AID TO THE I NJURED
BUL.-iXCE .-iSSOC IA
BY
JA:JIE CA.\"TLIE, M.A. . , M.B . ,
H ollom I'Y .dssociate oj the Order oj St. JOhll. Honol'ary L ife .l1dIl LUel' and Lcc t/ue,' aJid Exam mer to, the
With II. CHaPTER on .. tretcher Transport," revised from tha t originally writtE)n by ir JOHY FURLEY, Knight 0/ Justice of the O,'dd,' 0/ t, John, in al'l'Oruallce ,vith the A.rmy tretcher .Also a OHAPTER (heing' the Fifth L ectnre for Females only), by E. lI..I.CDOWEL COSGRAVE, M.D ., F,R,C.P,r., Klligllt 0.1 Grace of the Ortle;- 0/ t. Jnlm, HUllorarll Li/I oJ; Ulld LdC!U,'8,' and E .• aminer to, the .ds<>oci'ltion.
Il[be
Wrtot!! of tbe ®rbft of tbt
of 'st. lobn of lHtt.5alem in Qlnglanb.
ltltb' ,OJ it t <9rbtr.
His Most Gracious Majesty King Edward VII.
($rttnb' iri.or.
His Royal Highness the Prince of Wales , K.G. -11 riO!.
The Most Honble. the Marquess of Linlithgow, K. T. .of
His Royal Highness the Duke of Connaught, K.G. @ffi.c.c rli.
Prela t e - Hi s G race ( ,e Archbishop o f Y ORK .
C It.all cell or - The R i.!;h t H on. Earl EGERTON OF TATTO:-; .
S ecretary-Genera l-Colonel S ir H l' RBERT JEKYI L, K .C. :'>1. G . , R . E .
R eceiv er- Gutera l-ED wl N F RES HFIELO, • L L. D
R ev . C anon D UCKWORTH , C.\'.O., D D
Reglstrar-M aj or · General Th e Ri gbt H on. Lord C . V. O .
G enea lo{{ist-S i r ALF RED SCOTT SCOTT-GATTY (Garter).
Direc tor 0/ th.e Am bulance Depa rtm en t-Th e H on . the :'Il arq uess
o f B REA DALIlAI'E , K .G.
L ibra riall- Lie ut. -C olon el RICHA RD H OLBECHE.
S t cre t a ry - C o lo n e l ir H ERBE RT C . PERROTT, Bart. , C. B.
C ha inHa n 0/ th.e British. OJ>lttlta i mic H osp ita l , }eru sa l eHl - The R ight . H o n. Earl EGE RTON OF T ATTON .
C h,ie! S ecre t ary 0/ t lte AlJIb u l a ll ct D ej>a r lment- C o lo ne l S ir H E RB ERT C.
P ERROTT , BarL , C. D.
@ffi.c.eXll
.
A ssistant D inCl" r 0./ the A m bulan ce D epartmc1tt- Lieut..C o lo nei Si1 RI CII ARD CA RN AC T EMPLE, Bart., C. LE. Assis ta1t t R eceiver-EDWIN H. FI<ESIIFIELD , Esq , M.A.
A ss is tant L ibra n'a 1l - CY RIL DA I'ENI'ORT, Assistattt Secrera 1J,-LOCKIlART STOCKWELl., Esq R. EDIVARDS, Esq ., A.C.A .
HO ll . . S ecre t ary of the British Uphthalmic ffosjit a l , } erusalt mLl eu L -Colon el J . T . W OOLRYCIi PEtROIVi' f..
ASSIstan t Honora ry Sec r etary (jOr Scot/a n d) if tile British O plztltalmic f.{ospit a l, je nlsa le m - J. HORNESTEVEi'SON, Esq ., U n icorll Pursu ivallt . t1bIJe
The Council cOlbists of the" Sub·Prior, President ex-officio, tb e Executive Officers, and the follOWing iBcmbrrs :
Sir JOHN FURLEY. C. B.
2\ rajor-General J. C DA!.TON, 1{ \.
The Ri ght H on. Viscount KI'UTSFORD, G.C i\1. G
The Right H on Lord 2\I oSTY:-.I
Colonel C. W . ilOIl'JJI.ER BOII'DJ.ER, C. B.
Sir DICK, K.C.D., :'1 1. D ., R.N .
Culonel Sir CHARLES :-.r. \VA1'50 , K C.;' l. G., C.B, R . E. I
[ qe
Sir DYcr: DUCKWORTH, M D. :'lajor-General Sir Oil' El'i 1'. RUR:-IE, G .C .!.!!: . , K .C.S . L ir GEORGE HAYTER CHUBB, B u rt. I nspector-General BELGR A I E NI1';NIS, .:\1.U., R .N . Sir RICHARD UOUGLAS P OWELL, Bart., K.C.V .O., M.D . Lieut.·Colonel . ir RJCHARO C. TF\IJ'J.E, Dart., C . LE .
The CI!apler .cOJhists of the Knights of Justice and Sub:Prelates d e ju n ; the !-.xecullle Officers; the selected :'11embers of Cuuncd ; the followin g @fficia t mg (!J;bapf aml! ,
The Sub-Dean of the CHAPEL S I Tbe Rev . TJlo\IAS \ \ '. \\'000 . H.'\ ,.\1., C. \ .0., U.D . Hrprcsrntllt inc l"tniglJts of <5 IUCf.
The Ri\!ht Hon. the Earl of The Hon. The Earl of l'l,Y.\IOUTH, C . B. LATHO'!.
Thp Right H on . th e Earl of Surgeon-General .Ir \\'1 LLI AM V-\RUOROUt,H. TAYLOR, K.C' . B. :\lajor·General L . V . SI\'AI:-;l1:, C.B. , \ YII.L1 A\1 D . JUlES, Esq . C .!\LG. Sir EVW ARD O':\[ALLE\,. ED\IUND OIl'EN, Fsq .• F.R.C.S. Colonel E R. PRATT.
The Right H on . Lord l.AlO Lieut.-Colonel h'OR PHILIPPS. V . .0., :'Il.l>.
EDlII;-'; HANSON 1 RESIlFIELO, FSQ. Li e ul -Colonel CHA RLES F ST•
Colonel Sir CLI.:.\IX:\T 1\1. ROVDS, C LA IR
C. B. M.V.O,
'Qi:bt following art tbt lltnigf)ts of ] usiier :
H R.H. P rince CHRISTIAN OF S CHLESWIG. H oLSTEIN, K .G , G .C. B.
H . R.H. Pri nce CI!ARLES OF DE N· MARK, G .C . B., G.C.V.O.
H H. Prince ALBERT OF SCIILES· WIG· H 0 L S TEl N, G.C.B., G .C. V .O .
H. S. H .TheDuke ofTECK,G.C. V.O .
H .S . H . Prince FRA 'C IS OF TECK , K.C .V.O., D . S.O .
C aptain H.S.H . Prince LoUIs OF BATTENBERG , G.C.B.,G.C. \'.0., R. N.
H .S.H. Prince ALEXA ' DER OF TECK, G C.V.O., D.S.O.
L ieut..Col. TREVENE:'; ) AMES IIOI.· LAND, C.B.
Sir J . FURLEY, C.B. (HolL. Bailifl)·
The Right Eon Lord G .C.M . G .
F RANCIS ROBeRT DAVIES, .1;.''1.
Sir BROOK KAY, Bart.
Sir T . NORTH DICK·LAUDER, Rart.
Major Sir ARCHIB'ALD Hart.
Col. Sir HERBERT C. PERROTT, Bart., C.B.
The Right Bon. Earl FERRERS.
Colonel Sir JAS. GlI.nEA, C.Y 0., C.B .
HENRY JOHN LOFTUS, Colonel BETHEL MARTI:-; DAWES.
The Right Hon . Lord AMHERST C'F HACKNEY.
Gen Sir CHARLES \VARREN, G.C.l\l.G., K.C.R., R.E.
M ajor General JAMES CECIL DALTON, R.A.
L ieut.-Colonel A\' I MER GOULD HUNTER - WESTON, D . .O , R.E
The Right Hon. Earl EGERTO:" OF TATTON .
l.olonel The R ight H on. Lo rd
WILLIAM CEC IL, M.V.O
EDWIN FRESHFIELD, Esq., LL .D . (H01l01'ary COIJIJllfl1lda'.)
His Grace t he Duke of FIFE, K .T ., G.C.V.O
The Right Hon . Lord B llASSEV, G.C.B. .
The Right Hon. Viscount TOWN .
The Right Hon Earl
The Right Hon. KNUTS' FORD, G.C !\f .G. (I/OIL. l:JailijJ)
R. ]\[AcLEAN l\lAC],EA " I<" q.
ARTHUR FRANCIS GRESHAM LEVESON-GOWER, l:!.s'1.
Colonel F. A. HEVGATE LAMBERT
Colonel Sir CHARLES \VVNDIIAM MURRAV, C.B.
The Ril!'ht Hon. the Earl of RANFlJRIY, G .C . LG.
The Right Hon. Lord SANDIIVRST. G.C.S . I., G.C.l.E .
Sir HE:"RV A . BLAKE, G .C.l\LG .
The Rl.Hn.the Farl ofl\IEATH. K.P.
A. FRASER, Esq.
The Right Hon. Lord l\!OSTYN.
C o lonel CHARLES HUGHES-HUNTER.
The !\fost Hon. the Marquess of RREADALBANE, K.G .
His Grace the Duke of PORT! AND, !Z.e., G.C.V.O.
Field.l\larshal the Ri!<ht Hon. Earl ROBERTS, K.G., K.P., R OBERT RRUDENELLCARTER, Esq., F.R.C..
KORMA:" HAY FORBES, Esq., F.R.C.S. (Edin.)
Colonel Jom; ALExA:-mER MAN STUART, C.R ., C.l\1.G.
C ol. C. \V. Ro\\' DI ER BOWDLER, C. B.
The l\Iost Honble. Ihe Marquess of LI:-\LlTHGOW, K.T .
[' be fo ll owing an il)&
Lord Bishop ('If SALISBURY. I The Bishop of GIBRA! TAR . T h e Bishop in JERUSALEM . The Bishop of RRtTJl>H HONDVllAS.
£)t J'ngn
TlIE DEPART:ilIENT OF
Qt .ge @riot 2 of ib e ® rbet of th e of St . ] obn of ]etus:s alem in <!Englanb .
U}atrort .
HIS MOST GRA CIOUS MAJESTY KING EDWARD VlI. (SOVEREIG:-I HE.U) A:-';U l'AflW:-I OF THE ORDER.)
l/} rtsi1J mt.
HIS ROYAL HIGHNESS THE PRINCE OF WALES, K.G . (vR \ND I'RIOI, OF THE ORllER.)
([o mm itt rr.
Consisting exc.lusive\y of :'Ifembers and of the Order.
Dlnctor of the AJJll-tdaJlCl! Department and Cluzirmall Of COIJIJJlitue-
The ;-'10st Hon. the :'Ilarquess of BRE llALBA:-;E, K.C.
Assistant Direct"r alL.{ Deputy Clulirlllan - Lieutenant-Colonel Sir RICHARU C. Hart., C.LE.
JUII:" FURI.EV, C. B, (Llf" :'I I"llIuc:r of the Commlltee 110)lol'/'s Calls,i).
Ji(;JJltcFS.
Colonel J. C. n \I.TO:-;. R. \
Colonel C. \\' BU\\'IJLEJ<, C .B.
The Rev. T. \\'. \VU UD. ;\1 ajor-General .\s 1'1 F\' TFRln'.
\V. E,q .• :'II.])
Colonel Sir J. \\'. OrILEY, LC.LE.
InspecLOr.C;"neral H. )\I:-\ :-';IS, :\(1)
Inspector.Gen Sir HI·:-;I,V r:':ORI-'URY, K C.B., :\I.D., K.H.P., R .•. (Dlrector·General, J\I ell \Cal DepartmeIH Royal avy). '
S. C. \ VARUF.I.I, Esq.
Surgeon-General ]. J C.B • :'IT.D.
• Ir }UH:-\ ilv COLE READE, K C B
C . S. ELLISTUN, Esq., :\I.R.C S. . ...
Qrm tral QJ:o nu n i ttr t -r olltillmd.
General Sir R ICH ARD H ARRI SOK, G.C.B ., C.M .G.
Colone l S ir M. R oyos, C . B.
Captain ] . W . NOTT BOWER .
ED MUND OW EN, Esq, F.R C.S
Lieut.-Colonel A. C. Y.\TE
Admira l ALFRED JOflX C HATF IELD, C . l3.
The Righ t H on. J . L. W HARTON, P .C .
REGINA LD H ARRISOX, Esq., F.R.C..
Lieut.-Colonel E. WlLSON, C. B., C. L G., D.S O., R A. '\ LC.
S urg eon-General Ir ALFRED K EOGH, K.C . B.
C olone l G. HUNTER O·;\I ALLE\,.
S ir L EES K NOWLES, Baronet.
Lie ut.-Colonel Sir )A'IES R .A. CLARK, Baronet. C . B., F.R .C. ' E.
Surgeon·General S ir BENJMllN FRA:-IKLlN, K.C.l.E.
J OHN S AMUEL GRIFFITHS, Esq., l\ L R .C.S.
S urgeon -Colonel E. CURETON, M.D.
Sir EDWARD L. O'1\L\LLEY.
E DW IN D AWES, Esq
Surgeon-Major G, A . H UTTON .
Deputy-Inspector.Genera l 1\1. CoATES, :'II.D., R. F. R. CA SSIDI, Esq., 1\ I. D.
J. A STLEY BLoxAM, Esq., F.R. C .S.
' VILLlAM E. AUOLAXI), Esq, M.R.C.S.
Colonel T. H. HENOl.EY, C.LE
Ex-O.flicio !I[cJJlbcrs 0/ Comlllitte·i!. ./
Colonel Sir HERBERT JEKYLL, K.C .\1.G., R.E. (Secretary·General of the Order).
EDW IN .FRESHFIELD, Esq., LL.D. (Recei"er-General of the Order) The RIght Hon . Earl EGERTON OF TXrTo:-; (Chairman Llrilish O phthalmic '
QI;hirf .%cmtaru ,
Colone l Sir HERBERT C. Dart., C.B. (Secretary of t he Order) . anlJ ;:.torrkcqJrr.
W ILLIA:\I R. EDW,\ RDS, Esq., \ .C. \ (Accounta n t 0/ tIll: o rdr:r).
j!1calJ ®illers .
ST . JOH N 'S G.\ TE, CLERKEN W ELL, LO ::-mON, KC. Telegrapltic Address- " Firstaid, London ." Td,'pllone .-HollJorn, 801.
1l3anktrs .
LONDON AND W EST MIN STER B A NK, ( Lo tllb ury, E.C .)
REYI SED 1901.
FIRST AID TO THE INJURED
SYLLA B US OF I N S TRU CTION.
. \ . P reli minary (ll,jects of Instruction, &e.
B. A brief description of the Human Rkel/'ton, Bones, Joints. ann t h e . y. tem .
C. , ign. , and tl'calment of Fradnres, Dislocations, Sprains, and. trHin,:;.
D. The Triangular Bal1llag' and its application.
LECTl'RE.
A . T he IIeart an(l Blood Y l'ssels. ' The Oil'culation of the Bloo d .
B. T he genera l d ircction of the ::\ [ain . \ l'1l'l'1(,S, inclicatmg t he points where t h e circulation may Le anested 1.>y digital p re su re, or hy the apIJ1i('alion of the tOllrniquet, or by other means.
C. t h e clifference bet w ecn .·hterial, '\cnOllS, CapJi lary Bl eeding, a nd the vari ous extemporary means of arrestilH; it .
D. T he Triangu l ar Ban d age and it :1 p plication.
8
TI[IRD LFCTtJRE.
A. A brief description of the :\ervou: N,r. tom.
B. per ons sutfering fron1 shock or collapR mJur:r, .1l1Jury to. tho hrain, collapse frolll drink, famtmg, hysterIa, sun troko, electrie shock, effect:; of hghtmng, and convul ions in children.
0. Aid in .ca es of fro t-bite, burns or Rcalds, injury ?y vltnol throwmg, wounds, hitcs of animals, stiner ' (.if msects. '"
D. What to do when the dres:; catches lire.
E. The Triangular Bandage and its applieation.
FO('RTH
A. A brief description of the Organs <tnd of Respiration.
B. The .immediate treatment of the apparentlY drm\"llC(l or otherwlse suffocated. Artificial Respiration,' Treatment for Choking.
C. First Aiel to tho e poisoned.
D. The immediate First Aid treatment of injlll'ieR to the Internal Organs, and of those Ruflering from Internal Hremorrhage.
E. Foreign Bodies in the Eye, Ear, and T ose. ,') FIFTII LECTURE (for only).
A. Improvised methods of lifting and carn-in er the sick or injured. . '"
B. Methods of lifting and carn'in a the sick or inj urcd on stretchers. . '"
C. The eonveyance of such hy rail or in country carts.
FIFTll LECTURE (for Females only).
A. PI' paration for reception of Aceillent Cases.
H. of Lifting and Carrying.
U. Preparation of Bed.
D. "Removing the Clothes.
E. Preparat.iolls for 'nrgeoll.
TOTE 1.- The l:iuuject 0f puisor..,; 'hoult1 be treate(l in a general lIIanner ; the COUlmon P01l:iOllS dassi!i ·tl, and ouly their g neral ,ymptoJlls and effeeLs taught.
To !let, riel of the poison is Lhe only Lreatlllent \\ hich can be safdy pracliscu by non-profes ional person:>; the ad· mini tration of <\,ntitloLe il:! the medical ?new'.s (luty.
U.-Tho last half hour of e<l(;h lecture should be de\'ocecllO pr<lcti(;cl.l work, such as the applicaLion of bandages i.wei splints, lifting aud carrying wounded on :::.tl'etchers.
Xon: III.-Thf're . honkl be an interval of ,L \'cek hetween c<t(;h lecture. 'undiclatc for e),alllination 111U·t attend at I ast four out of the five lectures.
XOTE classes lllU ' (' pa"s in thllt ,ystem of streteher exerci e mo t suitable foL' th • lu(;ality.
Xon; Y.-As litLle time as po !'<ible il:! to be ' pen" on intruction in anatomical and physiologwal deteLlIs. Lecturers and Examiner are reque ' tcIl to i· " Fir. t Aid" that has to b e taught and t0slecl, and not anatomy aael phy iulog.).
sml
IART
OF
CONTENT'
-tbCliAPTER 1. Page
Explanatory 19
The Human Skeleton. ,pine, sku ll , ribs, bren. t Lone, upp er extrem iti es, peiYis and lower extremi.lie", anJ j uint.::l ., 20
Muscles. Y ol untar,\' <lud ill\'olllnLa ry 30
Fractures, Causes, Yariolics, sig n s and s:pnptoms 31
General Treatment of Fractures. App<lmtu, splints and ba.ndages. rules for treatment
Treatment of Special FractU'i'es. pille, cranium, lower j a w, ribs, brea t-bone, colla r -bone, houlderblade, arm, forearm, m etacarpu , Dnger, pelns, thigh, knee·cap, leg foot
Dislocations, Sprains , and Strains II.
Circulation of the Blood. Organ s ; general , lung, and liver circula.tion.,; the heart, arteries, veins, c..LpilliLries, blood, CO Llrse of circulati on
Hc.emorrhage or Bleeding, Arterial, yenou .. ca.pil. lary
Arrest of Hc.emorrhage, Pres.sure, direct and indirect; instrum ental (by tourniquet), and digital;
Course of the Main Arteries and Arrest of Arterial Hc.emorrhage , The aorta, arteries of the h ead a nd neck, of the upper extremities, with in Page the che, L <lud <lbcloillen, of the low er extrelllities... 78
CIlAPTE R II 1.
The Nervous System. Cerebro·spinal, sympathetic 102
Insensibility. General treatment, examination of patient, shock, concn sion and compression of the brain, apoplexy, collnpse from tIl'ink, epilepsy, fa,inting, hysterical tits, sunstroke, electric shock, effects of lightning , convulsions in children 104
CliAPTER IV.
Wounds and Injuries to the Skin . Bruise"" wountls, frost.hite, burlls an(1 scaltls, what to uu when the dress catches tire, yitriol throwing, bites of animal..;, snake l)ites, stings of insects, &c.
CHAPTER V.
The Respiratory S ys tem
Artificial Respiration. ,'ylYcster',<:, Ho\\,urd's , and Labol'lle's method:;
Drowning, Strangulation, Chokin g, Suffocation
CUAPTER YI. Han ging, Poisons and Poisoning. ,implc directions for treatment. Poisons alld t.heir treatmcnt classified (acid,; and alkalis), irritanti', und other deadl y poisons"
12
CIIAPTER YII. Page
Injuries of Special Or g ans . Foreign bodies in the eye, ear -passage and nose. The chest (thorax) and organs contained in it (heart and lungs), wounds of the lungs. The abdomen and the organs contained in it (liver, spleen, intestines, kidneys, bladder), with treatment of injury to tbem. Rupture... 153
CHA PTER VIII.
Bandag-ing . Application of the triangular handage to the scalp, forehead, &c., shoulder, hip, hand, foot, chest, hack, kn e, elhow 161
CrrAPTER IX.
Ca r r y in g P a t i e nts. Four, two, and three-handed seats, fireman's lift, temporary stretchers, to eros'! a di teh or wall, to load and unload a w:1gon 166
CHAPTER X.
Stretcher T rans p ort. Introcluctory. 8tretcherc;, stretcher exerci es. The Ashfor<l'litler 179
CHAPTER XI.
The Fifth Le ct ure ( for Fe males on ly). Preparation for reception of accident cases. Choice anr{ preparation of a room. Lifting and carrying. Preparation of bed. Removing the clothe::;. P repar a,tion for surgeon 200
LI'T OF ILLU
keleton, showing po iLion of main arteries
Vertebra
'kull and vertebra.l eolumn
Bones of the left upper
Hones uf the ri"ht lower extrelllity
The hip joint 0 •
Diagram shuwing reeLu. 'do thigh, with artery, vein and nerve ...
, 'implc frac.;Lure of leg ...
Compoulld fradul'e of leg ...
Triangn lar uanda,gc, spl'ea,d ou L ,. :
Triallguhtr bancl,l,ge, ollee folded. ... . " .. .
Triangular handage, folde(l as uroad bandage .. .
Triangular bandage, folded as nalTOW band.age
Reef knot
.:'..noLher metholl of :;ecnring , plint
Third method of eellring splint, with knot inc:omplete
The with knut eUl11pleled ...
Large arlll-sling
:-:llIall ." ... . ..
('oat tall turned IIp to form sling
SlillV formed from leeyc, lit up ...
BanJage for fmeturc uf lower jaw
Bandage for fraetllr ' of ri b: ... ,
Tl'catl1lenL uf fracture of collar-bUlle, \nth two l)c.ml1ag '8
_-1.ltemative method uf (liUn ... ... " ...
Treatment of fnwture uf eollar-uol1e, with one banuage
Treatment of fracture of arm
Angular splint ...
of fra.cture of forearm
14
Treatment of fracture of metarcarpus
Treatment of fracture of thig!l (man) . ..
Treatment of fracture of thigh (woman)
Fracture of knee -cap
Treatment of fracture of knee-cap
Treatment of fracture of leg
Ditto single handed ...
One form of dislocated shou ld er "
Principal blood ye sels and organs of reSpil'alioll
Diagram of circulation of the blood
Field tourniq net
Flcrew tourniqnet .. . . .. ...
Digital compression of carotid artery
Arrest of hremorrh nge from temporal artery
Arrest of hremorrhage from forehead
Arrest of h remorrh 'lge from palmar arche ...
Digital compression of radial and ulnar arterie.
Flexion of elbow
Digital compression of brachial arLery from helo\\'
The same from above
Compressio:1 of axillary artery ...
Digital compression of subclayian artery
Flexion of knee-joint
Digital pressure 0 1 femoral artery
"\pplication of tourniquet to femoral artery
nra.in and spinal cord, and neryes proceecli.Jg from it . ..
The lun gs and bronchial tubes ' " ... ... '"
Artificial respiration: in piratioll
Artificial respiration: expiraLion
The organs of the che t and abdomen
Bandage for head
Bandage for shoulder
Bandage for hip
Bandage for hand
Bandage for foot
Bandage for chest (front)
Bandage for che,;t (bact)
Bandag' for knee
Four-handed scat ] .)
Two_handcd scat... ... .,
Alternative grip for t\\.o-hanllc(l H.:.lt
Another altel'l1a.tive grIp for
Three-handed '1ea.t ..: ...
Fireman's lift
Fireman's lift .. , t ...
Seat improYisetl "rjth p<,Jl " and coa 1 "t
,'tl'etcher improvised poles anI
Stretcher improvised WIth poles tnu ordinary stl'eLchrl' (close! ) "')
Fmlc)' tclescopic-h<.\mlll'!l I
Stl'cLehcr No. I., preparmg to oal
Di ttn, placing Oil str tcher ... ...
Ditto , pbeing on streteher ... ..,
Ditt o carryin a stretcher .. , .: t"i d
, • TO. II., prel'<1l1 ng () ot\, ....
1>itto, t xloj<}r .,. on , .treteher .1. T U , ; , p" t j tion .. . .. .
Stretcher cxerelSC 1\0. 1\ ., til'S 1 .
Second position
Ashford Ii tter
Bed re t, three forms
?REFACE.
AT the' request of the Central Executive Committee, I have written thi manual a the officiallmndhook of the St. John Ambulance Association.
T he stride. made in the teaching of "Fir t Aid," and the reqUIrements of the ._t. John Amhnlance Brigade, have 11eces itated an enlargement of previou . works on the . ubject publi hed by the As ociation.
I have endeavoured to include only a. much anatomical and physiological detail as is ab olutely necessary to enable .·tudents to grasp intelligently the principles of treatment.
The greater part of the direction for the application of t.he triangular ba,ndage and for lifting and C:H rryincf patIents, is adapted almo t verbatim from the "\\ 01'1 of the late Surgeon-"jIajor hepherd, as re-writLen l)y Dr. Robert Bruce.
I "ish to expre. s my .:.hanks to Colonel C. Bo\wller, Drs . J. Brown, C. Chilcis, M. oate., ,V. Collingridg·c, J. R . Crease, G. H. Darwill, and H. A. Latimer, wh o have, as a sub-committee of the As ociation, a . i ·ted me in my ,york
J AMES CANTLIE.
Ju:n.e. ] 90l .
I NTRO DUCT I ON" rro THE SIXTH EDITION.
THE • t . J olm .AmImIance A. ociatioll ha. com pleted the twent:r-: ixth year of its existence. During the period . inee the As 'ociation its \York, hundred. of thon ..anrls of men and women have been taught at the classes of the A 'soc iation how to helF their injured neigh hour '. In eyery country where civilization hft. p enet raLed eloes vile teaching of the As ociation find a r each audience. AU rH.!}ks of 'ociety teotify to the llsvefnlness of the in truction given. The followcr' of 110 religion.' or political creed cayil at its aim' and ieleal '. Jew and Uentile, 'lui. tian and .J[ahomeclan Brahmin and Buddhist, accept it' tenet.', and appreciate the benefit it confer' .
UncleI' the m.u'picel:) of the t. John Ambulance A.. 'oc: iation, "Fir't .Aid " 11<1 ' into a distinct branch of . urgery, nece:-:; 'itating a pecial training. • either in 0111' mcdical . ehool nor in Oul ho. pital ' is ' Fir:sL ..'\'icl )) tanght, and it i to the initiative of the st. John Ambulance .A sociation that both the plll)lic and the medical profes 'ion n.re inclehted for clcyeloped and taught th:.-:> import:1.nt clcpn.rtlll'llt of general surgery.
The instruction beg-ill. and e nds 'iyith H First AId:' and the subject i.' tr-wght thoroughly nnd exbau.'tiYcly, The duty of the ambulance pupil ,,,here the doctor':::; commencc8, a.nd there o'lght to ll(' no oyerlappillg 01' cla.'hing of duty or intel'c ts, No more liberal or nscfnl in 't rnction hns oYcr been given to the puhlic, a.nd the \rork of the ..John Ambulance A ,'nciation musL continuc c:harity remains to us. and sympathy for. ufferinn' humanity
August, 1904.
CUAPTEH 1. EX
By , First Aid" i lllcant that foml of' skilled
i\ , i:,;tallcc "hich per. on: trailled ill mill ntlance wurk ('all afrorcl to thc :-;ick or injured.
" Fil''>t .Aid to the Illjured .. i, a In'<tllch of practical ,11l'gC1T dcmanding .'pccial tmilli]\!.;' an(l educatioll.
Thc: pl'iucipHl Hiltl anc1 ul)jcct of thc st. Jo1m .\ll1lmlallCl' ,AH.()c itltiOll i:-; to tC;\CJI ill :-;illlple language lu)\\ to help a OJ' illjlll'l'cl lll'l''iOl1 lI11til the sCl'yi ces Id' a doctor arc ol)tnilled .
•\ further and illJportnnt In'<lncll of a1l11mlaucc "ork j, the ('<tlTi'1.gc or .'ick or injurcd pl'n,oll,' "trctc:llc']', llY ,ulllntlilllcc "HU.'OIl: l)y mil. or illlPl'O\ i, ed lllC,lll 'of traIl.'port.
Bl'fo]'l' procl'ccliulJ' to ui \ 'C ill cldnil the "arion, to Le taken ill the accidl'llt or l-;nUdell illll<.':-;'> it i.' 11l'CC:-;:-..11'Y to kll()\\' ,()llll'thillf! of the Htrnct1.1rc of tlll·lH)d.\ (de;llclltar,\- <lllatolllY). aud thc flllH.:tiOU.' of ,Ollie oj' the lllOl'l' illl}IIH'lnllt allcl ,';n;tellls (elellll'lItal'Y . \ . llOl't de criptioll uf 11l'('C:,;, my Hnatomicnl an(( ,'ulogicnl point' of. illlIHll 'LlllC.'l' j" thcl'dul'l' giYl'll the ,eycml t ul)Jel't ' arl' <1i cth, cd ill detail. It ji') l',scutia l to rcnlC'llll)l'!'
"hcll iug alltltOlll:' that tlIl' lnmUlll Lody l'
20
supposed to be standing croct, with the palms of the ha.nds directed forwards alld the thumbs oLltwanl.' , or away from the body. Tho" midd le line" of the boEly is a" line drawn vel'ticn.lly froUl thc top of tho head to a point between the feet.
THE 'KELETOX.
The hmnan body j ,' moulded upon a bony framc,york \\"hich sene::;: (1) 'ro giyc shape and firumess to the body; (2) to attachment to .tho lUlL'dc ' '; and (3) to protect the lllure yital urgalls III the ::;kull, in the chcst, and in tho
THE BACK BOSE, ,'PI:--'E, Ol-t VElUEBllAL CULmw.
The Vertebral Column. -E,u;h .'eglllellt of which the spine it! compo 'eel is tCl'llled a cl'tebm.
A Vertebra consists (1) of a central body or Ill,"S::!; of procc::!so::;, twu uf which join hl'.hilld to fUl'ltl a canal for the 'pillal cord-the Splnal Canal ; behind, bony projections-the 'pinos of the YCl'tohnc -can be felt beneath the ::;kin for the whole length of the bctck (Fig. 1). ..
,The vertebne :33 in all, are groLlpeLlmto regwlls :1. 'rhe Neck or Cervical \' ol'telm,e are 7 in lllllUbol' ; the first 01' atlus fonus a joint \\' ith the btL'e of the skull, at which the nudding movement of. t.he head. take1:l place; the 'cconcl ur axi', by the between it and the a.t la.s, allows of the side to blLle
21
monmonts of t ht' head. n. Th o Back or Dorsal Yerte11l'cc, 12 in 11111111)c1', ha\'e the pairs of ribs ctttached on either side. Ill. The Loin or Lumbar
TRANSVERSl PROCESSES,r-_
BODY OF' V ERTEBRA
}i'n:. 1. SURFACES
SUPPORTING HEADS OF RI BS
Ycrtclll'le, 5 in 111111l1)l'J', are the large't of all the Yel'te1Il'<C. gr. 'rh e Hump Bone or Sacrum con--;i:t · of fiyo Yel'telll'cc, ullite(l in aclult a ' a solid III a ' , which \\'ith the b\'o hmlllch hOlle.' , forms the ph-is. Y. The Tnil BOlle or Coccyx eon 'i t . of fom ycrtel>n' "hieh nJ'C joined together to form a :-;ino'le group. The Y('rtelll'lc ill each region are '-by nnmhcl':-I, counting clowll\\'arcls-l:t, 2nd, etc.
Bctween the hocli.c') of the ycrtcl>n-c thick picco' of gristle 01' cartilngT' (inferl'f' l'to1)/'al rl/'sc ...;) are interposed, \\-hich, \\'hilst hill(l the 1loDc:-; t(wether allo\\' of free 1110\'ement to the colmlln a .' a wholo, anel .'o1"-e to hrcn.k the .·hock of allY . Helden force appliod to tl)(:)
. pine. T h e whole lCl1O'th of the spine is 'trapped together by ligaments rcachillg from cnd to end of the column.
THE
The bone of the 'kull are arranged III two groups, those of the brain casc, or cranium. and tho 'e of the face. 'rhe boundarics of the Cran i u m are the vault or dome, the l'(;nnded portion forming the top of the head; the front or brow; the bauk of the head, where the grcate.. t extcnt of brain cx.i t', and "here, tberefore,
FIG. '- KULL AND VERTEBRAL COLU::I1N, . ho/cina [pft ?·ibs allcl por· tion of breast·bone. The ,·ight Tits are removed.
the cranium is widl:·t n,nd clcepe.. t; the sides or temple' where thc opening.. into the cal' passagcti seen, and to which tllc 'Ill' atttc:hed. The La'e of the cranium is hicldell fwm "jew by the bones of the LH'f' Flnr1 the ycrtelmll eolnllln; in it are lHllllel'OllS perforatIOll' lor tile p.H:-!.:11! ' of the l)loocl YC,'sels to and from the bmu I ; through the lnrgc.. t OpClllllg the Lrelin alld spinal 'onl are eUllt,jatlOml. ,
The bOllt'. of the Face, \\'itll the exeeptlOll (If the lower jaw, nre finllly juilltccl too'ether, so that lllovement bl,t\\'cen them is inJpu,' ·ible.
The ca.vities of the nose and of the souket (orbit) arc fOJ'lueu l)y Uw hones uf the entlliulH and i'c.u.:e conjointly.
The mouth ett"it,' j fUl'lllc(l l)ct \\ cen the upper ancl lo\\'er jaw., the' palate beillg the bony roof. of the mouth, \\'hie11 separate::; it frolll lhe 1Ul 'al eaYlty aho,c.
1'11.1£ HIL',
The R i b s COU.-i8L of t\\'ehc pnir' uf cun'cel bone extending from the ycrtcbml colull11l behind to the front of the body, and arc kllo\\ n by numbers, L·t, 2nd, 3rel, etc. cOlllmencillg from abo\'e: They form joint. \yith the dol' 'al Ycrtebrrc.' an(l theIr mO,\'emont re'embIo' that of the hauc.lle of a lnu.:ket. 'lhe rib' arc llol, howen:!!', bony throughout their entire lellO' h. At a 8hort JisLlll1ce from the brca'l-bone the materiul ends, alld gri ,tIe (cw'! ilaoel take' its
24 place. The upper seven pair', named the inte ribs are attaehed by their cartilageH to the hreast-Uone the lower five pairs are termed the false riU" a:s thei;' cartilages fall short of the middle line. at cbe fnl::;l' ribs the 11 tIl and 12th pairs are termed the fioatil1U' Gr winged ribs, a' their ends are free in front. ribs enclo:sc the ehest, aud 'e1'\'e to protect the heart, liYer, :stomach, I:)pleon, etc. (see Thorns awl Al)c10111cn).
