O.S.J.J. Annual Report, 1874

REPORT OF THE CHAPTER (j[<'

IN

THI':

ENGLAND,

ON ST. JOHN

BAPTIST~ S

DAY.

\(/

~~'!d ~ REPORT OF THE CHAPTER '>1,'

~be

®rl1rr of

~t.

3j'obn of 3j'erlttlalcln

tn Qenglanl1. o

T

ST.

J0 I I N

IL\ P TIS T 'S DAY, IS 7+.

LONDON: IIARH.ISO AND SO . S, ST. l\L\PTL 'S L\NE llrinlw; in Q)rbinar!l 10 l!i rr ~lbi r ~ tl.l.

TIlE CIlAPTER SUBMITS TIlE FOLLOWING REPORT TO TIlE ANNUAL ASSEMBLY.

ADDITIONS ON THE ROLL, TO ST. JOHN'S DAY, 1874. lff~rbi1lirt'

] .\:'fES

TORY,

i.A.

of j}usticc.

I7' Brya.nstone Squa7'e, and Carlton Club.

{

May 5.1874.

lLal1!?

E"rILV AXXE, VI COUXTES '} STRAXGFOP D, l\XD BAROXES: 10, Chapel Street, Pa1'k Lane, PEXc.;lIURST. L07ldon. <iI~cbilHcr

Aug. 8, 18n

~rllce.

of

ILum.\' BLAIR, Ll\TE CAPTAIX} 38, U1lion 3RD REGIMENT . . . .

S. TV

Grove,

London.

TOV

18.1873.

<iII)aplain to ~e manTrA? ctrllstIe ctrommanl1ctJ!.

P E\T. Tno:\IAs WILLIAl\I WOOD. {Rlt)ldd

Sevenz.

Court,

Upton - on -

l\fay 5. 18 74.

mOllOtat'!~ <l.t~ebalier.

PI IILIPPE CO~ITE DE CHASTELAI ,some time Secretary to the Commission of the French Langues, and one of the D elegate for the Revival of the English Langue.

1Qolloraru

18, r8n

~s5ociatts.

\VILLL\l\I JA?lIE BURY } l\1cLEOD MOOI' E, LIEUT.COLO:\EL. . . ..

PAULT IA GRA VILLE

;:-J'OV.

Lapraz're, P1"ovz'lzce of Qucbec, Ca II ada.

:--Iay 5. 1874.

162, Fz'llborouglt Road, Rat-

M:lY 5, ISH

{

cliffe Gm'dc71s.

Iaonats.

GEORGE DIGBY DIGBY .

V.?VI. IG.FIE. LD} Shcrbornc Castle, Dorset.

MARY A I ROBERT' 13, Brz'ta7l71ia Sq., TVorccstcr.

JAMES Dv ON PERRI s, F.R.A.S. Davc1llw7lt Ban!.:, lIfaZ,uerll.

IDrl1t~.s.

THE HONORARY BAILLI ROBERT BIGSBY, LL.D. TIlE HONORAR\T ASSOCIATE ROBERT BRETT, l\1.R.C.S. A 2

Feb. r7, ISH 1\1:\)'

1S7.1

REPORT.

TlI L Chapter have much pleasure in reporting the resumption )[ the office of Chancellor by Sir John Philippart, who had previously filled that office for some years immediately subsequent to the revival of the English Langue.

His advanced age prevcnting him from attending the Chapters, Lieut.-Genl. Sir John St. George, K C.R, has, at the request of the Chapter, undertaken to act in hi behalf.

The resignation of the office of Assistant Secretary by 1\Iajor Burgess, is a source of sincere regret. His experienced and energetic services have been of great value to the Order, and have becn acknm\ lcdged by the special thanks of the Chapter. lIe still retains the post of Almoner, which it is hoped with the a~sistance of a Deputy Almoner, he may continue to hold.

Captain Blair has succeedecl Major Burgess as . .-\.ssistant Secretary.

Two of Oll r cOllf1'l\rcs have been removed from amoligst us by death, Dr. Bigsby and 1\1r. Robert Brett.

At a time when the English branch of the Order was, so to say, in abeyance as far as any signs of activity were concerned, Dr. Bigsby was zealous and energetic in his endeavours to promote its activity, and to make it known by his literary efforts.

IIis information upon every point relating to the history of the Order and the progress of the English LangtIe, from the period of its revival, was most profound and accurate.

It was in a great measure due to him and to the late General Ramsay, that an interest in the Order and the proper position of the English Langue was sustained.

6

7

Noone would have been more interested in the schcme in which we are now engaged-that of forming an Association for providing trained nurses for the sick poor-than our late lIon. Associate, Mr. Brett. Noone would have more gladly aided us with his valuable experience on this su bject, and his death is a real loss to the Order, which felt proud of numbering among its Associates one whose whole life was a realization of our mottoes, Pro Fide," "Pro Utilitate H01lli1tlt71l."

the Order) to look after, and convey it to the scene of accidents.

