an

en vel?pe, should be ?laced next the wound before applymg the pad. (Compare pages 75 and 76.)

7· Bandage tightly over the pad unless :-

(a) bodies are s uspected to be left unseen m the wound.

(b) There is danger of causing injury to a fracture. these c ases a light dressing only should be applIed.

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

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

(b) As a more permanent measure \Vhen bleeding cannot be. stopped by the pad and bandage on the wound, or when, in accordance with Ru le 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 \Vound IS lacerated (for examp le by the claw of an animal or by machinery) hremorrhage freq u ently does not come on at once, but as there is a danger of severe later, means for its arrest should be apphed to the lim b, but not tightened un less r..ecessary. not disturb a clot of blood formed over a wound. No should be made to cleanse a 'wound except WIth sterilised water (that is previously boiled

79

and allowed to coo!), and experience, in recent wars, has shown that those whlch were provisionally treated with a dry dress ll1 g subseauently dressed by a surgeon with proper appltances did best. .

Students p,actising arrest of arterIal hremorrhage should feel the pulse to see when the current of blood in the artery has been stopped, and should then immediately relax the pressure made on the In this way the importance ('If the accurate apphcatlOn of pressure will be and the amount of force necessary will be ascertamed.

THE COURSE OF THE MAIN ARTERIES, AND THE ARREST OF H1E?lIORRHAGE.

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

THE LARGE ARTERIES \ VITHIN THE CHEST AND ABDOMEN.

The Aorta is the central or of the body. Commencing at the lett ventncle lt forms an arch behind the upper p:ut 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 spi ne to just below the where it divides into two great branches (the lhacs)

which convey th e blood to the organs In the pelvis and to the lower lim bs

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

ARTERIES OF THE HEAD AND NFCK.

T4e Carotid Arteries (right and left) leave the upp e r part of the chest and pass up on either side of the windpipe and, just below the level of the anale of the lo\\"er jaw, divide into the Internal and E'\ternal Carotid Arte ri es . The Internal Carotid Artery ascends deeply 111 the neck, and enters the cranium to supply the brain with blood. The External 'Carotid gives off a number of branches; to the front the artery of the tongue (Lingual), the artery to the .face to the blCk the Occipital; the artery ltself lS contll111ed upwards in front of th e ear it changes its name to th e Temp oral, and supplIes the scalp in the neighb oll rhood of the templ es .

When a Carotid Artery is wounded, as in the case of a cut throat, apply the thumb of one hand on the .artery at pressure point I, pressing backwards agamst the and taking care to avoid th e windpip e . It m:1y also be necessary to apply pressure \\lth the other thumb above the wound for two reasons: (a) To arrest the flow of blood from the main (jugular) vein in the neck, which runs

81

alongside of the carotid artery and is usually wounded at the same time; (b) To check the fl ow of blood from the upper end of the carotid artery it.self? 'which is often considerable owing to commUl1lcatlOn between the branches of this ar tery a nd those of its

39· fe llow. Digital pressure must be by relays of assistants if nec essa ry, until the doctor arrives (Fig. 38). . . The Facial Artery crosses the lower Jaw 111 a sliaht hollow two finaers' breadth in front of the angle, and sends to the cbin, lips, cheek, and

FIG.

82

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

(a) D igital 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 vic: versa.

F I G. 41 .

. The Temp oral Artery may be felt pulsating m front of the upper part of the ear. Hcemorrhage from the of the temple may be arrested by press ur e apP !le? at pressure point 3 (Fig. 40 ) .

The OccIpital Artery supplies branches to the

83

reg ion of the scalp from behind the ear to the back of the head. Hcemorrhage from this region may be arrested by digital pressure on pressure point. 4, finaers' breadth behind the ear ( Fig. 41). This pomt is difficult to find , and it is usually sufficient to apply pressure immediately below the wound.

Hc:emorrhage from . t he Forehead or an ywhe re in the Scalp. may be arrested by applying a / small firm pad on the bleedin a point and securing . o it by a narrow bandage v\'l,th its centre laid on the pad, the ends carried round the head in the direction m ost convenient. and tied tightly over the pad ( Fig. 4 2 ).

'When a wound of the forehead or scalp is associated with a fracture, the F I G. 4 2 . best plan is to apply a ring . pad around the seat of injury. To make a rIng pad, pass one end of a narrow ban dage round your fing er s ; pass the other end o,f the bandag,e through the ring thus formed and contmue to pass It t?rough and throu a h until the whole of the bandage IS used and a ring O as shown in Fig. 43 is formed.

ARTERIES OF THE UPPER LIMBS

The Subclavian Artt ry passes from a point behi n d the inner en d of the collar-bone across the firs t rib to the a rmpit.

FIG. 43· FIG. 44.

To apply digital pressure :.-

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

2.-Place the patient 's arm against the body so as to depress the shoulder, and cause him to inclll1e his head towards the injured side.

3·- Take your stand opposite the shoulder.

4 · - U sing the left hand for the right artery, a n d vice versa, grasp the neck low down, placing the fi n gers behind the shoulder and the thumb immediately above the centre of the collar-bone jn the hollow between the 111 uscles attached to the bone (pressure pomt 5). 85

5. - Press the thumb an.d backwards against the hrst nb, whIch IS be neath the collar bone at t h is spot (Fig. 44 ) ·

The Axillary Artery , \yhich is a of the subclavian, keeps close to the shoulder JOInt, and can be felt pu Isating when the fi n gers ?eeply 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 banrlage on the sh o ulder; pull the ends tight .and tie them under tIle opposite armpit, takll1g care that the pad does not .slip . . .

FiG. 45.

3 . - Flex the forearm and tIe the hmb tlgb.tly to the trunk with a broad bandage, applied on a leve l 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 of the coat sleeve above the elbow roughly IndIcates Its course.

Digital or instrumental pressure may be applied at or near pressure point 7. __ 1'1(;. 4 6.

47,

To apply digital pressure extend the limb at right angles to the body, palm of the hand upwards. Stand behind the limb, and pass the fingers under the back

of the arm over the sea.m of the coat or the groove on the inside of the biceps muscle. Press the pulps (not the tips) on th e artery (Fig. 46). Some prefer to pass the hand over the. front of the muscle (Fig. 47) A slight. turn of the hand out\\'a:ds as it grasps the arm \\'lil better ensure compressIOn of the artery.

The Brachial artery rnay be compressed at the

49· 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 sleeye rolled or gathered up wIll serve ll1stead (Fig. 48).

FIG.

FIG.

. 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. of these arteries join to form the Palmar Arches in the hand. The arteries run along on p;ther side of the fingers to tll e tip.

Pressure may be applied to the Radial and Ulnar art.eries at pressure points 9 and 10, by the thumbs (F Ig. 49) or as follo\\'s :-

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

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

3· - Secure them by a tight bandage.

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

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

2.-Spread out a triangular bandage, t urn up the base about four inches, lay the back of the patient's hand on the centre of the bandaae fold the point over the knuckles and pass the two ends round the wrist, make

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

3.-Elevate the forearm and support it with a " St. John II sling (see page 49).

Arterial hc:emorrhage from the fingers may be arrested by applyin a a small pad on the wound, and securing to it firmly with a strip of tape, linen or plaster.

ARTERIES OF THE Lo ,\ ER LIl\IBS.

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 bon e to the back of the knee joint as the Popliteal artery.

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

I. -Lay the patient on his back.

2.-Kneel beside the patient.

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

4·-P lace the thumbs one on the other upon the pressure point, grasping the thigh with the hands (Fig. 51 ).

:' .- Press firmly against the brim of the pelvis.

As there is immediate danger of death it is important not to 'vyaste time 111 removing the trous ers.

When 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 devised for compressi on at this point, and relays of assistC" t1ts should be employed to keep up the pressure until the doctor arrives j each fresh assistant places his thumbs over those of his predecessor, who slips his away from beneath, and thus gushes of blood are prevented during the change.

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

\Vhen practising compression of tbis artery, it 1S a FIG. 52.

good plan to dralV a chalk line from the centre of the groin to the inner side of the back of the knee; place the pad of the tourniqu et on this lin e as high up as th e 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 fl exion at the knee (pressure point 13); the pad

FIG. 53.

should be the size of a lawn tennis ball, or if no pad is avai lable the trous er leg may be r olled or gathered up to serve inst e.ad . It is n ot n ecessary to take off the clothing (Fig. 53).

Just b elow and behind the knee joint the Poplit&al arte ry divides into the Anterior (fr ont) a nd Posterior (back) Tibial arte ri es.

The Posterior Tibial Artery passes down the

93

back of the leg to th e inner side of the a nkl e. It is at first deeply placed between the :TIuscles cf the calf, b ut it approaches the surface as It proceeds, so that it can be felt pulsating behind the large bone a t the inner side of the ankle. It enters the sole as the Plantar Arteries, which run forward amongst the mus "les to supply the foot and toes. .

The Anterior Tibial Artery , on leavll1g 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, d ips down to the sole between the and second metatarsal bones. Here it forms \\'lth the Plantar arteries what is known as the Plantar Arch. At the ankle (pressure points 14 and IS) p ressure may be applied by the fingers or by pads and bandages.

VEi\OUS HADfORRHAGE.

I. - Blood from a vein is red.

2.-It flows in a slow stream.

3. - I t issues from the slde of t he wound further from the heart. .

4 - In the case of a wound of a vancose it flow.s also from the side ?f wound to the heart, especiall y if the p::ttlent IS kept stand1l1g.

Varicose Veins.-The veins of the leg are specially apt to become varicose. A varicose vein is dilated, winding, and with bead-like (varicose) projections along its course. A vein becomes varicose from several causes, such as long standing or tight garters. The first effect is to throw extra work upon the valves, and the bead-like projections are caused by the blood accumulating in the pockets behind the valves. In time the vein becomes so dIlated that the valves can no longer span it.

GENERAL RULES FOR TREATME T OF A \VOUND ACCOMPANIED BY VENOUS H1EMORRHAGE.

I.-Place the patient in a suitable position, bearing in mind that the blood escapes with less force when the patient sits and is still more checked as he lies down.

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

3·-Expose the wound, removing whatever is necessary.

4.- Remove any constrictions, such as the collar or garters, 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 not stop the bleeding, make pressure near the wound on the side away from the heart. In the case of a wound of a varicose vein it may als9 be necessary to

apply a pad and bandage to the vein immediately above 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. - Afford support to the injured part.

CAPILLARY HJE:\roRRHAGE.

1.-The blood is red.

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

3.-lt wells up frem all parts of the wound. A slight amount of pressure will suffice to arrest C;l pillary hremorrhage.

INTERNAL HJE:\IORRHAGE.

\Vounds of the blood vess els within the trunk cause hc:emorrhage into the cavity of the chest or of the abdomen.

SIGNS AND SYMPTO?IlS OF INTERNAL HJEi\LORR HAGE.

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

2. -- Pallor of the face and lips.

3.--Breathing hurried and laboured, and accom· pani ed by yawning and sighing.

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

5.-The patient throws his arms ahout tuas at the clothing round the neck, and calls for air: 0 .6.-Finally the patient may become totally unconSClOUS.

TREATMENT.

I.-Keep 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 water on the face; hold smelling salts to the nostrils; aVOid other forms of stim ulants at all events until the hcemorrhage has been controlled.

s .-Give ice to suck or cold water to drink' if the seat of the .hcemorrhage is known, apply an 'ice bag ov€r the reglOn.

6.-Should the patient be reduced to a state of collapse, raise the feet an? bandage the limbs firmly fro :n the toes to the hIpS and from the fin aers to the shoulderf:. 0

HlEMORRdAGE FRO!\! THE NOSE (NOSTRILS).

I.-Place, the patient in a sitting position in a current O,f aIr before an open window, with the head thrown shghtly back and the hands raised above the head .

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

3.- Apply c old (ice, a cold sponge or bunch of 97

ke'ys) over the nose and also the spine at the level of the collar; place the feet in hot water.

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

Blood issuing from the mouth may come from the tongue, the gums, the socket of a tooth after extract ,on, the throat, the lungs, or the stomach .

HlEMORRHAGE FROM THE TONGUE, THE GUMS, THE SOCKET OF A TOOTH, OR THE THROAT.

I.-Give ice to suck or cold water to hold in the mouth. If this is not successful give water as hot as can be borne to hold in the mouth.

2.-If necessary make pressure on the carotid arteries.

, 3.- If .bleeding from the front part of the tongue IS excesSIve compress the part by a piece of clean lint held bet\\ een the finger and thumb.

4.-If the bleeding is from the socket of a tooth , plug the socket with a piece of clean linf or cotton wool; over this place a small cork or other subsiance of suitable si ze, and instruct the patient to bite on it.

HlEMORRHAGE FROM THE LUNGS.

Blood from the lungs is coughed up, and is scarlet and frothy in a ppearance.

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

FROM THE STOMACH.

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

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

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

99 QUESTIONS 0. CHAPTER III.

the circulation of the blood through the body and lungs

many times a minute does the heart contract on the average?

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

State the general rul es for treatment of a wound accompanied by arterial hremorrhage ...

If ?art of a limb had been torn off, lml there was not much bleeding, how would you act?

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

D escribe the arteries of the head and neck

80

Why 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 arteries of the upper limbs... 8-+ to 89

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

How would you know a case of venous hcemorrhage? 93

What is a varicose vein? 9+

How maya vein bec ome varicose? 94

State the general rules for treatment of a wound accompanied by venous hcemorrhage? ... 94, 95

How would you know a case of capillary hremorrhage ? 95

How would you st op capillary hremorrhage ? 95

What is internal hremcrrhage? 95

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

State the treatment for internal hremorrhage? ... • 96

How would you arrest hcemorrhage from the nose? '" 96, 97

\Vhere may blood issuing from the mouth come from ?... 97

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

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

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

How would you 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 position for the arrest of hremorrhage (see pages 72 , 77 and 94), folding firm pads (74 and 75), tying hard knots in bandages to form a 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 and bal1dage, or flexion, as directed in the text.

101

Pressure points - Carotid artery, 80 S ' b rac}al, T emporal 32. Occipital , 83. u c aVIan, 4·

A ' 11' '85

Brachial (by pad and bandage, XI aIY, . h d b pressure being made against the umerus an y flexion at the elbow), 86. Radial Ulnar,. 87. Femoral at the groin, 90. Femoral III .the 9 2 Popliteal, 92. Anterial and postenor TIbIal

arteries, 93.

Hremorrhage from the forehead or scalp .. . .., 84

Hoemorrhage from the palm 'of hand ... ....

Venous hremorrhage from a vancose or other vem

87 to 89 ... 93, 94

PAGK

CHAPTER IV. BRUISES.

A blow anrwhere on the surface of the b?dy may cause extensive hc:emorrhage bel'leath the skin, without breaking it-a" black eye" is an instance. The injury is accompanied by discoloration and swellmg.

TREATMENT.

Apply ice or cold water dressings. A piece of lint soaked in extract of witch ha:t.el may be placed on the affected part.

BURNS AND SCALDS.

A burn is caused-

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

(b) By a rail., wire or dynamo charged with a high pressure electric current.

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

(d) By a corrosive alkali, such as caU5tic soda, ammonia, or quicJdime.

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

A scald is. caused by moist heat, such as boiling water, hot 011 or tar.

The effect may be a mere reddening of the skin' blisters may be formed; or even the deeper tissue;

of the body may be charred and blackened. The clothing may 8.dhere to the burnt skm, and its is impossible without further detnment to the mJured par t. The great danger is Shock.

TREA 'I

I.-Carefully remove the clothing over the injured part. If stuck to the. skin,. the adherent clothing must be cut around wIth SCissors, soaked with oil, and left to come away subsequently.

2.-Do not break blisters. up or

smear pieces of 1mt or lmen with Oil, or vaseline, bnoline, or cold cream; a small quantity of boraCIC powder added to these will be of benefit. r The inside of a raw potato scraped out and spread on lint makes a soothing application. 'When the injured :> urface is extensive do not cover It \yith one large sheet of lint, but with strips about the breadth of the hand; this is advisable as they fit be tter on the part, and during subsequent dressings. one strip can be removed at a time and a fresh dressmg applIed before the ad· jacent st:ip is taken off. The shock to the system is thereby less than if the whole of the burnt surface were laid bare to the air by the removal of all the dressings at one time. covered by oily dressing envelop the part III cotton wool or a piece of flannel and apply a bandage.

. 'Vhen the face is burnt, cut a mask out of lint or linen, leaving holes for the eyes, nose and mouth. Dip this in oil or smear it with vaseline and apply it to the face and cover it with cotton wool, leaving openings to correspond with the holes in the mask.

'Vhen possible place the injured part in water at the temperature of the body (98 degrees) until sui ··:tble dressings can be prepared. A dessert spoonfd of baking soda added to a pint of the warm water will make a soothing lotion.

As it is important not to leave the part exposed to the air, it is the duty of the bystanders to prepare the dressings while the clothing is being removed.

. 4·-Treat Shock.- This is particularly necessary m the case of every burn or scald of any considerable extent (see page 135). Be very apprehensive of danger in the case of even slight burns of the neck.

5·-If the burn is caused by a corrosive acid, bathe the part with a weak alkaline lotion, such as washing soda, baking soda (bicarbonate of soda), magnesia, or slaked lime in wann water before applying the dressings. the burn is caused by a corrosive alkah, bathe the part with a weak acid lotion such as lemon juice or vinegar diluted with an equal quantity of water. Cautt'on.-Before using water brush off any lime that remains on the part.

7 -When a woman's dress catches fire-

• (a) Lay the woman flat on the floor at so that the flames are uppermost; that IS to say if the front of the dress is on fire lay he; on her back, and if the back of the dress is burning, place her face down wards. The reason for this is that flames ascend, so that if the upright position is assumed, the flames will quickly reach and burn the body, neck, and face; or if the lies with the flames undermost, they WIll, if unextinguished, pass over 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, as a rug, coat, blanket, or table cover; If made wet so much the better.

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

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

The use of fire guards would prevent many cai::tmities.