The Breast -bone (stemwll ) i:s &. lagger-slwpecl bone with the point below .in·t oyer the pit of the stomach' it support:s the iU11er ends of the collarbone.' aUove, and the seyen true ribs are C0l111!;cted with it on either side.
TUE "C PPER
The Shoulder 1)011CS are the cullar-oone (clavicle ) and (scapula), and they can tltnte all 1l1l}Jerfeet gi rdle-th e shou lder girdle.
The Collar-bone can be felt heneath the :skin at thE; lo\\'er and front part of the neek as a narrow cUn'<::d rod of balle, a,bont the thiekness of a finger. Its imler eud rests on the upper part; or t;he breast;bone; the outer cnd joins with the :shoulder-blade at the top of the shoulder; at either end a joint exi:-;t::; . The collar-bone is endowed \\'it h extra ela:stieity, 0wing to it'S be! 19 pO, 'se::;, cd of a c1011lJle Curye, the
Forearm Bone,. { UL'IA \ RADIOS 25
inncr two-third of the l)one beinb cnrYcd fOl'\\ 'ards and the outcr third Lack,,"ard... Thi: is neces 'arY in order to re. ist straiu thrO\Yll on the lJone h'\ fall all thc hand, elbo\\-, or .houlder.
The Shoulderblade lie: at the back or the che ·t, and form' joint. with the collar-Lonc and the bone uf the arm.
The bone of the arm (hllJJw'us) reachcH from the shoulder to the elbow.
In the Forearm arc two hone ' , the Radius 011 the outer, or thnmlJ side, and the Ulna on tlH' inner, or little finaer Both bones reach iro!'u the elUow to Lue
BONES 0.,.. 'rUE LEFT UPPER EXTRL\IITY.
wri st, and t h ey change their relative position with e " c'l'Y tu rn of t he hand.
T il e Hand is composed of: (1) the bones of the wr ist or carpus, eight in number, arranged in bro of foul'; (:2) the metacw]Ju (the framework of the palm), presenting five bones, ,,,hich form the knuckle ' and support the bone. of the tingers: the phaZrin.qe. 0 1' finger bones, three in (l(lch tillger, and t\yO in the thumlJ,
THE PELns AXD LOWER
The Pelvis. -The large basin-like ma.'s of bone attnched to the lo\\"er part of the 'pille is COlllPO. 'cd of three bone, the t\\"o haunch bones and tIll' ;-';,tl"l'lllll (or rump bone). The hal1nch bones meet (at the pIlIJf's) in the middle line in front, only n ,lllall picc'c of gri . tle intenening, but, behind, the . n Tum i.' placccl l)ct\\"een them. The pelYi:::; sene to r-;npl'nl't the abdoll1c.lI and its contents, to pruted the Ol'!.!·,lllS within the pel"ic cavity, to gi,'e aLtachment on its outer surfa.ce to the of tll hip and thi!!h, and presents the deep socket for the head of the thigh llone-the hip joint.
The Thigh bone (le1l/U1') reaches from the hip trJ the knee joint. rPhe 'haft of the I)one is :tollt, rounded, and arched forward .' . The upper encl pre. ents a rounded head, supported on a neck whi(:.h projects inwards at an angle from the . haft of he
THIGH BON E (FEMUR) .
FIG. 4.
'l'HR BO.'iR· OF TEE RWllT LOWER EXTRE:\lITY.
K."EE CAP (PATELLA BROOCH BONE (FIBULA)
HIN BO.'iE (TIBIA).
TARSU'.
METATARStJS. PHALANGES
bone to fit intc the ocket of the hip joint. The lo wer end expands to form two projectiOllB a. t the knee joint.
The Knee Cap (patella) is a thick triangular piece of bone with its bar:;e upwards lyinu in. front of the knee joint and the lower end of the tlngh bone. It can be felt immediately beneath the skin.
The bones of the leg arc the .'hin bone (tilJirl) and the Brooch bone ({ibnla). The Shin bone (tibia) is triangular in shape . It extends from the knee to the ankle, into both of \\'hich jointr:; it enter::> and plays an important pnrt. The sharp edge or shin can be fe lt immediately bellcatll the :-;kin of the front of the l eg; at the inner 'ide of the tUlk!e. a ,tout piece of bone projeet,' from the tIbm.
The Brooch bone (fiuula) lie:: parallel to, and all the outer side of the ti hi:1. Thi ' bone cloe.. not entcr into the for'mation of the knee joint, but it lo\\'er end forms the outer boundary of the ankle joint.
The Foot .-(1) The group of il:rcgulnl' at the in tep constituter:; the ta1·!)US . There arc seyen bones in the tar sus, of which the largc.' t i .. the heel bone, and the uppermost (the ankle hOlle) the 10':'er part of the ankle joint. (2) 1'11e fiye long bone ' III front of the tar sus conr:;titutc the metata? SZlS, 'lncl each bone suppor ts c:I. toe. (3) Each toe, except the llig toe, posse..ses three bonc,' , llamec1 the bt, 2nd: and 3 rd p h alan ges . T he Lig toc hm; t,\,O phalanger:; on ly.
29 J OINT. '.
A] oint i::; formed::t.t t h e junction of two or more b ones . I n jo ints uch a t h e hip, knee, elbo\\', etc., th e of the bOll c.' are coyerecl by gristle or ca? ·tilage , a h a r d, den. e, semi-transl ucent covering which les en' friction and the violence and . hock of a fall Lubricating the joint is a clcar, rather sticky or syrupy fluicl, the "joint oil," or s?Jnovia, enelo cd withill nmpsule. T ying the bOlle,' firmly together, but yet aHo\\,-
FIG. 5.-TIlE IIII' .f01'\,)" . ina of mOYCmcllt, nre a of hand ' ur ligaments. Bone. , cartilage, Rynoyia cap 'ule, and ligament.' are therefore the componcnt parts of Sectioll of (( Ball Clnd odet Joil/t. the limb
To exrlaill the formation of limll joint. , the foJIowing exampl r are given :-
1. The Shoulder , n hnll-alld- ocket joint, COlloj t of a shallow , aucer-like surface on the ouler angle of the shoulder-blade and the r ounded head. of the ann-bone (humerus) . Owmg to
TE NDON
Mu CULAR TISSUE
PATELLA OR LIGAMENT OF PATELLA
the shallowness of the shoulder-blade ,urface the round cnd of ann-bone is yery prone to e cape from it::; ::;ocket (eldoc, te).
2. The Elbow a hinge joint, itl ed of the arm-bone auoye, and of the two fore -arm bone below (Llle raclius and ul11n,). Tlt c npp l' end of the uhm {orlm; a stout projectioll botip of th o elbmy-which to embrace the ann-bollo anel maintain t11 e l,unes of the elbow joint ill pO 'ition. THE The muscle s of thc body are classificc1 illto
FIG. 6. -DIAGRA ,I SHOWING R ECTUS OF THIGH, W1TH AltTKRY, VEl,'; AND TER\ "E.
31
two groups, the ?:olu7Ifary and the involuntary mllsths.
The Voluntary mu s cles constitute tbe main lmlk of muscle ' met \I'iill ill the limb ' , the head anr1 neck, and the ,' u1'fa('c (If the trunk. The::;e mu. cle ' are attached to th and a.. they pa.' fr0111 one bone to another they cro.':) n jJint, and being endo\\'ed \\'lth the po\\"c1' of and relaxation, cau e the mOye1Uell ts of t Ite boely. A , a mucle cro 'es a joint, it lo.'c.' red, ftc 'by appearance anc1 become ' a tendon (leader). Dluod yc '::;el.. traYCl':::ie and 'upp]y the muscle', aml thc nenc ' cllterin a the llln ' c]e:::; briug them under the (lirect coutrol of the brain anel spinal cord.
The Involunt a ry muscles arc met\\ ith in tbe \\ all::; of thc stOllHlCh and illtctine ill the a ir pet 'sage ' , <tnel in 1110 ,t of the oro·an.' nucl blood ye ' e]', abo in a .. pecial fol'lu in the heart. They are not uncler the inflnence of the \y ill, lmt continue their work clurin o' the hour of leep' the, supplied b.y a epamtc 0 ::;et of ne1'Yc.' (see KenOl;:::; ystem).
FR:\CTrnES A"O rfHEIR
Dy a Fra cture i::; meGlllt it lll'C)kell bonc.
CAU:SE UF FRACTl."RE.
A bone may be brokcn 1)\' :Direct' Violence .. \Y hCll from a scyere blow,
impact of ,L lJllllet, or Cl'll ·h of wheel, eLe., ,I, hOlle urea,ks at the 'pot where the force i ' applied, the f r acturc i, ' termed direct.
Indirect Violence. "\Vhen the bonc break8 at some distanl:e from the ,' eelt of illj my, the fradure i8 termed indired. Alig-hting 011 the fcet and fraeturing the thigh-bone 01' the l)one, ' of the leg, 01' falling on the h cLlld ellld breaking' the nulill, , or thc collar-Lone, are familial' eX<llll ple:.
3. Muscular Action. The knee cap und the arm oOlle ,1,1'e o(;casionall)- In'okcll hy a, yiolent contractioll of the mm><.:le ,' attaclwd to them.
\ TARlETlE8 OF FUACl'1)RES.
1. Simple. The oone i8 brokcn ill two, with hut slight illj ury to :mrrounding part8.
Complicated. The honc is hroken and other important Ltdjaccllt 8trueturc8 injured 'ithcr by tlll: "violenccwhich CUll8Cd the fmcturc, or hy the ::;harp end::; of the bone \\'ouudiug- blood ye '::;eJ, 11en'c, or any of the Ol-g<Ul, \\ ithin the skllll che::;t, or ai>clomcll.
:3. Compound. The bone is broken <llld the skill and tis::;ucs punctured or torll, allowillg the air to (;Qmmullicate with the of the fracture . The frad ill' c1 end::; may protrude throllg-Il the :-;kin, or the \\'olllld lllay lead dOWll to the fractllre. The \'iolellce that the bone, or the jagged eucb of the Lone
themselves, especially during carde s moYcment, may a fra cture tc> hecomc compound.
l) as::;ing reference iliay also be made to three more
7'-
DIAGRAM OF SIMPL E FRACTURE OF LEG.
FIG. 8.
DIAGRAM OF COMPOUND FRAOTUIU: OF LEU, WITH PROTRUDiNG.
\'l:U'iotic,'. Comminuted :-Thc llOllO into seyeral pieces. Green-stick : -Tll chi1(11'en, (mill,!! to thc softer state of the bOlly 'ues, a bonc llln,\' lIend and entck without In'cakiug completely a Impacted :- ,Yhen, ill 'tead of oycrricling, the broken end,' of a bonc arc clriyen the ouc into the other, the i'ractnre i,' ,'aiel to hc impadccl. of the wmnl sigml and l-iymptollli'{ of fractnrc lllClItiullL'd below nl'C <.\ b. 'l'ut ill grecl1-,·tick and impacted fmctnl'el-;,
Su;x' OF FHA TunE.
1. Loss of Power in the lillll>.
:.? Pain n,t or llcar the i'3cat of fmdlll'c.
:1. Defomrity. The injured lim b lies ill <1.11 11Ill11"ltllntl positiun, nl1(1 i, Illis-shnpcll at the Hcnt or the iujury.
-:1:, Shortening. ()\\iug to the contl'llctioll ()f thc musclos, thc cnds of the bODe oyerriclc, eall, 'iug ::;hortening of the il1jlll'ed Jillll).
5. Swelling. The oycnidillg cucl' of tit, l11'okell l)one, the eontrnction of the lllUSc;}CH and cft'llsioll or l)loocl, " 'ill <.:<tllse the part,' arollnd tIll' 0[' the fmdure to iucrease in Lulk.
6. Irregularity. If the fractured hmc i ' c]o;-,c heneath the "kin atl in the catle of the jaw, wllnl'-hol1c, etc., the gap in thc hone 01' the cnd ,' of thc imO'ment' maY be felt hy the finger.
7. Unnatural Mobility. way 1)(;
35
made out at the seat (1f the break in the bone as well tLti at a joint.
. Crepitus or bony grating may be felt or heard
\\ hen the uroken ends lllOYC one npon the other.
The la ,t two 'igns should only IJC 'ollght hy a . Ul'o·eon.
ApPXRATU ' FOR OF FRACTURE ' .
Splints and Bandages are the by which uruken b011(,,' nre tu he treated. In ho,' pltal., -;plinttl and bandage ' to yariety of frneturc n.re at hanel, but for (, }11rsL ..:'ucl treatment they frequently bayc Lo be improYi 'cd. . . Splints may 1)0 imprm·i.·ccl from \\<1.1k1110' stIck. ' , umbrella " billiarcl CllC,' , In'OUlll or 1m1 h handle,', a po1iccm,lll" truncheon, n. mnsk e t, n. or '-: , \\ onl in its . cctuual'cl, a folc1,d loat, any plOce of wood firllllv folc1ecl no\\ or allY other paper, a roll eel-up l{lap, or, ill t!lut 1'8 .firlll and long £'1ulU(Jh to lc ep}J _ the lm7il ; dwtely aUure ant! belolc the (ract'ured lJon e ai " hether any of the aboye [l,}-pliances :U'e availaule or not, the ?PP l' 1il:ll) may he tied 1:0 the trulll, 01' 10\\'er 111111) to lt fellow.
Bandages may DC improyitied from belt, strap', brace ' , 11eckticH, or allY pIece of llllcn or cotton that come to hane!.
Esmarch's Triangular Bandages (Fig. 9) are made by cutting ,1 piece of linen or calico about forty
LOWER "BORDER.
Frv. 9. BANDAGE SPRE\D OUT.
LOWER BORnER.
FIG. 10. BANDAllE FOLDED. END
6 0'o
LOWEIt
. FIG. 11. BROAD BANDAGE.
LOWER BORDER.
FIG. 12. NARROW
i Bg nare mto two piece ' ero sways. The bandage n1ay be either ns a broad or narrow bandage. The broad i::; made by spreading the bandagc out,
FIG. 13. Fl!:. 14.
then bringing th 1 point dO\\l1 to the lower border (Fig 10), and then folclillg into two (Fig. 11).
'1'he narrow i' lll(\,de l)y folding the ul'oad bandage in t\\O (Fig. 1 :2).
'Yhell not in the triangular bandage should be folc1cd n · a nalTOW uunc1age, the two ends should be t.llrned to the centxc, and the bandagc then folded into four, reducing it to a pat:kct about 6t int:he::; by illc.:hc. ' . \\'hell the uandagc i folded ill thi' manner it i' unly llece ' nl'y to extend it length wi ' C to form a narrow bandage, and to unfold the nanow balldage and ::;0 douule it::; ·width to make a. uroad bandage.
· The bandage should alway,:; be fastened either In'' a plll or by t h o en ds with a r eef knot (Fig. 13f
15B.
F IG. 15A.
'Yhen used fur . eeur· ing splint , the hllldag e :::;honld be fulu'c1 narrow, and may 00 applil'fl either (1) 1)3' pa.·.·in/; it onee, t\yiec, or lJlore round the lillll) alHl splint and tying \yith a reef knot; or (2) llY doubling it, pa .· 'ing it round the lim hand splint, in.-orting one cud
tltrul1gh the 100p fol'llwc1 hy douhliug the hand..tgo and tying it to the fn'C' cnu witlt a recf knot (::;eo Fig. 1+); or bY])l·ouoedilH.; il,' in No. (2), hut hot7t cud.. tbrongll the loup in opposite direction.' (.. ee Fig . 1.):\) and tying them \\ itlt a reef knut (sec Fig. 1:iH).
KllOt' .' iloulc1 ttl \\ay...;, "hero po..si],ll', he tiefl OYer it . plinl, ·o that they lIlay l10t prl':-'''' upon '{oft strnd llrl'. to do thcIll injury. L arge a r ms lin g 16).,'p rl'ild otlL tl band age, put one e11d OYer tIll' siloulcll'r Oil the SOlUHl let the ot her hallg down in 1"11 •. 16. frout of tIll' chl'. t ; carry the point lIe
hilHl the cll)(l\\ or I hI ' injlll' (1 arm. :mel bend thl' (trill forward ()\ 01' llllddlc of the 1)<'lnchLgc ; tllell
l:ill'l'\ the .'l'l:oll(l l'IHl o\,er thl' .. honlelcl' of tIle .. iell', illld tie it) Lhe othcr elld; In'iJl!-!,'
FIG.t h e point forwa r d, and pin to t h e front of the bandage.
FIG. 17.
Small armsling (Fig . 17) . - Fold the bandage into the 1Jl'oael handage; then plrlce one end oyer the :-;honlcler on the :-;Ollllel Hide; the forearm over the middle of the hal1dacre ha ngi ng dOWll the che ,t ; then bring Lhc other enel oyer the Hhoulder on the injnred amI Lie at tlJU ..icle of tIle lll'l'k.
Slings may be extclllporiscd by tnrning np the tail of the 'on t nnd pinning it on the .' honlelcr (Fig. 18), or if the Hen,in of the ..lee YO 11 a:' beel)' . slit up, by 1'0. ting the arm in the strip of cloth . 0 formed, and pinning a.. ..bown in Fig:. 19 .
TO BE OBSERYRD IX THE T RE ATM Xl\T OF FRACTURE.
The object of aid tr el:ttlllent of fractures is to against further mischief, and cl:>pecially to pre-
FW. 18.
19.
v ent a im.ple fracture from l)ecolUin<Y complicated or compound . 'fo attain this eud:- 0
1. Attend to the ·Fracture on the spot where the accident occurred . 1\0 matter hOlY
crowded the thoroughfare, or ho'" short the di ., tance to a more cOlwe ni ent or place, no attempt mnst be mnc1e to moye the patient until the honr ha. l)oon rendered as immovahlc as possihlc hy a splint or othe r re training ap-pal':itn. ,Yith thi great principle e tabli hed, the treatment of special fractures i a question of detai1.
2. Steady and support the injured limb 'It once, so that it fmther movement Oll the part of either the patient or the by,tancle r is prevented.
3. When a bone of the lOwer extremity is broken gently pu11 upon the fo ot until the limb regains a more normal shape. " Then tho po ition of the limb is improved, on no accoun't l et go of the li mb until it is secured in po ition by sp1ints, othcrwiHe the mnscles will be allowed to contract, and the rough ends of the broken bone may penetrate the f>kin, pierce a blood-yes 01, or do fnrther damage. J t i not. woll to attempt exten. ion (i.e, strekhing) in ca.-o of a fracture of the npper limb. Thi. should be left to the surgoon.
4. v.,."hen fracture is com pound amI fmther complicated by seyero hremorrhage, arrest the hcemorrhage before fnrther steps arc tn.ken. In aU cases of compound fracture a-pply clean dressings to the wound,
5. Apply splints and bandages to th e limb in po ition, and to prevent rnol"ement whilst the
J1aticut is being to his home, to ;L ho . pital, (I]' to Lemporal'Y I:>he ltor. The plints hou1d be long LllOugh to keep the joints immec1iat ly aboyl' and lll,low the fractured oone at 1'e 't.
6. In evory case uf fracture, it is n ce-,,:-.ary to ke ep the patient warm , so <t,' to les::; n the effects lit' the .'HOCK Ol tlll' ac<:ident: thi.. i,' Llone by IJIacing a cloak, t:)hawl, or ('oat uYt.:r the pnti 'nt nntil Itl' roache.· shelter.
8PE\'rAL FRACTURES.
Fracture of the Spine .-The yel tebral column 11Jay be broken either b,\ dire·t "iolonce or by indirect "jolenee. Fal1int.; frolll 1;L heigh on tho back acro's a or upon ,lll llDeY\'ll :-.nrfaeu, is an e\.ample of direct \ ioleneo. FaJEuO' OJ) the he,'ld, or n. crushing force applied to the are example' of indil:ect Yiolence, causing lumal1y n. hrok 'n neck. . "\Yhat 1.' ,commonly n:,,·,trdecl at:) a broken IHlck <;on·1·t· or a fracture of proce,'t:) e::; conn oting- t he bone ' with displacement of the vertcbne, thereby endangering the pinal cord amI the nerves i'suing from it, leading to complete ur partial paralytiis of the parts helow the eat of injury.
Treatment.-Pr vent all moyement 011 the part o. th patient. If <b doctor i. "ithin call, keep the paLient quiet unti l he ar1'iw, . If th' :-.onic of a doctor cannot he htninocl \"ithill rea onahle time,
4-1
p<i." a b ln.nket, Hh eet, stont pl a id, pil'l'C of Sri i1 or cH,n nl. " etc ., b en ea.th the pa Lieut. ]) 0 not roll the pati--ent over in doing HO, IInL pa," t h e hlanket or Hhl't't, etc ., cn,refully fi rst bene(1,th the hearl. then uuder the body and lower extremitieH a, he lie' on his hlck.
P ol es a!'e then to h roll e(l in the hbnket one on eHth Hide. The patient may now he lifted 1>y funr P -!':-;Oll:--, t\YO on either side, gnvping the pole (eaeh. per.oll l13illg hoth h a n ds), !<l,id on a .'tl·etcher or shntter, and earried to s hel ter. No further treatment i' callcrl for nntil the doctor arri ves, except to giye the paticut watel', tea, etc I if he is con cious. '
Fracture of the Skul1. - Fradures of the cranilllll arc dan gerolls in proportion to the extent of the injnry to the hrain coubillecl \yithin it' boulldaric'i.
C :·;n·tlly there are ..ymptollls of injury to the hrain ( Compre. sion and Concus ion, lOv and 109).
1! racture. of the yrtnlt are Ie ':) clnngcrou,' than fractures of lmse of the cranium. ·When any part of vault IH fnctureel fmc! a scalp "'01.111cl reyenh the ll1Jnrecl bOlle, the fmcture may he CCll or felt . this or may not be \\'ith eyidelH..:e of hrain injm-y.
,Vhen t}lC hfl.se of the cranium is fracturcd, hloorl or clear fluid 111ay i. 'SIlC from the ear; or the hlood may e. cape from the llO.'C, or may pa.'8 clown to tIll' whence it mn.'i' hc YOm1tce1. 'rhe fmui.lll'c may im'olYe t h e orhit,' when blood will e cape into
45
the 'ueket· of one or Loth }'l':->: \Y hCll the fraetlll'e feLl' o<1<.;k, t h er e IlHty be illlli<.;a.tiul1l) ui ,L Lruj::,e al tbe back of the beatl.
1'reuttll(;,LI.--,-Arret:>t auy keworrhage frOUl a uloodve::,::,el ill the t:>ealp (see pitge 80 ), l 'lacc the patient in all ea;,j,)' 1Ju. itiOll to Lrc<1tl'l'; llllllo all tight clutbing j carry the paticll t illdoors or llllJer Hh Jtf'r; apply it clean JlHlldk.crchief, a pie<.;e of liut or lill'll Llippe<1 111 culel \\etter, or, if ;nadcI h1e, all icchag, to the head . ])0 llot give auythillg l)y the monLh jf tbe pntIen' w::,elltSlble, :llHl get 'j doctor sp eddy.
F ra ctur e o f t h e Lo w er Jaw .-Ther(! m'e the ut:>llld ::>f fradme, \\ ith iuability to ' peuk or moY!' tll'C jaw freely, irregularity of the teeth r.nJ from the gums . n·eafmeld.-PlnGc the palm of the hand below the injured bo_u e, prest:»t gently Ilpwanl' again t t h e.
46
upper Jaw, and maintain it lU that. position by a narrow bandage. To apply the bandage, place the centre to one side of the chin, carry the euds up thu side of the head, crossing them just above one ear, and the end Jound the head, tying them on ehe ide of the head oppo ite to the crossing (Fig. 20). Another method is to tie the ends on the top of the head, and pas a second bandage in front of the chill, fasten the end' at the back of the neck, and tie all four ends on the cro\vn of the head.
Fractured Ribs.-Thc l'ius usually fractured are tho'e occupying a central position in the chest, namely, the 6th, 7th, th, and 9th. The higher and the lower pairs are seldom fractured. A rib may hroken by a direct blow 01' by a squeeze or J t may be broken in any part of its coun;e, but it is usually fractured halfway between the breast-bone and the back-bone. The danger of a broken rib varic.' with the amount of injury to the iung. Practically, wherever a rib is to be felt there is lung beneath; therefore any force "hich tends to drive the ends of the broken bone inwards may tear the lung.
,Signs and Sym,ptoms.- 'When a rib is hroken the patient complains of a severe pain, on attempting to take a deep breath; the breathing is short and shallow, and crepitus may be felt em placing the hand oyer the injured part. •'hould the rib penetrate the lung lJlood may bo coughed np and expectorated.
47
Blood .coming from a torn IUllg is coughed up; it is of a bnght red colour, and pre ents l;L froihy appearH.lH..:e.
Treat7nent. - JVhen tlte lw,!! i.-; 1,Ot iNjured apply two broad. Landagcs tinllly rouud tll chct:it, with the centre of olle lnwdage illlmediatcly uboYc, and the cell tre of the :ccolld LUlldage iUHllediately below the bcat of fraGtme. The bandagcs are to be placccl so that the 10\\'er oYCrlaps the upper to half its extcnt. They are to be tied 011 the oppo ' ito of the body" illl ' . the knots l'aLher to the fran t of the boely, and tight enough to glye tbe :mpport ilnd. comfort
FIG . n. in breathing (Fig. 21).
,YhCll 110 bandage. are procura.ble, tightening tl1(; waistco,tt by pinninO' the Lad.: or securing it otherwi 'e is good plun. lrla'n the rios are broken., callsirlV mjul'!J tu, anfl it mal{ be ltWllw7'rhar;e from the llmg, do not place n.
ron nd th body, but lay the patient down, inclined a little towards the injured side, in order to give morc play to the sound lung; loosen the clothing, give ice to suck, and place an ice-bag on th cheHt over the broken rib. A bandage round the chest might tend to drive the broken bone further into the lun g . A In.rge ling to support the arm of the injllred side is advisable i.1 either ea 'c.
Fracture of the Breast-bone (ste'mwn).-"'iYhen thi accident i suspected, or when by pa ' ing the fingers over t h e breast-bone thE' fl'adure can he actually felt, the b'eafmenf to be followcd is, to undo all tight clothirig, to place the patient in a casy a position a possible until a doctor arrive. ' , and to u\"oid rough handling or udden movement.
FRACTURE OF TEE Bmm OF THE UPPER EXTREmTY.
Fracture of the Collar-bone (clavic7e).-The arm on the injured side i ' partially hplple s, and the patient usually supports it at the elbow \\ ith his hand, and incline. his head tmmrd::> the injured side. vVhen the finger i· passed along the inj ured hone Lhe fractured ends can genernlly be felt to overlap, the outer fragment ha;Ying dropped belo\\' the level of the inner one. The other sign,' and symptom_' of fracture [.1'e mostly present.
Treatment.-Remoye the coat with Q:1'cat care )Jeginning with Lhe 'ound ide n.nd 9uppc;-tin{!"
injured limh duriug the removal of the ..I eeye t herefrom; also take off as much mol' of the clothing a. is expedient. Place a pad abont the size of a in the armpit of the injured side. Gent1:· l)encl the forearm \Yen up, keeping FW.2:2.
t h9 ·lhmy a , far back a prac.:ticn.1)le illHl :->np]l()rt in a hlrgc arm . ling. of applying- the la,rO"L' ann "li11" in the m;nal method it is ;1chi:al,le to the ill the ordinary ,,-n), \ronld go ()\-er
the fractured bonc, beneath the armpit of the iujured ::;ide, and tie the ends bellind (Fig. 22). All alternatiye form of ' ling, preferred uy some, is put on a, ' follows: flex the IUl'earm a.. auoye; place one end of
.FIG. :23A, (Bandage round body, omitted to shoYl' deu.ilB of sling.)
the bandage on the shoulder of the uninjured 'ide, keeping the point towards the injured sIde: pa'l:) the base between the flexed forearm and the hody, then under the armpit and acrosl:) the baek, awl tie
51
the two ends on the shoulder of the sound side. The point and part of the sides of the bandage arc now to be folded to support the eluow and fixed with one or two pins (Figs. 23A and 2313); b.V" either of these plans the broken bone is not pre 'sed UpOll by the bandage, Ii inally, tightly secure the limb to the side of the bod, by a broad applied immediately oYer and upon the elbow of the injured limb, U" ,'hown in outline (Fig '. 22 and 23,A); carry the ends horizontal] ,round the chest "0 a to lever out tho arm at the shoulder joint, the pad forming the fulcl'lu1}
Fig. 24. '\'hell one bandage only}. ' ayailable place a pad in the armpit, fie:.\. the forearm as in diagram (Fig. 23), apply G narrow bandage immediately above the elbow, bring OllC end aero 's the front of the c:he t : carr\" the other cnd ucbind the arm, and theu bring it fu;'\\" nI'd
between the limb and the body; pass it to embr ace t h e po r t ion of the banda,ge on the front of the and finally carry it ro u nel t he hack; pa ll tight and tie oft· as in diagram ( Fin·. 2-1:)-
Fracture of the Shoulder-blade ("capula) is to be treated, ,tfter the clothing is l'l!IllO\ ed, by app lying a brocLtl tricUlO'lllar hanclagc firmly rOllllc1 the boch' the eat of injury and thcrefol'l' d()sc up to annpits; tho limb i::; ·thcn bupportccl ll} a large arm sling.
Fracture of the Arm lHme be 1,)1'ol\:e11 010, ' 0 up to the , houlder ill Lhl' lIli(kll ) of its, haft, or in thc illllllccliat e ]H.: ig:hl)olll'hoorl of the plhQw joint. The u 'ual mptotll' nre p re 'ent .
Treatm ent.- TVhm the Hwneru8 is lmcfur erl at z't .' vope)' eml clos e to the shoulder j01'nt Apply a brond Lnwdage with ccntre aboyc the 111ic1(llc of the arm, and c;arr,\' the cnd::; rouml tbe ann awl 1)()(ly, tyillg them 011 the opposite ide; t;L!Pport tIle forearm l)y a s?na71 arm sling. When th e of the IJulIleJ'lls is broken :-BClld the forearm a.t right mwles to the Larm; apply four splints of wood or folc1eclnc\\ 'papers, covert! of books, etc., to reach from shouldcr to cll)o\\', to the fron t, back, outer, and inncr sidcs of the arm (Fig. 2 .) ). The . plint ill fronL the biL:eps Il1llsc1e) lliUf,t "n no aCCOUll t be , so long as to pre:-;s _upo n the £O le! of the elLo w joint, other\\'isc the l)lood-
5" ,)
"essels arc in dn,l)!fer of being compressed . The 1-;tra \\ eoyer of a wine bottle cut to a proper l ength forms all excell nt ' pl in't for the fro.nL of. the. ann.
I n en e of diAiculty in procuring sp11l1ts, .It wIll. be .llfticicnt t() place them on the outer and mner SIdes only. • ecure the splint l)y t\\ (I
Fro . 25 . 1)andagcs, 0 n e abo\'e and the other helow the bea t of fracture. III ca, e no splint tl rea n1. i 1a b 1c , 'cC\1re the ann with t\\"O broad to thc ide. ' upport the forearm by a small Fractur es mv olvinfJ tit e elbol/; johd are attended 1»), 0 111 ncb ' \yelling, and it i , ..0 diilicult t o a certain the ex ttd nature of th e lllJury, that when the accic1ent occur indoor ' the limb hou1d be laid on it pillow in the comfortable pO'ition possibl e; ice or cold water dre 'ings
should be applied to the injured part, but no further treatment should be attempted pending the arrival of a doctor. 'When the acoident occurs out of doors, it is to be treated by the application of an angular plint (Fig. 26) made as follows :-Take two piece" of thin fiat wood, one long enough to reach from the armpit to just below the elbow, the othcr long clLough to reach from abovc the elbow to the fino'cr tip. ; tie them together KO as to form a right angle, and apply the angular splint so formed on either the outer or inner side of the flexed limb.
ecnre by narrow bandage ' a,bove and below the seat of FIG, 26. fracture, and upport by a la1:qe arm sling.
On arrival at home, rernoye tho splint and treat as if the injury had occurred indoors.
Fracture of the Forearm.- 8i,qns a7ul ymjJ
toms.- TVhen both bones (the Radius and Ulna) a1'e b,'oleen, the usual signs and symptoms of fracture are present; u,hen one of the two bones Onl.l/ is broken the signs are modified, but thb limb will 10 e power, a
deformity will hr fonnel nt th . cat of fracture, 'J.nd acute pain when movement is attempted.
A fracture of the Ulna alone 11s11al1v Occurs at the npper end of the bone, in the neigh l)onrhood of the elbow. The tip of the elbo\\' behilld 'i ,' formed by the u1nn, nnd it fall upon that pl'oces.· of bone i8 apt to break it off
The Radius i,' frE'r{1lCntly fractured immediately ahoye the wri,t, the 1'e nIt of n. f,llI on the hand. Fw.
rj1his fractnre is u.'ual1y impacted and the igns of fracture are uon cquently modified, hilt the deformity, aC11te pa.in 011 mo\'ement, and tIll' rO\ycrlcssness of the hanrl are, ufficiently trong that the bone is broken.
2'reafment.- Th e treatment i,' the, arne whether the
56
fracture is of one or both of the bones. Bend the forearm at right angles to the arm, keeping the thumb npwards and the palm of the hand towards the uody' ap ply two broad plints while the forearm is mai n tained ill the uellt pOlSition, Olle along the iuner, the other along the onter ::;icle of the limb . Tbe inner Kplillt should 1) ),) Iong enough to retwh from the cluo\\' to the tingers, and the ouLcr from the el1lOW to the uack uf the hand. ecure the 'plintlS by hmdages, one above, and anothcr bclow th seat of fracture, and a third to fix t h e hand in position :27).
F · 28 Finally, support the 19. . limb by a large arm sling.
Metacarpus .-Onc. or more of the metacarpal bones may be broken l ly direct or indirect violence.
57
\Vhen a metacarpal bone i. ' fractured, place a r ound pad, snch a.' a LCllni ' hall, in the palm of the hand, bend the fino·cr.' round the ball, and secure the whole b (F' '») by a bandn.o·c and apply a large arm lmg 19.... . Fractu ; e of a Bone of the Finger (phalanx).
-The natur G of the injury is l' adily recognizable, as thc d fOl'lnity cn.n be both seen and felt. the injured finger gently into po 'iLion, apply a, llarrow plint along the front of th e fillO'er, and .'eenre it hy a piece of linen, tape, or pIa. ter. 'Yhen seyeml finger are injured apply a plint large enonah to npporL the whole hand. •' upport the hand b l' anel forearm hy a large H,rlll S mg.
F ra c tu re 'o f the P e l vis. - Signs and ymptoms.
_ 'Whcn, after :cverc injury in thc of the haunch bone, there i: no ign of ll1Jury to the low e r e,t remity hut the patient i' unable to stanc1, or wnlk or to movc thc lower limb., ont great dittieulty n.nel pain, n, fracturc of the may llc a . ;';l1lned to imyc occurred. D efol'lmty, crei)itns, etc., cannot u.-ually bc out. The blood-\"esseI8 and organ", more c peclally thc hhclder, within the pelYi.-, '" ,lr in great danO'er of being wonnded.
Tl'eaflllent.-LlY the paticnt in ,rhateyer po. itiol is found to givc grente t ea ' e. Bind a broad bandage rounrl the hips tio'ht enough to upport the part, but not so tight a ' to pre the broken bone
58
furth er inwar ds towards the cavity of the pelvis, and mo r e damage t o the inte r nal or ga.ns. F or the l owe r limbs accor ding as the patIent WI he , and lay him carefully on a blanket, sh utte r, or 'tretcher before moving him to a place of sh el ter .
FRACTURE OF TITE Do:\F.. OF TITE LOWER EXTRE)fITY.