Ie

The Chapter refer with pleasure to the result of the efforts made by Drs. Sieveking and Rumsey at ollr Annual Assembly last year, to plac before us, and through us before the public, the great want of properly trained nurses for the poor. The Committee then appointed for the purpose of considerrng the subject, after careful deliberation and enquiries address( d to a large number of nursing institutions, issued the Report \vhich has been widely circulated, and which has laid the foundation for the important effort which is now about to be made to bring the subject more prominently before the public. It is hoped that every member of the Order may use exertion to promote the object of the meeting which will take place tomorrow. * An Ambulance system for the mining and colliery districts, the establishment of which has long occupied the attention of the Chapter, has been commenced, and has been already highly appreciated.

After consulting Mr. Manley, U.Q1 , and Professor Longmore, the Chapter decided upon purchasing two of the wheeled litters similar to those used in the Franco-Prussian \Nar, made by Messrs. N euss, the Royal Carriage Builders, at Berlin. One of these has been stationed at Burslem, in Staffordshire, in the centre of a large population employed in the coal mines and potteries, where, through the zealous exertions of our cOllfrere, Colonel Shaw, a local committee has been formed, who have undertaken the entire expense of housing the ambulance and maintaining it in repair, as well as the pay of a Serving Brother (who, when on duty, will wear a (( brassard" with the badge of

* A Report of this Meeting, which took place at Willis's Rooms, under the Presidency of Sir Rutherford Alcock, KC.B., has been printed and circulated, and a copy has been sent to every Member and Associate of the Order.

The following resolution, unanimously adopted at a Meeting of the Local Board of Health ,at Burslem, on the 3rd of June last, has been transmitted, through Colonel Shaw, to the Secretary:II Resolved-That the Board cheerfully undertakes to provide accommodation in the Town Hall for the ambulance litter) which has been provided for the town of Burslem by the Order of St. John of Jerusalem, and, on behalf of the inhabitants, thanks the Order for what they feel assured will meet a great want in a district where mining and other accidents are prevalent."

The charge of the ambulance, and its direction in case of accidents, has been placed by the Local Board of Health at Bllrslem, in the hands of their IIall Keeper, Mr. Hiram Syson, late Corporal in the 57th Regiment, who was for some time a hospital orderly when serving in the Crimea. It is recommended

by Colonel Shaw that he should be appointed a Serving Brother of the Order.

The other ambulance is destined for vVolverhampton, where 1\1 r. (J lldge) Rupert Kettle, a gentleman well known for his philanthropy, has undertaken to make himself responsible for all expenses of maintenance.

An application for a litter has been made by the workmen at Lord Granville's Iron vVorks, at Shelton Bar, in North Staffordshire, through Colonel Shaw, and they offer II to guarantee the sum o[ [rom eight to ten pounds, or any further sum, to keep the litter in perfect order, and to provide bandages and other necessities which may be required."

It is proposed to order six more litters, ann to make, if possible, a permanent arrangement with Messrs. euss, by which the Order hope to secure the sole privilege of supplying the litters in England, so as to prevent their being copied, and improperly made.

The Chapter will then be able to send any number of litters to localities requiring them, at a cost not exceeding £14 each, reserving those supplied from the fund, so liberally bestowed by Mr. Manley, for those places where there is, or is about to be, a local organisation of the Order.

The general superintendence of the ambulance departmell t

The number of diets is<;u<.:d was as follows: Charing Cruss II ospital ca<)es 8 r dids 7Sg King 's College J Iospital 5 3 " Gg<)

has bcen cntrustcd by the 'haptcr to Mr. l\T all ley, "Ill) has PI' 'parcd a short code of dircctions ', to those cnga~)' '<.1 in lI"iing them, for thc transport of inj urcd or sick perso11s, "hich \\ i II be scnt "'ith cach liller.

Connected \\jth thc ambul.lIlce !:len icc, is a propos,t\ to cstablish a system of rcwMds for bravery in sav ill"· Ii fc iI) accidents ill mincs and collicric"i. Sir E. Ll'chmcre lu. (lIT,\" '<1 the dic for a suitahle medal, and has c()nsultcd thc Earl or Dudley, a large colliery proprietor, who highly ,1ppro\'cs of till. ambulancc system, and belie\'cs that \\ Ih:1l that i gCl)c\",tlly carricd out, the pl<111 for gi\'ing the honorary mcd,tl \\ ill \ er} properly follow.

An oflcr of a considerable sum has becn madc by one of the Ladics of the Order, \Tiscountes: Strangford, in aid of the establishment of a small hospital, or similar institution, undcr the auspices of the Order, at Damascus, and a committec has been formed to consider the subject. There arc 'i0J111. difficulties attending the question, notably those of securing suf-ficient funds to supplement Lady 'trangford's noble nfCel', and the absence of any sufficient means of control at ~uch a distance from England.

At the same lime, it seem most dcsirable that the opportunity of establishing the Engl ish Br~111ch of the Order in Palestine should not be lost, and the committee \\"ill no doubt continue their enquiries on the subject, and \\ ill report to a future meeting.