BITES OF SNAKES AND RABID ANIMA LS, AND WOUNDS BY POISONED WEAPONS.

Hydrophobia is caused by the bite of an animal, such as a dog, cat, fox, wolf, or deer suffering from rabies. The special poisons introduced into wounds caused by venomous snakes and poisoned weapons cause immediate danger to life.

TREATMENT.

I.-1mmediate!y place a constriction between the wound and the heart so as to prevent the venous blood from carryit1g the poison through the b ody . If, for example, a fi n ger is bitten it should be encircled on the side of the wound nearest to the heart, with the finger and thumb, and as soon as possible a ligature (a string. piece of or strip of handkerchi ef ) should be place d tightly round the root of the finger. Compression with the finger and thumb must not be relaxed until the l igature has been applied. Additional ligatures may, with advantage, be applied at intervals up the limb.

2.- Encourage bleeding for a time :-

(a) By batrung the wound with warm water.

(b) By keeping the injured limb low; the upper limb should be allowed to hang do\\n, and in the case of the lower limb the patient '3hould be seated with the foot on the ground.

3. - Cauterise the wound, if it is quite impossible to obtain the services of a This is best done by burning with a fluid caustIc, such as caustic potash, pure carbolic acid, or nitric acid, or if these are not at hand, with a red-ho t wire or a fusee. The usual solid caustic is insufficient, as it does not reach the bottom of the wound, where the poison is.

To ensure the caustic reaching the bottom of the wound, it should be applied. on a piece of such as a match cut to a pomt. "When the caustIc has been thoroughly applied, but not till then, the ligatures may be removed.

4. - Cover the wound, <1.fter a while, with a clean dressing.

5.- Afford support to the injured part.

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

7.-1n the case of a bite by a venomous snake, rub in powdered permanganate of potash and inject under the skin in the neighbourhood of the wound a solution of permanganate of potash.

STINGS OF PLANTS AND ANHvIALS.

These give rise to serious inconvenience, and in some cases grave symptoms develop.

TR EAT.MENT.

I. - Extract the sting if left in.

2. - Mop the part freely with dilute ammonia

108 or spirits. A paste of bicarbonate of soda and sal volatile is an effi cient application. A solution of "-lashing soda or potash o r the application of the blue bag will rel ieve p a in . . 3·- Treat collapse if it occurs (see page I35).

FROST BITE.

exposure to severe cold, parts of the body, usually the feet, fingers, nose, or ears, lose sensation and become first waxy white and aft erwards congested and of a purple appearance. As sensation is lost in the it is often only by the remarks of bystanders tbat the frost-b i tten person is made aware of his condition .

TREATMENT.

I .- Do not bring the patient into a warm room until, by friction of the band or by rubbing with soft snow, sensation and circulation in tbe affected parts are restored . of this precaution may lead to death of the tIssues of the frost -bitten part.

'0'hen circulation is restored , keep the patIent In a roo m at a temperature of 60 degrees.

N EEDLE EMBEDDED UNDER , THE SK I N_ a needle breaks off after penetrating the skin and disappea rs, take the patient to a doctor at once. If the wound is near a joint, keep the l imb at rest on a splin t.

109

FISH- HOuJ{ EMBEDDED I N THE SK I N.

Do not attempt to withdraw the l)y the way it went in, but cut off the dressll1g of th e hook, so that only the metal is left, and then force the point onwards through the skin until the hook can be pulled out.

I NJUR I ES TO JOINTS.

When a joint is injured by a bullet, stab, or other cause-

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

2.-- Afford rest and support limb; if the uppe:- limb, a posItlO n by slIng , if the lower limb, m a stra Ight posltlOn by a sphnt.

FORE I GN BODY IN THE EYE.

I .- Prevent the patient rubbing the eye, ty in 3 down a child 's hands if necessary. ,

2. - Pull d()wn the lower eyehd , ,,"hen, If t?e foreign body is seen, it ca,n readily be removed a camel 's hair brush, or With the corner of a handkerchief tv\ irled up and wetted .

3. - When the foreign body is befleath the upper eyelid lift the lid push up the lid beneath it and let go. fhe hair of the lower hd brushes the inner surface of the upper one, and may dislodge the body . Should attempt be unsuccess f ul, repeat it several times If necessary. If

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

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

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

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

(d) Remove the foreign body.

4.- When a piece of steel is embedded in the eyeball a little olive or castor oil on the after pullmg down the lower eyelid, close the lIds, apply a, soft pad of cotton \\ 0)1 and secure it by a bandage tied sufficiently firmly to keep the eyeball steady; take the patient to a doctor.

5·-When qui,ck-leime is in the eye brush as much of It as possible; bathe the eye \\ith vInegar and warm water, and treat as for a piece or steel embedded in the eyeball.

FOREIGN BODY IN THE EAR PASSAGE.

A.s a rule I?ake no to treat a patient with a body m the ear If the services of a doctor can pOSSIb ly be had; any attempts to remove the foreian body' may lead to fatal consequences. If a child

cannot be induced to keep the fingers from the ear, tie his hands down or cover UP the ear. If an insect is in the ear-passage, fill the ear with olive oil, \\'hen the insect will float and may be removed. Never syringe or probe the ear.

FOREIG N BODY IN THE NOSE.

Induce snee ing by pepper or snuff. Cause the patient to hlow his nose violently after closing the unaffected nostril. There is no immediate danger from a foreign body in the nose.

THE ABDOMEN.

The abdomen is bounded above by the diaphragm; below bythepelvis; behind bythelumbarvertebn:e; and in front and at the sides by muscula.r walls. (Fig. 54.)

T!IE ORGANS OF THE ABDOMEN.

T he S t omach 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 lower ribs.

Th e Spleen lies beneath the rIbs at the upper part of the left side of the abdomen .

The Intestine s occupy the greater part of the c:w:ty of the abdomen.

The Kidneys lie at the back, in the region of the loin.

The Bladder lies in the pelvis.

FIG. 54.

'WOUND IN THE \VALL OF THE ABDOMEN.

When the z"ntestines or other organs protrude through the woun.d, whether vertical or transverse, bend the knees, raIse the shoulders, and apply lint, a towel, or cotton wool wrapped in soft linen, anJ keep the 113

patient warm until the doctor arrives. \Vhen there is no protrusion of organs, if tlze wound is 'l..' ertical, lay the patient flat on the back \\ith the lower limbs straight; if the wound z"s trflJIS'Verse, bend the knees and raise the shoulders.

INJURIES TO THE ORGAN \VITHIN THE ABDOMEN AND PELVIS.

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

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

The Kidneys 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, there may be pain and swelling over the injured kidney.

The Bladder may be inju red by a fracture of the pelvis. The signs and symptoms are either inability to pass water, or if a little is passed it is tinged with blood.

TR EATMENT OF INJURY TO THE KIDNEYS OR BLADDER.

Keep the patient quiet until the doctor arnves.

2.-Apply hot fomentations over the painful or inj ured parL . . Rupture (hernia) consists of a protrusion of an mternal organ, usually the bowel, through the muswall of the abdomen, mO,st frequently at the Sh,ould a sudden accornpanied by pam and sIckness take place m that region

I.-Send for a doctor instantly.

2.-Lay the, patient down with the buttocks raised.

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

IIS

QUESTIONS ON CHAPTER IV .

mtme7-als ind.'cale the pages w/lere the answers may be fJund.

a woman's

f

How

you try to remove an insect from the ear

-Would you try to remove any ot her form of foreign bod PAGE from the ear passage? Y

How wo Id . f'" ... ... .,. 110, III

U you remove a oreign body from the nose? I I I

State the boundaries of the abdomen and its contents' II I

State the treatm ': nt for wounds of the abdomen

How rna . . . t h l' ... lIZ, 113

Y InJunes 0 t elver, spleen and intestines be of . ':'. ... II 3 the t h d f' . . InJunes to . s ?mac an 0 InJunes to the liver spleen nd IntestInes? ' a

State the treatment to the dd" 113

State the treatment of hernia a er 114 II 4-

CHAPTER Y . THE NERVOUS SYSTEM.

T wo systems of nerv es, the C erebro-spinal and the Sympathetic, regulate the movements and functions of the

Thebody.Cerebro-spinal

System is made up of the Brain, the Spinal Cord and Nerv es, and through its ag ency sensations are received and the will causes the acti·on of the voluntary muscles. For example, when a part is injured a sensation of pain is conveyed to the brain by the n erve, thus affording an indication of the seat of injury, or a warning of a possible danger of further damage. On attention being directed to 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 within the spinal canal (see Ve rtebral Column, page 23). It leaves the brain through an op ening in the base of the cranium and extends to the upper lumbar vertetme.

1I8

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

The Sympathetic System extends as a nervous chain 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 ahdomen to control the involuntary mus ' les, and thereby regulate the vital functions. This system is not under the control of the 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 wind-pipe by an opening guarded by a sort of trap door or valve, so that in health ni l', but not solids or fluids, may enter. During insensibility, however, the valve fails to act, so that should solids or fluids be given by the moutll, they may enter the wind-pipe and cause :1sphyxia. The ,vind-pipe extends to two inches belolV the top of the breast-bone , where it divides into the right and left bron chial tube. Each broncllial tube enters a lung and divides into small a n d still small er tubes, unti l

FIG. 55. THE LUNGS AND BRONCHIAL TUBES.

A. Trachea, or Wind-pipe. . B. Left Bronchus, C. Right Bronc hus. D. Smaller Bronc hIal Tubes.

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

The Lungs, Right an? occupy the greater p.art of the they he Immediately within the nbs, and wherever a rib is felt, whether front, .back or sides, there is lung beneath. Each IS enveloped in a fine membrane (the pleura) whIch . It to move within the chest during breathmg wIthout friction.

or breathing, consists of two acts, an expansion of the chest, duri lJ g whIch aIr drawn into the lun?s, and Expiration, a contractIOn of the chest, durmg which air leaves the lungs. A pause follows the act of expiration health fifteen to eighteen breaths are taken an? at each inspiration about 20 to 30 cubic ll1ches 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 t?e muscles of respiration attached to the nbs, but the Diaphragm, the large arched muscular partitIOn which separates the chest from the abdomen. inspirat.ion, which is chiefly a act, the nbs are raised, and the arch of the falls and becomes flattened, thus inc:easmg the capacity of the chest and causina the to enter. In expiration, an act performed almost without eifort, the nbs fall and the arch of the

diaphragm rises; this lessens the capacity of the chest and forces air out. The mechanism of respiration is somewhat like that of ordinary household bellows, but without a valve; the ribs may be compared to the boards of the bellows, while the diaphragm corresponds to the leather, the air passages being equivalent to the nozzle.

As the blood depends upon the air fCAr its purification and the oxygen necessary to maintain life, interference with breathing very soon may Rrod uce a dangerous state called asphyxia, examples of which 3re afforded by drowning, suffocation, choking, etc.

ARTIFICIAL RESPIRATION.

PROFESSOR SCHAFER'S METHOD.

I.-Make no attempt to loosen or remove clot h :ng.

2.-Lay the patient in a prone position (i.e., back upwards) with his head turned to one side, so as to keep his nose and rnouth away from the ground. No pad is to be placed und er the patient, nor need the tongue be drawn out, as it will fall naturally.

3. - Kneel at one side facing the patient's head, and place the palms of your hands on his loins, one at each side, the thumbs nearly touching one another in the small of the back, and the fingers extending over the lowest ribs. Leaning your body forward, let its weight press straight downwards upon the

lo ins and lower part of the back, thus compressing the abdomen against the ground and driving air out 'of the ch est. This produces expiration (Fig 56) . Draw back

. 57. I NSPIRATION.

12 3 your body somewhat more rapidly and relax the pressure, but do not remove your hands; this produces inspiration (F ig . 57 ) .

4 - Alternate these movements, by a rhythmic s\yaying backwards and forwa·rds of your body, twelve to fifteen times a minute, persevering until respiration is restored, or a doctor pronounces life to be extiect.

DR. SlLVESfER'S METHOD .

1 . - Adjust th e patient 's position. - \ Vithout wasting a moment place the patient on his back on a flat surface, inclined if possible from the feet u pwards. ' Remove all tight clothll1g from about the neck and chest, and bare the front of the body as far as the pit of the stomach; unflsten the braces dnd the top button of trousers in men, and the corsets in women. Raise and support the shoulders on a small, firm cushion or folded article of dress placed under the shoulder-blades.

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

3 .- Imitate the movements of breathing. Induce Inspiration . - Kneel at a convenient dist ance behind the patient's head, and grasping his forearms just belm\' the elbow, draw the arm s

FIG

FIG. 58. INSPIRATION.

FIG. 59. EXPIRATION.

12 5

upwards, outwards, and towards you, with a sweeping movement, making the elbows touch the ground

FIG. 61. EXPIRATION.

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

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

Repeat these move nents alte.rnately, deliberately, and perseveringly about fifteen times a minute.

'Vhen a sufficient number of assistants are present, Howard's method may be combined with Silvester's, as follows:-

Th e additional assistant kneels astride the patient's hips wIth the balls of the thumbs resting on either side of the pit of the stomach, and the fingers grasping the adjacent parts of the chest. Using his knees as a pivot, he presses forward on h is hands. Then suddenly, with 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 with those being performed by Silvester's method, pressure on the chest being made simultaneously by those performing the two methods (Figs. 60 and 6 I).

LABORDl:<-'S METHOD.

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

12 7

The patient is placed on his back or side; the mouth cleared; the tongue is seized-using a handkerchief or something to prevent it slipping from the fingers-the lovver jaw depressed; the is pulled forward and held for two seconds 111 that position, then allowed to recede into the mouth. These movements should be repeated about fifteen times a minute.

Artificial respiration must be continued until breathing is established, or until a doctor arrives. 'Vhen natural breathing commences, regulate the artificial respiration to correspond \\'ith it. Success may result even after two hours ' time.

Excite respiration.- 'Vhilst artifical respiration is being applled, other useful steps may be employed, such as applying smelling salts or snuff to the nostrIls, and flicking the chest with a damp towel.

Induce circulation and warmth after natural breathing has been restored. \Vn1p the patient in dry blankets or other covering, and rub the linlbs energetically towards the heart. Promote warmth by hot flannels, hot-water bottles, or hot bricks (wrapped in flannel) applied to the feet, to the limbs and body. 'iVhen the power of swallowing has returned give hot tea or coffee, or meat extract. The patient should be kept in bed and encouraged to go to sleep. Large poultices or fomentations applied to the

front and back of the chest will serve to assist breathing.

Watch the patient carefully for some time to see that the breathing does not fail; should any signs of failure appear, at once begin artificial respiration. INSENSIBILITY.

Unconsciousness or Insensibility may arise as follows :-

Injury to the H e ad.-Concus sion and Compression of the brain.

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

Various Causes.-Shock, Fainting (Syncope), Collapse, Alcoholic and other poisoning, Sunstroke and Heat-stroke, Infantile Convulsions, Asphyxia.

GENERAL RULES FOR TREATMENT OF INSENSIBILITY.

I.-If a person appears about to lose consciousness, prevent him from falling, and lay him gently down.

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

3. - Lay the patient in the position in which breathing is most easy-usually this will be on the back, or inclined to one side. As a general rule 129

raise the head and shoulders slightly when the face is flushed, and keep the head low when the face is pale.

4.-Undo all tight clothing round the neck chest and waist, un.fastening the braces and top button of the trousers In men, and the corsets in women, the object being to relieve pressure 011 the air passages, 1ungs, heart and abdominal organs. Be sure that there is no obstruction to the air passages by the tongue or by a foreign body in the throat. The possibility of false teeth obstructing breathin a must be considered.

<:>

s.-:-Provide for sufficiency of fresh air by openmg doors aml WIndows, and by keeping back a crowd.

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

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

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

9.-Give. no food 0: .whatever by the mouth whtle the pattent 1S 1nsensible.

10.-Should the spine or an important Done of the upper or of the lower limb be fractured it must be steadied and maintained at rest as soon Should the unconsciousness be prolonged. the patIent may be removed in a recumbent position F

to shelter, provided that the broken bone is adequately su ppo rted.

II.-When the patient is in a state of convulsion, support his head, and after wrapping a piece of wood or any uther hard material in a h andker chief, hold it in his mouth to prevent biting of the tongue. Do not forcibly restrain his limbs; prevent him from hurting hims elf by p ulling 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 water may be given to drink. If the pulse is feeble give warm tea or coffee, provided hremorrhage, either internal or external, is n ot present. A desire to sleep should be enco uraged, except in cases of opium poisoning, a condition that may generally be recognised by the history of the case, and also by the pupils of the eyes (the black openings in the grey, blue or brown iris) being minutely cont racted (pi n -head pupils).

13·-1t must not be assumed that a person is insensible as the result of drink me rely because the breath smells of alcohol ; frequently when people are feeling ill they take or a re given alcoholic stimulants, after which they may become ins e nsible, n ot from the drink, but from the cause that indn red them to take it, for examp le, insensibIlity coming on, effects of poisoning, etc. Even if

13 1

drink is believed to be the actual cause bility it must be borne in mind that th e patIent IS 111 a dangerous state, and he must be treated for Collapse by being covered up and kept _

Th e above ge n eral rules ",ill en able aId, t? _ be rendered efficiently in most cases of 111sens,IbIllt?l although the exac t form from which the patIent IS suffering is unknown.

CONCUSSION OF THE BRAIN.

Th e patient may be stunned b y a blow or fall on the head, or by a fall on the feet or part of t?e spine, He may quickly regain or 111sensibility, more or less complete, may be prolonged, TREATMENT.

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

2.-Be very apprehensive of 10 all cases of injury to the head. The patIent may be stunned, and after a short interval may some degree of consciousness, or the b:-all1 may apparently have escaped injury; yet 111 both there is a grave risk that a structure \\',lth111 the cranium has been injured, and that a serIOUS state of insensibility may develop later. C' ee Fracture of the Cranium, page 43)' A caution shoyld therefore be given to a patient who has lost conSCIOusn esS even '" ?