.Fracture of the Thigh bone (femuT).-TIlG thIgh bone may. be broken at the neck (the upper end) ; anyyrhere 111 the leJ?gth of its shaft; or at the lower cIo. e t? the knee. Fracture of tb neck of the thIgh IS v?r.y apt to occu r in old people, a?d .from very slrght lll'ury. A severe bruise of the hlp IS apt to be for a fracture. I t rna} be a safe gmde, 11owe\'er, that "hen, after III the of the hip join the LnJuled person can, whIlst lymg on the ha.ck raise the heel off the ground, the bone is not broken ; hut if the heel ?anl1ot be raised it is safe to assume thnt bone IS "?roken. Fracture of the lower end 1)[ the 1 to im'olve the knee ill the illjury. wIth. senons detrIment to the joint. . r and usual signs of fr:t<.:bue. 1 of the lllJLlred limb will lie in some a on its outer side. The shortcning on tbe InJured slele may vary fr om one-half to three inches.
59
T1'eatrnent . - (1 ) Stea{ly thc llljurcd limb by IJol d i liO' the foot. (2) Gelltly dO\Yll the foot of the iujur d sic1e, an d hr!ng it into liUB 'with foot of Lhe sound limb. '\, hcn two or On'ce assu:itrults are Ht hand, it is 011e p duty tn attend to tilC foot, itolclil)O' it ill position and not Idting go until the t:' aud bandage. arc applied. (3) . ),. ppl,r a l' plint ell thc outcrirlc of the hmL, long (;11011gh to rcach fl'OlIl the nnuplt to ueyo:1d the foot . A urool1l IlHlldll', <c llli..sk -t (l)utt end III arm·
piL) , a :-.chool map rulled llP, h couplc of hilliard Gue::; tied together, or <tll," piece of \\ 00(1 cut .t o length lila" be u::l'(l as a .. plint. (4) Apply a splll1t 011 the inside of the 1n'o1\011 thigll, lOllg enough to reach from the inside of the top of thc thigh (tl1e fork ) to the knee. (5) ....·ecure the splint in po 'ition uy bandages. Pa " one round Ule .ch(,·t ,t uelow the armpit·; another round the pelns; a thud and fourth hrLlldage, embrftcillg l lOth 'plints, are placcd on Ule thigh, one aboyc and the otllt'l' uelo\\" the scat of
60
fracture; a fifth bandage round the leg; a sixth I to to be passed behind both ankles, the euch; cro Bed oyer the front of the feet, embracing the splint, and tied off below the feet. Finally, apply a seyenth bandage round both knees (Fig. 29) . Do not a.pply bandage over the abdomen, a it might cau' the patient to vomit, and, moreover, would n t keep the "plint finn. (6) shock by keeping the patient warm. lVhen a person is single-handed, it il:) expedient, after extenl:)ion of the limb, to tie the feet together to prevent the bones from again overlnppin,l(; and under t.hese circumstances, as well as "\yhen the patient if:, <l woman,. it is well to pass all the limb bandages round both limbs, dispensing with the inside splint (Fig 30).
I!'w.30.
Fracture of the kneecap (patella).-The kneemay be broken by falling on the knee (direct .JI ore frequently it is broken by muscular actIOn, an accident which may arise as follo ws :
61
When the foot slips and all attempt IS made to prcyent a fall, the muscles in the front of the thigh act \yith such force ill the attempt to maintain the hnlnnce that the knee cap may he ·napped in t\'w.
8£01/"'; and S?J7nptomr-.-Thc lilld) \"ill he quite helple s; a gnp may he felt h -tween the l)l'()ken ends of the kneecap; the knee joillt will . peedily ·well. l'reatment.-Lay the patient on hi hack; rai e well and FIG. 31. FR ,U'Tl IU: ,'upport the head and houlders. OF K '£EG.\I'. • 'lmighten and rai "e the limb pply a , plint along the hack of tlil' lillllJ rcnching from thL' hip to the heel; apply a 11arrow bnllchp:e with Its centre placed immediately abo\ e tbe lJrokell kncec.ap, <:1'.o::;s the end::; hehind ovcr the splint, H;1d tIC off ,Ill front below the broken b011e (Fig'. 32). finlll1c';s <l ,'econd hn,ndno'e may he applied 1ll;1, .1l11l1ar \\'n:,\" to the fir ·t, bnt commenced belo\y, and tled al)o\'c the hrokell bone . The plint i to be further by 11anclage round the thigh and leg. The fo?t l' then to he well off the ground l)y a l)111ow, roll of clothing, etc. ; or if none of the e can be had, by 1'e ·ting the foot of the injured lirnb on th top of the foot of the sound limb. n icc-bag or
IJold-watel' dl'e... ing ::,houll be Oll the frunt of the injured kn eecap <.ts SOOli as possIble.
Fw.32 .
Fracture of the Leg (hula amI jibul9').-Both bones may be broken at the .. nmc time or eIther lJ1ay • he hroken alone. and 'ymptoms .-Thc n .·1.wligns and ) IDp-
FIG. 33.
toms are pre cnt. The ti))ia is 0 dose to the that the fractured end ' can generally be readily felt.
A fracturc of thc fibula, thrcc or fOllr illl:hc above ita lower end is heqncuLly mistaken for a ,·prn.in, and not infrequently for a dislocation of the ankle, owillg to d i 'placement of the foot ucil1g the 1l10 ·t prominent Hign. 'Yh ell 011e OOllC i ,' brokcn therc \\ ill be no lUarked .. hortening.
Tl' ealment.-(l) toady thc liml) l)y holding the foot of the injured side. (2) ])r11 \\' the foot of the iujured side lc\'cl with thc [out of the 'ound lilllb, with
Fig. 34.
lite toc<; pointillg and do nut let go until the r-.plillc" ha\'c uecn nxed. (:1) Apply plint · to the leg, OIlC on the out ' ide, anothcr un th in ·idc. The splints f>honld be long CllOugh tu rcach from <\.bo"e thc kn ee to bcyond thc foot, 1;0 that thc knee and ankle joint nrc kopt at re.'t. If only onc splint i· uYaila,blCy place it on the outer ·ide. (J) 'ccure thc by bandage placed Olle abo ,'e and another below the eat of fracture. A chird bandage to be applied immediately aboye the knce, and tl. fuurth and fifth ronnd
both anJiles and knees as in the ca e of the thigh. lVhen sin.qle-handed, after extending the limb, tie the feet together, dispen e with the inside splint, n,nd carry a1l bandages round b oth limo (Fig,.34). ' Vhen the patient i::; a woman the in ide plint may he eli 'pensed with, and a1l the bandage may he carried r ound both limb oyer the clothing. \"h en no splint is available, tying the leg, ankle and knee .' together is of great service.
Fractures of the !vietatars a l Bon es a nd Phalanges (crushed of these l)one::; are commonly caused UJ' the pa::; 'age of lL hc;\'v)' weight over the foot . The accident jD reeogniDcd h)' pain on movement of the foot 01' toe.', tmelling <1lltl 10::;D uf power.
l'Teatment.-The treatment GUll 'ish jJl th' application of a flat splint of wood or other material, such a a book or piece of earduoanl, to tl10 Dole uf the foot with a bandage to enclose the \\ hol e foot.
DISLCJCATIOX
'.
A di::;location is the displacement of one or more of the bones ente r ing into the formation of n. joint.
T he joints mos't frequently di ..'located are those of the houlder, the elbow, the thumb, the finger.', lwd the lower jaw. The joint::; of the lower extremity are but seldom dislocated.
A. D SYMPTOM OF DISLOCATION.
(1) Unnatural positi o n of the limb. Pain of l.t sickenillg character, DeformIty 111 tho llei o hbollrhoocl of the illjnred ,joint. t:>
, 0) Fixity of the joint. Unlike a fnwtnre, the 11m (',1ll110t he lllO\'ed at the joint by either the patient or other '.
('-') s ing num bness of the part' lJelow the 'cat of dllOCrl.tlOll.
(G \ A bsence of the cre p itus characteri,tic of orclin<l1-Y fracture.
THEAl'lIlE\T 01<' DISLOOATION ' .
- '0 attempt be l.nade by anyone except a clflctor to reduce ,,1. (lI'locatIOll. The followilw treatlllent, lIm\ eyer, pending the arrival of the t"cludor ::;houlc1 he earried out : '
When the Accident Occurs out of doors.(I) III thl' ('ase of: of the shoulder, Dllppo rt th' upper cxtl'enllty whatever positiol1 lllO.'l. l',cu:;e ll)' it l.<ll'ge a.rm Sllllg; pre\'ent all jolting of the Juno. oy, ,L ba.ndage round the limb and ho(h' or br pllllll,ng the to the clothing VVllen no of a. ' lmg are at hand, f,utcl1 or pin the cout sleeye to. the clothing. (2) ''''hen the elbow i.. dislocated, tIC or fa ... tcll the npper extremity to the 'idG
66
of the body ill the most comfort,tble po itioll pos'ihle. (3) "Vhen any joint of thc lower extrcmity (lislocated, place the limh in the cll, icst position potltlible ,md carry the patient 011 a stretcher to housc or home.
When the patient is indoors.
- 1) RCUlOye the clothin<Y fro1'1 the illjnred'" joint and limb. (2) Pbcc the paticnt on a eoneh or beel. Rest the limh on ell.. hiollS or pillow:-; ill the position ,yhiGh ;Iffon b; most GOIll fort. (4) ,\pply colcl (icc, or l,Owch; wnUI!.!,' out of cold water) to the ddocatecl joint. (G)
trw. ,Vhell cold cca etl to ONE FORM 0]' DISLOCATED SrrOULDER. givc comfort apply warmth (ftn.nncls or towels wrung out of hot water). (R) \\Then the shock is severe keep the patient warm by appropriate rellledies. i::lhock.)
67 srRAIXS.
"Then by a suelden \\Tclleh or hvi.'t the ligaments allrl the parts around tllc joint arc strctched torn thc jO.illt is said to be .. pminec1. (C Uoing oyer" anklc IS onc of thc comlllune. t cxaulples of au accident (,f this kind.
Sraxs AXD Si \[1'T0:\I' 0[" ,'PRAL' ' .
, tHl c1 en. ,cyerc pain and inability to usc the joint a tWIst or wrcneh mark the OCClllTcncc a " a sprain. (Jmekly thc part 8\,"c11.· beeomc,-; c1iscolollredand b]lle "-owing" to the eH\l.iun of blood mto amI the joint. There is, ho\\'e\'er, no fractnrc or ell ' plaCCllll'tlt flf the hOlle'S,
THEAT\IE.'1' OF
When at some distance from house or not rcmm'c the ·tocking· or hoot, lHlt Illnd thc fuot and anklc tightly round hy a Thc bamlage i' to he pas ' cd below tIll! W<llSt of the hoot, on the front of thc ankle, nnd thcn c:arric(l ronnel awl round the ankh" ,it i.,. fir:nly tied, '''c't the bandage after applll-lttLol1: It h tio·htcnec1. After by the clown, rC1110\'C, :nthout draggll1g, thc hoot and stockiug, cutting both If ncct ::;:::;ary j place thc illj ured part in a . comforttl hIe . "' .
a position as possible, apply ice or cold-watcr drc 's ings to the joint as long as they relieve pain, and whell they cease to give relief, apply hot fomentation ' 01' 2 bran poultice.
When other joints are sprained they rcq nire nnwh the arne immediate trcatment as when they are di located.
TRAINS.
·When, during severe exertion, as lifting and pulling hea.vy weights, mnscles or tendons are o\'er- 'trctchcd, they are said to be "strained."
SIGNS AND YMPTOMS OF THAINS.
·When a part is strained a sudden sharp pain occur , r endering further exertion p ctinf ul, difficult, or impo' ible. If the strain has occurred in the back, the patient may be unable to stand upright or take a deep breath without pain. 'Vhen in a limb, the trained muscle may swell, cau ing severe cramp-like pains.
TREATMENT OF STRAINS.
Place the patient in as comfortable a po"ition as possible, and a.pply hot-water bottles or hot fomentations when the pain is very severc-. . A s?-c.alled strain in the groin (rupture, or hernia), IS an lllJury of a totally different nature (see paO'e 160). c
THE OHGAr IS OF CIRCULATION.
THE orgn.n: concerned in the circulaLion of the blood are the Heart, the Arteries, the Veins, anel Lhe Capillaries.
The Heart i::; situated ill the chest bebind the hre<1. -t-bone and rib cartilage, uetween the lUllg>; and ilnmeclialcl.\' above the diaphntgm; tbe llcnrL lie::; nllliqn ely \lith a (Illarter of it.- bulk to tbe right, and the rCllln.illillg three -qwtrters to the left of the llliddle line of the lJody. The beat of the henrt may he felt jn.L 1)l,jU W and to the iuner siele of tile left llirple. The heart has four C<1;vities, blo on eilher side of a central partition 'rhe t" c npper ccl\'itie8 a.re lu-uned the right and left auricles, the two 10\\ er the right and left ventricles. Tbe arLcrin,], red or IHlre blood it; driven from the ll'fL YL'lltride of the heart into the a.orta (the main ccnLral artery of the body). From the aorta bn1llullct-) (a rleri e8) are gi von off to all parts of the hod y The 'e arteries divide and sub-divide, and 0 h:a] do become that they assume micro copic dim en i01l8, \\ hen they are termed capillaries. In the capillarie, an interchange of gases takes place, whereby lhe llonri!'jhment and maintellance of the tissues and
L. Larynx (voico box); T. Trachea (wiwl pipe); R.L. Right Lung; L.L. Left Lung (the lungs are drawn back Lo expose the heart and blood vessels); R.A. Right Auricle; L.A. Left Auricle; R.V. Right Yentricle; L.V. Left P ..:1.. Pulmonary Artery; Ao. Aorta; •'.\r.C.
Superior vena cava (the I large vem carryi Ilg hloo<l from the upper part of the botly to the heaI'Ll; 1.\r.<':. Inferior vena cava (Lhc large yein carrying blood frum the lower part of the body to the heart). The four pulmonary veins cannot be shown in the lliagram.
'Jl
organ of the body are provided for, and the red blood a purple colOlu'; the purple (VtllOUS) blood llUW pa.,·l:)es from the eapillarie:) to the veins, whicll COllyey it the lWctrt, getting larger and larger as they by joined by neighbouring vein' until they finally as two hu-ge reach the ril.!ht auricle of the hoart. The veins, especially in the limos, are proyiJell with vahes at frequent intervals, wllit:h prevellt Llle bcwkward flow of tho Llooc.1. A of blood Yessels, called the pulmonary, i:-; <';olleerned in ccLrrying the lJlooc.l through the lungs. From the right <llll'iele the Llooel pets 'es to the right \'l·utricle, auel is tltellue carried to the lungs, where it is pllrified by eOlltuct witll air, amI beuolIlcs red in rolonr; it is then (xHlyeyed to tIle left auricle of tit, heart and iuto the left vcutl'lde, thus t:olllpleting- the uirunlatioll.
The hcart uonlrat:ls ill aclults at an average rate of seyent.y-two times a minute, Lut the rate \'ari s, illCrCi.l.::>illg' as the po 'lLiull i' ebnnged from the lying to the sitting or to Lhe standing pO'ition. About two onncel:) (a wiueght::lsflll) of blooel are eli 'charged into the aorta at ove1'\' contraction of the left ventricle, and the hlood i," sent into the arteries in jets or waves, call -iug the pulse, which may be felt along the cour e of all the main <1xteries wherever the finger can be placed on an artery a it passes over a Lone. In the veins no pul e is to be found, a. the
72
Explanation. In the mic1<llp of the diagram is the helll t \\ ith its four chambers. .A hove the heart is shown the lung (pulmonary) circulation. The lower part represents the geneml circulation. Vessels contall1ll1g impure (venous) blood are sho\\ II black while those containing pU!"1j (arter'ial) blood are shown ,,-hite. The connecting represent the capillaries. The alTOW" "ho\\ the direction of the tiow of blood.
FIG. 37.
DIAGRAM OF TITE CIRCULATION OF THE BLOOD.
heart wave is expended during the passage of the bloorl through the capillaries and reduced to a regular and eve n flow.
H-LEMORRHAGE.
Hremorrhage or bleeding signifies the e cape of blood from an injured or diseased blood-vessel.
73
Arterial Hremorrhage.-Blood from an artery (1) is scarlet in colour; eseapes in spurts or jetl:5 cOlTel:5pollding to tIle pulsation of the heart; and (3) flows from the side of the \yolll1d llearest the heart. It i, however, chiefly \"hen the wounded artery is close below the skin, as in the hand, foot, temple, etc., tb::!t the blood may be ..,een to escape in jetl:5. \Yhen the artery is deep seated, it in the leg, the blood muy well up from the bottom of the wound \\'ithout marked signs of pull:5ation. The quantity of blood 10 t varies with the size of the artery wounded. \Yhen the aorta, or one of the large arteries at the root of the neck is wounded, death is instantaneous; when the main aneries of the thigh, armpit, neck, etc., are wounded, death will occur in a few moment' unles the flow i btopped. Pres 'ure applied to medium sized arteries, a' those of the leg or forearm, within a. few minutes of being u;oullded, will save life; hmmorrhage from smaller arteries may cau e C!'iOllS 10 '1) of stl'cnf!th unless the flow il:5 speedily arrested.
Venous Hremorrhage. - \Yh en a vein il:5 cut the hlood (1) is of a clark colour; (2) it flows in a 'low, continuous stream; (3) it is lles from the side of the wound furthest from the heal t. vVounds of veins of the limbs are somewhat less dangerous than in the case of arteries of corresponding size.
Capillary Hremorrhage.-Blood flowing from capillaries, as from a slight wound of the skin: (1)
74
is light-red in (;olour; (:2) flo\\". hri:skl'y in n eontilll10111'1 stream; (3) wells up from all of the cut i:>urface.
GENEHAIJ PRIXCIPLE OF THE ARRE "]' OF ARTERrAL HiEMORRHAGE.
The principles of treatment to be followed in the event of uleec1ing from }L htrge aro :. L t, to n.pply direct pressure on the '0leeding point; and 2nd, if direct pre :,mre it; un'ucce'sl'ul or illllJOsiblc, to apply pressure on the main trunk of the artery between the wound and the heart as close to the wound as possible. The closer to the wonna the artery is <.:umpre... ed, the less "'ill ue the damage to the limb.
The mean' employed in the temporary alTc·t qf hmlllorrhage are dig'ital and in trnmelltal COlllpre sion anr1 flexion of the lim1J. LayilH!,' thc patient down and elevating the limb will les 'en the f01'<.:e ,yith whieh the ulood e ·capes.
1. Digital compression is the application of the thmnh or fingers eiLhcr on the ulecding point it 'e1£-dil·pf't ('01J11J?"ess1'o77-or on the trunk of tho main artery leading to tho ,yonncl-huJi(pl'f ('olll}JJ'e;;.-.:io71.
IT. Instrumental compression may also be applied by the direct and indireet methods. (a) Dirprf 1'llstJ'Zl1Jlenla7 may be carried ant by applying a h3;-udkervhief, piece of lint or linon
75
foldedjnto a small, bard pael, and placed on the bleeding point, "'hcre it i.:; Hccul'ed by a bandage firmly tied round tho part. To fold the handke1'(,hiej as a pad, proceed fo11ows :-Lay the handkerchief out on a flat surface; bring tho four corners to the centrc of the handkerchief; ag-ain bring the corner' to the centre, and continue folding' the corners towards the centro until tho h;mdkcn:hicf hecomes a hard pad. The ronnel, smooth surfil'o i' placed 011 the skin oyer tho artcry, alld to prcvent the pad lU1folding, the pue:kerec1 surface may he fixed uy a afety pin, or stitchcd with a needle altd thread, if such appliancc are at Land. A harel suhstallce such as a stonc, cork, llut, mar1)}c, etc., may, j f nC'cessary, bo enolo cd in the centre of the pad. •'houlel oeca ,ion permit, a gradllat('d ('omp]'('ss may be wade and applied a follow': Place a .. mall fu1cled piece of linen or lint, or cotton, upon the ulecdillg point j oyer thi' phce a sccond and larg-cr picco of the I'<lllle material; a third and a fOlll'th P1' lllure pac1::>, cavh larger than its preclece,'sor, are 'nperilllpOt;cd, until a regular cone is formed, with its point or apex resting on the wound, and its base down hy a tightly applied handage. (0) Inriirpf'i hl:4/'Un1f'lltal compression consist in stoppill" the fio,," of 1)100c1 through the main artery by no tonrniquet. A tourniquet is an instrumcnt whereby pre'Slll'e call he made on the trunk of an artery so to .. top tho flow of blood through it. .A
tourniquet may consist of a pad to be placed Oll the trunk of an artery, a st?'ap or bandage applied so as to encirule the limb and pad, and a buckle, screw, or twisting apparatus (such as a stick) whereby to tighten the strap or bandage, The three principal tourniquets are the improvised, the field, and the
F IG, 38. FIG, 39.
FIELD ToUR IQUET. SCREW TOURNIQUET. screw tourniquets. T ourn iquets are seldom applied except to the brachial and i.::.noral arteries. An improvised tourniquet is lllaJe and applied ai'S follows :-On the trunk of the main '1.rtery, say the femoral or the brachial, apply a firmly fold ed pad, about 77
the size of a tennis ball cut in t\\ 0 for the thigh, and of '1, walnut for the arm; over this pad place the centre of a narrow triangular (or other) bandage, and tie the end 011 the side of the limb oppo -ite to the pad. ...\'fter the half-knot of the bandage it; made, pla.ce a ,tick, pencil, walkillg- tick, poker, polieclllan's trnm:beon or orne ueh instrument, upon it, and tllen complete the knot, adding yet another half-knot for SI 'Clll'ity. The (( stick" is now to be twi tcd, whcn the lJandage will be tightened, and the pad pressed firmly upon the trunk of the artery with force to arrest the flow of blood. bould a l11table pad not be at hand, a knot may be made ill tllC centre of the bandage, a.nd when ayailable, a 'tone, cork, etc., enclo:ecl in it to give it firnme sand lmlk. See that the bulging, and not the fiat, side of th knot is nu. t the ..kin. The " ,tick" i ' finally "locked" in by the end' of the bandage wed for the to"l'lliCJ.uet, or by another bandage pa. :ecl round thu limb and made to enelo e and fis th stick. I
Tho field tourniquet consisu - of a pad 'and trap. 'Th pad is placed on the 00U1' e of the artery au(l fixed there by the trap, which i ' pulled tight a.nd lnwkled ofr. The screw tourniquet (ll,}' some idcl'ed ob olete) acts Oll the allle prill (;ip1c, uhe strap, howeyer, being tightened by n. crew <lpparatus. An elastic bandage passed round the limb immediate1y aboye the seat of an arteri a1 hremolThagc and
pull ed tig h t "ill arr e't bleeding. The simp le t prepar ed fo r m of t h is bandage is a t:itrir of c lastic \\chLing or inche' long and t\\ 0 inehc:-) ,\i<le, with a piece ol tape at cach end . An brace or belt will, ho\\ CYer, the purpose. It i not to u:-;e a, cord or ela,tic bal1(lnge nale' no other appa,ratus can lIe harl, as the pre'sure of the cord cuts off nIl eirclllatiua in the limb.
Ill. F l exion o f the Limb.-Th e arteries of the Lack of the knee and the front of the hend of the ell)o\\- ma.y be compressed by placing a pad llpon the trunk of the main artery at the knee or el 110 \\', and, after fully f.lexing the iim: ), securing the limb ill a flexed position by a bandage.
thtJ 1.lJou,nd. After the h<ell1onhage has h Cl' ll :LITe. ted by the indirect methorl, the WOHll(1 lllU.:t be l'o,ered oyer by a clean nrc '::ling. (S vt\ ,, -on ncb.)
In all cases, especially when the patien t has to he mo,ed some distance, the injul'c(l l im1) or pnrt should be raised, if po. 'sible, and ma.intaincd <'I.t rest by splint · and Landages, if need he.
'rHE COURSE OF TIIIl: MAIX ARTERIES AXD THE ARRHST OF H.lnWRllHAnE.
( See ce).
The Aorta is the main arter, of the bo(ly. Commencing at l eft ventricle, it 'fonn::; all arch 79
thc 1l1)pcr part of the hrrH.·t hon? From the arch are given otf the lnrg'e trunks WhICh earry the l)looel to either 8icle of thc head ancl neck anel to th e uppcr cxtremitIes . Thc aorta pa . e' clmnl on the left of the Spill to jut l)do,," the mwcl, 'wher? it rnel .. .I)y
dl,·idillg into t\\'o large hranches (the IlIaC"';) "Illch com Cy' the b100cl to the organs in the pelYi.:, ancl to th e ('1' extr'lllitie.'.
\nn:nLE OF 'TIm HEAD Axn XEC K.
The C omm o n C arotid A rt er i e s l'llll up the IICl'k Olle Oll eltbcl' .'iele of t11c \\ llldpipe, allel on a lm-el with" . \dal1l· jll ,t hclow tIle augle of the 1o:,"er j:t\\' , eli'lclC' mto thc llItL·rna1 and c_·tern:11 carotids. Tlie Internal C arotid pa ' sc ,' up deeply III th e neck, nlHl l)lltt' llllg the (,),1l1111l11l jll .' t interllal to th e car tllt' lll'tlill WIth l)lood. The External C arotid :trtl' rY otf brallchc, ' to the tllllg'lle, tbe throat. the J';u:e,' the llU:l': tll' temple anel tllC ."calp
,\Youxns OF TTIE AnOTID A . ' D THEIR
W hen a Ca r ot i d a r te r y is wou nded, a, in the ea 'c of cut tbront, app1) digital compresHioll h)-. plal'.ing thc thumh on the artery h)' the side of the WllHlplpe, either on the wound or hetween it and the heart, PI" 'sinO' htebmrcls agnint the hackhol1c, taking care to the l1111 ' t -:")C maintained
80 by the thumb (by relays of n.ssistants if neG0S 1'1ry), until the doctor arrives ;no other method being applicable ill this situation. from the Temple is readily arrested by the thumb on the wound, or by placing a firm pad on the wounel. and making pressure by (;1, bl:1.lldage applied a ' rollow ' . -Apply a, ' mall pi1.d on the bleeding point, then
FIG. 40. place the centre or a narrow banclauc on the opposite siele of the head to the \ronuel, carry the bandage horizontally rOllnel the head ju t ahoye the level of the cyehro\\ tj, make a twi·t oyer tho pad, pass the ends round the head again, or carry one end over tho top of the head and the other under the chill, and tie firmly (Fig. 41). lLomorrhage from the Forehead, or from uny 1)(1.l't of the Scalp can be arrested ('11 the same principle. Hremorrhage from the Tongue is usnally controlled by suckinO' ice; should ice be unsucces ·ful or unand the wound far forward, the Lleecling point may };e grasped between the.. finger thumb.
Hremorrbage from the Lips may be by i.ce, or, if very severe, by compressing the bleedmg pomt between the fillO'er and thumb. Hremorrhage from the Cheek is by passing the fore-finger inside the cheek and the thumb out ide, and compres ing firmly either on the wound or below it, i.f., between the wound and the heart. The trunk of tbe Facial Artery may be compre 'sed on the edge of the lower jaw, about all im:h and a-half in front of the angle. \\'hell the bleeding i' from the Tonsil, Palate, or the inside of the Throat, give ice to suck; If the
FIG. 41. hremorrhage i . severe itmav be nece 'saryto compre 's the carotid artery in the from the Nose i treated 1), follows :-Seat the patIent on a chair with the head slightly thrown back; undo
an tight clothing ronnd the chest amI neuk ; thc haud' :1.boyc the head, apply eold ice, a eold or a hunch of keys OYC1' the ::;pinc at the of the collar ,; keep the patient in n Cllrl'ellt of fresh ail', aml
on 110 a<';C()llllt a]]ow him to h:UJg hi"'! hea(1 forwarn over a l)<t,;in; place the feet in '- hot water, Blood from the E a r c h an n el, which generally 3
indicatcs a fracture of thc Ilil 'C of the Cl'allil Il, 11 ll::>t be wiped away (;l. it iHSlICS; no attempt i Lo 1)e wade to plug the ca.l'. Wb 'n the cxternal part of the ?Hr itself i' \\ouuded and bleeds freely, !.!,T<lSP thc l)lccdlllg point bet\\ cen the finger and thml11),
ARTEHlES
The Subclavian artery p<1::<,'L' i'rOlll hdlincI t110 inller encl uf the <.;uIlar-h()l1c aCl'( s' t lie Jll', t l'h tl) the armpit (",1///11), J11 thc nnllpit the Axillary artery, "h:<.;11 i. a contilluatioll of the :-:-lll,('la "iall, keept> duse to the ,hou1ul'l' jOillt, am1 L',m 1)l' felt pulsatirw; \\ ben tIlL' are prl':-;::;ed 'nto the armpit. The BrachIal artery 1:-, 11. l'1l1lti lluatiull of the axilla!T, allrl l'llll' do",n the atlll on the inllcr 'ide of tile 1)il'l'P, lllw,c1e, gTacl,wlly pas.. illg- furward' ulltil it uaill' thl' middle of the flOlit nf the elbow The inllcr SCHlll of the coat 1:>ll'L'\ C Lho"c the (,]l)O\\- l'Oug'hl,v indiL'Htc.' it, ('()ur::;c, )\1. L bl'low the dhow the hrauhinJ cliyidL" into t 1)( ' lwlial and ulnar artcric'.', The Radial artery nlJlS along- the outer siue of the front of the fU1'l'.11111 ; lllay l)c indicated 1)\" a line c1ra\\"ll frotll the middle of the bend of the in front to thL' rooL of the ball of the thumb, l\l)Ollt one illdl aLoye tho wrist, and one hn,lf illch frOIl! the cluteI' (thUlllh or radial) sine of thc forcar111, \\ here the radial artery lies UPOll t.he radiu,', the pul '0 is to hL felt, The
R4
radial arter y, at the wri 't, turns backward above t h e r oot oE t h e thumb to the b:1,c k of the hand, and pas. 'os forward between the metacar pal bonos of the t h umb an d forefinge r to r each the pal m of the hand. The Ulnar artery runs along the front of the forea r m, corresponding to a line drawn from the centro of the front of the elbow to the root of the ball oE tho li ttle finger . In the hand the branches of tho radial and ulnar arteries combine to form the snpel'fieial and deep Palmar arches. The superficial Palmar arch i' near the surface of the palm, and COlTe pond::> to the line that runs along tho inner side of the hall DE the thumb . The deep Palmar arch is I:)lightly nearer the wrist, but lies deeply on the bones. In the finger, the arteries run along either 'ide of the fingel" to the tip, where they unite.
A RRES], OF ARTERIAL H 1EMORRHAGE IX THE UPPER Lum .
When a Digital (finger ) artery is wounde d place the thumb on the bleeding point and compress t h8 par t fi r mly; subsequently, apply a small pad on t h e wound, and bandage witb a piece of tape, trip of li nen, or a str ip of plaster, round the finger clncl pad. When the Palmar Arch is wound e d , phce (he left t humb fi r mly on the bleeding point, leaving Lne ri ght hand fr ee to apply a pad an ll handago . Apply a fi r m pad (a folded handkerchief), or botter
85
still , a graduated compress on the bleeding make the patient grasp tbe pad fir:n1y, and apply "bandage as fo llows :-Spread out a bandage, turn up the lower border about four mcbes, lay the back of the patient's hand on the centre of bandage, fold the point over the knuckles and W:lst, p ass the two endl:) round the wrist, make the patIent
FIG. 43.
p ull on the point of bandage, cross the end' ?ver (jhe fingers twice and tIe them as firmly a po Ible, Bring the point (A) down to the and fa ten with a pin at B (see Fig. }i mally, the forear m well up and support WI t h u large arm sling.
The Radial and Ulnar arteries may be COlTIpres ed by p lacing the on the arteries Ol1e inch ahoye the w1'is' (Fig. 44). Thi' may he llCCC8sary when the wonnd III the palm i' too lctrgc to lIe coyered by the thumb; instead of the thnmhs, the cork of a pint or quart bottle may be cut in ' byo
PH: ..J.!.
l engtlr\Yise, :tno one half bill on the radial, and tIJ(' other on the uln:tr Hrter? a little aboye the wrist: place the ronnded sides of the cut cork next the skin and secure them by a tight bandage. Sec al'o llut paragraph.
Hremorrhage from a wound of the Radial or Ulnar artery in t h e fr ou
of
llWy lJe arret:)te d hy n pad p lHced
FIG. ·15.
the elbow, the forearm heillg firml.'· flexed on t h e arlll, alld mai ll tained ill the flexed no ·itioll by a ban dage.
The pad may be made of a folded with a small stone or cork wrapped up in it; but when no pad is available the coat sleeve roll ed or gathered up ,l..' far as the elbow will serve as n, pad. Bend the fOrOa,1'111 upon the arm and tie a. narrow bancbge rounel the wrist and then round the upper part of the arm, crossing the ends between the forearm and arm .'0 as to better prevent the bandage slipping off Finally, tie the limb to the side by a bandage encircling the limb and the trunk.
FIG. 4 " .
Hcemorrhage from the hand, forearm, bend of elbow, or lower part of the arm, may be arre.'ted by compressing the brachiCll artery by digital compression or by a tourniquet. 'When applying an improvised tourniquet to the brachial artery, it is not al ways necessary to use the stick; the best plan is to tie a half-knot and pull the bandage tight; if the bleeding stops, complete the reef knot, but if it does not stop use the stick, as described on page 77.
9
To apply digital to the Brachial artery.-Extend the arm at nght <lnglcH to Lhe body, palm of the hand up\\'al'dH . Stn,ncl behind the hnh, grasp the arm, the thll111h 011 the outside of the lilnb, and pass tile fingert:l lmcler th back of the arm until the 'eam of the coat, or the "Toove on the in.'ide of the' mn ,ole (bicep.. ) is reached. Pre.'t:l the pulp. (not the t ipt:l) of the finger' finn!r 011 the COU1"(' of the 'lrtL ry C'pe Fig, 4G). ome prefer to
]<'11 :. -1.7.
gl'a p till' arill {rOlIl nho\'e the mu 'de, bllt if this com 'e i.' adoptec1, grent care nln 't, he t,:ke11 to the artery agnillst the bone, [l,lllll'ot acramt the IHt;ep,' mmiCle 17), A ,' light turn of the hand a. it gra 'Pi::' the arm will heLLer ell 'lll'e of Lhe artery. In practice feel Lhe pulse \nth tbe free halld dm:ing attempt' at (!OlUpre of the to a certain if tbe flow of blood along the artery 1 stopped.
Hcemorrbage from the armpit or arm mnv he ar r ested by compression of. axillary artery. Rofl IIp a hard pad the Slze of a hlllHU'd ball in a triangular
91
bluclngc; phwe the pad ill the armpit; crOfiS the bandagc on the pull the ends tigllt, alJd tie ofl' uncleI' the oppu:-;itc <l1'l1l]>il, takillg carc that lleithel' the pad 1101' lJandag-e Itas . lipped. •'c(' l1'e t11C injured Hl'Ili to the patient's side, ;t:) ...:hO\\"l1 ill Fig. ! . , ; Frl,. +9.
Digital compression of the Subclavian arterY·lIla., lle 1l1<lc1(\ ,,-hell the wouud ill the llUliu artery 1.' high up in the a1'111 or ill the armpit. 1l l'uct'cil as follows :-Darc the llcck tu beluw the collar h()lIl': place the inj ured limb do ' agaim;t the SiU3 ur the patiellt'::, body so ll::l to c.loprc.'.' thehouldcr) and
9·' o
take your stand opposite the s!lOulder, UbC the left hand for the right artery, and VIce Yersa,; grasp the ncck l ow down, placinK the fingers b h111(l and the thumb immediately above the centre of tbe collarbone in the hollow between the mu cles attached to the bone (the bird's ; compre s firmly, pres ,ing the thumb deeply downwards and the first rib which is beneath the cln;Ylclc at thIS pot, (Fig, 4:9.) 'In pra.ctice the pulse ,may he felt at the Bame time to a certain if the flow l' • topped,
' VOUNDS OF TilE LARGE ARTEltIE WITHIN THE CUE T OR ABDO.}1EN.
