First Aid Journal 1940 - 1941 by Museum of the Order of St John

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F IR S T

A ID

J m k p eru k u l J o u r n a l fo r tlje A m b u l a n c e

a ttÂŁ

ie ie

3$ ,u r s m tj p e r u k e s :

il y it i

>f r

No.

553.

V o l.

X L V II.

JULY,

1940.

P ric e

3d.

T h e

n e w e s t

s ty le s

“ FIRST AID ” WALL DIAGRAMS

S J .A .B . U N I F O R M

( Si ze 2 ft. 2 Ins. by 3 ft. 4 Ins.) C o m p l e t e S e t of 19 s h e e t s on tough cartridge paper, with R ol le r , 4 4 6 n e t . P o s t 9 d . ; o r m o u n t e d o n Lin en , 7 2 ' 6 n e t . P o s t I/-. A d o p t e d by t h e W a r Office, t h e A d m i r a l t y a n d t h e B ri tis h Re d C r o s s S o c i e t y ,e t c .

DANCO T O

M E A S U R E

New Style Great Coat from 57/6 Raincoat

Spec ial S e t o f 6 S h e e t s fo r t h e use of

75 /-

LECTURERS

A . R . P.

Costumes 90/-& 105/-

CLASSES

Dresses - - 21 /(Stock Sizes 15/-)

com prising A na tom y, Physio logy, H a e m o r r h a g e , Di s lo c a tions and F ractures. M ounted o n linen w i t h r o l l e r , 21 /6 n e t ; p o s t a g e 6d .

Aprons with Cross - - - 5/10 & 6/4 New Indoor Cap with Cross - - - 1/9

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C arly le

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3 / 9 Illus.

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T U N S T A L L ’S

342 p ages.

“ F I R S T A I D ” a /e -::

O U T F IT T IN G

A S S O C IA T IO N

207th Thousand.

W A R W IC K

Order by post with confidence from

NURSES’

R e p rin t.

T O T H E I NJURED & SICK. Postage 4d_

L T D .,

An A d v a n ce d A m b u la n ce H a n d b o o k .

S to c k p o rt.

E d ited by F. C . N I C H O L S , M . C . , M . B . , C h . B . , l a t e C a p t . R . A . M . C . ( T . )

L o n d o n - A b b e y H o u s e , W e s t m i n s t e r , S . W I. L iverpool 57, R e n s h a w S t r e e t M anchester 36, King Street. B irm ingham 3, R y d e r S t r e e t . N e w c a s t l e - o n - T y n e - 26 , N o r t h u m b e r l a n d , St. A b e r d e e n ( A g e n t ) - Miss G r a y , 9, H o l b u r n St. S o utham pton 135, Hig h S t r e e t . G lasgow I N , U nion Street.

T h e c h ie f f e a t u r e o f t h is e d i t i o n is t h e m u c h fu ll e r a c c o u n t g i v e n o f G as Po i s o n in g in W a r f a r e FIRST AID JOUR.— '' One o f the most concise works on the su b ject published at a popular p r ic e .”

JO H N

W R IG H T & B R IS T O L

SONS

LTD .

When considering Trophies, remember it is only by dealing direct with the Actual Manu facturers that intermediate profits are eliminated and lowest prices obtained. It is this service that has made Alexander Clark Official Silver smiths to leading First Aid Societies throughout th e World, for more than half a century. Apart from Cups and Medals, Alexander Clark always have an enormous range of utility Prizes and Gifts suitable for Ambulance Competition Prizes. Catalogues and Wholesale Terms allowed bona-fide First Aid Societies, gladly sent upon request.

ALEXANDER CLARK Co

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a n u f a c t o r i e s :

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38, L E A D E N H A L L S J A E .C .3 SHEFFIELD

F IR S T A ID Jntapenieitf Journal jo r flje A m bulance anb p u r s i n g J^m nces Editor :

No.

553 .—

V o l. X L V II.

N OTICE

GEORGE

JULY,

CRAFT

1940.

[«££ ?£«*]

PRICE TH«EE™ A n n u m , P ost

P er

F r e e

EDITORIAL.

READERS.

F I R 5 T A I D is published on the a o t h o f e a c h m o n t h . Annual Subscription is 4 s . post free ; single copies 3 d .

[4/-

The

A ll Reports, & c., should be addressed to the Editor at the address below, and should reach him before the 1 2 t h of each month, and must be accompanied ( not necessarily fo r publication) by the name and address of the Correspondent. Subscriptions, Advertisements and other business Communications connected with F I R S T A I D should be forwarded to the Publishers. D A L E , R E Y N O L D S & C o ., L t d .,

the

W ill

general

A id .

b o o k le t,

Hom e

p u b l ic to tak e u p local

d e fe n c e issued

S e c u r i t y c o m p e l m e m b e r s of the

C om pulsory F ir st

M in is t e r

work?

“ W h a t you

the

n ew ly

must know ;

W hat

y o u m u st d o , ” S i r John A n d e r s o n writes “

, . . I

m a y , in the near fu ture, h a v e to call on m a n y of y o u to g i v e s o m e part of y o u r tim e to on e or other of these s e r v ic e s . . . . ”

46, C a n n o n S t r e e t , L o n d o n , E .C .4 .

The

Telegraphic Address— " Twenty-four, London. ” Telephone— City 3710.

first aid section of the C i v i l D e f e n c e is

b y no m e a n s well su p p o r te d b y the g e n e r a l p u b lic ; an d a c o m p a r is o n

b e tw e e n th is se r v ic e a n d other

s e r v ice s g i v e s the a n s w e r for this n o n - s u p p o r t . CONTENTS

THIS

NUMBER.

the A . F . S .

m e m b e r s are g i v e n a u niform

an d the t r a i n i n g is s p e c t a c u l a r ; a c tu a l a t t e n d a n c e s E d i t o r ia l :—

are m a d e in m a n y distric ts at o u tb r e a k s , an d e v e r y

Compulsory First Aid

c o n sid e ratio n

A.R.P. First Aid Services S.J.A.B. Headquarters and District Reports A Foolproof Tourniquet for all Purposes ... Removal of Patients News from Overseas A. R. P. Topics Nursing and Treatment of Head Injuries... Reasoning Silvester’s Method of Artificial Respiration The Prevention of Contamination of Wounds St. Andrew’s Ambulance Association Our Nurses’ Page St. John First Aid Classes Bandaging Extracts from Readers’ Letters ... Reviews Q

u e r ie s

a n d

A nsw ers

2 3 4 5 5 6. 6 7 8 9 9 10 10 11 14 14

given

e q u ip m e n t .

W a r d e n ’s S e r v i c e a u t h o r i t y is g i v e n so th at t h e y m a y q u e st io n

16 16 16 16 16 16 16 18 18 18 18 18 18 18

the

to m e m b e r s

the b l a c k - o u t l i g h t i n g ;

an d here a g a i n e q u i p m e n t is q u ite e x c e lle n t . m e m b e r s of the n e w ly - f o r m e d

L .D .V .

The

are issued

w ith rifles, can s to p traffic a n d are issue d w ith a u n iform . In the first aid se rv ic e , r e fe rr in g to p art tim e on ly,

there is s p e c t a c u l a r a c tio n ,

no a u t h o r i t y to

q u e stio n of l i g h t i n g or s t o p p i n g of cars, a n d a t t e n d a n c e at at

actua l

p rac tic e s o n l y ,

cases.

an d

W ork

o u t of

prefer to se rve eyes

of the

is carrie d on

sigh t.

Can

w o n d e r e d at that m e m b e r s of the g e n e r a l

C o r r e s p o n d e n t s :—

Artificial Respiration and Pregnancy... Examination Howler Arterial Haemorrhage During Infancy Fractured Leg and Burst Varicose Vein Treatment of Fractured Patella Salt in Treatment of Wounds Surface Markings of Diaphragm and Nipple .. Objects of Textbook Inclement Weather and Treatment of Fractures Simple Fractures of Both Legs Treatment of Compound Fracture of Femur Transport of Patient with Spinal Injury Treatment of Fractured Leg Humour in First Aid

p u b l ic

in a s e r v ic e t h a t is for e v e r in the

local

p o p u l a t io n .

And

y e t , for

all

that, the first aid s e r v ic e is a m o s t im p o r t a n t on e. It tak e s m a n y m o n t h s of hard w o r k to b e c o m e an efficient first aid er. and

M e m b e r s c a n n o t be e n r o lle d

s e n t o u t im m e d i a t e l y

a job

work.

C o n s t a n t practice is e ssen tia l b efore it is p o s s ib le to detail a n y m e m b e r to a n y case. Therefore, compel

m en

alth ough

and

women

may

e ss e n tia l to

to tak e u p this w o r k , it

w ill be s o m e little w h i l e b efore t h e y can t a k e th eir p la ce in the ran k s of efficie nt first aiders.

FIRST A .R .P . By O

F ir s t ur

A id

S e r v ic e s.

S p e c ia l C o r r e s p o n d e n t .

E a r l i e r in the year a full-time stretcher bearer of my acquaintance decided to resign and rejoin on a part-time voluntary basis. Unfortunately his steel helmet and service respirator were taken away from him, and he was confronted with the difficulty of attending his post without the reason able means of protection to which he felt he was entitled. Being a family man he thereby lost his enthusiasm, and the A.R .P. Services are now devoid of the services of an expert first aider. A similar point has been raised in a letter received from a north country reader. He states that in his mining village the stretcher parties are composed of three shifts, each work ing on a voluntary basis and attending their post when required. The majority of the personnel have to walk a distance of two miles to reach the centre where the equip ment is kept and, as there is only sufficient equipment for one shift, the same helmets and respirators have to serve for all, quite irrespective of their fit or hygiene. Moreover, there is no protection available during the two mile walk and, in view of the increasing number of air raids, the per sonnel are naturally becoming extremely apprehensive. The question is, of course, one of supply and demand, and 1 have no doubt that the authorities are doing doing their best in the matter. Nevertheless, I would suggest to the A.R .P. authorities that one of the best ways of obtaining voluntary recruits is to emphasise the fact that steel helmets and service respirators will be made available as soon as possible for the exclusive use of each worker. Another letter received comes from a trained hospital sister who was formerly attached as a paid worker to a mobile hospital unit in central London. She states that some months ago she resigned and re-offered her services on a voluntary basis, but in spite of this has heard nothing further from the authorities. Moreover, she assures me that she knows of several other cases in which would-be voluntary workers have offered their services and have been ignored. I rather suspect that my correspondent’s experience is not confined to one borough alone. Notwithstanding appeals for voluntary workers it is apparent that the machinery for utilising their services leaves much to be desired. Nothing is more disheartening to a well-intentioned would-be A.R .P. worker than to be made to feel that he or she is not really wanted, and that the appeals for voluntary workers are mere propaganda slogans and not really meant. I, personally, am intimately acquainted with several first aid posts and stretcher party depots and, as I write, I am trying to recall one single voluntary worker, and I ’m afraid I cannot— and this in one of the most thickly populated boroughs in London ! A Birmingham correspondent makes the suggestion that stretcher bearers or others who have long tedious hours of duty, might utilise part of their time in performing work of national importance actually in their depots or posts. He believes that certain forms of light productive work could be brought to their posts, or else stretcher bearers might actually be attached to factories as a floating squad to be immediately released when the “ yellow warning” comes through. This, in effect, reverses the scheme of things, the full-time first aider becoming the part-time munition worker. I consider that there is sound reasoning in this idea and that much may be made of it, especially in view of the necessity of utilising man-power to its fullest possible extent. A Southwark reader is extremely concerned with the efficiency of personnel. He is attached to a stretcher party depot and has seen personnel becoming highly trained as a

AID result of intensive teaching— only to be transferred to the armed forces as soon as they become of age. The needs of the armed forces must, of course, be met in full but, un fortunately, the transfer results in a decrease of A.R.P. efficiency, because the younger men are being replaced by older substitutes who have not the physical capacity of the younger men and who, through no fault of their own, find it more difficult to assimilate the principles of first aid. My own particular investigation this month is concerned with mobile hospital units. I recently attended a meet ing of Borough A. R. P. Controllers on behalf of my own Borough, and “ Mobile Hospital Units ” were the principal item on the agenda. The general concensus of opinion was that the mobile units should function as temporary “ fixed” posts at a site near the seat of the incident and, as such, should work in a limited capacity, the actual sorting out of casualties being left to other doctors, etc., who would actually be on the “ incident.” 1 appeared to be the only one at the meeting who had received (thanks to our M.O.H. A .R.P.) a special memorandum entitled “ General Organ isation and Work of First Aid Posts and Training of the Personnel,” and 1 read out to the meeting the extract deal ing with mobile units. The following is a precise of some of the more important points of the Memorandum which will be of interest to all first aiders :— Firstly the unit is intended to be unloaded so as to set up a temporary dressing station affording cover. It was originally intended to serve areas in which first aid service was lacking, but experience has proved that it may be of great value in other respects, especially in densely populated areas. The two main functions are to take the place of a fixed post where one is lacking and to augment a fixed post which is being overworked. In addition it is suggested (a) that the unit might exercise a supervisory capacity, the doctor and nurse leaving the unit and supervising the actual work of the stretcher parties, giving morphia and rendering other assistance as indicated. (b) That the unit might “ unload ” as near as possible to the site of the damage and form a rallying, classifying and disposal point, and (c) That the unit may set up temporary casualty hospitals in suitable buidings in the event of the ordinary hospitals being overcrowded, where the personnel may be augmented by a “ mobile surgical team ” which is, in effect, a special squad of surgeons, anaesthetists and nurses, etc., all fully prepared to perform any degree of surgery which may be necessary as opposed to tbe ordinary “ first aid ” treatment which normally would be afforded by the regular personnel of the post. In practice the use of the mobile unit will depend upon circumstances. In one place the unit will both serve as a classifying and evacuating point, in another, especially in congested and narrow streets, it may prove more advisable to keep the unit back until wanted. 1, personally, recently conducted a practice test with a mobile unit and stretcher bearers, and I have come to the conclusion that only experience under actual working condi tions will decide exactly where the unit should be stationed and how it should function for that particular incident. Lastly I would suggest that in setting up a first aid post, personnel are too inclined to concentrate on the “ operation theatre ” scheme of layout. The bulk of the work will be done outside the “ theatre” proper, especially with minor casualties. I have made the suggestion that the doors of the cupboards should be covered with towels or clean triangular bandages and, on the “ t r a y ” so formed, the first aider may carry sufficient dressings, etc., to treat most minor injuries, one member of the personnel being detailed to act as a dispenser, standing behind a counter formed by two cupboards on which are laid out further antiseptics, scissors, dressings, etc., which may be called for if required.

FIRST

St. John Ambulance Brigade H EADQUARTERS

AND

D IS T R IC T

REPORTS.

Brigade Headquarters U n i f o r m P e r m i t s . — In addition to permits to wear uniform which have been issued to the Nursing- Personnel, similar forms are available for Ambulance Personnel. In these days when so many different uniforms are to be seen it is advisable that all members should obtain and carry the permit on every occasion.

N o . I (Prince o f W ales’s) District W e s t e r n A r e a . — Owing to County Surgeon Wrangham

having joined the R.A.M.C., Dr. F. Stansfield, M.A., of 36, Gordon-place, Kensington, W. 8, has been appointed Acting County Surgeon, Western Area.

Dr. I. G. Forbes, son of Dr. Forbes, late of the Hospital Saturday Division, has been appointed Divisional Surgeon of the No. 1 (St. John’s Gate) Division. He was a Private in the Division for some years. Although the annual church parade of the Central Area was officially cancelled, some SO members attended St. Clement Dane’s Church, Strand, on Sunday, June 23rd. Asst. Commissioner Capt. R. V. Steele, District Officer T. McBride and other Central Area officers were present.

N o . II District P r in c e s R i s b o r o u g h . — On Sunday, June 23rd, Mr. Ernest Turner handed over to the Princes Risborough Division its first motor ambulance. Rev. J. Gower Williams (Rector) dedicated the ambu lance, assisted by Rev. F. G. Benskin (Pastor, Baptist Church). Before handing over the ambulance, Mr. Turner expressed his appreciation of the work the members had done and were doing. He had taken a keen interest in their work for some years and had acted as their president. He hoped the town would help and support the gallant efforts of the Brigade on behalf of humanity. County Commissioner Major P. G. Darvil-Smith, expressed, on behalf of The Order, their very high apprecia tion and giateful thanks to Mr. Turner for his most generous gift. The 20 ambulances in the County carried over 5,000 cases and travelled 120,000 miles last year. Those present included Dr. H. G.'Edwards (ambulance) and Dr. Connoly (nursing), Corps Officer Day, Acting Supt. Connorton, Acting Amb. Officer L. S. Woman and Mr. M. B. Parry-Jones (Clerk, High Wycombe R.D.C.).

N o. V District The annual conference of officers of the Nottingham shire Area was held at Mansfield, on Saturday, June^lSth Asst. Commissioner Capt. P. Muschamp presiding welcomed the return of the Nottingham Corps to his Area’ Despite the large number of men in the Services the strength of the Brigade continued to grow, one new corps two divisions and three cadet divisions having been formed during 1939 and the first three months of this year one new corps (F‘rbeck Main) and three divisions (Ruddington, iNuthall and Kimberley) had been registered.

AID

A tribute was paid to Lady District Officer Miss W. Gibson for her unceasing work with the nursing divisions, which showed 100 per cent, increase in membership during 1939. Figures to December, 1939, showed ambulance mem bers, 1,621 ; nursing, 363 ; cadets, 108 ; a grand total of 2,092 and an increase of 510 over the preceding year. The Nottingham Corps, whose returns were made separatelyreturned a total of 768 members. The number of cases of accident and illness treated during the past year reached the remarkable total of 19, 069. Corps Officer Longdon referred to the gift of three trailer ambulances which Capt. Muschamp had made to the Area.

B a t l e y D i v is i o n . — This Division has been very busy promoting efforts for its Comforts Fund. Each month a whist drive has been held and two parties have taken place. Appreciations have been received from the recipients of the parcels which the Comforts Fund has been able to forward. As more men are due to be called up efforts are being kept up by the Committee and the President (Mr. H. Anderson) to satisfy all calls upon them.

N o t t i n g h a m . — The Nottingham Corps held its annual church parade on Sunday, June 23rd. Corps Supt. F. Wilson Moulds was in charge of the ambulance divisions which were joined at the Parliament-street Methodist Church by the nursing personnel, under Lady District Officer Miss W. Gibson and Lady Corps Supt. Miss A. L. Oldfield. The Rev. G. I. J. Cushing gave an inspiring address after welcoming the members.

B r a d f o r d . — The important part which is being played by members of the St. John Ambulance Brigade in A . R . P . work was commended by the Lord Mayor of Bradford (Alderman M. F. Titterington) when he presented certificates to members of the Thornton Ambulance Division last month. The Thornton Division, he said, deserved congratula tions on the progress made since its inception only six months ago, and he was interested to note that the members were taking the home nursing course. Corps Officer F. Hanson (Bradford Corps) presided ; a vote of thanks was moved by Supt. F. Carr and Div. Treasurer W. Etherington.

N o . V I District D a r l i n g t o n . — After 40 years’ ambulance service Supt. M. Fletcher has resigned his appointment with the Darlingl° n D >vision. Mr. Fletcher began his ambulance work about 18l)8 with the Railway and captained the Traffic team He presided at a meeting in May, 1914, which led to the formation of the Darlington Division and, during the Great War, was Lieutenant in the 1st Durham Volunteer Ambu lance Corps.

Ambulance Officer H. H o g g is succeeding Mr. Fletcher. Mr. H o g g is also connected with railway ambulance work and was a member of the Darlington team which won the Wharton shield in 1931. He also captained the Dar lington team which successfully competed in the “ Coroner Graham ” cup competition.

S o u t h M oo r D i v i s i o n . — The new headquarters were officially declared open on June 27th by Mr. Basil Sadler managing director, Holmside and South Moor Collieries Company, who described ambulance work as the most interesting of any and stressed the value of such work in industry.

FIRST

T h e H a l l , w h i c h is a b o u t 8 0 f t . b y 3 0 f t . , is a g i f t f r o m the C o lliery C o m p a n y . O n b e h a lf of th e D iv isio n , S u p t. W . G ib b o n presen ted M r . S a d l e r , w h o is a w e l l - k n o w n n a t u r a l i s t , w i t h t h r e e v o lu m e s of “ B ird s of th e B ritish I s le s .” C o r p s S u p t . J. H . P i g g g a v e a s h o r t a d d r e s s on the w o r k of th e B r ig a d e

N o . X District C h e l m s f o r d . — C o m p e titio n s for th e “ L a n g l e y J o n e s ” c u p , o p e n to a m b u la n c e d ivision s, a n d for th e “ B e th S m e l l i e ” c u p , o p e n t o n u r s i n g d i v i s i o n s , in E s s e x , w e r e h e l d on S a t u r d a y , Ju n e 2 2 nd, a t C h e lm s fo rd . T h e ju d g e s w ere D r s . J. T . W h i t e l e y , M e r v y n T h o m a s , L . B i l l i n g h a m a n d C o u n ty O fficer W . E. N o rfolk. L a d y C o u n ty S u p t. M rs. S m e llie presented the “ L a n g le y J o n e s ” c u p to D u n m o w a n d th e “ B e th S m e l l i e ” c u p to

AID mary, Doncaster, has recently published an article in the Medical Press in which he describes a modified Samway which overcomes all these objections. Its essential features are a shaped oval handle, large enough to admit four fingers to which is fitted a Samways anchor with large locking wings (Fig. 1). The rubber tubing is of soft texture and of ample diameter. Application is simplicity itself. The handle is held in one hand and the free end of the tubing taken round the limb with the other one or two times, as desired, and then fixed tightly in the anchor wings. Illustration (Fig. 2) shows this, but it must be

W e st M ersea. A r r a n g e m e n t s w e re m a d e by m e m b e rs of th e C h e lm sfo rd D iv ision .

C r o m e r . — L a s t m o n t h , in t h e p r e s e n c e o f a l a r g e a n d re p re s e n ta tiv e g a t h e r in g , th e V i c a r of C r o m e r d ed ica ted the r e c e n tly a c q u ire d n e w In v ic ta m o to r a m b u la n c e of the

C r o m e r D ivisio n . T h o s e p resen t in clu d ed C o u n ty O fficer W . H . B a lls, D iv . S u r g . A . B u r to n , S u p t. R . L . R a n d a ll, A m b . O fficers F . R . C a rte r a nd F. P ea rce, M r. H . G. M a n c e r (ch a irm an ) a n d m e m b e rs of th e C r o m e r C o u n c il P ro te ctio n C o m m itte e , th e D o w a g e r L a d y Suffield, a n d a ls o m e m b e r s of the V . A . D . and R ed Cross. A fter th e service

the

com pany

in spected

the

new F ig.

a m b u la n ce .

F o o lp r o o f

T o u rn iq u e t

For

A ll

P u rposes. The

S a m w a y T o u r n i q u e t is p r o b a b ly th e m o s t w id e l y used i n s t r u m e n t o f its t y p e e m p lo y e d fo r t h e c o n t r o l of H a jm o r r hage. L a r g e n u m b e r s h a v e b e en is s u e d to F i r s t A id P o s ts . M a n y s e rio u s c ritic is m s h a v e been pu b lish ed a b o u t so m e o f t h e p a t t e r n s in u s e , a s t h e r e h a s h i t h e r t o b e e n n o s e t s t a n d a r d of m a n u f a c t u r e . A w ell k n o w n L o n d o n D a ily N e w s p a p e r re c e n tly p u b lish ed a n in te rv ie w w ith an em in en t L o n d o n M e d i c a l m a n in w h i c h t h e S a m w a y s T o u r n i q u e t s s u p p lie d to A . R . P . P o s ts , w e r e s e v e r e ly c o n d e m n e d . It w a s s t a t e d t h a t t h e t h i c k n e s s a n d r i g i d i t y o f t h e r u b b e r is s u c h t h a t it is e x t r e m e l y d i f f i c u l t to a p p l y t h e i n s t r u m e n t ; a l s o t h a t t h e r e is a g r a v e r i s k o f c a u s i n g u n d u e c o n s t r i c t i o n t o th e tis s u e s w ith r e s u lt a n t pain a n d p e r m a n e n t in ju r y to th e n erves of th e lim b . F r o m t h i s it w i l l b e j u d g e d t h a t a n o rd in ary Sam way Pattern T o u rn iq u et c a n be a v e ry

emphasised that it is essential to cross the fixing hand over to grasp the tubing and to fix the rubber first in the anchor wing farthest away from the hand as shown in the picture and then to lock it in the second wing. Once applied, the tubing lies fiat on the limb. To those workers who have struggled with some of the ordinary Samways Tourniquets, this new instrument will be a boon. A well known medical man has recently stated “ /

could not imagine a better Tourniquet fo r emergencies o f any bind. ” The Instrument is illustrated by the courtesy of the manufacturers, Messrs. Chas. F. Thackray, Ltd., 10 Park Street, Leeds, 1.

Field-Marshal Sir Philip Chetwode has been appointed chairman of the Red Cross and St. John War Organisation, in place of the Earl of Cromer who resigned to take up home defence work.

d a n g e r o u s in stru m en t.

Nurses of the British Red Cross Society and men of the St. John Ambulance Brigade from all over Hertfordshire were present at a service of prayer and music, held in St. Albans Abbey, on Sunday, June 30th. An appeal for the joint funds was made by Lord Lytton.

Registered

N o . 838091

F ig .

M r. L. D o u g a l C a lla n d er, S u rg e o n

to th e

Royal

Infir

The Royal Life Saving Society has recently published a poster entitled “ How to Apply the Schafer Method of Artificial Respation.” It contains four illustrations and the instructions are printed in bold, clear type. The poster should be exhibited in every first aid room. Copies are available at 3d. each, post free, from the Society’s Head quarters, 8, Bayley-steet, London, W. C. 1.

FIRST R em oval

o f

AID

P a tie n ts.

T he usual method of lifting a patient from the ground on to a stretcher is well known, and, although the practice has been recognised as standard for many years, it is quite possible that some readers will feel there are certain phases where an improvement can be made. This fact has been brought home forcibly after continuous practice with Stretcher Parties, and a new method has been devised. The following particulars will be of interest if for no other reason than that it facilitatesthe removal of patients with greater comfort, both to the patient and to the carriers. The new lifts make it possible to carry out the operation at speed, and also greatly aids the removal of patients from the most awkward positions, which, of course, are only too frequently en countered in war-time first aid work. The lifts, four of which are used, are simple in construction, consisting of a length of webbing with two handles of different dimensions. Two of the lifts used to take the larger parts of the body— shoulder and hips— and two shorter ones for the head and feet. One great advantage is the speed with which a stretcher can be loaded ; details of one drill are : — The usual C a n t e r b u r y a n d W e s t C o a s t C e n t r e , S.J.A.A.— The Stretcher Party numbering 1, 2, 3 and 4 is advised ; Nos. 1 54 th annual report gives particulars of work carried out and 3 go to the right of the patient and Nos. 2 and 4tothe during 1939. On April 23rd the first Investiture to be held left ; No. 1 goes to the hips and No. 3 totheshoulders. in Christchurch was performed by Sir K. Heaton Rhodes, The lifts are pushed smartly under the shoulders and hips of Knight Commander of The Order and Head of the Comthe patient (using the long handles), and Nos. 2 and 4 pull mandery in New Zealand. The National Blood Transfusion them through ; No. 4 then goes to the head and No. 2 to Service continues to do excellent work ; and a Blood Bank the feet and insert the remaining two lifts. One point to is now in operation. remember is that the patient should be slightly lifted from During 1939 first aid, home nursing and hygiene the ground by each member, using his left hand for the certificates gained numbered 1, 432, making a grand total of purpose— a quarter of an inch is quite sufficient. The 18,217 issued since the formation of the Centre in 1885. patient can then be lifted and moved in any direction to the Ambulances carried 4,856 cases, with a mileage of commands of No. 1. 47,371 and, in addition, 38 calls were received from Racing It may be of interest to mention that a squad, after Clubs —792 miles being covered. training, have lifted a patient on to a stretcher in five The report also contains a financial statement and Subseconds. Only quite a short period of training is necessary Centre reports. before becoming efficient, and ladies can without difficulty We congratulate our colleagues in far-off New Zealand undertake the work. on their excellent work. Other methods suitable for different sets of circum stances have been devised ; for example, when lifting a heavy patient, two lifts are crossed under the hips, the smaller lifts being used at the shoulders and feet. In these P a r s i D i v i s i o n , B o m b a y C o r p s , S.J.A.B.— This Divi circumstances, a fifth person is co-opted (a bystander) to sion, according to the 36th annual report, had on December hold the head. 31st, 1939, a membership of 115, which must surelv he a Again, there is the method that can be used when a record for a Division overseas. Nearly 9,000 persons patient is found lying against a wall or other obstruction attended instructors and short courses on A.R.P. that prohibits the personnel to get either side. In this event, Members attended 577 public duty calls including 476 the smaller handle is bent over the long handle and then invalid and sick persons, besides rendering aid to 101 pushed under, the long handle being withdrawn ; by this injured persons during public functions. During the year means the patient can be lifted out quite easily. the ambulance, presented by Mr. Dinshaw Darabshah Shroff, Full particulars may be obtained from T rigg Bros., was handed over. 41, Chiswick Lane, London, W . 4. H.E. Sir Roger Lumley, Governor of Bombay, in spected the Division, together with other divisions of the Bombay Corps, on March 25th, whilst Asst. Com. Lt.-Col. At the West Oxford divisional ambulance competition, A. R. Ransford, accompanied by other district officers, held on June 16th, the team captained by Mr. F. J. Jackman inspected the Division on November 19th. During the year Div. Supt. D. F. Panthaki, M .B.E., gained first place and received the “ Faulkner” challenge J.P., was promoted to Associate Commander (Brother) of cup from Mr. F. Dearie. The Order, and Staff Sergeant A. C. Doctor, one of the founder members, was appointed Associate Serving Brother. At the postponed annual meeting of the Seaton and The annual report sets out particulars of the various Beer Division, S.J.A.B., it was reported that .£260 had been competitions, service medals and bar awards, report of the collected as a result of an appeal. Eleven members of the Cadet Division, now in its fifteenth year, and the financial Division were serving with H.M. Forces. statement.