During the rear ended yestl:rclay, the system of issuin g nourishing food to poor convalescents, out-patients of the Charing Cross and King's College IIospitals, \\'ho are recommended for that benefit by the Medical Officers of those Hospitals, has been carried on as in former years, and with similar satisfactory frsults. The experience of the Superior and Sisters of St. John's House, 1\ orfolk Street, in all matters relating to the sick IJoor, and the kind eare and attention with which they have brought to bear upon the object which the Order of St. John has in view in this branch of its organisation in London, tend in a great degree to the satisfaction with which the Order is enabled on each succeeding anniversary of the Festival of the Baptist, to look back upon its past year's work. .. These are, " Directions for the use of the \Vheeled Litter," as well as a second papcr of " Directions which it will be useful to carry out in the case of an I njurccl ] 'crson lJefore Surgical Aid is procurred."

Total cas<.:s 134 di<.:ts 1,477 The toted cost of diets, £75.

Averag<.: cost of each. IS. Id. The rep()rt of the \Vorcestcrshire Commandery to the 31st ()f ])ecemlxr, 1873, shows that the work of this Commandery in <lid uf convalescent patients of the Worcester Dispensary, still pruceeds with advantage, and has produced most beneficial results in th e direction which the Commandery has intended.

Tile estimation in which this branch of the work of the Order is held by the local authorities, is shown by the following extract from the P eport of the Committee of the Worcester Dispens;uy for the year 1873 :"Your Committee hav<.: again to express their gratitude to the Order of St. John of Jerusalem for continuing the supply of diets to the convalescent patients.

These diets, which are supplemented to a small extent from the funds of the DispLI1Sary, have been found most beneficial in accelerating the perfect recovery of the patients, and thus restoring them more speedily to their usual avocations.

"The Order of St. John has also generously placed at the disposal of the Dispensary the valuable services of a qualified nurse, to visit at the houses of such patients as may require her assistance; and the IIouse Surgeon reports that already manifest good has resulted from these services."

The following is a table of the issue of diets for the period since last report : , ~

8

II

19

28 7

45

6

I

oJ.{

29 Sept.

5

II

16

434

67

II

I

I

25 Dec.

I 10

10

20

497

69

8

1 oYz

25

25

58+

83

8

0

27 10 6

,---~ ~E

~

1873

" I

l' I

" 18 74

I

-I

Quarter ending.

24 June

25 Mar.

10

IS

1- ~ .

I

g." ~£

10e,] I)let~.

l'Ifaximum \\'ccks' I{clief.

"'eeks repre~l:nteu.

Cost per Diet.

Total Cost.

--1-1 s.

tI.

I I I~

£

s.

tI.

14 13 0

32 10 2 IS

7

I

The experiment of providing a trained nurse [or the benefit

10

II

of the sick poor, has been successfully tried in connection with this Dispensary, and the Commander reports that the help such services afford cannot be over estimated, whilst there has been ample proof that as a sanitary agent the nurse of the poor may not only alleviate the sufferings of the sick and promote their cure, but may actually check the commencement of disease by drawing attention to those defects in the means of drainage and proper ventilation, and that neglect of the most ordinary precautions and rules of health which are so frequently its most fertile cause.

The ambulance litters obtained from Berlin have been on view in the City of Worcester, and have excited considerable attention. Many enquiries have been received from the adjoining colliery district, and in some instances personal visits of 111spection have been made by colliery owners.

Our confrere, Mr. John Furley, Honorary Secretary of t.

John's House, Ashford, is at present engaged in tending the wounded in the deplorable civil war now going on in Spain, but the following statement from the last Report of t. J 011l1's House will show the amount of work which has been done there-

respect what could be wished, it is not likely either to be devoted to more ignoble purposes, or to be alienated from those associations with our ancient predecessors, which, in spite of modern vandalism and utilitarian changes, cluster so thickly around its precincts.

" Since the Hospital was opened on the 1st January, 1870, :24:2 cases haye been treated within its walls, namely, 49 in 1870,57 in 1871,69 in 1872, and 67 in 1873. But in order that these figures may be properly understood, it is perhaps advisable to call attention to the time the patients remained in the House, the total being 1,944 days, with an average of:29 days to each of them."

The Chapter could hardly close their Report without alluding to one subject for congratulation, the acquisition of the ancient Gate House at Clerkenwell, the building in which we are at present assembled, by a Member of the Order, who has at some personal sacrifice ti.chieved the long wished for recovery of this ancient possession of the Knights of St. J o11n. The Chapter had no hesitation in accepting the offer of a room in the building for the purpose of a Chancery, feeling that though at some distance from the West End of London, the interest which attaches to this relic of the ancient possessions of our Order, would amply compensate its members for any inconvenience.

It is to be hoped that at some future time the Order, as it increases in numbers and influence) may be enabled to become the purchasers and actual possessors of this venerable building, but in the meantime it is satisfactory to feel that it is in safe hands, and that though its present application is not in every

(Signed)

EDMUKD A. H. LECHMERE, Secretary.