(I -TERKAL
' Vounds of the large arteries within the trunk cause hremorrhage into the cavity of the ehe t or of the abdomen, and give rise to signs and "'Yl1lptoms of internal hremorrhage.
Signs and Symptoms of Intl'rna7 a1·e.:-
A rapid loss of strength; pall or of the f;tL.:e <'tnd hps ; coldness of the extremities giddiness and inintnc. s, more especially when the upright position is ; the 'breathing becomes hurried and laboured, and ,IS accompanied by yawning and sighing; the pulse gr adually and may altogether disappear at th e wn, t; the patient th r ows his arm about, tugs at the clothmg round the neck and calls fo r air. Finally, the patient may become totally unconscious .
'Ireatlll nt of i lltemal IIcpmon'hage.-Keep the patient flat; all cloth:ing ronnd the ll,eck; pro ride for free Cl1'cu latJOll of fan the patIent; sprinkle co ld water 011 the face; apply 'mellmg. altlj to the l1o.'tril ; give icc to or cold water to ell-illk, Raise the feet a foot or t\\ 0 from t.he grounel, . and bandage the limb - firmly from the feet to hip', and from the halld' t.o the A voul stimulant.' in all Cel. 'ef:> of lucmorrbage, at all eyent. until hUf:> b ell controlled.
TilE C()l-RE OF 'l'IIIJ: AWl'EIlIES IX TEE L0" ER
Th e F em oral a rt e r y, n. continuation of t.he iliac enter' the tbig'h ill the centre of the fold of the groi;l, "here it be f ·It pnl 'ating below the. 'kin, The conrtie of the artery may be Jl}dicated hyaline dm wn from the centre of the groin to the part of Lhe iuner side of knee., artery occnpie' only the t\yo-tlllrds of thIS hul', as at the lower part of the tlllgh the femoral artery passes to the back of the knee joint under t.be llame of the pnpliteal.
The Popliteal artery-the artery of the hamoccupie. the celltre of the space at the back of the knee (thE ham), It is plnced deeply between tht projection of at the lower end of the femur, and is further protected hy t h e muscles and tendons
around the ham. Just belo\\" and behind the knee joint the popliteal arter)T divides into the anterior (frout) and posterior (back) tihial arteries.
The Posterior Tibial artery passes down the centre of the hack of the leg to tIlE' inner of the ankle, where, between the heel a11e1 the lower end of t.he tibia, it enter::; the 'ole of the fuot a ' 1,11 Plantar the npper part of the leg the hblal artery IS deeply phu.;ecl heneath the of the calf, but towarcl' the auklo it comes nearer tho .urface, and can be felt pulsating in the hollo\\ on the inner side of the ankle. In the f';ole of the fooL the plantar arteries run forward among t the InU cles to supply the foot and the toes.
The Anterior Tibial artery comeR from the popliteal and at once pll'se forwnrd. ' lJt:t ween the leer .1.'he artery run::; down the front of the leg, deeply placed among'st the 1l11.l.'c1c", to the front of the ankle. A line drn.\\ n from th e front of tIle upper end (he:1c1) of the I1hul<1, to the centre or the frout of the ankle indicates the C:Ol1rse of the artery.
The Dorsal artery of the foot is the continn11,tiOll of the anterior tihial arterY: it paNse alollO' a line drawn from the middle of front of the to the interval bet\Yeell the metatnr al hones of the hig toe and the next, ,"vhere it pas::;cs clo\rn wards to the sole of the foot. to 1'01'111 an arch with the arterie' of the
AnIlE 'T OF ARTElUAL HLEMOnRHAGE IX THE Lo\\,ER .EXTREMITIES.
]. When the arteries in the Sole or Back of the Foot are wounded, remove Lhe Loot and tOl:kll1g j apply the lefL tlnunL firmly on the bleeding puint, awl, with the right hand, and place a pilci on the \\ ouml amI lmnclage tightly. All experienced per. 011 might bL. al)le to further lSccUl:e tlw alTl':-it of hWlllorrlw.ge J y lllCil.ll:-; of pach, tlglltly placed 011 tho <l11kle at the pointlS indic:atcd ill the fruntispieL:e.
1"[(: ..')0.
When the arteries of the Ham or of the Leg are wounded. or when a pad is insufficient to arrest hremorrhage from the foot or an kle, place tt pad the size of an urange
behind the knee of the inj ured limb' tlcx the leg upon the thigh until the heel almost touche, tho buttock; ,' eCUl'e the limb in the flexed position by passing a narrow bandage (or a strap) round the log inuncc1iatcly abo'\e the ankle; cro s the encl,' hetween the leg and thigh, and, carrying them ronl1(l the limb do ' e to the top of the thigh, tie them off firmly. , Yhen no pad is to be had, roll up the trou,'er leg at:) far as the knee, and flex the leg on that as a pad. It i.. not necessary to take off the clothing to compress the popliteal artery by a pad and flexion . Except at the lowe r third of the leg, it is seldom pOt:) 'ible by direct pressure on the bleeding poillt tu arrest hmmorrhage from the arteries of the leg.
:l When tb femoral artery i n t he lower h a lf of its C0urse is wounded , a nd w hen a pad and flex i on fail to control h rem orrhage from the popliteal or tibial a r te ri es , apply digital compres 'ion to the femoral Hrtery at the groin, nntil a tourniquet can be applic(l.
To apply D i gital Compres s io n to the Femoral artery at the Groin. - llplJosing it it-> the right femoral that i to be comproKKccl, proece 1 as follows :-Lay the patient down flat on the back. ; stand or kneel as cOllvenient on the left. ,ide of the patient's body; to find the rai' the foot h igh o as to flex the thigh on the body (the fold i n t h e dothing at t h e to p of t he thigh will indicate t he
97
groin);. pa s t h e fingors of the r ight hand oyer the onter SIde of th e rig h t h ip j ll ·t below the edge of the front part of th e haunch bone, and lay the fleshy part of t h e thumb flat on the centre of the groin . Pas. the fingers of the left hand to the inner :-;icle of the right thigh cIo 'e up to the fo r k, and lay the left thumb on t h e top of the right thumb
already in,Po 'itjon o".e1' the arter y . Pre firmly back\\'[lrcb a.gam ,t the bnm of the pel,j ,_ , when the flow of \\'111 completely a rr ested (Fig. 51). death i,' 111 h::cmorrh age from 0 large an artery it il::i llnportnllt not to waste time remo,illO' the clothing' the femoral artery a t t h e g r oin can men be pressed as a temporary measure over the clcthing.
To apply a Tourniquet to the Femoral artery. -;--In practice it is a good plnn Ll<ll'k the conI' e of t h e a r tery by (hawing' a chalk lUlO from the coutre of tho ("ruin to the back part of the Glller 'ide of the knee' the arter\' can ])e COlll]lY H, tOll"r!liqnct at any point on the middle third of tho line tllLls indicated 01' :\, little All impro'Visec1, a field, J1' ,L screw tourniquet may he The pad )f tho improYised tourniqllet should be as Im'be as haIr an orange; n, narrow bandage. is to he placed 'with its centre oyor tho pad. and the knot tied on the ont 'ide of the thigh .: tho " slick)) is to ho placed bcbyeen the of the knot, so as to ayuHl injmilJO' the skill whon it is FIG. 52. twllite L Finally, the "stiek" is to be "locke(l," an(l the limb put ill a splint or tied to its fellow .'):2).
4:. When the artery is wounded in the upper thIrd of the thio'h the femoral m,u,t be compre ':::;cd by the thumbs at the lllstead of applying a toul'niq uet. Reb,ys of asslbtallt' must
99
be employed to keep up the pressure until the doctor arrives, the fresh n, 'f;istant applying his thum1s on tho, e of the preyious as.'istant, '\vho carefully slips his thumb from beneath, 1'0 a,' to preyent gushe,' of blood during the chang:. "TLen a i ,tants are few, or a doctor not to be llac1, an attempt may be made to arrest the h<Bmorrhagc placing a pad on the centre of the groin) anelmailltailling pre ' 'nre by an ehvtic cord pa eu. from the lnlCk of the thigh, ero' ed oyer the pad, and the end.' fastened behind oYer the loins.
H,l::\IORRHAGE.
The current of blood ill the yeins is ill a direction toward- the heart, therefore, Whell a yein i' cnt the blooel will i.' 'ue from the end of the wounded yein fm'thest remoyed frum thc heart. The rea on why the end ncarer the hcart docs not bleed i explaincd partly by the direction of the flo\y of the blood, and partly 1y the yahe o ' in the yeins) which arc so placed a' to prcvcnt a backward How, The superficial ....eins 'ire more apt to be \\'olluded than are the deep ycins.
'l'HEAT:\IEXT OF \. E. 'OU" H.'IDIORRilAGE.
(1) Lay the patient down, the head re. tint; on a low ' npport 01' pillow.
(=?) Sholll<l it be. a 'Vein in one of the extremities tlwt i:::; lllccclmQ,', elevate the limb.
(3) Undo the clothing and expo e the bleeding part.
(4) Apply direct pressure on the wound by the thumb, and maintain the pressure subsequently by a pad and bandage. .,
(5) Should direct pres ure prove msuffiClent, a pad and bandage on the trunk of the veIn, on the side of wound furthest from the heart.
Varicose Veins. -The veins of the legs are specially apt to. .varicose. ,Vh en a varicose vein is exammed, It WIll be seen not only to be dilated and tortuous, but bead-like (varicose) occur <.1.long its course . A vein :-anco e from various cau es, such as long standmg, tIght garters, etc., etc. The first effect to work upon the valves, and the bead-lIke projectIons a.re .cau ed by the blood accumulating in the pock.ts behmd the val ve. In time, the channel of the vem becomes so wide that the yal yes can no longer span the ve e1. When one of the e dilated vein, ay, in the leg, is wounded or bur ' ts, blood flows from the lower end of the cut vein, but from the end nearer the heart it flows in much larger amount, owillg to the imperfect state of the valves in the vein . .-
T?"eatment.- 'When hremorrhage occurs from a varicose vein in the leg, the treatment is to-
(1) Lay the patient fiat, the head resting on a lo\\' support 01' pillow.
(2) Elevate the limb, raising it high, at a right angle to the body if necessary. 101
(3) Remove the clothing 0 a' to expose the bleeding part.
(4) Apply direct pressure on the wound by the thumb, and 'ub:seq llently by t1. pan and handage.
(5) Apply bandages, fi.l"t, on the .'ide of the wound further from the heart ,; 'cc:oncll:v, on the 'ide near'r the heart, :shoulu the direct prc.· ure prove insu fih:ien t.
'l'HE.AnmXT OF 1APILLARY H,E)WRRIIAGE.
See al.'o Treatment of Wounds.
To tl.lTe, ·t from capillarie. , a light degree of pre' ' ure :suffice '. Pre ' ' ure ma," he applied by the thumb, and maintained ub 'equent1y by a pad or pleclget of linen or lint. Pre 'sure may ala be exerci.. ed by applying' a piece of trapping (ph tel') to the wound over a pad. Any medicament which aidb in th arl'e:st of hU:lllorrlw.ge i .. termed t1. Styptic. old, a. cold air or ice, arre.-t, hrcmonhage hy conLracting the blood vesbcl ' . ,Yater a ' hot as cn.n be borne, by CaUl'3illg the blood to clot, lllay check cc1.pillary lucmorrhage.
,'uch remedieiS aiS fine strand::; of 'wool or cotton wool coarse blotting pa.per, etc., etc., lu ve, if clean, something to recommend them. Collodion applied on a fine web of cott,m wool i' an efficient styptic and proyide,' an artificial skill, helping to exdud air from tbe wouud.
CHAPTER III.
TH E NERVOUS , YSTEU.
Two systems of nerves, the Cerebro pinal and the 'ympathetic, preside over the moyements and functions of the ooely.
The Cerebra-Sp in a l sy s tem i' made up of the Brain, the Spinal Cord, and the i\
The Brain is situated within the craniulll, and i.' divided in the middle line, so that, with the of a few connecting bands, the right and left side: are scparn.tc.
The Spinal Co rd i' the long cord of ncnou:-; matter lying within the spinal canal in the hOllY nl'dl fonned by the vertebne (see V crtebrnl CUIUlllll). It leaves the brain case through the ba'e of the and reaches as low as the upper lumbar vel'tei>l"c.
The Nerves proceed from the bl'ilin and 'pinal cord in pairs; the former are termed the crania I, and the latter the spinal nerves. A pa.ir of spinal llerYeS emerges between each of the vertebrrc. The cross the brain about its base, and in the spinal corel, so that the right half of the brain presides over the left half of Lhe Lody and limbs, and the left half oyer the right side of the body and limbs. In the limb and tnmk the nCl'yes a r e met with as large pc<.trly white trunks, and can be traced to the muselm; and ski n .! 'Wh en th e ne r ves arc torn thr ough ther e is
103
par a1). is of motion and cmmtion in the rcgions ill which they arc distributed.
T he Sy m path e ti c S ystem of nen es c:ouilSts of a c1l'ul)lc elwin of nerves
llCl'YOn.· m,l.' 'es (t 'rmed ,II{I1!,r;lia ) on either side of the front of thcspinal CO]Il11ll1. The chain extend.' fl'Olll Ole lJ<l.e of tlie '1mll to the coccyx. The nervcs of the lSYlnpatllctic: t'} tem send l'ranche' to all the organs of the chc. ,t and nbdo\ncn. It i thi,' 5)' ·tem that control · the tnl'y of the ]Jody; it rcg'lllate ' all onr yita1 function .' as \\'en as adjusts the "npply of Llo to the and excreting 01'-
FIG . 53.
• nOWI"G TIIE BRA IN AND T1lE <;!'IXAL CORD, \\ ITH TilE NERVES OF T HE LEFT IDE OF THE BOD Y.
104: gans. T he sympathdic system d iffer s from the cerebo-spinal 'ystelll, inasmuch as it acts d u ring sleep, and knows no prolonged r est.
"' INSENS I BILI TY.
Unconsciousness or Insensibility arise when the functions of the brain are in abeyance, either directly from injury or disease of the brain it clf, or indircctly from disturbance of the action of the lungs or heart.
TREAT:JI ENT OF I NSE T IBILITY.
' YHEX A PER ON IS FOUND IN A STATE OF IN E J TBILITY:
1. Arrest hcemorrhage , if present.
2. Lay the person on the back , or in the position in which breathing is most easy.
3. Undo all tight clothing round the neck, chest, and 'waist, unfastening the braces and top button of the trousers in men, and the corsets in women.
4. Proyide for a sufficiency of fresh air by keeping the c.rowd a"ay if in the street, or by opening the doo rs and windows if the accident has occurred indoors.
=> . Obtain a doctor ' s help at once; as a gcneral ru le, until he keep the head low if the face is pale, and raise it somewhat if t he face is flushed.
6 Never leave the patient until you have pIac('d him in charge of a responsible per son.
N . B. Give no food or fl uids (nei th er stimulants, tea,
water, nor medicines) by the mouth while the patient is insen ib le.
TIIEN PROCEED TO EXAMINE THE AS INDICATED BELOW, TO LEARN TilE NATURE OF TH E IX ExSmILITY: --
1. Feel if the pulse beats at the wri t (radial artery), at the temple (temporal artery), or in the (carotid artery). The pulse may be ab ent, or It .may be unnaturally slow, quick: or feeble; it may mISS a beat occasionally (intermittent pulse) j or, the may beat quickly and slowly alternately (lrregular pulse). All t h ese conditions indicate some serioll mi ,:'hen associated with in ensibility. A feeble pul e mdlCates that the use of stimulants (sal drop ' in water, or a tea poonful of m a wmegln' 'fuI of water) is advi 'able, provH]ed that the patient i ' able to wallow. ,Yith a strong pulse withhold timulant.
If the pul 'e cannot be felt place the hand over the heart, or apply the car to the chc t to a certajn if the heart beats. '
f. 3. Ob.·crye if the pcr on breathes, and note the odour of the brea.th. The brcathing may be 'low, laboured, and accompanied by loud llOring and puffing of the checks during expiration (. tertoJ'ous breathing).
4. Examine the scalp, temple and back of the h ead fo r in jury; the ears and the no c for 'igns of
1...6
hmmo.rrhage; and the mouth for blood, froth, ' tains by aCId, etc., and for foreign bodics.
5. Raise the eyelid ' , and cxaruine the state of the pupils.
The pupils are the dark round pots in the ccntre of bh:e, brown, .01' crrcy iri'. l: llller ordinary c.onditlOlls III shaded bght the pupil dilate; in In'ight they contract to sma1l dimen'iolls. In [lIsen. ed . the pupih;. are altered, they lllay be bofh lIlclply a'l,lated, 01' bath 7Il11lutelll contracted, 0:', on the ?thcr hand, thoy may be unequal or ilTl'gnial'that I , one may be la/'u e and the other small. E "\,eryone of sueh altered conditions denotes a ' tate. ' The pupils are said to be fi.,· ed \ybon ill either n, -haded or a brigbt .light no alteration takeb place ill their -ize.
6. Exanll.ne the body and extrell1itie for ·i!.!n8 of fractures, du,;location, wounds-the neek forio'n ' of strangulation or compare the t\\" Ob of the as to lllllpne ' or "nCbS.
7. 1\ otlCe the temperature o f the 'kill, \"bether it be. hot, or cold. The quickest "n.y of doing tIllS IS to place the lJack of the hand 011 the naked chest of the paticnt.
SHOCK (smIETDlES LEADTXG TO FHOM ] :\JL"Rr).
Aftcr eyory accident. of allY se"crity the patient suffer<) from shock. It IS not much a mentd con.
107
dition that results, as one dependent upon tho phy icn.l conscquences of injury.
Siyns and Symptom ..::.-Tbe patient complnin, of feeling cold and may actually shiver with cold . The face j.. pnJe, the ..kin is cold and clal1uny, thc pulse i . weak, the hreathillf!: i ' 'carcely perceptible, and the temperature of the lJocly, if taken by <1. thenll omcter, will be fon11(1 to lJO uclow the normal (9 " '-!-) . ]n yery ' c"Vere j 11 i uric ' uch n,' cxteni ye UUl'll:-;, h'okcn bOlles, lace-
I'n'ted \\'OHllC1., Ol'cYel'C crush with c1 cc:!?- "eated injuries, t be telll pern t uro may fall to 9 ·1 el l gTeL" or eWll lower; ill 'Such C<lf:>C::l reCOyelT is rendercd doulltful. Tbe paticnt, lllcantime, vmay relllain con CiOllS, hut appcar' dazcd. In somc ea' cs of :hock thc p,lticnt keep fluito fluid, but in oth.cr en ,e a unrea.:onalllc 1'IJ tll' ,.;nc · pn.!\,Hlls. 1 he patll'ut lUllY l Jl'COtllC dclil'iuu: to ..('yerc pain, loss (If 'blood, 01' lllcutal cli..:tnrlwll cc, or IlJ a y colbpse from cxtreme 10. " of lJlood, 01' thc severity of the shock.
1 j'I 'atment.-PreYent tllO tcmpl'ratul'c fa11ing by c()\'erin!.! thu patient up with n ClHlt, ::;hil\\ 1. 1,lullkct, ur am tltin!.! at hand. A: OLl ll p o::;ihle thc ullder coYcr in n waI'll! r O( llU, {II' in 1>cd. awl promute wal'lllth by h ot lb.tll H,+" lw t l Jo tt] c..,; to t he fcd and al>clomcll, and, if thc patien t i' not un COllsciolls (Iivc \\ <1,1'1n ell'inks, tC<1, hot lllilk, c'"c ,\Yhen applY;l;;; hot uottle8 sec th t thc}' are 'II l'<ll)l)cc1 un
lOS in a piece of flannel or cloth of some kind to prevent possible injury to the skin.
CONCUSSION OF THE BRAIN.
When the cranium is struck a severe blOW, or in jured during a fall, the brain may be concu sedthat is, the person may be stunned. There may be no wound of the scalp or injury to the bone, but the brain is so shaken that for the time being it is functionless or paralysed.
Signs and Symploms.-Insensibility, a feeble pulse, shanow breathing, the pupils fixed, and genc.rally equal in size. History of a fall or a severe blow may be obtained; or injury to the head may be evidenced by wounds, bruises, etc.
Treatment.-See Apoplexy (page 109).
C01tfPRES ION OF THE BRAIN.
When from a fall or blow the cranium is fractured, and a piece of bone driven inward, the brain may be compressed. On the other hand, the broken bone may injure a blood-ycsscl within the cranium, and eompression may re ult from prcssure of blood on the brain. In the former ea e the insensibility will come on immcdiately j in the latter, after some minutes, possibly 15 or 20, that is, when the blood has accumulated in sufficient quantity to exercise pressure on the brain. r
Signs and Symptoms.-Insensibility; evidence of a 109
wOlmd of the scalp; the fracture of a cranial bone may be felt: a slow, fnll pulse j stertorous breathing. unequal pupils, becoming fixed when the pressure is severe. In injuries to the brain symptom of concusion may first prevail, succeeded by symptoms of com pression.
Treatment. -Sec .Apoplexy.
ApOPLEXY.
'When a di 'ea cd lJlood-ves el gives way within the craniLlm the bra.in i ' compressed and its ti' 'ue partly by the llloocl \yhich escapcs. When the qua.ntity of blood i· large the ymptom develop so rapidly that the condition is termcd an apoplectic fit or f:)eizurc.
IgrLS alul ympioms.-Insen ibility, a fnll, slow pulse, stertorou. breathing, unequal (one large and 011 small) and fixed pnpils, a fln hed face, a hot skin (tl.lC temperature. of the body. is usually ma.rkedly and the 11mb ' of one Ide of the body limp, whIle, on the other, the normal rigidity may be retained-arc the incli<;ation of a seyero apoplectic attack. The age of the patient is a hel p in recognising the condition, as it is elderly people are seized.
Treatmc:nt for Apoplexy, Ooncu. sien and Compression of the Butin.-(l) General treatment for insensibility (loosen the clothing round neck, chest, and abdo-
men; provide ior a free draught of air) . (:3 ) Lay the patient on the back "with t h e head slig htly raised . (3) Get a doctor at once . (4:) Apply cold to the head, either by an ice-bag or by doth::; wrung out of cold water. (5) Kecp the fect warm by hot wnter bottle, mustard lease ' , or a lllu::;tard pl..l'ter. N.B.-Prevent anything being given by the lllouth. Take care that the skin i:' not injured by the hot-,,·t1ter bottles; they ought to lIe tested lJY feeling thc:n " 'ith the back of the hand, and then wrapped in flannel, etc., before placing them i.1'j<tillst the ,kin.
COLLAPSE FRO:'-l DRIXK.
Physical colla.p 'c from drink i" generally in very poor persoll.', upon whom, from want of nourishment, i 1 ' uffi cient clothing, etc., drink (it may be eyen a small quantity ) has all undue etfect. It i::; seldom that dnmkanl:s uecome physically collap 'edtheir ment:)'l powers lllay be paralyse(l, but the circulation of the blood retain' it · power.
Signs altcr Symptoms.-Iw;om;ibility lllay be complete or partial, the patient being either capable of being roused, or totally uneon 'cicus . The pulse i::; feeble or completely at the "\\Ti::>t; the breathing is slow, and perhaps slightly stertorous j the breath smells of drink; the pupil' are dilated, eqnal, and respond to light; the face i pale, and the surface of the cold and clammy.
III
N.R. -It lllU t not be a.umed t.hat '1. person has coll apsed from drillk lllcrely becau.-e the breath smells of drink: fre(lllenLly, whcn people are fcclillu ill, they take or arc givCll :--tim111nnt ' , after" hieh may become inSellf-ii],h', not from the drink Lut from the can e "" hi<.:h inc111cerl them to tnke it, e.g., apoplexy coming 011, effcct , of POi , 01lll1!.!'. etc., ete. trcn.t111ent for ilrcll. ihilit)' (100, en clothin!!" proYicle free of air, and ill ill "hi·h breatl1.ing is poslSil)le), (2) hecp the patIent ",,'anll hy COYC'l'lllg- hill! oycr or taking hilll indoors. and applying hot-water Lottles and friction to thL' f:iurfacc, more (','pecially to tJlt' 'Yh'11 th e p ·ttil'llt <!f1n UC ronsed o'iYe \\'<trm tea 01' coffee. (·1 '''hl'll the puI 'e is restored giye nn emetic of n de s scrt o, poonfll1 of lllustard ill a tll111hlerfnl of luke-warlll water. ( 5) When thL' emetic ha, effccted it · P1ll1)O C, "l1pport the paticnt'.' strcllgth 11)' giYing ten, l)c e f tea, l>nmdy in small qlln.ntity, or hy nlly of the prepared food ' , soup', or el),'eIH'; CS.
The n.poplectic state anfl collapse from drink are not nnfreqllently mi.takcn the 011e for the other. The more prominent 111 e.:U1" , of (li, tingni:shing them are as follow :-
1. III apoplexy the paticnt is u'uany g ttiug on III year ; collap e from drink may occur in a person of any age.
2. The absence of the smell of drink would indicate apoplexy,
3. Pupils generaJly unequal and fixed in apoplexy; equal and responding to light in collap e from drink.
4. The pul e at the wrist in apoplexy is usually strong and full; in collap 'e from drink it i feeble OI altogether absellt.
5. The featurE; in apoplexy are usually congested and suffused; in collapse from drink they are pale and pinched,
6. Should means of ascertaining the temperature be at hand, it will be found in apoplexy con'iclerably above, and in colla}J8e from drink considerauly below the normal (9 '4:).
EPILEPSY.
This disease is frequently termed the "falling sickness." It occurs in per 'ons of almor:;t :my age, but most frequently it is seen in young adults. It is a common form of "fi t," and as it occurs with but little if any warning, the seizure may take place by night or day, at home, in the treets, at public me8tings, in a public conveyance-in fact, anywhere. Owing to its sudden deyelopment the patient may incur serious danf;!er, c pecially when the attack comes on near a fire, machinery, a steep bank or precipice, or where traffic is great.
, i[j}twndSYIII1 ,l' rll/l ., .-, omctimc . ' with, but r;enerally without, a ,'cream the patient falls to the ground, insensible, The muscles of the body are in a state of spasm, so that the fe<.ttul'es are distorted, and the hands are tightly clenuhecl with the thumb. ' inwards. Very quickly, tIl(' rigid spa'm hy which all the e parts have been fixed IS exdumgecl for a state of convulsion, (luring "hich the face, liml>' and hody are violently cOllLortccL The eye ' may 'qnint the pllpil are equal, c1ibtcd awl fix ecl. The face nt fir,' t pale, becomes clu 'ky, and froth freqnently appear ' at the mouth and at the nOo'tl'ik The tongue is apt to be hitLen, aud \\ I:en iL i.. the froth from the mouth may he with bloorL r1'he duration of an epilcptie fit is uncertain; it may continne for lmt a mi:lllte or two, or for fiye to fifteen minute.;, When tllC' lit cease ' tbe patient may recover may fall into a deep 'leep, or may have a ' IlCC<':"lSiOll of similar fit"
TT eatm l' ld.-(l ) (:(,11e1'[1.1 treatment for in en 'ihility (100 'ell clothing, allow free circulation of air, attend to po ition). (:2) h'c\' ent the patient from hurting himself a ' he fall awl after he ha' fallen. (3) During the fit drag him away from a wall, heavy piece of furniture, or other , ource of danger not ea ily moyed j pu 'h lighter fnrnitul'c out of the ,Yay. (-!) Kneel down be ide the patient and upport hi head. (5) 'Vrap it piece of wood or any hard material (handle
of knife, inc1in,rn bhe r , pen cil , etc. ) in a h a ndke r c h lCf, a n d. h old. it between t h e teeth to prevent t !le tOl1!.(110 b0111O' lntton . N. B. T he l110Vl'l11en t of t h e 1l1nh::; must be 1'0 ' trained, b n t not ·t.l togeth er p r evented or compll:tely cbecked, as during the spa. ms t h e muscle::; be torn. Give nothin a by the mouth. (6 ) j..fter the tit 'ee tIl.lt the patient is cared for hy friends or cOll\'eyed to hdter, and nllo\\'ed to rest al;d sleep. '
(. Hi'I'OrE) ,
. Crrlls es.-A close or crowded room tio'ht clothina f nght, .nclden Imd news, f<1.tjo'ue wn;lt fooel ] f bl d 1 f '1 b , , os.. o 00, lenrt iLl nrc, etc.
SI,rt 'I ,'1 n"rf a fee l ing of giddiness, n. feehle ::;h'1.11o\V Im?<lthing, h1nned vi 'ion followed by 111 en 'ihility l110re or les complete. '
T)'(lrltm p 71t,-:-(l) treatment of il1.'cnsibility p1'()Y1dc c1.renln tiol1 of air, attend to po ltIon). (-) Lay tlle' P;ttICl1t (10\\'11 flat on the floor on con.ch, or on the gronnd, or, if pO:'!:sil)le, as ",hen pa,t!ent 1. on a let the head drop oyer the edge of the. form n lIttl e helo\\' the l eyo1 of the Lody ( 3 \ neUse feet n Get n mnch a,ir to nla; on pnt18nt as posslhle by cr eating n dnmo' h t by etc. (4) Smell ing salts h eld to t h e WIll r ecover:. 'Wh en 'en ibility i,' r estored r emo' e the patIent llltO t h e open ai r , b u t ' b ou ld recover y be delayed for seve r a l m inutes a fte r th e fl a t 115
po it ion h p..s b ee n m;sn mecl, thc paticn t l11 U t be ca,rri ed yet in to t b ' 0l)ell ai r . .LY(,fe.- If bl eecling tlJe can 5e of thc faint, a 1'1'c ' t the h remorrbnn'c l,dorc tl'eatinL( the If the patient is ,'lllferiu!..!; from \rant of nOlll'il;l11ent, giYC fuod sparingly at fir t.
Hy TELH '.\L FIT ' (HYSTERIA).
Si,rII1S a nd Sympfolil,'1.-The patient, m;nnlly a yr)1l11L!: in consequcnce of 'elltla In 'utal excit clllent, 'lIc1dcal\' 10. cs ce1l11lH;md of Iter feclilH.(.' (1n<1 ncti oll<;. :-:.llC snh,'iclcs on n. conch or in :-\U)\lC COlllfOl'laLlc p( ::;it iOll, and commences thro\\ iIlL( her:-;df alJ u nt. gl'indi1H!: her tecth, her . It:tl\.ill!..!; bel' loe )so, 110\\' clutchillg at fl.llythillg or anyolle nC'ar bol', C1'.' il1t!, or langhing. The eyehall.' nUl," lJe turncd upwarcl ' alld the eyclilb op elll·(l :tll(l rapidl,". . \ t timo' a froth lllay app cal' at the lill ' all(l ._' C'yor<11 otbL' r symptom; dcyelop. The pntiell t i.' not completely insen . il,le ill
Trealmntf. • 'poak 1irllll,\' to the patilllt : threaten her with n. c01(1 "atel' do nelle, <111(1, if she pL'l' ' ists in her " nt," I-;p1'i11k1e her \\ ith cold water. Mec1ic:al trea tment. llec:e'>S<1l'Y to C111'e the p;lticllt of the eOllllition of l1liurl alul hody \\ hieh rise to the tendency to hyt:itcrica1 ' . . '
• Tr.OKE.
Heat Stroke an d Heat Apop' exy are te r ms
also b,pplied to this condition. "unstroke" is usually applied to that form of the ailment which on suddenly whilst expo 'ed to great heat· and h k " ) " eat stro e is the term used when . ymptoms appear after the sun has set, in C:Oll equellce of expo ure to severe heat durinp: the day.
Signs and Sympto171s.--'Vhil t expo. cd to great heat, as in the engine-room or stoke-hole on board steamers, e p ec ially ill the tropi<.:·, or during a march whilst heayily burdcned in yery hot weather persons so situated may develop sickne s: a feeling of faintness, and difficulty in breathing. The patient complains of thirst, the skin \ )ecomes dry and burning, the face congested, the pulse quick and bounding. Finally, in ensibility may rer:.ult, with stertorous urcnthing, followed by collap 'e.
Treatment. ndo all tight clothing: remove the patient to a cool, sIla,dy spot--if on uoanl between decks; if in the open, to the shade; if ncar a house, him and darken the 1'00111. Strip the patlen t to the wal t, procure a, free a circulation of air as possible by fa.nning vigorously, by opening door and windows if in the hOllc, or placing 111 a draughty place if on hoard . hip. Keep the patient lying down, lJut with the heau, neck and shoulders well ntis d on a pillow or folded coat. rour ccld ,,·[lter on the head, neck and body, jugful after
jugful, until conciCJUI:>l1ess returns. An icc-bag to the head and spine or cold water applicatiolls should be continued for some hours. The patient may have cold water to drink when conscious, but no stimulant.
7cELECTRIC IIOCK.
Through contact with an electric cable, wire, or other electric medium the 'hock may be 0 severe as to cau e in en ibilitv, and the sufferer ,yilL be unable to extricate him 'elf.' Immediate teps mu't be taken to remove him from contact, but an attempt to do thi is. attended with rit:ik, as anyone touching the sufferer wIthout prnp2r precautions is liable him 'elf to receive a t:ib0ek. Thc risk can hO'weve r be materially reduced, if 11 It entirely obyiated, by ava.iling oneself of the t:iH.fesuards which are a.pparent to anyone po'essing an elementary knowledge of the laws" hich govern an electric CldTcnt. ome bodie. , known a' "conductor ," are particularly :mited for the tramnlli'sion of electricity and are intantly seized, when po 'ible, by a current a' it, path, As instance of ueh bodies lllay be mentioned, iron, bra's, water or moisture, and one's own body. Oth er bodie', called" non-conductors" or " in ulators," re the enrrellt, and amongst the e are iudiarubber, g'lass, dry ilk, dry cloth, dry wood and dry hay or straw. An electric current always choo es the ________________________________ r'----
* This article has been kindly revised by Mr. . B. Engineer and General Manager of the Liverpool 9verhead Railway
118
best conductor and the hortest to the earth, but it will not pa s into a body, no matter how good a conductor that body lllay be, if its egres " preyented by an insulator thrOll(yh 'Iyhieh the current cannot pas.
No doubt the simplet way to free a 'uffercr from contact with an electrie Cllrrent would be to switeh off the current, but thi' courcie would oftcn be quite impossible, and eyen if pO,' 'ihle, 0 lllllCh inconyenience and perhaps dancI'er to the Ii \'es of other' llli"'ht ari ' 0 that some other to ue 'Yhenliberatin'" thl',-;utIL'l'cr from contact rCI nel1l1,el'-
1st. Do not touch ",ith nakc'l ha.ndci the sufferer or his clothing if it i.. damp, 2nd. Keep yourself in,-;ul tted from the caLlc or apparatus, from the sufferer, and from the earth as" ell.
3rLl. Although illdiarn1)ber i' prub:1.bly the !Je:t in. ula.tor do 1l0t ",a,'te time in for illdiarul,hcr gloyes or mats, 1mt u,'e dry 1l.l'ticleB..... of dothill!.!; .; an indiarubber touacco pouch 01' ponches, or cap, would sene to protect the hands in ,m emcrgeIlcy.
" To rlz'vut the ('/l}'}'t>nl fmlll the insulated your OW11 hanel' amI bod,Y, get all iroll roel or nlly other form of conductor th'lt ll1ny 11C at hand, and connecting' one end to the earth nIl(1 the othl'J' end with the cable or what eyer mill' he the medium of the current; 01' if the ufferer i,' ol)bining the shock from two cables or conductors neithcr of \\ hieh is
119
"earthed" place the rod in with both and the (;urren t will then be diverted from him. If the sufI'ercr is not released by the aboye lUCCllH:l iwmlate your own persoll by on a dry board, dry clothing, 11 bundle of dry hay or stra w, l,ricks, !:!latc' 01' all iudiarllbber lllat or heeting. Proteet your htlnd . hy placing a' wany thiekllcse n, ' ilJJc of dry clotlliug them and the 'utterer, and ende.;youl' to r:li 'c anel him frolll contact \\'itlt the cart 11 anel the eUlIllm:tol'. When the ' u ttcTel' i' iu!:!ulatecl the current teasc ' to pas' through hill).