FIRST

A .R .P . T o p i c s . A ir

R a id s.

The Ministry of Home Security has issued a 64 page booklet (4d. post free) on “ What You Must Know : What You Must Do.” It is divided into five chapters which deal with The Civil Defence Services ; Self Protection Against High Explosive Bombs and Behaviour During a Raid ; Incendiary Bombs ; War Gases ; Simple First Aid. There are some 30 illustrations, an appendix giving a table of war gases, and also a selected list of official publications. The booklet is primarily intended for the uninitiated, but even the experienced personnel may find some useful information. Under treatment of haemorrhage, we note that there is no mention of probable foreign bodies in a wound, when dressing with pad and bandage, neither are the instructions for the treatment of wounds in the abdomen, altered accord ing to whether the wound is vertical or transverse.

A complete catechism on “ Personal Protection Against Gas ” has recently been issued by Mr. A. Noble, L.C.P., A .R .P ., price 7d. post free. This booklet gives correct answers to nearly 200 questions, in a concise but understand able manner, is printed on good paper, fits the pocket or bag, and is therefore recommended to readers as a useful book. It is divided into various sections : War Gases, Effect of Weather, Effects of Gas on Persons, The More Important Gases, Detection of Gases, Chemical Indicators, Air Raid Precautions and Protection, Respirators, Care and Inspec tion, Anti-Gas Treatment of Persons, Decontamination of Clothing and Respirators, and lastly, reference to “ Contex” ; a mine of information to the instructor and pupil. “ Air Raid First Aid ” is a reproduction, in book form, of Col. Robert J. Blackham’s set of charts. In this handy pocket size, the contents should prove of great interest and assistance to readers. There are illustrations of incendiary bombs, the human body showing arteries and pressure points, the application of the triangular and roller, together with subject matter on bombs, gases, arteries and pressure points, asphyxia, fractures, dislocations and sprains, haemorrhage, insensibility, poisoning, wounds, etc. The cost of the book, which is published by John Bales, Sons & Staples, Ltd., is 7d. post free. Copies of any of the above books can be obtained from Dale, Reynolds and Co. Ltd., 46, Cannon Street, London, E.C. 4.

The

D octor

A.R.P.

In The Lancet of June 15th, there appears an editorial on “ A.R.P. : Where the G. P. Comes In.” It is suggested that where there is a mobile unit working at a scene of air-raid damage, any doctor at hand should get in touch with the medical officer in charge. Where there is no mobile unit he should contact with the senior police officer at the incident post, and in accordance with the requirements of the situa tion, support, advise and even organise the casualty work. It is further suggested that if there is only one doctor, he can usefully station himself at the ambulance loading point and here check any first aid work and help by first line classifica tion and by advice as to the initial disposal of the casualties, assessing relative priorities for removal.

The Ministry of Home Security has just published “ Air Raid Precautions Training, Bulletin No. 1 ” (7d. post free). This Bulletin has been prepared in response to suggestions made that it would be convenient if a single publication

AID could be published which would include material issued by the Ministry of Home Security through Circulars, etc., which modify existing handbooks and memoranda or in other ways affect the work of Instructors. The present Bulletin deals with anti-gas (23 items), high explosives (3 items), incendiary bombs (six items) and four miscellaneous items. Further training bulletins will be issued from time to time. Home Security Circular No. 138/1940 refers to First Aid Kits for Wardens, and sets out treatment expected from Wardens dealing with casualties. During air raids Wardens will be primarily concerned with reporting damage. First aid is not a primary duty of such personnel, but if it is necessary to render first aid they should confine themselves to “ life-saving first a id ”— severe external haemorrhage, true asphyxia, removal from danger, noting location of seriously injured casualties. It is suggested that two empty civilian respirator cartons, excluding platforms, should be utilised for dressings, &c., and a list of such articles is given.

N u r sin g

and

T re a tm e n t

o f

H ead

In ju r ie s .* By

HARVEY

JACKSON,

F.R .C.S .,

L .R .C .P .

Hon. Surgeon West London Hospital and National Hospital for Diseases of the Nervous System. T h e r e are certain delayed complications which may appear

days to months after head injury. Two of these are sub dural ha;matoma and subdural hydroma. With subdural haematoma the exciting trauma is more likely to be a thrusting form of blow. Symptoms and signs of increasing intra-cranial pressure develop in headache, possibly vomiting, and, in some cases, changes in the optic discs, together with an intermittent drowsiness. Quite often the signs do not indicate on which side the lesion lies, although at times definite localising signs are to be ob served. The signs may vary in intensity from day to day. The only treatment is evacuation of the haematoma followed by drainage, or, at times, excision of the sac. By subdural hydroma is meant the formation of a local ised collection of fluid, probably cerebro-spinal fluid, in the subdural space. This is an occasional cause of persistent headache following injury to the head. Treatment consists of evacuation of the fluid. The main sequelae of head injuries are cerebral abscess, epilepsy, cerebro-spinal fistula, and arterio-venous fistula. When an abscess of the brain arises from a wound, it may develop by continuity of tissue, but it may be due to dissemination by the blood stream, as in a so-called meta static abscess. The former type is the usual one. Signs of increased pressure within the head due to the formation of an abscess are slowing of mental activity, headache, vomit ing, and possibly paralysis. If the abscess encroaches on the surface of the brain convulsive attacks may result. The formation of an abscess will not necessarily be associated with a rise in temperature ; in fact, the temperature is more inclined to be normal or subnormal. The temperature may rise from other causes, but if no other possible cause is found, the question of oncoming meningitis has to be considered. Epilepsy is a frequent relic of injury and a most dis turbing sequel for a patient. The attacks may be of general * Extract of lecture given Exhibition and Conference.

the London Nursing

FIRST ised or localised forms. Localised epilepsy appears in the form of Jacksonian attacks ; in such an attack a progressive course is followed in that convulsive movements begin in some part of a limb from which progressive extension takes place, spreading to adjacent parts, thence to the correspond ing arm or leg, and possibly involving the whole body. Such an attack, however, may terminate at any of the d etailed s ta g e s .

Other cases complain of minor lapses in which sud den, evanescent losses of memory occur, and the patient looks blank and pale. These are attacks of minor epilepsy or petit mat. G e n e r a lis e d ep ile p tifo rm a t t a c k s m a y be c o n s e q u e n t on local lesion s, h e n c e s u c h lik e ly c a u s e s s h o u ld be e x c lu d e d . In th e a b s e n c e of li k e l y lo c a l c a u s e , a d m i n i s t r a t i o n of th e u s u a l s e d a t i v e s is n e c e s s a r y .

Cerebro-spinal fluid fistula follows on injuries in which the sub-arachnoid space, or one of the cerebral ventricles is brought into communication with the surface. These fistula; are a constant source of risk of meningitis. Opera tive closure is demanded. Arterio-venous fistula may develop with or without bony injury. The commonest communications are between the internal carotid and the cavernous sinus, or between the carotid and jugular bulb. Patients afflicted are apt to com plain of “ noises in the head,” described as pulsating, and found to be synchronous with the heart beat. In nursing these injuries, make careful observation of the pulse rate and tension, the respiratory rhythm, and the state of consciousness of the patient, at frequent in tervals. A slowing pulse is most important as an indication of increasing tension. Respirations become slowed and then adopt a rhythym ot a Cheyne-Stoke type, as the fatal issue is encroached. In shocked states, the recumbent position is demanded, the head raised well above the body, as soon as is reasonably possible, in order to reduce the risk of excessive (edema. Should cedema become marked, then give enemata of mag nesium sulphate (3 02. mag. sulph in 6 oz. of water), otherwise simple treatment by an initial dose of calomel (2 or 3 grains), followed by daily saline purgatives, suffices. More serious degrees of oedema demand intravenous in jections. Diet should be light, with limitations of fluid in the earlier stages (16 to 20 oz. per day). Restlessness will be met by giving chloral and bromide, pheno-barbitone, or chloretone. Should oral administration be impossible, it will be necessary to give double the dose of chloral and bromide. Morphine is not a safe drug for use in head cases except in the presence of much restlessness, uncontrolled by the application of the drugs already men tioned. In these circumstances, only small doses are advisable (one-sixth of a grain at a time). The bladder and rectum must be watched with care. It is easy in an il patient to neglect retention of urine, and this must be avoided. Catheterisation may be necessary, but the use of Doryl or Esmodil is worth consideration. Following head injuries, constipation may involve straining at defecation, with the consequent rise in blood pressure. Careful attention to patients’ backs is more than ever necessary. The backs of all my head cases are attended to four-hourly. Should patients be submitted to operation, with the use of Averlin as an anajsthetic, there is additional risk of pressure trouble with the skin, and such patients need particular care in the early post-operative period.

The Rhyl Division, S.J.A.B., held its first whist drive and dance on Thursday, June 27th. During the evening Councillor Williams, on behalf of the members, presented a wallet to Dr. J. G. Macqueen for his services to the Division.

AID

R e a so n in g . B y C apt. A.

W h it e K n o x , m . c .,

m . b .,

ch.b.

“ A d a y l i g h t raid by enemy aircraft has been made on your local village and you are called to the area where the bombs have been dropped. You are a team of four and arrive on the scene by car with full kit, stretchers and blankets. “ You find a cottage demolished and, as you approach, you notice that the wind blowing towards you smells strongly of peardrops. Your eyes begin to irritate and you realise that some kind of gas bas been dropped by bomb as well as high explosive which demolished the cottage. “ A moaning sound comes from the cottage and you realise that there are casualties to be attended to.”

F irst Reasoning. The peardrop smell and the irritation of the eyes immediately, would appear to indicate an ordinary lachrymator gas probably K.S.K . Lewisite, though causing irritation of the eyes, immediately smells of geraniums and is much more irritant to the respiratory tract. Mustard gas has a latent period before the eye signs appear and can be ruled out immediately. The diagnosis is, therefore, K.S.K. and, in any case, No. 1 immediately gives the order to put on respirators, so protecting both eyes and respiratory passages. He orders the car to proceed to the other side of the cottage into the wind so as to be clear of the fumes if possible. Accompanied by No. 3 he then approaches the cottage to search for casualties. He looks out for any danger from falling masonry, an important point if he is to successfully carry out his duties. There are several pieces of masonry and beams which might fall, so Nos. 1 and 3 pick their way carefully through the debris inside the cottage. A rapid survey shows only one old lady lying on the kitchen floor with a fairly heavy beam lying across both lower limbs. There is a fairly large wound on the front of the right shoulder from which blood is flowing briskly. The old lady is calling out for someone to relieve the pain and she is weeping copiously. Her gas mask is by her side.

Second Reasoning. Bleeding must be stopped the gas mask must be applied ; the beam must be removed from the lower limbs ; and the patient must be got out of the building quickly before further falls of masonry or timber takes place. The bleeding is the most important, so No. 1 takes over the task and orders No. 3 to adjust her gas mask. No. 1 notes the blood is dark red in colour and is flowing steadily out of the wound from the side away from the heart, so he diagnoses venous haemorrhage. He notes also that the end of the humerus is sticking up in the wound. He realises that he cannot apply direct digital pressure so he quickly gets a triangular bandage from his haversack and ties it round the upper limb near the wound and on the side away from the heart. He ties the bandage just sufficiently tight to collapse the vein and stop the bleeding. It is not necessary to completely stop all circulation in the limb, and care is therefore taken to pull the knot up quietly and progressively until ha;morrhage has just stopped. No. 3 is trying to get the gas mask adjusted, but the old lady is very frightened and every time it is applied she tears it off with her sound hand crying that she cannot breathe with it on. Is she to be forced to wear it or not ? Nos. 2 and 4 arrive with a stretcher and are detailed at once to remove the beam from the legs. No. 1 decides it is better to remove the patient from the dangerous cottage, especially as Nos. 2 and 4 say that the air is free from gas on the windward side of the cottage. He considers it will only aggravate the shock

FIRST

condition of the patient if he forces her to wear the mask, considering it is only a lachrymatory gas and that the effects will pass off quickly. He reassures her and calms her down while ordering the lower limbs to be tied together, a broad bandage placed round the right arm and body, and the sleeve pinned to the front of her dress. He does not feel justified in proceeding with further treatment on account of the danger, and the signs of shock showing in the patient’s pale face, her feeble pulse, her cold and clammy skin. She is quickly but carefully lifted on the stretcher, wrapped up in a blanket, and carried out of the cottage near the car in as sheltered a spot as possible and clear of the gas. The old lady is now questioned quietly as to pain she may have, but she is still very shaken and cannot give any real information.

AID ensure there are no further injuries. There are none found, and the patient is pinned up in the blankets. She is spoken to quietly and encouraged with the object of allaying her anxiety. Her head is kept low but it is thought unwise to raise the fractured lower limbs. The ambulance arrives and the patient is loaded and removed immediately.

Conclusion. That is No.l's reasoning ; but as several argumentative reasonings have been given, readers should use their ingen uity and knowledge and work out for themselves, their own reasonings on the case. Further, careful study will show that a deliberate “ howler” has been made. Can you spot it ?

T hird Reasoning. Is the shock so severe that further shelter must be found before treatment is carried out ? She is in a sheltered posi tion, the day is warm, and the ambulance has not yet arrived, No. 1 decides that keeping her as warm as possible with blankets, he will carry on with the treatment. He therefore details Nos. 2 and 4 to the legs, while he with the assistance of the wound. He already has knowledge of injury and rightly deals with them first. wound himself because he considers it the the possible injuries.

carefully examine No. 3, deals with these two areas of He takes over the most important of

With his scissors, he cuts away the torn clothing round the wound on the shoulder. The clothing is already destroyed so that extra damage by cutting does not matter, and he wants a good look at this severe wound. He finds it about four inches across, fairly clean, some clothing driven into the wound, and the upper end of the humerus broken in the wound.

Fourth Reasoning. He carries no antiseptic, so he decides he cannot poke in the wound trying to get out the pieces of clothing (to paint his fingers with an antiseptic is the only method of surgically cleaning them). He therefore, gets out of his haversack, a large size sterilised dressing, and carefully un doing the outer covering by pulling the tape, he removes the inner covering, and catching hold of the dressing by the two pieces of roller bandage stitched to it, he opens out the dressing and lays the clean surface on the wound. The short end of the bandage goes round the upper arm and the long end over the shoulder, down round the opposite arm pit, up over the injured shoulder, down round the armpit and round again— a figure of eight crossing on the wound area. No. 1 then loosens the constricting triangular bandage from the arm, watches and notes that hsemorrhage has stopped and he therefore leaves the bandage in position. No. 3 has all the time been carefully holding the injured arm. The forearm is now flexed at right angles to the upper arm and a broad bandage placed round the upper arm and the body, holding the arm firmly against the body. The body makes an excellent splint for the broken arm. The forearm is now supported in a small arm sling, allowing the weight of the elbow to make extension on the fracture. Nos. 2 and 4 have now found signs of fracture in both shin bones. They found swelling, irregularity of the bones, and both bones bent slightly to one side at the sites of the fractures. There are no wounds.

F ifth Reasoning. As both shin bones are broken, No. 1 decides that one splint in the middle, and one on the outer sides of both limbs will give the steadiest support. The bandages pass round both limbs as they should do in any case with a female patient.

A quick examination of the rest of the body is made to

S ilv e s te r ’s

M eth o d

A rtific ia l

R e s p ir a tio n .* T h is m e t h o d s h o u ld o n ly b e u se d w h e n , on a c c o u n t of w o u n d s , f r a c t u r e s o r o t h e r i n j u r i e s , it is i m p o s s i b l e o r u n w i s e to p la c e th e p a tie n t d o w n w a r d s . In all c a s e s i m m e d i a t e s te p s s h o u ld b e t a k e n to s u m m o n m e d ic a l aid. P r e p a r a t io n .

^r> -e

Without a moment’s delay, turn the patient fully on his back on the nearest level, flat surface. / Loosen constricting clothing, especially the collar, and place a pad about three inches thick (say, of folded clothing) under the shoulder hlades. Place the forearms, one on each side of the breast bone, so that the hands (palm downwards) are just beneath the chin and elbows are resting on the front of the chest. Meanwhile it is essential that the patient’s head should be turned to one side as far as possible, and that an assistant should pull the longue well forward and hold it or fix it in that position by fastening a piece of string or an elastic band round the tongue and lower jaw. Unless this step is fol lowed carefully, the base of the tongue may fall back and block the windpipe. Practice of Silvester’s method should never be done without an assistant, who must be constantly watchful that this position of the head and tongue is correctly maintained. I n s p ir a t io n .

(1) Kneeling behind the patient’s head and facing the feet, grasp with fingers outside and thumb inside each of the fore arms immediately below the elbow. The grip must be retained throughout. Now pull the forearms so that the upper limbs sweep through a path at 45 degs. to the ground (i.e., partially up wards and partially outwards) with a steady motion until the upper limbs, in line with the sides of the body, are extended above the head and the elbows are brought to the ground or as near to the ground as is possible. This action expands the chest and causes air to flow into the lungs. E x p ir a t io n .

(2) Return the forearms steadily by an identical path until they are back again in their initial position (para. 1). Then press the forearms firmly (not heavily) downwards on the chest wall. The movement constricts the chest and forces air from the lungs. * Reprinted, by kind permission, from the Royal Life Saving Society’s handbook, “ Artificial Respiration— Are you Prepared ?” It is the outcome of a conference held in London between Mr. A. C. P. Handover, Vice-President of the Society, Dr. N. Corbet Fletcher, and the Editor of F i r s t Am. The pages referred to in the article are those of the Booklet, which costs 7d. post free from the Society’s Headquarters, 8, Bayley-street, Bedford-square, London, W.C. 1.

, /* /

FIRST Continue these movements smoothly, allowing three seconds for inspiration and two seconds for expiration, a total of twelve cycles a minute. Assistants should loosen all restricting clothing without undue exposure of the patient which would cause loss of body warmth, slip a blanket or similar article under and on top of the patient to prevent cooling of the body, and apply external warmth (see p. S3 and pp. 61 and 62). When efforts at natural breathing return, regulate the movements in time with it (p. S3— Signs of Recovery), and later promote circulation by friction upwards along the limbs (p. 54). The general principles of after-treatment are as for the Schafer method.

The

P re v e n tio n o f

o f

C o n ta m in a tio n

W ounds.

A w o u n d causes a breach i n the skin, which, if the correct treatment is not given, will allow germs to enter the broken, cut or crushed skin and to penetrate the recesses of the wound. Thus the wound becomes contaminated, infected, septic or poisoned. It is the prevention of this occurence which we, as good first aiders, should endeavour to counteract in our treatment of wounds. Germs are very minute living cells, invisible to the naked eye ; and they are present and living everywhere— on our skin, on our clothing, in the air we breathe, in the water we drink, and in the food we eat. Once germs enter the body they increase and multiply at an alarming rate ; and whereas a few harmful germs do little mischief, from these few, are born in a very short period, thousands of other germs which may cause trouble. It is interesting to recall that years ago, before anything was known about germs, it was expected that every wound would, as a matter of course, become dirty and filled with matter or pus. Later a French scientist named Louis Pasteur discovered the existence of germs ; and an English surgeon, Joseph Lister, realised that living germs were the cause of all that we now know by the name of sepsis. It was Lister who argued that if, while the surgeon was operating, the germs on his hands, his instruments, the patient’s skin and surroundings could be killed, few, if any, would remain in the wound and a clean healing would result. He therefore did all his operating under an antiseptic (“ germkilling” ) spray which contained carbolic acid. Although not entirely successful, Lister’s method was an epoch making advance and many lives were saved thereby, while in certain instances, operations were made possible. Later, other surgeons who followed Lister, went a step further. They were of the opinion that better results would be obtained if, instead of killing as many germs as possible as they entered the wound, steps could be taken to prevent them entering the wound at all. They endeavoured, therefore, to have the patient’s skin and surroundings entirely free from germs before making their incisions ; to make the surgeon’s hands and instruments free from germs ; to have all dressings that were applied to the wound free from germs ; and to see that nothing that was not absolutely sterile (that is, free from germs) even touched the patient. Thus began the aseptic method of operating which is universal to-day. The conditions under which first aiders work, it is not possible to carry out the asepsis method. Certain rules must therefore be carried out before we can combine asepsis and antisepsis methods. First, we must see that our hands are sterile (antisepsis). This can be done by applying an antiseptic which will kill germs and thus render our hands germ free. Secondly, water used to wash a wound must be sterile

AID

(asepsis), poured directly on to the centre of the wound and not first on to the surrounding skin and thence to the wound. Thirdly, the wound must not be left exposed to the air, which contains germs ; and the dressing used must itself be germ-free (aseptic). The ideal dressings are those which consist of a sterilised (germ-free) piece of gauze or lint attached to a roller bandage. Such dressings are enclosed in a sealed wax paper covering, which should not be opened until actually required. It must always be remembered that once the hands have been sterilised, or rendered germ free, they must not touch anything that is not sterile. It is a fairly common occurence at competitions, for a competitor first to sterilise his hands, and then immediately undo a packet of cotton wool or use scissors which have not been sterilised. It is not good first aid if a wound which is at first slightly contaminated, becomes more so, by faults in the aseptic or strict germ-free cleanliness of the first aider’s hands, water, dressings or instruments. To avoid contamination of wounds, it is therefore desirable (1) to follow rigidly the instructions of the Text book ; (2) to have hands as surgically clean as is possible ; (3) to use only sterile dressings ; (4) to be careful that during the dressing of a wound, the hands, instruments, dressings, etc., which are to be used, do not come in contact with anything that is not itself sterile.

S t.

A n d rew ’s

A m b u la n c e

A sso c ia tio n .

Cowdenbeath Section was inspected by Dr. R. C. Wal lace, assisted by Hon. Surgeon Veitch, on June 16th. Provost Young, Bailie Drylie, Dr. Wightman and Capt. Robertson, were also present. Commandant R. Wilson was in charge with Asst. Commandant W. M. Ferguson. After a series of exercises, tea was served, at which con gratulatory speeches were made by Bailie Drylie and Dr. Wallace.

A new ambulance has been delivered to Leven and Dis trict Committee of the S. A. A.A. The Committee have now two ambulances and one on loan from Glasgow for emergency A.R .P. purposes.

At the annual meeting of the Oban Centre, it was stated that 82 patients were conveyed by the ambulance, which covered 2,220 miles. Capt. D. A. Ross, Chief Constable, was appointed President of the Centre.

Mr. Frank L. King has been appointed secretary and treasurer of the Perth Centre in succession to Mr. J. T. Douglas who has given 14 years service.

At the annual general meeting of the Stirling Branch, it was intimated by the president, ex-Bailie J. F. Millar, that Mrs. Margaret Cowan had given a sum of ^,350 for the pro vision of a war emergency ambulance for the Stirling area. It was also reported that Mrs. Colville had given an ambu lance to the Glasgow Association to be known as the Kippen and Arnprior waggon. During the past year the ambulance waggons had been requisitioned on 708 occasions, the total mileage covered being 8, 381, as against 5,000 the previous year.

FIRST

Our Nurses’ Page. COM PILED

H .R .H .

T he

D u ch ess

AN A M B U L A N C E

o f

K ent

a t

SIS TER .

K e n s in g t o n .

On Tuesday afternoon, June 5th, H .R .H . The Duchess of Kent, accompanied by Lady Louis Mountbatten, both dressed in the uniform of the St. John Ambulance Brigade, visited the Derry Roof Garden, High St., Kensington, which was open to the public on behalf of the funds of the British Red Cross Society and the St. John Ambulance Brigade. The Hon. Mrs. Orpen, O .B .E ., and Miss Eddon also accompanied Her Royal Highness. The gardens were opened by the Countess of Bessborough. Mr. Trevor Bowen, Vice-Chairman of Derry and Toms, who was accompanied by Mrs. and Miss Dorothy Bowen, said that during the past two years they had collected over ^ 12,000 for the St. John Ambulance Brigade and the British Red Cross Society. A Guard of Honour formed up on the Roof Garden and was inspected by the Duchess of Kent. No less than 120 girl employees were on parade with Miss Guy (Messrs. Barkers, Ltd.) as Senior Commandant, and the Misses Gatrell and Saye as Commandants representing Derry and Toms and Pontings respectively. Later, Her Royal Highness visited the beautiful gardens, which are over an acre in extent. The Mayor of Kensington, Cr. R. C. D. Jenkins, L.C.C., J.P ., was received by the Royal visitor, and he afterwards received the Duchess at the Town Hall opposite.

No.

D is t r ic t ,

The Nursing Division was registered in 1932, and now including 9 officers, and 70 probationers.

110 members,

After watching demonstrations in squad drill, first aid and home nursing, the Inspecting Officer congratulated all on their smartness in appearance, and their practical work. It was extremely gratifying to learn, she said, that the mem bership of the Division had trebled since her last visit a year ago. During the past 18 months the Division has been responsible for assisting in training over 3,000 persons in first aid and home nursing. A large number of the members were already in the Civil Nursing Reserve and others were completing their training in the local and London hospitals. Lady District Officer Miss Cherry was presented with a beautiful bouquet of white carnations by the officers and members of the Division.

No.

D is t r ic t ,

P r io r y

for

W ales,

S.J.A.B.

Certificates were presented on Wednesday, June 5th, to 115 women who have been attending the special first aid classes organised by the Priory for Wales. The ceremony took place at a social gathering of the Cardiff Nursing Division at Brigade Headquarters, Cardiff Castle. Lady Div. Supt. Miss A. Rosser, presided, supported by Lady Corps Supt. Miss V. W. Rees, Lady Amb. Officers Mrs. Thomas and Mrs. Woodward, Miss Kernick, Lady Reserve Supt., and Miss I. E. Woodward, Divisional Secretary. Corps Surgeon W. G. Williams, lecturer to the class, presented the certificates. An address on her experiences as a V.A.D. in France during the last war was given by Lady County Officer (Reserve) Miss M. Metcalf.

G arden

P arty

a t

S horeh am .

Lady Hermione Buffer, Deputy President of the Horsham and Worthing Division of the British Red Cross Society, was present at a garden party on June 19th, held at Ravenscroft, Shoreham, the residence of Mrs. Theakstone. The proceeds were in aid of the funds of the hospital supply depot. There was a good company present. Lady Hermione Buffer kindly distributed first aid, home nursing, and anti-gas certificates, and three years’ and six years’ service badges. At this ceremony she was supported by Mrs. Theakstone, Mrs. Trenchard, Miss Frith (Com mandant No. 174, B.R.C.S.), Miss Jones (Assistant Com mandant) and Quartermaster Mrs. O ’ Key. An exhibition of graceful dancing was given by Rachel Clemow, Empire; June Events, Irish jig; Elizabeth Wrightson, Welsh ; Helen Toms, Scottish Reel. It is hoped that ^12 will be raised by the event.

S.J.A.B.

No. 72 T u d o r ( E n f i e l d ) N u r s i n g D i v i s i o n . — Over 100 members and probationers of this Division earned high praise from Lady District Officer Miss Cherry at the Annual Divisional Inspection which was held at the headquarters, Enfield Grammar School, on Friday, June 28th. Owing to hospital duties and A. R. P. work at First Aid Posts, some of the members were unable to be present on this occasion. has

AID

S.J.A.B.

Reynolds, who is leaving the First Aid Post for another appointment, has been presented by her colleagues with an eight-day clock and a pencil, and by the women ambulance drivers and attendants with a fitted leather case, as tokens of their affectionate regard. She has been for many years one of the officers of the Herne Bay Nursing Division.

S t.

John

F ir s t

A id

C la sse s.

F o l l o w i n g on the announcement made last month that special four-course lectures had been instituted so that a much larger number of persons could obtain a knowledge of first aid in a short time, we have been informed that many hundreds of such classes have already been arranged and completed. During June some 50,000 copies of “ A Preliminary Course in First Aid ” — the textbook used for these courses— were sold, which indicates to some extent the enthusiasm with which these classes have been received.