OBSERVATIONS 0 :\ T H E

PRELIMINARY CARE AND ATTENTION TECESS.t\RY FOR ACCIDENTAL BODILY INJURIES AND l\IUTILATIONS OCCURRING IN MINES AND ESTABLISHMENTS WHE RE MANY

WORKPEOPLE ARE

EMPLOYED.

R\

SURGEON-GENERAL T. LONGMORE , C.B., l k/l(lrill)' Sm:t:i.'O/l to I lt:r lIfajesty; H onorm), Asso(1'ate o./Ihl' Order (If St. J(lh/l (If J erusalem 711 E llglaud; P r(lfi:ssor of lIlililary SIf7:r:o)' //1 thl' Army lII ed/L'al Srh(lol, dr. , I'it"., etc.

READ AT THE ANNUAL GENERAL ASSEMBLY OF THE ORDER OF ST. JOHN OF JERUSALEM, HELD L T 1.0 DON ON ST. JOHN BAPTIST'S DAY r874.

OBSERVATIONS ():'\ TIlE

Prc//millc7I)1 Care alld AlludiOIl llecfssary f or Accidmlal B odil), Injuries alit! jJilft/lat/olls ocmrri7lg ill MillfS alld Esfablisl11llfllfs 'where Illa/l) ,

TVorlpeople are Employed.

:\'Iy L ORDS, LADI ES) GE TLE:\1E T-H o PITALLERS)

The Secretary of the Order) Sir Edmund Lechmere) who appear not to be satisfied with the good works he is already engaged in) but to be constantly on the look out for fresh opportunities of exertion pro 'lttilitate h011Z£7'l?t11'Z) has asked me to furni sh a short paper on the care and conveyance of inj ured persons in peace time) with particular reference to the Mining and Colliery Districts where accidents are frequent. In obedience to that request, I beg to submit the following notes) merely prefacing them with the remark that I have taken tlte liberty of considering the necessities of injured persons) not only in mines and collieries) but in all situations where bodies of people are collected together under conditions which render them liable to meet with grave injuries requiring hospital treatment.

In every establishment in which many persons are employed) and in which the nature either of the occupations followed) or of the machinery in usc) entails risk of accidents and injuries) there ought to be some arrangements made beforehand for dealing efficiently with these casualties should they happen to occur.

The necessity for such a provision is all the greater in proportion to the distance at which the establishment is placed from a hospital) or from skilled surgical aid. But even 'when profes .. sional aid is not far off) the means of affording immediate preliminary help ought still to be provided; for this preliminary

16

h21p in many cases will materially lcssen thc ill cOl1:-,equcllce<., ()f an accident, and in occasional cases will bc the means of saving lives which, without it, would be lost before the patients could be placed in a hospital, or professional assistance be brought to the patients.

The organisation for providing the necessary attention in accidents entailing bodily inj uries should be simple and inexpensive in character, and, like the means for extinguishing a fire, should be so contrived as to ensure that, whatever provision is made, it shall always be at hand and be in working order.

The organisation should be simple and inexpensive, because, if so, it is more likely to be generally adoptcd in mining, manufacturing, and other such establishments: it should ensure thc means of help being always at hand and ready to be applied, because no one can say beforehand at what moment the need for their application may occur.

In order to carry out the last named requisite the provision for administering the first help must be within the establi hment concerned, and must form part of it. If placed outsidc the establishment, no dependence can be placed on the help provided being forthcoming at the moment it i urgently required.

The provision to be made must include certain material means of help, and certain perso7lal means of help. To carry out the analogy with the arrangements for meeting the accident of fire, just as these ordinarily comprise a supply of water at hand, and the necessary mechanical appliances for conveying and applying it to the place where the fire breaks out, and just as there must be on the spot persons knowing where to find these appliances and how to use them, so, in cases of bod ily injuries, certain protective and supporting materials must bc on the spot for use on these accidents occurring, and certain persons capable of using them in the requisite way. But the analogy ceases with this general resemblance. In the case of fire, if the maCefld.l llleans are well devised and well disposed, anyone WI10 possesses sUI11C1ent bodily strength can give valuable assistance in applying them to meet the existing exigency. Not so, however, in bodily injuries. These vary so greatly in their characters, they are always of so delicate and complicated a liature, that though the requisite material provision may be at hand, persons not acquainted with the proper mode of applying it, may, if they attempt to put it to use, do no good, and indeed

17 in some instances may do so much mischief that the patients would have been better without the interference. In short, to meet cases of serious bodily inj uries, it is not enough to provide the needful material means of help, but the persons on whom the application of these means will devolve must be trained to apply them.

I will not attempt to mention the various ways in which early assistance in cases of severe bodily injuries by persons having a certain amount of needful knowledge may be of essential, even vital, benefit; nor the various ways, on the other hand, in which ignorant, though zealous and kindly intentioned, interference may entail serious mischief on the disabled recipients. It would require time to enlarge on the topic, and I take for granted that most persons are sufficiently acquainted with the general truth, that immediate attention is required in all grave bodily hurts, but that, when given, whether it does good or whether it does harm will depend upon the manner in which it is given.