The eaulc WHy then ue withc1nn\"ll, but tare must IX' takcn ill wi thclnl Willg the enble that tb c pcron :-in doing', him 'elf remaiu: insulated, otherwi " he will rcc.:eiyc a !Shod,,-. \\'hen the ::iuilerer is rculOycd from coutact :-
1. .\ ppl,Y the !i('lI cwl tl'cn,tm nt fol' ihility (loosen duthill!.!,', prue 1'e free circulation of ail' ,llld plac.:c ill a rl'dillillg positioll).
2. Dip a towel in cold water and attcmpt to arouse him by sllarp]"r fiieking the fttce and ehe:st.
3. Comlllcnce a1'tificialrc 'piratioll if other methocl::. tail to retorc animation. "Laborde')l methud, ( 'ee page 14::2 ) lin' been founel to he Yery sllcl'cful.
4. Treat LLll'll', if thcre arc any ('ce page 1:2<').
EFFECT OF LIGIlTi\IXCr.
A pe1'::;oll stl'ud- by lightning i::; u::;ual1y 1110rc or less
deprived of consciousnet;;s. The trea.tmcnt i the same as that for electric shock, except, of COlln;e, that the instructions for removing the p::ttient from contact with tho electric medium do not apply.
CONVULSIONS I
Teething or stomach troublos are the commonest causes of convul ions in infants.
Signs and Symptoms.- pasm of the muscles of the limbs and trunk, lividity of the fnce, inscnl::!ibility, occasion LIly squinting, suspended an:! frequently froth at the mouth.
T(eatmeni.-Put the child in a warm bath about the normal temperature of the body (9 clegrees Fahr.), so that the water reaches as high as the lllidclle of the trunk; and place a sponge dipped in cold water on the top of the head.
121 CHAPTER IV. W·OUKD. 1 IN.JURIE OF THE SKIN. BRUI.'ES.
A BLOW anywhero on the surface of the body may cau e extensive hremorrhage belo,,' the skin, without the kin being wounded. A" black eye" is an injury of this nature.
Sir;llS Ull 7 • '!J/JIjJf()])/s.-The injured part i at fir t reddened by the blow, but the colour quickly assumes a du ky hue and then becomes purple, and afterwards almost black. In a fow cla,ys the colour appears of a lighter tint, and nfter gradllally passing through pm'plo and violet 'hadeR, it change to a greeni ' h colour and then to a yello\\' tinge before the normal colour of the kin i· attained.
Tr ea tm pJd.- Beyoncl tho immediate application oi ice or coW-water dre l::!ings, no" fir·t aid" treatment il::! required. Tho, irtuo popularly a cribed to raw meat applicd to a hlack eye hn, no foundation beyond the fact that tho piece of men.t i· cold.
A surface wound may be defined as tLn injury involving an opening in the skin.
'l'REATMEKT OF 'Vomm IN
Be sure that your Bands are quite Clean. 1. Arrest Hremorrhage at once when the
source can be a certained. ,Yhen internal hremorrhage is 'uspected the measure to be adoptJd arc;Re t, free circulation of ail', loosening clothing, and free use of ice to suck; an ice-bag may also be applicd externally in the of the wound.
2. Cleanse and Dress the Wound-(A.) TT71en md-oJ-doors it is but . eIllom that appropriate means of cleaning a "ound are at hand. (a) If no water i nt hand, and but one clp({n handkerchief is to be had, "ipt3 the wounrl, if it is dirty, with a corner of the banclkerchief, then fold the h::mclkerchief and tie it oyer the wound. If the handkerchief is soiled apply a piece of clean (unprinted) paper, a ' the inside of an envelope, on the wound, and tie a. handkerchief, necktie, or brace over it. (ll) If cl ean water is ncar by, and the wound is dirty, but not othcnyi:-;c wah the w01lnd freely, dip (or wash if the handkcrchief ill the water and apply oyer Ole " 'UlUld, (B.) When £71-rlVO I'S fli p u10und with "Rter that ha been boiled and allowed to cool. To the water might be a(ld ed, in the following proportions, if at hand, a few crystals of pennangal1a te of potash to a half-tumbler of water ; Lorncic-aciel (,L teaspoonful of t.he powder to a half-tnmhlerfnl of ,yater); or any of the di infectant lotion ill common 11se. The parts the wound are to he clean.eel by 'washing \"ith soap and water. 'When the part has been dried, absolute cleanliness ,,-ill be 1)sl1l'cd hy 123
mopping the skin around the wound with spirits of "inc 01' with whisky. Dress the 1I I ound.-The wound Ulay now be dressecl by one of the following methods: -(a) A piece of dry lint, linen, or calico 'everal thidmes 'es, and bandagerl. (II) The dres 'mg may 1le soaked in water. boil ed and tooled, or in any of the alltieptic 01' ill Friar:> balam. (r) C,otton wool, lint, or gauze (Ill \c1icatL:(1) may be applIed wet or dry n ext the wound, ill tead of the aboye clre:sing, or' applied o,er the eIre 'sing;. ((I) Antiscptie powder, such boracic acid, be oyer the wound, and then coyered WIth hnt or cotton wool and hnnela<reel. X.D.-Carbolic acid, although valuable as an ' optic., on account of ma:)y <ttcidont:::; h,LYillg oCl'lll'1'l'cl 111 rec ent years Its mi:applil'ntion is llut a .'a fe lotion to be kept 11: home a c1re :::;in'" fur wound ' . T eel ' contmmng carllolic acid lotion huuld not 1Ie left about.
:J The cletluline " of (Ire ' ing" of lint, cotton " '001, or gallze can be guamnteed ouly after they haye .been su1ljected to great heat. 'l'his be nccompl: by placing the quantit;\ to be used. III a .clo ed tm 111 n. hot oven for half an hom. It I ' ad nsa l)le not to touch clean dre in!:?:s \yith the hanel, but with clean forcep:::;, pincers, sug:u' tongs, &c.
"' nlCn the blood ha C1'11 ted o,er a do not di8turo it unless the wound is known to be (lirty.
3. Rest. The wounded pa,rt, when dre . :ec1, should b e kept qu iet by splints, slings, or by rest in bed.
, VOUNDS AND THEIR rECIAL TREAT)lENT.
The treatment of wounds in general applies to the e wounds :-
Incised Woun d s .-,Vhen the ..kin i.. cut by i1 knife, a piece of glass, or other sharp instrument, the wound i termed incised. The edge. nre dean eut and the wound gapes.
The edges of a large incised wound mny be held together, after it has been cleansed, by narrow ·trips of adhesive plaster laid across the wound with a slight 'ntenal between each Rtrip.
Punctured Wound s.-The wouml cflUsed by the stab of a knife, dagger, bayonet, etc., i ' termed punctured. The wound is u ually small, rounded, or jagged, and the edges driyen inwards by the weapon. '£ he danger arising from the injury depends upon the situation of the wound, or the depth to \\'hieh the inskument has penetrated.
""Punctur ed wounds mu t not be probed. Foreign bodies in wounds, when hidden frolll vie\\", are not to be searched fo r by probing, they are to be left till the doctor arrives. (See also Internal Lacerated Wounds., Vhen a part of the body is torn off by machinery, by the bite r:>r claw of an a nimal, by an artillery shell, etc ., a In.cerated wound
125
resu lts. The parts are torn unequally 0 that t h e su r face of the wound presents a very' uneven and ragged appearance.
wounds seldom bleed much, but when par t of. a has been torn off, ay by machinery, a tourmquet 1 to be applied 100 ely round the limb above the wound, ready to be twisted tight should actual hremorrhage come on.
Con.tused W o u n d s . - \Yhen from the blow of a blunt mstrument, uch as a stick truncheon etc the. skin is the parts' around brUIsed, the wound IS saId to be contu. ·ed. The ed <Yes of the wound are lUJcven and driven inwards' the hremorrhage is. usually in 'igniflcant, a few drops of blood merely tnckling from the wound.
Treat as a wound and a bruise.
Gunshot W oun d s .-\Vhen a person is " peppCl·ed.)) at some distance with small shot from a gun, so the shot has time to pread, the wounds. may be WIde apart. Every hot causes a small pam:ul wound, from which a little blood oozes, and speedIly gets hardened into a scab 1:n1ess t h e " shot" has penetrated the chest or ' abdomen or .th.e eye or a joint, there is little from the InJury- The wound from a rifle bullet will show. or two wounds, according as the bullet r emams In or leaves the body, for ming the aper t ures of entrance and exit.
Gunshot wound s ar e to be cov er ed over by lint gau ze, or cott on wool (mecl icated), if either is to b e had , or if not, hy some ot h er clean dressing. 'Wh en t h e surface of t h e body ha. been " peppered " by a number of small sh ots, do not attempt to remove them, but wrap the par ts wounded (a whole limb it may be) in a sheet or towel wrung out of hot or cold ,Yater whi chever is t h e more comforta,ble . '
Poisoned Wounds . -'Younds may be poisoned at the t ime of the injury, or may become so afterwards by the nature of the discharges . Under this heading might b e incl u ded the bites of animah, the stinl/" of insects, the poisoned wound cau cd l)} native p u r posel y poisoned hy some drug, etc.; these will lJe con idered in detail In.ter. 'Yhen wounds hecome poisoned by dirt, rcdect, in. anitary surroundilw' etc., they are aid to be (( -eptiG," r:rhe ,yord means putrid, and anti -eptic materials and t:;ubstanccs are those that prevent a wound hCGoming putrid or septic: with the treatment of the c condition!:> "fir t aid" has little to do, but all that i po'.-il)le to prevent a wound becoming septic when it is first t:;cen ":lhonld be attempt ell.
. For treatment, . ee Bites, Stings, etc.
, Whe n a j oi n t is woun d ed, . ay hy a. lmllet other foreign body, or 11Y a . tah, the part is to he wrapped up in cotton wool and the limh put in a splint. Th e limb should b e maintained in the
p O.'ltiou best ca lcu lated to preyent gaping of t h e won nel . a r:eedle breaks off after p enetrating t h e Sklll an d disappear, take the p:l.tien t to a docto r at once. If. the llear :l. joint keep t h e joint at ret on:l.. plmt. " hell n fish-hook i' embedded in the o:)kin, do not attcmpt to \\ith,lmw it by retractionthat i:, l)y the \\'it:'" it wcnt ill-but cut ofr the of th hUlIk, :-;0 that only the metal i left,. anfl theu fllre 1 the pl/iut thrrngh the skin, lllaklllg' the hook to tmn!l onw<,trd· lib ",;1 it can be withc1rn.wl1.
FnnST BITE.
During to c\'cre cold, part of tho body, u"iually th8 :2d, till!.!' 1':-;, 1.1O:C, or cars, 10'e 'en 'atiol1 , alld become first wa ',\' \\ Illte, and then (;onge.tcd and of purple appeanUll'e. Cll:-lation 10 t in the part, it is often onl,\' 1,," Ull by talldcr.' dl':ming attention to th,e ill of the Oel\' , 11o.'e, etc., tha.t the fru 't-bi tten P'1'-;011 1:-; made nW:l.rc of the fact.
J.'/'eatlilent.-Do not Lring the patient into a W:l.rm room until by friction.l :.' the hand, or by rubbing with 'oft snow, the sensatlOll aml circulation in the bittell parts are restoret1. .I. T eglect of this precaution lilay lCLul to death of the ti'snes affected. 'Vhen ?irenlation is restored the patient ought to be kept tIl n 1'00111 at a tempf;rature at 60 deg. Fahr.
BURXS AND SCA.LD
A burn is caused by dry heat, such as flame, hot metal , etc. ; a scald is caused by moi t heat, such as boiling water, hot oil, tar, etc . Signs and Symptoms.-'l'he effect of heat on the body may be a mere reddeniug of the kin: if more severe it may cause blebs or "bli ' ten;" to form. When the burn is very severe, the deeper ti ' 'ues of t he limbs or trunk lllay be charred and blackened. The clothing may adhere to the burned skill, rendering it imp ossible to separate them. The immediate dan ge r to life is SHOCK, caused uy the extent of injur y to the skin; the more remote dangers are exhau tion, severe r ear.tionary inflammation, deformity from cars, etc.
TreatJnent.-(l) The clothing over the injured part must be carefully removed. If to the skin, the adherent clothing mu ,t be cut around with scissors and left to come away subsequently. If the foot is scald ed, the boot mu t be carefully removed, undoing the lace and cutting the back seam of the boot, so that the boot ma.y fall off instead of being pull ed off; the stockine: must also be cut all a lon g, so that it falls away from the scalded p a rt. It is the duty of the bYl'tanders to prepare the dressing while the clothing is being remo,eel , (2) Immediately cover up the wound from
1:29
:?,e (a) 'Vh en the skin i, merely reddened the .m 1ll,1.y be exclnded by dn "ting it, ,vith flour whiting chalk, &c. The part is then to l;e cove' d lly ,:1. of eottoll wool, lightly htmdaoed
ll) thc most comfortal)le position l;o, " ible. ,;, Ilcn, are or \\ hen the :-:iurfacc is c ),111 eel, l->ocll\. or SIliCaI' lllC('t' ()f ll' llt l' I} l' .) , '. or lUell, WI" 1 U ,n c, llUseed, all11ulld, ur cod liycr oil., or \\ I til 'a 'cllll?, lanolinc, or colel crealll. reUl.cely, i.. l1lllc1c ll'y mixing equal () lllSCCtl od awl lime \\ atcr: oliyc oil IlIa \' he U ' (lci I'IISt ,. 1 t' tl ]. • v C,lC 0 I c lllsccd 011 "VI tile IHll'llt l' ' . . len , S1I1' aee IS C,\ Lensiyl', do ]lOt coycr the part WIth one large .' hed uf lint Imt \\ itll t " . 'd)(Hlt tll) U dl' . J' lipS : . . c rca L:. uf t w hand; thi i.. aell isable , l., dnl'lllg suubcclllent ure,'. il1g':-;, une strip c'm ue at _:L time and <t, <1<) )licd hefure the llt!J<lCCllt strip i:::; taken off. The to the l ' thereby Ie " than would lJC the C'lse the \\ hole of the Ulll'llt sLll'faee laid uare to ,lll uy removal of all the dres 'in o ' at one time ,V}, t; OYCl'l'c.l L tl '1 1 h leu .y 1e?1 y c re::lSillg, cllye10p the part in C?ttou \Yool, or 1f that canllot be obtaincd \\ it'1 a pIece of iia I \V 1 • • " " nne. ueu the ince is burnt cut a ma' k l) for th f- . ' lIe d,ce out of hnt or linen f?r the ey:es, the nose, and the mouth. ' Dip thE; Iltlsk III the. 01 1 or vascline, apply' it to the, face aud coyer' over th tt ' WI co on wool, leaving apertures for the D
eye, no. e and mouth. 'IN'hen the hand or foot is burnt or scalded, &:cd warm water- that is, water at the temperature of tne '.Jody (98'4) is at hand, place the injured 1imb in the water until suitable dre sing can be got; and if a des ert-spoonful of 'ocla (bicarbonate of soda) be added to a bal5inful of the warm water, a soothing alkaline lotion i.' prepared. Do not prick the blebs or blister s; leaye that to the doctor to do if he thinks it right.
(3) Treat Shock.-'rhe severe shock, whieh accompanies every burn of any size, m u ,t be dealt with by applying warmth to the surface of the body generally, and b:v ving warm (ee Shock.)
Be vm.. y nsive )£ the aanger of eyen l:ilight burns of the neck.
When a Woman's Dress catches fire , proas follows :-Lay the pert;on flat 011 the floor at once, Place her so that the flames are ; that is to say, if the front of the dre s is on fire, lay her on her back, and if the l)ack of the dre" is on fire, place her faoe downwards, The reason for this position is readily understood when it i remembered that flames ascend vertically: so that if the upright position is assumed, the flames 'vili quickly a8cend and envelop the body, neck, and face' or if the per on is thrown down with the flame undermo t, they \yill, if unextinguished, pass over and burn the limbs and set fire to the rest of the dresR. A8 soon as the per
131
son is placed flat, smother the flames with anything at hand, such as a rug, coat, blanket, tal11e coyer, etc. If made wet so mnch the Letter. A "oman rendering assi tance, should hold a nlg or 1J]allket in front of herse1£ \Y}lCll approa<.:hing the flamc.. If a woman's dre s cat<.:h fire "hen 110 Ol1e i.' hvhe 'honlcl lie flat, flames uppermo.t, smother the with anything halldy, afl table-coyer, mat, JoG., and <.:all for n.·. i::;tance; on 110 a<.:count should f>he rush into the opcn air.
VITRTOlJ THROWING.
Yitriol if-; frequently 11 eel as a weapon for deadly injury. If it is da hcel in the face it is a yery f:ierious mattcr. Jf it touches the eye it would generally mC,lll 10,::-; of sip:ht; wbateyer part of the skin is t01whccl by the aGid il:) furrowed and bU1'llt.
Treatment.-Carefnlly "ash all the yitl'iol posillIe from the skin, 1)y sqll('czing a ponge dipped in tepid water, to which .01110 "a 'hillg or Laking l-:iocla has he en adcled, allowing the water to run gently oyer the inj ured part, then trea t as an ordinary bum,
BITER OF Al\IMALS.
Hydrophobia is caused hy the bite of an animal Fmilcring from rabies. Several animal.s, sueh a dog", cat,', foxes, wolYes, deer, &c., become ral)icl. The poi on is contained in the animal' saliva, and may he com'eyed ou the teeth beneath the skill and
132
thn into the 1)100c1 of human bcIi1g. ,Yhcn the bite is tbrough the dothillg there is les" dall12'e1' of hydrophobia, as the sali,Ta is wiped oft' the teew by the clothing. It i::; therefore by way of the parts (the hands and face) that the POi , Oll u.llally enters the Lody.
T1'eaflnent.-In case of a hite a clog or other animal, do not lose time in the attempt tu a,'certain whether the animal lw.: or ha Dot rabie, hut proceed immediately as follows :- ( I) Prevent the vellou .blood from carrying the poison through the body by llllmediately placing a cOllstriction llctween the all.d the heart. Snppose, for exa,mple, a finger IS lnttell, It should he encircled nboye the ::;ClLt of the bite (that is, on the side of the wound neare::;t the heart) "ith the fore-finger and thumh. As soon as possi1)lc n (that lL ::; trillg, n, piec e of tape, a of handkerchief, etc.) tightly ronnel tile root or the finger; do not cease to com pross with .t he DnO'er and thumb until the ligature has been applied.
Suck the wonnd vigorom;ly, prc)\'icle<l that )'0\11' lips are sound, spitting out the saliva; or (:3) wa ' h 111 water (warm water hy preference, as it Cl1('ot1l'<l/2:C' bleeding). (4) As soon as possible the wounel h.Olllel be burned by a fluid caustic, such as caustic pota::;h, pure carbolic acid, nitric acid, or if the. arc not n.t hand, by a red-hot wire, fu ec, ctc. It IS Hot HuAito apply a solid caustic, uell as Illnar
132
cau tic, to the wound; it doc::; not reach any (leeper than the !:ikin, and the poison is at the hottom of tho wound. To en. 'ure the caustic reaching tho bottom of the wound apply it on a . harpened piece of wood, sueb u::; a wooden mntch cut to a point. (5) Dre" the wonnd, and when it it) in thc upper extremity !:iliu" the urlll. (6) Treat ::;hock, if it occur.
:\AKE BITE.
The poi 'on ot the "l1ake i conveyed froUl the poison /2:11111d alung a ChUllllUI in the ::;erpent" fang!:i, !:iO that whell a snake bite ' the .ceretion is com'eYed heueaLh the t)kiu alollg the hollow in the fmw thu::; gain::; direct entrance to the l)lood. b'
'lY71S f(]ul '//lJlpfOlno,- \rithiu a few minutc ' after beillg bitten the part will s\\ un nllcl feel ,tiff : the patiullt llCl'OlllC ' pale allCl faint; a11(1 if tllC ::;crpcllt i ' one of hif!"hly vellOlllOU::; the train uf tOlllS w111 lle a fo110,\8: hurl'! ,c11n'cathillg quick pnl 'c, l'lclltal excitement, eOl1vul 'ioll ,', and ill 'ell 'ibility. a ligature (,t ::;Ll'iug, leather ::;trap, :-.tnp of h:tmlkercluef, brace, utc.) nt once between the \\'ollml anel the heart, .'0 a::; to oL'truct the "eill ' leading from the t-leat of the LJite. Two 01' three s.llch may hJ applied at illtel'Yal. up the lUlll) t1/2:ht1y t\\'it-lt.ccl (toul'lliquct). a fluid call tIc, ,'uch n,:::; callstiC potash, pure carholie acid, or ltll)' ::;trollg acid 011 a poil1ted piece uf ,,·ood, lH1J'llil1:;
deeply so as to destroy the poison at the hottom of the wound. When the caustic ha. be8n thoroughl.\' applied, but not till then, the ligatures may 1J(, removed. Sucking the wound is not without cbngcl', but if no caustic is at hand sucking mn:-,t he employed, the saliva being immediately spat out, and the mouth wa 'hed out with water or spirits awl water, and the wonnd may be burned with a fll 'ee or ill any other available manner. hock i ' to he treaLe(l in' the 11 'ual way, and spirit of sal yolatilc (n. teaspoonful in a wineglu.st:) of water) . or spirits (whisky or brandy), are to be freely admini teredo Bees , Wasps , Centipedes , Scorpions, Tarantulas, Spiders , Jelly-Fish , HarvestBugs , etc., mn.,)' each give 1'ise to seyerc <YlllptOllls, attended by actual dangep to life in some int:) a11te '.
Remoye the stillg b.1 . qneezing the part, or hy pre:snre with the barrel of a key ",hell that ib po "i1>le ; mop the part freely with liquid ammonia, pirits of wine, or brandy, whisk.1, etc. ; if these are not at hand, the application of the blue-bag, or strong solutioll of carbonate of soda or potash, will relieve pain; a paste of hicarbonate of soda and spirits of sal yolatile is an efficient application. The patient's strellgth must he supported hy the free administration of alcohol or sal volatile. As the harvest-bug bUl'ie itself beneath the skin, it is neces 'ary to have the insect removed by a doctor.
13.:>
CIIAPTER V.
THE RE PIRATORY YSTEM
TilE air I' aches the lungs by way of the no triL (or the mouth), the pharynx, the larynx, the trachea, and the bronchial tubes.
The Pharynx is the space at the back of the throat and no e, partly seen behind the tou:::;il when the mouth i. opened widely j the phar}11X gives pn.. sage to food and air.
The Larynx (the voice-box, Adam's apple) is situa.tcd Oll the top of the \Vind-pipe in the middle line of the neck; it is compm,eel of cartilage (gri tIe) anel cOlltnin ' the yoc..1.1 cords and the mud\.!.' conCCl'l1c<l ill the production of the voite.
The Trachea, or Willclpi.lJe, i:::; composed of . trips of lJOtll1u together by eIa. tic alld fibruu ti . 'ne,', so n.' to form an opcn tube; it cxtend:::; frolll the larynx to two inches IJelow the top of the hrca ' t-bone, where it c1iyidcl:> into the right and left lmJl1chial tubes. Each 1>ronchu ' "hen it enters the 11l11g diyicles into l>mall alld still malleI' tube, until the ultimate ot the lung-the air celb or air spaces -are l'eaChefl.
The Lungs, Hight and Left, occupy the!.!,Tcater part of the thorax; they lie immediately within the ribs, and practically whereyer a rib i' felt, whether front, back or ider:>, there i a portion of the lun g beneath.
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Each lung enveloped in a hue memhn1,ne (the ple1(,rrt) ",hich it to moye within the chest during llreathing without friction.
rlhe Air enters :,be cbest cluring Inspirat ion , and lccwes it during E x piration. The movement of 1>rcathing are cau 'cd partly lly the mu 'cle of 1'e piration atLachecl to the che,t, but chiefly by the Diaphragm , the large movable l1llL' cular partition 'which 'eparates the thorax from the abdomen.
He piration con 'i ' L' of two act, i nsp i rat i on and ex piration. TIl proc , ' S of is chiefly a mn 'cular act; expiration is almost wholly mcchanical. In in 'pirntion the rihs are rn.iscd by mLl cles attached to them; and also the diaphrclgrn, which in a quiescent statc is conycx (or rUl'Yed) upward, become ' flaLt cncd, t im ' Lhe capclcity of the thorax, and the air flows in. In expiratioll the ribs fcl11, and the diaphragm ngain hCCCfficS COllvex upwards ' this Ie 'cn ' the capacity of the thorax and forces the air out. Th e meclumi 'I'll of re 'pinltioll is ' Olllc\V hat like that of ordinary household bellows but without a valye. The ribs mnT be compared to tbe board of the b ellow ' , wh ile the dia,phragm corresponds to the the air pa 'sage' hein o' equivalent to the nozzle. Fifteen to eighteen breaths are taken per minute in health.
Dbstnwtion to breathing, whE'n complete, can e. ctsph yxia, examples of which are afforded in ca es of urowning, uffocatioll , choking, etc.
ARTIFIClAL RESPIRATION.
Dr. Sylveste1"s Jl1ethod.
RULE I.- A djust the patient's position.-Place the patient on his back on a flat surface, inclined it possible from the feet upward. Remoye all tight
FIG. 55.
clothing from about the neck and chcst, and bare the front of the body as far as the pit of the stoma,ch j unfasten the braces and the top button of trou er in men, and the corsets in womcn. Ra.ise and upport the shoulders on a small firm cushion or folded article of dress placed tmder the houlder-blades.
RULE n.-Maintain a f1'ee entrance of ai7' info th e
139
lI'inr7pipe. *--Cleanse the lip'" and nostril:); open and wipe tile mouth; draw forward. the tongue a'> hI' ClH po 'sillle, and keep 1t forward hy getting some one to h01:1 it with a or picl'e of cloth, 01' h.Y pa . 'lD,g a narrow, ..lightly tWl ted 'tri p of hnnclkerclllef, a strmf,(, or tape, oyer tongne, a-; far back as the anglcs of the mouth w111 allow; hrill'" the cmt uuder the lower jaw and tic them
The end.. may be Ja;tene(1 on tnp of the head t? preyent shpplll¥. An cla,tll' h1.1H1 111ay he m; d ulo'tead of the stnp of hal1clkerGhief, etc.
RULE TTT.-lmt/lde the lilovements ureathin,r;.
Fir:-;t: Inrluf'e [nspimllon,-Kneel at a cOlwcnient distiUll'c behind the patient's head, the patient's forearm jll:t. helow the e]1)o,,"; the ann::; np\Y<1l'c1', 0111..\\,,1':(1.', and to\\'ard.. \\ Ith a mo\'cmcnt, ))laking the elLo\\'.::, almo·t tOll<:h tile 011 either Hide of the patIent'.. head, or (Tossing the forearm oyer the top 0[, thc hcad. By t II is the G,n i ty of the chest 1 cnlarged, and ail' is drawn into the itlllg'S, '-""c('onc1Iy: !"r!lU'P c.rpi(cdinn.-Bl'ing the 1(c'\.ticnt'H flexcd arm "10\\ Iv for\\'ard, do\\'m\n.rcls anel lllIYCl]'c1s, jll'l SS the arms ,\;](1 ell)o\\'s firmly t,lle hody \\ ith the elhn\s t-;Ot)]C ronr or fi,'c llll'lles frolll the :See also Drowning, pages 143 and 1-14.
14:0
bren, t bone (see Fig . 56). By this mean. air is expelled from the lungs.
Thirdly: Repeat these moYements, alternately, deliberately, and perseveringly at the rate of about fifteen times a minute . Continue until spontaneous breathing is established, or until n, doctor arrive.
FIG. EG. EXPIRATIOX.
' Vhen spontaneou breathing commences regulate the artificial respiration to c01'respond with the nn.tnral effort. Hopes of restoring the patient may he entertained even ufter byo hours' time.
RULE IV.-E.rcite rnJlimhon .' Yhil ,t the al)oy e mea.'l11'(, are being taken, other n.'efnl .'tep ' may I>e employed, such as applying t>lllelling 'alts or sl1nlf
141
to the no ·tril:, and c1a.. h iug hot and cold wetter alternately oyer the head ,md neck.
gULE V . - l ndw:e ('irculation ,\,u<1 warmth after llatnnLl breathing' 11m; beon restored. \ Vmp the pn.Licnt in dry blatlkets or other co\' or ing, and I'1l1) the limb.. energetically the heart. Promote w;\'l'lllth by hot ti,tIl11els, 11Ot-water bottle.', or hot uricks (wrapped ill flanllel) applied to the feet, td the lilllh ancl hud,'" \ Vhull tile power of 8wallowillo· has rctul'lled gi YU 'ip.. or hot water, ten. or coffee, of wine, lll';tlltly <1.11(1 water, utc, The pati ent t>bonld be hpt iu bed awl ulll'olll'agecl to go to -lcep. Lal'!{t' poultiee1:; or fomcntation.. applied to the frout and b,Ll'k of Ull' \\ ill :-;ene to a .... i::;t bl'eathiul.!,'.
\Llt<..:h the patient, l'ard'llIly for ::;ome to i'L'L' that, thc 1)l'cathillg llot fail; . hould allY .. igu uf failme appeal', at Oll<.;e l)ogi11 ;Lrtificial respin{tioll, //(Jll'llrd';; JldllO methud i::; e 'pL'l'ially applicable to ea.-e:; \\ hun the pati unt '!'; arm i. hrokul1. Deal \\ith the dOtilill)! and tougne, etl'., n.. de 'cl'ibcd uIHler the 'ylve tel' meLhod.
Till'll the patient on the back. Placo a roll uf elothing' belleatll the body, 80 as to mise the regioll of the ' tomadl above the level of allY other purt of the boely. Pbeo the patient" hands above hi ' head. Kueel n.stride the patient" hip ' , anLl with the ball.. of the thumb ' 1'0 ·ting on either ' ide of the pit of the "ltomaciJ, le t th -:! fillO' e r;:; thc ac1j ;tCcllt part of
the chest. Now, u.'ing the knee as a piYot, throw all your weight forwa.rd on yom and at the same time squoeze the waist between them as if you wi 'hed to forco everything in the np\\Hrc1 toward the mouth; deepen the pres, 'uro \rhilu you can count ..lo\\'ly 1, 2, 3; then 81ldrle7l1!J let go ,,-ith a final puh, which springs you back to your tir-;t kneeling Remain erect Oil yonI' knee.
\\'hile yon can count 1, 2, 3. Thell repeat the Hallle motioll8 as before, <],t a, rate g:radually im.:ren1>ccl from -! or 5 to 15 times in a minute, a;1<l cOlltinue the 11l0yell1ellt.. with regularity. Induce circulation and warmth in the manner descrill d under Rnle Y. 1\'e ' ter'8 method. '
. \rllCll a sntli(;i 'Ht n111n1>er of a 'sit,tant.. are pl'e:-'l!nt, R ()\\'ill'd 's and SylYe 'tOl"8 methods may be (;om1)inecl the pre.. sllre on 'the che ,t being made simultancoul '/ W hCll from anI' cause, as fractnrcd rib.. ncither the abo\'e meth;ds can be carried out,' lJ)etltorl of artifiuial respiration should be tricd. It i ' e.-pecially useful ill . llffocated children. It i · c;Lrried out as follow/) :-The 'Patient i/) pla<.:ed 011 hi ' hnck; the mouth clearcc1; the tongue i.. . eiY.;ed-w'iing· a handkerchief or to it from the finger. - -the lower jaw depressed; the tongue i. pulled forward and held for two seconds that po 'ition, then allowed to recede into the mouth . The 'e l110Yements ::;houl d be repeated ahont fifteen
143
times a minute. After treat ment is t h e same as 111 Sylves t er 's and Howar d's meth ods.
To R ESTORE TH E APPAIlEKTL Y D ROWNED.
P er on completely immersed in water for even ten or fifteen minnte. haye heen restored l)y artificial mean ' . If, therefore, the body is recovered within a. rensonahle time, ahscl1ce of sign::; of life is not to deter immediate attclllpt.. to animation.
Drowning per:sons nttempt to tn'eathe whil t submerged, and, ill <.:OllSCljUCllUC, water i: inhaled into their air pa::.;:-;age: and they become asphyxiatec1 an d in:-;ensij,]c. The fin;t thing to do ",hl'n the l)o(ly is re(;oYl'l'ed is to get rid uf the \\ ateI' and fr oth obstructth e air aud thl'll to artifitial1y restore breathing. '1'hi:-; is h e t accompli h ed by lool'lling th e clothing nnd opening the month, lllle! <.:l ea rim!,' Loth it atHl the back of the throat. The pdi ent . hould then he tnrned face dowllward ' , with a pad below th e che -t and with the forehead upon tllC right forearm. '\\,hil t ill this po itiou apply pressure by tho hand::; to the patient's hack oyer the lower ribs, and keep the pressure up for three Turn tbe patient on the right .' id o, maintaining that pOHition also for three ·econds.
Hepcat the '0 1ll0YCmont ' alternately, as long as froth and watt' r i ' 'ne from the month The. e operatiom; in thoms01 \'es tend to promote re piration, but it iB n.. ua l, when the air pa sages are clear of froth
B-1
and water, to a.dopt Sylvester's or one of the other methods of artificial respiration alrea.dy described. ,Vhile performing these operations send om cone to the nea,rest house to proenre Llankets ancl dry clothing, hot-water bottles, etc., and to fetch a dodor.
Owing to con triction of the windpipe by n. cord, n. rope, or tightened necktie, etc., round the neck, the breathing may he arrested and a 'pbyxia cau 'cd.
-Cut the constricting band amI commence artificial respirn,tion .
CIIOK[:\'O.
,Yhen a. foreign Lody, as a. coin or pleve of meat obbtnwt.' the air pH. 'I:mge, suffoc;ttion may en 'ue. the month, foreibly if neeel ho' pa" the forefinger right to the Lack of the throat anel to dislodge the obstructing hody; if YOIllitlllg results from this step so mueh 1he heLtor. If lll1.'uccessful, thump the back hard bet\yeen the shoulders whilst the head is bent f01'\\'<11'(1. ,Yhen tho foreign body l:emoyed, but breathing is ,'u:-o;pcllducl, COlllmence artlficw1 ro .'piration.
HAK OfNG.
Grasp. the lower limbs and raise the body to take the tenslOn off the rope. llt the rope, free the noek, and commence artifieial respiration.
145
.'U FFOCATIDK BY ,'MOKE OR GASES.
R emoye patient into the frefh a.ir, loosen clothe " and flip the hare che't with a towel, wet with cold water, for 15 seeonds. If this fails to 1'e tore ?reathin?, ,a.pply artificial repiration. Before cnterlllg a hlllldmg full of smoke, tie a handkerchief wet if po sihle, rounel the head, em-erin a the no and mouth It. is well. to lllOye "lowly, keeping low, or eYCll cmwlmg, whIlst ill a room full of in seaI:ch a IJcrt>Oll. Eyery opportunity of lcttmg III frc::;h mr by opening doors or windows should hc ,'cizccl.
SUFFOCATIO:\' BY SWALLOWTNG VERY HOT ,yATEn.
Thi accident not illfrequently occurs to children attempting to drink from the of a kettlc. l'reatmpl1t.-.i\ppl.y a sponge or flaIlnel (or other) cloth, wrung out of ycry hot water, to thc front of thc lll'ck, from ellin to the top of the hrea't-bone, and -.;et tb e patIen t llcfore the nrc. Ui "e ivc to uck if it l'Hll he had, or if not, cold watcr. Olive or salad oil, a de'sert-spoonful at a time, \\ ill oothe the scalded throat and tend to ea 'e the pain.
CIIAPTER
VI.
AND POISONIN G.
WHEN a person has t ak en p oison, t h e sudden on se t of symptoms, appearance soon etfte r h aving taken food.o r d rmk, or after ha-ving . wall owed some substan ce madver ten t ly, may be the first intimation of t h e danger.