Copies of “ Instructions on Stretcher Exercises,” recently issued for members of the St. John Ambulance Brigade, can be obtained from Dale, Reynolds & Co. Ltd., 46, Cannon-street, London, E .C . 4, price 4d. per copy, post free. Mr. Glyndwr Davies, County Officer, Aberdare Centre, Priory for Wales, died at Cardiff Royal Infirmary on Thurs day, June 3rd. He had been connected with the growth of the St. John Ambulance movement at Aberdare for some years.

H e r n e B a y N u r s i n g D i v i s i o N . — Miss Ada

The Dowager Duchess of Devonshire, President, County Red Cross Society, gave an interesting account of the work of the Society during the last war and also what had been done so far in the present war, at a well-attended meeting held in the Town Hall, Ilkeston, on June 18th.

FIRST

B a n d a g in g .* B a n d a g e s are em ploye d for the fo ll o w in g purposes :—

AID

FRANKLAND’S VITAL PULSE WATCH Regd.

Specially made for your professional purposes. Its large pulse calculating hand is invaluable.

(1) To give support to injured parts. (2) To keep dressings in place.

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(3) To fix splints and other apparatus. (4) To stop bleeding by means of pressure.

D E P A R T M E N T S — F ur s , F u r C o a t s . J e w e l l e r y , P l a t e , C u t l e r y , F u r n i t u r e . & c . W rite for Catalogue.

Bandages may be classed into three groups :— (1) Triangular Bandages.

VISIT O U R S H O W R O O M S O R S E L E C T I O N S SENT O N APPROVAL.

(2) Roller Bandages. (5) Special Bandages.

1. T h e T r i a n g u l a r B a n d a g e .

P ro tectiv e

FRANKLAND

(1) After adjusting the splints to the limb, place the centre of the bandage, folded either narrow or broad, over the outer splint, then pass the ends round the limb, cross them on the inside and tie on the outside over the splint.

Paym ent

Ltd.

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This bandage is made by taking a piece of calico about 40 inches square, and cutting it diagonally into halves. Of the three borders of the bandage, the longest is called the base and the others the sides. Of the three corners, the upper one, opposite the base is the point, the two others the ends. The bandage may be used either unfolded or folded as a broad, narrow, or medium bandage. The Broad Bandage is made by spreading the bandage out, bringing the point down to the base, and then folding in two. The Narrow Bandage is made by folding the broad bandage again in two. The Medium Bandage is made by bringing the point down to the base, and then folding into three. This bandage may be used instead of the broad or narrow bandage, when it is better suited to the proportions of the patient. It is sometimes advisable to halve the size of the band age by bringing the two ends together, before folding it into the broad, narrow, or medium bandage. When not in use it should be folded as a narrow band age, the two ends should be turned to the centre, and the bandage folded into four, reducing it to a packet about by inches. The bandage should be fastened either by a pin or by tying the ends with a “ reef knot.” The “ granny k n o t” must be avoided. To Tie a Reet Knot. — Take one end of the bandage in each hand, pass the end in the right hand over that in the left and tie a single knot, then pass the end in the left hand over that in the right and complete the knot. The ends when pulled tight will be parallel with the turns of the bandage. In a Granny Knot the ends lie at right angles to the turns of the bandage, and it is inclined to slip. Remember the rules for tying a reef knot :— Right over left, left over right.” For Securing Splints the triangular bandage may be used broad or narrow, as convenient. They should be applied firmly, but not so tightly as to constrict the circula tion of blood in the limb. Either of the following methods may be used :—

M o n th ly

T erm s.

( E s t . 1885) CEN.

2188.

IO D IN E is th e

m ost

e ffic ie n t

a n tis e p tic k n o w n . In w a r a n d p e a c e it has

been

w o r ld

over

use d

th e

fo r

th e

p a s t h u n d r e d y e a rs . Io d in e co sts lit t le , n e v e r fa ils t o p r o t e c t a g a in s t in fe c tio n . Iodine S to n e

TH E

Educational

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L o n d o n ,

FIR S T

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for lifting patient from the ground on to a stretcher. SIM PLE, E F F IC IE N T &- E A SY L O A D IN G

(2) Fold the triangular bandage narrow or broad, and * Extract from the Manual of Instruction for the Royal Naval Sick Berth Staff, reprinted by permission of the Controller of H.M. Stationery Office. Copies of the Manual can be had of H.M. Stationery Office, Adastral House, Kingsway, London, W .C . 2, or any branch, price 4/Sd. post free

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LOCAL

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DESCRIPTIVE BOOKLET. C H IS W IC K

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FIRST double it lengthways on itself. Place the loop upon the outer splint, carry the ends round the limb from without inwards and pass both ends through the loop in opposite directions. Tighten the bandage by drawing on the two ends, and tie over the centre of the splint.

AID 2.

R o lle r

( 2 ) Cotton, woven— supplied ready rolled in various

widths.

A p p l i c a t i o n o p t h e T r i a n g u l a r B a n d a g e to W o u n d s o f S pecial P a r t s.

For the Scalp.— Fold a hem about l i inches deep along the base, place the bandage on the head so that the hem lies on the forehead, close down to the eyebrows, and the point hangs dow'n at the back ; carry' the two ends round the head above (not over) the ears, and tie low down on the forehead : draw the point first downwards and then turn it up and pin it to the bandage on the top of the head. For the Forehead, Side of the Head, Eye, Cheek, and any part of the Body that is Round (as the arm or thigh).— The narrow bandage should be used, its centre being placed over the dressing and the ends being carried round the head or limb (as the case may be) and tied over the dressing. For the Shoulder.— Place the centre on the injured shoulder with the point running up the side of the neck, fold a hem along the base, carry the ends round the middle of the arm and tie them. Place one end of a broad bandage over the point of the first bandage and sling the arm by carrying the other end over the sound shoulder and tying the ends at the side of the neck ; turn dow'n the point of the first band age, draw it tight and pin it. For the Hip.— Tie a narrow bandage round the body above the hip bones, with the knot on the injured side. Fold a hem, according to the size of the patient, along the base of the second bandage, place the centre of the bandage over the dressing, carry the ends round the thigh, and tie them ; then carry the point up under the first bandage, turn it down over the knot and pin it. For the Hand when the Fingers are Extended.— Fold the hem along the base of the bandage, place the wrist on the hem with the fingers towards the point, palm downwards; then bring the point over the wrist, pass the ends round the wrist, cross and tie them, bring the point over the end and pin it to the bandage on the hand. For the Knee. — Fold a narrow' hem along the base, lay the point on the thigh and the middle of the base just below the knee-cap, cross the ends just behind the knee, then over the thigh just above the knee-cap, and tie them, bring the point down and fasten to the base. For the Elbow’.— Fold a narrow hem along the base and lay the point on the back of the arm and the middle of the base on the back of the forearm, cross the ends, first in front of the elbow’, then over the arm, and tie them at the back or front. Bring down point and pin. For the Foot.— Place the foot on the centre of a bandage with the toes towards the point, draw up the point over the instep, bring the two ends forward round the ankle and cross them. Now pass the ends round the instep and tie them ; draw’ the point forward and pin it to the bandage on the instep. For the Front of the Chest.— Place the middle of the bandage over the dressing with the point over the shoulder on the same side ; carry the ends round the waist and tie them ; then draw' the point over the shoulder and tie to one of the ends. For the Back.— The bandage is applied as the foregoing, except that it is begun at the back. For a Fracture of the Jaw.— Place the palm of the hand below the injured bone, and press it gently against the upper jaw ; apply the centre of a narrow bandage under the chin, carry one end over the head, cross the ends at the angle of the jaw, carry the long end across the chin, round the head and tie the ends.

B a n d a g e s a r e m a d e from various materials.

(1) Calico, unbleached— supplied in sheets and torn up in different widths as required.

(3) Flannel. (4) Muslin— used with Plaster-of-Parls. (5) Elastic w'ebbing. (b) Plain Elastic— called Martin’s Bandage. Roller bandages may be applied in three ways ( 1) The simple spiral. ( 2 ) The reversed spiral.

(3) The figure of eight. The Simple Spiral is applied by winding the bandage spirally round the limb, each turn overlapping two-thirds of the previous one. It can only be applied to parts which are of uniform thickness, such as the fingers, the wrist and the ankle, or in cases where the muscles are badly developed. The Reversed Spiral.— After fixing the bandage by two or three turns, place the disengaged thumb on the low’er border of the bandage at the outer side of the limb and reverse the bandage held in the other hand, that is turn it over so that what was the upper border is now the lower. Continue the turn round the limb and again reverse at the same point, so that the crossings are kept in line. Each turn should overlap exactly two-thirds of the previous one. This is applied to parts which are gradually increasing in diameter, such as the leg, thigh, and fore-arm. The Figure of Eight.— The bandage is carried up the limb from within outw’ards, round the back, down from within outw’ards and round the back again, thus forming a series of loops like the figure of eight. This is specially designed for bandaging joints, but can be applied to any part of a limb. A Spica is a special form of figure of eight, used at the junction of a thin with a thick part, such as the arm or the leg with the trunk, and the thumb with the wrist. A spica bandage may' be applied ascending or descending. A Divergent Spica is used to cover the knee and elbow. A turn is taken round the centre of the joint and then alternately above and below. This allows a certain amount of movement at the joint. R u le s

for

B a n d ag in g .

( 1) Fix the bandage by a few turns round the limb. ( 2 ) Bandage from below' upw'ards.

(3) Bandage from within outwards over the front of the limb. (4) The crossings should be in line and slightly to the outer side of the limb. (5) Each turn should cover two-thirds of the pre vious turn. (6) Keep the bandage taut w'hile winding it round the limb. Do not wind it round and then pull it tight ; this moves the dressing and causes the patient pain. (7) Always place cotton wool between opposing skin surfaces, as w'hen bandaging the arm across the chest. (8) Bandage the limb while in the position in w’hich it is intended to be kept. Do not bandage it first and then put it in the correct position. (9) Fix the end of the bandage by pinning it or by slitting it, tying a knot in the two ends to prevent it slitting further, passing the ends round the limb and tying in a reef knot.

FIRST

AID

W AR N E R V E S ! SLEEPLESSNESS! E X H A U ST IO N ! BREAKDOW N! These ills arise from too rapid a consumption of the grey matter of the brain, and vital nerve tissue, as a result of W O R R Y , A N X IE T Y , F R IG H T , S H O C K , LOSS O F SLEEP, O V E R W O R K , etc., and until the deficiency of the cell-salt is made good, no restoration is possible. Colloidal Phoskalium contains that which approximates the grey matter of the brain, and it is this which is necessary to manufacture the vital tissue, and is the greatest curative agent man has ever discovered, for the highly sensitive nerves of the human anatomy. Prepared in tablet form ; bottle of 65 tablets 3/- post free. Worth their weight in gold! The above is the claim of only one of my unique C O L L O I D A L and D EFICIEN C Y R E M E D IE S : an abridged list of others below, all equally astounding. D o n o t h e s it a t e to w r it e f o r a d v i c e ; t h i s s e r v ic e is S U L P H U R D E W (C olloidal S u lp h u r ) Liquid. a lw a y s a t y o u r d is p o s a l. Cures All F o r m s of Skin Diseases. R heu A ilm e n t s f o r w h ic h T r e a t m e n t S h e e t s h a v e b e e n m a t i s m ; A s t h m a ; C a t a r r h ; M a la ria ; Dysentery; p ro d u ce d a re e n u m e ra te d b e lo w . A ny o f th e se Dengue and all tropical Fevers ; Impetigo, etc. s h e e t s w ill b e s e n t on re q u e s t , f r e e o f c h a r g e w it h o u t o b l i g a t i o n o r f o l l o w i n g u p l e t t e r s . M a rk th o se 2 oz. B o tt le 3/C O L L O ID A L D EFICIEN C Y R EM EDIES. U p -to - d a te B io c h e m istry . 9 Remedies in tablet form. For S c ia tic a ; C r a m p ; N e u r a l g i a ; B rain T r o u b l e s ; Skin and Bone D eficiencies; V a ric o s e V e in s; W a r t s ; C a t a r r h ; Anaemia. The natural sleep inducing remedy, etc. B o tt le 65 T a b le ts of o n e k in d , 3/C H L O R O -1 O P I N E

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Indigestion Alopecia Appendicitis Leucorrhoea (Whites) Asthma Lumbago Migraine Bladder, Kidney and Liver Troubles Muscular Atrophy Blood Pressure Neurasthenia Boils Obesity Bronchitis Pernicious Anaemia Catarrh Piles Chilblains Prostate Enlargement Colitis Psoriasis Common Cold Rheumatism Conjunctivitis and Cataract Skin Diseases (All) Constipation Sinus Cramp and Sciatica Tuberculosis Dermatitis Tonsillitis and Quinsy Ear Troubles Ulcerated Stomach Eczema Urticaria Epilepsy Varicose Ulcers Gallstones Varicose Veins Goitre Whooping Cough Hay Fever Veterinary Service All c o r r e s p o n d e n c e t r e a t e d w ith a b s o l u te confidence.

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Separate booklets describing these remedies sent post free upon application. XELEEH ONE

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FIRST ( 10) necessary. S p e c ia l

Never use more bandage than is absolutely

R e v ie w s .

B a n d ag es.

T Bandage.— Two pieces of 4-inch roller bandage are fixed together by pinning or stitching to form the letter “ T . ” The horizontal part is tied round the waist, and the vertical part is carried from the back through between the legs, split as far back as the scrotum, and each end tied or pinned separately to the waist part. A quicker method of connecting the two bandages is to fold over the vertical part for about six inches, and in this double part cut two parallel vertical slits four inches long. The horizontal part is passed through these slits and tied round the waist. T bandages are used to keep dressings on the perineum and in tying in a catheter.

( T o be concluded.)

E xtra cts

fro m

R ead ers’

L e tte rs.

11 W i t h the advent of air raids, would it not be possible to place on the gate of a first-aider's house a red cross to denote that assistance and equipment is available in cases of acci dents, etc. ? This may save many lives and also assist the A.R .P. first aid personnel.— W.A. (London). (The use of the red cross in such circumstances would be against the Geneva Convention. There is however, no reason why persons skilled in first aid and willing to have equipment available should not place on their gate “ First Aider ” or some other such sign. — Editor.) “ R e Casualties, Could not all members of organised first aid bodies be sworn in and made to wear uniforms always ? Then they are ready at all times to render assist ance.” — F.G. (Bermondsey). (The non-wearing of uniforms does not debar first aiders from rendering assistance. Further, the cost of replacing uniforms worn out would be considerable, as has already been pointed out by part time workers at First Aid Posts. A first aider, like a policeman, is always on duty, even when in civilian clothes.— Editor.) “ Enclosed find renewal subscription for a further twelve months. 1 have been a reader since 1903, and the knowledge gained from the Journal since then has greatly assisted me in my training of personnel. Continued success and increased circulation is my wish for the Journal for First Aiders. 1 would, however, suggest that reports be cut down to a minimum.”— E. D. (E. Yorks). (Thanks for your good wishes. F i r s t A i d is published to assist first aiders, and therefore we require no thanks for doing our job of work. Reports have already been drastically cut down to the increasement of instructive articles. — Editor.)

At the annual meeting of the Hull and East Riding County Centre, S.J.A.A., Mr. F. Bilton, hon. treasurer, reported that the total contributions in the collecting boxes at 17 road-side ambulance stations amounted to 4s. Id. As 125 accidents received attention the amount received worked out at just over one farthing per case ! The New Milton Division, S.J.A.B., held a sale of work on June 26th, followed by a dance. Lady County Supt. Mrs. Hayes, Lady County Officer Miss Hayes, Lady Supt. Miss Collier and Nursing Officer Mrs. Walker were present. The stalls were in charge of Mrs. W. E. Kirkman (Presi dent, Nursing Division), Mrs. Coulter (vice-President) and others,

AID

Q U ESTION S

AND

ANSW ERS

FIRST

AID.

By F. G. Harwood.

Price 6\d. or ps. per doc. (posf free). This is the 7th Edition of a popular aid book ; and it has been completely revised to comply with the 39th edition of the first aid Textbook of the St. John Ambulance Associa tion. It consists of a series of questions which are for each of the 18 Chapters of the Textbook and are answered by quotations therefrom. It ends with five appendices, of which the first and second set out the scheme of examination for St. John certificate. The third and fourth provide some useful notes and suggestions for competition work, while the last, which is an innovation, consists of a list of quanti ties mentioned in the Textbook and would be improved if tabulated alphabetically. Those who have derived benefit from previous issues of this compact little book will be well advised to purchase this edition. Supplies can be obtained direct from the author at “ Hurstbourne,” Horsell-road, Woking. TRIANGULAR

B A N D A G IN G

W ITH O U T

WORDS.

London : John Bale Sons and Staples, Ltd.

Price 8d. net. This book presents a useful series of approximately 100 diagrams illustrating the different stages in the application of the triangular bandage, together with diagrams showing the various pressure points and Schafer’s method of artificial respiration. It is claimed that these will enable any person without previous experience or teaching to apply a bandage accurately— with which statement we are not in agreement because we hold that bandaging can only be learned at a practical class. Students of St. John Ambulance Association classes should, however, notice that in certain particulars the diagrams here and there show some minor differences from the instructions of the St. John Textbook.

L I P P I N C O T T ’S

Q U ICK REFERENCE FOR NURSES.

BOOK

Compiled by Helen Young, S.R.N. London : J. B. Lippincott Coy.

Price gs. net. This Quick Reference Book has been written by trained nurses for trained nurses and is now in its fourth edition. It presents literally a mass of authentic information which is immediately available to meet problems of all kinds encountered in the daily practice of nursing. The compiler, with the assistance of two colleagues, has made critical survey7 of modern textbooks ; and from this she has selected tacts and data which have proved both useful and helpful in the course of a wide experience. This material has been arranged in the form of a thumb index under six main headings— (1) General information including abbreviations, tables, &c. ; (2) Materia medica ; (3) Nursing technique ; (4) Diets for sick patients ; (5) Medical and surgical dressing, and (6) Obstetrical nursing. The scope of this book has been kept within bounds ; and readers will find that it meets all reasonable expectations of trained nurses who are looking for a concise, correct and compact reference library in o n e volume and ready for immediate use.

FIRST

AID

B e tte r p a tf fo r l i n t d id M e n o v e r th e B r itis h

Is le s , W o r k s ’ M a n a g e r s , F a c to r y M a n a g e r s , C o llie r y M a n a g e r s

in d u s tr ia l c o n c e r n s m a in ta in

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R esearch

M assage N o w every

has sh o w n t h e r a p y is

and

th a t th e

th e

up on

r e h a b ilita tio n

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and

c o n v a le s c e n t p e r io d

e m p lo y e d , a n d

E le c tr ic a l)

In s titu te

is y o u r o p p o r t u n i t y w om an

o f

s k iile d

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and

a ll la r g e

F ir s t- A id

m en

and

s m a ll

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m o s t F a c t o r ie s , S h ip y a r d s , C o llie r ie s , W o r k s h o p s , e t c ., w h e r e

tre a tm e n t, b u t

fir s t-a id

fu lfil

b e c o m in g in

th e

m en

th e s e

b e in g

d is c h a r g e d

th e

su rgeon s

can

re c e iv e

p e r io d .

S P E C IA L L Y fo llo w - u p

o f

w o r k - p e o p le .

S p e c ia l d e p a r tm e n ts a re b e in g in ju r ie s

b u s ily

T R A IN E D

is r e d u c e d

b y

are

s p e c ia lly

b e in g

as m u c h

80 p e r c e n t, w h e r e

tr a in e d

b y

th e

a d e q u a te

S .M .A .E . (S w e d is h

r e q u ir e m e n ts .

tr a in e d

fo r

th e

great w o rk

a r t o f s c ie n tific M a s s a g e

and

w h ic h

lie s a h e a d

M a n ip u la tiv e

T h erap y

th is

v a s t fie ld —

w ill b e

a n a tio n a l

o f th e

S .M .A .E .

a sse t.

TREM ENDOU S Y o u r

k n o w le d g e

In s titu te —

th e

T rem en d o u s o u t h a v in g F o r o ver

o f fir s t- a id

badge

o f

w ill b e te n

O P P O R T U N IT IE S

m o r e v a lu a b le

o p p o r t u n it ie s lie

b e fo re

S .M .A .E .

F IL L IN a n d p o s t t h i s c o u p o n

yo u

th is

u n til y o u

(S w e d is h

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q u a lify as a n e x p e r t a n d

M assage

m assage an d and

and

n u m b ers p a id

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"c o u p o n To The Secretary, The SMAE Institute, Leatherhead, Surrey. Please send me without obliga tion, a copy of your free Booklet " Manipulative Therapy as a Profession.”

if yo u

b ad ge

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le a v e y o u r p r e s e n t w o r k

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tim e s

is n o w

and

tu itio n

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been

its g ra d u a te s , s o m e

w om en

op en

com m an d

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N O T H IN G T h e v e r y m o d e ra te

r e a lm

o f

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have

you

u n til

D ip lo m a

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n o th in g to s u c c e ss fu l secu red ,

w ith

o f

S .M .A .E .

te a c h in g

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b y e a s y in s ta lm e n ts , e x a m in a tio n

I n s titu te

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fu ll.

Name Address,

" F A . " July, 1940.

s c ie n tific

LO SE

fe e s , w h ic h c a n b ; p a id

th e

y o u w ith

th e m o s t s u c c e ss fu l

in c lu d e s a ll n e c e s s a r y t e x t b o o k s , c h a r t s , d ia g r a m s a n d and

e x p e rt’s p a y .

F IL L IN T H E C O U P O N FO R T H IS F R E E B O O K

SMAE INSTITUTE LEATHERHEAD S UR R E Y \

fe e s ,

FIRST

AID F ractured

Q u e r ie s to

a n d

A n s w e r s

C o rresp o n d en ts.

Queries will be dealt with under the following rules :— L — Letters containing Queries must be marked on the top left-hand corner of the envelope “ Query,” and addressed to F i r s t A i d , 46, Cannon-street, London, E .C . 4.

2.— All 3.— All

Queries must be written on one side of paper only.

Queries must be accompanied by a “ Query Coupon ” cut from the current issue of the Journal, or, in case of Queries from abroad, from a recent issue.

4. — The

Textbook to which reference may be made in this column is the 39th (1937) Edition of the S.J.A.A. Manual of First Aid to the Injured.

A r t if ic ia l

R e s p ir a t io n

an d

P regnancy.

G.C. (Surbiton). — If I should be called to a patient who is not breathing, and I found that the patient, a woman, was pregnant, what method of artificial respiration would you recommend ? This question was asked at a recent A.R.P. lecture, and, as I was rather diffident in answering same, I shall be glad to receive your expert advice. The Textbook answers your query in the first two lines of p. 149, where it states that Silvester’s Metliod “ is to be used only when it is impossible to turn the patient on to his face.” In other words, with a patient in tie early months of pregnancy you would adopt Schafer’s Method, but with one in the latter months, and with a much enlarged abdo men, you would have to do Silvester.— N. C o r b e t F l e t c h e r .

E x a m in a t io n

H o w l e *.

L.R. (Charlton Park). — In a recent examination I asked a candidate to explain the difference between Epilepsy and Apoplexy. I confess that I was surprised and considerably amused when he gave this answer :— ‘ ‘ Epilepsy is a *orm o f Apo!>lexy which occurs in young adults ! ” Good !

Next, please ! ! ”— N.C.F.

A r t e r ia l

H .e m o r r h a g j

D u r in g

In fan cy.

H.G. (Surrey Docks).— If a c.iild only a few months old should be suffering from arterial bleeding, is the appli cation of a tourniquet th< proper method of treatment? If not, do you suggest any other method of treatment owing to age of the infint and the soft character of the bones which may be injured by the tourniquet ? Also, please state at what afe you consider that a tourniquet may be safely applied ? The ordinary tourniqiet, would, of course, be too large to control the pressure "points in the limbs of an infant. Properly applied, an improvised tourniquet, adapted to the size of the infant’s limbs, might be successful and would do no harm to the bones. Personally, however (if the infant still lived), I would put my trust in digital pressure or in a ligature, and remove the infant to medical aid without further delay.— N .C .F

L eg

an d

B u rst

V a r ic o s e

V e in .

VV.VV. (Pinner).— I was asked recently how I would treat a simple fracture of the left leg and a burst varicose vein of the right leg. I replied that I would treat each injury separately, and complete treatment by tying the legs together. 1 shall, however, be grateful for your advice. I agree. You would, of course, postpone your treat ment— other than temporary fixation— of the fractured leg until you were satisfied that the bleeding from the burst varicose vein has been controlled. Further, I would end treatment by keeping both Iow'er limbs elevated (Rule 10, p. 130 of Textbook).— N . C . F . T reatm ent

o f

F ractured

P atella.

P.S. (Truro).— I shall be grateful if you will tell me whether or no a pad should be placed beneath the knee joint in treatment of a fractured patella. During a recent dis cussion on this point, a friend maintained that a pad should be so placed, and justified himself by quoting Rule 2 on p. 90 of the Textbook, where it says— “ the splint must be well padded under the natural hollows of the leg.” On the other hand, I replied that the diagram on p. 90 (Fig. SO) does not show such a pad, and that if a sufficiently large pad is placed in the hollow above the heel, to raise the foot off the splint, there is no hollow below the knee joint. The main object in the treatment of a fractured kneecap is to prevent further separation of the broken fragments. Consequently, you are correct in your statement that a pad behind the knee joint is definitely contraindicated. Incidentally, your friend is misquoting the Textbook, which reads “ under the natural hollow (not hollowr) of the leg . . . . ’’— N.C.F.

S alt

T reatm ent

o f

W o u n d s.

C.B. (Radstock). — May I enquire if salt is an antiseptic? Also, what is its purpose or advantage when used added to a pint of sterile water as prescribed on p. 107 of the Textbook. Also, presumably, the same use and purpose is desired when used for wound of abdominal wall, internal organ protruding (p. 131). Meanwhile I thank you for your past query solutions. Salt solution is used for irrigation of a wound to replace in part the blood salt which has been depleted by the associated bleeding, and thus to revitalise the tissues which are rendered more resistent to infection. Its action is similar with protruding bowel, which if allowed to become dry, might receive irremediable injury. In no sense can salt solution be regarded as an antiseptic.— N.C.F.

S u rface

M a r k in g s

D ia p h r a g m

an d

N ip p l e .

H.S. (Old Trafford).— Please tell me(l) what are the surface markings of the diaphragm and (2) if the nipple lies approximately on the fourth rib. (1) The central tendon of the diaphragm has a mean position at the level of the joint formed by the sternum and the cartilage of the seventh rib. The right vault rises to the upper border of the fifth rib in the nipple line, while the left has a slightly lower level. (2) The male breast ranges in diameter from a third of an inch to an inch. It is usually placed over the fourth intercostal space, a little internal to the large muscle of the chest (pectoralis major) ; but its position is very variable and the two glands are often unsymmetrical.— N.C.F.

FIRST

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F IR S T

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2 . POISONING.

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3 . BANDAGES AND BANDAGING.

F ractu res;

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FIRST O b je cts

o f

T extbook.

J.B. (Stroud).— May I request your impressions upon the following- questions which recently formed the subject of a discussion at a meeting of Brigade members ? Is the Black Book a source of information and instruction, or is it only a guide to first aid students in their efforts to administer to the needs of the sick and injured ? The answer to your query is to be found on p. 21 of the Textbook where it states— “ The directions and illustrations which are given throughout this book are intended as a standard of treatment ; ” and an p. 22, when it is impossible to carry out the treatment exactly in the manner indicated— “ In such cases it will be necessary to comply with the principles of treatment in the best manner consistent with the actual circumstances.” In other words, the Textbook is a source of information and instruction and also a quide to first aiders in their treat ment of cases in actual emergency. — N.C.F.

In clem en t

W eath er

an d

T reatm ent

o f

F ractu res.

AID I agree with you that, provided no force is applied to the lower fragment, the figure-of-eight bandage, which is used in the treatment of fractures of thigh and leg, cannot exert traction on the limb and that it should always be applied when the foot of the injured limb can be placed more or less accurately in contact with its fellow on the opposite side. Indeed, its purpose is, as you say, simply to steady and support the injured limb.— N.C.F. T ranspo rt

o f

P a t ie n t

w it h

S p in a l

In ju r y.

A. W. (Marylebone).— In a recent test an unconscious patient was examined and the diagnosis was “ a suspected fracture of the spine in the lumbar region.” If the diagnosis was arrived at by the history of the case and the signs, how should this patient be transported ? This question is asked because of difference in opinion of the interpretations of Rule A, on page 73 of the Textbook. If the patient is unconscious and the nature of the injury is clearly defined, as in the fore going case, I suggested that it should have been treated as a fracture of the lumbar region ; but my colleagues said that as the patient was unconscions and despite the known region of the injury he should have been transported face-upwards. Your kind ruling on this will be greatly appreciated.

J.B. (Stroud).— In treating a patient in the street for a frac ture of the leg, is inclement weather a sufficient source of danger to justify the immediate removal of the case to a more convenient or comfortable place without even taking the precaution of renderng the limb as immov able as practicable before doing- so ? Your observations will be esteemed.