The following questions then arise : I.

2.

What are the material means of help which should be provided?

Who are the persons to be trained to use them?

3. What training should these persons receive?

I will try to furnish replies to these three questions in succession.

First,

~Vllat

material means of Izelp should be provided 't

These must consist of (a) some materials for dressing woun'ds, and contrivances for the protection of the parts injured; (b) a few instruments for special purposes or for general use in injuries; and lastly, (c) some kind of conveyances for removal of injured persons to their homes or to hospital.

In considering the particular articles that should be provided under these three sections, it is to be borne in mind that ONly provisional treatment and protection are contemplated, and that this preliminary treatment is to be afforded by persons whose knowledge and experience will be of comparatively a very limited character.

The nature of the injuries which persons engaged in special occupations are liable to must also be taken into account. If the occupation be such as to cause the occurrence of extensive B

IS

burns to be not improbable, obviously the materials for dressing such inj uries should form a large proportion of the provision under the first section. If it be such that severe lacerations by machinery or cutting of limbs by sharp instruments are to be feared, the dressings provided will principally consist of those necessary for the first care of wounds. If it be such as not improbably to cause fractures of bones from falls or crushing violence, an ample provision for the protection of the inj ured parts against aggravation of the original inj ury until they can be placed under the care of a surgeon will be necessary. These modifications in the arrangements must be made when the provision for particular establishments is being settled.

As, however, in every undertaking in which many workpeoplc are employed, such as a mine, colliery, large factory, or a steammill,* accidents of anyone of the kinds above named may occur, the material means of help provided should include the necessary primary dressings for all such inj urics. These primary dressings, whatever their nature, should be as few in number and as simple in character as possible.

The following list will probably include all the materials and instruments that need be at hand under the first two sections (a) and (b) : (a.) Materials for first dressings and appliances: lint, triangular bandages, carbolized tow, cotton wool, splints. (b) Instruments: Tourniquets, hospital attendants' dressing case.

The quantities of dressings provided need not be large, as in the fixed establishments of civil life they can be readily renewed when expended.

The splints for the protection of broken limbs should be of a simple kind, easily applied, and accompanied with plain directions for their use. The splints, to which the name of Moffitt's battlefield splints" has been given, would perhaps prove the most suitable for the circumstances contemplated.

The tourniquets under section (b) should also be of a kind easily applied, and such as are not likely, though their use may be long continued, to lev.d to inj urious constriction and conges(I

*

In docks and very large establishments "where accidents are liable to occur frequently, there ought always to be a surgery complete in surgical appliances and materials, and a surgeon on duty during the hours of general work. The remarks in this paper refer, howevcr, only to establishments where there is no resident surgeon.

/

tion of the limbs upon which they arc placed. The tourniquets known as the \Vinged Screw Tourniquets would be the best lIited for the purpose.* The dressing case need contain but few articles. A surgeon's pocket-case, containing cutting and other special surgical instruments, would be quite out of place as part of the provision to meet the needs contemplated. The army hospital attendants' dressing case, arranged by the Surgeon who designed the [.r acture splints just now mentioned, contains the following articles, and they are all such as are usually required when bodily injuries ha\'e to be attended to in numbers together: ( I) strong clasp knife, suitable for cutting up boots; (2) strong scissors, suitable for cutting thick clothing, &c.; (3) pins; (4) needles; (5) thread; (6) forceps.t The third section includes the conveyances for the removal of injured persons to their homes or to hospital. These will probably vary to some extent according to the distance and the nature of the ground that has to be passed over before the homes or hospital can be reached, and to the kind of vehicle in ordinary use in the locality concerned. As a general rule it cannot be expected that regular wheeled ambulance carriages constructed for draft by horses will be available for such purposes in civil life. Ambulance conveyances that can be moved and managed by a COLI pIe of men will be more generally suitable. If the distance be not far, nothing is better than carriage on a handlitter or stretcher; but it is essential for the comfort and safety of patients that those \vho act as bearers of such conveyances should have had preliminary instruction and practice in the mode of carrying them. As a kind of conveyance that can be managed with comparatively little training, and that combines moderate cost with general suitability for the removal of sick and \\'ounded persons, that can be easily wheeled over e"en rO<lcls by one man, and ea ily carried O\'er a ditch or other obstacle by a couple of. men, I have generally recommended N eus 's two-wheeled litter. These litters are equally suitable

* Thcsc tourniqucts, and thc splints mentioned in the previous paragraph, arc to bc obtaincd at il1cssrs. Evans and Won11ull's, 6, Dowgate Hill, London, E.C. . t The army hospital attendants' drcssing case contains. in addition to the abovc, a spatula and a probe, but these would nN be required for use in the prc!illli7lm:1' dressings of injuries.

20

for moving sick people as for moving wounded ones, but of course it would not be prudent to use the same litter for removing persons suffering from small-pox or infectious fevers, and for the conveyance of persons disabled by injuries or sickness of a non-infectious character.