13 2

for only a after an inj ury to the head not to resume physlcal or mental activity without the consent of a doctor.

COMPRESSION OF THE BRAIN APOPLEXY.

'

Compression of the Brain may result from the same. as produce Con cussion; in fact, CompresslOn lS frequently preceded by Concussion.

. Apop.le?ty usually occurs in elderly people, and no sIgns of Injury are necessarily present.

In .both c c nditions the face is flush ed; the stertorous; one side of the body may be more lllnp than the other, and the pupil of one eye may be larger th.an that of the other; the temperature of the body IS generally raised.

TREATMENT.

I. - Apply the general rules for tr ea tment of Ins ensibility.

2. - Promote warmth in the lower part of the body by the application of hot water bottles to th e abdomen and lower limbs. Care must be taken not to burn the patient with the bottles which be wrapped in flannel, and their tested wIth the elbow .

EPILEPSY.

Epilepsy occur in persons of any age . but usually :)ccurs 111 young adults. The patient falls to

the ground, sometimes with a scream, and passes into a state of convulsion, throwing his limbs about. The treatment is according to the General Rules, especially Rule 11.

HYSTERICAL FITS (HYSTERIA).

SIGNS AND SV;\IPTOMS.

The patient, usually a young girl, in consequence of mental excilemeat, suddenly los es command of her feelings and actions. She subsides on a couch or in some comfo rtable position, thro\\ s herself about, grinding h er teeth, clenching her fists, shaking her hair loose ; sh e 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 tim es froth appears at the lips, and other irr eg ular symptoms may de\'el op .

TREAT;\ll:.I\T.

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

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

3.-A pply a mustard leaf at the back of the neck

Medical treatm e nt is necessary to cure the condition of mind and body which gives rise to hysterical attacks.

]34

SHOCK, FAINTING ( 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 new s, or sometimes sudden removal of fear and anxiety after prolonged susp ense, produce shock or fainting.

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

4.-Hremorrhage or h ear t weakness, a close or crowded room, tight clothing, fatigue, or want of fo od may bring on fainting or collapse.

SIGNS AND SYMPTOMS .

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

135

collapse is the liability to sudden relapse after a temporary improvement, and the utm ?st care a?d watchfulness must therefore be exercIsed to ma1l1tain the heat of th e body and to guard against failure of the h eart and lun gs.

TREATMENT.

I. - Remove the cause by arresting hcemorrhage, attending to injuries, loosening all tight clothing especially about the chest and rem?ving from a close or crowded room, usm g encoura gmg words, etc .

2. - Lay the pcrtient on the back, with the 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 h;emorrhage has been seyere and the patient is collapsed, firmly bandage the lImbs fr o m, the to es to the hips, and from the fingers to the armpIts.

5. - To stimulate the action of the heart, sal volatile and water may be given if the patient can swallow, or smelling salts may be held to the nostrils.

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

136

rugs or blankets over him; get him to bed in a warm but well ventilated room as soon as possible. Apply warmth to the feet and to the pit of the stomach by hot bottles or hot flannels. (Test the heat of wIth the elbow before applying them.) If the patrent can swallo:v, give hot . drinks, such as milk , tea or coffee. It IS well to add suo-ar as it aids in raising the temperature of the body. 0 ,

7·-:-If cannot be discerned, apply artIficIal respIratIOn.

want of nourishment has been the cause of famtIng or collapse, give food sparingly at first.

SUNSTROKE AND HEAT-S TROKE.

When exposed to great heat, as in the stoke-hole of a steamer, in tropics, or to th e rays of the dUring a march In very hot weather when bu.rde?ed, persor:s may. deve lop sickness, famtness, gIddIness, and dIfficulty m breatbin o-. The complains of thirst, the skin beco m es dry and the face very flushed, the pulse quick and A . very high temperature, stertoro us (snorIng) breathmg, and ins ensibility may ensue.

TREATMENT.

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.

5.-Procure as free a circulation as possible of fresh air, and fan the pa tient vigorously.

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

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

CONVULSIONS IN CHILDREN.

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

SIGNS.

Spasm of the muscl es of the limbs and trunk:, blueness of the fa€e, insensibility, more or less complete, and occasionally squinting, susp e nded respiration, and froth at the mouth are the prominent signs.

TREATMENT.

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

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

138 ASPHYXIA.

'When, owing to want of air, the blood is not supplied wi . h oxygen the patient beco mes insensible, and is said to be asphyxiated. This condition may be brought about as follows:-

I. Obstruction of the air passages.

(a) By DRONNING.

' /1) By PRESSURE FROM OUTSIDE: Strangulation, hanging, smothering.

(c) By A FOREIGN BODY IN THE THROAT: Choking.

(d) By SWELLI. G OF THE TISSUES OF THE THROAT: Inflam mation, 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.

II 1. Pressure on the chest, as when crushed by sand or debris, or by a crowd.

IV. Nervous affections, as the result of narcotic and certain other poisons, collapse, electric shock, or stroke by li ghtning.

GENERAL TREATMENT.

In all cases of Asphyxia attem\Jts must be made to remove the cause, or to remove the patient fro:n the cause. 'V hen this h3.s been done artificial 139

respiration must be applied, taking care that the air passages are not obstructed, and that there is abundance of fresh air.

DROWNING.

Persons completely immersed in water for even ten or fifteen minutes have been restored by artificial means. Therefore, if the body is recovered within a reasonable time, absence of signs of life is not to deter immediate attempts to restore animation.

The first thing to do when the body is to get rid of the water and froth obstructIl1g the. aIr passages, and then artificially to restore Tbis is best accomplished either by proceedIl1g at once to perform artificial respiration by chifer's method, or as follows:-

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

2.-Turn the patient face downwards, \yith a p8d below the chest, and with the forehead upon the right forearm.

3. - Whilst in this p os iti on apply pressure. by the hands to the patient's back over the lower nbs, and keep the pressure up for three . ..

4.-Turn the patient on the right SIde, m::untaIl11l1g that position also for three seconds.

5.- Re peat these movements altern::ttely as lor.g as froth and water issue from the mouth.

These operations (Marshall Hall's method) in themtend to promote respiration, but when the aIr passages are clear of froth and water Silvester's artificial respiration may be used by Itself or wIth Howard's method in conjunction.

'Vhile performing these operations send someone to the nearest house to procure blankets and dry clothing, hot water bottles, etc, and to fetch a doctor.

STRA TGULATION .

Cut and remove the band co nstricting the throat. Apply artificial respiration.

HANGrNG.

Do not \yait for a policeman: grasp the lower limbs and raise the body to take the tensi on o ff the rope; cut the rope, free the nock. Apply artificial respiration.

SMOTHER! TG.

Remove whatever is smothering the patient. Apply artificial respiration.

CHOKING.

Open m (' uth, forcibly if need be; pass the nght to back of the throat and attempt to dIslodge the foreIgn body; if vomiting r es ults, so much the better. If unsuccessful, thump the back bard. the head is bent forward. Apply artificial reSpIratIOn.

SWELLING OF THE TISSUES OF TH 8: THRO AT.

"Whether the swelling is caused by inflammation by swallowing very h ot water: as not infrequently happens to children attempti ng to drink from the spout of a kettle, or by the effec t of a c orrosive poison, the treatment is as follows :

I.-A pply a sponge, piece of flannel or other cloth, wrung out of very hot water, to the front of the neck, from the chin to the top of the breast-bone.

2.-Set the patient before the fire.

3.-Give ice to suck if it can be had; if n ot, give cold water to drink.

4.-Give animal or vegetable oil, a dessertspoonful at a tim e, to soothe the scalded throat and ease the pain.

S.-If breathing has ceased apply artificial resp iration.

SUFFOCATION BY SMOKE OR GASES.

I.-Remove the patient into the fresh air. Before entering a building full of smoke tie a handk erchief, wet if possible. round the head so as to cove r the n ose and mouth. It is well to move slowly, keeping low, or eve n crawling, whilst in a room full of smoke in search of a suffocated person. Every opportunity of letting in fresh air by opening doors or windows should be seized.

2.-Apply artificial respiration.

3·-In case of producer or water gas, inhalation of oxygen wIll also be necessary.

ELECTRIC SHOCK.

Electric current is conveyed by a cable wire rail or bar, called the "Positive," and Source of supply by another cable, wire rail or bar ca\.led the " N or through the In case of an elec,tnc raIlway, the current is generally conveyed by an ll1sulated rail called the third rail and returns through the ,running rails or an insulated raii called the fourth raIl, and in the case of a n It' t "f e ec nc ramway It 1S conveyed by an overhead conductor or trolley WI re, and returned through the running rails.

Through contact with a "positive" the shock rna be so severe as to cause insensibility, and the be to extricate himself, and must be WIth all possible speed As it is generall ImpossIble or inexpedient to switch off the curren{ some method must usually be adopted; but ust be, or else the person re n delJ,ng ass istance WIll hImself receive a shock.

To lIberate the sufferer from contact-

. from the earth by stand. mg on an . msulator or" non-conductor " that' b d h' h . , IS, a \,; y \\' IC reSIsts the c u rrent . Amongs t such bodies

143

are in diarub b er , dry glass, d ry bricks, d ry silk, dry cloth, dry wood and dry h ay o r stra \V ,

2. - Protect your hands from contact with the sufferer or the electric medium by cover ing them with an in sulator. Alth o ugh indiarubber is probab ly t he best insulator, do not waste time in running for indiarubber gloves. b u t use dry articles of clothing; an indiarubber tobacco pouch or cap, o r folded newspaper, would serve to protect the hands in an emergency. If no means 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 infrequently the case that the" stick" of the umbrella is a metal tube.

3.- Pull the suffe rer a way from con t a ct. 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 the re.

vVhen the sufferer is removed from contact-

I .-A pp ly t h e general t reatment for insen -

* A conductor is a body through which electricity readily passes, Amongst such bodies are copper, brass, iron, moisture and one's own body.

sibility (loosen clothmg, procure free circu latio n of air and place in a recumbent position) .

2. ·-Dip a towel in cold water and attempt to arouse him by sharply flicki ng the face and chest.

3·-Commence artificial respiration if other methods fail to restore animation. " Laborde's" method (see page 126) has been found to be very su ccessful.

4·-Treat burns if there are any (see pages r03, 1 0 4).

EFFECTS OF LIGHTNING.

A person struck by lightning is usually more or less deprived of consciousness . The treatment IS the same as that for electric shock, except, of that the instructions for removing the patlent from contact with the electric medium do not apply .

145

QUESTIONS ON CHAPTER V.

The numerals indicate the pages where the answus may be found.

\Vhat are the two systems of nprves ? ...

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

\Vhat is the spinal co rd?

are nerves like?

the sympatheti: system

the respiratory system

the acts of respiration

are the exp::tnsiol1 and contraction of the chest eftected?

to 121

In what system of artificial respiration is the patient laid back upwards? ...

In what systems is he laid on his back?

In what system is he laid on his back or side ..:

In what system is he rolled alternately on hIS SIde and face downwards? ... '" 139,140

How long should artificial respiration be persevered with? 127 What is exciting respiration?

127, 128

... . .. 127 What is inducing circulation?

\Vhy is it necessary to watch the pat;ent? 128How may insensiiJilily arise? ... 128

State the various forms of insensibili ' y 128

State the general rules for t:eatment of.insensibility 128 to 131

\Vould you examine the patIent to see If any bones were broken? . . ... ... 129

\Vhat wrong opinion may be formed when the patient smells of drink? 130

Is collapse from drink a seriou condition? 131

'What is concllssion of the b rain? ... ... 131

State the rules for treatment of concussion 131, 13 2

Wha( danger injury to head?

\Vhat caution should be gIven to a patIent who .h::s lost consciousness, even for a moment, after an Injury to the head? ... . ..

What are the causes of compre sion of the brain?

In what aged pe ople does apoplexy usually occur?

What are the signs and symptoms of compressIOn and apoplexy?

State the:rules for treatment of these conditIOns ...

What dangE'r is there in applying hot w<l;ter bottles to insensible persons, and what precautIOns should be

taken?

Describe a case of epilepsy 13 2 , 133

\Yhat special care must be taken in treating a case of epilepsy? ... 130, 13 2

Describe a hysterical fit 133

How would you treat a hysterical fit?

\Yhat are the commonest physical causes of shock? 134

\Vhat may produce shock or fainting? ...

\Yhat conditi ons do certain poisons bring about?

What may bring about fainting or collapse?

How would you rec ognise the general condition of shock?

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

State the treatment for shock, fainllng (syncope) and collapse ...

135, 136

\Vhat is the effect of sugar on the temperature of the bodYI

'What are the causes of sunstroke and heat-stroke?

State the treatment for sunstroke and heat-stroke

What are the causes of convulsions in children?

\Vh at are the signs of convulsions in children? .. .

State the treatment for convulsions in children .. .

State fully the causes of asphyxia ...

t two things have to be done in all

two things must be seen to before it is possible for artificial respiration to do any good?

Is artificial respiration likely to do any good if the air passages are obstructed. or if there is not abundance of fresh air?

What is the first thing to do in a case of drowning?

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

What steps must be taken before proceeding with Silvester's method?

should be done while artificial respiration is being performed?

the treatment for strangulation

the treatment for ch ok ing

lIow may a swelling of the tissues of the throat be cau. ed

State the treatment fur swelling of the tissues of the throat

the treatment for suffocation by smoke or gases

is electricity cOl1yeyed ?

How would you liberate a sufferer from contact with an electric medium?

\Yhat would you do when t he sufferer was r em') \-ccl from contact?

What would you do in the case of a lightning stroke? ... I-t4

CHA PTER VI. POISONING.

Poisons may be classified according to their treatment under two heads:-

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

(a) Arsenic, Phosphorus (contained in rat poison and lucifer matches), Tartar emetic and Corrosive Sublimate, which cau se a metallic taste in the mouth and a burning pain in the mouth, throat and stomach.

C

:) Strychnine, Prussic Acid, Belladonna (deadly nightshade plant) and several other varieties of plants, such as laburnum seeds, etc. ; these give rise to convulsions, delirium, failure of respiration and collapse.

(c) Poisonous meat, fish and fungi (often mistaken for mushrooms). Suspicion of these poisons should be directed to cases where several p e rsons who have partaken of the same food develop similar signs and symptoms .

(d) Alcohol, which may cause collapse.

(e) O pi um and its preparations, Morphia"

149

Laudanum, Paregoric, Chlorodyne, Syrup of Poppies and various soothing dri nks a nd cordials; these ca us e a tendency to go to sleep, which continues until sleep becomes deep and bre 'lthing stertorous; the pupils of the eyes become minutely contracted (pinhead pupils).

2. - Those which burn or stain the mouth, and in the treatment of which no emetic is to be given. Th ese are of two classes:-

(a) Acids, such as Nitric Acid (Aqua fortis), Sulphuric Acid \ O il of Vi triol}, Hydrochloric, or Muriatic, Acid (Spirits of Salt), strong 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 TREATMENT OF POISONING.

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

2.-Except when the lips and mouth are stained or burned by an acid or alkali,

ISO

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

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

(b) )Jfusta1'd-a dessert-spoonful in a tumblerful of luke-warm water.

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

(d) Ipecacuanha vVine-for a young child, a teaspoonful repeated at intervals of fift een minutes.

3.-1n 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 phosphorus poisoning. may be given either before or after th e emetic ,;{ 6e poison calls for one.

Strong Tea acts as a neutraliser of many poisons

151

and is always safe. A handful of tea should be thrown into a kettle and boiled .

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

(a) If an acid is known to be the poison give an Alkali at once. First ""ash the mouth out freely with lime water or other alkaline mixture, such as soda, chalk, whiting, or magnesia or wall plaster in water, and afterwards let the patient sip a little of it. Soda and potash are not to be given in the case of poisoning by oxalic acid.

(b) If a stro ng Alkali is known to be the poison give an acid at once. First wash th e mouth out freely with lemon juice or vinegar dilut ed with an equal quanti ty of \Vater, 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 chest with a wet towel. Strong black coffee may be given 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 front of the neck and give frequent sips of cold drinks.

15 2

7· - Apply artificial respiration if breathin g cannot be discerned .

8. - Treat shock and collapse .

9·-Preserve any vomit e d matter, food , or other substance , suspected of be i ng th e poison. Do not wash vessels which may have contained the poison, and carefully guard them.

Certain poisons require special treatment, and a few of the commoner of these are mentioned below with their treatment.

CARnoLIc ACID .

The odour of the breath will aid in the detection of this poisoll; the lips anj mouth are usually stained white, and several nervous symptoms come on.

TREATMtNT.

I.-Gi ve 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, staggering, inse nsibility accompanied by panting respiration, profound collapse and possibly convulsions are the general signs, and in addition a smell of bitter almonds is often present.

.TREATMENT.

I.-Place the patient in the open air.

15 3

2. - Dash cold \yate r on t he head and spine

c :) ntinuously .

3 -Apply artificial respirat ion.

4·- Hold smelling salts to th e nostrils .

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

POISONOUS MEAT, FISH AND FUNGI.

The signs and symptoms are vomiting and purging (diarrhce3.), colic, headache, great weakness, raised te mperature and a quick pulse.

J .-Give an emetic.

2. vVhen the emetic has acted, give castor oil.

3·-Treat collapse . (See page 135.)

STRYCHNINE.

The signs ana symptoms are a feeling of suffocation, livid features, and convulsions. The patient rests on his head and feet, and the body is arched.

TREATMENT.

I. -Give an emetic .

? .-Apply artificial respiration.

ALCOHOL.

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

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

QUESTIONS ON CHAPTER VI.

The numerals iudicate the pages wlure tlte answers may be found.

Under what two heads may poisons be classified?

\Vhat are the symptoms of poisoning by Arsenic?

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

vVhat poisons give rise to convulsions, delirium, failure of respiration and colhflpse? ...

8

I55 CHAPTER VII. BANDAGING.