I agree with you. On the other hand a member of the Revision Committee once told me that the instructions of the Textbook were drawn up on the understanding that all cases of spinal injury should be removed face-upwards if the patient was unconscious.— N.C.F.

Emphatically no ! Inclement weather does not involve danger to life (Textbook Rule 1, p. 66), though it does expose patient to the risk of increased shock. In these circumstances it would necessitate rendering the fractured leg as immovable as possible bj tying the fractured to the unfractured limb (as per instrnctions of Rule 1— “ other means of restraint ” ) and postponing the normal treatment of the fracture until after the patient has been removed to shelter in some more convenien. place.— N.C.F.

M.N. (Wimbledon).— Recently a hot discussion arose among the members of our class as to whether, when we have to treat a patient suffering from fracture of the leg, the bandages should all be placed in position before we begin to tie them off or each should be secured as soon as it has been placed in position. As we cannot agree we refer the point to you.

S im p l e

F ractures

o f

B oth

L eg s.

P. S. (Coventry).— In some recent tests we had to treat a man who, as the result of a motor accident, sustained a simple fracture in the micdle of the shaft of each leg. Some of us applied four splints and some two outer splints. We shall be grateful for your ruling on this point. Were I in your place I vould treat each fractured leg separately and then bind limb to limb. By so doing you would facilitate your work as a first aider and also that of the doctor who subsequently takes charge of the patient.— N .C.F.

T reatm ent

o f

C om pound

F racture

o f

F em ur.

W.H. (Nottingham).— In alocal A .R .P . test our squad was called upon to deal wth a compound fracture of the femur, with bone protruding. We applied a figue-of-eight bandage round ankles and feet in the coursr of our treatment, in order to— “ Steady and support the injured limb,” so preventing further movement, efc., without causing extension. We are now t>ld that this was wrong, as the application of such a bandage would tend to produce extension. Several of us lelong to Divisions of the Brigade : and this contentior is new to us. As the Textbook is silent on the treatnent of this special type of fracture, would you kindly give your ruling on this point ?

T reatm ent

o f

F ractured

L eg.

The Textbook allows freedom in choice of method. Most first aiders, however, find that the method suggested under the treatment of fractured femur more convenient when they have to treat a fractured leg. Consequently, having placed the bandages in position, they tie them off in the sequence laid down in Rule 4, on p. 92.— N.C.F. H umour

F ir s t

A id .

M.S. (Wetherby).— I wonder if you think the following is good enough for inclusion in your column. Although it happened on April 1st, it was perfectly serious ! When demonstrating how a ring pad should be made, to a pupil at a Refresher Course, I asked where and in what circumstances such a pad would be used. After being given one illustration I pressed for a further one. The pupil was silent for a moment ; and then, as if suddenly inspired, he put his hand to the top of his head and said “ When there's a haemorrhoid here." It took all the self-control I could muster to keep a straight face. Good ! Next, please ! !— N.C.F.

1A A 111

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E E

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H IN TS

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NOTES

FIR S T

12 pp .

A ss is t an t C o m m is s io n e r , T h e St. J o h n A m b u l a n c e B rig a d e . POCKET FIR S T A ID S E R IE S . By C o l. R. J . B L A C K H A M , C .B ., C . M .G ., C . l. E . , D . S . O . ,

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D A L E ,

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R E Y N O L D S

CA N N O N

STREET,

C O .

LONDON,

M .D .

(1) P o iso n in g , (2) H aem orrhage, (3) In se n sib ility, (4) A s p h y x ia (S u sp en d ed B re a th in g ), (5) F ra c tu re s, D islo c a tio n s and S p r a in s , (6) W o u n d s, B ite s , B u m s , S cald s, R u p tu r e an d M in o r In ju ries. T h e S e rie s c o n ta in s a ll the essen tials o f F irs t A id . P rin te d on lin en -lin ed c ard s, 3 i in . X 5 ^ in. T h ird E d itio n . 6 d . net ea ch , p o sta g e 2d. ex tra . By t h e s a m e A u t h o r —

L T D .

E.C. 4.

AIR

RAID

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V IA D U C T ,

A SYNOPSIS OF DEFENCE AGAINST

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JOHN FENTON, M.B., B.Ch., B.A.O., D.P.H.

INCURVED EDGE OF SOCKET S . 1343 “ S A N O I D ” I N T E R L O C K I N G E X T E N S I O N SPLIN TS W i t h M e ta l s o c k e t s f o r j o i n t i n g . 2 p i e c e s : 2 5 / 8 t h s . in. x 3 /1 6 t h s . in. x 15 in. 2 pi e c e s : 2 5 / 8 t h s . in. x 3 / l 6 t h s . in. x 13^ in. I p i e c e : 2 5 / 8 t h s . in. x 3 / l 6 t h s . in. x 7\ 'in. I p i e c e : 2 5 / 8 t h s . in. x 3 / 1 6 th s . in. x 6 in. 2 W e b b i n g S t r a p s w i t h m e t a l b u c k l e s : 18 in. x I in. 2 W e b b i n g S t r a p s w i t h m e t a l b u c k le s : 2 7 in. x l £ in. 3 sockets. By t h i s i n v e n t i o n S p l in t s m a d e in a n y c o n v e n i e n t l e n g t h s m a k e ^ rig id c o n n e c t i o n s by m e a n s o f i n c u r v e d o p p o s i t e e d g e s o f t h e m e t a l s o c k e t s o r s le e v e s f ir m l y e n g a g i n g w i t h t r a n s v e r s e g r o o v e s in t h e s u r f a c e s o f t h e S p l in t s w h e n p r e s s e d h o m e i n t o t h e s o c k e t . U n l i k e t h e o r d i n a r y s o c k e t t e d S p l in t , t h is t y p e is ri g i d ly c o u p l e d ^ t o g e t h e r a n d h e ld a g a i n s t r e l a t i v e d i s p l a c e m e n t b u t c an be d i s e n g a g e d by p u l l i n g a p a r t w i t h s u ff i c i e n t f o rc e . N . B . —T o e n s u r e p e r f e c t l o c k i n g it is i m p e r a t i v e t h a t t h e S p l i n t s h o u l d b e c o r r e c t l y i n s e r t e d in t h e s o c k e t , i.e., BY M A K I N G C E R T A I N T H A T T H E I N C U R V E D E D G E O F METAL S O C K E T E N G A G E S W I T H T H E T R A N S V E R S E G R O O V E O F T H E S PL IN T. Pr ic e : C o m p l e t e w i t h t w o p a ir s o f s t r a p s - - 4 /- p e r s e t . W ith o u t straps - - - - - - 3 / - p e r s e t.

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J n ta p e iu k n f J o u r n a l f o r ttie A m b u l a n c e

No.

554.

V o l.

X L V II.

am i ^ u r a r u j

AU GU ST,

1940.

^ m r ite s

P ric e

3d .

e w

e s t

s t y

l e s

“ FIRST AID ” WALL DIAGRAMS

i n

S .J .A .B . U N I F O R M

/ / J *

( Si ze 2 ft. 2 ins. by 3 ft. 4 Ins.)

tcnjiM nn” DANCO T O

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Spe cial S e t o f 6 S h e e t s f o r t h e u se o f LECTURERS

A . R . P.

CLASSES com prising A na tom y, Physio logy, H a e m o r r h a g e , Di s lo c a tions and Fractures. M ounted o n lin e n w i t h r o l l e r , 21/ 6 n e t ; p o s t a g e 7d.

9/9 N e w St yl e H a t s A v a i la b l e .

17 th E dition .

Now

R e p rin t.

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“

O U T F IT T IN G

A S S O C IA TIO N B u ild in g ,

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W A R W IC K

3 19 Illus.

Som e co lo u red . 342 p ages.

T U N S T A L L ’S

f i r s t

” a/e

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L T D .,

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An A d v a n ce d A m b u la n ce H a n d b o o k .

S to c k p o rt.

E d ited by th e la te F. C . N I C H O L S , M . C . , M . B . , C h . B . , C a p t . R . A . M . C . ( T . )

L o n d o n - A b b e y H o u s e , W e s t m i n s t e r , S . W I. L iverpool . . . 57, R e n s h a w S t r e e t M anchester 36, King S t r e e t . B irm ingham 3, R y d e r S t r e e t . N e w c a s t l e - o n - T y n e - 26, N o r t h u m b e r l a n d , St. A b e r d e e n ( A g e n t ) - Miss G r a y , 9, H o l b u r n St. S o u th am p to n . . . 135, Hi gh S t r e e t . G lasgow I I I , Union Street.

T h e c h ie f f e a t u r e o f th is e d i t i o n is t h e m u c h f u ll e r a c c o u n t g i v e n o f Gas Po i s o n in g in W a r f a r e FIRST AID JOUR.— " One o f the most concise works on the subject published at a popular p ric e .”

JO H N

W R IG H T & B R IS T O L

SONS I

If you would be sure of life-long grateful remem brance, let your Gift be one of thoroughbred quality. Welbeck Plate suggests itself, for it fulfils every demand of even the most fastidious, and every piece is guaranteed for 35 years’ hard wear.

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Wholesale Discounts to bona-fide First Aid Organisations.

R a t Tail

Cam bridge

Pattern

P attern

A E E X V N D E R C L A R K

Go fra

L O N D O N :

1 2 5 -6

L E A D E N H A L L

F E N C H U R C H

S T R E E T ,

E .C .3 .

S T ., E . C . 3 . (P h o n e : M A N . H O U S E

10 5 4 ).

LTD .

F IR S T A ID 3hutepen6ent Journal Jx>r rheAmbulance anb 3ft\n"Mrt£ ^erxnce5 Editor :

N o .

5 5 4. _V m 344 ----V O L .

AUGUST

X bL V II. v n .

NOTICE

GEORGE

- n .w v ju .ji,

CRAFT

1940

T E tti^ ‘ d a t IstatioH irs’ Hall\1

lu -n j.

READERS.

p ric e th re e p e n c e [ /- P e r A n n u m , P o s t F r e e

EDITORIAL.

F I R S T A ID is published on the 3 0 t h o f e a c h m o n t h Annual Subscription is 4 s . post free ; single copies 3 d .

The T i-i e

Its aim and object being the advancement of Ambulance Work in all its branches, the Editor invites Readers to send Articles and Reports on subjects pertaining to the Movement and also welcomes suggestions for Practical Papers. A ll Reports, & c., should be addressed to the Editor at the address below, and should reach him before the 12 t h of each month, and must be accompanied ( not necessarily for publication) by the name and address of the Correspondent. Subscriptions, Advertisements and other business Communications connected with F I R S T A I D should be forwarded to the Publishers. D A L E , R E Y N O L D S & C o ., L t d . ,

F ir s t

Telegraphic Address— "• Twentv-four, London." Telephone— City 3710.

w a r

h a s

b e e n

re s p o n sib le

fo r g r e a te r in te re st b e in g ta k e n

T e a c h in g .

first

aid

W here

a n d

a llie d

p revio usly

s u b je c ts.

one

person

atten d e d a class, the n u m b e r is n o w 10 or m ore ; and even this figu r e is b e i n g im p r o v e d u po n . W h i l s t s tu d e n ts are on the in crease, the n u m ber of

46, C a n n o n S t r e e t , L o n d o n , E . C . 4 .

A id

e x p e r ie n c e d

teachers

teach ers

is d e c r e a s in g .

it is m e an t, of c ou rse , d o ctors

to w h o m

we, as l a y m e n , lo o k for a s sis ta n ce an d g u i d a n c e . T h i s de cre ase is du e to calls of H . M . F o r c e s . M a n y ne w do ctors h a v e been e n ro lle d for the

CONTENTS

THIS

NUMBER.

teach in g

first

aid,

but,

an d

this

the

g r e a te s t im p o r t a n c e to our m o v e m e n t , th e y d o n o t

th e m s e lv e s u n d e r s ta n d f i r s t a id a n d w h a t i t s t a n d s

E d i t o r i a l :—

A Simple Eye Irrigator

...

Extracts from Readers’ Letters Mechanical Revivification

... ...

21 22 23 24 25 26 27 28 28 29 30 31 31 32

...

36 36 36 36 36 36 38 38 38

First Aid Teaching A.R.P. First Aid Services Blood Transfusion ...

...

... ...

S.J.A.B. Headquarters and District Reports Competitions at Bristol... ... ... Priory for Wales ... ... ...

... ... ...

Reviews

...

Railway Ambulance News

...

“ First Aid for War Casualties ” Bandaging ... ... ... Our Nurses’ Page ... ...

Marking Sheet

...

Q u e r ie s

an d

A n sw er s

...

... ... ... ... ...

...

... . . ., ...

Treatment of Fractured Pelvis

...

Examination Howler

...

Loading Ambulance

...

. .

...

Substitution of Thomas Splint

...

Antiseptics at First Aid Post

...

Neck Pads in Treatment of Fractured Spine ... Transport of Spinal Injury Face Upwards

...

The Worries of a First Aider

...

H o w , then, can t h e y teach o t h e r s ? U n f o r t u n a t e l y , m a n y s u c h lecturers h a v e been

a s k e d , an d in m a n y c a s e s p ers u a d ed

a g a i n s t their

better j u d g m e n t , to take c la s se s w i th o u t first a s c e r t a i n i n g w h e th e r t h e y can know

the

lecture ;

s u b j e c t ; an d w h e th e r ,

w hether they if

they

not

k n o w first aid, t h e y are w i l l i n g to learn. T h e presen t tim e is v e r y a p p r o p r ia t e to in sti tute

c la sse s

m ed ical

in stru ction

p rofe s s ion .

profession

th at

fe w

first

aid

is a c k n o w l e d g e d d o ctors

can

for

the

tea ch

e v e n k n o w ) first aid, an d, therefore, s u c h

(or

in str u c

tion w o u l d be of benefit to th e m an d to the g e n e r a l p u b lic.

C o r r e s p o n d e n t s :—

Application of Thomas Splint

fo r .

M e m b e r s o f the v o l u n t a r y first aid a r m y o w e a g r e a t d e b t of

gratitude

to the

m e d ica l

sion ; b ut first aid has to be m astered

b y

p ro fe s

lecturers

an d p u p ils alike. M a n y c a se s h a v e been r e c e n tly o f lecturers on e can do that.

b r o u g h t to o u r notice

“ r e a d i n g the b o o k . ”

Any

It is e x p e c t e d of lecturers that

t h e y e lu c id a te to the c la s s, in e v e r y d a y l a n g u a g e , the

m ean in g

the term s

used in the t e x tb o o k ,

22 and

FIRST so

give

stu d e n ts

better

and

useful

k n o w l e d g e of the s u b je c t. Therefore

e arn estly

suggest

the

au th o ritie s c o n ce rn e d that th e y institute c la sse s of in stru ction to p oten tial m e d ica l lecturers.

A .R .P . Bv

F ir s t

O ur

S p e c ia l

A id

S e r v ic e s.

C orrespondent.

O n e of th e m o st im p o r ta n t e v e n ts th a t h a s o c c u r r e d sin c e I l a s t w r o t e , is t h a t t h e f u l l - t i m e fir s t a i d e r ( i n c l u d i n g s t r e t c h e r b e a r e r s in L o n d o n ) is n o w n o l o n g e r n e e d e d f o r m i l i t a r y s e r v i c e if o v e r t h i r t y y e a r s o f a g e . O n t h e o t h e r h a n d h e is not p e rm itte d to le a v e h is p resen t e m p lo y m e n t w ith o u t the p e r m is s io n of th e a u th o r itie s c o n c e r n e d a n d , ap p arently', th is is n o t g o i n g t o b e g i v e n l i g h t l y . T h e c h a n g e w i l l b e g r e e t e d w i t h e n t h u s i a s m b y t h e g e n u i n e a n d s in c e r e first a id e r w h o n o w k n o w s e x a c tly w h e r e both he an d the services stand.

On the other hand, certain individuals entered the services merely as a stop-gap until they found more remuner ative work. These were the people who treated the work lightly and who, in many cases, openly boasted they would resign if ever they were called upon to function actively. They will now appreciate that A. R. P. is a serious business and an important part of the defensive mechanism of this country. I, personally, welcome the new regulation from every point of view, and I have good reason for believing that previous articles in this paper dealing with the subject have not passed unnoticed by the authorities, and that this Journal has therefore contributed in great measure towards the first aider obtaining proper recognition and respect. In a previous article I made the point that first aid was everybody’s business, although the degree of first aid administered would be progressive as required when the patient passed to the more experienced first aiders. Un fortunately, in some boroughs an opposite view has been taken, i know of one district in which the control has ordered that each of the A.R .P. services should function only in its own particular special capacity. For example, air raid wardens should confine themselve to “ wardening ” and nothing else. I agree, in principle, that each service is primarily concerned with its own particular function, but, surely, it is the spirit rather than the letter which counts. Assuming an incendiary bomb fell into a first aid post, one wouldn’t expect the personnel to ignore it until the fire brigade came along. Why, then, should an air raid warden who is first on the spot not administer first aid, providing his routine duties are all being fulfilled ? The point is well illustrated by an “ incident” test which took place only a few days ago in central London. The wardens concerned all belong to a post which is extremely efficient in first aid, in fact each member has already obtained his St. John Voucher and proudly wears the St. John badge on his sleeve. As might be expected, they were first on the scene and there were three casualties to be treated. The next to arrive were the stretcher parties (twenty-five minutes later), and long before that time all the patients had been efficiently treated. First aiders will appreciate what might have really happened in an actual case w'hen there was a delay of twenty-five minutes in treat ment. The point I would stress is that the routine wardens’ duties were adequately carried out— and yet, in some districts, the wardens are being instructed that on no account must they “ bother” with first aid. It is not their business ! Since writing this, Home Security Circular No. 138/1940

AID has been issued which states that, although first aid is not primary the duty of wardens, if necessary they should attend to “ life-saving first aid ” such as severe haemorrhage, true asphyxia, removal from danger and the like. This confirms my previous observations. This month’s postbag has been exceedingly (and gratifyingly) heavy. Space only permits me to deal with a selected few letters, but I can assure all correspondents that their letters are much appreciated and are of great assistancce to me in helping to state the case of the first aider in A.R.P. The medical officer of health of a London borough confirms my remarks concerniug the lay-out of a first aid post. He strongly agrees with me that the “ operating theatre ” scheme is over-emphasised, especially in the case of mobile units, and that such over-emphasis is apt to give the personnel an entirely erroneous conception as to the real meaning and value of a first aid post. Two letters have been received from medical officers in charge of first aid posts stating that my suggestion of using the cupboard doors as trays, etc., has been tried out by them and found to be eminently satisfactory and efficient, especially where large numbers of minor casualties have to be treated. The matron of a Midland hospital writes to say that in her district the scheme has been in practice for many months, with the addition that personnel working out of doors wear school satchels in which are packed sufficient first aid dress ings for “ immediate ” temporary use. The medical officer in charge of a North County first aid post has again brought up the question of steel helmets. He states that in his post there is an adequate supply and, on his own initiative, he therefore allowed the personnel to take them to and from their homes. The matter came to the notice of the local A. R.P. controller, who countermanded the permission on the grounds that it was irregular and against Government orders. The personnel are extremely resentful and, on their behalf, the doctor writes for advice. He will find the answer to this problem in Home Security Circular No. 75/ 1940. “ Retention of Items of A.R.P. Equipment by Individual Members of Services.” The gist of the circular is as follows : Personal issue of equipment, when permissible, must be confined to steel helmets and respirators. It, therefore, follows that personal issue of gum boots and protective clothing is irregular. Personal issue of steel helmets and respirators is only permissable when the numbers available are sufficient to cover the whole personnel of the service and, so limited, that sufficient numbers remain available for common use to make it possible to equip other members of the service who have not received a personal issue when they are called to duty. Moreover, every authority must retain a proper number of helmets or respirators in reserve. These may consist partly of those articles awaiting repair or replacement, but there must also be a local reserve of serviceable equipment for emergency replacements. The authorised issue is so calculated that a full issue will permit a reserve of ten per cent, of helmets and twenty-five per cent, of civilian duty respirators. Incidentally, the recipient of a personal issue is made responsible for loss or damage of equipment in the event of it being due to circumstances not outside his or her control, and proper steps will be taken to recover the cost of such loss or damage from the individuals concerned. For this purpose the charges to be imposed will be :— Steel Helmets.— Steel body only, 5/6d. ; lining only, 2/- ; chin strap only, 1/-. Service Respirators.— Complete, ^,1 ; facepiece only (with tube), ll/6d. ; container only, 4/-; haversack only, 4/6d. Civilian Duty Respirators.— Complete, 7/6d. ; facepiece only, 5/9d. ; container only, 1/- ; haversack only, 9d. Finally, I was extremely interested to read that several refugee doctors, many of them men of great eminence, had recently sat for the recent L.C.C. examination in first aid.

FIRST I have since spoken to two of the candidates who told me they had enjoyed the experience and really learned quite a lot of things normally outside the curriculum of the ordinary medical student. On a recent visit to Guy’s Hospital I observed on the notice board that classes in first aid are even being run for the benefit of the medical students. I should imagine that this must be the very first occasion in the whole history of that old and distinguished hospital that first aid had been taught as a subject on its own. Textbooks stress the point that the duties of the first aider ends where that of the doctor begins and, without practical experience, any doctor will admit that the reverse is true. A good doctor is not necessarily a good first aider until he learns the subject, and my medical colleagues will be the first to endorse this view. Why not courses in first aid for doctors ? After all the medical student is instructed to treat a patient on the assumption that hospitals, nurses and x-ray apparatus, etc., is to be readily had for the asking. First aid in A. R. P. will necessitate modified treatments, judicious selection of patients for priority purposes, and improvisation of appliances under difficult conditions. Only practical first aid experience will guide the doctor in distributing his services to the best possible advantage.

AID

( 1) Glass wool in a glass bulb as a connection between two pieces of the rubber delivery tubing. This is not a recommended type as coagulation is likely to cause obstruction to the flow, and also it is difficult of cleansing after use.

NEEDLE—

B lo o d

T r a n s fu s io n .*

T h i s subject has received quite a considerable amount of attention since the present war began, and we are therefore reproducing a Blood Transfusion Outfit, as provided for the Emergency Blood Transfusion Service at Sectors and Depots in London and the Home Counties, from Bailliere’s Complete Medical Dictionary, by kind permission of the publishers. In addition to this reprint, the Dictionary contains instruc tions on how to withdraw blood, how to administer blood, how to clean the apparatus after use, and sterilization. T he

1. 2. 3. 4.

Container ready to be filled. Tubing for applying suction. Position for administration, with filter and needle. Gas-mantle type of filter.

A ppar atu s.

(a) A modified milk bottle (pint size) with a slight “ waist ” so that it can be more easily held, and having a metal band and loop at the base by which it may be sus pended when inverted. It is fitted with an aluminium screw cap with inside it a rubber diaphragm. There are two markings on the bottle— one at 180 c. c. and the other at 540 c.c. The lower figure is the amount of sodium citrate solution required to prevent coagulation of 360 c.c. of blood (180 + 360 = 540). The anticoagulant is sterilized in the bottle in an autoclave, which is then hermetically sealed until the blood is added. (b) F or withdrawal of blood.— A rubber bung perforated with two glass tubes 3 inches long. The top of one is lightly packed with cotton wool and is for admitting air. To the other is attached 3 feet of rubber tubing (which can be cut to the required length), and a hollow needle protected and kept sterile in a closed glass tube. (c) F or administering blood.— A rubber bung perforated with two glass tubes, one inches long to reach to the bottom of the bottle so that when this is inverted it acts as an air inlet ; the other is 2\ inches long, with a fish-tail shaped end inside the bottle to prevent too rapid flow of blood. To the other end, rubber tubing is attached and a hollow needle for insertion into the vein, it being likewise provided with a closed glass tube for protection. One of the three possible types of filter is also supplied. The kinds are :— * Extract from Bailliere’s Complete Medical Dictionary (Appendix XV), price 3s. 2d. post free.

(2) 25 c.c. of glass beads are sterilized and kept in a wool-plugged glass tube. They are poured into the blood immediately before the bung is fitted. The fish tail end of the short tube prevents the beads causing blockage. (3) The “ gas-mantle” filter (see illustration). This has the advantage of preventing wastage of time by cleaning and re-sterilizing, as is required if the previous types are used— a fresh one being put on each time and the old one discarded. The filter is of cotton mesh 3| inches long and having a purse-string threaded through at the apex and base, a quarter of an inch from the edge. On the long tube, 2 inches from the inner end of the bung, is fitted a small piece of rubber tubing (£ inch). The filter is passed over the glass tube so that its apex can be secured by its string in the small circle of rubber tubing (A) and the wider end secured round the bung in the neck of the bottle (B). When in position, the cone must be taut, and the whole can be sterilized in an autoclave, ready fitted. On inversion of the bottle, any clots fall to the neck, outside the cone mesh.

Dr. Cyril Banks, Medical Officer of Health, City of Nottingham, has been appointed President of the Nottingham Corps, S.J.A.B. Presentation of his Badge and Warrant of Appointment was made on August 4th, by Corps Supt. F. Wilson Moulds.

FIRST

St. John Ambulance Brigade H EADQUARTERS

AND

D I S T R IC T

AID H o s p ita l R e s e r v e affo rd s n o e x e m p tio n s h o u ld he be called u p u n d e r h is a g e g r o u p .

REPORTS.

Brigade Headquarters

E v a c u a t i o n . — In stru ctio n s h a v e been issu ed b y the C h i e f C o m m i s s i o n e r in t h e e v e n t o f c o m p u l s o r y e v a c u a t i o n of ce rtain areas.

T h e J o in t W a r O r g a n is a t io n h a s b een re q u ested b y the M i n i s t r y of H e a l t h to u n d e r t a k e th e o r g a n i s a t i o n a n d m a i n te n a n c e of a n u m b e r of a u x ilia r y h o sp ita ls an d c o n va le sce n t hom es. G e n e r a l S e rv ic e m e m b e rs of the B r ig a d e and also t h e B . R . C . S . , w i l l f o r m p a r t o f t h e staff's. T h e s ta ff w ill c o n sist of p a rlo u r m aid s, h o u se m aid s, e t c . , a n d s u c h w i l l n o t b e r e q u i r e d to h a v e f i r s t a i d o r h o m e n u r s in g certificates, but th ey sh o u ld h a v e s o m e k n o w l e d g e of t h e p a r iic u la r d u tie s fo r w h i c h th e y v o lu n te e r. M e n a r e r e q u i r e d f o r t h e f o l l o w i n g c a t e g o r i e s :— O r d e r lie s , b a tm e n , w a ite r s , liftm e n , etc. T h e y sh o u ld be

O fficers and m e m b e rs of the B r ig a d e w h o a re e v a c u a te d s h o u l d o n a r r i v a l in t h e n e w l o c a l i t y w h e r e t h e y p r o p o s e t o resid e, g e t into c o m m u n ic a t io n w ith th e n e a re s t u n it of th e B r ig a d e , w ith a v ie w of c o n tin u in g th eir B r ig a d e w o rk . In c a s e s of d iffic u lty m e n s h o u ld a p p ly to th e R e c o r d O ffice , St. J o h n A m b u l a n c e B r i g a d e , S t. J o h n ’s G a t e , L o n d o n , E . C . I , and n u r s in g m e m b e r s to th e L a d y S u p t.-in -C h ie f, 3 , B elg ra v e-sq u are, L o nd on , S . W . l . A ll m e m b e r s s h o u ld h a v e in t h e i r p o s s e s s i o n ( 1 ) N a t i o n a l R e g i s t r a t i o n I d e n t i t y C a r d ( 2 ), U n i f o r m P e r m i t a n d , in t h e c a s e o f a n u r s i n g m e m b e r ( 3 ), H o s p i t a l A t t e n d a n c e R e g i s t e r .

Photograph by Courtesy]

{Gloucester Newspapers, Ltd.

L a d y M a r l in g p r e s e n tin g a w a r d s to th e S tro u d D iv isio n . A lso

present,

from

l e f t : M i s s A l l e n , O . B . E . , A s s t . C o u n t y C o m . H . J. L e w i s , S i r H a r r y W a t e r s , L a d y Cripps, S u p t. P en d ry.

o v e r 41 y e a r s o f a g e ; t h o s e b e t w e e n 17 a n d 1 8 | m a y be accep ted tem p o rarily. A ll w i ll b e r e q u i r e d to h o ld a first aid certificate. T h e m in im u m ra tes of p a y tor fu ll-tim e m en w ill he £ i p e r w e e k ( 1 0 / 6 d e d u c t e d if m a r r i e d ) ; w i f e a l l o w a n c e 2 2/6 d. a n d c h i l d r e n ’s a l l o w a n c e s . A ll p e rson s w ill w o r k u n d e r th e C o u n ty W a r O r g a n i s a t i o n a n d , t h e r e f o r e , l i s t s o f n a m e s s h o u l d b e f o r w a r d e d to the C o u n ty C o m m issio n e rs

V . A . D . officers a n d m e m b e r s a w a i t i n g a llo c a tio n w ill, o n a r r i v a l in t h e i r n e w l o c a l i t y , g e t i n t o c o m m u n i c a t i o n w i t h th e S u p t. of th e n e a r e s t n u r s in g d ivisio n or the C o m m a n d a n t of th e n earest V . A . D e ta c h m e n t. F u lle r p a rtic u la rs ca n b e o b tain ed fro m th e a c tu a l in s tr u c tio n s issued.