Two of these ambulance litters have been already procured by the Chapter, and one is now established at Burslem, under the direction of a Committee of the Order, and the other at Worcester, and as four others have been ordered, their practical advantages for the purposes contemplated will shortly be fully tested. It is a subject for congratulation that Surgeon-'Major Manley, tl.<!t., whose generous donation of money has enabled the Chapter to carry out Sir Edmund Lechmere's suggestion of the formation of an Ambulance Department, has consented to take general charge of this portion of the work of the Order, for no one could have been selected more competent to undertake the task.

The seco1Zd question is: TVlto are tlte persons to be trailled to apply the means provided for administering the first help tJZ cases of accident?

In all large establishments like collieries and factories, Il1 order to ensure the persons who have been trained for administering help being constantly at hand, it seems to be essential that they should be persons forming part of the establishment in which the need of help may occur. The party should consist at least of one head as director, and four subordinates for every hundred persons employed in the establishment; or still better, if practicable, of six subordinates, so that the casual absence or disability of one or other of the party may not impair the efficiency of the help provided. If more than one party be formed, a chief director should be appointed.

The head should always be a person of general intelligence and of- acknowledged influence, and one who, in training, had exhibited the necessary aptitude and liking for the work. The su bordinate aids should also be reliable persons selected for aptitude and willingness to undertake the charitable and responsible duties of helping their wounded fellow-workers, and conveying them, if needed, to hospital. The chief of the party should be in charge of the surgical stores for accidents. Local means should be adopted to ensure a knowledge among all the persons employed in a given establishment of the arrangements made for meeting accidents, and especially for preventing delay

21

in communicating with the chief of the aid staff whenever an accident may occur.

For general purposes, in a town for example, the necessary Ambulance Corps can be trained, equipped, and stationed ready for call, under the direction of a Committee of the Order; or, if the perso1t7lcl can be obtained by other means, and the Order would provide the conveyances, retaining proper control over them, very great advantages would accrue from even this help to sick and injured persons requiring removal to hospital. So long as the necessary primary assistance and protection can be furnished on the spot itself where a grave accident occurs, the time occupied in sending a messenger and collecting the Ambulance Corps and their litters would be of no material account.

Tile tlu"rd questZ"on is: -VVlzat training s!wztld tlte persons named z"ll the second question receive.9 N either reading nor oral instruction are sufficient for training persons to deal with the accidents and injuries to which men are liable in great manufacturing or mining establishments. There must be a certain amount of manual practice, in order to enable a theoretical knowledge of the modes of attending to injured per 'ons to be turned to really useful account. How to stop the flow of blood from a severed artery-how to treat a person when faint, or in a state of collapse from bleed ing-how to lift inj ured persons according to the kind of inj uries they have received -how to protect a broken limb, so that it may not be further damaged beyond probable hope of recovery during the removal of the patient - how to carry disabled persons on stretchers, or to convey them to their destination in wheeled litters, without aggravating their inj uries, and increasing their sufferings -and other like matters, can only be taught by demonstration and practical instruction.

The training should be as si:nple and brief as practicable consistent with obtaining the requisite efficiency.

I would suggest the following as the heading of the course of instruction which should be acquired by the accident helpers contemplated in this paper : 1. A slight general knowledge of the human body, with particular knowledge of the position of the main arteries of the limbs.

2. The use of tourniquets, and a knowledge of other methods of arresting bleeding-.

22

23

3. The attention to be given in the first instance to injured persons according to the nature and situation of the injuries.

4. The application of the first dressings to wounds and burns, and of temporary splints in cases of fractured bones.

5. Modes of lifting and carrying injured persons, and the modes of putting them in and out of conveyance, according to the nature and situation of the injuries.

6. The mode of resuscitating a person rescued from suffocation or drowning.

7. The use of hand and wheeled litters.

The attainment of an useful amount of practical information on these subjects need not occupy a long time. Two or three weeks' systematic instruction and practice would suffice for the purpose with persons suitably selected for the work. At the same time an annual repetition under the direction of the chief of the help party would be advisable, in order to maintain the necessary adroitness and readiness of the subordinates.

I am not able to name any civil institution in which this practical instruction can be at present obtained. In the army instruction of the kind is afforded to the men of the Army Hospital Corps, but as these men are engagerl to act also as nursing attendants on the sick and hurt in the hospital wards, their education is necessarily far more extended than would be necessary for the occasional helpers in cases of accidents in the civil establishments referred to in this paper. It ,,,"ould be easy for the required course of instruction to be given in every County Hospital, and it might be given by simple arrangements at a very small expense. It seems very unlikely that there ,vould be any difficulty in respect to the instruction being afforded, provided the necessity for obtaining it were felt by the large employers of labour and the heads of mining and manufacturing establishments. The means of giving the instruction exist at every large hospital. But the principle must first be established, that just as motives of prudence cause the necessary provision to be made for meeting the calamity of fire when it occurs, so motives of prudence, and still more motives of humanity, require provision to be made for affording primary care and attention 'when the personal hurts and mutilations referred to in this paper take place. No establishment in which large numbers of workpeople are employed should be held to be complet~ in its organisation 'w ithout provision having been made for immediate

personal and material assistance of a suitable kind on the occurrence of grave bodily injuries.