Esmarch's Triangular Bandao-e has been described m Chapter II. It may be applied to keep a dressing on a \\"ou?d., burn or of any part of the body, or [or an 111Jury of a jomt.

If several people who had partaken of the same food developed similar signs and symptoms, by what would you suspect they had been poisoned? 148

Vvhat condition may result from poisoning by alcohol? 148

vVhat are the effects of such poisons as opium?.. 148, 149

\Vhat two classes of p oison burn or stain the m outh? 149

\Vould you give an emetic for such poisons? 149

Name some of the principal acids 149

Name some of the principal alkalis 149 of pois on-

State the general rules for the treatment ing

State the best methods of making a person vomit

How would you treRt a case of acid poisoning? ... 149 to 15 2 150 15 1 15 1

How would you treat a case of poisoning by an alkali?

State the signs, symptoms and treatment of carbolic acid p oisoning .. . . .. ... ... ... ... 15 2

State the signs, symptoms and treatment of p oison ing by Prussic Acid 15 2 , 153

State the signs. symptoms and t.reatment , f poisoning by poisonous food ...

State the signs, symptoms and treatment of poisoning by Strychnine

\Vhat would you do in the case of alcoholic poisoning? 153 IS3 153

For the Scalp (Fig. Fold a hem about It Il1ches deep along the base of a bandage ; place the bandage on the head so that the hem lies on the forehead close down to the eyebrows, and the point hangs down at the back; carry the two ends round the head above the ears and tie them on the forehead ; draw the point first down\\'ards, and then turn it up and pin it on to FIG. 62. th e banda;e on the top of the head.

For the Forehead, Side of 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

6 dressing, and the ends being carried round the head or limb, as the case may be, and tied over the wound. For the Shoulder (Fig. 63)· Place the centr::! of a bandage on the shoulder, with the point running

if W ' f'

63 . --===:o.-===--

FIG. 64. up the side of the neck; fold a hem along the base; 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 neck; turn down the point of the first bandage, draw it tight and pin it.

157

For the Hip (Fig . 64). Tie a narrow bandage round the bodv above the haunch bones, with the knot on the injured side. Fold a hem according to

FIG. 65· the size of the patient alo n g the base of a second bandage; place its centre over the dressing, carry the encs round the thigh and tie them; then carry the point up under the

FIG. 66. first bandage, turn it do\\ n over the knot a nd pin it.

For the Hand when the fingers are exte nded (Fig. 65). Fold a hem a long 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; bring the point over the knot and pin it to the bandage on the hand.

158

For the Foot (Fi g. 66). Place the foot on thE: centre of the bandage with the toes towards the point; eraw up the point over the instep, pass the ends round the ankle and cross them in front; no\V pass the ends round the instep and tie them. Draw the

FIG. 67a. point forward and pin it to the bandage on the instep.

For the Front of the Chest (Figs. 67a and 67 b). Place the middle of the bandage over the dressing with the point over the shoulder on the same side; carry the ends round the waist and tie them;

159

th e n draw the point over the shoulder and tie it to one of the ends.

. the Back. The bandagt: IS applIed as the foregoing, except that It is begun at the back.

For the Knee. Fold a narro\V hem along the base of a bandage; lay the point on the thigh and the middle of the base just below the knee-cap; cross the ends first behind the knee, then over the thigh and tie them. Bring the point down and pin it to the base (Fig. 68).

FIG. 68. For the E!bow. 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 Fingers and Toes wrap a _ stnp of callco or linen ",,,--':' round and round the < \, , ://l 1 h q!! " . v. part;sp Itt e.freeend, \' ' '# / ,./,II;, lnd secure It round , the wrist or ankle. \FIG. 69.

CHAPTER VIII.

METHODS OF CARRYING.

THE FOUR-HAND ED SEAT.

This seat is used when the patient can assist the bearers and use his arms.

1.-Two bearers face each other behind the patient and grasp their left forearm with their right hands and

FIG. 70.

each other's right fore.um 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 TI\ O-HANDED SEAT.

This seat may be used to carry a helpless patient.

FIG. 71.

1.-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

below the shoulders, and, if possible, takes hold of his clothing. They slightly raise the patient's back, and then pass their other forearms under the middle of his thighs (Fig. 7 I), and clasp their hands by one of the methods shown in Figs. 72 and 73. A handkerchief should be held in the hands if the first grip is used.

FIC. 73.

2.- The bearers rise together and step off, the rie,ht-hand bearer with the right foot, and the left-hand bearer with the left foot (Fig. 74).

THE THRhE-HANDED SEAT.

This seat is useful for carrying a patient and supporting either of his lower limbs, when he is able to his upper limbs.

I.-Two bearers face each other behind the patient. For supporting the left limb the bearer to the patient's right grasps his own left wrist with his right hand, and the other bearer's right wrist with his left hand. The bearer to the left grasps the first bearer's right wrist with his right hand (Fig. 75). This leaves his

left hand free to support the patient's left leg. For the patient's right lower limb follow the same directions, substituting" right" for" left" and" left" for "right." The bearers stoop down.

2.-The patient places one arm round the neck of each bearer and sits on their hands.

3·-The bearers rise together and step off, the

FIG. 75.

right-hand bearer 'vvith the right foot, and the left. hand bearer with the left foot.

THE FIREMAN'S LIFT.

(To be attempted only by a strong man).

Turn the patient face down wards; place yourself at his hea.d, stoop down, slightly raise his head and

should ers and take hold of him close under his armpits, locking your hands on his back. Raise his body and rest jt on your left knee j shift your arms and, taking him round his waist, lift him until his h ead res ts on your left shoulder. Throw his left arm over your head, stoop down and place your left arm between his thighs, letting his body fall across your shoul ders . .Rise to an upright posi tion j hold the pati ent's left wrist with your left hand and leave your right hand free.

Assistance may be given to an injured person by supporting him in the manner shown in Fig. 76 .

Tlze plan of carrying tile patient by tlz e arms and legs wz"tlz the face downwards, commonly called the "frois marciz," must never be used, as death may ensue fr om thz's treatmen t.

biPROVISED STRETCHERS.

A stretcher may be improvised as follows :-

r. - Turn the sleeves of a coat inside out; pass two strong poles through them; button the coat. The patient sits on the back of the coat and rests against the back of the front bearer (Fig. 78). If a longer stretcher is req u ired two 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 AND AFT METHOD.

This p1an of carrying is useful when space does not permit of a hand seat.

FIG. 77.

2.-Make holes in the bottom corners of one or two sacks and pass stout poles through them.

3·-Spread out a large piece of carpet, sacking, tarpaulin, or a strong blanket, and roll t\Vo stout poles up in the sides. Two bearers stand on each side and grasp the midd .e of the pole \\"ith one hand, and near the end with the other. They walk sideways.

4·-A hurdle, broad piece of wood, or shutter may be used as a stretcher; some straw, hay, or clothing should be placed on it, and covered with a piece of stout cloth or sacking; the latter is useful in taking the patient off stretcher.

Always test an improvised stretcher before use. Stretchers must be carried, and the pati e nt placed on them, as laid down in the" Stretcher Exercises."

As a general rule carry the patient feet foremost. 1 he exceptions are: -

(a) \Vhen going up hill with a patient whose lower limbs are not injured.

(b) When going down hill with a patient whose lower limbs are injured.

Avoid lifting the stretcher over ditches or \\'alls, but where these cannot be avoided the stretcher must be carried in the following ways: -

To CROSS A DITCH.

In crossing a ditch, the stretcher should be lOwer !d with lts foot one pace from the edge of the ditch

Nos. I and 2* bearers then descend. The stretcher, with the patient upon it, is afterwards advanced, Nos. I and 2 in the ditch supporting the front end while its other end rests on the edge of the ground above. No. 3 now descends. All the Nos. now carry the stretcher to the opposite side, and the foot of the stretcher is made to rest on the edge of the ground, while the head is supported by NO,3 in the No: I climbs out, No. 2 remaining in the dItch to aSSIst NO.3. The stretcher is lifted forward on the ground above, and rests there while Nos. 2 and 3 climb up.

To CROSS A WALL.

The stretcher is lowered with the foot about one pace from the wall. Nos. 1 and 2 bearers then take hold of the foot of the stretcher, and NO.3 of the head; the stretcher is raised till the foot is placed on the wall. No. I then clim bs over the wall and takes hold of the foot of the stretcher, while Nos. 2 and 3 support the head; the stretcher is then carried forward till the head rests on the wall, No. I supporting the foot. Nos. 2 and 3 then climb over the wall and take hold of the head of the stretcher, which is then slowly lifted off the wall on to the ground, and the bearers take their usual places.

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

To LOAD A \VAGON.

The stretcher is lowered with the foot one pace from 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 raised and carried forward till the front wheels rest on the floor of the wagon. No. I then jumps into the wagon, while No.2 goes to the head of the stretcher and helps NO.3. The stretcher is thee pushed slowly into the wagon. If the tailboard cannot be shut, the stretcher must be lashed firmly to the sides of the wagon.

To UNLOAD A \V AGO.N.

Nos. 2 and 3 take hold of the head Qf the stretcher, while No. I gets into the wagon; the stretcher is then gradually drawn out till the foot-wheels rest on the edge of the wagon. No. I jumps out of the wagon, and with No.2 takes hold of the foot of th e stretcher, NO.3 supporting the head. The stretcher is now gently dra,Yn away one pace and lo\\"ered.

\Vith four bearers Nos. I and 2 \\"Quld lift the foot of the stretcher, \\ hile Nos. 3 and 4 lift the heau. This applies to crossing a ditch or wall, as well as to loading and unloading a wagon.

CHAPTER IX.

STRETCHER TRAN 2PORT.

The "Furley" Stretchers (Model J 899) are of three patterns, viz,," Ordinary" "Telescopic-handled " d "P I' ,,' , an 0 Ice. In general principle they are alike the component parts being designated the poles:

80.-0RDINARY STRETCHER-CLOSED.

81.-TELESCOPIC·HANDLED STRETCHER- OPEN.

handles, joir:ted traverse bars, foot 'wheels, bed, pillow sack and

. The Ordinary Stretcher (Fig, 80) is 7 feet 9 inches m len,gth, and I foot 10 inches ,,,ide. The bed is 6 In, and the handles inches The heIght IS 5"4 Inches. At the head of the stretcher is a overlay (the pillow sack) which can be filled wIth hay, clothing, etc., to form a pillow. The Jomted traverse bars are provided 'with joints.

173

for opening or closing the stretcher. The Telescopichandled pattern (Fi g. 81) is very si mi Iar, bu t the handles can be slid underneath the poles, thus leducing the length to 6 fe e t. This arrangement is of great value working in confined spaces, or when a patient has to be taken up or down a narrow staircase \\ ith sharp turns. The Police stretcher is similar to the Ordinary pat'tocn, but is more strongly made, and has, in addition, straps for securing a refractory patient

vVhen closed, the poles of the stretcher lie close together, the traverse bars being bent imvards, the ca'nvas bed neatly folded on the top of the poles and held in position by th e slings which are laid along the canvas, and secured by a strap, placed transversely at the end of each sling, being passed through the large loop of the other, and round the poles and bed.

In closing a stretcher care should be taken to raise the centre of th e canvas pushing in the traverse bar, as it is c therwise liable to get caught.

To prepare, or open a stretcher, unbuckle the trans verse straps of each sling; remove the slings from the stretcher; separate the poles; take hold of each traverse bar and draw it forward. The slings will then be folded to half their length, on e being laid neatly over the handles at each end of the stretcher.

As a general rule, the stretcher will be prepared by Nos. I and 3 bearers in Exercises I, n., and III. ;

FIG

FIG.

174

and by No. 2 in Exercise IV. These bearers will, ho-wever, if required, assist the other bearers in attending to the patient's injuries.

Note.- The various movements detailed in the following Exercises should be carried out steadily, the bearers '>'lorking in unison, hurrying being carefully avoided and every attention being paid to the bearer who gives the words of command.

STRb.TCHER EXERCISES,

Originally drawn up by Sir John Furley, and revised in 190 4 to accord with the drills adopted by the Royal Army Medical Corps :_

EXERCISE No. 1.

FOR FOUR BEARERS.

I.-The Instructor selects the bearers and numbers them -I, 2, 3, 4 at his discretion. Should one man be taller and stronger than the others, he should be styled NO.3. as he "vill have to bear the 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 facing the patient. No. I places himself at the patient's knees, No. 2 at the hips, NO.3 at the patient's shoulders. At the same

,

* Bearers should, however, be taught to take any of the positions named in the following exercises, whether that of No. I, 2, 3, or 4 bearer.

175

time No. 4 places ' the prepared stretcher on the ground by the right side of the patient about two

FIG.

ay from him and then takes position opposite paces aw '. to and facing NO . 2. (FIg. 82).

3· (( Ready. "_-The bearers kneel down on the knee and take hold of the patient, No. I passing hIS hand.s and fore-arms beneath the patient's legs, hands wIde apart. Nos. 2 and 4 pass their hands

FIG. 83. and forearms beneath the patient's hips and loins and grasp each other 's hands. NO.3 passes his leff hand across the patient's chest and under the right shoulder, and his right hand beneath the left shoulder 83)

4.-"Lift."-On the wOod "Lift," the bearers raise the patient gently and rest him on th e knees of Nos. I, 2, and 3 bearers (Fig. 84) ; as '" oon as he

is securely rested, NO.4 disengages I.ands with No. runs round by the head of the stretcber 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 knee1s down and locks his hands with those of No.2 (Fig. 86).

5. -" Lower."-The bearers place the patient on the stretcher (Fig. 87), disengage their 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 ills face to the patient; Nos. 2 and 4 remain on each side of the stretcher.

7·-" Ready."-Nos. I and 3 place the slings (if used) over their shoulders, stoop down, and slip the

179

loops of the slings on to the handles of the stretcher, which they then grasp. . .

As soon as all is right the word IS gIven :- .

8.-"Lift Stretcher."-Nos. I c::.nd 3 bearers raIse the stretcher steadily together and stand up.

Note.-N03. 2 and 4 will now adjust the slings the sh oulders of Nos. I and 3, taking care that each well b elow the level of the collar and lies In the hollow of the shoulder in front. They will also lengthen or shorten the slings, r.egard t? patient's injuries and the relatIve heIghts 0 t e bearers.

l · IG. 86.

9.-" March."- The bearers move off :-Nos. I, 2, and 4 steppmg off with their left foot, and No . 3

with his right foot (Fig. 87) . The step should 8e a short one of tvventy inches, and taken with bent kn ees and no spring from the fore part of the foot. IO. - " Halt."-The bearers remain steady.

II. - " Lower Stretcher."-The bearers place th e genLly on the ground, slip the loops of the slIngs off the handles of the stretcher remove the slings from th e shoulders, and then stand up.

I2. -" Unload Stretcher - Ready." - The bearers 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 from No.2, removes the stretcher (Fig. 85), and r es umes his former position. If necessary, the bearers will then steadily rise together, and co refully carry the patient to the bed, or other plac e to which it has b een arranged to convey him.

I4.-" Lower."-The pati ent is carefully lo wered.

EXERCISE No. II.

F OR THREE BEARERS .

r. - Number the bearers I, 2, 3.

All orders will be given by No.2, wh o will lo o k after th e injured part of the patient's body or limbs, to see that no bandages or splints become displaced, and also that No. I bearer, in lifting or carrying the stretcher, does not touch the patient's feet.

2. -" Place the Stretcher." -No.3 places the stretcher in a line with the patient's body, th e foot of the stretcher being close to his head.

3.-" Fall In."-No. I places himself on the left side of the patient in a line with his knees, No.2 on the left side just below the pati€nt's should c. [5, and N O.3 at the right sid e , and faces NO.2.

4.-" Ready."-All kneel on the left knee. No. I places his hands, well apart, underneath the lower limbs, always taking care, in case of a fracture, to have one hand on each side of the seat of injury. Nos. 2 and 3 grasp each other's hands under the shoulders and thighs of the patient (Fig. 88).

5.-" Lift."-The bearers rise together, keeping the patient in a horizontal position (Fig. 89).

6.-" March."-All take short side-paces, carrying the patient over the stretcher until his head is immediately above the pillow. 183

7.-" Halt.-The bearers remain steady. 8.-" Lower."- The bearers stoop down, gently place the patient on the stretcher, disengage their hands, and then stand up.

FIG. 89.

9.-" Fall In."-No. I places himself at the foot of the stretcher with his back to the patient, No.2 places himself at the left side of the and NO.3 at the head, with his face towards the patient.

1 84

lo.-"Ready."-N os. I and 3 place the slings (if used) over their shoulders, stoop down, and slip the loops of the slings on to the handles of the stretcher, which they then grasp .

1\S soon as all is right the word is given-

11.-" Lift Stretcher."-N os. 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, having regard to the patient's injuries and the r e lative heights of the bearers.

12.-" March."-N os . I and 2 step off with the left fJot, and NO.3 with the right. The step should be a short one of 20 inches, and taken with bent knees, and no spring fron the fore of the foot .

13. -" Halt."-Th e bearers remain steady.

14. - \( Lower Stretcher."- The bearers place the stretcher gently on the ground, slip the loops of th e 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."-T be bearers raise the patient, as at Or der 5, and carry him by short side steps, clear of the stretcher, to the bed, or other place to which it has been arranged to convey him (Fig. 89).

17. -" Lower."- The patient is carefully lowered.

EXERCISE No. III.

\VH EN ONLY THREE BEARERS ARE AVAILABLE AND THE STRETCHER CANNOT DE PLACED AS IN EXERCISE II.

r .-The Instructor numbers the bearers-I, 2, 3. All orders will be given by NO.2.

2.-" Place the Stretcher."-No. I taking the foot of the stretcher, and NO,3 the head, place it on the ground by the side of the patient, and as close to him as practicable.

3. '- " Fall In."-The three bearers take the same positions on one side of the patient, as laid down in Exercise No. I.

4.-" Ready." -Nos. I, 2, and 3 kneel down on the left knee, placing themselves as close to the patient as they conveniently can, and then take hold of hi m as directed in Exercise No. 1.