N o . I (Prince o f W ales’s) District R .A .M .C . E n lis t m e n t a n d T r a n s f e r s . — T h e B rig ad e H e a d q u a rte rs h a s receiv ed in tim a tio n from the M ed ica l D e p a r t m e n t , W a r O ffice, th a t at p res en t tra n s fe rs b e tw e e n a r m s are tem p o rarily suspen ded. W it h r e g a r d to e n lis tm e n t of B r ig a d e m e m b e r s in to the R . A . M . C . , it is p o s s i b l e t h a t o b j e c t i o n s a r i s e in s o m e c a s e s b y v i r t u e o f t h e a p p l i c a n t ’s c i v i l t r a d e o r c a l l i n g , w h e r e b y e n lis tm e n t in to the R . A . M . C . , w o u ld in v o lv e th e loss of a s k ille d t r a d e s m a n to a n o t h e r a r m . T h e fa ct th a t a m e m b e r h a s re g is te r ed w ith the M ilita ry

S o u t h a l l . — O n A u g u s t 3 rd, a d a n c e o r g a n i s e d b y th e S o u th a ll B r itis h L e g i o n E n t e r t a in m e n t C o m m itte e , w a s held in t h e C o n c e r t H a l l in a i d o f t h e S o u t h a l l A m b u l a n c e a n d N u r s in g D iv isio n a l B u ild in g F u n d . S u p t . J. E . T a y l o r e x p r e s s e d t h e t h a n k s o f t h e B r i g a d e to th e B r it is h L e g i o n , a n d r e g r e t t e d t h a t M r. C . E . C o llin s (P resid en t a n d C h a ir m a n of the B u ild in g F u n d ) w a s u n ab le to be p r e s e n t o w i n g to a p r e v io u s e n g a g e m e n t . T h a n k s w e r e a ls o e x p r e s s e d to th o s e w h o h a d s u p p o r te d th e fu n c tio n in c lu d in g m e m b e rs of H . M . F o rc e s an d of a C a n a d ia n R e g im e n t.

FIRST Mr H Beeson M.M., said it was a pleasure for the Committee 'to assist the Brigade in raising funds for per manent headquarters. He thanked Mr Collins for sending a donation towards “ spot ” prizes. Dancing continued merrily until 11.30 p.m.

II District

C o u n t y . — According to the County Circular No. 5, it is now proposed to organise the county for handling and transport of wounded on a permanent basis. At some recent first aid A. R. P. trials, staged by A/County Com. Bishop in which Brigade A. R. P. squads competed with A R.P. First Aid Parties, Buckingham A team won the four cups, in a high speed display which was two minutes faster than any other team.

B ucks.

S t r o u d . — Beatrice, Lady Marling, recently presented awards to successful members of the Brigade. Asst. Com. H. J. Lewis presided, and apologised for the unavoidable absence of Dr. Cardew. Mr. Lewis quoted figures from the Chief Commissioner’s report, and paid tribute to the work of Corps Officer J. C. Badge and Supt. P. Pendry, and also Miss C. Allen, O.B.E. Supt. Pendry stated that over 400 had attended lectures and gave details of the various efforts made by local con tributions. Lady County Supt. Miss Faber announced the formation and sanction of a division in Stroud, and expressed the hope that all classes of first aid work would be forthcoming. Thanks were expressed to Lady Marling and to Mr. Lewis. Mr. Fred Daniels, Sir Harry Waters, Knight of Grace of the Order, Miss Allen, Lady Cripps and Mrs. Horsfall, A.R.P. first-aid Commissioner, also addressed the meeting.

W i n c h e s t e r . — The presentation of awards to the Win chester City and District Division, took place at headquarters, before a good gathering, including the Mayor of Winchester (Lt.-Gen. F. Hi Griffiths) and the Mayoress ; Miss B. Errington-Loveland (president) ; Mr. R. Errington-Loveland (vicepresident) ; Mr. Jordan, assistant pathologist, R.H.C. Hospital ; Amb. Officer Rose, Lady Amb. Officer Mrs. Rose, and members of the Winchester City Nursing Division. In the course of his remarks the Mayor spoke of his interest in the S.J.A.B. and B.R.C.S., and the help they had given to the city, especially in the matter of A. R. P. He also emphasised a greater help that could be given by its mem bers, and that was the stopping of rumours, which in some cases assumed an ugly aspect.

AID

after the band had played the National Anthem, the company was dismissed.

N o . VIII (D uke o f Connaught’s) District H e n f i e l d . — Mr. Frank N. Clarke (President) presided at the annual meeting of the Henfield Ambulance, Nursing and Cadet Divisions. Particulars of the Nursing Division was given by Lady Supt. Miss Barter. All members had passed their re examination ; 58 journeys had been made by the ambulance ; hospital and clinic duties had been carried out. A rota of nurses was always on call to staff six first aid points, day or night. Supt. C. A. Barnes reported that members of the Ambu lance Division had carried out 109 public duties, 113 road service duties, 228 transport duties. Courses of practical first aid had been given in the surrounding villages ; several members, including Div. Surgeon H. F. Squire, were on active service. Both divisions were in constant touch with A. R. P. headquarters. The President said that the reports, including that of the cadets, presented by Miss Goodliff, reflected true devotion to duty.

N o. IX District We regret to announce the death of Capt. F. H. Rodier Heath, M.R.C.S., L.R .C.P ., County Commissioner of Dorset. A well-known practitioner in Weymouth for 34 years, he was the first divisional surgeon of the Weymouth Divi sion and in 1933 became the Dorset County Commissioner. He was appointed a Serving Brother of The Order in 1927, being promoted to Officer in 1933 and, some eighteen months ago, was promoted to Commander. The little chapel of Weymouth crematorium was filled by friends who wished to pay their last respects to one who had done much for his fellow men. The following members of the Brigade were pall bearers : Asst. Commissioner Dr. E, S. Bowes, County Surgeon Colin Forbes, Div. Surgeon R. V. S. Cooper (Weymouth), Div. Surgeon M. J. Saunders (Portland), County Officer J. M. O ’ Hara and County Gas Officer A. E. Cox. In addition to the Brigade there were represented the medical profession, numerous Freemason Lodges, and local organisations and associations.

C o m p e titio n s

a t

B r is to l.

annual competitions of the Bristol Centre S.J.A.A., were held on July 13th. Results and judges were :—

T h e

No. V District The annual inspection of the Harrogate Ambulance and Nursing Divisions was held in the grounds of the Oatlands Preparatory School. The Inspecting Officer was County Surgeon E. H. Lodge, accompanied by Mrs. Lodge, the Mayor and Mayoress of Harrogate (Coun. and Mrs. J. C. Topham), Dr. H. Mathers, Dr. Dorothy Potter, Supt. A. Ridsdale and Lady Supt. Miss Paley. At the close of the presentation ceremony the Brigade gave demonstrations, and the nurses an exhibition of practical bandaging. On the completion of the demonstrations the parade marched past the saluting base, and the salute was taken by Dr. Lodge. Dr. and Mrs. Lodge both addressed the assembly and, H a r r o g a t e .—

“ Beavis ” Cup, Butler’s Division; Dr. H. G. Kyle. “ Lavington ” Cup, G .W .R . Filton ; Dr. J. Lanson Roberts. “ Mather ” Cup, North Somerset, L .M .S ; Dr. Kettlewell. “ Novice” Cup, John Robinson & Co. ; Drs. N. S. B. Vinter and S. B. Green. “ W alker” Cup, No. 1 Nursing Division ; Drs A. S. Gorham and D. T. Richards. “ Squire’s ” Cup, G.W .R . Filton ; Dr. Claremont. “ W eber” Cup (junior trophy, first time competed for), No. 1 Nursing Cadets ; Drs. R. T. Moore and Helen Aldwinckle.

Lady Wills presented the awards.

FIRST

Priory for Wales. P r io r y

H eadquarter

N o tes.

By the removal of Professor George Knox, M .I.M .E ., F.G.S., to Scotland, Officers of the Priory have lost a col league whose long and intimate connection with almost all departments of activity had endeared him to a wide circle of ambulance workers in Wales. Resolutions of sincerest regret upon his departure, coupled with good wishes for the future, were recorded at the monthly meetings of all the committees upon which he had served with distinction. At the quarterly meeting of the Motor Ambulance Transport Sub-Committee, held on July 29th, it was reported that a satisfactory scheme for co-operation on the part of the Priory with A.R.P. Authorities had been finalised in consultation with the Commissioners of the No. 8 Region. The number of cases removed in the Priory’s co-ordinated service of ambulances in the South Wales coalfield during the June quarter was 5, 855, involving a total mileage of 92, 137. During the first six months of the year the Association Department at Priory House arranged examinations or re examinations for 899 First Aid and Home Nursing Classes within the Principality. The Chief Commissioner at Home and the Lady Superintendent-in-Chief have agreed that all officers and members of the Brigade, including V . A . D .’s, shall be issued with a Uniform Permit, which they will carry at all times when wearing uniform. Books of 25 numbered permits have been issued to Commissioners and Assistant Commissioners of County Areas for distribution by an officer or officers delegated by them. Brigade A. R. P. Instructors have been advised that the Home Office has issued an A.R.P. Training Bulletin in re sponse to suggestions made from many quarters that it would be convenient if material issued by the department through circulars, etc., which, by modification of existing handbooks and memoranda or in other ways, affects the work of instructors, could be brought together in a single publication, issued periodically, could be made available to all instructors. The need has been partly met in the past through the publication by the Air Raid Precautions Schools at Falfield and Easingw’old of school pamphlets and in structional addenda ; but, although these have been of great value and widely appreciated, their usefulness has been limited by the fact that they assumed the background of in struction given at the schools to C.A.G.S. and A.R.P.S. I nstructors, and they wrere not'suitable for, and were not issued to, the very much larger number of locally-trained L.A.G.C. and L .A .R .P . Instructors. The difficulties were specially acute in the case of commercial or industrial firms whose locally-trained instructors, having no access to departmental circulars and being unable to obtain copies of the publica tions of the schools, have been seriously handicapped in keeping their instructions up-to-date ; but it has been repre sented that, for instructors of local authorities also, it would be a real convenience and assistance to have material affecting their instruction issued periodically in this com prehensive way. It is proposed to issue the Bulletin at frequent intervals, as regularly as the flow of new material may permit. Copies will be on sale at H.M. Stationery Office, the price of the first Bulletin being 6d. net. The Sub-Prior, acting on behalf of H .R .H . the Grand Prior, has approved the following Awards of 45 Service Medals and 33 Service Medal Bars on the application of the Priory for Wales :— S e r v ic e

M edals

(15

Y ears’

E f f i c i e n c y ).

Glamorgan Centre.— Asst. Commissioner S. B. Turner, .M.R.C.S., L.R .C.P . ; Corps Supt. T. J. Jones, Llynfi Valley Corps ; Corps Secretary Stanley Sharp, Riches Corps ;

RID Corps Treasurer attached David J. John, Dulais Valley Corps ; Div. Supt. John H. Jones, Bargoed and District Division ; Amb. Officer William T. Jones, Pontlottyn Divi sion ; Corps Sergt. Major Calvin J. Quick, Riches Corps ; Amb. Officer David J. Thorley, Bargoed and District Divi sion ; Sergt. Sidney I. Cockwell, Briton Ferry Division ; Corpl. William A. Nicholas, Ogmore Vale Division ; Pte. Henry Dodd, Bargoed and District Division ; Pte. Alfred E. Sharp, Ogmore Vale Division ; Corps In. Stores David Williams, LIpper Cynon Valley Corps ; Div. Supt. John R. Jones, Hirwain Division ; Sergt. Thomas J. Thomas, Aber dare Division ; Corpl. David A. Owen, Duffryn Aman Divi sion ; Corpl. William G. Bryant, Hirwain Division ; Corpl. William Williams, Aberdare Division ; Div. Surgeon Harold E. Thomas, Merthyr Borough Division ; Corpl. Robert G. Hancock, Troedyrhiw Division ; Pte. Meirion G. Roberts, Troedyrhiw Division ; Pte. Emlyn Lewis, Troedyrhiw Divi sion ; Pte. Arthur M. Jones, Troedyrhiw Division ; Pte. John Targett, Treharris Division ; Amb. Officer Evan J. Davies, Rhymney Division ; Amb. Officer Herbert F. Yelland, Pentwyn Division ; Amb. Officer R. H. Brown, Cwm Division ; Corpl. Joseph Swift, Abertillery Division ; Corpl. E. Moss, Cwm Division ; Pte. William J. Jones Pentwyn Division ; Pte. William Stone, Pentwyn Division ; Pte. Herbert L. Handy, Pentwyn Division ; Pte. T. H. Wooldridge, Cwm Division ; Pte. Robert J. Preece, Ponty pool Division ; Amb. Officer Charles E. Horler, Ystrad Rhondda Division ; Amb. Officer David C. Chown, Fernhill Division ; Corpl. John C. Thomas, Fernhill Division ; Pte. Frances G. Smith, Fernhill Division ; Pte. Richard J. Rees, Fernhill Division ; Pte. John O. Davies, Tylorstown Divi sion ; Sergt. David J. Thomas, Tycroes Division ; Sergt. Cecil D. F. Gibbs, Newport Town Division ; Sergt. John A. Stevens, Barry Dock Division ; Pte. Owen Jones, Barry Dock Division ; Pte. William E. Foley, Barry Dock Division. 1s t

B ars

(20 Y e a r s ’ E ffic ie n c y ) .

County Surgeon E. J. Herington-Budge ; Pte. Thomas Hughes, Barry Dock Division ; Amb. Sister Helen Connor, Cardiff Nursing Division ; Corps Supt. David Thomas, Amman Valley Corps ; Amb. Officer Stanley Anthony, Tycroes Division ; Amb. Officer May Prothero, Llanelly Nursing Division ; Corps Supt. James Leach, Islwyn Corps ; Corps Secretary Attached Thomas A. Forster, Avon Llwd Corps ; Corps Secretary Alfred Poole, Aberavon Corps ; Corps In. Stores William Regan, Riches Corps ; Div. Supt. Thomas Hockin, Taibach and Port Talbot Division ; Div. Supt. William A. Carter, Llanbradach Division ; Sergt. Frank R. Clark, Taibach and Port Talbot Division ; Corpl. George Phippen, Ogmore Vale Division ; Div. Supt. William Anthony, Cwm Cynon Colliery Division ; Div. Supt. William H. Thomas, Abercynon Division ; Div. Supt. Luke Thomas, Blaenclydach Colliery Division ; Pte. Thomas J. Protheroe, Clydach Vale Division ; Pte. Thomas G. Thomas, Tylorstown Division ; Sergt. Benjamin Jones, Treharris Division ; Pte. James Sussex, Troedyrhiw Divi sion ; Pte. Harold Carr, Bangor Division. 2nd

B a r s (25 Y e a r s ’ E f f i c ie n c y ) .

County Officer Emrys James ; Div. Supt. David Jones, Troedyrhiw Division ; Pte. David W. Davies, Merthyr Borough Division ; Sergt. John G. Davies, Tylorstown Division ; Corpl. Thomas M. Brooks, Tylorstown Division ; Pte. David J. Lewis, Clydach Vale Division. 3rd

B ars

(30 Y e a r s ’ E ffic ie n c y ) .

Corps Supt. Charles Lennox, Barry and District Corps ; Amb. Officer William H. Adams, Barry Dock Division ; Amb. Officer John L. Collins, Barry Dock Division ; Corps Treasurer Gordon Edwards, Mid-Rhondda Corps ; Corps Treasurer (deceased) Thomas Davies, Taff Valley Corps.

FIRST R e c o g n it io n

o f

S e r v ic e s

C row n.

The Ambulance Committee of the Priory has decided to send a message of congratulations to all Brigade Members who receive awards for distinguished conduct whilst serving with H M Forces ; and steps have been taken to have such awards brought to the notices of Priory Headquarters by B r ig a d e O ffic e rs.

The Commissioner for Glamorgan recently drew atten tion to the award of a Military Medal to Lance/Corporal W R Walters, formerly a member of the Bryn Colliery Ambulance Team, for gallantry in rearguard action, the details of the incident being as follows “ On June 1 all troops were ordered to abandon La Panne beach and march alon<' the sands towards Dunkirk. Lance Corporal Walters returned to the town of La Panne, and under heavy shell fire rescued and attended to six wounded men and success fully transported them by road to Dunkirk in an abandoned motor car. He then transferred them to an ambulance. This was a 10-mile journey, and entailed a mile detour across fields and jumping the car across a ditch.” The Com missioner for Wales, in congratulating the recipient upon this distinction, states that the account of his exploit warms the hearts of his former comrades in the Bryn Division and of the Brigade.

R e v ie w s. A IDS

HYGIEN E

FOR

N U R SES.

By Edith M. Funnell, S.R.N ., D.N.

AID

circumstances in which these occur, while it gives a clear insight into some of the technical problems involved. We note with interest that iodine, acrillavine, and surgical spirit are named as useful antiseptics in certain circumstances, that acriflavine and tannic acid solution or jelly’ are recommended for the treatment of burns and scalds, and that the barrel bandage is favoured for the treatment of fractured jaw. Two useful tables are given. The first shows clearly on one page, the causes of insensibility as given in f ir s t A id to the Injured, whilst the second, taken from Methods o f A i r A nalysis , describes the effects of lack of oxygen and of various noxious gases which may be encountered in coal mines. ADVICE TO T H E EX PECTAN T HER HEALTH AND T H A T OF

M O T H E R ON HER CHILD.

By F. J. Browne, M.D., F.R .C .S ., F .R .C .O .G . Edinburgh : E. & S. Livingstone.

Price 6d. First issued in 1926 and now in its fifth edition, this excellent book has been written for the expectant mother by the Professor of Obstetrics in the University of London. It gives as shortly and as plainly as possible experts’ advice regarding food, clothing, exercise, and the general care of the mother’s health during pregnancy and afterwards of her baby. It seeks to supplement, not to take the place of, personal interviews with the doctor or midwife. A useful index is provided ; and the expectant mother will find that the book anticipates all her wmrries and gives sound and practical advice.

London : BaillRre, Tindall & Cox.

Price 3's. 6d. J. Hygiene is an applied science and is notoriously difficult to teach owing to the need for innumerable digressions into chemistry, physics, bacteriology and other sciences. In these circumstances the authoress merits our congratulations in that she is in no way discoursive but keeps the matter so clear and concise that all students of hygiene, and especially those who are preparing for examination, have the main facts set before them at a glance. That the textbook supplies satisfactorily a popular demand is proven by the fact that a second edition has been published within two years. The value of the book, which was written primarily to cover the hygiene section of the Syllabus of the General Nursing Council, is enhanced by 26 excellent illustrations, these being made as line drawings and so easy to reproduce if required in examination. Finally, the book can be carried about in the pocket and studied at odd moments ; and it will prove a valuable aid to knowledge of those readers of F i r s t A i d who desire at small cost a complete and concise textbook of hygiene.

S U T H E R L A N D ’S

IN C O A L

AID.

Edinburgh : E. & S. Livingstone.

Price 6d. ; by post, fd. This popular little book which was first published in its successful career and has now run into forty-two editions, thus completing 165,000 copies. It is based on the syllabus of instruction of the St. Andrew’s Ambulance Association and provides a clear and consise account of first aid within the scope of a volume which can be carried in the waistcoat pocket. The number of illustra tions have been increased to 46 ; and the book has been thoroughly revised and rewritten for this issue, which will be welcomed alike by new and old readers.

1887 continues

The Vicar of Seaton (Rev. H. M. Cooke) dedicated a n e w ambulance of the Seaton, Beer and District S.J.A.B.,

on Sunday, August F I R S T A ID

FIRST

Edited by Halliday Sutherland, M.D.

4th.

MINES.

London : The St. John Ambulance Association.

Price gd. net ; by post io \d .

Brigadier-General Sir Bertram Portal, K.C.B., C.B., D.S.O ., has been appointed a vice-president of the Hamp shire County, S.J.A.B.

We have received from the Chief Secretary of The Priory for Wales, the first edition of F irst A id in Coal M ines , which we cordially commend to all concerned. The book is intended for the use of men who have already qualified in first aid and is to be read in conjunction with F irst A id to the Injured , the official textbook of the Association. The book is very practical, covering, as it does, the special treatment of accidents in coal mines and the peculiar

The following members of the Penzance Division, S.J.A.B., serving with the R.A.M.C., are prisoners of war : Corpl. P. A. Care, Corpl. F. C. Semmens, Pte. W. C. Richards, Pte. J. M. Rosewall and Pte. Gordon Barr. Two further mem bers, Corpl. V. J. Farmer and Pte. E. C. Cook, have been reported missing.

FIRST

Railway Ambulance News. G reat

W e ste rn .

P a d d i n g t o n . — Members of the Paddington Goods ambu lance class met on July 16th to receive their examination awards at the hands of Mr. W. A. Lambert. After con gratulating the class on their high percentage of successes, and presenting 44 awards, Mr. Lambert asked Dr. C. H. Perram, lecturer, to accept an attache case from the class members in appreciation of his services. During the past ten months this class has been actively engaged on A. R. P. duties, and the members are to be congratulated on the keen way in which these have been carried out.

N e w p o r t D o c k s . — At the outbreak of war this class had a membership of 75, which has since increasen to 116, 41 being first year members from all departments at the Docks. Practically the whole of the members, in addition to some 150 First Aid Auxiliaries, are enrolled for A.R.P. duties in the event of air raids, and are manning five first aid posts, and the casualty clearing station every night throughout the week. These duties are carried out before or after the ordinary day’s work, and thanks to the co-opera tion of local officers, the personnel are made comfortable during their all-night vigil. In addition to the voluntary night staff, ambulance men engaged on their ordinary duties report to the posts each time an alarm is sounded, and “ stand by ” for duty. A really first rate organisation has been built up by Principal First Aid Warden T. J. Raines, who is the class secretary.

London,

M id la n d

and

S c o ttish .

Promoted by the L.M.S., Radstock Centre, competi tions for men and women were held on July 23rd. Mr. R. Gould, J.P. (Chairman, Norton-Radstock U.D.C.), presided, Lady Hylton presented the awards. Also present was Mr. A. H. Whitaker (district local supt.) and Mr. S. Sealy (District Controller). The judges were Dr. Hilda F. Ashworth and Dr. K. E. Lane ; arrangements were in the hands of Mr. A. C. Pearce (hon. secretary) and his assistant, Mr. H. Andrews. The results were: Women’s tests, Radstock No. 1, 201 ; Radstock No. 2, 180. Miss D. Chivers gained the individual prize. Men.— Radstock No. 1, L. M.S., 229 ; Peasedown, 199L Mr. James Tyte (Peasedown) gained the individual prize. In addition to the awards a framed Vellum Vote of Thanks of The Order of St. John was presented by Mr. Whitaker to Mr. Fred Griffin of the L.M.S.

London

and

N o rth

E a stern .

The Hull District Council of the L. N.E. R. Ambulance Centre held their annual field day competition last month at “ Birkholme,” Hedon, by permission of Major G. W. A. Todd and Mrs. Todd. Drs. A C. Minn and J. H. Sutcliffe adjudicated the team test, whilst Messrs. H. A. Marshall and T. B. White head judged the work of 15 first year and 6 second year competitors.

AID The results were : Team test, Dock Engineers, 209 ; Dairycoates, 208 ; Paragon No. 1, 205. First year, J. B. Marshall followed by J. Patrick ; second year, J. Train followed by J. H. Lyons. Mr. L. Ballan (District Supt.) presided and presented the “ John Larder ” challenge shield and other prizes. The organisation and arrangements were made by Mr. G. H. Oakes (District Secretary) and members of the Council.

Presentation of awards to members of the Scarborough class was held on July 11th, by Mr. F. Dowson. All mem bers had passed the examination. Appreciative reference was made to the excellent services of Dr. T. F. R. Griffin and also Mr. VV. Millions (instructor) and Mr. E. Ward (secretary), both of whom received gifts from the members.

“ F ir s t

A id

fo r

W ar

C a s u a ltie s .”

T he accepted basic principle of ‘ ‘ pure ” first aid apply to any casualty, but procedures and routines may need modification, especially to war casualties. The training provided by the acknowledged first aid teaching bodies is of tbe greatest value, but war-time first aid requires special instruction in addition to peace-time training. It is with this object in view that a new book entitled “ First Aid for War Casualties” will be published on September 4th, the cost being 1/8 post free. In this book will be set out : Possible War Injuries, types of wounds and injuries ; Wound-Shock, primary and secondary ; Haemorrhage, internal and external, Fractures, Burns and Scalds, Asphyxia, Concussion and Compression, and other such conditions, including an important section on Sudden Childbirth, The work of First Aid Services in action is fully dis cussed, casualty-collecting, patient’s position on stretcher ; whilst precautionary self-protective measures against Blast and noise are fully discussed. The author of the book is Major Norman Hamer, B.Sc., M.R.C.S., L.R .C .P ., whose practical knowledge has been responsible for the publication of important first aid and other A.R.P. pamphlets. The publishers are Dale, Reynolds & Co., Ltd., 46, Cannon-street, London, E .C . 4, and orders should be sent to them.

The Vicar of Lymington (Rev. M. R. Bethune) dedi cated the second ambulance of the Lymington St. John Ambulance on Sunday, July 28th. It was provided through the generosity of Mr. and Mrs. G. E. D. Fullerton, who paid for a chassis to be reconditioned and for a modern body to be built on it. St. John Ambulance Lindsay Corps League contests at Gelligaer on Saturday, July 20th, resulted as follows : Penallta, 129£ ; Gelligaer, 123 ; Trelewis, 120 ; Nelson, 113£. The divisional aggregate awards were : Nelson, 54l | ; Penallta, 524£ ; Trelewis, 519 ; Gelligaer, 518. Silver cups were handed to the first team captains by Commandant (Mrs.) S. B. Turner, Bargoed, who also presented ex-Supt. W. Davies with a fountain pen and Mrs. Davies with a cake stand. Supt. William Evans, Trelewis, presided.

FIRST

B a n d a g in g .*

(Concluded, from page 14..) M a n y - T a il e d

B ondage.

Take several strips of bandage long enough to surround the part to be covered once and a half times. Lay them parallel, and over-lapping one another for two-thirds of their width. Now si itch these together in two lines a few inches apart across the width of the bandages, so as to form a sort of backbone, with over-lapping ribs at either side. To apply it, the backbone is placed at the back of the part to be bandaged, and the side pieces brought forward singly, each side in turn, and crossed over the dressing. The last turn is secured by a safety pin, and when completed the results resembles a reversed spiral bandage. When used for the thorax, shoulder straps are often sewn to the upper part of the backbone of the bandage which are brought over the shoulders and pinned down in the front. These prevent the dressing slipping downwards. Similarly, when used for the abdomen, two lengths of band age are sewn to the lower part, brought forward between the legs, and pinned to the bandage in front. When used for the leg, a length of bandage is sometimes sewn to the lower part, brought under the sole of the foot and covered by the lower tails. Many-tailed bandages are used when a dressing has to be changed frequently, and when it is inadvisable to disturb the body or limb to pass the many turns of a roller bandage. F o u r - T a il e d

B an dage.

A 3-inch roller bandage 1 yard long is split from both ends except for about 4 inches in the middle, and in the centre of this a small hole is cut. To apply it, fit the chin into this central hole, tie the upper tails over the occiput to draw the chin back, and tie the lower tails at the top of the head to draw the jaw upwards. The four loose ends are then tied together to prevent the bandage slipping off the head. This bandage is used in fracture of the lower jaw and to secure dressings. E ye

B andage.

Using a 2-inch roller bandage, take a turn round the head commencing at the temple of the sound side, and pass ing across the forehead. The next turn is reversed and crosses the eye to below the ear and then round the back of the head. The third turn is reversed over the eye, passes above the ear, round the back of the head and is pinned at the temple. It is wrong to take too many turns over the eye. C a p e l in e

B an dage.

This is used to keep a dressing on the head and may be applied in two ways :— ( 1) Take a 3-inch roller bandage and commencing below the occiput, bring it over the centre of the skull to the eye brows and then back again slightly to one side, overlapping two-thirds of the first layer. An assistant holds the back turns in place while you attend to those in front. Now bring the bandage to the front again, but on the other side of the centre strip, and so on, taking each side in turn until the whole surface is covered. The loops thus formed are held in place by taking a few turns round the head, the end being pinned. (2) Take two roller bandages, one 3-inch and one 2-inch, * Extract from the Manual of Instruction for the Royal Naval Sick Berth Staff, reprinted by permission of the Controller of H.M. Stationery Office. Copies of the Manual can be had of H.M. Stationery Office, Adastral House, Kingsway, London, W .C . 2, or any branch, price 4/5d» post free

AID

and pin or sew the ends together so that both unroll the same way. Place the united ends below the occiput, bring both bandages round to the front, and cross the narrow over the broad one. The latter is now taken back over the vertex while the former is continued round the head, and below the occiput they are again crossed. This is continued until the scalp is covered, the narrow bandage passing round the head fixing the turns of the broad one which passes back wards and forwards over the vertex. The two bandages are then tied together in a reef knot in front. In both cases the bandage must be applied very firmly, and the circular turns must be below the prominence of the occiput and the frontal eminences. Similarly, half the skull may be covered alone ; either the front, or the back, or one side. A rm

S l in g s .