A just comprehension of the necessity for preliminary aid in cases of accidents hardly appears to exist at present, if we may judge from the little that has been done practically towards meeting the want.

Even in our large metropolis, where accidental injuries are so frequent, as shown in the weekly reports of the Registrar-General, no organised system, as far as I am aware, exists for affording trained primary help to the unfortunate sufferers.

Some years ago I observed at Paris, stations at various parts of the city, with the words Scco'ltrs auz Blesses, in conspicuous letters over them, where sufferers from bodily inj uries '\Tre sure to find both material and personal assistance, and proper means for removal to hospital. These stations were well known, so that no delay took place in the removal of a person \vho fell in a fit, or met with an inj ury in the streets, to the nearest help station. This system, I find, continues in force to the present day.:' \ \'hy should there not be similar establishments in our metropolis? · If the need were acknowledged in London, as it surely ought to be, there would be less difficulty in getting it acknowledged in the establishments mentioned in this paper. The need is equally urgent in both cases in proportion to numbers.

The Order of St. Jo11n has already taken the initiative in devising the best means of calling public attention to the necessity for establishing and maintaining training institutions for nurses for the sick poor-a necessity of first importance; it will be extending its useful and charitable work if it can also become the means of calling attention to the urgent necessity that exists for a proper organisation being established in all large communities of people, whether collected in cities, or at work in mines, collieries, mills, factories, and other similar institutions, for meeting the first needs of sufferers from wounds and inj uries, and for ensuring the early and safe removal of the patients to the hospitals where surgical aid and the cate and attention of trained nurses will furnish the best prospects of recovery. The work, so far as it rests on man's help, will be complete in all its parts, when the sufferers from accidental injuries have tlw benefit of proper preliminary care and attention, proper means of conveyance to their homes or to hospital, and surgical advice with skilled nursing when they arrive there. ;:t

The arrangements in Paris are under a special Bureau, the COlluil ,It' ,'tZIIlDn"le of the Pf'Pfi:ct!1I e d :' Po/iCt'.

APPENDIX. SURGEON - MAJOR MOFFITT'S BATTLEFIELD AND ACCIDENT SPLINTS.* The splints are in two sets: one set (the shorter of the two) is for fractures of the upper extremity-the upper-arm and forearm; and the other set (the longer of the two) is for fractures of the lower extremity-the thigh and leg.

In time of ,var it is intended that each stretcher or litter should be furnished with these two sets of splints.

They should be strapped on to picces of webbing, sewn on the canvas of the stretcher, at each side of where the patient's feet rest, or pockets mig-ht here bc provided for them .

I.

Directiolls for Al'plj'illg.

FRACTURE OF TIlE UPPER J-\[' .\1.-P ip the sleeves of the coat and shirt up th eir inner seams, as far as the arm-pit, apply a suitable first dressing to the wound, should such cxi!:>t, mal"c

movement. If time and circumstances permit, apply a roller bandage from the fingers up to the elbow. That done, carry the fore-arm across the chest and su pport the hanc1 and wrist in the lesser arm-sling.

FRACTURE OF TIlE FORE-ARM.-Rip the coat and shirt sleeves as high as the elbow, apply a suitable first dressing to the wound, should such exist, make extension of the limb, and replace the broken fragments in their natural position. Now, bend the elbow to a right angle, place the short splint on the inside, and the long one on the back of the fore-arm, and buckle the straps sufficiently tight to prevent movement. This done, carry the hand across the chest, and support the whole of the fore-arm in the large arm-sling.

FPACTURE OF TIlE TIIIGII.-Lay the patient on his back, rip the trousers up the outer seam, as high as the hip; apply a suitable first dressing to the wound, should such exist, and make extension until the limb is the same length as the sound one, and the broken fragments are replaced in their natural position.

N 0\\-, place the short splin t-one end close up into the perineum on the inside, the long one on the outside, and buckle the straps-the lower one immediately below the knee, the upper round the hips, and the two middle round the thigh. If time and circumstances permit, apply a roller bandage from the toes up to the knee.

FH.ACTURE OF TIlE LEG.-Place the patient on his back, rip the trousers up above the knee; apply a first dressing to the

extension of the limb, and replace the broken frrlgmellts in th eir natural position. Now, having bent the elbow to a righl angle, place the short splin t on the inside of the arm, the long one on the outside, and buckle the straps sufficiently ti g ht to prevent

'*'

As these SplllltS have been referred to in the preceding observations, a short account of them IS here :l ppenclecl .

wound, should such exist, make extension, and replace the broken fragments in their natural position.

N ow place the short splint on thc inside, the long on the outside, and buckle the straps-the lower one, in the figure of 8 round the foot and lower end_ of the splints.

27

26 2.

ILLUSTRATIONS OF NEUSS'S T\VO -\\'IIEELED AMBULANCE LITTERS. *'

Publislled by permission of tile TVar Office.