5. - " Lift."-Nos. I, 2, and 3 raise the patient as directed in Exercise No. I, and th en move in a kneeling position up to the stretcher.

6.-" Lower."- The bearers bend forward, carefully lower the patient on to the stretcher, and disengage hands.

7.-" Stand to Stretcher."-All the bearers stand up; No. I goes to the foot, No.2 remains in position at the side, and No. 3 goes to the head of the stretcher.

8.-" Ready."-Nos. I and 3 place the slings (if used) over theIr shoulders, stoop do .\"11, and slip the loops of the slings on to the handles of the stretcher which they then grasp. '

,9.-" 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. 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 lenathen or shorten the slings, having regard to the injuries and thE relative hLights of the hearers.

10. - " March."-N os. I and 2 step off \yith 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.

11. - " Halt."-The bearers remain stead\".

12 . -" Lower Stretcher."- The place the stretcher gent ly on the ground, slip the loops of the sl.ings off handles of the stretcher, remove the slmgs from the shoulders, and then stand up.

Unload Stretcher-Ready."-No. I on the left side of the patient, and in a lme wIth hIS knees, No. 2 on the left side just below the pati,ent's shoulders, and NO.3 at the right

187

side, and faces NO.2. All kneel on the left knee. No. I places his hands, well apart, underneath the lower hmbs, always taking care, in case of a fracture, to have one hand on each side of the seat of injury.

Nos. 2 and 3 grasp each other's hands under the shoulders and thighs of the patient.

14.-" Lift." - The bearers rIse together to their feet, keepll1g the 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 convey him.

15·-" Lower."- The patient is carefully lowered.

EXERCISE

No. IV.

'FOR USE IN MINES AND NARROW CUTTINGS \\,HERE T\\o MEN ONLY CAN BE ENGAGED.

Nos I and 2 WIll carefully place the stretcher in a lme wIth the injured man's body, the foot of the stretcher being, If possible, oJ,< close to hIS head.

No. I straddles across the patient's legs, placing his nght foot, with the toe turned outwards, a little below the patient's knees, and with the toe of the left foot close to the hee l of No.2; he then stoops down, passes the left hand und er the patient's thIghs and

It is not advisable to be too particular as to the head o r foo t of a stretcher in a mine, as it would probably be quite impossible to reverse I t.

188

the right hand across and lX1der the pa6ent's ca·lves. 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 stoops down and passes his hands between the sides of the chest and the ar :ns underneath the should ers, and locks .FI G. 90.

the fingers (Fig. 90). If the patient's arms are uninjured .he may put them round the neck of No.2, and by thIS means greatly assist him in lifting.

189

When both are ready, No I \yill give the order " Lift and move forward." The pati e nt is then to be slowly lifted, ju st sufficient to allow his body to clear the stretcher. Both bearers will slowl y and gradually move the patient forward, NO.2 b y very short steps, N o. I by be ndin g his body forward as much as he can with out m ov ing h "s f eet (Fig. 9 I ) . No. I now g ives the ord er (( Halt," wh ereupon No.2 remains stea dy, .1n1 No. I advances his ri ght foot to his le ft, and

FIG. 91.

again advances his left foot till the toe touches the heel of NO.2. No. I then gives the order "Advance," when the patient will again be moved forward. These movements are to be repeated until

190

the patient is over the stretcher, when he is to be gently lowered .

The follo\\'ing Stretcher Exercise is adapted by permission from th e Royal Army Medical Corps Manua l, 1908.

All orders will be giv en by NO.4.

I. " Fall in. "-Six bearers fa ll In b ebind each other.

2 . "Number. "-The bearers number from fr ont to rear.

3. "No.3 Bearer, right (or left) turn - supp ly stretcher- quick Inarch."-No. 3 b earer will march to the stretcher, stoop, lay hold of it and place it on bis right shoulder at the slope, holding it by the lower fool wheels, wheels to the front. As soon a s the bearer is provided with a stretcher, he will turn about and rej oin bis squad in quick time, halting as b e arrives in his place. He turns to the front, and, passing the lower end forward, places the stretcher on the ground to tbe right of the squad, wheels to the right , fro n t end of the poles in line with the toes of No. I and rises.

4. " S t and to Stretcher."- No. 1 places himself with his toes in line with the front ends of the poles. NO.3 with his heels in line with the rear ends of the po les, close to and touching the stretcher with

92.

FIG. 93

his right foot. Nos. 2, 4, 5 and 6 take up their position s one pace behind and covering off the bearer in fro nt of them (Fig. 92).

5· "Lift Stretcher."-Nos. I and 3 stoop, grasp both handles of the poles with the right hand, rise together, holdin g the stretcher at the full extent of the arm, wheel to the right.

6. "Collect Wounded - Advance ." - The squad doubles by the shortest route to the patient, an d halts without further word of command one pace from the head of and in a line with th e patient (Fig. 93).

7· "Lowe' Stretcher."-N os. I and 3 stoop, place the stretcher quietly on the ground, and ris e smartly together.

8. "Prepare Stretcher."-Nos. I and 3 turn to the right, kneel on the left knee, unbu ck le the transverse straps , and place the slings on the gro und beside them, separate the poles, and straighten the traverses . .

T wo . On the word two each takes a sling, doubles it on itself, slips the loop thus formed on the near handle, and places the free ends over the opposite handle, buckle uppermost. They then rise and turn to their left together.

While the stretcher is being prepared by Nos. r and 3, the disengaged bearers will advance a n d render to the patient such assistance as may be required (Fig. 94) .

193

The necessary assi.stance having been rendered, NO.4 will give the command-

9. "Load Stre tche:-." - The bearers place themselves as follows: -Nos. I, 2 and 3 on the left, Nos. -1-, 5 a nd 6 on the right of the patient; Nos. I and -I- at the knees, 2 and 5 at the hips, 3 and 6 at the shoulders, the wh ole kneeling on the left .kne;. Nos. I and 4 p::tss their h:l.l1ds beneath the patlent s knees, 2 and 5 beneath the hips, 3 and 6 beneath the shoulders, care being taken of the injured part, one of the bearers being detailed for this purpose (Fig. 95). .

10. "Lift."- The \vhole will carefully 11ft the patient on to the knees of Nos. I, 2 3. '.

Two. Nos. 4, 5 and 6 will then dIsengage, rIse; N os . -t and 6 step back one pace. No. 5 turns to his left, doubles to the stretcher, takes hO.ld of and raises it, left hand across, the near pole restmg on the left hip; carrying the he returns to hi.s place between 4 and 6, and places it beneath the patIent.

Three. Nos. 4 and 6 step forward one pace, and together with No ') kneel down on. the knee, and prepare to assist in lowering the patIent (FIg. 9(l).

II. "Lower -The pa.tient is lower ed slowly and gently on to the centre of the canvas (special care being taken of the injured part).

T w'J. The bearers disengage, rise; Nos. I, 2, 3 and 6 turn to the left; Nos. 4 and 5 to the right; H

8 o. 4 places him:..elf three paces in flont of the stretcher. IO. 6, h::l\'ing collected the kit and arms of the patient , places himsf!lf three paces in rear of the stretcher, Nos. 2 and 5 opposite the centre of the stretcher The \\ hole are no\\' ready to lift stretcher and move off (Fig. 97 ).

FIG 97.

195

12. " Lift Stretcher. "-l os. I and 3 stoop: grasp the doub!ed sling midway between the pol es with the forefinger and thumb of the nght hand, sweep it off the handles, ris2, holding the sling at the full extent of the arm, buckle to the front, take a side pace to the front between the handles, and place the sling over the shoulders dividing it equally, huckle to the right . The slings should be placed so that they lie well below the collar of the coat behind and in the hollow of the shoulders in front . In the event of the slings 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 b uckles.

Two. Nos . I and 3 stoop, sli p the loops over the handles, commencing with the left, and grasp the handles firmly .

Tlzree . Nos. T and 3 rise slowly together, No. 3 conforming closely to the movements of No . I . .

13. !I Advance."-Nos. I, 2, 4, 5 and 6 step off with the left foot, NO .3 with the right, steppirJg short, knees bent, feet raised as little as possible .

I4. "Halt."-The whole halt.

IS. "Unload Stretcher."-T he bearers ,?lace themselves in the same position at the stretcher as described for Loading (Order 9) ·

I6. "Lift."-As descnbed for Loading (Order 10), HZ

I96

except that the stretcher is carried forward three paces clear of the pati e nt's fe et.

17 . "Lower."-The patient is gently low er ed to th e ground. The bearers diseng age, rjse; Nos. I, 2 and 3 turn to the left, 4, 5 and 6 to the ri ght, and the whole step off to their places at the stretcher, as at Order" Stand to Stretcher" (Fig. 98).

The Ashford L itter is made up of either of the Furley stretchers mentioned on pages 17 2 and 173, a wh eeled under-carriage and a waterproof hood and apron , or, if preferred, a light \yet-resisting canvas cover. The stretcher is kept in position on the under-carriage by the foot-wheels, which fit into slots in the sides of 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 stretche; between the wheels instead of lifting it oYer them. At both ends are two legs which may be turned up as har:-dles when wheel ing the litter. The hood and apron fit m,to sockets screwed to the stretcher. In wheeling the lItter, care should be taken to keep the patient in a horizontal position. Should it be necessary, two bearers can easily lift the litter and patient.

. Th e, L it t er, introduced in 19 0 4 IS used m 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 propulsion.

I97

CHAPT ER X.

(Being tlze Fi/tlz L ecture .for Females only, in accordance wz'tlz Syllabus 58.)

BY E. l\IACDO -SELL COSGRAVE, l\l.D., F.R.C.P.I.

PR EPARATION FOR RECEPTIO:"l OF ACCIDENT CASES.

'WHEN news of an accident C0!11eS, preparations should at once be made so as to have everything ready before the injured person is brought in. Of course the preparations needful will vary according to the nature and extent of the injury, but the following are the chief things which may have to be done.

CHOICE AND PREPARATION OF ROOl\1.

A room must be chosen. In a bad case this should be one easily reached, as it is difficult to carry an injured p erson through narrow passages and up -s tairs. Unless there is some such reason against it, the injured person's own room is best.

Th e way to the room must be cleared, projecting furniture and loose mats in the hall or in lobbies should be removed. If the injured person is carried on a door, shutter, or stretcher, tw o strong chairs should be placed ready to support it wherever the bearers would be likely to r equire rest.

Useless furniture should be removed from the bedroom. The bed should he drawn out from the wall

198

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 se\'eral hot bottles and blankets may be required; CO\'er the hot bottles \\ Ith flannel.

If the injury is very severe, if mud-stained clothes hlye to be removed, or if extensive dressinCTs haye to he applied, it may be to have bed, ::t couch or ,a table placed near the bed to lay the S Jfferer on 111 the first instance. This should be so arranged that soiling may do no harm; old sheets, waterproof lllaterials, thin oilcloths, or even nelYs' paper, may be used as a protection.

LIFTING AND

If present at the place where the accident occurred it will be necec::sary to see that the patient is fully ltfted after proper "First Aid" has been rendered.

The following rules should be remembered :-Select the proper number of persons to assist, and do not let them llft the patient until they thoroughly understand how they are to do it.

+ cases, where the injured person has cO oe, llfted a very short distance, three helpers are sufficlent: Two (who should be as far as possible of eq ual heIght) are to bear the weight, the third is to support and take charge of the injured part. This is

199

best done by a person who has been through a " Fir -t Aid" course. If the injured person is insensible, another 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 lower part of the shoulder blades, and under the hips, clasping each his right hand in the other's left. The injured patient should, if practicable, place his arms round the necks of the bearers .

The third helper should attend to the seat of injury; if this is a fractured limb, he should support it by placing the palms of his hands under the limb, one abm'e and one below the seat of the injury, grasping it firmly but avoiding unnecessary pressure.

The helpers should remCiin thus until tbe order " Lift" is given, and then they should all lift slo\dy a,nd steadily, avoiding jars, attempts to change posilIon of hands, etc .

If the injured person is to be placed on a stretcher or sbutter, this should be previously placed with the bottom end at his head; the bearers should then move, one at each side of it, until the patient is over it. The word" Lower " should then be given, and the injured person should then be slowly lowered. A pillow or folded·up coat should be ready, and as the sufferer is lowered this should be placed under his head.*

" Full directions are given in Chapter IX.

201

MEANS OF CARRYIKG.

Besides a stretcher, and substitutes such as a gate, a shutter, or a door, other means of carrying can be improvised.

In slight injuries, where the injured person is unable to walk, two bearers can carry him by forming a fourhanded, three-handed, or two-handed seat.

A four-handed seat is formed as described on p:-tge 160.

A three-handed seat is made as described on page r62.

The two-handed seat is made as descri bed on page r61.

A single helper can lift by supporting with one arm the two knees, and with the other the back. The arms must be p.1ssed well under before commencing tJ lift.

A single helper can give support by putting his arm round the waist, grasping the hip and placing injured person's arm round his own neck, holding th e hand with his own hand (Fig. 76, page r65).

A capital stretcher can be im provised out of a strong sheet and two broom handles or other short poles. Each side of the sheet is wound up on a broom h:-tndle until there is just room for a person to li e between. This r eq!.lires four bearers, two at each side, to prevent the sheet slIpping.

CARRYING UP STAIRS.

In carrying a stretcher up stairs head should go first, and an extra helper should aSSIst at the lower end, so as to raise it and keep the stretcher nearly horizon tal.

The' twO, three, or four-handed seat may be used fur carrying up stairs; or a strong chair, the patien{ beina carried up backwards. In the latter case one should walk after the chair and help to It, and to prevent the injured person slipping out.

LIFTING INTO BED.

If the bed is narrow and there is room the stretcher should be placed on the floor with the head close to the foot of the bed. The injured person should then be lifted over the foot and placed on the bed. If the bed is too wide to admit of this, the stretcher should be placed beside it, and two helpers should stand at the far side of the stretcher. One helper passes one ann beneath the shou ld e rs and one beneath the middle of the back, the other helper placing his und er the low er part of the back and under the knees. The injured person is then lifted, another helper pulls away the stretcher, and after a sLngle step forward the burden is placpd on the b : d.

PREPARATION OF BED.

A firm mattress, not a feather bed, should be ( elected. If there is much injury, or if dressings haye to be applied, a dra\y-sheet ought to be placed on the bed. It should be of four or more thicknesses, extend across the bed, and reach from the middle of the patient's back to the knees. A piece of waterproof sheeting or of thin oil-cloth should be placed und er the draw-sheet. As the draw-sheet becomes soiled, the soiled portion should be roll ed and a clean part drawn smoothly under the patient.

In fracture of the leg or thigh, sprained ankle and some other cases, a "cradle" (Fig. 99) should be improvised. The use of a " cradle" is to support the bed-clothes and keep them from pressing on the lim b.

A band-box (Fig. roo), three-legged stool (Fig. lor), or hoop sa\,·;n 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 c ork, and tied by string to the bed or a nail in the wall, will relieve the pressure of the bed -clothes effectually.

REMOVING THE CLOTHES.

In taking clothes off an injured person a few rules should be borne in mind.

In serious cases it is much better to sacrifice the clothes than to run any risk of increasing the injury,

99.

10,).

10L

FTG.

FIG.

F1G.

h

In a coat, etc, in a case of fractured arm t e unmJ,:-red arm should be drawn out first.

b In on a coat or shirt the injured arm should e pu t m first. in burns and nothing should ever be

o. A, sharp paIr of scissors should be used and everyt.hmg not should be cut awa):. If anythmg adheres it should be left until medical aid

FIG. 102.

can be obtained. The clothing adhering may, with advantage, be soaked with oil. To remove the trouserhs frlodm b a ,severely injured limb, the outside seam s au e rIpped up.

PREPARATIONS FOR SURGEON.

As so?n as the injured person has been attended to preparatIon should be made for the surgeon's visit '

2C5

The preparations needful will depend upon the nature of the case. The following hints may be of use:A fire in the room helps ventilation, even 1l'l 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 \\'ater 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 sh o uld be torn up for bandages.

In the case of hremorrhage, plenty of water should be boiled and allo\\'ed 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 rescued from drowning the sheets should be taken off the bed, plenty of blankets should be heated before the fire, and several hot bottles should be ready.

If poultices are likely to be required, bOIling water, 1inseed meal, mustard, a loaf of stale bread, a small basin, a large spoon, sweet oil, and tow, flannel or handkerchiefs may be required.

20b

. For lomentation, have boiling water, flannel, a kItchen roller, and two sticks, or a large to\\·el.

"When summoning a medical man to an accident always let him know by a written message what kind of case is required to treat, so that he may bring whatever IS needful. By this means valuable time may be saved.

QUESTIONS ON CHAPTER X.

The numerals il/dzca.'e the pages where tlte answers ma)1 be .foul/d.

'What points would you consider when choosing a sick room?

II ow would you clear the way to sick' ?"

,Vhat me.ans of would you pro\'ide for those carryIng a patIent on 8. stretcher? ... '" ...

'lIow would you place and arrange a bed fur an accident case?

I97, Are hot bottles necessary, and how would you prepare them?...

'"

, "What is often necessary to lay the sufferer on in the first instance?

£low would you protect this from gelling soiled?

lIow you see to the proper lifting and carrying of an Injured person?

... I98 I99

\Vhat. substitutes for a regular stretcher can you suggest? '200

How IS the four-handed seat made? 16:) r61

For what cases is this seat useful ?.. ' 160

How is the three-handed seat made? 162, lc4 207

For what cases is this sea{ useful? .. .

How is the two·handed seat made?

For what cases is this eat useful ? ..

IIow can a single helper lift? ."

How can a single helper give support?

How would you improvise a. stretcher? ... ..,

lIow many bearers are for thIs ?trelcher ?

How should a stretcher be earned upstaIrs? ...

IIow would you carry a patient upstairs on a chair?

How would you lift a patient from a st.re.tcher to a b ed?

How sh ould a hed be prepared for an Injured person? . . .

lIow should a draw sheet be made?