The best arm sling is made with an unfolded triangular bandage. Place a triangular bandage on the chest with one end over the shoulder on the uninjured side, and the point of the bandage pointing out towards the elbow of the injured side. Place the across the bandage, turn up the lower end over the forearm, passing it over the shoulder of the injured side, and tie it to the other end behind the back. Fold the point over the elbow and pin it in place. Instead of this, a roller bandage may be used by form ing a “ clove hitch.” The forearm is passed through the two loops, which are separated so that one supports the wrist and the other is just below the elbow. The ends are tied at the back of the neck. C love

H it c h .

To tie a clove hitch, hold a length of bandage near i(s centre in the right hand, palm upwards Grasp the nearest part of the bandage with the left hand, the back of which must face the right with the little finger upwards. Now turn the left hand outwards and the right hand inwards, when two loops wall be formed. Place the right hand loop in the fingers of the left hand, grasp the loose ends with the right hand and the clove hitch is made. This may seem rather complicated, but it is quite easy in practice. The advantage of a clove hitch is that when the ends are pulled on the loops do not tighten. F oot

S l in g s .

A length of stout bandage is passed round the sole of the foot and the ends tied at the back of the neck. It is used to support the leg when the patient is allowed to walk about with crutches after a fracture. It should be tight enough to keep the foot in front of the body, so as to prevent it touching the ground.

Mr. and Mrs. Corah, who have rendered many years’ valuable assistance to the Leicester Centre S.J.A A., have been admitted Officer (Brother) and Officer (Sister) of The Order of St. John. The new ambulance of the Leicester S.J.A.A. was dedi cated by Canon C. H. K. Boughton last month, following a special parade of Brigade personnel. The Iodine Educational Bureau has issued a pamphlet on “ Antiseptics : What You Need to Know in an Emer gency.” Copies can be had on request by readers writing to Stone House, Bishopsgate, London, E .C . 3, mentioning this Journal.

FIRST

Our Nurses’ Page. COM PILED

B Y AN A M B U L A N C E SIS TER .

The Joint War Organisation of the British Red Cross Society and the Order of St. John has been requested by the Ministry of Health to undertake the organisation and main tenance of auxiliary hospitals and convalescent homes throughout the country. General Service members of the St. John Ambulance Brigade and the British Red Cross Society will form part of the staff's. The staff will consist of parlour maids, house maids, cooks and possibly laundry maids. Such members will not be required to have first aid or home nursing certificates, but should have some knowledge of the particular duties for which they volunteer. They will be attached to the local unit. Those employed on full-time service will be paid by arrangement at normal local rates, part-time service will be on a voluntary basis. These members will wear a simple and inexpensive uniform, details of which will be announced later. As such persons will be required for this work under the County War Organisation, Officers in charge of Divi sions and Detachments should forward a list of names of those enrolled to the County Staff of their own Body, who will keep the secretaries of the County War Organisation informed of the numbers available.

U n if o r m s

for

N u r s in g

D iv is io n s ,

S.J.A.B.

A specification of the summer dress approved for off-duty wear for V.A.D. members, and also for the use of Brigade Officers when doing office work, has been issued. This dress may be obtained from the usual sources. With this off-duty dress grey stockings may be worn. Officers and members should note that when out of doors hats or storm caps must be worn. Also that the approved corridor cape is not permitted for outdoor wear. The Lady Supt.-in-Chief has kindly consented to allow the following relaxations in the dress rules as a war-time measure :— 1. Petersham belts, 2\ inches wide, may be worn by members working in hospital instead of the starched belt. Trained nurses and other officers will wear black petersham and Ambulance Sisters will wear grey. 2. Rucked lawn cuffs, although not regulation, may be worn to cover rolled-up sleeves, when working. 3. Dark-grey non-transparent stockings may be worn with indoor uniform when working in hospital. Nursing members should wear the C.N.R. badge on the right-hand side of the apron bib and on the right-hand side of the great coat just above the Brigade badge.

No. 6

D is t r ic t ,

S.J.A.B.

N u r s i n g D i v i s i o n . — The first inspection of this newly-formed Division was carried out by Lad)’ Corps Supt. Mrs. Howel last month at the East Hull Clinic. She was accompanied on this occasion by the Lady President, Mrs. L. F. Hull. Mrs. Howel handed the records of the Division to Miss Sayner, Officer-in-Charge, and said she was pleased to welcome the new Division to the Hull Corps. After the inspection, the members demonstrated practical work. Among those present were Dr. L. F. Wilson, County Surgeon ; Miss M. A. Nicholson, S.R.N ., M.S.R., S.C.M. ; S outh coates

AID Lady Corps Secretary Mrs. Haley, and Lady Corps Officer Mrs. McDonald.

D e t a c h m e n t , B .R .C .S .— On Monday, July the Kineton Detachment of the B.R.C.S. met at the Hall for an inter-sectional competition, for which the judges were Mrs. D. Fielden, O.B.E., Vice-President of the County, and Sister Cox. After a uniform inspection, tea was served by Mrs. Wade and Mrs. Baldwin (retired members of the Detach ment), and then an accident was staged and treated by each section in turn. The cup was awarded to Section I, which was under the leadership of Mrs. Clarke. K in e t o n

22nd,

C am bs.

a n d

Isle

o f

E ly

B ranch,

B.R

C .S .

A competition to encourage recruiting for the Civil Nursing Reserve was recently held, every Division in the above Branch of the B.R.C.S. entering, even to the smallest village. In the semi-final 14 teams competed at Cambridge. On Saturday, July 13th, Miss Darbyshire, R.R.C., Matron-in-Chief of the Joint War Organisation, visited the Guildhall, Cambridge, and before a large and distinguished gathering presented prizes to the three winning teams :— 1, Cambs. 8 (leader, Mrs. Clark-Kennedy), 91 per cent, of the total marks ; 2, Cambs. 20 (leader, Mrs. Dainty), 88 per cent. ; 3, Cambs. 56 (leader, Mrs. Clapton), 85 per cent. The prizes consisted of wrist watches, gold safety pins for nursing caps, and fountain pens respectively. Lady Spens, Deputy President, Cambs. and Isle of Ely Branch, introduced Miss Darbyshire, at the same time apologising for the absence of Mrs. Adeane, County Presi dent. The Matron-in-Chief spoke of the trying “ standing-by ” period all had been through. The time had not been wasted ; a great deal had been learned in this period which would be of great service. She realised it was hard not to be able to use one’s knowledge, but who wanted a battle of Britain to provide patients to nurse ? Speaking of those who had undergone training in hospitals, Miss Darbyshire said that everything they had learned would be stored up for future use. At this time, welltrained members were urgently needed who were accustomed to discipline and they were to be found in the members of the Red Cross and Order of St. John. The team work found in the members of the two organisations was the highest possible, and those belonging to these bodies had a distinct advantage in their own spirit of loyalty. “ I do wish you God-speed,” concluded Miss Darbyshire “ and ask you to remember the symbol you have before you. Keep it precious and your flags flying high.” Major Lee Warner, County Director, proposed a vote of thanks to Miss Darbyshire. He said that team spirit, which played a great part in the last war, was invaluable. Under the present arrangements it was in danger of being lost. Volunteers were trained in teams and then went oft' as nursing auxiliaries in various hospitals. He hoped that team spirit would begin again in the convalescent homes. The Mayor, Mr. W. J. Wing, seconded the vote of thanks. He remarked that Miss Darbyshire’s words on “ standing by ” recalled to him his words in the Guildhall a short time ago when, quoting Milton, he had said : “ They also serve who only stand and wait.” He urged them all to fight on to the bitter end. The Mayor mentioned that it had been his privilege to sign a cheque for ^J2,000 to be sent to the Lord Mayor of London, this being the result of the Red Cross Flag Day. He was very gratified by the response of Cambridge to that appeal.

FIRST

AID

Miss Darbyshire also presented the “ Emma Cann ” Challenge Cup for home nursing to Mrs. Clark-Kennedy, Commandant of the winning team. It was given by officers and members of Cambs. 2 in memory of Emma Cann who died in the service of her country, February 1st, 1940. The County Director, Major Lee Warner, received a cheque from Mrs. Clark-Kennedy amounting to £ ' 550, raised by officers and members of Cambs. 8, the cost of an ambu lance for the wounded. This ambulance is one of several which the Branch hopes to provide. At the close of the proceedings, Mrs. Lee Warner, VicePresident, handed Miss Darbyshire a box of red and white carnations from officers and members of the detachments.

S im p le

Eye

Ir r ig a to r .

I n t h e t r e a t m e n t o f c e r t a i n e y e i n j u r i e s , a n i r r i g a t o r is a n essen tial part of th e treatm en t.

A reader of “ First Aid ” has sent in particulars of a very simple but nevertheless useful irrigator, which any person can make. It is used in conjunction with the ordinary water bottle carried whilst on duty, and is therefore, available at a moment’s notice. Briefly, it comprises a cork through which has been bored a hole to take a glass tube, such as a fountain pen filler. An air passage, 2-3 mm. diameter, is drilled obliquely from the side of the cork to the bottom. After fixing the glass tube the end is filed to the level of the cork and the irrigator is ready for use. When not in use, a second cork, pierced in a similar manner to the first, can be used to protect the protruding glass tube. The accompanying illustration clearly shows how this irrigator can be made.

E xtracts

From

R ead ers

L e tte rs.

H.N. (London).— Should not the wearing of identifica tion discs be made compulsory? With the advent of more intense air raids it would greatly assist the identification of persons, especially those who were unconscious. (The Government has on many occasions stressed the importance of such discs. Members of H.M. Forces, the Police and other bodies are compelled to carry identification discs, and first aid personnel can set an example to others by wearing a disc in uniform and out of uniform.— Editor.) Class Secretary writes.— “ There is at present a dearth of good first aid lecturers among the medical profession. Most of the more experienced ones have been drafted to H.M. Forces, and those left are overworked. The initial teaching to the general public is so important that I venture to suggest that classes of instruction should be held for doctors and also for laymen, who should be issued with a ‘ teacher’s ’ certificate.” (This is but one of many letters received on the subject of instruction by doctors and lay persons. We have urged the appointment of lay lecturers over a period of many years but the authorities still require “ medical” lecturers in spite of the fact that to-day the dearth of good lecturers is very apparent. It is an acknowledged fact that very few doctors can teach first aid, and therefore classes are very necessary. The time is also very applicable for the instituting of laylecturers. — Editor.)

Career with a futur

ll over the British Isles, W orks’ Managers, Factory Managers, Colliery Managers and all large and small industrial con cerns are now busily seeking the assistance of fully trained First- Aid men in order to maintain the efficiency of tbeir work-people. Special departments are being organized in most Factories, Shipyards, Collieries, W orkshops, etc., where injuries cannot only receive first-aid treatment, but upon being discharged by the surgeons can receive massage treatment and so decrease the rehabilitation Deriod. S P E C IA L L Y

T R A IN E D

Resear h has shown that the convalescent period is reduced by as much as 80 per cent, where adequate follow-up therapy is employed, and first-aid men are being specially trained by the S .M .A .E . (Swedish Massage and Electrical) Institute to fulfil these requirements. Now is your opportunity of becoming trained for the great work which lies ahead in this vast field— every man and woman skilled in the art of scientific Massage and Manipulative Therapy w ill be a valuable asset. TREM ENDOUS

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Your knowledge of first-aid w ill be ten times more valuable if you can wear the badge of the S .M .A .E . Institute— the badge of qualification. Tremendous opportunities lie before you in this greatly extending field which is now open to you without having to leave your present work until you qualify as an expert and can command an expert’s pay. For over 20 years the S .M .A .E . (Swedish Massage and Electrical) Institute has been teaching scientific massage and numbers among its graduates some of the most successful and highly paid men and women in the realm of Massage. N O T H IN G

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T h e v e ry m oderate tu ition fee, w h ich can be p aid b y e a sy in stalm en ts, includes a ll n ecessa ry te x t books, ch arts, d ia g ram s and ex am in a tio n fees, an d rem em ber th at w ith the S .M . A .E . In stitu te yo u h ave n oth in g to lo se, as it g u a r an tees to coach y o u u n til su ccessfu l a t the ex a m in a tio n an d y o u r D ip lo m a secu red , or return y o u r fees in full. W R ITE N O W f o r th is I n t e r e s t i n g b o o k l e t , e n t i t l e d “ M a n i p u l a t i v e T h e r a p y as a P r o f e s s i o n . ” It will be s e n t t o y o u f re e a n d p o s t f re e a n d in v o lv e y o u in n o o b l i g a t i o n w h a t s o e v e r . A d d r e s s : T h e S e c r e t a r y , 50, S M A E I n s t i tu t e L e a th e r h e a d , Sirrrey. ■A N PAYS

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SMAE INSTITUTE UATHERHEAB

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M .I .F ir e E .

C hiej Surgeon to the National F ire Brigades Association.

B e f o r e considering the various mechanical means of per forming artificial respiration, it is well to recall not merely the principles that govern it but also the occasions when it becomes necessary for the preservation of life. Artificial respiration must be applied whenever normal respiration is suspended, or impeded to such an extent that there exists a serious deficiency of respirable air in the lungs. Generally speaking, such conditions are produced by accident, or by disease ; but to appreciate the subject fully, it is necessary to understand the process of normal breathing. Anatomically, the chest, or the thorax, is a closed cavity, formed chiefly by the ribs in the shape of a crate, the base of which is separated from the abdomen by a sheet of muscle, known as the diaphragm. In this sealed crate, the lungs, composed of inter communicating air cells, are suspended in such a way that access of air to them is by the windpipe, and its bronchial tubes. A ir

C ells.

Whenever the chest cavity is expanded, air is drawn into the countless air cells of the lungs. This expansion is accomplished in two ways : (1) by certain muscles of the chest and the neck elevating the ribs, which are specially shaped to produce an alteration of size of the crate ; and (2) by the diaphragm which, dome-shaped during relaxation of its muscles, is flattened out by muscle contraction. These muscle fibres of the neck, the chest and the diaphragm contract and relax under control of the various nerves which supply them in synchronised manner with impulses emanating from the brain. To a very small extent the acts of respiration, namely inhalation and exhalation, can be controlled by personal desire, such as when one holds his breath for a minute or two, or breathes heavily or quietly. This voluntary control, however, is limited to the extent permitted by an automatic, or involuntary, breathing control which incessantly endeav ours to ensure the necessary supply of air, according to the demands of the body. This automatic control is worked by a specialised group of brain cells, called the respiratory centre, from which emanates all impulses through the nerves to the muscles concerned in the expansion and contraction of the chest cavity. In the normal working of the body, it is the chemical condition of the blood, as supplied to the respiratory centre, which influences the rate and the volume of breathing. Whenever hard w'ork is being done, more oxygen is consumed by the tissues, and more carbon-dioxide, the waste product of oxygen consumption, is developed in the blood. N erve

Im pu lses.

Increases of carbon-dioxide content of the blood stimu lates the respiratory centre to send impulses through the appropriate nerves to increase the action of the muscles concerned in the act of respiration. The converse is also true ; decrease of carbon-dioxide in the blood will diminish the rate and the volume of breathing. Oxygen is essential to human life, and to maintain life in normal conditions, the lungs require to be inflated and deflated in an atmosphere containing 20 per cent, of oxygen and 80 per cent, of an inert gas, such as nitrogen. Rhythmical movements of the chest, at a rate of about

AID

16 times a minute, spontaneously controlled by the brain, ensure the necessary oxygen, increased or decreased, accord ing to the work of the body and regulated by the amount of carbon-dioxide in the blood. If any circumstances causes these movements to cease, they must be continued artificially, or death from what is termed asphyxia will occur in a few minutes. The principles underlying artificial respiration may now be considered in the light of our conception of the normal working of the chest and the lungs. Evidently the most desirable methods will be those which imitate the movements of the chest cavity, by promoting movement of the ribs and the diaphragm, and permitting air to enter the lungs by atmospheric pressure. This is exactly the principle of the manual methods of artificial respiration taught by Sylvester, Howard and Schafer. The large number of successes which have attended these methods, especially Schafer’s, prove that the principle is sound and efficient. P r o l o n g a t io n

o f

E ffo rt.

As these methods are manually operated they require relays of performers for any prolonged working. Year by year we are encouraged to prolong our efforts on the apparently dead. To-day, even 12 hours of continuous artificial respiration is not too long to wait for a recovery from electric shock. In some cases of paralysis of the chest muscles, artificial respiration has been continued, in this country, for more than two years. Perhaps, however, the most justifiable demands for prolonged mechanical methods are those cases of temporary paralysis of the chest muscles and the diaphragm, a condi tion which may complicate some of our curable diseases, such as diphtheria and infantile paralysis. Such is the justification for some mechanical method to make it possible to continue artificial respiration almost indefinitely. T he

P u lm otor.

With the success of Schafer’s method as an established fact, mechanical devices which imitate this method must be given preference. There is no need for a method which requires a pressure pump to force air into, and extract from, the lungs. In this category is the pulmotor which forces air into the lungs and, of course, into the stomach of the masked patient, frequently to the point of injurious over-distension. D eath

T rap.

In addition to this, expiration or exhalation is produced by suction, without any warning note as to when the air cells have been collapsed. No apparatus of this description, employing pressure and suction through a mask, can, in my opinion, be anything else but a death-trap, and especially in the hands of an unqualified man. Without a mask, and by utilising an air tube passed into the windpipe by a medical practitioner, and with a relief valve which will guarantee that the pressure never exceeds that of 40 mm of mercury, such type of apparatus can be successfully used in hospitals, but only by a skilled doctor, never by a layman. No more need be said concerning this type of “ in sufflator ” which utilises pressure and suction from an air pump, as a means of performing artificial respiration. How ever, it must be recognised that the face mask may be a useful adjunct, as for instance, in the administration of a purified or medicated atmosphere, during the progress of artificial respiration by other means.

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A m b u l a n c e a n d it p r o v id e s an ideal m e th o d of m o d e r n i s i n g v e h ic l e s a l r e a d y in use.

This illustration shows the clear gangway for loading the lower stretcher when only one case is being carried.

FIRST T i ie R o c k i n g S t r e t c h e r .

To the first aider with no knowledge of medical tech nique, an apparatus, known as the rocking stretcher, is perhaps the simplest and most useful for a case which may require the shorter periods of prolonged artificial respiration. We owe the rocking stretcher to Dr. F. C. Eve, who, in 1932, described how he had been able by its means to maintain the breathing of a child suffering from diphtheritic paralysis of the diaphragm. The principle underlying the apparatus is the fact that the weight of the abdominal contents is sufficient to distend the diaphragm ; consequently, if a recumbent person is tilted until the head is well down, the abdominal contents will stretch the diaphragm upwards into the chest cavity and cause exhalation by forcing the air out of the lungs. On the other hand, when the body is tilted the opposite way, through an angle of about 45 degrees, so as to relax the pressure on the diaphragm, the elasticityof the diaphragm and muscles of the chest will allow the chest cavity to expand and so cause inhalation. In other words, if a person is placed on a “ see-saw ” couch swinging on a central axis, and tilted through an angle of about 45 to 50 degrees, at regular intervals of 15 times a minute, the weight of the abdominal contents work ing on the diaphragm, will imitate in some degree, the acts of respiration. Some of these “ rocking stretchers ” can be worked by hand, or by electricity, in such a way that the rate of respira tion can be regulated to the desirable 15 times a minute. While continuing the Schafer’s method until all is ready, the patient may be quickly transferred to the stretcher, and the movement started at once, during the fastening of the necessary retaining straps. An unconscious person may be placed in the prone position, with the face in the padded opening, so that the tongue cannot fall backward and water may drain from the stomach and air passages. A conscious patient, such as a person suffering from paralysis of the diaphragm after diphtheria, or of the chest muscles on account of infantile paralysis, may lie face upper most. In both positions carbon-dioxide may be administered when required. This apparatus ensures a sufficient interchange of air in the lungs to continue life ; it could not be termed a mechanical means of respiration, if it were not so. One of its greatest advantages is the ease and rapidity with which it can be applied; moreover, its lightness facilitates transport. It is not quite correct to term it a “ resuscitation’’ stretcher, in as much as it merely acts by continuing the breathing until normal breathing is restored. Artificial respiration and resuscitation are not synonyms. C a r b o n -d j o x i d e .

Other means may be required to resuscitate normal breathing, and if the patient is unconscious, and probably not making a sufficiency of carbon-dioxide, it may be necessary to administer this gas to stimulate or resuscitate the respiratory centre. Whenever the rocking stretcher is used on a person rendered unconscious by such as electric shock, or carbon-monoxide poisoning, it is advisable to allow him to inspire about 10 per cent, of carbon-dioxide in air, or oxygen, every half hour for a period of about five minutes. By this means, resuscitation will be obtained sooner than if no C 0 2 is administered. Unlike the rocking stretcher which depends for success on the pressure on the diaphragm from within, the Bragg Paul pulsator mechanically exerts pressure from without, imitating, somewhat, the Schafer manual method. It was devised orignally by Sir William Bragg for the treatment of a friend, who, although suffering from extensive

AID paralysis, was kept alive for three years, by an apparatus which lacked the many improvements of the machine of to-day.

( To be concluded.)

M a rk in g

S h e e t.

I n d i v i d u a l T e s t (Nos. 2 and 4 ) . — This man was push ing a heavy barrow along when he slipped and fell forwards, his face hitting the barrow. He now lies face downwards groaning. You have first aid equipment with you. Act. Weather, warm and fine. Time allowed 6 minutes.

Hurried approach, warn patient to lie still Detain bystander ... ... ... Speak to patient, does he respond (he trembles) Is there any obvious haemorrhage (no) ... Draw barrow clear of patient ... ...

... ... ... ... ...

1 1

1 1 1

Examination. Rapid examination of spine and body in position as found (no injuries) ... ... ... Very carefully turn patient on to his back ... Colour of face (pale), breathing (shallow) ... Pulse (quick and weak) ; Skin (cold and clammy) ... Pupils (a) equal (yes), (b) response to light (sluggish) Scalp, head, ears, nose and mouth ... ... Find swelling and irregularity of teeth and lower jaw, left side. ... ... ... ... Has gum been bleeding (yes, nowstopped) ... Gently support lower jaw with palm under chin ... Examine remainder of body ... ... ... Find swelling and irregularity middle of forearm ... Any wound or haemorrhage (no) ... ... Steady and support limb ... ... ... (Judge to state : There are no further injuries)

2 2 2 2 2 2

2 1 2

Administrative Treatment. Bystander to phone doctor and ambulance (here in 6 minutes) ... ... ... ... Decide to await ambulance (fine da)) ... ... Borrow blankets and cold water and filled hot water bottles from nearby house ... ... Identify patient and tactful messages ... ...

2 1 1 1

Treatment of Concussion. Head low and turned to one side ... ... Undo tight clothing ... ... ... Feet raised and supported ... ... ... Patient covered with blankets ; apply hot water bottles Apply cold continuously to head ... ...

2 1

2 2 2

Treatment of Jaw. Palm under injured bone, gently press against upper jaw ... ... ... ... Narrow bandage under chin tied above forehead ... Narrow bandage front of chin, tied back of neck ... Tie ends of bandage together ... ... ... Does patient shew inclination to vomit (no) ...

2 1

1 1

Treatment of Forearm. Place forearm at right angles to upper arm Padded splints front and back Bandage above fracture Bandage round wrist, hand and wrist Support in large arm sling General grasp and efficiency ...

2 2 1 1 2

3 Total

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(Send this form in unsealed envelope stamped Id.) A D D R E S S ................................................

FIRST

Q u e r ie s to

a n d

A n s w e r s

C o rresp o n d en ts.

Queries will be dealt with under the following rules :—

1.— Letters

containing Queries must be marked on the top left-hand corner of the envelope “ Query,” and addressed to F i r s t A i d , 46, Cannon-street, London, E .C . 4.

2.— All 3.— All

Queries must be written on one side of paper only.

Queries must be accompanied by a “ Query Coupon ” cut from the current issue of the Journal, or, in case of Queries from abroad, from a recent issue.

4.— The

Textbook to which reference may be made in this column is the 39th ( 1937) Edition of the S.J.A.A. Manual of First Aid to the Injured.

T reatm ent

o f

F ractured

To me it is obvious that the knot must be tied in front on the patient’s lower abdomen and in the middle line. In no other position can we give uniform support to the fractured pelvis.— N. C o r b e t F l e t c h e r .

H ow ler.

M.R. (Charlton Park).— Though your supply is clearly in exhaustible, I dare say that you will welcome another howler perpetrated recently. In a recent examination I asked a candidate to tell me what a dislocation of a joint was ; and I was much amused when she replied : " A dislocation is the male form oj a fracture ! ” Good !

Next, please ! 1— N.C.F.

L o a d in g

(2) No mention is made of how to unload an ambu lance in relation to its upper and lower berths or right and sides. What advice have you to offer on this point ? (1) In the loading of an ambulance it is obvious that In.-re must be a definite system. Otherwise confusion would r< ,ult. The “ near side ” of a vehicle is always the left and the “ off side ” always the right. In R. A. M.C. training loading in fields rather than loading in roads has to be taken in consideration, whereas members of the Brigade are trained for loading in roads. In roads there is a camber (or slope toward the gutter) which causes the vehicle to lean more or less markedly towards the pavement (or edge of the road). In these circumstances if the near side is loaded first the tilt of the vehicle is accentuated, whereas by loading the off side first it is neutralised. (2) Bearing in mind these facts, you will now realise that in the unloading of an ambulance the nearside must be cleared first. Further, in order to avoid the possibility of injury to patient in lower berth during removal of patient from upper berth, it is better to evacuate the patient in lower berth first.— N.C.F.

P e l v is .

(Bedlington).— Will you please advise concerning the treatment of fractured pelvis? The Textbook in Rule 2, p. 87, tells us to “ apply broad bandage round pelvis in line with hip joint. . . . ” My difficulty is to decide where the knot is to be tied if the broad part of the bandage covers the pelvis entirely. The knot has been tied on one side in all practices which I have seen. This does not seem to support the pelvis completely, because the bandage is beginning to narrow as it passes over the pelvis towards the tying point. I thank you in anticipation for your kind reply.

E .R ,

E x a m in a t io n

AID

A m bulance.

F.A. (Manchester).— (1) Please tell me what is the correct way to load a two-berth ambulance. The R.A.M.C. Manual says :— Left (near) upper Right (off) upper Left (near) lower Right (off) lower while the Textbook, on p. 226, says :— “ The upper berths are to be loaded first beginning on the off side.” Also the left (near) side as per the R.A.M.C. Manual will vary according lo the side of the street the vehicle is parked and the direction in which it is going — that is if I take it to mean “ left side, i.e., near side,” “ right side, i.e., off side,” etc. Or does it mean “ left side or near side,” “ right side or off side,” etc., accord ing to circumstances ?

A p p l ic a t io n

T hom as

S p l in t .

H.G. (Surrey Docks).— While we were carrying out Rule 5 (a) on p. 252 of Textbook during practice recently, it was noticed that when Bearer No. 3 released his hold the leg moved towards the thigh a matter of roughly' J: in. It was questioned if there should be any move ment at all, unless it is the intention to allow the ends of the broken femur to be brought into apposition. Will you kindly say whether the extension bandage should be tied taut enough to prevent the slightest movement ? In the application of the Thomas Splint it is not possible for the bandages to exert traction to the same extent as that applied by Bearer No. 3 ; and it is a common experience to find that some slight movement does take place. X-rays alone will show if the fragments of the broken femur are in apposition ; and your object in the application of the splint must be to prevent movement of the limb as best you may.— N.C.F.

S u b s t it u t io n

o f

T hom as

S p l in t .

H.G. (Surrey Docks).— If a patient is brought to a First Aid Post suffering from a fractured femur and a Liston splint has been satisfactorily applied by the mobile party, would you, in the absence of the doctor, advise removal of splint by first aiders in favour of the Thomas Splint ? The decision on this point rests with the Medical Officer in charge of the First Aid Post. As a general rule, how ever, it would be definitely inadvisable for first aiders to substitute a Thomas for a long Liston Splint which had been satisfactorily applied in the treatment of a fractured femur. Incidentally, hospital cases— according to Home Office Training Manuals— should not find their way to First Aid Posts but, should the mistake be made, it is imperative that no further time be lost in transferring the patient to the proper destination.— N.C.F.

A n t is e p t ic s

a t

F ir s t

A id

Post.

F.A. (Manchester).— At our First Aid Post acriflavine and biniodide are the antiseptics in use ; but no definite advice can be obtained as to the use of each. Are they interchangeable or are they to be used for definite conditions? Thanking you for your kind advice.