TllE LIl"lEK AS S EE . ·

r:-:

I' t:R!-' I' H T [\'r:.

SIDE VIEW (SCALE OF I ~ INCH TO I FOOT).

The dotted lines indicate tlu manne1' in whic!t the sail-cloth hood and cover are used 70hm nq7ti1'ed to p1'otect a patimt .from rain 01' sun.

* These littets being now in use under the direction of a Committee of the Order of St. JOhl1, it has been considered useful to append illustrations and a brief description of them.

DESCRIPTION

OF NEUSS'S TWO-WHEELED LITTERS.

Early in the course of the war of 1864, between Germany and Denmark, the Prussian "J ohanniter Ord en" (Knights of St. John) had some two-wheeled hand-litters constructed at the factory of the l\lessrs. N euss, Government carriage-builders at Berlin.

These carriages were constantly employed in the service of the Prussian wounded throughout the war; but their practical advantages ·were particularly noticed at the time of the storming of the forts of Duppel. As this ·was the first occasion on which "'heeled carriage, moved by hand labour, were systematically employed during the active operations of warfare, a special interest is attached to them.

N euss's conveyance consists of a litter partly made of wood and partly of canvas, stretched between two side poles and placecl upon springs, these springs being again made to rest upon an iron axle connecting the two wheels upon which the weight of the whole machine, when in motion, is supported. The side poles are provided with handles at both ends, A single man, on grasping two of the handles at either end, can wheel the machine either by pushing it from behind, 'or by drawing it from the front; or two men, one in front and one behind, can together push and draw it, or can carry the litter, if required, without the wheels being brought into contact with the ground, In order to combine lightness with solidity, the framework has been made of hickory wood. The wheels are also constructed on a peculiar plan, with a view to obtain the same ends; for each nave is of unusual length, and the spokes twelve in number, radiating from it to the circumference, are alternately inclined in opposite directions, so as to cross each other at very acute angles, and clistribute support evenly from whatever side pressure may be pri nci pall y exerted. :lVIeans are provided to support the litter firmly \\ hen at rest} and in the absence of an attendant. These means consist of two pairs of strong, well-connected props, one in front and one behind. The hinder prop alone, in conjunction with the wheels, form s a sufficiently stable support for the conveyance. Each prop is so joined to the framework, that when the two together are resting on the ground, they stretch out at obtuse angles with the middle portion of the litter in opposite directions, and thus

28 ensure perfect stability of the whole. By a simple arrangement, a man pushing this litter from behind can, without moving from his place, either raise or lower, as well as fix in position at pleasure, both the front and hind supports. The hind support consists of a single piece, but the front support is jointed, so that when shortened, the litter resting on the wheels and upon this shortened front support, has such an inclination given to it from the head downwards towards the foot, that the ingrcss or egress of a patient is greatly facilitated.

Considerable attention has been paid in the design of this litter to secure an easy and steady position for a patient \\'hile being transported in it. The patient does not lie in a completely horizontal posture; his head and back are somcwhat raised and inclined at an angle with the pelvis and thighs, and these again form an angle with the legs. The head of the patient rests upon a pillow covered ·w ith glazed cloth or leather; the back, pelvis, and thighs upon a flexible support of sailcloth, while the part for supporting the legs and feet consist entirely of wood. There are two padded supports for the arms and clbo\\'s of the patient. A folding sailcloth hood is fixed to the upper end of the carriage, and can be drawn over the head and shoulders of the patient, so as to form a sunshade or protection against rain, without interfering with the free access of air. A cover of sailcloth is also rolled up, and fastened by two straps at the foot of the litter. This covering, when unrolled, can be drawn up so as to lie under the upper edge of the expanded hood, and be fastened to the upper part of the framework. By these means the patient, during transport, can be protected against dust or inclement weather on every side.

Under the part which is made to support the head and shoulders of the patient there is a space, enclosed within two wooden sides and a floor of strong sacking, capable of carrying refreshments, bandages, or other parcels to the front, or of receiving the knapsack or accoutrements of a wounded man who may have to be transported to the rear. This space is covered behind with a canvas flap, secured by a button.

The weight of the litter complete, as thus described, on weighing it at the Royal Victoria Hospital, has been found to be I09lbs. 130z., avoirdupois.

[Extracted fi'071Z Ii A Treatise 01Z the Transport of Sick and Wounded Troops," by P7'ofessor Longmore, C.E., an H01zo1'ary Associate of the Ordt!r of St. John of Jerusalem.]

A small length of rope, or leather strap, with an iron ring at each end may be usefully employed when, in going over rough ground, the litter has to be occasionally carried. The rope is then put over the shoulders, and the rings passed over the two hooks of the litter, thus relieving the hands of part of the weight. It may be also used, if necessary, to assist in drawing the litter from the front.

~rll

HARRISON

AWD

SONS,

[ttilitate

PRINTERS

IN

ORDINARY

~alninltm.

TO

HIlR

MAJESTY,

ST.

MARTIN'S

LANE.