S UmURY OF S IMPLE DIRECT[QN FOR THE TREATMENT OF PO ISONING.
Send for a doctor a t once , stat i n g what has o c curred .
W he.n the p a tient i s n o t i nse n si ble , giv e :_
1. M1l k.-It i' safe to gi, e CO]JiUllS drawrhts of 'lk :\1'1 ' ,-, r. .' l.k, when s\\ allo\\'ed, dots or eunglllatcs, and ,he POl::;Oll may he therehy enclo cd in the milk clot, n,nd the whole got rid of Ily an emetlt:. Cream Hnd beaten up together lllay he giWll as \Yell a ' or Illsteac1 of the milk.
2. E g gs. -Beat up a cOllp lc of raw eggs with milk or water. 'rhe raw egg .. et:-i or coagulates in the stomach , and as in the case of milk lllay include the poison in the clot . .
. 3. several spoonfuls of olive, salad, or Any vegetable or animal oil, . ueh as that III wlllch sar d ines a r e p r e erved or cod-li vel' oil may be given . Mineral oils are not :-.nitahle.
147
oil sootheH the l-iurfnce already inj u red by the poi '011, and protects the uninjlll"C c1 parts of the stomach or gull et. Oi l is not to be given when phosphorus is the callse of the
..t-. Tea .-Strollg tea (a, handful thrown into the kettle and hoiled) acts a neutraliser of many poi 'ons and it; ::ll \\ ayt; safe.
n. An Emetic .-Ciye hal emetic, e:ccept 11,h en it <'een that the hi)·' and '}flOll tIl w'p, i4ainfd or lJll1'lm 1 (1).11
acids OJ' The ellletic m01:1' be :-(a) a c1eert'poollflllof rnm.;tltrcl ill a lmnblrrfu l (If ,Yater; (b) a talJle 'pOOUflll of salt in a tlll11blerful of luke-warm water .: ({.) for a y01111g child, a of ipec;tcu:lnlm wille, repeated twice at intel"Yals of 1::> minutes, lllay l)(J giHm lllsteacl; ( d) the rillgcr 'or a feather pn. sed to the back of the throat and moycd nhout may scne to unload the stomach . The emetic may be given first, or after one or more of the above rcmedic ' have hcen ac1 mini::; 1.,cred.
6. If an acid is kno\nl to haye been t>"allowed, !!;iYe an alkali once; amI should an , lkali have lleen the poi on , giye an ,wid.
7. Treat for Shock when it occurs .
In all cases , any vomited matter and food , or other substance suspected of being the poison, should be preserved.
BROAD FACTS -WORTHY OF REME iBRANCE.
When a person has swallowed a poison and threatens to go to sleep, keep him awake.
When there are no stains about the mouth give an emetic . also milk, eggs, oils (except !in phosphorus poisoning ), and end up with strong tea .
When there are stai s about the mouth give milk, eggs and oils, but no emetic .
POISONS ARRA:'fGE D ACCORDI!.. G TO THEUt
I ARCOTrcS.
Opium, or one of the :mu8tancc::; ueriyed from it, such as Morphia, or some one of its su ch Laudctnnm, or Paregoric, or some of the popular r emedies, such as Chlorodync, syrup of pop pie " and variolls soothing syrups and cordittll:), all pos,'esl:) the poisonous nn,rcotic pl'opertim; aS80viatcd with lhe name of opium .
Symp 'oms . - Tendency to go to I:)leep, ",hic:h continues to increase llntil sleep becomes deep and u reathing stertorous. Finally, it may be imlJOS 'ible to ron 'e the patient, and death il:) iUlllllllent. The pllpil' are
149
contr acted to the utmost extent (pin-point pupils) ; they do not re 'pond to The face i,' pale, the skin clammy, and a smell like that of poppy heads may be detected in the breath.
Tl'eatment.-Give an ellJetic and keep the patient a -wake. X ever give an emetic -wIlen the patient i iusen illle. Keep the patient awake by walking him a,bout, slapping his ftLee and neck or che -t w-ith a \yet towel, and by giving' trong hlack coffee to drink. the poles of tile feet with a slipper may be tried when ntllCl' means of ronsing fail. Employ artificial re pirntion if the i>l'eathiug' 11a ceased.
C\lHHO . IrE. .
Acids and Alkalies are the chief examples of thi cla. of poi 'on .
Acids .-The acid. 111O.'t c0111111on1 \' taken aq poi on ' nrc, Oxalic (the nJt:-; of l en;on, alt of 'orrel ) ; Carbolic; 11lphuric (oil of vitrol); Nitric (aqua forti.); Hydroc:hloric or ( 'pirit of s,tlt ).
J in the month throat, and stomach; acid let ·tc: l:)tainillg of tile lips and mouth of a \"bite, yell 0 1\' , or dark-urO\Yll colour; and \'omiting; shock; exhnn Lion and collap ' e, or ufi'ocation. Wh en the poi on is carbolic acid the mell of the hreath helps to disclo e the fact.
150
Tl'eatment.-First wash the mouth out freely with lime water or other alka,l1l1c mixture, suth clmlk, whiting, magnesi,l" or wall pIn. ·ter, in Witter, milk, U1' olive oil, and aftcl'wa,rd::; let the patirllt ip somc of it. Demulcent drinks nch a ' ulll'lcy water, milk, etc., may UP given sub 'C'qllcnt1y, awl hcatcn up with water or mille Treat sho uk.
Alkalies.-Caustic Potn..-h, Can tic oel,a, Quick Lime, and trong AmmoniiL arc the principal example' of alkaline corrosives. They tau.e "ymptOlm; 1'13semhling tbose set up by acid .' 'lUll it il) only l)y seeing the bottle In,bel that unskilled pel' 011S can be sure of distinguishing IJetwecll ,1cid awl nlkaline poi.'on. .
Treatmenf.- \Ya. h the mouth ont with an acid mixture, as lemon jl1ice or vlne!!ar, diluterl with an cqual quantity of "water. .\ ftcl'w<lrcl ' give milk, olive, salad, linseed, or cod liver 0'1, or eggs beaten up ill water or milk. Treat f;ho('k.
Do not give an emetic when the lips and mouth are seen to stained by a corrosive fluid, whether acid or alkaline, as -"romiting is likely to further the corroded surfaces of the stomach, etc
IRRITANTS (1IEl'AT LW POI
The chief sub.;;tances cout<vnecl in thil) group are:
- Arsenic (Ii'owler', solutioll]; 1fercury (corrosive 'ur:r
151
limate); Antill1011Y (butter of antimony, tartar emetic); Lead ot lead); Copper (verdigri,,); 8i1"er (lunar cau 'tIt): Phosphoru (rat poison, matche ').
I 'Y17'1ptoms,-A hurning pain in the throat and at the pit of the stomath; a mctK'tllic tastc in the mouth; retching emel vomiting and great dread and alarm. 'l'hc appearance of the vomit, . nuh as the green colour in poisoning by copper, and the fact that pho.'phorn .' glows in the dark, may in detennininf.( the poi '011 taken.
the vomiting hy gi"\ illg un emetIC. Alter or before it has acted giv a couple of eggH beaten up ill WeLLer or milk or if the T arc not at hand o:iYC plctin milk" strong 'tea, and, in the case of pho 'phorns, olIve or 'alad oil.
. Especially after poi 'ouing by metallic irritant it IS necc. 'sary to COlllltemct hy prompt treatment the deprcs.·ing influences of shock.
Other deadly poisons are ,trychnine Pru ' ic l\cid, yallide of Pota.'sinm, Belladonncl,' (deadly lllght 'hade planO, ] )igitalis (fox-glove ), Henbane, Hemlock,. and He,'eml varietie'3 of plants, as fungi (often nll'taken for mushrooms) laburnum seeds monk hood, etc ' ,
,'!/1njitollls.-Eauh of these poi '011S 11<1 it · myn symptom ' . ,ions and several llenon ' ymp· toms earl,'TIII mm;t, and al'e the mORt prominent eYldeuce of the poison havillg been taken.
T?·ealm,eni .-A.dminister an emetic before conyulsions or in ensibility COllle on, and when cesl:)aLioll of breathing threatens apply artificial respiration.
GE -ERAL NOTE.
. Iany poisons have a double action, and tecllllically mIght be grouped under more than one of the hcadings given. The rule ill dealing with a poison of thit; complex nature is to note the train of 'yl11}ltOl1l:, and treat the patil nt, aH thc symptoms an 'e, acconl mg to the general directioll:::; viYcll on page:::; 146 to 1-11).
0
153
HAPTER YII. IKJURIE OF SPECL\.L ORGAX,.
Trm EYE
The moye upon thc eyeball, moi::;tenin rr ClJlrl cleansing' the nrface; anet )hen closed the eyclid"! prcyent ho(tic· injuring the cyc1m lt. A lllUCOUS mem hrnne COYCl'H the in 'ide of the eveli 1 and the surhl'e of tile globe of the eye, and it'i' on thi' lliembrane that foreign hodie"! colled.
FOREIG.Y BODY [K THE EYE.
Tr eatment.-frc\·ent the patient ruhhing the eye, tying n. child's himel.' clown if l1eccssary. Pull dowll the 10\\'01' eyelid. \\'hen, if the fureign hody i:-:; ,'een, it Celll he rcadih' rCII1O\'erl with a camel' hail' hru-h or the corner' of a handkerchief twirled up ami wetted.
W'hen tlle foreign heneath the upper eyelid:(1) Grnt-;p the upper eyelie1 het\yeen the finger and tlmmb (\.11(1 lift it forward from off the eyeball; then pnsh up the lower bcnenth the upper, and let go. The hair of the lower liel bru ' he8 the inner of the npper lid and may di 'lodge the Should a "ingle mani pnlntion llot be sueee' fuI, repeat it two or three timc if llcce'sary. _ If the foreign body i' llot eli. 'lodged, call the eryices of a doctor "soon a po" il,lc. 0\ '- When. howevet, skilled help
cannot 1)e had, a on board hip, or e1. '\\ 11l..-1't'. proceed as follows to the inside of the upper :_ eat the patIent so as to face the light; ·tand behind the patier:t, steadying the head again. t the place a tooth-pIck, wooden match, knitting 11C'tlle, or allY naITO\", .firm rod, on the uppcr lid uf the inJured eye half an mch above the edge, pre::; 'ing- it hlckwarc1::; as far a. po. sible. Now cize the urlpcr-Iid l',H:l:t.' hc,' between the finger and thumh, Cln(l pull tllCl1l upward' oyer the rod. The eyclid will he L Ycrtcd, and the foreign boely, if it is thcre, ean he readily s('en and l'cmoyed. ·When a piece of·tec1 i:-; lInllec1dcd in the eyeball, a, little olive or castor nil on the eyeball after pulll11g down the 10\\01' eyelid, do.·c the Edl'>, a soft pad of cotton on the lid. amI "ccure hy a hallcIcl o'e tied sufficiently firmly to the cyeball steady, and take the pa.tiellt to Ll ell lct' 11'.
FOREIGX BODY IX TIlE E.
"\Yhen a doctor can be had, eyell "'ithin t\\ cnty-fullr hour, never attempt to treat a patient with a fnrcio'll body in the car. A pea in the eolr iH a accident, a,nd any attempt.' a,t removal may lea(l to fatal If the patient, a I,;hilcl e.pecHtlly, be mduced to kepp the fiugen; from the car tIe the down, or cover up the ears by t.yinO' a bandkerchief rOlmd the head and over the If an insect is in tne ear-pa::iliuge, fill the eal yith olive
155
oil, wlt"ll tbL' ill, 'cct \\ ill Hoat, and may be remoyed. N ever or prol)e the car.
FOREWN HODY IN TilE No E.
Induce the patiellt to l)low the 110.'e yiulently; give a pinch of :nuff or pepper to the unaffeeted no.'tril so a. tlJ induce . neezing. niffing up water or syringiuQ" out the no tril with water may effect dislodgement. There i::; no immediate (lang'cr from a h(.dy -,ay n button, in the 110C,
TIm ('ITEST (TrrORAX),
rrhc t1IC1!'aX i. hUl11111ecl in i'rollt by thc hrcu:st-1JU11e (.. ternlllll). and the rlb cartilngel:l; hchind hy the ycrtehnd UIUlllll (the dorsal vcrtebne): and on either ::licI(' l,\' tbe rillS. the thorax i:, hounded bv the .... tl'lw·tul'e at the root of the neck; and below, the di;) plm\!!lll (lllidritr), the movahle lllU cular purtitioll \\ hich 'L'parate,' the ehc::;t and abdomen.
THE (lUlo.\S" OF TIlE CHEST (THORAX).
The JW<lrt nnc! luug::; occupy the chc t. The po ·ition amI trnetUl'e of the is decribed with the organ of thc circulation (sec page 69).
"\Yonnrl 01 tile heart arc usually inbtantaneouly fatal.
The Lungs ot.;eupy the che't-front, back, and :sides. They are under the He8pirutory s)"telll ( ee i>age 135).
Womms OF THE LUNG.
'Vhen a rib is broken, and the ends driven inwarclo, the pleura and IW1g are apt to be tom. Thc:-;e organ' mayal 0 be injured by a stab with a knife, .'hletto, or bayonet penetrating between the ribs A rifie bullet may traver e the chest, wounding the lung in it..
:ii!!ns and Symptoms. -Difficulty of breathing, ymptoms of collap e, faintne , spitting of :'.loocl (red amI frothy), u ually indicate injury to the lUllg. £\il' lllay escape bencath the skin or into thc cll.Yity of the chest. Internal hffilllorrhage may rCl'3ult, the hlood accumulating in the cavity of the chcl>t, cau ing pallor, slowness of breath, LlulTccl vi 'iml, feeble pull:)e, sighing, yawning, delirium, and faintnc .. · going on to unconsciousness.
T, ea t," ent.-Lay the patient down \\ ith the hend lo\\', give ice to suck, apply ice over the injured part, keep the room cool by free ventilation, turn the patient towards the injured side. Do llut tie a bandage round the chest \'r hen the hmg i1'3 injured hy a broken rib, as chere is danger of the rough ends uf the fracture causing further damage to the lung'. :-lhould the injury be accompanied by a wound, alJply clean dressings, &c.
THE ABDOMEN.
The abdomen ia baulldeu above by the uiuphragm
157
(midriff), belo\\' hy the bones of the pelvis, behind the vertebral column (the lumbar vertebrre), and III front and al the sidc. by the muscular wal1. · of the al)(lomen.
Wounds of the front wa11 of the abdomen mav l)c cither vcrtical or tmn verse. When the ca\'ity of 'the ahdomen is opcned, the intestines or other nU1Y protrnrle through the wound
....Tr rl/!nu.."I- 1) 'When the wound of thc front wall (If the a,hdomcn i vcrticill, Iny the patient c1o\\ 11 fiat \\ ilh the low '1' c:s.trcmi.tiel:) ·tl <tight; coyer the \\ o1.111cl 0\ IJY a pad of dry .. or lill?n, aml,Flacl', a bnllda!.!,'(' rUllnel thc hod.\' hurly tlgltt. "hen the wonnd hcnd the knccs ,'0 a. to relax thc tis.·ne. of the witll of the abdomen. aneI 1'aie the .holllc1el'. to allo\\" of the of the wound cO!uil1g together: itppI,)' it pacl <t1lc1 bandage C:3)
When the intl' tine or ut,her orgalll> pl'otl'lld' through the \\"ollnci in the abdollliniJ \yall, bend thc rai'c the ·hollider.·, <Lud apply lint, a towel, or it cleiLn Hponge \\ mppccl up in soft linen, out of \\ itllll watcl'. all l keep the part warm untLl the doctor ani\"('. .
Eyery wound that injures the tomacb, ]iyc1', . plecn, intctil;c', or pancrea', lUll·t travel'e
Blood or thc content of the, to mach or mte ·tme· Will thercrorc e cape iuto the abdominal cayity, cau 'ing ymptom:- of internal hromorrhagc.
158
THE ORGANS OF THE AUDO\lEN.
The Stomach lies irmnccliately beneath the" pit of the stomach " just below the brea. t-bone.
Fw 57.
Injuries of the stomach arc 1 y collapse, and sometimes by retchmg, illld YOlllltmg, of dark blood like coffee grounds.
159
the patient down on hi ba k, apply all ICL·-l oycr the pit of the stomach. N othillg' shoulcl bl' "'lH'll hy the month.
The L lio: ill the upper part of the uh lomen, wh ere it i.... lIlO tly coycrecl by the right lower rill.
Injnr ie ... or tbe liYer may be e;allscd 1)), aLlow 0\ r the orgall, Ly fnwtnl'cd rib' penetrating it, or lly the :-;tab of n .... 11l1rp \\'CapOll, or hy a bullet. 'TIle great (langeI' oi a "01111'1 of the liYer is the 1,100(1 e.'cal'ill!.!" iuto the c;avity of the abdomen. 'Tll!' iujur,Y i attcudccl 1),\' pain alld s\\clling in tbe region of the lin')'. :ll1(l hy the signs and )'llJptoUJ::i of iuternal hiL'lllOrrhage.
J'reatll ien t.-- Lay the patient do\\ 11, giye icc tn apply ice IIYer tl1(': regioll of the liYcr, turn the patielll to\\ anI the side.
The Spleen lie.:: llcncath the rih; at the upper part of thl' l,rt . ide of the abdomen.
'1'110 cnn eO, (If inj ury auJ the dangrr arc .-imilar to tho c of tl1t liver and the treatment i· t-;imilnl', ou]y that the patient 'should be turned toward, the left t-;icle. Tlljllt'ih of t hc spleen nre n. nally peedil)" fatal
Injurie s of the Intestines 'ymptomiS of collap e,lll.! intcl'l1H.I hrcmorrhage may oc:<:ur, 01' the contents litH)' L.... ' ,Ipe illtq the rayit.v of the ahdomcn.
T1 Batm ld.- Keep the patient lying clown and a. qlliet as pI,,, ... illjc. Apply a large pad of flannel or cotton wuul tu the nbc1omolJ, kept in place by a to\nl
fai rl y tightly round tho abdomen and pinned III t hree or fou r places. GiYe nothing by the mouth.
The Kidneys lie at the back in the region of the Join. They may be injured \vhen the lowest ribs (the I Lth and 12th) a r e fractured by a c:ru8h, blow, or by a .bullet or sharp weapon. Blood ,,\'ould e cape WIth the unne, and would be pain and perhaps swelling over the injured kidney.
The Bladder lies in the pehi ' , and. may be wounded by a fracture of some of the pelvic bone. ::he signs and symptoms would be either inability to pass "'ater, or if a little i8 passed it iB tinged with l.Jlood.
T reatment. - When either the kidney or bladder i. wounded, keep the patient quiet until the doctor arrives, and meantime apply hot fomentations oyer the painful or inj Llred part.
Rupture (herllia ) con. i ts of a protru 'ion of an internal organ, usually the bowel, throuo'h the wall of the abdomen. It rno t frequently occurs at the groin. Should a sudden swelling, accolllpanied by pain and sickness, take place, send for a doctor instantly, and meanwhile put the pa.tient ill an easy position, and place ice or cold \yater applications on the affected part.
CIIAI''l'ER VI II . BANDAGING.
Esmarch ' s Triangular Bandage has been descr ibed in Chapter 1. I t may be applied to any part of the body.
For the scalp (Fig. 5 ).- Fold a hem about p. inches deep along the lower 2 border, place the bandage on the head so that the hem lies on the forehead and the point hangs d.own at the back; theu carry the two ends round the head above the ear , cross them at the back, and bring them forward. and tic on the forehead; then draw the point downward.', and turn it up and. pin it 011 to the top of the bead..
FIG. 5
In applying this bandage, care must be taken to put the hem close down to the eyebrows, to carry the end above, not ave?', the cars, and to tie them cI')se down to the eyebrows, and not high up on the
For the forehead , side of head , eye , and for any part of the body which is round (a the or thigh, tc.) the nar row band.age lllU. t be used , It centre being placed on the wound, and
162
the ends being carried round the limb and tied over the wound.
For the shoulder (Fig. 59).-Place the centre of a bandage on the injured shoulder, with the point running up the ::lido of the neck; turn up a hem;
FIG. 59. FIG. GO.
carry the ends round the middle of the a.rlll and tie them; take ,1 ::lecond banda.ge, folcl it into a broad bandage, place one end over the point of the first bandage, sling the arm by carrying the oLlter end bandage over the sound shoulder, and tying at the sIde of the neck: bring the point of the iirst bandage
163
under that the sling resting on the lnjured 'houlder, draw .It tlg}?t. tnrn it down, and pin it.
For the hlp (li 19. 60).-Tie a narrow banchwe the body abo:re the haunch-bones, tying the knot on the same sIde as the injury; take Hllother han.clage, turn .ep a hem accorcHng to the si7;e of the patIent, place Its centre on the wound, carry the ends
Fw. 61.
rOllnel the thigh, alld tie them; then carr, the POlllt IIp nnder the wai-;tbanc1, tllrn it down tlll' kllot, <LlHl pin it.
For the ?and Fig. 61).- pread out a b<l.lHlage, place WrIst 011 border :vith the tinger ' toward::: the pomt; then bnng the pomt over. the wri8t, pass the tw·) end::; oyer the wri t, C"'OS8, and tie them ,
164
For the foot (Fig. pread out a bandage, place the foot on i ts centre with the toe towar ds the point, d raw u p t h e point over the instep, bring the two ends forward, cross, and t ie them either on the sole (if to keep a splint on) or round the ankle.
Fw.
l!\;.64 .
.For the chest (Figs. 63 and 64).-Place the lll?dle of the bandage on the injured side, with the pomt over the sho ulde r ; car ry the two end round the waist and tie them; then draw the point over the 'houlder and tie to one of the ends.
165
For the back. - The bandage is applicd as the foregoing, but beginning by placing the bandage ()n th e back.
Fo r the knee. --Spread out a bandage, fold a narrow hem on the lower 1)on1c1'; lay the point on the tlligh and the middle of the lO\\'L'r border ju ' t below the kncecap, cro, s the end, nn,t behind the Imce, then oycr the t.high, again under the and tie in front bclow the ' knee-cap. Dring the point (A) down to (B) ('ce Fig. fo) alld fa't "1 \"ith a 'afety pin. If the bhnclage is not large cnough to l)c bro'ught the 'c('oncl time helow the kncc, t.ie it on t110 thigh.
FIG. 65 .
F or th e elbow . - Tll is is similar to that for the knee, the point and middle of the lower border 11cing' placed on the back f the nrllJ and forearm respectiycly.
CHAPTER IX.
CARRYING PATIENT
In accidents where the patient bas hern rendered unable to walk alone, he may be carried by the hystandel's making either of the following seat :-
(1) The four-handed s eat is made by two
FIG. 66.
grasping their left with their right hand., then grasping each other's right wri ,t 1\ iill their left hands (as Fig. 66).
After the hands are clasped together, the l)c<1.1'or stoop down behind the patient, who on Lhe luuxhi, and at the same time places one arm 1'ourl!l the nock of each bearer.
168
This seat is used where the patient is sufficiently conscious to giye some assi tance to the bearers and is able to Uf:ie his arms, but i· unable to walk. '1'0
FIG. 69.
lower the patient the bearers toop down 01' kneel on one knee, gently place the patient on a chair or bed, &c., and unclasp and withdraw their hands.
169
The two-handed seat is made by two bearers clasping their hanels as ill Fig. 67, and placing their free hand on en,ch other'f:i shoulder. In case of the p;ttient being a short person the bearers should place their hand on cach other's hip (as shown in the tigure), in.. tl!ad of on the shoulder.
In ·tead of the grip shown in Fig. 67, e:ther of those sho\\ n in Fig... G and G9 may be used. If that shown in Fb;. 69 be adopted, it is well to ,ycar gloves (n' to hold a handkerchief in the hands.
This ,'cat is uf:ied when the patient is unable to g i \ ' C any a . i::>tance with his arms, and may be used to lift a helplc s patie n: :-
_\. bearer each e d :1"1e paticnt stoop down, passes one arm under thighs, n ear the knees, and cIa p the hand of the :>1.her bcarcr. 1{; : then pn. f:i their arlllS ·round the bac:k of the patient and gra, p cach oth cr' ::>houldcr (or hip). To 10\\"cr the patient the l)eH.rcr · 'hou1d ·toop down or kncel on one knee. 'tYhrn the lo\\"cr part of the paticnt's body is re ·ting upon t11 e 1H·d, or pIneo \\' hcre it is de::>ircd to place him, the I lear '1" shonld unc:bsp the hnnds whieh arc under his taking care to uppod the upper part of the Indy, \\"11ic:h call thcn he gently lowcred.
The three-handed seat is a lllodification of the a l)o\'(', alld i' 'olllctimcs u 'cd for a ::>hort persen or child.
It is mndc a follo\\" :-One ;Jrasrs his O\\"n
-;-I}. 171
left forearm; the other hen,rer gragps the right foren.rm of the first hearer" ith hi' left hand, and the fir!:>t hem'er grasp' the left forearm of the second bearer with IllS left hn,ncl ; the second bearer places his right h< nel on the left 'honlder of the first bearer. The forearm should in all Cel 'e' be grasped slightly above the wrist (Fig. 70) .
rfo lower the patient the bearers should l:itoop down or kneel on one knee, gently place the Intient on a chair hed, &c., and uncla p D.nd withdraw their hands.
Une hearer ill:),Y celrry a patient by the Fire man's lift as follow :-
1'u Lift the Pati ent .-Turn the patient face downwards with his lelrs extended and anns ClOHC to hi' ide' . pla(;e 3'otll"elf at lli' head, stoop down, slightly rai. e hi.. head and shoulders, and take hold of him ch e uncler his annpit, lockinlr your hnllds em hi' btl.ck. H,tise his body as high a' it can be lifted with your hands and arms in tbis po:::;ition; then rcstill).! hi· hody as far a' pos ible on your left knee, shift your arnu; and take him rOlmd his waist, lock yow' hanels allLl lift him to an almost uprig11t po ·ition with his henrI re, ting on yom left shoulder, your left thigll as much of hie;; weight as possilJle.
Holding the patient in tbis position with yom' left arm, gra p hi left wri t with yonI' right hand, throw hi' left arm oyer 'four head, and nt the time drop yourself into stooping position; let go of tl ,
172
patient with your Idl ann, which then place hetween hi::; thighs. The patiellt' · body will 11O\)' ttll
your shoulders, [111(1 .'·ou hould liO\\" to all llprigllt p(}.:;i t ion, and valance it carefully. 'fran fer the
173
patient's left wrist to your left and so leave your right free for s.teadymg yourself when carrying the patient downstalrs, or clown a ladder (Se€; Fig. 71). .
To Lowe?' the Palient.-Transfer the patient; left \Yrist to your right hand, take your left arm from :FIG. 72.
between his thiahs anti place it ronnd them, bringing lheUl to the right-hanel -icJe of your body. Sink dO\Yll npon your right knee, let the patient's legs 1'e -t on. the ground while yon , npport 011 your left thlgh, place yonI' left arm ronn.cl IllS shoulder, let go of his left wri:-;t, and puttmg your nght ann unc1er-
neath his left arm and ruund his back, place him gently on the ground (Fig. 72).
bearers who prefer to carry the weight of the patient on the right shoulder I:3houlcl read " left" for "right" and vice 've7'Sct throughout the above ins.tructions.
The plan of catrying the patient by the «-1'ms and legs with the face downward.', c()]nmonly called the (( f7'ogs' march," rnust never be as death may ensue from this treatrnent.
Where a proper stretcher cn,nnot be obtained, a, temporary one may be made in either of the following way:::; :-
(1.) The sleeves of a coat may be turnerl iUl:3ido; two :::;tout poles are then passed. through thcm, ancl the coat buttoned. This makes a good seal. (Fig. 73). The patient sits on it, and rc ts against the hack of the first bearer.
If a longer stretcher is required, two coats must be treated in the same way. (Fig. 74:.)
(2.) A sack may be taken; a hole is made in each conler of the bottom, and two poles passed through the sack and out of the holes. (Fig 75.)
(3.) A large piece of carpet, sacking, tarpaulin, or a blanket may be sproad out, and t,yO stout poles rolled up in the sides.
fwo bearers then stand on each side. They grasp the middle of the pole with one hand, and neal' the
175
end with the other. To carry the 'patient they must walk sideways.
(4.) A hurdle, broad piece of wood, or shutter may
75.
he employed as a srreteher: but if either of them is some straw, or elotoing should be placed 011 It, and then a picc p of .tout cloth or sacking; the
176
sacking is useful in taking the patient off the stretcher when he arrives at the bed-side.
Always test a temporary stretcher bcfoJ"'J j!:ctcing the patient on it.
Temporary stretchers must be carricd, amI the patient placed on them as laid down in the" trett;her Exercises. "
N ever allow stretchers to he carried on the bearers' shoulders.
As a general rule carry patient feet foreJl1o::;t. Tit, exceptions are : (1) when going up hill 'rith n, patient whose lower limbs arc not illjnred ; (2) whell dO\yn hill with a patient \yhose lower limbs are inj merl.
In carrying a patient on a stretcher carehould \)(, taken to avoid lifting the stretcher oyer ditdlCS Ill' walls, but where the 'c cannot he <l.yoided the stretcher must be carried in the following ways :-
To CHOSS A DITCH.
In crossing a ditch, the, -tl'etchel' should 10 lowered on the ground, with it, foot one pacc from the edge of the ditch. J os. 1 and 2 then de, 'cend. The stretcher, with the patient upon it, is aftel'\\'ardl:> adYanced, Nos. 1 and 2 bearers* in the ditch upportillg the front end of the stretcher, while it, other eurl rests on the edge of the ground above. \Vhile the
• These numbers are exphtined later in the detailed Stretcher Exercises.
177 v
stretcher i thus supported, No. 3 .All the 0'. now carry the stretcher to the OpposIte sIde, and the foot of the stretcher is made to rest on the of the ground, \V hil l' the head of the 18 supported by No.3 in the. ditch. N? 1 clImbs out, N o. remn.illing in the dItch to assIst No.3. The 'b'etcher is lirted for",arc1 on the ground a10'\'e, and re ' t. there while N OR. and 3 climb up. No '. 1 and 3 then re ' ume t lie of the st'r etcher.
To (' it )::)s A \YALL.
Thc stretcher 1::; lowcred 'with the foot about one paC'e from the wall. Nos. 1 and 2 then take llU1tl of the foot of the stretcher and 1:'; o. 3 of the head j the 'treteher i' raised till the foot is placed on the wall. 1\ o. 1 then clim over the wall and takes hold of the foot of the ·tretcber. while _ T os. 2 and 3 support the head: the stretcher then carried forward till the head ' rests on the " 'all, K o. 1 llpporting the foot. Kos. :2 lmc1 3 then climl) oyer the ,,'all and take hold of the bead of tlw l:ltrewher, which i then slowly lifted off' the wall 011 to the ground, and the bearers take their usunl places
To LOAD A \YAGOK.
The ·treteher il:> lowered \vith the foot one pace from the end of the wagon Nos. 1 and 2 take hold of the foot of the stretcher, () 3 the head. The stretcher
178 is tlmn ed and carried for'ivard till the frollt \\Theel 1"6st ' on the floor of the wagon. No . 1 then jurrps into the wagon, while No. 2 goes to the head of the ,tretcher and helps No.3. The stretcher is then pu, hed slowly into the wagon. If the tailboard cannot be shut, the stretcher must be la hed. firmly to the ides of the wagon.
To UNLOAD A WAGON.
.Nos. and 3 take hold of the head of the streicher' while No. 1 gets into the wagon; the tretcher i,' then gradually drawn out till the foot-wheel,- l' st 011 the edge of the wagon. o. 1 jumps ouL of the wagon and with No. :2 takes hold of the fooL of the stretcher, .J.. o. 3 supporting the he leI. 'rhe stretcher i' then gently drawn away one pace ancl lowered. The Thearors then fall in in their n. n<11 placeBo "hen four bearers are attending to the patient, No . 1 and 2 would lift the foot of the :trctdwr, .Nos. 3. and 4 lift the he..'td. This applie' to cros,'mg a. dItch or waIl, as well as to loading and unloading a wagon.
CHAPTER X. STRETCIIER TRANSPORT.
The "Furley" Stretchers (Model 1899) are of thr '0 patterus, viz., " Ordinary," "Tclescopic-halldled," and "Police." In general principle they are alike. the component parts being designated the poles.
handl s, jointed tra'"er::;e !Jar" foot-wheel, bed, pillow :-inC'1\: :mcl sling::!.
Tlte Ordinary ""tretcher (Fig. 76), is 7 feet 9 inches in lengtl1 1 foot 10 inchc wide. The bed i 6 feet in length, and the handles lOt inches. The foot-whN'l:,; I"tise the stretcher 44 inches from the CT,l"OUncl. At the head of the stretcher is a canva overla pillow sack) which can be filled with str
I 0 clothing, etc., to form a pillow. The jointed tnn "l'se bars are proYidec1 with joints, :--0 arranaed as to o·t1l1.nl again -t ,be posf)ibility of the hearers o c; t 'hina t"'their fingers in them when opening or clm;ing the The pole are rounded on the top, and have an to add to th e corn fort of the patient and p1'e\'co t .. The Tc1?Rcopic-handled paUcrn (FIg. I () 1'3 H'r), "u11lln.r, hut I "0 arranged that the !landles can he .. lid underneath the poles, thus redllt.:mg the to G ff'et, the lenoth of the hed hC'ill II' 6 .Thi ' is great vahlC III c')nfinecl or when a patient to 1){) • tn.ke:l l1P:1'. clown a with tillns. The nhce. trctchcr I' slln:lar to the Ordinary p 1rlt iq more strongly made, anll hn<;;, 1;1 a ' Li':1ir; f,)l' sef'lll'ing :1. rcfr:1.ctory patil'nt. \ hen c:hsd, tly' p)le, c i the <;trcLther lie (;10.0 t the b-,FC'1':'>e "'l.rs 11 bent inward., the (' hell . l:,:,at 1:: foldecl on the top 01 the pole ' a11l1 helclm by the dings \\ hich are hid along' tll l' cmwas, and S2Clll'e.d l:ilrnp placed tl'n,n.'''ersely :t t the end of c:'..eh sImI?; belllg pas ed throngh the In l'!.!: l loop of the othcl', round the pnleq rncl hed, and bncklefl.
In [t .'tret(;her care. hm 1(1 he taken to rai:--(' the ,f the Cn1n'as \\ hen pushing in the traverse bar, a. It IS othcl'\yise lialJle tn Q'C't (':1.ught in the joint of the tl'avcl'.e 1)(1.1'. '
1 1
To prepare, or opell, J. .")lretcher, unbuckle tile transvertiC straps of each <;ling ; relllove the slings from the stretcher; separate the poles; t<.Lkc hold of each tra\'cr8e bar and draw it forwa.rd. The sling " ,ill then be folued to half their lew,·tb, oue beiug bid nen,Uv over the handle· at each enu of the stretcher. a genoml rule, the 'trdther \\ III be prepared by K u::;. 1 and 3 bearer::; ill Exen.:i:::.e:::. I. Il. alld Ill.; and by 1. o. 2 in Exerci::;e 1\". These Learer::; \\ill, 110\\ e\ er, if rcqnireu, as::)!:::.t th e other bearer III attenuillg to the p ;Ltient'::; iujurie::;. lYul e.-Tlw variuus l11U\ Cluellb ddaih:cl ill the fulll)\\ lllg should ue tarried Gut . teaclily, the bearer::; ill Leillg tarcfully a\'oicluJ, and e\er,\ aLlentiull beill g'- I'i,iLl to the bearer \\ hO'e uuty it i-:i to giY1 th" \\ ('l.b of <.:ullll1land,
'Tln:TCII E[{ EXERer 'E',
Origina.lly drawn up by 'il' J uhn Furk'y, un\.! r .;yi::;cc.l ill 1901 to accuru \\ iLh the drill::; adupted Ly the H.uyal Army Medical Corps:-
E.l -EHl'I E No. l.