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FIRST

The decision as to the use of the antiseptics named rests with the Medical Officer in charge of the First Aid Post to whom I refer you for an official explanation. They should not be used without his authority. Biniodide of mercury is used in the strength of 1 in S00 for hands and patient’s skin ; 1 in 1000 for ligatures, and does not irritate the skin or damage instruments (Home Nursing Textbook, p. 203). Acriflavine in the strength of 1 in 1000 provides a very useful dressing for wounds.— N.C. F.

N eck

P ads

T reatm ent

o f

F ractured

S p in e .

L.L. (Ebb Vale, Mon.).— In a recent Divisional Practice a discussion arose over the placing of the pads in the case of a patient suffering from fractured spine in the cervical region. The Textbook in Rule B ( 1), on p. 73, instructs us to place three pads four inches thick, one under the neck and one on each side, to prevent movements ofthe patient’s head and neck. The difficulty we had was how to place the pad under the neck without any move ment. We tried various methods ; but in each instance slight movement occurred. This was of little import ance perhaps in practice ; but inactual emergency it might prove fatal. One of our difficulties was the thickness and best width of the pad. So we ask what you consider to be the best width and also the best way of getting the pad in position. Another difficulty arose in our attempts to keep the pad under the neck in position while the patient was being lifted high enough for the stretcher to be pushed into position. To this end a bandage placed round the patient’s neck seems rather unsightly and does not keep the head and neck steady enough. We would much appreciate your suggestion on this point also ; and we thank you for the many helpful hints which we have received from your answers to queries each month in F i r s t Am. You fail to realise that the neck pad is to be placed on stretcher in readiness for loading the patient and that the necessary instructions are given on p. 73 of the Textbook under “ Transport.” So the question of a bandage round neck to control the pad does not arise. As 1 read the instructions, width does not enter into the size of the pad which will be most effective as a roll four inches thick, this measurement being merely a guide to the thickness required with a normally built patient and varying with individual patients. Such a pad can be improvised from triangular bandages folded broad and then converted into a roll.— N.C.F.

T ranspo rt

o f

S p in a l

I n ju r y

F ace

U pw ard s.

J.S. (Blackpool).— We are likely to come across a man during air raids who complains of persistent pains in the lumbar region ; and the history may lead us to suspect a fracture of the spine. W7e are quite aware that the excitement, which will prevail among enthus iastic A.R .P. workers, may make the removal difficult and, as this accident requires extreme care, I venture to suggest a method which I find excellent in practice and which would enable novices to meet the difficult situation without fear and be in the best interests of the patient. The man is laid on his back. With a small splint insert bandages under the natural hollows of the body and fasten elbows, hands, knees and feet. Then place other bandages under head, chest, hips, knees and feet. Then place a pad or rolled blanket across chest in line with collar bones. Then place double-fold blanket the length of the patient. Then place the stretcher over the whole lot. One bearer is next detailed to hold

AID the stretcher in position while the other bearers fasten the bandages to stretcher, taking care that the lower end of stretcher is against the instep and feet. The two bearers cross hands, grip the handles and turn and the whole lot comes over perfectly. The man does not move and, being face downwards, he is ready for immediate removal. We rather like the idea, especially for A. R. P. work, but would like to know if you consider it good first aid and if we should continue with it. Thanking you for past favours. Your suggested method is novel and interesting ; but I do not see in what way it is an improvement on the method laid down on pp. 76 and 77 of the Textbook.— N.C.F.

T he

W o r r ie s

o f

F ir s t

A id e r .

W.E. (Child’s Hill).— I am a member of the Brigade, and am just entering my second year of membership. I am also going to a First Aid Post and am attending lectures in first aid with other members of my Division. Nevertheless, there are many things which I do not understand and which classes do not explain. My chief difficulty is to know what I would do if I was by myself and came across someone lying in the road. Study of textbooks do not help in these circum stances, especially as 1 really want to know what equipment I should have with me. So please can you suggest a few things which I ought to have with me ? I possess any number of books on first aid, but I cannot seem to understand them. I read the Journal and also N ursing Illustrated each month, but, though I took great interest when I first started, I have fallen away and I cannot feel the same enthusiasm as I did. So if you can help me, I shall be very grateful. Your worries are by no means uncommon. Most first aiders, after taking their first certificate, experience a nervous dread of having to diagnose and handle their first case ; but this feeling soon passes, more particularly if public duties are undertaken in company with senior mem bers of the Division. Considerable help would also be obtained if you had some practice in methods of diagnosis on the lines laid down in Chapter XV I of the Textbook. To this end, you might put your difficulty to your Superintendent, who might arrange such practices and who would also advise you as to the articles usually included under the term : “ light equipment.” These might comprise (1) dressings—1 or 2 triangular bandages, several roller bandages of various sizes, £ ounce of cotton wool, boracic and plain lint ; (2) drugs — small bottle of smelling salts, £ ounce of surgical spirit, £ ounce of bicarbonate of soda ; and (3) instruments— pair of scissors, packet of safety pins, medicine glass and teaspoon. Pack all neatly in a small attache case, and you will be ready for the fray. Prosit!— N.C.F.

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T h ird E d itio n . P o s t free, 1 s. 2 d . E r r o r s in F i r s t - A i d D e t a i l e d a n d E x p l a i n e d . “ T h is book g ives a c le a r e r in sig h t in to th e m ethods a n d d iffic u ltie s oj em ergency tre a tm e n t by laym en th a n the o fficia l T extb o ok its e lf. " — L a n c e t .

AMBULANCE

F r a n k W r i g g l e s w o r t h ( C . A . G . S . , Special).

Single Copies

T h ird E d itio n . Post free, I s . 3 d . P r o b l e m s in S t u d y , T r e a t m e n t a n d E x a m i n a t i o n s o lv e d f o r S e n i o r S t u d e n t s . “ W ith o u t doubt th e book w i l l l e or g r e a t service in th e tr a in in g o f those / o r w hom i t is design ed. ” — B r i t i s h M e d i c a l J o u r n a l .

IN C E N D IA R Y

A ID .

By N. CORBET FLETCHER, M.B., B.C., M.A.(Cantab.), M.R.C.S. AIDS

U niform C lo thing & E q u ip m e n t Co. Ltd .

FIR ST

N U R S IN G

12 p p .

FEW

M .R .C .S .E n g . (280th th ou san d )

S tro n g p ap er, 2 d .

R e v is e d . P o s t id .

W O RDS.

(7 1st th ou sand). R e v is e d . S tro n g p ap er, 2 d . P o s t id . B A N D A G IN G D IA G R A M S . ( 80 th th ou san d) revised. 12 p p .— 72 b a n d a g in g d ia g ra m s, w ith notes. S tro n g p a p er, 2 d . P o s t id . W it h u sefu l refe re n c e tab le s

PO CKET

14 pp.

F IR S T

A ID

S E R IE S .

By C o l. R. J . B L A C K H A M , C .B ., C .M .G ., C .l.E ., D .S .O ., M .D . (1) P o iso n in g , (2) H aem orrhage, (3) In se n sib ility, (4) A s p h y x ia (S u sp en d ed B r e a th in g ), (5) F ra c tu re s , D islo catio n s and S p ra in s , (6) W o u n d s, B ite s , B u m s , S ca ld s, R u p tu re an d M in o r In ju ries. T h e S e rie s co n ta in s a ll the essen tials o f F irs t A id . P rin te d on lin en -lin ed c a rd s, 3$ in. X 5^ in. T h ird E d itio n . 6 d . net ea ch , p o sta g e 2d. ex tra.

1 /- p o s t free.

(Reduction for quantities.)

By the sam e A u th o r—

All First Aiders should procure a copy.

It will

assist them in their general work, as well as in the competition room.

D A L E ,

46,

R E Y N O L D S

CA N N ON

STREET,

C O .

LONDON,

L T D .

E.C. 4.

AIR

RAID

FIRST

AID

A S e r i e s o f 15 C h a r t s coverin g a ll the d u ties o f a F irst A id W o rk er, g iv in g full in structio ns as to A ir R a id effects an d p recau tion s, recog n ition an d treatm ent o f in ju ries. T h e I d e a l W a l l C h a r t . S iz e 22I- in. x 14& in ., has b een p rep ared for use in A ir R a id S h elte rs, R e d C re ss an d S t. J o h n ’s A m b u lan ce S ta tio n s and C la sses, an d a ll p laces w h ere F irst A id an d N u rs in g a i e req uired. P ric e 7 / 6 . P o s ta g e 6d. T h e H o m e C h a r t . Size 13 in. x 7^ in ., h as been s p e c ia lly p re p a re d for use in the H o m e or sm a ll grou p s. P rice 1/ - . P o s ta g e 3d. P r in te d on stro n g p a p e r and m o u n te d on r o ller fo r h an gin g.

J O H N B A L E , S O N S & S T A P L E S , L t d ., 8 3 -9 1 , G re a t T lt c h f ie ld S tre e t, L o n d o n ,

w .l

< £ J> ARE ESSENTIAL TO ALL DIVISIONS OF THE

.^ > 0 ?

J . A. W Y L I E & CO. m . W holesale M a k e rs o f

M E D A L S , B A D G E S

St. John Ambulance Brigade

AND

T R O P H IE S

and can be OBTAINED from

HOBSON & SONS (LONDON) LTD. UNIFORM CLOTHING & EQUIPMENT MANUFACTURERS. 154 - 164 , T O O L E Y S T R E E T , L O N D O N B R ID G E , S .E .i. ’Phone : Hop 2476 (4 lines)

’Grams: “ Hobson, Boroh, London.”

NORTH OF ENGLAND OFFICE:

s u i t a b l e lo r

“ F IR S T A I D ” A M B U L A N C E CORPS A N D S O C IE T IE S . SEND

FO R SE LE C TIO N

APPROVAL.

O riginal D esigns and Quotations post free.

Wholesale Prices to all “ FIRST A ID ” SOCIETIES. Contractors to H .M .Ministry of Munitions, Russian Government, etc.

22, York Place, LEEDS, 1. ’Phone: Leeds 23334

’Grams: “ Hobson, Triers, Leeds.”

London Showroom:—

62.

HOLBORN

HOBSONS FOR SMARTER UNIFORMS.

“ SA N O ID ” R E SPIR A T O R FRAME

VIADUCT,

T e le p h o n e — 2 5 3 5

A TIMELY

E.C.

C E N tr a l.

REMI NDER T H A T

Registered Design No. 806838

Price of Filter Masks (Respirator Refills) on Application

PRICE 7

d .

e ac h

6 / - PER DOZ.

This frame has been designed especially for the purpose of securely locating and thus preventing slip of Cotton Wool Filters or other Masks when used as Respirators in safeguarding workmen against dust arising from industrial operations. It possesses many advantages over other articles of a similar character inasmuch as : It is rustproof and smooth, being flexible it readily conforms to contour of the face thus ensuring correct positioning of the Mask. It is light, easy to adjust, and the lower portion fits comfortably under the chin thus anchoring both frame and filter. Sole Manufacturers :

CUXSO N,

C E R R A R D & CO. LTD. First Aid Specialists OLDBURY, BIRMINGHAM

is s till th e m o s t e c o n o m ic a l g e n e ra l antiseptic l o r d o m e s tic u s e . • • ■k For h o u se ho ld s of m o d e r a te means, t h e in exp en sive b o ttle of Iodine, o b tain a b le fo r a few p en ce fro m any chem ist, is a sou nd re c o m m e n d a t io n fo r first aid appli cation in m i n o r injuries. Write for Free Emergency Chart

IODINE Stone

EDUCATIONAL

House,

Bishopsgate,

BUREAU

London,

E.C.2

Printed and t-ubllsheu by D alb , R eynolds & Co., Ltd., 46, Cannon-street, London, E.C.4, t0 whom all communications should be addressed Telegrams— “ Twenty-four, London.” Telephone—City 3710. To be had of all Newsagents, Booksellers and Bookstalls in the United Kingdom and at all Railway Bookstalls 0/ Messrs. W, H. Smith and Sons.

F IR S T

A ID

^ntapenbcnf Journal for tljeAmbulance anb pursing ^eruicosf

No.

555.

V o l.

X L V II.

SE PTEM B ER ,

1940.

P ric e

3d .

The newest styles in

“ FIRST AID ” WALL DIAGRAMS

S J.A.B. U N I F O R M

(S iz e 2 ft. 2 ins. b y 3 ft. 4 Ins.) C o m p l e t e S e t o f 19 s h e e t s o n tough cartridge paper, with Ro lle r, 4 4/ 6 n e t . P o s t 9 d . ; o r m o u n t e d o n Lin en , 7 2/ 6 n e t . P o s t I / I . A d o p t e d by t h e W a r Offic e, t h e A d m i r a l t y a n d t h e B ri tis h Re d C r o s s S o c i e t y ,e t c .

c t n A i i n n ”

DANCO

T O

M E A S U R E

New Style G reatC oat from - - - 57/6 Raincoat - - 75 /Costumes 90/-& 105/Dresses - - 21/(Stock Sizes 15/-) Aprons with Cross - - - 5/10 & 6/4 New Indoor Cap with Cross - - 1/9 Storm Caps, new style complete with badge,

Spec ial S e t o f 6 S h e e t s f o r t h e us e of LECTURERS

A . R. P.

CLASSES c o m p r i s i n g A n a t o m y , Ph y s i o logy , H a e m o r r h a g e , Di slo c a ti o n s a n d F r a c t u r e s . M o u n t e d o n l in e n w i t h r o l l e r , 21 /6 n e t ; p o s t a g e 7d.

9/9 N e w St y le H a t s N o w Av a i la b l e .

17 th E dition .

Order by post with confidence from

NURSES’

O U T F IT T IN G

A S S O C IA T IO N C a rly le

B u ild in g ,

L T D .,

S to c k p o rt.

L o n d o n - A b b e y H o u s e , W e s t m i n s t e r , S . W . I. L iverpool 57, R e n s h a w S t r e e t . M anchester 36, King S t r e e t . B irm ingham 3, R y d e r S t r e e t . N e w c a s t l e - o n - T y n e - 26, N o r t h u m b e r l a n d , St. A b e r d e e n (A g e n t ) - Miss G r a y . 9, H o l b u r n St . S o u th am p to n . . . 135, H ig h S t r e e t . G lasgow I I I , U nion Street.

R e p rin t.

207th Thousan d.

W A R W IC K

3 19 lllu s.

S om e c o lo u re d .

T U N S T A L L ’S

“ F IR S T A ID

T O T H E IN JU R E D & SICK.

342 p a g es. S t iff B oa rd s.

2 / 6

net-

P o sta g e 4d.

An A d v a n ce d A m b u la n ce H a n d b o o k .

E d ite d by th e la te F. C . N I C H O L S , M . C . , M . B . , C h . B . , C a p t . R . A . M . C . ( T . ) T h e c h ie f f e a t u r e o f t h is e d i t i o n is t h e m u c h fu ll e r a c c o u n t g i v e n o f Ga s Po i s o n in g in W a r f a r e FIRST AID JOUR.— “ One o f the most con cise works on the su b ject published at a popular p ric e .”

JO H N

W R IG H T & B R IS T O L

SONS

LTD .

ALEXANDER CLARK Co Od

9 1

L o u d o n

1 2 5 - 6 , F E N C H U R C H S T . , E .C .3 . M anufactories:

LONDON

S h o w ro o m s:

38, L E A D E N H A L L S T . , E . C . 3 SHEFFIELD

BIRMINGHAM

F IR S T A ID Jntapentant Journal Jx>r the A m bulance nnb p u r s i n g Services E d i to r :

No. 5 5 5 . —

V o l.

SEPTEM BER,

XLVII.

N OTICE

GEORGE

C R A FT T E n te r e d a t 1 L S ta tio n e r s ' H a ll\

1940 .

READERS.

F I R 5 T AID is published on the a o t h o f e a c h m o n t h 4 s . post free ; single copies 3d.

P ost

London,

E .C .4 .

S A

in ce

our

last

attacks

this

country

have

becom e

more se v e re an d

ctiv e

F ir st

n u m e ro u s . aid

s e rvice s ,

issue

w ith

m a n y distric ts

w a r - tim e

enem y

C o n sequ en tly,

like o th e r o r g a n is a t io n s ,

“ b l o o d e d ” an d v e rs a n t

Not

Telegraphic Address— " Twentv-four, London." Telephone— City 3710.

THIS

are

now con

first aid ; v a s t l y

different

so m a n y

m onths a g o

p erso n n el at first

aid posts w ere sn eered at b y certain s e c t io n s of the p u b lic as tim e w asters, dart p la ye r s, & c . , an d s o m e

NUMBER.

however, They

E d i t o r i a l :—

Active First Aid A.R.P. First Aid Services S.J.A.B. Headquarters and District Reports Parratt’s Improved Type Stretcher Police Ambulance News Railway Ambulance News “ First Aid for War Casualties ” Methods of Reducing the Temperature of the Body Red Cross and St. John War Organisations The St. John Textbook Carbolic Acid Poisoning A.R.P. Topics Mechanical Revivification Convulsions The Miners’ First Aid Alphabet Our Nurses’ Page Treatment of Boils

41 42 43 44 44 45 47 47 47 48 49 49 50 51 51 52 54

Q u e r ie s a n d A n s w e r s t o C o r k e s r o n d r

Stings of Insects ... Examination Howler Functions of Ureters Order of Bandaging Fractures ' Compression of Axillary Artery Treatment of Snake Bite Asphyxia and Its Causes Concussion or Shock Pin in Tongue During Insensibility

first

h a v e been

e v e n w e n t so far as to call th em s hirk ers. CONTENTS

K kfe

from p e a c e -t im e or t r a i n i n g ac tivitie s.

L td .,

S tre e t,

TH R E E PE N C E

A n n u m ,

The

Its aim and object being the advancement of Ambulance Work in all its branches, the Editor invites Readers to send Articles and Reports on subjects pertaining to the Movement and also welcomes suggestions for Practical Papers. A ll Reports, & c., should be addressed to the Editor at the address below, and should reach him before the 1 2 t h of each month, and must be accompanied ( not necessarily for publication) by the name and address of the Correspondent. Subscriptions, Advertisements and other business CommunicUions connected with F I R S T A I D should be forwarded to the Publishers. 46, C a n n o n

P hr

EDITORIAL.

Annual Subscription is

D A L E , R E Y N O L D S & C o .,

P R IC E [4/-

56 56 •56 56 56 58 58 58 58

such

have

p erso n n el

a tten ded

h as

their

proved

arduous

To-day,

its

w o r th .

d u ties

m a n n e r w h ic h d e m a n d s the respect of the p u b lic , in p er ilo u s p o s itio n s , for l o n g hou rs, w i t h o u t food or rest. A s m a y be e x p e c t e d there h a v e been m ista k e s m a d e not o n l y b y the p ers o n n el b ut b y the a u t h o rities.

Our

Specia l

Correspondent

F ir s t A i d S e r v i c e s h as p o in te d o u t on o n e o c c a s io n , th at actual w o r k i n g d itio n s

w o u ld

alo n e

find

the

u nder w a r c o n

weak

h a v i n g been fou nd the r e m e d y will

A .R .P .

more than

spots ;

but

no t be hard to

ap p ly. W e are n o w d e fin ite ly in the front lin e an d it is the d u t y of all

m e m b e r s , men an d w o m e n , an d

e v e n b o y s an d g i r ls , to g i v e of their b est an d so d e s t r o y the

e v il w h i c h

endeavours

ruin

ou r

c o u n t r y an d e v e n o u r lives. A s the P r i m e M i n i s t e r said in his b r o a d c a s t — “ T h e y (our f i g h t i n g forces) k n o w th at t h e y h a v e b e h in d th em a p e o p le w h o will no t flinch or w e a r y o f the s t r u g g l e , hard a n d p rotrac te d t h o u g h

it will

be, b u t t h a t w e sh a ll rather d r a w from the h e art of s u f f e r i n g itself the m e a n s of in sp ira tio n

an d s u r

v i v a l , a n d of a v i c t o r y w o n , not o n l y for o u r s e lv e s b u t for a l l — a

victory won

not o n l y for

our own

FIRST

tim e b ut for the l o n g and better d a y s that are to c o m e .” We

know

that all

members

of the first aid

s e r v ic e s , f u ll-tim e or part tim e, will do their j o b u nde r all c ir c u m s t a n c e s , no m atter w h a t m a y h a p p e n ; an d in their w o r k we w ish them all “ G o d S p e e d an d G o o d L u c k . ”

A .R .P . B y

F ir s t

O ur

S p e c ia l

A id

S e r v ic e s.

C orrespondent.

my last notes the A.R.P. first aid services have been well in action, and reports to hand indicate that, on the whole, the services have responded splendidly. Pride of place must be given to the Mobile Hospital Units, which have more than justified their existence. So successful have they been that the M.O. H. in many districts are advocating that the numbers of Mobile Units be increased at the expense of the fixed posts, and I have reason to believe that the authorities are not adverse to the idea. The weakest link in the services has been the stretcher parties, but this is not surprising in view of the fact that the cream of the service has been skinned to meet the needs of the fighting forces. This Journal has constantly warned the public of the general deterioration that was becoming apparent, and results have, unhappily, justified its opinion. Recently I examined stretcher bearers for certificates of pro ficiency in first aid in a Central London Borough, where I had previously examined their predecessors with excellent and pleasing results. Unfortunately, on this occasion, out of a dozen candidates only one was successful ; the failures were not even near the pass border line ! Personally, 1 shudder to think of the first aid that would be revealed by these men under actual raid conditions. In strict fairness I would emphasise that the surgeon-lecturer is well-known to me as an outstanding able lecturer, while the demonstrator has actually assisted me personally, and is extremely effici ent. He bemoaned the fact that all the active highly trained men I previously knew were now with the colours, and that the newer men were either unwilling or unable to concen trate sufficiently. Later 1 had a chat with the M.O.H. concerned, and he confirmed the opinion of the demonstrator. I have been informed that the loading of patients, and par ticularly the control of haemorrhage, have left much to be desired, and that the surgeon at one hospital at least, in the London area, has expressed his displeasure at the handling of casualties. Efficient first aid service does not mean simply the swift handling and removal of patients, but also the necessary dexterity and gentleness in transportation— facts which make all the difference to the progress of the case. We are told that we are now all in the front line. Since that is the case, could it not be possible for personnel of the R.A.M.C. to assist the civilian casualties, to the mutual advantage of the patients and of the personnel as part of their routine training. Alternatively, might it not be possible for the skilled personnel of the R.A.M.C. to be released from military duties and attached to stretcher parties. They could be immediately recalled if necessary, and in the meantime would still be performing active duties in the front line. 1 do not want my readers who are stretcher bearers to take my remarks amiss, because they themselves have prompted me to write these remarks as a result of personal experiences encountered in their own depots. While on the subject of stretcher bearers, I have never been able to understand why in large congested towns it should be necessary to proceed to an incident in relatively small cars. In rural areas, where there may be distance of miles between different incidents, it seems quite reasonable, S in c e

AID but in a congested area four or six light vans could easily carry sufficient personnel to all the probable incidents, and as a result economy would be effected, efficiency would be in creased, and, finally, the streets would not be congested by numerous cars which otherwise might impede the passage or proximity of other essential services. The M.O.H. of my own district feels strongly about this matter. He pointed out to me that in our particular borough by stationing our stretcher bearers in four instead of two depots, as at present, it could be so arranged that no part of the district was more than 500 yards from a depot, and that, if necessary, the stretcher bearers could easily proceed to an incident “ at the double” without the use of cars at all, and in a very short space of time. There is no doubt that the hire and maintenance of large numbers of private cars (to say nothing of the drivers) is extremely and universally expensive, and that both in the interest of efficiency and economy something might be done about it. One aspect of first aid has come rapidly to the fore as a result of the recent extensive raids. A large number of children have been born in an air raid shelter, and as a result the authorities have published a pamphlet dealing with emergency midwifery. Lectures are now being held in “ Emergency Midwifery,” and some of the instructions given are immensely detailed. A word of warning is neces sary. Legislation emphasises the fact that only doctors and qualified midwives are permitted to attend a woman in child-birth under normal conditions, and therefore first aiders must not permit themselves to utilise the knowledge gained during these lectures unless the condition is an actual emerg ency in every sense of the word, and then only such attention should be given as will permit the patient (and child if necessary) to be removed to hospital. The actual tuition necessary can easily be given in less .than half-an-hour. A very able Nursing Sister recently contracted to give a series of four lectures on Emergency Midwifery, and invited my co operation in drawing up a syllabus. She emphasised that four lectures had to be given as the course had been adver tised as such. By judicial manipulation, we managed to obtain sufficient material for three lectures, the only sugges tion I could make for the fourth was the future career of the unborn child. The final matter I wish to deal with this month con cerns the voluntary working of overtime by the full time personnel at first aid posts and stretcher depots. Some of the recent raids have lasted several hours, and members of an outgoing shift frequently volunteer to stay on in case they should be needed. In the case of a raid lasting an hour or two, their assistance would be invaluable, but, as a result of prolonged raids, their efficiency on the following day when they are officially on duty is frequently diminished owing to tiredness and lack of sleep. The tendency now is to release members of an outgoing shift as soon as they are replaced by the incoming ones, and should a post or depot become over-worked it can be augmented by personnel from a mobile unit or other post, or, in the case of stretcher parties, by the surgical officers department. I am glad to see that arrangements have now been made to provide light refreshments without payment to personnel who are compelled to remain for more than two hours over their official time at their posts. Small wage earners cannot afford to pay for extra meals, apart from the fact that catering arrangement have frequently broken down owing to the extra numbers of personnel remaining over time. The comfort, especially for the womenworkers— who are compelled to remain in a shelter for some hours, and yet be prepared to render active service at a moment’s notice— often leaves a lot to be desired. I would strongly suggest to officials who are responsible for the welfare of the first aid personnel, that they should investi gate the conditions under which the personnel exists when in the shelter for lengthy periods. In many cases I am afraid they will receive some unexpected surprises.

FIRST

AID

N o . V District

St. John Ambulance Brigade h ead q u ar ter s

a n d

d is t r ic t

r epo r ts

No. I (Prince o f W ales’s) District H o n o u r s . — Since the beginning of this year the follow ing members of No. 1 District have been recognised by The Order :— Asst. Commissioner Capt. R. V. Steele (Officer), Amb. Officer B. Stitcher, No. 30 (East London) Division (Serving Brother, Associate), Mr. A. Granard, President No. 2 (Haggerston) Div. (Officer, Associate), Supt. H. V. Shrosbree, No. 28 (Harrow and Wealdstone) Division (Serving Brother), District Officer E. Laurie Long (Serving Brother), District Staff Officer W. A. Roust (promoted to Officer). In addition, Supt. N. J. Ware and Amb. Officer H. Dunford, both of No. 13 (King’s Cross) Division have been admitted Serving Brothers, as notified by the London and North Eastern Railway.

A course of instruction on First Aid for men will be held at Aldersgate Ward School, 181, Aldersgate-street, E.C.I, commencing Wednesday, September 18th, at 6 p.m. The course will consist of 12 lectures, six by a surgeon. Fee, including examination, 5/-. Applications should be made to the Class Secretary, Div. Supt. F. W. Bishop, 208, Downhills Park-road, N . 17.

N o . II District A n d o v e r . — Mr. W. J. Armstead (President) presided at the presentation of awards by Mrs. A. A. Cockayne. The chairman thanked Dr. M. Savory for the work done at lectures, and mentioned that County Surgeon A. A. Cockayne, who was present that evening, had recently become Medical Officer of Health for the joint Andover Borough, Andover District Council and the Kingsclere and Whitchurch District Council.

B a n b u r y . — The annual presentation of awards to mem bers of the Banbury Ambulance and Nursing Divisions was held last month. Col. H. du C. Norris (president) presided, supported by County Commissioner Dr. C. Gardiner-Hill, Lady County Supt. Mrs. Beckwith-Smith, Supt. H. Bagley, and Lady Supt. Mrs. G. Barrett. Mrs. Beckwith-Smith presented the awards. She knew the recipients could be trusted to give unstinted service in the future. Dr. Gardiner-Hill said that the Division could be proud of those absent in the serving forces and others absent on local duties. The Division had fully maintained its reputa tion for efficiency and devotion to duty.

No. IV District S teel C o r p o r a t io n L t d . — On August at the annual presentation of awards to members of the Brigade, it was announced that Mr. J. Sinclair Kerr, who presented the awards, has been appointed District Officer of No. 4 (Lancashire) District. This announcement was made by Mr. Fred Clarke (secretary). Presenting the awards, Mr Kerr, who is also president of the Division, said it was a pleasure to preside at the function, and offered his congratulations to the 66 recipients of awards. L a n c a s h ir e

13th,

The ‘ Gibson ” Shield competition was staged at Nottingham on August 25th. The viva-voce tests were given by Supt. Longstaff and the individual practical by Supt. Carrier. Dr. J. Glasgow Bell judged the team test, and in his general remarks stressed the importance of the time element in artificial respiration. The result of the competition was announced as follows : 1 (winners of the “ Gibson” Shield), Bulwell Division ; 2, (winners of the “ Speight” Cup), Mapperley Division; 3, (winners of the League Trophy), City Division. The individual members of the three teams also received oak and silver candlesticks as prizes. Seven teams in all competed this year. Miss Gibson, daughter of the donor of the shield, pre sented the trophies.