\Yhat would you place under the draw sheet?

\Vhat should be done w'ith the soiled part of a draw sheet?

\V hat is the use of a " cradle"? ...

In what ways maya cradle be ?

How would you remove a coat or shu't .m 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 ciothing that adhered to the patient? ...

How would you remove trousers from a severely injured limb?...

\Vhat. l?reparations would you make for the surgeon's VISIt? ...

\Vhat would you get ready in the case of a burn?

And \"hat in the case of hremorrhage ? ... ....

And wha.t in the case of a person rescued from clrowmng?

\Vhat would you get ready for making poultices? ...

And for fomentalions ?

What sort of a message would you send to summon a dector? ...

208 INDEX.

Abdomen P'ge III

wound of 112

Accident case, preparation fur 197

Acids, poisoning by 149: 151

Air, always necessary ... 18

Alcohol, caution as to smell of 130

Alcohol, poisoning by 134, 153

Alkalis, poisoning by 149, 151

Ammonia, poisoning by 149

Anatomy (elementary) 20

Ankle 30, 3 2 " sprained.. . 64

Anterior tibial artery 93

Aorta 79

Apoplexy 132

Apparently drowned, to restore ...

Arm, bone of fracture of Arm-slings

Arsenic, poisoning by

Arter.ial h<emorrhage, 139 28 52 39,49 arrest of 74 practising arrest of 79 " signs of 74

Arteries . H course of mam ....nery, axillary .. 7° 79 85

Artery, brachial... carotid dorsal of foot facial femoral ... iliac occipital plantar ... popliteal radial subclavian tibial temporal " ulnar

Artificial respiration 121, 129, Asphyxia Atlas

Auricles ...

Axillary artery Axis

Back, bandage for 159

Backbone 23

Bandage, to apply 42 to fold 37 " tc improvise... 37

Bandaging 155

Bed, lifting into... 201 " preparation of 202

Belladonna, poisoning by 148

Page

Bites of rabid animals 106

Bladder ... III, 113

Brachial artery ... 86

Brain 117 compression of 132 " concussion of 13 r

Breast- bone 26 " fraclure of 48

Broad bandage ... 37

Broken bones, see Fracture.

Bronchial lubes... II8

Brooch-bone 30

Bruises 102

Burns 102

Circulation of the blood, organs of

Circulation of the blood, to induce Clavicle "

CapIllaries 70, 72

Capillary hremorrhage ... 95

Capsule ... 31

Carbolic acid, poisoning by Carotid arteries ... from" Carpus h<emorrhage 80

Carrying, means of " upstairs

Cartilage

Cerebro-spinal system

Cheek, bleeding from Chest, bandage for Chlorodyne, poisoning by Choking .. ,

Cervical verle br<e 2:5 160, 200 201 25 II7 25 149 140

Diaphragm 120 Digital pressure. .. 74 Direct violence... 33 Dislocation 62 Ditch, to cross with stretcher 169 Dorsal artery of fo ot 93 nrtebrre... 25

Dress, woman's, on fire ... 105

Drowning 139

Ear channel, blood issuing from 98

Ear-passage, forei6"n body

Fireman's lift

First aid, meaning of " student

Fish-hook, embedded

Flexion ... at elbow

Electric shock

Emetic

In Elbow, bandage for joint, fracture in1:0 159 volving 53 14 2 148 , Lt9, ISO

Epilepsy ...

Esmarch's ... 13 2 tliangular bandage

Expiratiun

External carotid artery ...

Eye, bandage for foreign body in

Face, bones of Facial artery

Fainting ...

Femoral artery " "digital presure at groin ...

Femoral artery, tourniquet for

Femur fractme of " fracture of Fingers, bandage for fracture of

" at knee ...

Food, poisoning by'

Foot, bandage for bones of ... " cru 'hed

Forearm, bones of " fracture of F oreheacl, bandage fl.'1. .. " hcemorrhage from

Foreign body in the calpassage .•. in the eye " "in the r.ose F our-handed seat

Fracture, apparatus for treatmer. t of '" causes of definition of ... general rules for treatment involving elbow joint of arm ... of breast- bone of carpus of collar - bone of cranium of finger

Fracture of forearm 54 " " of knee-cap 58 of leg ... 60 of lower jaw... 44 of metacarpus 55 of metatarsus... 62 of pelvis 56 of ribs... 46 of spine 45 of tarsus 62 of thigh-bone... 56 of toes.. 62 signs and symploms of " varieties of 35 34 108 Frost-bite Fungi, poisoning by 153 General circulation 70 Granny knot ... 40 Green-stick fracture 35, 36 Gums, hremorrhage from 97 H::emorrhage, arterial ... 74 capillary... 95 " from gums 97 from head and neck 80 from lower limbs... 89 from lungs 97 from nose 96 from stomach 98

Hremorrhage from throat 97 from tongue 97 from tooth socket... 97 from upper limbs 84 intern al 95 kinds of 73

for

J 40

Headand neck, arteries of 80 Head, bandage for 155 injury to... 128, 13 1 " side of, bandage for ISS

70 " rate of contraction of 72 Heat-stroke 13 6 Hernia 114 Hip, bandage for 157 History, meaning of 17 Howard's meth od of artificial respiration 126 Humerus 28 " fracture of 52 H ydropho bia J 06 Hysterical fits 133

Page

Insensibility, general rules for treatment . .. . .. 128

In spi rati on 120

Instep 30

Insulat'Jr .. , 14 2

Internal carotid artery 80

Internal h::emorrhagt.: 95

Intestines, injury of J 13

Involuntary muscles 33

Jaw, angle of 23 lower 23

" "fracture of 44

J oint, definition of 3 I " injuries to. 109

Jugular veip 80

Kidneys .. , .. , 1 I I " injury of II3

Knee, bandage for 159

Knee-cap 30 " fracture of 58

Knot for bandage of lower limb 4 2

Kn ots, reef and granny 40

Laborde's method of ar i. ficial respiration

Laburnum seeds, poison· ing IJY ...

Lac e rated wound

Large arm-sling ...

Laudanum, poisoning

Leg, Gones of 126 30

Leg, fracture of ... Lifting and carrying " into bed .. . Ligaments .. . Lightning, effects of Limbs, lower " upper Lime in the eye ...

Lips, bleeding from Litters

Liver " injury of Lower limbs

LUl11 bar verte br::e Lungs hremorrhage

Marshall Hall's method of altificial respiration 140 Medium bandage 37 ::'Ietacarpus ... ... 28 " fracture of ... 55 :Metatarsus 30 " fracture of 62

Middle line of body 20 l\IOlllh, blood issuing from 97 Muscles 3 2 "ruptured 65 :Muscular action... 34

Narrow bandage 37

Needle, embedded 109 Nerves liB

N ervous syste m ...

Nose, foreign body in h::emorrhage 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 ...

Phosphorus, poisoning hy 148, Physiology (elem entary)

Plantar arch .. , .. , artery

Plants, various, poisoning by .. , Pleura

Poi son e d w e a p 0 n s, wounds by Poisoning

Popliteal artery ...

Posterior tibial artery

Potash, caustic, poisoning by ...

digitaL .. "

Principles of .First aid ...

Prussic acid, poisoning by Pubes ... ... ...

Pulmonary circulation

Pulse

Pupils of eyes

Questions on Chapter I. II. III. IV. \ -. \'I. X.

Rabid animals, bites of...

Radial artery

Ra cli us " fracture of Reef knot

Respiration artificial Ill, 129, 13 6, " to excite

Respiratory system

Rest, necessity for Ribs " fracture of ... Room, choice and pre· paration of

Pa.(,e

Ruptur e (hernIa) 114

Ruptur ed muscles 65

214

21S

Sacral verte brre ...

Sacrum ...

Scalds 25 25, 28 102

Scal p, bandage for " hremorrhage from Scapula ...

" fractu re of Schafe r's method of artificial r espirati on Seat, four- handed three-handed " two handed Shin-bone

Shock

" elect ric

Shoulder, uandage for ... blade ...

" fract ure of boncs .. . " joint .. .

Sick room, choice and preparation of. . .

Signs, mea ning of Silvester's method of artificial respiration impl e fracture ...

Skeleton ... Skull "-' ISS 83 26 51 121 160 162 16'1 30 134 142 IS6 28 SI 26 32 197 17 1 23 34 22 22

Small arm sling... 39

Smothering 140

Snake bites 106

Soda, caust ic, poisoning by

Spleen " injury of. . . 149 III 113

Spi:lal cana l cord 23 23, II7

" fracture of Spirits of salt, poisoning by

Splint, angular ...

Splints, rules for applying to improyi se

Sternum .. , " fractur e of Stimulants

Stings of plants and 23 45 149 5-+ 19 animals 107

Stomach... I I I hrem orrhage fr0111 98 ,. injury of .. . . .. 113

Strains 65 140

Stretcher exercise, Army 19.)

N o. I. 174

N o . n. I8I

N o . Ill. I8S

" ., N o . IV· 187

Stretchers, Furley 172

" fracture of Slings, a rm 43 39, 4 0 , 49 Page

Stretchers, to carry " to im provise poisoning by Sllbcla\·ian arte ry

Suffocation ...

Sunstroke

Surgeon's visit, preparation for SyIlablls of instruction ...

Sympathetic system

Symptoms, meaning of . ,.

Syr icope .. .

Synovia .. .

Systemic circulation Page 169 1 66 153 q.l 136 20-+ 7 lIS 17 134 3 1 70

T a rsus 30

T emporal arte ry . ._ 82

Thi gh-bone 30 " fracture of ... 56

Three-handed seat 162

Throat, hremorrhage from 97 " s\\'ell ing of tissues of . .. 141 Ti bia 30 " fracture of 60

T oes, bandage for 15 9

T ongue, hremo rrhag e from 97

w T ooth c;ocket, hremorrhage from 97

T ourniq uet 75 wOllnd of abdomen 113

Tw o-handed seat 161

Ulna " fracture of . Ulnar artery

U nconsciollsness

Upper limus

Yaricose veins

Veins

Venous olood " hremorrhage

Yentriclcs

Yertebra .. .

Yertcbral column

Yenical wound of abdomen

Yitriol, oum by ... Yoluntar)' muscles

"Wagon, to load or unload \Yall, to cross \\ ith stretcher

\Yarmth, neces "ity for " to promote Wind-pipe .. .

\Y oman's dress on fire

\Y oullds by poisoned weapons " accompanied oy arterial hremorrhage ... \Younds accompanied Ly venous h::emorrhage ','.r ounds, hcerated \Yri st

$t. 30bn EltllDnlance H950ciatton.

GENERAL PRICE LIST .

A complete and reliaule . 'un uulance Equipment is an actual necessity, and experience has proved thaL employers of labour and others interested in the district readily subsc riue for the p 'Hr:hase of such appliances. All information r egarding lhe work of the can be obtain ed upon application to the Head Office, St. John 's Gate, Clerkenwell, L ondon , KC.

All stores will be sent carriage paid to any part of the United Kingdom. Returns may be sent carriage forward. 1f carriage is prepaid it will be allowed .

C wing to fluctuations in market prices it is impossible to guarantee that the quotations herein can be adh ere d to.

Quotations will be furni shed [or Ambulance Carriages, moto r or horse-drawn, and u h er articles relating to Ambu· lance, Nursing and Hygiene, not mentioned in this list.

Orders and correspon dence should be addressed to the St. John Ambulance Association, St. J ohn'5 Gate, Clerken well, London, KC .

Remittances should be made payable to the St. John Ambulance Association, and crossed "London County and \Vestmin<;ler Ihl1 k, Lothlmry."

carriage Paid on all Orders In the United Kingdom.

THE .. ASHFORD" LITTER.

Th e "Ashford" Litter (r899 model) consists of a twowheeled under-carriage fitted with elliptical springs, and either of tbe "Furley" stretchers, with a coyer so arranged on a jointed frame that it can be folded up inside the stretcher, or with a hood and apron (as shown aboye). Thc undercarriage, having a cranked ax le, the bearers can pass between the wheel s with the stretcher, and thus avoid lifling it over them. \Vh e n travelling, the legs of the under-carriage are raise d, and thus form the handles hy which to propel it. Should it be necessary to pass o\'er rough ground, two bearers can easily lift the litter and patient. The" Clemetson " stretcher can be used inst ea 1 of the "pattern For prices, see p. 7·

Carriage Paid on all Oraers In the United Kingdom. THE .. REA=EDW ARDS" LITTER.

The under-carriage or wheeled portion of this Litter is of an entirely new design, and is adapted to carry either of the "Furley" or "Clemetson" Pattern Stretchers in precisely the same manner as the "Ashford" Litter. It is fitted eithe r with bicycle wheels and extra strong pneumatic tyres, or with light but strong wooden wheels, either with solid indiarubber or iron tyres. Owing to the reducti on in the height of the wheels it is easy to lift a loaded stretcher over them, and

Carriage Paid on all OrderS In the United KingdOM.

the cranked axle has, therefore, been replaced by a straight one. Ball bearings are fitted to the wheels, both cycle pattern

" REA-EnWARDS" LITTER , fitted with pneumatic tyred wh eels , showing the "Clemetson" and wooden and the hubs are so arranged that the wheels can be removed from the axle without disturbing the bearings. A push bar, capable o f. raised or lowered is used at the head end. \Vh en raised as a handle it may be locked in one or two po sitions, and lowered it is locked in a vertical p osition. The pneumatic tyred wheels are strongly recommended in cases where the small amount of care necessary to keep them ca? be giv:n, as the comfort to the patient and ease In propulsIOn are Increased beyond all comparision with any litter yet produced.' F o r Frices, see p. 7.

Can iage Paid on all Orders In ttie United KingdoM.

THE It ST. JOHN" LITTER.

The under-carriage of this Litter presents .some entirely new has been specially designed to carry the reaulation stletc?er, a maLle.r of some imporlance, at ;, e pr esent It wll1 also carry either "Furl ey " or Clemetson Stretchers. When loaded, the patient is over axle, lhu.s ensuring the greatest comfo rt to the ?atlent,. ease propulSIOn, and rapidity in manipulation. d h.en uSll1g a mlhtary strctcher, the balance is obtained by a Justmg the when loading. Th e exact position can be asce rtall1 ecl lJ1stantly; but when using eith er of the ot her three stretchers, the balance is automatic. rhe is fitted with a leg or support at each en "" whIch IS Ha"ecl or lvwered by a new but very simple

Carriage Paid on all Orders in the United I<ingdam ,

'When raised, they go beneath the frame of the und ercarriage .

The question of storage, so often a matter of difficulty and expense, has been carefully c onside r ed. As a rule, a shed of a more, 11' less pe r manent nature is required, but as the wh cels of this lill e r can be easily and quick ly rem oved and r eplaced, and are interchangeab le, it allows them to be taken off and the under-carriage, which can then be passed through any ordinary doorway. stored where convenient, the space r equired being comparatively small. " 'he n wanted, one man can ea'iily put the parts together, a!1d have the litter r eady for use in two or three minutes. For prices, see p. 7·

THE" CLEMETSON" STRETCHER.

(S ee page 4. )

On this stretcher the patient can be moved as desired, from the recumbent to the sitting position. Th e re is no complicated mechanism to get out of ord e r, and the adjustment dependsimply on the balance of the patient's body. The stretcher will fit either the "Ashford," "R ea -Edwards ," or the "St. John" Under-Carriage. Price £3 3s.; with extendin g legs, £4 3s.

FIRST AID BOX,

T o be c arried be low the axle of the" Rea-Edwards" LiLt er, fr om which it is easily detachable.

Contents :-Set of Splints, 12 Triangular Bandages, R oller Bandages, 2 i lb. packets each Colto n \V oo l and Boric Lint, Adhesive Plaster, Pair of Sci so rs, Knife. 2 oz. eaC:l Tinct. Iodine B.P.C., Sal Volatile, and Boric Acid Powder, Dredger, Graduated l easu re Glass, Kidney-£haped Basin, St. John T ourn iquet, Pins, Safety Pins, - eedles. Threao , Tap e, 2 Saucers, and 2 Camel Hair Brushes. Price £2.

PRICES OF THE "ASHFORD," "REA EDWARDS," AND "ST. JOHN" LITTERS.

., ASHFORD" and With Iron Tyres to Wheds. With India RubberTyresto Wheels

., ST. JOHN" Without With Without With Cover or With Cover or With Hood and LITTER:' Hood and Cover. Hood and Ilood ann Cover. Apron, as Apron. Apron. Apron. illustrated.

(no

comtete with Ordinary tretcher*

Telescopic

Ditto with Police

with' 'Clemetson"

Tile prices of the Rea Edwards" Litter are, with Iron tyres, 10s. Od., and with Ii: dla rubber or pneumatic tyres, £1 15s. Od. less In each Instance.

Prices quoted for Litter with Ordinary Stretcher include Wid e Webbini Slings but no " Strap Leather, instead of Webbing Slmgs, IIi. 6d. extra; Cheat Strap, IS. 6<1. extra. If 5' !>upplied without any Slings, 4S. allowed.

t Prices quoted for Litter with Telescopic.hand led Stretcher include Wide Webbing Slings and 0 ChC!St Strap. Leather, instead of Webbing Slings, IlS. 6d. extra. If supplied without any Slings, 4S, allo wed; and if without Chest Strap, IS. 6d . allowed

! Prices quoted for Litter with Police Stretcher include Wide Webbing Slings and Leather Slraps fur securing a refractory patient. Leather, in stead of Webbing Slings, lIS. 6d. extra.

PRICES OF THE "FURLEY" STRETCHERS. WITH THE LATEST IMPROVEMENTS. N. n.- TIle prices or the Standard T\lodels are shown in heavy type.

Without With Wide Slings or Webbing Chest Slings Strap. (no Chest Strap).

With Wide With Webbing Leather Sling., Slings and Chesl (no Chest SU<lp. Strap).

Ordinary Stretcher, for G t.:neral

and Brigade use ...............