FOR FouR.
1. Th e Illtitructor eleeLti the bearer.; and 1l1l1111)crs th m -1, 2, 3, 4, a,t hi8 eli't.:retion. Should one mall be taller awl stronger than the other::;, he ShOll IJ be
styled No.3, as he will have to bear the heavier part of the blll'llen.*
"Fall In.''
At the words "Fall in," Nos. 1, 2, and :) Lake po 'itioll on the left tiide of and facing the patient. I J o. 1
FIG. 7
pbce ' hinu;elf at the patient's knees, No. 2 aL t1lC hips, o. 3 at the paticnt's shoulders. At Jthe ,' nnw time No. 4 pa e8 the prepared stretcber on thL ground by the right ide of the patient abon t t \\ C
-:. * Bearers should, ho\\'c\'cr, be taught to ta.kc allY of thl position namen in the follo"ing Exercises, whether that 01 No.1, 2, 3, or :I: hp.arer 1 3
paces away from him, and then takes position oppo,'ite to and facing No.2.
" Ready."
The bearers kneel down all thc left knee and take of the patient, No.1 passing hands and fore
FlO. 79.
arnlH bene,lth the patient" legs, hand widc apart. No,'. and ± pas ' their hand ' and forearm::; 1)eneath tll patient'::; hips aud loin.' . and gra 'p ea·h other' hanel ' . No.:1 pu. ' cs hi .' 1 'ft hand aero::-, ' the patient" chest and under the right, shoulder, u.nd hi right halld bencath the left 'boulder.
4. "Lift . "
On the word" Lift/' the bearers r aise the patient gently and rest him on the knees of Nos. 1, 2, and 3 bearers; as soon as he is securely rested, No.4 disengages hands with No . 2, runs round by the head of the stretcher and places it lmder the patient, clo rtotheotber
.FI<;. O.
bearers' feet, being careful that the pillow IS ately under the patient's head (Fig. 7 ') ; he then kneel." down and locks his hands with those of -'- o. :2 (Fig 79).
5. " Lower. "
The bearers place the patient on the stretcher (Fig. 80), disengage thei r hands, and then stanel 'lp.
185
6. " Stand to St re t c he r." .'
Ko. 1 goes tc the foot of the hIS baek to the patient; No 3 to the WIth hI. face to the patient; No') . :3 ancI 4 remam on eaeh .llle of the stretcher.
7. " R eady." .
os. 1 and 3 place the sling (if used) oyer -houlders, stoop down and slip the loop: of the ,'hngs on to the handle ' of tbe stretcher, ,vhlCh tbey then gru::;p. . .
oon a. all is rig;ht the word IS glven-
<. "Lift."
At the word, . os. and 3 bearers the st retcher ::;teaclily tcgcther and tand up .
Yoli .-:\0 . 2 and 4 will now adjnst the ?11 the of Nos 1 and 3, t,lkillCl care that eneh 1;' well helo\\ tho 1c\'cl of the collar accurate1): l!l the hl/llow of Lhe shou1ller in front. They w111 a1 '0 leucrthcn or shorLell the slingq, having reganl to the p Iticllt's illjnrie':i and the relative heights of the be 'trot'-- .
9. c'March."
The hen1'e1" moyo oft' :-No. 1, 2, and 4 sLepping oIl' \\ ith their left foot, and No. 3 with his right foot (Fig. J 1). The ·top should be a short one of twenty inche', and taken with bent knees. Th ere should be no spring from the fore part of the foot.
10. "Halt."
.The being reachea, UI1 the word " Halt 7) bemg gIven, the bearers remain steady in position.
Fig.
11. "Lower."
At this order the bearers plare the stretcher <rent1 V on the ground, 'lip the loops of the Hlings off tlt'(' handles of the stretcher, remove the lings trOtn the
and then stand up ; care ueing taken to let the patient's feet reach the ground before hi beac1.
12. ' Unload Stretcher - Ready. "
The bC,Lrers prepa.re to take the patient off the :-;tretc..:her, as at Order 2 and :3.
U. Lift. "
The lJearers raise the patlCnt as at Orc1l'1' 4- (Fig. 79) ; l.\o. '1, in this ca.. e, disengages hand:.; from No.2, rcmoyc .· the Htretcher (Fig. 7't3), and reS11111eH hi . former pO'itiol1. If necessary, the b arers will then ,·teadily 1'1He together, and carefully carry the patient to the ychide, bed, or other place to which it ha. been ,lrrangec1 to con roy him.
1·:1-. "Lower."
The patient is carefully lowered.
EXERcr E No. II.
FOR TnREE BEARERS.
1. T umher t.he hearers I, 2, :l
All order. ' will he given by So. who will look after the injured part of the patient' body or limbs, to Hee that no ba.lldag;es or splin tt:l become displaced, and also that No.1 bearer, in lifting or ea1'1'),i11O' the stretc..:her, doe. not tonch the patient'. feet.
188
2. "Place the Stretcher. "
1 taking the foot of the stretcher, and 3 the head, place it in a line with the patient' body, the foot of the streteher being close to his head.
3. " Fall In. ''
X o. 1 places him elf on the left t.;ine of the patiel1t
3 2
FIG. 82.
in a line with hi knees, N o. on the left 'iJ e just below the patient's 'houlders, anu No. :3 at the right ide, and faces No.2.
4. " Ready. "
All kneel on the left knee. .... o. 1 place ,' hi · hands, well apart, underneath the lower limhs, always taking care, in case of a fractnre, to hayc
189
one hand on each side of the seat of injury. Nos. 2 and 3 grasp each other's bands under the shoulckrs and thig"lli of the patient (Fig. 82).
3 2
FIn 3.
5. "L ift."
All three bea rer:::; rbe tug,ther to their feet, keeping the patient ill a. hUl'wmt'l.l position. (Fig. 3).
G. " March. "
All take ,11. Irt carrying the patient over
the stretcher until hi head i · immecliatc1y above the pillow.
7. " Hal t."
All three bearers remain steady.
" Lower ."
The bearers stoop down, gently place the patient 011 the tretcher, disengage their hand::;, and then .tand up.
9. " Fa ll In ." On this order bein o o'i"en
No. 1 places him elf at the foot the 'stretcher with his h1Ck to the No. -' pLwc'i IWllself at the left side of the patient, and TO. 3 at the head, with hi face towards the patient.
10. " Re ady."
os. 1 and 3 place the ::;ling::; (if n '0(1) ,f,e r their shoulders, toop down, and lip the loop'i of the 'lings on to the handles of the stretcher, "'hid) they then grasp.
As soon as all is right the ,,'o:'d i::; g:iYell-
11. " L i ft. "
At this \Yorel, Nos. 1 n,ncl 3 Len.rer.' J'n,isc the stretcher steadily together ,mel stand IIp.
No.2 will now ndju t the sling;; on the :-;lwulclers of Nos. 1 and :3, t'lking care th'lt eac!l is well helow the level of the coillr, and lies accnrately in the hollo\\' of the shoulder in front. He ",ill ,1b;o lengthen 01' shorten the slings, h'lviug reganl to the patient',; injurie3 and the relative heights of the l)p·lrer,;.
191
" March. " On this word being given, No'. 1 and 2 step off with the left foot, and No . 3 ,rith the right. The step sh ould be a short one of twenty inches, and taken with l)ent knees. '1'here ::;honlcl b no spring from the foro part of the foot.
13. " Halt. "
The de ·tination being reached, on the " 'o l'd " Halt" the hcarer ' remain steady in po:::;ition.
14-. " Lower. "
The bearers place the stretchcr gently on the gl'onml, 'lip the loop.' of the sliufT::; off the handles of Ute stretcher, remove the slillgs from the shoulders, anel then stand up; care taken to let the patient'· feet reach the ground before hi ' head.
1:). " U nload S tretcher- R eady."
The lJc<.tl'el'· prepare to take the patient off the ·tl'ctcher, as at Orders 3 anel 4. (Fig. '2).
1G. ' Li ft.'
Till' l)(:'<1.1'or ' raise the patient, a' at Order 5, and ca.rry him by hort side step', deal' of th 'tretcher, to the ychide, heel, or other place to which it ha l)oen arranged to conyey him (Fig. 3).
17. ' Lower. "
The patient i ' cClroflllly lowered.
E XERCISE _TO. Ill.
ONLY T H REE B EARERS ARE AVAILABLE AND THE STRETCH ER CANNOT BE PLACED AS I' EXERCI E II.
1. The Instructo r numbers the bearer - 1, 3. All orders will be given by N o.
" Place the Stretc h er."
_ o. 1 taking the foot of the stretcher, and ... T o. 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 salle po. 'itions on one -ide of the patient, as laid down in Exercise No. 1.
4. " Ready ."
1, 2, and 3 kneel dO\vn on the left knee, placing themselves as close to the patient a - they conveniently can, and then take hold of him as directed in Exercise No. I.
5. " Lift. "
Nos. 1, 2, aDd 3 i 'aise the pati nt as directed in Exercise No. !', and t hen move in a kneeling position up to the stretcher (Fig. 84).
6. " Lower ."
The bear ers bend forward, carefully lower the patient on to t h e str etch er , and di engage hand ' .
7. " Stand to Stretcher. "
At t hii::! direction all the bear ers stand up j No. 1 goes to t h e foot, K o. 2 remains in position a.t the ide, and No. 3 goes to the hea.d of the stretcher.
L " Ready. "
Ui::!. 1 and 3 plac;c the i::!ling::; (if used) o\,er their 3 2 1
FIG. 4 .
shoulders, stoop down, and 'lip the loops of the t)lings on to tile hau(llci::! of the streLcher, which they then grasp.
9.. , Lift. "
os 1 and 3 bearers raise the stretcher steadily together and -tandup .
]94
N o. 2 will now adj nst the slings on the shou l ders of N os . 1 a lld 3, taking care that each is well below the level of t h e collar, and li es accurately in the hollow of the sh oul der in front . He will al so lengthen or shor ten the slings, having regard to the patient's injuries and the re lative heights of the bearers.
10. (( March ."
Nos . 1 and 2 step off "with the left foot, and N o. with the right . ffhe step shou1d oe a hort one of twenty inches, and taken ,,-ith bent knee.. There should be no spring from the fore part of the foot.
11. " Halt ."
The destination being rea ched, on the\\'ord (( Halt " the bearers remain steady ill position .
12 . (( Lower ."
The bearers place the tl'etcher gently on the groHnd slip the loop of the 'ling:, off the handle' of the stretcher, remove the from the 'houlders, ancl then stand up; care being taken to let the patient'::, feet reach the ground before hi. ' head,
13 . " Unload St retc h er- R ead y."
No. 1 places himself on the left side of the pn t ien t. and in a line with hi ' knee, No. on the left .. iell just below the patient's shoulderB, anel No.3 at tll,l ' right side, and fa.ce ' TO. 2. All knt::cl on the left knee. No.1 plaees his hand, "well apart, underneat h the lower limbs, alway" taking care, in eel e of a fmt: · ture, to have one hand on each side of the seat of
195
inj ury. Nos. 2 and 3 gra.sp each other 's hands under the sh oulders an d thighs of the patient. (Compare Fig. 2).
14. ' Lift. "
, ?cal'ers .ri 'e to their feet, keeping the p.a.twnt 111 a hOrIzonta.l pU.'ltlOll, and carry him by 'hort 'Ide steps, clear of the .'treicher, to the bed or other place to \\ hich it Jm.' lJCell arran,ted \" y him (Fig. 3).
0
1;3. ' Lower. "
The pa.LicllL is c<lrefully lowered.
EXERCI 'E Xo. IV.
FOR '[J,'E IX :JIINE,' AX D X ARHOW CUTTIXGS "HERR Two 1fEx OXLY CAN lJE EXG.\.GED.
. XU::" , 1 <lIltl carefnlly place the stretcher in a luw \nth the lll.Jurcel man', bu(h, the fout of the ,t l'elchel' beillg', if po..,iLlc,;'" close' tu hi head
" Xo. 1 ilcro's the patient's le o' , hi llghL fu.ul, mLlI the Loe lurned ()nllYtlrcb, tl. little below the knee ', and \\ i th the lUL' uf the left foot tOllc:l llllg the heel of Xo, :2; he theu tit oops dowll,
• It is not allvlsa.hIe to. he too pa {'ti cu lnI' as to the head or of ,a lretcher In a !l11l1e, as it "ould pl'oba Ll \' 1)e (ll! itt' ImpOSSIble to reverse it. " .
the l eft hand under the patient's thigh' and the l'lghL hand across and und er the patient's calves. No. 2 hi feet Olle on eR,ch side of the patient between IllS l,ody and arm, the toe of each foot as ncar the R,l'l1:pits as po sible . He then stoops down and pa eR hI::; hand between the side of the che t and the arms underneath the shoulder and locks fingers (Fig. t;5). If the patient'::; be uninJured .he may put them round the neck of TO. 2. and by thIS means greatly a, si t him in liftin(T. " both are ready, o. 1 " 'ill the orelcr LIft an? forward. " The patient is then to be slo\"ly hfted Just sufficient to allow his body to clear 19i
thc stretcher. Both bearer' will slowly and gradually IllO\'C the paticnt forward, o. 2 by very ,' hort ,'tq>t-), 1 hy bending his bod," fOJ ward a' rnlu.:h a,' he t:Ull wit hout movin[! hi feet (Fig'. KG). .L o. 1 llOW gin'S the order" Halt " wherenpon No :2 remain,' ,'teady, and Xu. 1 ad \',l1lt:es his right foot to hi,' left, <lnd
again aclYance' his left foot till the toe touches the !Jeel of No.2. Xl). 1 then give' the order " Advance " when the patient \yill again be moved fur ward. The,'c 1110\,Clllcnt. ' are to lll' rel)cn.tcc1 until the patient i· over the 'tret<.;her, \\ hen 110 i:s tu be lowered .
The bearers will thCll act in the ordinary m<lllllCl' as Ltl' as the nature of the lut:ltlity will permit.
The Ashfo rd L itter i.' made up of either of the Furley stretchers mentioned on page 179 and 1t-10, a wheeled nnder-carriarreandn, waterproof hood and apron, or, if preferred, a light wet-l'esi ,ting canvas cover. '1'h, )
FIG. 87.
stretcher is kept in position on the under-carriage 11Y the foot-wheel, which fit into. lot in the side.' of tll c under-carriage, and it can he removed at pleasure. The under-carriage is fitted with a cranked axle , which allows bearers to pass with the stretcher
199
between the 'wheel::; im;tead of lifting it oyer them. At both ends are two legf:) fitted with automatic se1£locking hinges which allow the legs to be turned up as handles 'when wheeling the litter, and ecurely lock them either a. leO'f:) or handles. The hood and apron fit into sockets to the :stretcher. In wheeling the litter, care should be taken to keep the patient in a horizontal po ition. •' hould it be necessary, two bearers cun easily lift the litter and patient.
The Rea-Edwards Litter, introduced in 1904-, is u 'ed in <t imilar wanner, and one model of it i' fitted with pneumntit.; tyrc ' , '",hieh add immensely to the comfort of the patient H,ud to the ease of propulsion.
201
CIIAPTER XI.
(Being the Fifth L ectu?'e f ur Females only, in arcordance with Syllab1£s 58.)
BY E. MACDOWETJ COSGRAYE, M.D., F.R.C.P.I.PREPARATIOX FOR OF CA ES.
news of an accident come, preparations should at once be made so as to have everything ready before the injured p ersoll is brought in. Of cour e the preparations needful will vary according to the nature and extent of the injury, but the followin o' are the chief things which may haye to be done.
eHOreE AND PREPARATIOX OF
A room must be chosen . In a had case this should be one easily reached. a. it i difficult to carry an injured through narrow pa sage.' and up-stairs. Unless there is some such reason again. t it, the injured person's own room is best.
The \vay to the room mn t be cleared, projectin <Y furnitlu'e and loose mats in the haU or in should be r emoved. If the injured per on is carried on a door or shutter, or even on It .-tretcher, a couple of strong kitchen chairs should he placed ready tu support it, wheTever the bearer would bc likely to require rest:.
Useless furniture should be removed from the bedroom. 'rhe bed should be drawn out from the wa.ll so that both sides can be approached, and the clothes turned back to one side to their full l ength. A hot bottle Hhould be got ready. If there is much collapsc 'e veral hot bottles and hot blankets may he required; covel' the Qot bottles with flannel.
If the injury i ' yery 'eyere, if mud-stained clothes have to be removed, or if extensive dre 'i11 gs have to be applied, it may be necessary to have another bed, :L couch, ur tl, table placed neal' the bed to lay the un ill the first instance. Thi ' should be so arranged Lhat .'oiling may do no harm ; old sheets, waterproof mn.teriab, thin oilcloth', 01' cvcn ne\\'spaper may be used a' a protection.
CARRYING.
If pre ent at the place \\ here the oc.curred, it will he necessary to 'ee that the patIent It) care· fully liftc(l after proper "Fir ·t Aid" has been rendered.
The following rules 'hould be rem.e mbercd :-, elcct the proper number of pert)oll ' to a' 'It)t, and do not thelll lift the patient until they thoroughly under . tand how they nre to do it.
.For orcliumJ' en 'es, ",here the injured pert)on hat) to he liftcd a "cry short lli tance, three helper ar c ·uffieicnt. Two (\\ ho :-;hottlcl be (U:; far a,' pOt) ible of
equal height) are to oear the weight, t h e thi r d i to support and take charge of the injured part. 'I'his is done by a person who has been through a <, First AId ' course.
If the injured .person is insensible, another helper should upport hI head.
_ '1'ho lifter , one. at each side, should kneel on ono
11..11e(' and p l."\, theIr hand' under the patient's back at lower J?art of the .'houlder-1Iades, anu under the lup '. 'pmg e,:ch his right hand in the other'· left.
The InJured pa.tIent should, if practicalJle, place hi::; arms round the necks of the bearers.
. helper ,'hould attend to the 'cat of injury'
If I. a fractured limo, he should support it placmg the palm' of hi hands under the limo ono and one b?l?'" the seat of the injury, It fi,llllly but aVOldlllg lUmece sary pressure.
" he" 'hould remain thus un til the order LIft l!::i. glyen, and then they should all lift slowly a,nd ayoiding jars, attempts to chancre positIOn of ha.nds, etc.
b
If the persoll is to he placed on a strcL 'li e r or hutter, tIns should be previously placed with the bottom end at his head; the bearers should thou OGe at each side of it, until the patient iii) 01'01' It. ,'1 ,\'ord "Lo\ver" should then be given, aIlEI In,Jured per on 'hould thon be slo\vly lowered. pilla" or folded-up coat should oe ready, and as the 203
snffel'er is lowered, thiH should ue placed under his head.';"
Beside:::; <1. streteher, and ' \lb titute::l such as a gate, a :::;hutter, or a. door, other mettll,' of carrying can be i III pro \' iscd.
In . light ill.llll'ie:-;,. "dlCl'e Lhe illjlll'ecl person is unable to walk, two heclr'1':-; Cllll (;<1,rry him hy forming a four1uU1<1ed, Lhree-hamle(l, or t\fO-Imllded seat,
A four -handed seat i' fOl'med clS de::lcribed on page lG(;,
A three-handed seat IS made as described on IGU,
T he two-handed seat IS made ab dm;e;ribed on pltl'"e IG0, single helper Gnu lift by snpportillg with one arm the two kuee.." awl \\ilb Lhe other the back, The arn! 111lL L nc pils'cd well under before commen(;ing to lift.
.\ -;iuo'le helper C<lll gire ':luppmt hy putting hI ,ll'lll nmlHl the wl1.i.t, the right hlp and pl<iGillg the iujllrccl left round hi OWll ned:, holding the left haw 1 with his OWll left hand,
. \ G<tpital .tretdlc r ',lll I,e illlpl'o\'llied out of a L1'ong sheet and t\\() hroolH hawlle::; or other 'hort pole.' , Eacll .. ide of the :::;heeL i .. wOllnd up on a broom '* .Full directions are giyen in Chapter X.
handle until there is just room for a person to lie between. This requires four bearers, two at each side, to prevent the sheet slipping.
CARRYING UP TAIRS.
In carrying a stretcher up stair the head should go first, and an extra helper should aasi·t at the 10\\'e1 end, so as to raise it and keep the stretcher nearly horizontal.
The two, three, or four-handed 'ca t mn? be used for carrying up stairs; or a strong chair, the pn,tic nt being carried up backwards. In the latter 011e helper should walk after the chair and help to support it, and to prevent the injured person slipping out.
LIFTING INTO BED.
If the bed is narrow and there i · room the stretcher should be placed on the floor with the head close to the foot of the bed. The injured pcr.'on should then be lifted over the foot and placed on the bed. If the bed is too wide to admit of this, the streteher should be placed beside it, and two helpers should stand at the far side of the stretcher. One helper pas 'es one arm beneath the shoulders and one beneath the middle of the back, the other helper placillg his under the lower part of the back and under the knee '. The injured person is then lifted, another hclpcr plllls away the stretcher, and after a single step forward the burden is placed on the bed.
PREPARATION OF BED.
A firm mattress, not a feather bed, should be ,::>elected. If there is much injury, or if dressings hn,Ye to be applied, a draw-sheet ought to be placed on the bed. It .·houlcl be of four or more thicknesse , extend across the bed, and reach from the midclle of the patient's back to the knees. A piece of waterproof 'hecting or of thin oil-cloth shm.lid be placed under L ...e drttw -.·hcet. As the draw-sheet becomes oiled, the soiled portion should be rolled up anrl ,L elctm part dra,wll smoothly under the patient.
ttl fmttlll'e of the leg or thigh, sprained ankle and 'OI11C other en,cs, a "cradle" (Fig. 8 ') r:;hould he improYi ·eel. The u'e of a, "cradle" is to support tho becl-clothes and keep thcm from pressing on the limb Band-boxes (Fig. '9), thrce-legged stools (Fig. 90), <111r1 imilnr article may be u ·ed. A cork crew pn· 'cd through the heel-clothe' with its point guarded uy t\ cork, and tied hy string to the bed or a nail in the \\'all, will relieve the pressure of the bed-clothes effectually.
REMOVIXG TilE CLOTHES.
In taking clothes off an inj ured person a few rules hould be borne in mind.
In selious tases it is much better to sacrifice th" clothe than to run any risk vf increasing the injury.
In remoYing a coat, etc., in a case of iractured arm the uninjnred arm should be drawn out first.
FlO.
FIG. 89
FIG. 90.
III putting on anything the injured arm should 1)0 pn t in fir ·t.
In burns and scalds nothing should eyer be dragged off. A bha? p pair of scissors should be us el, amI everything not adhering l:ibo111d be Cllt away. It rUl)'thing ad1.lCres it . hould be left until medical aiel can he obtained. The clothing adhel'iug Illay, "with aclYnntag, be soaked ,,"ith oil. To remoye tIle trou 'ers from a. Rcye1'ely injured limh, the oulside should he rippcclup.
PREPARATlO1" FOR. 'URGEO;\,
. 'oon a the injl1l'nd pcr'oll has 1) eC11 attended to, prepara.tion should he made for tlw \ i:-.i t.
The preparations necllful will depcl1l1 upon the natllre of the case. '1 h e following hillts may he oj' 11:-'C :-
fire in the room "will generally 1e of 'en-icc, eY011 in ummer. There shol1ld be plcnty of "atcr, both bot and cold, also .'eyoru,1 ba 'in " pI nty of clea11 towels and soap. There >..hould 1e omething to empty wuter into; a foot-bath doc ' well. The l)[tsills should be placed on a tu,blc, t:oycred with a dean whit cloth; a large towel make::; a ' uitable doth: the towel , folded up, should he placed on the 'ame table, and the hot and cold water :hould be withIn
easy reach. The foot-bath should be under the table or close at l\n.nd.
I n the case of a burn, cotton wn.dding, . oft old l inen, oil, flour, bread, and bicarbonate of sodn. (baking soda) should be ready, and should be torn up for bandage. 1£ a chemi t'.' shop i. within reach, carron oil and plenty of cotton wool shfluld be sent for.
In the ca e of lu-cmorrhage, sponge, plenty of water, and n.t lea t two basins should be ready.
In the case of a person rescued from drowning the sheets should be taken off the bed, plenty of should be heated before the fire, and . evera] hot, bottles should be ready.
If poultices are likely to be required, hoiling "'atel', linseed-meal, mu tard, a loaf of stale hread, a mall basin, a large poon, sweet oil, and tow, flannel or handkerchiefs may bo required.
For fomentation, have boiling water, flcll111 el, a. kitchen roller, and two stick, or a large towel.
When summoning a medical man to an accident always let him know what kind of case he is requirecl to treat, so that he may bring whatever is needful. B)' this means valuable time may be aved.
Abdomen
Pag e 1:')6
Accidcnt cases prepamtion for ... 200
Acids. poisoning by ... 149
Alkalies, poisoning by .. . J;)O
Ammonia, poisoning by ) 50
Am Lorn y .. . Hl
Ankle. prainccl G'i
Anterior tibial a.rtcry...
Antimony, p oisoning by J.il
Aorta ti9, 18
Apoplexy ... ... l09 " to clistinguii';h from collap<;c from drink Jl1
Apparently drowned, to rcstorc ." ...
Aqu'L fortis, poisoning by... ... .. 1 J!)
An11, blcc<ling from S,. gO " bonc of 2;) ,. fra cturc of fi2
Armpit, blecc1ingfrom ...
Ari';enic, poi oning hy .. , 1i1 ()
Arterial h:en10rrhagc .,. " " general principlcs of arre8t ()f 7-1:
Arteries ... ... ()9, IH
Arteries, coursc of the main I
Artery, axillary brachial carotid .. . ligital .. . Page ' 83,86 83 79 dorsal, of foot.. . 4 94 81 facial .. . femoral .. . iliac plantar . .. popliteal radial ... subcla\-ian tibial ,. ulnar
Artificial re piration ..:\ tlai'; .l\ .,. ...-\xillary aT tery ... Axis
Back, blndagc for 165
Backbonc 20
Bandage, to fasten 38
Bandage, to folel 37 Bandages 35
J3andagin6 ... 161
Beel, prep'1ration of 205
Bclladonna poisoning by 151
Bitei'; of animals... 131
Bhdder ... ... l60
Bloo,l Page 69
Bones, general description of ...
Brachial artery ... " " digital to 13rain compression I)f ., con<.;us;;ion of Brea'\Lbone " fradure of .. .
Breathing, stcrturuus .. .
Broad bandage ...
Bruken bone , see Fracture.
Bro{)l:h-l)one
Brui:,c3
Burn.,
Calillarics .
Capillary rhnge 7:3
C. l rotid arteries... . .. 'wound of Caq;ns
Carrying, Illeans of " patio nts ., llpstairs
CarLi.lage... ... ...
Caustic (LclllUJ), ing hy... ...
Cerebro-spill'll . ystem .. .
Cheek, bleeding from
Chei't ...
bandage fur
Ch lorodyne, poisoning by...
Choking
Circulation of the blood
Circulation, orga.ns of .. . Clasicle
Page
" fracture of 148 144 69 (9 24 4
Clothes, remo\'al of
Coccyx ...
Collapse from th'ink
Comminuted fracLme .. . Complicated fnwtUl'e .. .
Compress, gradllil tell .. . ompression of Lhe brain
Componnd fracture
Concussion of the brain
Contused wounds
Convul ions (inf.tntile) .. .
Copper, poisoning by .. .
Corro ive poisons
Craelle .. .
Cranium .. . " fracture of
Crepitus ...
Cyanide of potJ.. ium, poi onir,g by ... 151
Deep palmar arcb .t
Diaphragm 1:37
911
Parte
Di gita l artery wOlln(l of Digital compression ... 7+ poisoning 11." ... 1.')1
Direct el)mprossiol1 74-
Direct yiolencc ...
Dislocations t-l
])ilch, to ,,,ilh !'ltrctchcl' .. JIG
Dorsal artery of foot ...
Dres!" on hl'P I :!()
Drink> collI p:.;e 1'1'0111 I ] II)
Dro"ning l-ll
RIl'·dlnnn{'l. I,ll·{·,ling fro III
Ear-pa<; . 'lgc f01'f'ign ho(l\' ill J.i-l-
El.lstic hanc1agc t .ll1rni(ll1C't , I
Elhow. for I (i.)
Elbow, bleolling fro111 hcn(l of , El],ow j(lint
Electric shock 1] 'i
Ellldics ... 1-1-1
caution as to gn ill!.; ].in ... 11:2
E"march triang111nJ' unn(lage :l')
F.. -piration I
External carotid urlen 7n
Ey!' . I.i:i
F;l(,,c 23
Page
Facial artery, to compress ... HI
l<'ainting... JI4 :Fcllloral artery... " " digit:ll compression of 96
Femoral artery. to apply tonrnicillet to Fcmur 26 ., fractur(' of !i
Filml ( 28 ]<'ibulu. fracturc of (j:!
Field tourniquet 77
Finger, blceding frnlll .. H-I-
Finger hon A , frat:lm (. nf 117
Fircm '1l1's lift .. . 171
First aid, moaning nf ]!)
Fi:.;h hook emllec1ded 127
Flexion of limh . .. j
FOOl, han(lage for 16-1 hleeding from 8;') hones of .,. 2 cru· hed 64
F'1I'l'l11'll1, hleeding fl'Ol1l hones of 2.) fracture of .,. B4
Furchea(l, bandage for ... 161 " bleeding f1"')111 80
Foreign hody in the ('ar pa<;sage ... .., 154
Foreign hoc1y in the eye 153
Foroign lJody in the l1O!'1e 15S
Four-banded seat 166
212 Page
2J3
I ntestines
Frost-bite
Fungi, poisoning by
Fracture, apparatus for treatment of ... 35 causes of 31 " " " " definition of... 3 1 general ru les for treatment ,1,1 of arm 52 of bones of foot ()4 of breastbone 4 of co11ar- bone 48 of tinger bone 57 of forearm 54 of knee cap... 60 of leg 62 of lower jaw 46 of metacarpns 56 of pelvis 57 of ribs 46 of shonlderblaue of skull of spine of thigh-bone signs and symptoms of 112 44 43 " varieties of .. ::34 32 127 l 5l
Ganglia... 103
Graduated compress 75
Green-stick frar:ture 34
Gunshot wounds 125
Hremorrhage " arrest of " internal Ham, bleeding from Hand, bandage for bleeding from " bones of Hanging ... Haunch bones ... Heart " con traction of IIeat ctpople'\.>' ... " stroko
Hcmlock, poisoning Henbanc, poisoning Hernia
hy
Hip, bandage for Howard'" method of It3 artificiall e,;pirabon .. Rumctus .. , fracture of Hysterical fits ... 141 2:) 52 115 Iliac artery 79 Impacted fracture 3,1, Incised wounds ... 124Indirect compression 74 Indirect violence 32 Injuries of special organs 153 InsectA, stings of 134 Insensibility... 104 " general treatment of 104 Inspiration 137
Instrument:tl P Cl(JP. 159 compre88ion
In ternal carotid artery
Internal hremorrhage
Int ervertebral discs I nvoluntary muscles
Irritant po·isons... 74 79 92 21 31 130
Jaw. lower, fracture of 4."5 .Toint, woundc el .. 126 ,Joints
Kidneys .. , .. , Knee, '\)<.lndage for Kneecap " fracture of Knot., 160 165 2 60 37
Lahmde'.,; method of artiticial respiration . 142
Laburnulll S lcds , poiso11ingby... ...
Lacerated wounds 1:,A
Luge arm-sling ... 39, 49, Lal'ynx .. , .. , ... }.3.)
Laudanum, poisoning by Lead, poi<;oning hy Leg, bleeding from 9.) " bOlle ' of 2 ,. fracture of... 62
Lifting and carrying 20]
L ime (quick), poisoni ng by...... 150
Lips, bleeding from 81
Litter, Ashford ... 198
Liver 159
Lungs...... 135
Lungs, wound of 156
Mercury, poisoning by .. . 11etacarplls .. , .. . " fracture of .. .
Metatarsal bones, fracture of ... 11 ctatal'SUS
Metallic poisons
LiftilW into bed 20-l cffects of 119 Pa(Jc
Middle lill 'l (If hody .:'Ilonkshoocl, poisoning ] 50 2G 56 64 ]f)O 2C) by ':\Iorphia, poisoning .:'Iluscular action 151 by 146 30 ::,2 148 arrow Lalldage T eedle, a broken 125
Nerves 102
Jervous sv tem 102
ITO!;C, bIte"cling from 8l " foreign body in 155
Oil of vitriol, poisonin!! by...... 149
Opium, poisoning by 14.8
PCUl f
Pad, to make... ... 73
Palate, bleeding from .. , 81
Palmar arches .. , .. . -t
" " bleeJing from Paregoric, poisoning by 148 Patella fracturc uf (i( I Pel\:is :W . fracture of Phalanges '"
Pha lanx, fracturc of Ph tl,ryn.x ., . . . . ..
Phosphorus , p oisoll in cr b" 'Physiology .. . 0.:.
Phl,ntar arteries... . ..
H1l'iou, p lison· mg by ... .. . . ..
P oisoncd \vollI1ds . , Poi oning, direction::; for treatment of ...
P oison::: :t1lL1 POiSOllilll( classification uf 'with doublc ac· tion ...
P o pli tcal artery ...
J:>o'iterior ti bi 11 mtcl"\' . , cau stic, mg by ... ... . ..
Pr eparation for surcreon
Pru::;::;ic acid, by 0 .i7 :.W ,)7 1:1.") ].") 1 19 D-I i.i 1 1:.26 I-lJi I ·U) H ' l.i(/ '207 1.")1
Pub es Pulse
PUlwtured 2n 71 , ](I.i B,I,
Pupils
Pag e ... 106
Rabid animals, bites of 1:31
H,ndia l artery ... 3, blecding from .. , 87 comprc Si()ll uf
Ra(liuK '" ., fracturc of H espira,tivll, artinciu 1 H.cspirntory systcm
Hill,; ... ... " fmdurc of. .. Roolll, choic':) alld pre· paratiun of Hump.honc
Hllptl,!'C '"
Nacl'ulll ... ,\:<11p, halldat!;e for .. 1lit: l'tl i1'1'" frOlll ,)capnla.... 0 fmetlll'c of , \'rc \\' tOll!'lli(ll1cli ... , 'hock clectric . .. . 'houltlcl'. handage for .. . ,. Illaclc ... ... " fraclurc of j oint ...
Pau e
Sickroom, choice and preparation of 200 3:2 20
Simple fractur e ... ...
'k in , wonnds and injuries of l:21 ''' kull.. :.2:2
" fracture of 44
Nling, .. 39, 49 & ;)() arm·sling . . 4()
Nnakc·biLo 133
Soda, c,wstic, poisoning Ly ... ._ ... Lin
i-;u1e, arterial blccding from ,'plcen .. cal1"ll " cord ,'pinc :-""pilH'. frnc-ltlJ'c of of salt, poisoning I", a.ngular .. . Nj,linLs lo ficcurc 9,j 1.i9 20 1 2 20 4'1 H!:l .i4 ,'plai'ls Oi
" fmcturc of 4"i
Nll'rLorou'i IJl'c<lthing lll.") of insects, &c. LOlll" ell .. 1.") . ,'trains C, ]4-1.
,'lrctl'hcr exercises I vl
215 , 'tre l ehcr, Furlcy to carry to prclJa r e Page 179 176 1 1 to make a t ClllporClry . transport
Strychnine, poisoning Ly Ntunning .. . f-lLypLic .. . , llbcla\rian art')ry " "digital comprcssion of 'nfloeation by smokc or gases ... !-luG'Il'ation II" .·w<lllow· ing ycry lw't \yatcr .. , ,'lllHtrokc
pn Imar arch ,.'l1ll('OIl'S visit, llI"cpara· tJOn for S\lYc."l · I'" llll'thnli of . ... sy tClll , }llC()PC _n
Tail·llono
Tars lls
Temple, blecding from ... Thicrh ·bone 0" fracture of 'I'hur11.- ...