Telescopic -handled Stretcher for wori-inginconlll1l:d

Police Stretcher, Ash Poles, Leather Straps, and \VelJuing Slings

!::llings (per pair), Wide 'Webbing, 4S. 6d. Leatber.

Chest Strap, Wide Webbing

Il ood and Apron, "Furley" Stretcher (see illusL?'ation, pa,fe 2)

Do. do." Clemetson" Stretcher

Awning Cover for "Furley" Stretcher (when ordering please state pattern of Stretcher)

Sockets and Studs for fitting Hood and Apron or A wning Cover, per sel

Spare Bed for Stretcber ..,

Am1y Rug to cover· Patient on Stretcher

Pillow for Stretcher, horsehair "

Waterproof Sheet (\\'asbaule) to be laid on the stretcher bed

Carriage Paid on all Orders in the United Kingdom.

Dressing Basin, kidney shaped, made of enamelled iron.

Price IS. 6d. LAMP.

This is fitted wilh ::t soekel, lJy \\bieh to fix it to a Litter,

01 il can be conveniently carried by hand. Price complele, g". od.

Carriage Paid on all Orders In the United Kingcl.om.

REGULATION POUCH FITTINGS

for the St. John Ambulance Brigade, consisting of:-

I Triangular Bandage, sealed up in waxed paper.

2 Grey Calico Roller Bandages (2 in, and I in.).

I Packet of Surgeon's Lint.

I Packet of Absorbent Cotton Wool.

I Pair Scissors.

6 Safety Pins.

I Box of 3 Ampoules of Iodine Tincture.

I Piece of Strong Cane, for tightening improvised Tourniquets.

List Price, 2S. 6d. each; 6 doz. or more, 2S. 5d. each.

Box of 3 Ampoules Iodine Tincture, packed for post, each 6d.; per doz., 5s. 9d.

SAFETY PINS.

All fasten or unfasten on either side. s. d. Facile No. S 600 or S 602 per 3 doz. " "S 603 ... " Duchess Duplex, No.2... per doz. "

Ambulance Station Plate, Enamelled Iron, 35. 6J. each.

Stretcher Depot Plate, Enamelled 3s. 6tl. each. . _

C . Sheet for carrying pal1ents up and down slall arrymg 'D' d 1 the late T. C. or otherwise about a house. eSlgne)y . J3 'If 'd

Derham Esq Blackpool, and i\Irs. Alfred PaIne, e( 01

The is 'filled with rope haudles and

I 1 1 Y be l)la ced on a stretcher without C.1£tUl bIng po es, anc 11 a . 6- 1 the lJatient. Pnce complete, 22S. u.

Pocket Cork Line and Drag, with 80 feet of line, in case; for recovering a drowning person from the water. Price complete, with instructions for use, 6s. cd.

Pocket Reel and Ice Line for use in ice accidents, with o feet of line in C::l5e. Price complete, with instmctions for use, 6s 6d.

13 Can' iage Paid on all Ordel s In the United Ki ngdom,

The St. John Tourniqu e t , as supplied to the Admi ra lty, with di rect ions for use

(Speci:d quotat ions fo r la rge quantities.) 5. d. o

Splints, 'W ooden, per set, 2/6 ; Ca.ne .. . ., .pe r set 6

Greatly improved Wooden Splints, with grooved joints and angle piece, strong ly recommended .. . 4 6

Tow, fo r splint padding . .. . .. per lb , 0

Firs t Field Dressing (Army Pattern) 0 Q

Jaconette, about 42 inches wide per yard 2 3

Tow, Carbolized or Styptic ... . .. per lb. 0

First Aid Dressing, consisting of a smal l compressed packet of boric lint, a compressed roll er bandage, and a safety pin 0 3

Dredger, containing bo ri c acid powder I..; . and I 4

Measure Glass . . . 0 5

Knife with strong Llade .. . each Is. ; per doz. 1 0 6

Pair Scissors... each IS . ; per doz. IO 6

Small Bottles strong Smelling Salts ... per doz. G

Splint Straps, ' Vebbing, and suitable Buckles. Pe r set of 1 2 yards o f st rong 2- inch ' \'ebbing and 15 Buckles 4 :5

Th ese make very compact Slraps fo r carrying in the Pouch.

T he Webbi n g shou ld be cut to meet local requi rements.

Bu ckl es onl y, IS. 3d . pe r dozen. W ebbing only, 3s. c d . pe r dozen yards .

I t is unn ecessary to sew t h e Buckles. T he sp ikes should be passed t hrough the webhing, and the shor t end of the wcbJing should lie outwa rds.

Ca rn a g e Paid on a ll Orders in the Un i ted I(in g dom

LARGE HAMPER FOR AMBULANCE STATION AND RAILWAY PURPOSES.

F)I c )ntents see next Dage.

to; Carriage Paid on all Orders in the . United Kingdom . THE HAMPER CONTAINS

[ Set of Cane Splints.

I St. John T ourniquet.

lb. Cotton Wool } In Tin

lb. Lint ... Cases.

I Roll Adhesive Plaste r.

20 Roller Bandages, asso rted .

I doz. Tri ang ular Bandages.

3 pieces T ape .

4 oz. Tincture Iodine.

I Box Ampoules Tin ct ure Iodine .

4 oz. Sal Volatile.

! lb. Powdered Boric Acid.

4 oz. Bicarbonate of Soda.

I Dredger for Boric Acid.

1 Knife.

12 Surgeon's Needles.

I packet each Safety and Plain Pins.

Carbolised Silk Silkworm G Ul.

I reel each Black and \Vhi te Sewing Thread.

1 Kidney-shaped Basin.

1 Stopper Loosenel.

1 Graduated

I cake 20 per cent. Carbolic Soap.

I l\' ail Brush.

3 Empty 8 oz. B ottle s. 4 oz.

I pair Art e ry Forceps. 2 Sauce r'S.

[ pair Scissors.

2 Ca mel Hair Brushes.

Size: Length 24 in. Wid th I I in. De pth 10 in. (app rox ) Pri ce complete, .£4

Carriage Paid on all Orders in th e United I<ingdom . 16 SMALL AMBULANCE HAMPER.

,\Vith waterproof cover a.nd strap, for use in factories, collieri es, stations, and large works, as well as for pa.rochial and domestic use.

CONTAINING

Set Splints. I St. John Tourniquet. Bo x Ampoules of Tinct ure of I odine . 2 Packets Lint. 4 Roller Bandages (wide ancl narrow). 4 Triangular Bandages, Cotton Wool, Boric \Vool (two latter in tin cases), Spool of Adhesive Plaster, Knife , Scissors, Thr ead , Tape, N eeclles, and Pins.

'Weight complete, lbs.

Length, I ft. 6 in. Depth, 5 in. Width, 7 in. (approx.).

Price £ I I J s 6<1.

n Ca rri a ge Pai d on all Or de r s in t h e United SURGICAL

IMPROVED PATTERN, filled \\'ith a tin. so arranged that an: article can be taken out witholll disturbing. the rest of the content:; .

Contents: I Set of Splints, 6 Triangular Bandages, 6 Ro ll er Bandages (wide and narrow), Cotton \Yool, Boric Lint, I Roll Aclhesi\'e Plaster, I Pair Scissors, I Knife, 2 oz. Tinct. Iodine, I Box Ampoules Tinct. Iodine, 2 oz. Sal Volatile, 2 oz. Boric Acid Powder, I Dredger, I Graduated Glass l\Ieasure, I St. John Tourniquet, Pins, Needles and Thread, 2 Saucers, 2 C8nlel Hai r Brushes . Price £1 lIS. 6d. Wh ite Ration H a v ers a cs , 2 ' each.

FIRST AID COMPRESSE D KIT.

box is. macle of. wood covered with damp-resisting rnatenal, and IS filted wIth a lock and key. It contains a nUl:nber of practical ambulance appliances arranged so that any artIcle can be withdrawn or replaced without disturbing the r.cmainder. (. Being fitted with a handle it is portable, and the hd, when let down, can be used as a table. All bandages anJ dressings are compressed . Size- Length, in. ; width, in.; height, gin.. (approx. ), without handle.

Con.tents: 4 Triangular Bandages, 6 Roller Bandages, 4 First Aid Dressmgs, 6 Small Packets of Cotton \Vool, 6 Small Packets of Boric Lint I St. John Tourniquet, I Measure I tin uox containing a Roll of Plaster, D0ric Lint Patches, Scissors and Pins, I tray containing 3 (Sal Volatile, Tincture of Iodine and Boric Acid Powder) and a Dredger set of improved Splints, with angle piece, 9 Splint Straps Isufficient for fractured thigh), 2 Saucers, 2 Camel Hair Brushes. . < Price £1 I IS. 6d.

Carriage Paid on all Orders in the United Kingdom.

FIRST RID COMPRESSED).

B)' Post

Size, by 3! by Ii inches (approx.). Suitable for the pocket.

CONTENTS.

1. Tliangul ar Bandage. 2. First Aid Dressing. 3. Cotton \\'001. 4. Two Splint Straps. 5. Adhesive Plaster. 6. Ampoule of Tincture of Iodine. 7. Boric Lint Patches. 8. Safety and Plain Pins.

Price, each IS. 6d. Packed for Post IS. 8e1. Per doz.

175. 6d.

SEPARATE ARTICLES.

No. !\o.

I 41d. each or 4/3 per doz. 5 rd . per box or Iod. per doz.

2 3d. 2/9 6 2d each or 1/9 "

3 " " 1/3 " 7 rt!. per p:tcket or lOd.

4 3d. per strap or 2 /9 " " 0 HI. " " lod. Not less than one d ozen suppiled at dozen

Carri"ge Paid (1n all Orders in the United Kingdom.

FIRST AID BOX FOR USE

IN MINES.

CONTENTS.

Set of ImprCJved Wooden Splints; t. John Tourniquet; Cotton Wool; Lint; 12 Compressed R oll er 6 Triangular Bandages in waxed pnper; Adhesive PaIT SCissors; Measure; 2 oz. Sal Volatile; 8 oz. BoraCIC Powder; 8 oz. Tinct. Box Ampo';11es Tincture Iodine; Dredger; 2 Saucers; 2 Camel Hair Brushes; PinS; Safety Pins. PRICE CO:\lPLETE, £2 105.

This First Aid Equipment is also very suitable for USA in and other large wOlks, ant! can be fitted for carrying on the" Ashford' Litter.

Carr:age Paid on all Or ders in the United Kingdom.

SMALL FIRST AID OUTFIT.

\Vhen closed can be carried by a Strap-handle.

Dimensions - 9i by 7! by inche s (approx.).

CONTENTS: 2 Trianguiar Bandages, I St. J oh n Tourniquet, 8 Splint Straps (for securing Splints in lieu of Bandages ), 2 oz. Cotton 'Wool, 2 oz. Plain Lint, 4 I-in. and 2 2- in Roller Bandages, I 2 -0Z Bottle Sal V olatil e, I 2-0Z. Bottle Tincture I od in e, B.P.C., I Pair of I 2 -0Z. Measure Glass, 2 China Saucers, and 2 Camel Hair Brushes to be used when applying Tincture of I oJine .

\Yooden Box, covered wiLh Damp ResisLing Material, I5 s-

Cani age Paid on all OrderS in th e Un ited Kingdom.

BANDAGES in Assortm.ent.

Pacli.ed in neat Cardboa rd Box.

RECO?lIMENDED FOR CLASS PRACTICE.

Tw o 3 in . two 21 in . ; one I in.; each 6 Fuels long.

Grey Calico

ROLLER BANDAGE MACHINE. Designed by Dr. A . C. Tun stall.

23

Carriage Paid on all Orders in the United Kingdom.

TRIANGULAR BANDAGES.

P).ain, each (Special quotations for large quantities.)

DItto Compressed (thInner quality), each 41rl. ; per doz. 4';' yl

[lJustrated, showing 25 applications of the Triangular s. d. Bandage, with printed instructions... ... each 0 6 per doz. 4 6

COTTON WOOL.

Plain, r oz., 2d.; 2 oz., 3d.; 4 oz., 4d. ; lb., 7d.; I lb., IS. Id.: small packet (CoI11pressed),

Medicated, Boracic, lIb., 6d.; I rs. 6d.; Carbolic, per lb., 2S.; Alembroth, per lb., 25. 6d.; Double Cyanide pe r lb., 25. 6d. '

LINT.

Plain, I oz., 2d.; 2 oz., 4d.; 4 oz., 7d.; lb., Is. rd.; I lb., 25. rd.

Boracic, 4 oz., 6d. ; I lb., IS. 9<1. ; square foot packet, 3d. ; !-l11all packet (Compressed),

GAUZES.

Th ese are supplied in 6 yard lengths, width about 36 inches.

Unmedicated white

Alembroth ...

Double Cyanide

Boracic s. d. per length a 10 o 2 2

Packets of Cyanide rioz., 25. 8d. ( I yd. compressed), per

GAUZE TISSUE.

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.

CLINICAL THERMOMETERS.

Round.-No. I, ordinary, IS. 6d.; No.2, minute, Is. 9d . ; NO.3, half-minute, 2s. ad.

With Magnifying Lens. -l o. 4, ordinary, 2S. od.; No·5, minute, 2S. 3d. ; No.6, half-minute, 2S. 9d .

With Broad Index, will not roll.-No. 7, ordinary, 2S. ·oel. ; No.8, minute, 2S. 3d.; NO.9, half-minute, 2S. 6d.

In ordering it is only necessary to quote the registered number of the Thermometer required.

N .B.-11inute and half-minute instruments will only register in the time stated under favourable circumstances.

BATH THERMOMETERS.

To Dr. Forbes' specification. Japanned with zinc scale, 2S. 3d. ; Clinical Therm ometer size, in case, IS. 6d.

No liability is taken for breakage oj Thermometers in tramit.

NURSING INSTRUMENTS.

Forceps, spring dressing, full size or small as desired, IS. 6d.; Artery, 5 in., 4S. 6d.

Scissors, round -pointed blades, IS.; small round-pointed blades, or 5 in., 2S.: sharp·pointed blades, for delicate work, 2S. 3d.; curved blades, 2S. 6d.

Spatula, IS. Probe, 6d. Director, with Ear Scoop, IS. 9el.

Knife, very thin, ivory handle, two bladts, IS. 9d.; single blade, I S.

Nursing Chart, by Miss InCierwick, each.

Temperature Chart, each.

25 Carriage Paid on all Orders in the United Kingdom.

NURSES' WALLETS.

ORDINARY PADLOCK SHAPE.

\Vi thout instruments, 4S. 6.1.

Fitted complete, contaming Spring Dressing Forceps, Spatula, Probe, 2 pairs Scissors (round and sharp pointed), Clinical Thermometer, and Knife.

Plice 12S. 6d.

ST. JOHN'S PATTERN, as illustrated, but improved hy the addition of flaps to protect the instruments.

\Vithout instruments, 8s. 6d.

Fitted complete, containing Spring Dressing Forceps, Artery Forceps (also useful for dressing), Spatula, Probe, Director with Ear Scoop, 2 pairs Scissors (round and sharp pointed), CliBical Thermometer (minute, round), _ Knife, Pencil, and Safety Pins.

Plice £1 3s .

Carriage Paid nn all OrGel'S in the United I(ingdom PLASTERS.

Leicester Adhesive Plaster on Cambric, in tins of yard, 6 inches wide 6d. The Leicester Adhesiye

Ribbons, in lin boxes, 6 yards long.

National Rubber Adhesive Plaster (Antiseptic) on spools.

5 yds. 10 yds. inch wide lId. IS. 2d. IS. 2d. IS. 9d. 2 2s. oj. 2S. 9d .

Dillo in card box, in. 'wide, yds. long tin I :i

COURT PLASTER, TRICOLOR.

Large Size, 9d. ; Medium, Sd.; Small, 3d .

27

Carriage Paid on all Orders in the United Kingdom

TEXT BOOKS, &c.

"First Aid to the Injured." By James Cantlie, B., F.R.C.S. The authorised Text Book of the First Aid Course. I S.

" A Catechism of First Aid." Compiled from Dr. Cantlie's Manual. By J. M. Carvell, M.R.C.S., L.S.A. 6d.

" Problems in First Aid." A companion to the authorised Text Eook of the St. John Ambulance Association "First Aid to the Injured." By L. M. F. Christian, M.B. , C.M ., Ed., and W. R. Edwards, A.C.A. 6d.

"Hints and Helps for Home Nursing and Hygiene. " By E. Cosgrave, M.D., illustrated, with chapter on the apphcatlOn of the roller bandage, by Sir R. J. Collie, M.D. The authorised T ext Book for the Nursing Course. IS.

"A Catechism of Home Nursing" (based on Dr. Cosgrave's Text Book). By the late J. Brown, L.R.C.P., L.R.C.S., and J. M. Carvell, M.R.C.S., L.S.A. 6d.

"Home Hygiene." By John F. J. Sykes, D.Sc. tru blic Health), M.D., &c. Illustrated. Th e authorised Text Book for the Home Hygiene Course. IS.

"A Catechism of Home Hygiene" (based on Dr. Sykes' T ext Book). By J. M. Carvell, M.R.C.S., L.S.A. 6d.

"Questions Answers upon Ambulance Work." By J ohn W. MartIn, M.D., and John MarLin, F.R.C.S., Ed. IS. and Answers upon Nursing." By John W. :'larLIO, M.D. I S. 6d.

"Elementary Banda?;"ing and Surgical Dressing." By Walter Pye, F.R.C.S. 2S.

"To Restore the Apparently " printed in Iargt Type with two Diagrams. 2d. '

carriage Paid on all Orders in the United Kingdom TEXT BOOKS, &c.-(co1ltinued).

Dr. G. H. Darwin's "First Aids," being a card to hang up giving treAtment of various accidents. 2d.; packed for post, Sd.

IC Manual of Drill and Camping for the St. John Ambulance Brigade." Sd.

"Manual for St. John Voluntary Aid Detachments." By Lieut.-Col. G. E. Twi ss, R.A.M.C. (Retired Pay). 6d.

"How to Act when Clothing takes Fire." By J. E. H. Mackinlay, !lI.R . C.S. 2d.

"First Aid Principles." Cards of concise directions for waistcoat pocket, each; 4d. per doz. Special quotation s for large quantities.

" Specimen Examination Papers, First Aid, ancl Il ygiene Courses." 3d.

Small Anatomical Diagram. Showing the human skeleton. main arte ri es, and points where pressure should be applied to arrest bleeding. 2d. Post card size for pocket, Id

Directions as to the Restoration of Persons suffering from Electric Shock. Large print, poster sileo 3d. each; or 25. 6d. per dozen.

General Notes on First Aid to be Rendered in Cases of Poisoning. By Milnes Hey, M.A., i\l.R.C.S.,L.R.C.P. 2d.

Notes on Military Sanitation. By Li eut.-Col. II. P. G . Elkington, R.A.M.C. ·6d.

"Emergency Book," for instantaneous refe rence, giving concise instructions; to hang on wall. Size about one foot square . 2S. 6d. ; packed for post , 2 . 8d.

Aids to Memory for First Aid Students. Revised La date. AdJilional Illustrations. By the late L. ;'T. Frank Christian , 11.B., C.M., Edin. 6d-

29 Carriage Paid on all Orders In the United Kingdom.

TEXT BOOKS, C3c.-( contz"nzted} .

"Order of the Hospital of St. John of Jerusa le m and its Grand Priory of England." By H . W. Fincham , a ssisted by W. R . Edwards. 100 pp. , crown 4 to. , on antique laid pap er, with 2 3 Plates on Art Pape r. Bo u nd cl ot h boa rds, g il t lette red, price 65. (packed fo r post 6s . 6d.).

Cheape r Edition , pape r cove r s, p ri ce 2S . (packed fo r post 2S. 4c1.) .

Gen e r a l Reg u lations for th e S t . John Ambulance Brigade , 19 I 3. 3d .

Rules for Corps and Divisions, St. John A mbu lance Brigade . zcl .

Registers. Class A ttendance , 2S. 6d . CerLificates, 4S . 6d . Case Repo rt, IS.

St. John Ambulance Brigade Cash Boo k, Min ute Book and Occurrence Book. Set of three, 7S. 6d . . Receipt Book, 6d .

Large Phy siological Diagrams (New Series). For Lecturer:;' use . The I-I u ma n Skeleton, showing the main arteries and p ressure points . T he Gene ra l Anatomy of the Body. The Systemic and Pulmonary Circulalion of the Blood. Section T h r ough :\1iddle Li ne of H ead and N eck, sh owing the T ongue in two positio ns in r e lation to the T ra c hea , and Sch afe r 's of A rtificia l Respiration (Expiration and I nspirat ion). D islocat ion s . Pri ce , p e r set of five I5 s. T hese may be h ired fo r a course of "First Ai d" lectures, given unde r the auspices of the Association, for a fee of 5s., or with the add i tion of Splints, T ou rni quet, and 30 plain Triangu la r Ba n dages, fo r a fee of lOS. '-'

Boxes of Stationery fo r t h e use of Class Secreta ri es and otbe rs connected wi th the Association, co n tai ning twelve sh eets of high.class pape r, sui tab ly headed, and twelve envelopes beari ng th e device of t h e Assoc iation . 6d.

T wice that quant ity, I S.

carriage Paid on all Orders in the United Kingdom. 30

ELECT R OTYPES.

ttbe CilranO I)rlOr\? of trlie of tbe 1)o9plta( of St. 30bn of 3eru9alem In JE.n gIRll0.

Af.!Bt'lAN( l:. I'1EPA.R TM i: N T \tbe $t. 30bn 5mbulllllCC Bsso.cilltioll.

N o. I AH.

1\ 0 . 2 D.

ttbe CilranO IPrlor)) of Ubc OrDer of tbe lboepltal of St 30bll of 3eruoalcm til iSngl alli.'

AM BU L AN CE DEPARTMENT

tlbe $t. 30hn Rmbllllmce

1\' 0 . T Dl-L

Carriage Paill on all Orders in tne United Kingdom.'

ELECTROTYPES OF THE ST. JOliN AMBULANCE DEVICE.

For r\ ssoc iation use. Series Series

No.

I. For Cards, Tick ets, &c.

2. For Note P ape r. Smail Circulars, .xc.

3. For Quarto and Foolscap Lett e r- pape r, Cir-

4. For Small Posters

5. For Large Posters

Prints of the above Electrotypes (1 to 3) Series A. a nd B, and ([) Series AH and BlI, appea r OD page 30. Th e diameter of 5A and 5B is inch es.

FLAG8.

Association Flag -I2 ft. lly 6 ft. 5 fL. by 3 ft.

Bngade Flag, new cle sign, 6 ft. by 4 ft. 9 ft. by 6 ft . Pennon, 3 ft. 3 in. by 7 ft. 6 in. S

by 12

carriage Paid on all Orders in tne United KingC:cm . B:A..DGES. :K

3 and 6. :K os. 7 and 8. (Actual size.)

Badges, wiLh the device, issued under the aULhority of Lhe CenLral ExecuLiye Commillee, having been first app roved by II.R.II. the Granel Prior as the sole offtc ial and r ecognised Badge of the Association and Brigade .

N B - Tltis design £s protected SERIES A. -For the use of indi\'idual certificated pllpils-

In Nickel Silver, Large Size

DilLO, Small Size

Ditto , SrHall Size fo r buLlon h ule

In Electro Plate , Large Size

Dlllo , Small Size

Ditt o , Small Size for bullon hole

In Enamel fo r button hole

Ditt o, as brooch

In Cloth and Silk

In C loth and Sil \'e r

I n Cloth and Cotton

Small Celluloitl Badge, for but to n hole or brooch

\ Vhite SaLin Armlet, with woven Badge

l B.- Tlte:;!! Badges a1 e 1101 1(1 be tt, d,·co'·atinll.<'

'B Carriage Paid on all Orders in th e United I<ingrlom BADGES.

N os. 15 to l8 (Reduced ). No . 19 (Actual Size ).

SERIES B.- Fur members of the St. John Ambulance Brio:acle . not wearing uniform, having the name of the Corps or Division annexed on a label, only issued in quantities-

N o. IS I n Nickel Silver, 2 ins. in diameter, first doz., £1 ; sulJsequentdoi>:s., 12S.

16. I n EleGtro Plate, 2 first doz. , £ 1 1 2S. ; subsequent dozs. , £1 4s.

17. I n Cloth and Silk, 2 per doz., 12S .

18. I nCloth and Silver, 2 per doz., £1 l OS.

19 . The "Brigade" button hole lJadge, eacl), IS . ; wit h brooch pin , each 1/3

N . B . -TJuJI! bCI(i..r;es are 1lot to be wont as decorations.

Curriage Paid on all Orders In the United Kingdom 34

UNIFORM BADGES, BUTTONS, Etc . St. Jobn Ambulance Brigade.

Ambulance Division- , O ffice rs .

Cap Badge (No. IOr)

Col lar Badges (" 103)

Pouch Badge (" 3,657) per pair

Badges of Rank, St. John Crosses (No. 4[) per plir

Surgeon (Crosses B -0. 33) per pair

Superintendent (Stars A 1 O. 32) per pair

Prince of Wales'Plume Badge ( 0.44) pair

Reserve Badge (for all ranks) (No. 34) pair

Lace, per yard, Silver , lOS. ; Black

Whistle and Chain

, Yarrant Officers Badges (No. 35) per pair

Buttons, No. 4 (large) per doz. NO . 5 (medium)

" No.6 (small, for cap)

S er geant s , Co rpo ral s an d P rivates.

Cap Badge (1\" 0 . 102)

Collar Badges (" J04)

Overcoat Badge (" 1,582) per pair

Titles, S.J . A.B., J to 12 per pair

Shoulder Straps, filled with titles and numerals ... per pair per bar

C l {Silver ... 1evrons, \Yorsted

Div. Sec. and Sergeant's

l\led;'lIion

Badge (No:'25) Silver W or: teci '('D TO . 26)

Nursing Badge (E No. 27)

35

Carriage Paid on all 0 r d ers in th e Un ited J( i n g donl

S er geants, Co r p o rals an d Privates. -contl"nued. Black Khaki Uniform. Unifcrm.

Signaller 's Rtdge tor (Yo 28) ,""lIgna er (2\0.' 29)

Bugle r 's Badg-e (;\To. 30)

Drummer'!, Badge (K J 3 r)

Bugler's Cord

Bandsman's "Wings

B elt Furniture per pall'

\Vhite Piping, per packet of 71 yards, enough for 3 pairs of trousers (packets

cannot be broken)

Buttons, No. 1 (large) per doz.

No . 2 (medium) 0

6

NO.3 (small, [o r c.t ps) 0 0

St. John Voluntary Aid Det ach ments. Officers. Men's Detachments.

Collar Badges (No. 2.1)

Cap Badge (Nu. 23)

Badges of Rank (Stars A No. 32)

Buttons, N o. 1 0 (large) No . II (medium)

No. 12 (small , for CJp)

Rank and File.

Collar Badges (No. 22)

Cap Badge (N o. 24)

Sho ul de r T itles, S.J. A.A. ...

Ch { S ih'er ... evrons \\'orsted

Belt F urniture

Buttons, NO. 7 (large)

N o. 8 (medium) ...

N O. 9 ( mall, for cap)

Car riage Pai d on a ll Orde r s in th e Un ited Kingdom

St. John Ambulance Brigade. O fficers . Nursing Divisions.

Lady Dist. Supt. , Cloak (No. 3,6 58. 3 Stars, A)

" "Arm (No. 3,659, 3 Stars A) ...

Lady Corps Supt., Cloak (No. 3,658. 2 Stars A)

" "Arm (No. 3,659. 2 Stars A) ...

Lad), Divisional Supt., Cloak (No. 3,658. I Star A)

" .. Arm (No. 3,659. 1 Star A)

ursing Officer, Cloa].; (Ko. 365))

" " Arm ( o. 3,656) ..

Prince of \ ,"ales' Plume Badge (No. 44) ... each

District Number . all ranks, single, 3d . ; double

\ Yhite Box C10lh Backs ... per pair

Badges of Rank (Slars A, No. each

Black Silk Armlet for Arm Bacl!2;e, all ranks

Pin Cushion Bad!>e, all ranks (No. 37)

Hat Badge, all ranks (No. 20)

Bullons, all ranks, N " 13 (large)... per

N o. :'4 (small) ... N u rsing Sisters-C loak Badge (No·3, 52 I) ...

Arm Badge (No. 3,522) ...

Shoulder Titles, S.T.A.B. , I to 12 per pair

Prince of Wales' Badge (Ko, 45) each

St. John Voluntary Aid Detachmen.ts. Officers. Women's Detachments

(Ko. I I )

Commandanl (No.

" ., Lady Superintendent, Quartermaster and rharmacist ( o. 39)

37 Carriage . Paid on all Orders in the United Kingdom.

Offi ce rs -co n ti lilted.

Black S ilk Armlet (all officers)

Badges of Rank (Stars A. 36)

Buttons, all ranks, No. 15 (large) .. " No. 16 (small)

O t her R a nks -Shoulder Titles, S.J.A.A., each per doz. per pair

SW AGGER S TICK

for th e use o f O ffice r s and M embers o f the

St. John A mbulance B rigad e.

Ebonised Canes, German Silver :'Iounts bearing the Brigade De\'ice.

PRICR IS. I;:ACrT.

Officers' Special Canes. with Sterling Silver :'Iounls.

PRICE 7S. EACH

BEARER' S DRESSING CASE

.

PR[Cr, I2S. 6d.

A II Orders fo r th e fo reg oin g Sto r e s s hou Id be g ive n to the Local Secretary , or sent direct to

The St. J ohn Ambul ance As sociati o n , St. John ' s Gate, Clerkenwell, London, E .C.

I ;..JDEX T O PR I CE L I ST

(For General Index see pages 208'215).

.

PAGK

Ambulance Hampers... 14 to 16

Station Plate

Awning CO\'er for Stretcher 9

Badges, &c 32 to 37

Banll:\ge Rolling l\lachinc 22

Bandages.. 22,23

Basin, Dressing... I I

Bearer's Dre<;<;ing Case 37

Belt Furniture 35

Books ... .. . 27 to 29

Bottles (Water) 10

Buttons ...,.. 34 to '37

Carrying Sheet II

Cash Book ... 29

Cotton Wool... 23

Diagrams, Large 29 " Small... 28

Dredger (Boric Acid) 13

Dressing Basin II

Drowning Tackle 12

Electrotypes ... 30 3 t

Emergency Book 28

Fir,t Aid 130x .., 6, 20, 21 " Companion.. JQ " "Compressed Kit 18

First Field Dressings... 13 flags 31

Forceps ?4

Litter (St. John)

Lowmoor ] acket

11easure Glass .. .

l\linute Book .. .

Nurses' \Vallets

Nursing Charts

Occurrence Book

Pillo\\', Stretchers

Pouch Fittings Receipt Book ... Registers Roller Bandages ...

Bandage

Rules for Corps or Divisions St. John .-\mbulance Brigade

(Stretcher) 9

Smelling Salts ... Splint Padding " Straps .. . Splims... .. . Stationery...

Stretcher Depot Plate

Stretchers

Swagger Stick... ...

Gauzes 23

Gauze Tissue... ." 2, Hampers (Ambulance) 14 to 16

Haversacs ... .. ' ." 17

Hood and Apron for L itter 2, 3, 7, 9 I nstruments (various) 24 J aconette 13

Knife...... ... 13, 24

Lace for Caps, &c . 34 Lamp

Lin t ... 23

Litter (Ashrol d). .. 2, 7 (Rea.Edwards) ... 3, 4, 7

Temperature Chart

Text Dooks

Thermometers... ... Tourniquet (St. John)

Tow (carbolized) " (plain) ... Uniform Sundries

Uniforms ... \Vater Bottle W"terproof Sheet

Whistle and Chain \\ 'h ite Piping ..

39 Contractors' . List. Carriage out of London Extra.

PRICE LIST.

UNIFORMS FOR AMBULANCE UNITS OF THE S.J.A.B.

Th ese may be obta ined from HAZ E L & Co. proprietor, D. H aze l, for many years asso cia ted wi th the late firm of H ebbe rt & Co., Ltd. , as Director), Clothing and Equipment

Manufact ur e rs, 65, East Road, City Road, London, E. C. ; and at 6, Yo r k Pla ce, Leeds; 69, Piccadilly, Manchester; and 84, l\Iill er Stre et, Telep,hone: 5678 Wall.

Teleg rams : "Haze hsm, L ond on.? Wh ere two pnces are given fo r an article th ey a re fo r first and sec ond q uali ties.

All B adges , and ca rr iage Oltt s £de L Olldo ll area, extra. /V£eas uremmts to· be supp lied free of cha rge.

CORPS SURGEON AND DIVI SIO NAL SURGEON.

Tunic, Superfin e Bla ck Cloth... ...

Trouse rs, Supe rfine Bla ck Doeski n (if

Stripe, e xt ra)

Be lt and Pouch, Plain, 20/- ; Silver

Pat rol'Jacket, Supe rfine Black Cloth

Trousers, Su perfine Black Doeskin

Cross Be lt and P ouch . ..

G loyes, 4/6 ; L eggings, 8/6

G reat Coat, G rey Cl ot h .... ...

Fatigue Jacket , Black Vicuna Serge . .. " Trousers, Black Vicuna Se rge

Cap-Divisional Superintendent £ 1 4 0 and Ambulance

Cap , 2/9 ; G loves, Buckskin , 4/6; G loves, Cotto n, 8d .

SERGEANTS, CORPORALS A ND PRIVATES

Patrol Jacket, Black Tartan

CheYrons, Silycr . .

Trousers, Black Tartan . . . ...

\ Vaist Belt and Pouch , Brown Leathe r

Cap, 2/9 ; G loves, Cotton, 8d

SUPERIN TEN DENTS AND CORPS OFFI

rs, Sup erfin e Black Doeskin

Cross Belt and P ouch

G loves, 4/6 ; L eggings, 8/6

Great Coat , Grey Clot h

DRAB SERGE U NIFORMS.

J acket, D rab Mixtu re erge

Trouse rs " "

ST. JOHN l1Jv\BULl1NCE BRIOl1DE .

UNIFORMS FOR NURSING UNITS.

T UESE GOODS MAY BE OB T AINED

Messrs. E. & R. GARROULD,

150 to 162, EDGW ARE RD., . LONDON, W.

CLOA K ( Badge ext ra) 25/6, 29 '6

{ N u rsing Si"ter's 9/6 BONI'ET Office r's. 10/6 3/ 1 [

DRESS O fficer's ,,4/ 3

{ " 21 !n., 5;(l. doz. COLLARS m., 6, 6 " . .. 4 in. , 6/6 " CUFFS 7!J . " 7/6 " { Nursing Sister' s & 1/- each CAP "Officer 's - 1/4, APRON I I I [ & 2/ 6 . , a lso i n Pu r e Irish Linen 3/ 1[ "

ILL US T RATED PR I CE LIST FREE.

T elep!tolles5320, 5321, & 6297, PADDl:-l G r O :>l. Te l e,I'rrms"GARROULD, LON DO.'1. "

TH E UNI FORM S, CLOAK S, BONNETS, APRONS, DRESSES, ETC., FOR THE ST. JOB AMBULA N C E BR I GA D E, MAY BE OBTAI 'ED AT E. & R. GARROULD.

To H .l\I. VAR OFFICE, 11.1\1. INDIA OFFICE, COLO:-lIAL OFFICE, LONDON COUNTY COUNCIL, E rc. AN I LLUS T RATED PRIC E LI ST of the "ario u'i articles requir ed by the ST. A;\IBULANC !!: BR IGADE, ON APPLICAT I ON.

WrWI'r:R COAT (as ill ustration) 25 / 6

SUi\IMER COAT 3 1/ 6

ISO to r62 , Edgware Road, LONDON, W.