Thrcc·hamlet! sca.t
Tibia fracturc of
5t. 301)n Bmbulance Bssociation.
Page
Throat, bl eeding from i n side of 1
Tibial arteries .. . 94
Tongu e, bleeding from... 0
Tonsils, bleeding from.. 81
Tourniquet 7:5
Trachea ...
Two-hanueu seat 169
Ulna " fracture of Ulnar artery 'from 25 53 ' 4, (:i bleeding 87
Veutrides ...
Verdigris, poisoning
Vertebra... .
Vertebrre, ceryical dorsal " lumbar
Vel'tebral column
Vi trol throwing ,'olec box
Voluntary lllllSdcs
Wagon, t,Q loau and Ullload
Ulnar artery , compression of ... 6 10-4:
Unconsciousness
Varicose veillS
V eins 100 71 \T enous hremorrhago
Wail, to cross wi th stretcher
Winu-pipc ... W onnd of ahclnmen 'Youncl of 1, J...., \\'uul1Ll",
INTRODUCTION.
This Price List, which is sub ject to revision from time to time, has been compiled with a view to assist members of the Associrttion and others in the purchase of the necessary equipment for corps and divisions of the Brigltde, ambulance classes and first aid and nursing work generally.
A complete and reliable Ambulance Equipment 1S ltD: actual necessity, and experience has proved that. ot In.bour and others interested in the district read1ly subscnbe for the purchase of such appliances. Collecting c.ards, the purposes for which subscriptions Itre reqUlred, be supplied gratuitously on application to the Ottice of the .\ssociation, where also any information WIth regard to Its work can be obtltined .
•'tores of the value of lOs. or upwards will be sent c a rri age p a i d to any part of the United Kingdom.
Owing to fluctuations in market prices it is impossible to guarantee that the quotation herein can be adhered to.
Quotations will be furnished for articles relating to Ambulance Nursing and Hygiene, not mentioned in thH:! list.
Orders and correspondence should be addressed to the , t. John Ambulance Association, t. John's (Jate, Clerkenwell, London, E. C.
Remittancps should be made payable to the t. John A mhulance Assocu'l.tion and crossed "London and W estm inl'lter B e.nk, Lothbury." ,
H ORSE AMBULANCE CARRIAGES &: WAGONS.
Register ed d esign 41 8,030 .
A number of improved designs for Ambulance Oarriages have recently been p erfected, a nd sever a l sp ecim ens can usually be seen at St. John' s Gate, v a rying fr om a ligh t vehicle, to be drawn by two men or by a pon y , cos t ing with india-rubber tyres to wheels £32 lOs., to a. large single or pair-horse wagon capable of accommodating thrt;e patients in a. recumbent position and an a.ttendant inside. A full y Illustrated price list will be sent on application.
PltIC E LIST.
" ASH FORD '" LITT E RS .
The "Ashford" Litter (199 moc1elr-consists oia twowheeled under-carriage fiLted with elliptical springs, and either of the" Furley" stretchers, with a cover so arranged on a jointed frame that it can be folded upinside the stretcher, or with a hood and apron (as shown above). The undercarriage having a cranked axle, the bearers can pass between Lhe wheels with the stretcher, and thus avoid l if ting it over them. vVhen travelling, the legs of the under-carriage are r aised, and thu s form the handles by:w hich to p rop el it. , 'hould it be necessary to pass over rough two bearen can easily lift t he litter and p atient. T he" Olemetson " stret che" can be u sed instead of t he. "_Furleyt pattern.
OF THE IMPROVED ASHFORD LITTER, 1899 MODEL.
, With Iron Tyres to Wbeels.
Withou Oover or Hood an Apron. ; d
With Oover.
With Hood and Apron.
With India Rubber Tyres to Wheels.
Without I With Oover or With Hood and Hood and Oover. Apron. A.pron.
Under-carriage (no Stretcher)
Litter complete with Ordinary StretcherDitto with Telescopic handled Stretched Ditto, with Police Stretcher:):
• Prices quoted for Litter with Ordinary Stretcher include Wide Webbing Slings but no Ohest Leather, instead of Webbing Slings, 55. 6d. extra; Ohest Strap, Is. 6d. extra. If supplied mth out any Blings, 48. allowed.
t Prices quoted for Litter with Telescopic-handled Stretcher include wide WebbinA' Blings snd "nest StrILp. Leltther, instead of Webbing Slings, 58. 6d extra. If supplied without any slings .8. pllowed; ILnd if without Ob est Strap, Is. 6d. allowed. '
t Prices quoted for Litter with Poli ce Stretcber include wide Itnd Leather Straps for .ecuring II, refractory l"a.t ient. Leather, iD fltead of Webbing Sling!!, 51. 6d. extra.
- "ii Hood and Apron, comolete -..;Extra Sockets and Studs, per set ._ Waterproof Sheet (was hable) to be laid on the stretcher bed Cntes (retura3.ble) chq,rg e i 4'1 6d. for e3.'!h Litter.
PRICI: LIST.
over them , a n d th e cranked a xle has, therefore, been repla.ced by a str aight one constructed of · tubular stee.
" REA-EDWARDS" LITTER, fitted with pneumatic tyred w heels, showing the" Clemetson " tretcher.
Ball bearings are fitted to the w heels, bo t h c ycle pattern and wooden , and t he hubs a r e so arr anged that the wheels can be r emoved f rom the a x le w i thou t disturbing bearings. In place of the four legs made 1,0 raIse as handles, t w o fixed legs fitted with small incliarubber wheels or rollers are placed at the foot e nd. while a combined leg a.nd fitted with a crossbar and capab le of bemg raIsed or lowered is used at the head entl. When raised as a handle it may be locked in 011e uf two positions, and when lowered it is lo cke d in a ,-ertical position . The advantages daimed for thi. arrange-
ment simp l icity, ease and rapidity of manipul ation and the fd.Clhty afforded by the t w o fixed legs for raising the litter, if on to the pavement. The qu littOn of bahnce h.l.s been carefully studied, and the is shifted forward so that the middle of it is several ,uches in front of the axle, a p erfect btlance when the i::l ina horizontal posiLion being thus obtain eu , an I consequently thtlre is no weight on the handi! of the per:3on pro · pelling the liLter.
The pneunntic tyred wheels are strongly recommen led in ?ases where tile s,mall amount of care neces:3ary to keep them ca:n be the comfort to the p altd ease prupul!OlOn are lIlcretsed beyond all comp lti'lon with any 1I yet prod uced. It will be noted thitt tile prices are lower than those of the I, Ashford" Litter, and Lile following are given as but owing to the va t number of combinations tha,L CLn be malle with the cliffeI' 'nt and coverings, it is impo ,;ible within rea'llJllable lim Its to set out quotatiom for tile whole of them, but the'e may be c,tlcullLed by a,ddmg togt3ther the prIce '! ot Lile under-carri .lge, stretcher selecLeli, and hood and aproll_or cover, see p.1ges 4: an 18 to 11.
SPECIMEN PRICES.
only, either with pneumatic-tyred cycle wheels or sohd rubber tyred wooden wheels. £11).
Litter co:nplete with ordinary stretcher (no slings or che. 't stra,p) and and £ L4 :3s, 6d.
Dltto wlth Telescopic Handled tretcher (with chest strap) tnd hood and Lpron, £l-l lIs.
H with iron tyred wheels pnce are £2 less.
The lowest; priced litter complete i titted with iron -tyr ed woo<leu wlleels ordtntry stretcher (no slings or chest trap) and cover. Price, £ Iu s. 6d.
When ordering'please st1.te which wheels are req uired.
THE" CLEMETSON" STRETCHER.
" CLEMETSON" STRETOHER, with back rJ.ised, also showinci extending legs.
On t h is stretch er the patient ca,n be moved as desired, from t he recumbent t o t h e sitting position. T here is no complicated mechanis m to get out of order, anel the ad j ustment depends simp ly on t he balance of the patient's body . The stretcher will fi t either t he" A sh fo rd " or the" Rea-Ed wards Jl U nde rCa r r iage. Pri ce £3 3s . Od. ; with extending leJs, £ 4.
Hood a.nd Apro n, Ve n tilated., £ 2 15s.0el.
PRIOE LIST.
ADJUSTABLE LEGS FOR
P·fi mar ily these legs, which are independent of and additional to t he ordinary foot wheels , are intended to facilitate the carriage of a stretcher in a railw ay compartment , in which case two on one side would be l owered and adjusted by a telescopic arrangement to the proper height, so that the foot wheels on one side w ould rest on the seat and !;he adjustable legs on the other sMe would rest on floor . The four legs may be usell to raise the stretcher as required . When not in use they are folded up immediately under the poles of the stretcher.
Price per set of four, 17s.
FIRS T AID BOX
To be fixed below the axle of the" Rea-Edvmrds" or " Ashford-Edwards" Litter.
This is intended to be kept permanently attached to the litter, and is not designed to hang in a station or to be carr ied by hand .
Contents: - et of ,plints, 12 Triangular Bandages, 12 Roller Bandages, 2 i-lb. packets each Cotton Wool and Boric Li n t , Adhesive P laister, Pair of , cissors, Knile, :2 oz. each Olive Oi l, Tinct. EucaJyptus B.P.C., al ;Volatile, and Spirits E ther Comp., Graduated Measure Glass, KidneyDressing Basin, 6 Tampons for washing wounds , To u rni q uet Pins, a fety Pins, Needles, Thread and Tal-'e.
P r ice,: £ 2.
PRICES OF THE" FURLEY" STRETCHERS, WITH THE LATEST IMPROVEMENTS (1899 MODELS ) N. B.- T he prices of t he Standard M odels are sho wn i n
Ordinary Stre t cher , for General
a nd Briga de use, taking the place of both the old or dinary and military patterns
'Ielesoop ic-h andled St retcher for
working in con fi ne d spa ceil
Police S tre t cher, v ery strong, with Ash Po les, a n d pr ovid ed wi Lh L eather S t raps to secure a r efractory patien LComplete, with Wide W ebbing Slin gs " " L eather Slings
Slin,s, Wide W ebbing
Do. L eather
(or if pur chased wit h t he S Lr e t ch er instecLd of W ebbiug Slingil , 5/6 extra)
Cover for Stretch er H ood an d Apron (see itllt8tr a tioll, lmlJe 3)
Bed for Stre Lc her
A r my Rug t o cov er P aLie nL on SLreLc h er Pillow for S treLcher, SL uffed h tir
PRIOK LIST.
THE EQUIPOISE BED .
INVALUABLE FOR INVALIDS, CONVALESCENTS, AND THE GENERAL PUBLIC.
The movement of the bed to any position is so easily effected that the person lying on it can regulate the movement of the bed to any angle without assistance. It can be locked in seven different positions. Price from £5 J 5s. 6d.
FOLDING CAMP BEDS.
This can be folded in a very corr..pa s and can be readily eet up to form a oOO1fortable bed. Price 25s. ; case for same when folded, fitted with carrying strap , 5s. 6d.-
'Pocket Cork Line and Drag, with 80 feet of line, in c::ase. For recovering a drowning person from the water. Price comple te, with instructions for use, 61:' . 6d .
Pocket Reel and Ice Line for nse in ice accidents, with 80 fee t of line, in case. Price complete, with in s bru ctions for use, 6a. 6d.
PRICK
L 1ST.
" LOW MOOR JACKET."
For llse in mines, ships' holds, &c., to secure a. patient on-:a stretcher (see illustration) which can then be placed In an upright position. Price £1 5s.
WATER BOTTLE.
Sopper tinned, with carrying strap
Price lOs Od.
Enamelled Iron Water Bottle
Cloth with. tl a}J 51:> t'd.
LAMP.
This is fittcd with a socket; by which to fix it (,0 a Litter, or it can be conveniently carried by hand, or attached to a belt or the clothing.
rl'ic.:c complete, 5s. 6d.
Dressing Basin, kidney shaped, ma de of enam Iled iron. Price Is. 3u.
Knife with strong blade ... Pa.ir of Scissors ... . ..
e'1ch 9d.; per doz. 8s. each Is.; per doz. lOs.
Carrying Sheets for carrying patients up and down Rtairs or otherwise about a. house. De igued by J. C . Derham, E q ., Blackpool, and Mrs. Alfred Paine, Bedford. The sheet i. fitted with rope handles and detachable bamboo poles, and ma.y be placed on a stretcher without disturbing th e patient. Price complete 15s.
LAROE HAMPER FOR AMBULANCE STATION AND RAILWAY PURPOSES.
For contents se e next page.
THE CONTAINS
1 Set of Cane Splints.
1 Elastic Band Tourniquet.
Carbolic }
CoLton Wool ... Boric Lint .., .
1 Roll Adhesive Plaster.
20 Roller Bandages, assorted.
1 doz. Triangular Bandages
3 Tape.
4 oz. al Volatile.
oz. Bicarbonate of Soda.
4 oz. Olive Oil.
4 oz. Spirit Ether Compo
!-lb. Tin Powdered Boric Acid.
4: oz. Tincture Eucalyptus
B.P.C.
1 pair Pean's Forceps.
SMALL HAMPER.
With waterproof coyer and strap, fori u se in factories, collieries, stations, and large works, I1S well as for parochial and domestic use.
1 pair Scissors.
1 Knife.
12 • urgeon's Needles.
1 packet each afety and Plain Pins.
Carbolised Chinese Twist.
ilkworm Gut.
1 reel each Black and Wh i t l' ewing Thread.
1 Kidney-shaped Basin.
1 topper Loosener
1 Graduated Measure.
1 cake 20 per cent. Carbolic oap.
1 Nail Brush.
3 Empty oz. Bottles.
Price Complete £4.
CONTAINING
et plints. Ela, tic Tourniquet. 3 Tampons, for washing wounds. :2 Packets Lint. 4 Roller Bandages (wide and narrow). 4 Triangular Bandages.
Wool .. . . .. } In Tin Cases. Bonc vVool .. . . .. "pool uf Adhesive Plaster.
Knife, cissors, Thread, Tape, Needles, and Pins.
Weight complete,
Length, 1.ft. 6 in. Depth, 5 in. Width, 7 in. Price £1 lIs. 6d.
SURGICAL HAVERSAC .
IMPROVED PATTERX, fitted with a tin, so arranged that any article can be taken out without disturbing the rest of the contents.
Contents: 1 Set of Splints, 6 Triangular Bandages, 6 Roller Bandages, wide and narrow; Cotton \Y001, B ric Lint, in tin cases; 1 Roll Adhesive Plaster, 1 pair cissors,1 Knife,2 oz. Olive oil, 2 oz. Tinct. Eucalj1ILus, B.P.C., 20z. al Volatile, 2 oz. Spirits Ether Comp., 1 Graduated G lass leasure, 1 Elastic Band Tourniquet, Pins, Needles and Thread.
Price £1 11 s 6d.
White Linen Ration H aversl1 cs, Is. Pd. each.
N URSES' WALLETS.
ORDINARY PADLOCK SHAPE.
'Yithout instruments, 4s. 3d.
Fitted complete, containing Bow
Dressing Forceps, Spatula, Probe, 2 pairs Scissors (round and sharp pointed), Clinical Thermometer. and Knife.
Price 8s. 9d.
T. JOR "5 PATTERX, as illustrated, buL improved by the addition of flaps to protect the in truments.
"\Vithout instruments, 7s. 9d.
Fitted complete, containing Bow
Dressmg Forceps, Artery Forceps (also useful for dressing), 'patula, Probe, Director with Ear •'coop, pairs cissors (round and harp pointed), Clinical Thermometer (minute, round), Knife, Pencil, and afety Pins.
Price 21s.
FIRST AID BOX FOR" ASHFORD" LITTER OR AMBULANCE STATION.
This is primarily designed to be placed on the" Ashtord " Litter (1899 Model), but it is further adapted to be hung up on a wall. A detachable leather handle is 3,180 fitted for carrying purposes.
F or contents see next page.
PRICE LIST.
CONTENT/:) OF FIRST AID BOX. (Illustrated on previons page.)
Set of Woollen Splints; 1 Elastic Dand Tourniquet; Catbolic Wool, Boric Lint, ill tin caEes; 1 Roll Adhesive Plaster; 12 11 011er Bandage8, !l8S0) ted; 6 Triangular Bandages i 3 Pieces of Tape i 1 Pair Scisson 1 Knife; 1 Kidney·Shaped BaaiD; 1 Graduated Measure; 2 oz. Olhe Oil i 2011.. Tinct. Eucalyptns B.P.O. i I! oz ,al
i
6 First Field Dressing (.Army regulation pattern),
Wound Pad. This c:onsitils of a pad of cotton "001 and gauze, to WhICh a bandage is attached. By a clever contrivance the surface of the t,ad cuming 111 contacL ,\ith the \\ ollJ1d is noL touchetl by tbu hand of the pel','ull Cl pplying the pad. l:'l'ice .f(1.
SAFETY PINS.
All fa ten or unfastell on Fa.clle No. '600 or " 602 6():3
Duchess Duplex, No. :2 ,. A orted pecial Blanket afet,)' Pins, 3 ill. !D. either side. per:3 doz. doz. o 6
Ambulance Station Plate , Enamelled lrOlJ, :3 . 6el. each. Stretcher Depot Plate, Enamelled.Iron, fid. each.
22 PltICt<; LIST.
Nursing Chart, dcsigned by Miss Inderwkk, each. Temperature Chart, ea.ch.
Registers. Olass Attendance antI Oertificate (two to set), 6s.. Oase Report Is.
Large Physiological Diagrams. For Lecturcrs' use. Oomprising : The Human Skeleton, the Muscular, Arterial and Venous Systems, the Heart and Oirculation of the Blood, imp Ie Fracture, Compounu Fracture, Dislocations. Pric e, per set of six, 15s. These may be hirer! for a course of "First Aid" leotures, given under the auspices of the Association, for a fee of 5s., or with the addi Lion of , plints, Tourniquet, and plain Triangular Banchges, for a fee of lOs.
Boxes of Stationery for the use of Olass I 'ccrctn.ri es and others connected with the Association, containing twelve sheets of high-class-paper, suitably headed, and twelve envelopeR bearing the device of the Association. Pri ce 6d., by post 9d. Twice that quantity, price Is., b y post Is. 3d.
Medallions , issued in accordn.nce with special.regulations, for which see leaflet No. r*h, to be had on application. Coinage Bronze, 2s.; Silver, 7s. 6d.; Gold, £2 including engraving name and number on back. M orocco velvet-lined case, 2s.
Labels, to be placed auoye Medallions for each subsequent year's cxamination issued in accordance with regulation s, as pcr paper Ooinage Bronze, 6el.; Silvcr, Is. 6el. ; Gold, ] 2s. 6d.
NURSING INSTRUMENTS.
Bow Dressing Forceps , full size, Is. 3d.; small, extra well finished, Is. Gel.
Scissors, round-pointed, Is. 3u. ; sharp-pointed, for delicllt work, Is. 3d. ; small rounu-pointeu, blades take apart for cleaning, Is. 9d.
CLINICAL THERMOMETERS.
Round. Ordinary, Is. 6d. ; minute, 2s.; half-minute, 2s. 6d.
Flat. Str9ngly re?ommended as they wHl not roll. Ordinary , 2s.: rapId (speeH\1ly select (1 anu reserved for the Association), with very open scale, :39. 6(1.
Lense Fronted. 'When held in the proper position the c.olumn of magnified, and so easily read. A IS reqmreu to ascertain the correct position 111 wl11cb to hoW the instrument. Price oruinary, 2s .· minute, :28. 9d. ; half-minute, 4s. ' , Kew Certificates (to order), Is. ild. each. '.B.-These certificatcs either state that the instrument is correct or point out cWY slight error there may be; they are not usually consiuered necessary. and half-minute instrnments will only regIster 111 the tIme tated under favourable circumstances.
BATH THERMOMETERS.
To Dr. Forbes' specification. .JapannetI. with zinc scale 2s. :3tl.: Clinical Thermometer size, ill case, Is. 6d. ...Yo liaollity i, tal:en for breal.:aye oj Therm,om,eler.i in tran-it.
TEXT BOOKS, &c.
"FIRST AID TO THE INJURED." By James Cantlie, M.B. F.R.C. '. The authorised Text-book of the First Aid Course. Is.; by po t, Is. 2d. . -4 " OATECHI M OF I!'m T AID." Oompiled from Dr. Oantlie's Manual. By J. Brown, L.R.O.P., L.R.O .. , anu J. M. Oarvell, M.R.O .. , L. .A. Price 6d.; by post, 7d.
"HINTS AJ."<D HELPH FOR HOME NURSING
By E. Cosgrave, M .D., illustrated, with chapter on the applicatIOn of the roller bandage, by R. J. Collie, M.D. The authorizeu Text -book for the Nursing Course. Is., hy post, Jr ?ri.
Spatula,9u. Probe,9d. Director, with Ear Scoop, Is. 9d. Artery Forceps, 2s. 4.d. Knife, very thin, ivory handle, two Is. 9d. 23
FRIe!: LIST.
TEXT BOOK S, &c.-(co?ltinued).
"HOME HYGIENE." By John F. J. ykes, D.Sc. (Public Health), M.D., &c. illustrated. The authorised TextBook for the Home Hygiene Course, Is., by post, Is. 2d. "CATECHISM ON HOME NURSI",G" (based on Dr. Cosgrave's Text book). By J. Brown, L.RC.P., L.RC.S., and J. M. Carvell, M.RC.S., L .. A. Price 6d., by post 7d.
"QUESTIONS A.1"<D. A",SWERS UPO", AMBULANCE WORK." By John W. Martm. M.D, of heffield, and John Martin, F.R.C.S. Ed., of Huddersfield. Is., by post Is Id.
"QUESTION'S AND ANSWERS UPON NURSING." By John \Y. Martin, M.D. Is. 6d., by post Is. Sd. "FIltST AID TO THE INJURED (Six Ambulance Lectures)." By Professor Frederich Esmarch. Translated from the German by H.RH. Princess Christian. 2s.• by post 2s. 2d. "ELE"'1:E TARY BANDAGING AND ,DRES ING." By Walter Pye, F.RC.S. 2s., by post ZS. 2d.
DR.. H. DARWIN'S •• FIRST AIDS," bewg a card to hang uR, gn'mg treatment of various accidents. 2(1., by post 5d. "'1'0 THE ApPARENTLY DROWNED," printed in large Type Wlth Two Diagrams. Unmounted, each 2d. Mounted with red border, and varnished to hang up, 6el., post free: packed, Is.
" How TO ACT WHEN CLOTHING TAKES FIRE." By J. E. H. Mackinlay, M.RC.S. Unmounted 2d., by post 3d
Mounted on card and varnished, 4d.; by post, packed, 7d. "FIRST AID PRI!'rCTPLIl:R." Card of concise directions for waistcoat pocket, each 4d. per dozen. pecial quotations for large quantities.
,. SPECIMEN EXAMINATION PAPERS, First Aid and Nursing Course." 3d., by post 4d.
SMAL!-, ANAT?MICAL Showing the human skeleton, mam artenes, and pomts where pressure should be applied to arrest hleerling. 2d., by post :-3d.
PRICY. LIST. 25
TEXT B OOKS,
DIRECTIONS AS TO THE RESTORATION OF PERSON SUFFERING FRO 1 ELECTRIC t>HOCK. Large print, poster size. 3d. each or 2s. 6d. per dozen.
AIDE MEMOIRE. On cardboard, in linen-lined envelope, for the pocket. By the late Surgeon-Major P. Shepherd. Containing useful hints for First Aid to the Injured. 3d.; by post 4d.
GENERAL NOTXS ON FIRST AID TO BE RENDERED IN CASES OF POISONING. By Milnes Hey, M.A., M.RC.. , L.RC.P.
Price 2d. ; by post 3d.
NOTES 0:;\ MILITARY SA "\;"ITATJOS. By Lt-Col. H. P. G. Elkington, KA.M.C. Price Is. ; post-free Is. Id.
"EMERGENCY BOOK," for instantaneous reference, glvmg concise instructions, to hang on wall. Size about one foot sqllare. Price 2s. 6d.; by post 3s.
A HISTORY OF THE ORDER OF THE HOS· PITAL OF ST. JOHN OF JERUSALEM. By the Rev. \V. K. R BEDFORD, M.A., Genealogist of the Onler, and Lieut. -Colonel R H. HOLBECHE, Librarian of the Order. In one Vol., Demy vo., 23G pp. Profusely illustrated.
Price 7s. 6d.; by post 7s. lOd. A limited number of copies, injured by damp, can be had at 2s. 6d. each; post free, 2s. lOd.
THE KNIGHTS HOSPITALLERS IN SCOTLAND, AND THEIR PRIORY AT TORPHICHEN. By
lh:uXOE THOMAS BEATSO;-;, M.D., C.B. With 15 pages of illustrations. Price 2s. 6d., bound in cloth, Post free, 2s.8d.
ROLLER BANDAGES.
(6 yards long).
Open Fine Grey Calico, Best quality, Wove or Superior wbite, witb Grey. Wbite Open Wove. woven edges.
i in., per doz.
1 in. in.
Z in. in.
3 in.
4 in.
6 in.
ROLLER BANDAG ES in Assortment.
Each packet contains 6 bandages as follows;-
6 yards long-one 6-inch, two 3-inch, one I-inch; 4: yards long-two 2}-inch.
Fine Grey Calico ... per packet
Plain Triangular Bandages per doz.
Illustrated Triang ular Bandages (after Esmarch), showing 21 applications of the Triangular Bandage,
with printed instructions ... each
ROLLER BANDAGE M.ACHINE.
Designed bY,Dr. A£Tlll1stall. Price 2s. 6d. COTTON WOOL
. White absorbent, good, 1 oz. packet, 2d. ; 2 oz. packet, .M. ; 4: oz. packet, 4:u. ; lb., 7el.; 1 lb., Is.
Boracic, per lb., l!'l. Bel.; Carbolic, per lb., Is. 8d.; Alemhr0th, per lb., Is. Bd. ; Double Cyanide, per lb., 2s. 6d. LINT.
:\Iedium quality, 1 oz. packet, 2d.; 2 oz. packet, 3d.; 4 oz. packet, 6d. ; lb. packet, lOd.; lIb. packet. Is. 6<1. ; Boracic, 1 lb. packet, Is. 6tl. ; 4 oz. packet, 6d.
These are supplied inches.
Unmedicated white ... A lembroth
Double Cyanide Boracic GAUZES. in 6 yard lengths, width 'about . 8. d. per length
GAUZE TISSUE.
A layer of absorbent cotton wool between two sheets of game good quality, per lb., Is. 6el. ; superior, per lb., 2s.
2' f'HllJE Ll ·T.
PLASTEI{S.
"Manufactur ed by Messrs. A. De t. Dalmas'& Co.
Leicester Adhesive Plaster 1 011 Cambric, in tins of s. d.
y ard , 6 inches wide U 6
' I he Leicester Adhe. iye
RiLbou, ill tin boxes, 6 yards long. inch \due ... 6d. 1 ineb wide... J.
N ational Rubber Adhesive Plaster (Antiseptic).
gn spools.
5 yds. 10 yd'.
inch wide 9d. Is.
I Is. Is. 6(l.
2 Is. 9d. 2".3J.
Ditto in card box, i in. wide, i yds. long
tin 1 ! I .... H 3 5 "!,, 5"
COURT l'LA TER, Tt<.ICOLOUR.
Large ::5ize, gel.; Medium, 5d.; mall, :3d.
Arm Badges , with the device, issued under the authority of the Central Executive Committee, having been approved by H . R.H. the Grand Prior as the offiCIal (I.ncl recognized Badge of the As ociation and BrIgade. lo,·.B.-ThIS desigl' 1I lJl·otl'cted. ani ntllst /.e ohtalH6d. dil'ect trom the CentraL OlficG.
No.1, for the use of inelivirll1a.1 certificated pupils- s. d. In German ilver ... ... ... ... ...
In Cloth and ilk ...
In Cloth and ilver (Registered Number, 3,.)2'J) ...
In Cloth and Worsted ... 0 6 mall Celluloid Badge for button hole, arm, or brooch ... ... ... ... ... .•. 0 2 \V hite, Ltin with woven Badge ... ... 0 7!
J.V. B . - ·fh e.se H ."dae.s ure not t o be lUorn decorations.
No.2.
No.2, for members of the St. John Ambulance Brigade, having the name of the Corps or Division annexed on a label, only issued in quantities-
In German Silver, first doz., £1; subsequent dozs., 12s.
In Electro Plate, first doz., £1 12s.; subsequcnt dozs .• £14s.
In Cloth and ilk, per doz., 12s.
In Cloth and ilver, per doz., £1 lOs.
All the above may be worn by members of the t. John Ambulance Brigade not uniform, and the Gecman Silver and Electro Plated ma.y be worn as tile Arm Badge for all ranks on the Brigade Uniform.
PltIC& Ll T.
BRIGADE UNIFORM BADGES. Officers.
Collar Badges (Registered Number, 3,524) per pair
Pouch Badge (" ,,3,657) cach Sergeants.
Cap Badge (Registered Number, 3,520) each
Arm Badge ( " ,,3,523) "
Fatigue Cap Badge for Officers and Sergeants (Registered Number, 3,55 )
Corporals and Privates.
Cap Badge (Registered Number, 3,5'21) each
Arm Badge (" 3,542)
Overcoat Badge ( " ,,1,582)
Field Service Cap Badge for all Ranks
Lady Officers of Nursing Divisions.
Superintendent's Cloak Badge (Reg. No. 3,658)
Superintendent's Arm Badge ( 3,659)
Other Nursing Officer's Cloak Badge ( 3,555)
Other Nursing Officer's Arm Badge ( 3,656)
Nursing Sisters.
Arm Badge (Registered Number 3,522)
Cloak Badge ("" 3,521)
Honorary Surgeon's ilver Wire Cross (l'attern B)
Superintendent's ilver 'Vire •'tar (pattern A)
Medallion Badge (pattern D)
Nursing Badge (pattern E) ... ... ...
Satin Badge for Nursing. 'isLer's Pin Cushion
Whistle and Chain ... ... ... ... each
Field Service Cap, complete... ... . ..
Private's Brown Waist Belt and Pouch "
White Piping, per Packet of yards, enough for 3 pairs of trousers (packets cannot be broken) ...
Lace, ilver per yard
Black... " (A Cap Band generally runs about 24
PRICE LIST.
BUTTONS FOR THE UNIFORM OF THE ST. JOHN AMBULANCE BRIGADE.
leaued only for the use of Officers and Members of Corps and Divisions wearing the prescribed uniform.
Plate, large ...
ELECTROTYPES OF THE ST. JOHN AMBULANCE DEVICE.
el-ies A. Series B for for AbbUclatioll. B ri?lide
No. 1. For Cards, Tickets, &c.
2. For Note Paper, mall Cir(;ulars, &(;.
I, 3. For Quarto d Foolscap Letterpaper, Circulars, &c.
" 4. For Small Posters
" 5. For Large Posters
Complete Series
Prints of the above electrotypes, with the exception of No.4, which is showu ;on page_29, appear on the 1011u\\ illg )Jcl.ges.
ELECTROTYPES.
EoI' prices see page 32.
ELECTROTYPES.
No.5 A. . e page 32. For prlCes be
BRIGADE FLAG.
For marking the position of Ambulance Stations at Fetes Exhibitions, &c., 4 ft. in. by 3 ft. Price 12s.
LiSWAGGER STICKS
for the use of Officers and Members of the St. John Ambulance Brigade.
Ebonised Canes, German ilver Mounts bearing the Brigade Device.
Is. KACH.
All Orders for the foregoing Stores should be:g iven to the Local Secretary, or to the stores Department, St. John Ambulance Association, St. IJohn's Gate, Clerkenwell, E.C.
These may be obtained direct from Messrs. Hebbert and Co., 35, Bethnal Green Road, E. Telephone No. 909, London "Wall; Telegra.phic Address, "Otherwise, London."
SURGEON AND HONORARY
SUPT. AND O'l'HJ-:R CHIEF OFFIOERS. Tunic (Badges extra)
Patrol Jacket (Badges extra) ...
Fatigue Jacket (Badges extra) .. .
Trousers: Two-inch Mohair Braid down side seams ...
Cross-helt, White Patent Leather and Black
Morocco Pouch (Badge extra) Forage
Mohair Braid
Cross-belt, 'Vhite Patent Leather and Black
Morocco Pouch (Badge extra)
Forage Cap and
38 LIST.
MESS DRESS FOR. OFFICER.
Jacket (Badges extra)
Vest
1ST CLASS SERGEANT.
Patrol Jacket (Badges extra) ...
Chevron, 4 bars ilver, 3s. 6d., 'Yorsted
Trousers
Forage Cap (Badge extra) ..
Cross-belt and Pouch (Badge xtra)
Field Cap (Badge extra)
Buckskin Gloves
(Chevron and Badge exLnl.)
SERGEANTS, CORPORALS, AND RA::\K At-D FILE.
Patrol Jacket, Black Tartan (Badges ex tra)
Sergeant's Chevron, 3 bars, Silver, :2s. 6e1., 'Vorsted 0 1
Corporal's 2 bars, Silver, Is.' d., 'Yorsted 0 0 CYCLISTS- SUPERINTE>ND ENT.
Patrol Jacket (Badges extra)
Cap (Badge extra)
Breeches: Grey Serge Shoulder Belt and Pouch Gloves .... Gaiters
PRIOE LIST.
CYOLISTS-RA.NK: ANn FILE.
Jacket extra) .. .
Cap (Badge extra) .. .
Breeches: Grey Serge ...
Shoulder Belt .,. . ..
Gloves (per pair)
Gaiters (per pair)
All Badges to be obLainei by the Corps or Division from St. John's Gate.
If the Corps or Division is out of Vmdon, me:1surements to be supplied to contracLors free of charge. I
Carriage out of Lon(lon extra.
lXDEX TO PRICE LIST.
Aabulance Hampers 15, 17 " Station Plate 21
Bll.dgee ... ... ... ... 29, 3t
Bandage Rolling Machine... '27
Ba.ndages .. . 26
Baein. Dressing 14
Bed, Equipoise 12 " Camp ... 12
Books ." 23, 25
Bottles (Wll.ter) 13
Buttons ... 82
Carriages (Horse Ambulance) ... 2
Oa.rrying Sheet 14
Cotton Wool .. .. 27
Cover for Stretcher or Litter 12
Large 22 "Sma,ll 24-
Ilrelling Ba.sin 14
Drowning Tackle 12
Eiecttotypes ... ... 32, 35
Emergency Book ... 25
First Aid Box 10,20,21
Firat Field Dressings 21
Fla.gl ... 36
Ga,uzes ... ... 27
GiLuze Tissues 27
Ha.lII.pers (Ambulance) 15, 17
Haversacti . .. ... 18
Hoed &ndApron for Litter... 4
Jaoonette 21
KDile
Laoe ... 31
toamp ... 14
Lint 25
Lowmoor Jacket Medallions .. .
Nurses' Wallets
Litter (Ashford) :.:, 4, (Rea-Edwards)
5, 7 13
Nursing Char ts "Instruments 22
Plllows ... 11 Plasters ... :.!8
Registers ... .. Roller Bandage Machine 27 Rug 12 Safety Pins 21
Scissors ., ... H
Slings, Stretcher 12
Splint Padding 20
Splints ... 21
Stationery ., ,., 2:l
Stretcher Depot Plate 22
Stretchers :::. 8, 11 Adjustable for 10
Swagger Stick .,. 36
'£tlmverllturtl Ollart 22
Text Books ... ... 28, 24
Thermometers 23
Tourniquets 2l
Tow, carbolized 21
II plain ... 21
Uniform ... 29, :j1
Uniforms ...:;7, :w
Wa.gona (Horse Ambulan ce) 2
Water Bottles ... 13
Waterproof Lint 21
Wa.terproof Sheet 4
Whistle a.nd Chain 31
Wool (Cotton) ... 27
Wound Pild :ll