B a t l e y . — Recently Mr. John Cuthbert, of the Batley Ambulance Division, and treasurer of the Comforts Fund since its inception, married Miss Edilh Wood, of the Nursing Division. Both have been good workers for many years. A further party in aid of the Comforts Fund proved a great success, financially and pleasure. During the in terval Mr. H. Anderson (president), in a concise speech, announced the sums made by the Fund since last November and to what use they had been put.

M a p p e r l e y D i v i s i o n . — It was with feelings of intense relief that the members of this Division learned that two of their members, Privates Harry Sellars and Frank Godfrey, who had been reported missing since last May, are now known to be alive. They are both members in the R.A.M.C. and, sacrific ing all chances of freedom, stayed with the patients and so became prisoners of war.

N o . VIII (D uke o f Connaught’s) District Owing to war conditions No. 8 District has been re organised as follows :—Inspecting and Advisory Officer to Chief Commissioner, Commissioner E. A. Richards. K ent.

Acting County Commissioner— The Lord Harris. Acting County Secretary— County Officer B. Beaumont. Assistant Commissioners and Areas as before. S urrey.

Acting County Commissioner— W. Geo. Pape, O.B .E. Assistant Commissioners and Areas as before. S u ssex .

Acting County Commissioner— D. Bryce. Acting Assistant Commissioners— W. J. B. Trotter and C. Heywood. Acting County Secretary— F. A. Trott. Lady County Superintendents.— Mrs. C. A. Falwasser (Kent), Miss D. Hubbard (Sussex), Mrs. C. Thomas (Surrey). District Officer J. A. Borne (Cadets) has resigned.

R a m s g a t e . — The Ramsgate Ambulance was called to the West Cliff at Ramsgate about 1 p.m. on Saturday, August 18th. A man had been bathing and was cut off by the tide ; it was impossible to use the ordinary paths in the cliffs. The man was found at the bottom of the cliffs, and

F I' R S T

as it was impossible to rescue him by ordinary means, T/C Packham lowered Pte. Thomas in a “ Neil-Robertson ” stretcher over the side of the cliff, which at this point is about 60 feet high. By this time the Chief of the Fire Brigade had arrived and assisted in hauling the man up, Pte. Thomas being hauled up after. The man was taken to hospital, but was found to have no injuries other than shock.

AID period of months at the Princess Mary’s R.A. F. Hospital, Halton, in five major cases. Full particulars can be obtained at addresses given above.

P o lic e

A m b u la n c e

N ew s.

M ETROPOLITAN. P a r r a tl’s

Im p roved

Type

S tre tch e r.

from its “ Bed to Bed ” service, in use on one of the main line railways, this stretcher is ideal for factories, coal mines, &c., where space is limited and narrow passages have to be negotiated. The new improved stretcher (Reg. Patent No. 799805) is fitted with a back rest and has an extension panel at the foot which can be drawn out to various lengths to suit the length of the patient. This panel can also be used as a

A part

Five members of the Metropolitan Police have been admitted to the Order of St. John for services rendered to first aid. They are :— Supt. C. R. Briggs, “ M ” Division, Inspector Evans, “ X ” Division, Sergt. Gilmore, “ G ” Division, P.C. David son, “ VV ” Division, and P.C. Baker, “ Y ” Division. Members of “ M ” Division are especially pleased that their “ Chie f” has been honoured. He has given every encouragement to the first aid movement oveFa number of

The “ Parratt ” Stretcher in Use. fracture board giving full support without “ lag,” in cases of fractures of the leg, thigh or spine. It has-a sorbo mattress, telescopic handles and, at the sides, grooved handles have been let in for four bearers. At the head and foot are crossed handles, so that in confined spaces or passages it can be carried with ease. It is suitable for both medical and surgical cases, and is contained in a canvas bag, always open and ready for use, being so constructed that no transverse bars are required to keep it rigid. Under present conditions, with the shortage of petrol adding to the difficulties of road transport, the use of the stretcher for the conveyance of patients long distances by rail is recorrtmended, it being unnecessary to remove patient from the stretcher, no matter how many changes might be involved in the journey. Further information as to prices, etc., can be obtained from Messrs. Down Bros. Ltd., 21, St. Thomas’ Street, London, S.E 1, or from F. Parratt, at 871, Harrow Road, N.W 10. In addition to the stretcher there is the Parratt Metal Splint (Reg. Pat. No. 500046), which has been tested over a

years and his enthusiasm for this part of police training is well known throughout the Metropolitan area. CITY

LONDON

SPECIAL CO N STA BU LA R Y.

On September 4th, Divisional Commander Lionel Walter (in the unavoidable absence of the Commandant) presented some sixty awards to members who passed their examination in March last. The occasion was the opening lecture of a new course at which the lecturer is Capt. A. C. White Knox, M.C., M.B., Ch.B. (Chief Medical Officer). Of the members attending, two-thirds are first year students.

Bournemouth Centre, S.J.A.A., reports that during July 198 first aid certificates, 58 home nursing certificates, and 16 preliminary hygiene certificates were awarded. Some 400 persons took advantage of the emergency classes organised by members of the Brigade.

AID

Railway Ambulance News. G reat

W e ste rn .

H o n o u rs.

As a result of recommendations made by the Great Western Railway Central Ambulance Committee, the follow ing members of the staff have received recognition from the Order of St. John of Jerusalem of exceptional services rendered to the movement over many years : — Serving Brother.— Mr. W. H. Teagle, Chief Messenger, Solicitor’s Department, Paddington. Mr. H. V. Cross, Glazier, Engineering Department, Neath. Mr. V. H. Stand ing, Signal Telegraph Lineman, Port Talbot. Mr. F. Toulson, Signalman, Newquay. Vellum Vote of Thanks :— Mr. C. W. G. Hipkin , Checker, South Lambeth. Dr. J. M. Morris, Medical Officer of Health, Neath, who has given gratuitous services as lecturer and examiner to the Neath ambulance class for upwards of forty years, has also been admitted as Serving Brother of the Order of St. John. Dr. Morris is this year entering on his well earned retire ment. E x c e p t i o n a l l y E f f i c i e n t F i r s t Am. The award of the Company’s Chief Medical Officer Dr. H. Cavendish Fuller, on reports of exceptionally efficient first aid rendered during the year 1939 has now been received, and the following awards have been made :— Gold Medal.— Raymond W. Driver, Bristol. Silver Medal.— John C. Department, Newport.

Manners,

Richards,

Acting Motor

Hoistman,

Docks

Bronze Medals.— George H. E. Pointer, Clerk, Fish guard Harbour. George H. Taylor, Checker, Fishguard Harbour. Certificates. — Frederick A. Kynaston, Boilersmith’s, Assistant, Oswestry. Arthur S. James, Fireman, Oswestry. James H. Tippett, Station Inspector, Plymouth Millbay. Alec B. Cornish, Goods Guard, Rogerstone. Frederick J. Carter, Clerk, Locomotive Department, Shrewsbury. Hubert M. Jay, Parcel Porter, Bristol. Elred R. Griffiths, Shunter, Port Talbot. Cecil Chard, Shed Fireman, Radyr. Haydn E. Jones, Telephone Operator, Coke Ovens. Hugh R. Row lands, Signalman, Ciliau Aeron. The case for which the gold medal was awarded to Mr. Manners was a nasty accident resulting from a head-on collision between a private motor car and a laden lorry on the Bath-Box road on August 16th, 1939, involving four patients. Mr. Masters arranged the lifting of the car to release the entrapped occupants, instructed bystanders as to the removal of the patients to the grass verge for treatment with improvised materials, and arranged suitable and speedy transfer to hospital. He also took precautionary measure to prevent further accidents on the same spot owing to obstruc tion and the bend of the road, and he was particularly com mended for his discrimination in arranging the transport to hospital, of the two most serious cases first. In the case of the silver medal, Mr. Richards attended the third mate of the steam trawler Ava nt Garde , at Newport Docks on August 5th, 1939. The mate sustained serious injuries, which unfortunately ultimately proved fatal, as a result of boiling pitch becoming dislodged as he was passing beneath. Messrs. Pointer and Taylor (the recipients of the bronze medals) rendered artificial respiration in circumstances of extreme difficulty, in the midst of a gale, to the Chief Steward of the s.s. Great Western in January, 1939.

The presentations of the awards will be made bv the local officers of the Company this month.

T a v i s t o c k — Members of the Tavistock ambulance class, which combines Great Western Railway stall' and the staff of Messrs. Hoare Bros. Quarry, received their examina tion awards on August 21st, at the hands of the Hon. J . H. Parker, District Traffic Manager. They were congratulated on their success, and Mr. A. S. Hoare and Mr. H. T. Langsford spoke in praise of ambulance work. A gift in apprecia tion of his services, was made to Mr. T. Smale, Class Secretary.

London,

M id la n d

and

S c o ttish .

In rec ignition of 43 year’s service with the ambulance movement on the L.M.S. Railway and with the St. John Ambulance Brigade in Wales, Mr. S. T. Beard, O.B .E., Assistant District Controller and Station Master (Abergavenny Junction), has been promoted to the grade of Knight of the Order of St. John. Mr. Beard, who is S.J.A.B. County Commissioner for Monmouthshire (Priory for Wales), also holds the L.M.S. Long Service Gold Medal and five bars. W e offer our sincere congratulations to Mr. Beard on t h i s l a t e s t recognition for services rendered ; more especially a s h e h a s been a reader of F i r s t A i d since Vol. 1, No. 1.

C h e s t e r . — Presentation of awards to members of the Engineering Dept. Class, was held on August 24th, by Inspector R. F. Phillips. All members passed the examina tion, and reference was made to the valuable services rendered by the class instructors, Messrs. A. E. Letman and W. Cliffe. A presentation was made to Inspector Phillips.

London

and

N o rth

E a stern .

The following members of the Southern Area have been admitted Serving Brothers of the Order of St. John during this year :— Great Central Centre.— Joseph A. Dawson, goods checker, Immingham Docks ; Samuel Cooper, ticket collec tor, Leicester Central. Great Eastern Centre. — Frederick S. Dare, labourer, Chief Engineers’ Dept., Stratford Works ; John Arthur Bellett, w'agon builder, Temple Mills, Stratford. Great Northern.— Herbert Armitage, labourer, Engi neers’ Dept., Stanningley ; Walter C. Shalders, foreman, Derby ; Harry Dunford, checker, Kin g’s Cross ; Norman J. Ware, canvasser, Liverpool Street.

On August 19th Dr. May Rutledge (Lady County Supt., S.J.A.B.) presented awards to the Norwich Division of the G.E. Centre. There were 71 awards and Dr. Rutledge said the number was very encouraging. Mr. R. H. Statham (District Goods and Passenger Manager) presided, supported by Dr. W. E. Rutledge (Asst. County Commissioner, S.J.A.B.), Mr. R. D. Brown (hon. secretary), Dr. B. M. Tracy, Mr. H. G. Rampling (Asst. District Supt.), and others.

On Tuesday, August

20 th,

Dr. T. J. Miur presented

FIRST

awards to members of the Pickering- class. Mr. E. Tindall, station master, presided. Mr. Hansell, secretary and instructor, was presented with a smoking outfit by members of the class.

Mr. G. Brown (Div. Supt., Sunderland) paid tribute to all those who furthered ambulance work in this country, at the presentation of awards to the Tyne Dock class on August 31st. The guests present included the Mayor and Mayoress of South Shields (Aid. and Mrs. W. L. Pearson), Mr. J. Dickinson (resident engineer and president of the class), and Mrs. J. McRee. who presented some of the awards. The awards included Gold Bars presented to C. H. Patrick, W. Pears, James Henaghan, Edward Whipp and James Burrows.

L .P .T .B .

AID and appreciations expressed to the hon. secretary and Mr. Goddard (District Secretary).

G u i l d f o r d . — Mrs. Hollins (wife of Mr. A. J. Hollins, Asst. Loco. Supt.) presented awards to members of the Guildford Class. Praise for members was extended by several speakers. Mr. A. Barrow (District Secretary) praised the work of the Class Secretary (Mr. H. Bicknell), whose services were appreciated by the presentation of a barometer. Mr. Bicknell in acknowledging the gift, gave particulars of the sessions work. Some 50 awards had been gained, and up to December last, 200 cases of injury had been treated among loco. men. Four members were on active service. In conclusion, Mr. Bicknell voiced the thanks of the Class to Dr. D. Faraday Whitaker for his valuable help. Mr. E. Uzzell (Welfare Officer) expressed thanks to the class on behalf of the company.

(M e tro p o lita n ).

The annual distribution of awards was held on August when the President, Mr. Evan Evans, presided, the awards being presented by Mr. John Cliff, Chief Staff Officer of the Board. Dr. Corbet Fletcher was the chief speaker and he took for his subject “ The Textbook.” He gave a brief outline of its history and stressed the fact that first aid is a science and that every first aider should always have his textbook handy for reference. He particularly emphasised the importance of the first two chapters and the strict observance of the virtues of the eight-pointed cross. The speaker was heartedly thanked for his inspiring talk After a report on the year’s work by the Centre Secretary, Mr. J. A. Gravestock, the distribution was held. Examination awards numbered 238 (70 certificates, 45 vouchers, 20 medallions, 103 labels) ; other awards being 3 certificates for the best cases of first aid rendered during the year ended Sept. 30th, 1939, three 15 years’ long service medals in gold, six 20 years’ bars, five 25 years’ bars and one 30 years’ bar. Also three medals for the highest marks gained by first, second and third year members, presented by Mr. George Hally, late chairman of the Centre. After thanks had been extended to Mr. John Cliff and officers of the Centre, a Remembrance for Absent Friends was read. [Extracts from Dr. Corbet Fletcher’s talk are published in this issue].

14th,

A presentation of awards to successful candidates of the Charing Cross and Hilher Green Ambulance Classes (Traffic and Loco. Depts.) took place on August 28th. Mr. F. Bassett, Station Master, Charing Cross, presided, and was supported by Mr. E. LIzzell, Welfare Officer, Capt. F. Britten, R. T. Officer at Charing Cross and Mr. W. Hagell, Ambulance District Secretary. Mr. Bassett paid warm tribute to the success of the effort of Mr. A. Scribbens, Class Secretary, in restarting the Charing Cross Class after a lapse of some 20 years. Mr. Scribbens gave interesting details of the two Classes ; he was proud to report 100 per cent, results. Mrs. Uzzell, who presented the awards, made an appeal to the wives and daughters of the staff to attend the forth coming season’s classes. Mr. Uzzell stressed the importance of each man doing his best in order to increase membership. Mr. Hagell, District Secretary, strongly supported the appeal of the Welfare Officer and Mrs. Uzzeli.

Mr. F. B. Ulston (Asst. Works Manager), presented awards to successful members at the Lancing Class. He had seen the members at work and he was confident of their capabilities in an emergency. Dr. R. H. Wilshaw (lecturer), Mr. W. Townshend (class secretary) and the Committee, were thanked for their services. Mr. A. Packham received the Certificate of Merit.

S o u th ern .

R e d h i l l . — The annual presentation was held on August

20th,

when Mr. F. C. Bishop (Asst. Div. Supt. Central Division) presided. Mr. H. Hunneybell (Class Secretary) reported on a satisfactory session, during which some 60 awards were gained. Congratulations were extended to the ladies from the Divisional Offices for interest taken, and the valuable services of Dr. F. C. Cope, and also officials of the Company, were referred to. Mr. C. J. Latham (Div. Supt.), after presenting the awards, congratulated the class on its successful season and increased membership. Mr. Chrimes proposing a vote of thanks to Mr. Latham, assured him of the full support of the Loco. Dept. Mr. E. Uzzell (Welfare Officer) conveyed the apprecia tion of the Directors and General Manager, on the success ful efforts of the class. Thanks were also extended to Mr. Bishop for presiding,

Mr. A. Barrow, District Secretary, presided at the pre sentation of awards to the Feltham Class, being supported by Messrs. E. S. Moore (Div. Loco. Supt.), F. E. Campion (Div. Engineer), E. Uzzell (Welfare Officer), G. W. Oxley (Loco. Foreman), W. Bullen (C. & W. Foreman) and A. Willcox (Station Master). Mr. Moore presented 46 awards, also a 7-year medal to R. Penfold, 14-year medals to E. Cording, T. F. Mansey and W. T. Warren, and a gold medal for 21 years to C. Everest. Mr. Upton, class secretary, who expressed thanks to Mr. Moore, attributed the success of the Class to the interest taken by higher officials and to the excellence of Dr. Fraulo as lecturer. Mr. F. E. Campion presented a Meritorious Certificate to Mr. E. Coster of Virginia Water Class, who, although having just passed his first examination, restored breathing, treated burns, and arranged transport for a workmate who had come into contact with the live rail.

FIRST “ F irs t

A id

fo r

W ar

C a s u a ltie s .”

A n e w book under llie above title was published on Septem ber 4th, and already reports are such that those who ordered their copies in advance are definitely of the opinion that the context is of the greatest service to them in their training and work. Such important items as Sudden Childbirth, collapse of lung from blast, exceptions to artificial respiration, wound shock, bleeding recurring after initial arrest, are fully dis cussed and treatment given. The work of First Aid Services in Action, Casualty-collection in the Field are also discussed ; whilst the appendixes deal with position on the stretcher, self-protection hints (blast and noise, fire and gas), and specimen marking sheet for training purposes. War-time first aid at home occurring from air raids or other forms of attack is totally different from assistance rendered in peace-time. As the author, Major Norman Hammer, B.Sc., M.R.C.S., L .R .C .P ., writes in his intro ductory, “ The accepted basic principles of ‘ pure’ first aid always apply, but procedures and routines may need modifi cation, according to the special circumstances.” Orders, together with remittance 1/8 post free, should be sent to Dale, Reynolds & Co., Ltd., 46, Cannon-street, London, E.C . 4.

AID

Do not wring the sponge out dry'. Twenty minutes is the usual time required for sponging. Take the patient’s temperature and if not sufficiently reduced, sponge again using colder water. Do not rub the patient dry ; leaving the skin slightly moist helps to lower the temperature. The patient’s temperature should be taken 20 minutes after sponging, and should be reduced 2 or 3 degrees. If, while sponging, the patient shivers or shows signs of shock, stop immediately and apply hot water bottles and blankets. Cold Pack.— The patient is wrapped in a sheet wrung out in cold water and covered with a blanket, the under bed clothes being protected by a long mackintosh sheet. The feet should not be covered, and a hot water bottle should be applied to them. When the temperature has been suffi ciently reduced, the sheet is removed, the skin dried, and the patient wrapped in a warm blanket. Ice Pack.-— This is applied in a similar manner, but the sheet is wrung out of ice cold water, and pieces of ice are wrapped in the folds. Ice Cradle.— This consists of a large bed cradle, sus pended from which is a metal tray, on which ice is placed. The bedclothes are replaced over the cradle so that the patient lies in an ice-cold atmosphere. B a t h s in C o m m o n

Name. 1. Cold Bath

M eth o d s o f R e d u c in g th e T e m p e r a tu r e o f th e

B o d y .*

( 1) By reducing the number of bedclothes. (2) By the action of drugs (diaphoretics). (3) By the external application of cold. The first method may always be used, the second method is not satisfactory, while the external application of cold is the most efficient. There are many ways in which cold may be applied to the skin. (a) Cold bath. (/>) Cold sponging. (c) Tepid sponging. (d) Cold pack. (<?) Ice pack. (/) Ice cradle. Cold Bath.— The approximate temperature is about SO degs .-65 degs. F. The temperature of the bath is best lowered gradually. The patient’s pulse, temperature, and general condition must be carefully watched. Cold Sponging.— Start with water at a temperature of F. and cool down to SO degs. F.

70 degs.

Tepid Sponging.— Start with water at a temperature of 90 degs. F. and cool down to 70 degs. F. To sponge a patient, screens, one blanket and mackin tosh for the patient to lie on, one blanket to cover the patient, towels, a basin with water, a bath thermometer, and a clinical thermometer are required. Method.— Place the patient on one blanket and mackin tosh sheet and cover him with the other blanket. Remove his shirt, proceed as in a blanket bath, sponging with long strokes the face, neck, limbs, trunk and back in rotation. * Extract from the Manual of Instruction for the Royal Naval Sick Berth Staff, reprinted by permission of the Controller of H.M. Stationery Office. Copies of the Manual can be had of H.M. Stationery Office, Adastral House, Kingsway, London, W .C . 2, or any branch, price 4/Sd. post free

U se.

Use. -Toreducethe temperature. 2. 1 epid Bath 90” F. Water Toreducethe temperature. 3. Warm Bath 95° F. Water - Cleansing. 4. Hot Bath 100° F. Water - Cleansing & diaphoretic. 5. Alkaline Bath 95° F. Sodium Carbonate, 6 In Rheumatoz. ; water, 30 gals, ism and Skin Diseases. 6. Bran Bath 95° F. Bran, 4 lbs. ; hot In Skin Diswater, 1 gal. added eases, to warm bath 7. Sulphur Bath 100° F. Sulphurretted Potash In Skin Dis£ oz. to each gallon eases, of water. 8. Mustard Bath 100° F. Mustard, 1oz.;water, Diaphoretic 5 gallons. & Stimulant.

Temp. Constituents. 65° F. Water -

Vapour Bath—

R ed

Steam

C ro ss

and

S t.

John

- Diaphoretic.

W ar

O rg a n isa tio n . T h e figures below show the main items of expenditure of the

War Organisation to July 31st last. The total is an increase of £ 363,250 over the sum spent to June 30th which was £ 800, 250. Purchase of general and medical stores and comforts (including material for the Central Hospital Supply Service) ... 652,500 Purchase of ambulances, X-ray units and equipment ... ... ... 99,000 Parcels for prisoners of war ... ... 74,000 Work of commissions overseas ... ... 72 500 Convalescent hospitals for officers ... 6,000 Red Cross and St. John County Branches and Joint County Committees for local work ... ... ... 185,000 Scottish Branch B .R .C .S .— Scottish sub scriptions ... ... ... 64,000 Relief in Finland ... ... ... 10,000 . £ 1, 163,500

FIRST The

S t.

John

T e x tb o o k .*

Bv N. C O R B E T F L E T C H E R ,

. a .,

. b .,

.r .c .s .

A t these Annual Meeting's you are wont to invite an Officer of The Order to talk to you on some aspect or other of its history or work. To-night your choice has fallen on me. So, with the concurrence of your Secretary, I propose to talk to you about the Textbook which 1 may praise without bias because I am not a member of the Revision Committee. H is t o r y

o f

T extbook.

Some of you know that at the close of the FrancoGerman War of 1870, in which the Voluntary Aid Movement had its lirst testing, the authorities realised that volunteers ought not to go to the assistance of sick and wounded with out more systematic training than had been possible previous to the recent conflict. They, therefore, suggested that steps ought to be taken in times of peace to educate members of the civil population in methods of rendering such assistance. At this date The Order (which had been revived in this country in 1838) was a small and private philanthropic body which included in its charities the provision of supple mentary diets and of joy-rides to the top of Highgate Hill for convalescent patients. When, therefore, the National Society for Aid to Sick and Wounded (which in 190S gave way to the British Red Cross Society) declined as too great an enterprise the responsibility of training civilians, the Order— chiefly through the efforts of John Furley and Sir Edmund Lechmere— seized the opportunity which has brought it fame and transformed it into an imperial organisation of world-wide reputation ; and in 1877 it established the Association. This, as you know, is the Department which controls instruction, examination and certificates in first aid and allied subjects. The enthusiasm which greeted the invitation to undergo training and so to be ready to give aid to sick and wounded was immense and quickly became as potent for good as a religious mission. Even the dry records of the past (which I have twice read) breathe the intense interest of its early converts ; and they tell us that women, in the proportion of three to one man, crowded the lectures (the first of which was given at Woolwich by Dr. Peter Shepherd in such numbers that the new cult was ironically called “ an ephemeral feminine fashion.”) The enthusiasm was maintained at top pressure during the years that followed ; and certificated pupils of the Association up and down the country formed themselves into Corps to keep up their practical knowledge, with the result that in 1887 The Order was compelled to recognise these units and so to establish the Brigade. This, as you know, is the Department which primarily undertakes public duty ; and, composed of surgeons and trained lay persons, it is a uniformed and self-desciplined body which is ready and willing to render first aid on all occasions and especially when crowds foregather and accidents happen. Having accepted the mission of training civilians, The Order made contact with the War Office which detailed two of its surgeons— Peter Shepherd, M.B., and Francis halwasser, F .R .C .S .— to give professional assistance. The latter in due course prepared the first Syllabus of Instruction while the former compiled the first Textbook which was called A id s f o r Cases of Injuries and Sudden Illness and was published in October 1878. Both surgeons were recalled a year later at the outbreak of the Zulu War and set sail for South Africa whence Shepherd did not return. * An address given on August 14th at the Annual Distribution of Awards to members of the London Transport Centre of the St. John Ambulance Association.

AID In his preface to the Textbook Shepherd stated that its preparation was hurried owing to the fact that he was going on active service and that he had “ been aided by kind and able coadjutors who have given of their knowledge and experience.” The latter statement always intrigued me and after so many years seemed inexplicable. It was, therefore, an amazing chance which, after the death of Cantlie, brought me into passing contact with Dr. Mitchell Bruce, an eminent physician of those days. Hearing that 1 was interested in the Textbook, Dr. Bruce one day volunteered the statements that he had had a hand in its compilation and wrote the Chapter on Poisons ; and that Peter Shepherd just before his departure to South Africa had passed his rough notes to James Cantlie and himself with the request they would amend and amplify the notes for publication. Up to that time, like others interested in the Textbook, 1 had thought that Cantlie’s connection with the Textbook dated from 1901 when, after his return from China, he prepared the so-called First Edition of the Textbook after 750,000 copies of Shepherd’s Textbook had been sold ; and that in it he laid the foundations of the modern science of first aid. It was news to all of us, therefore, to learn that Cantlie had had a share in the preparation of the original issue of Shepherd's Textbook. From the earliest days The Order has appointed a Revision Committee, the first Chairman of which and later second author of the Textbook was Dr. Robert Bruce con cerning whom nothing further is known and who was succeeded by Cantlie. S chem e

o f

T extbook.

The Textbook was the first official manual of instruc tion. It is still far away the best, because in the 1908 Edition James Cantlie (who has rightly been called “ The bather of First Aid ” ) built it on a scheme for the purposes of instruction and actual practice. By so doing, he con verted first aid from a collection of facts and instructions into a special science. Cantlie’s scheme has been developed by subsequent Revision Committees ; and it is in the posses sion of a definite scheme that the Textbook takes precedence over other official manuals which, in several instances, remain mere collections of facts and instructions, some being far beyond the limits of first aid. For this reason Chapters I and II are, in my opinion, the most important in the Text book. Originally in one, the scheme has been enlarged and now spreads into two chapters. In Chapter I are set out definite, precise objects, fixed limitations and essential qualifications, while Chapter II details the principles on which first aid is based. In the 1901 Edition Cantlie had introduced general rules for the treatment of some of the different injuries and conditions, and so took a big step forward towards simpli fying the subject ; and in the 1908 Edition, as we have seen, he introduced further improvements which help keen students to become efficient first aiders. In this way Cantlie formulated a plan by which the modification of general rules, which must necessarily occur in actual circumstances, can be systematically accomplished ; and consequently students under the St. John Syllabus have ever since (or should have been) taught how they should modify the general rules in accordance with the principles of first aid by the exercise of their qualfications as first aiders. Incidentally, it was a pretty fantasy to associate the last named with the eight points of the St. John Cross ; and I know full well that first aiders— lecturers and students— who put into practice these qualifications are more successful at their daily jobs, whatever these be, than their colleagues who know them not ! The result of this is that we doctors who teach first aid must study the subject as you lay folk, the difference be tween us being that, whereas we must bring our knowledge

FIRST down to, you must raise yours up to the standard which separates first aid from its parent sciences, medicine and surgery. When doctors fail to realise this fact, their lectures become mere dissertations on various aspects of their daily work, and are often beyond the comprehension of their lay students. S tudy

o f

rendered absorbable bv digestive processes. The effective dose would have to be at least half-a-pint. The patient will have all his functions seriously impaired, and thus shock should have great care. Prolonged journeys and inadequate provision of warmth should be vigorously avoided. Large amounts of fluid are indicated in order to facilitate the work of the kidneys.

T extbook.

This year it was my privilege to conduct your annual re-examination, at which, as was anticipated, most of you put up a good show, though a few failed to satisfy me as the examiner. It would appear, therefore, that some of you are resting on your laurels and trusting to your memories. Of course, it is an open secret that some first aiders only open their Textbooks on the evening before the annual re examination ! These do not realise how fleeting is memory and how necessary it is to continue our study of so practical and progressive a subject as first aid. Twenty-five years ago I wrote my first reply to a query for the journal F i r s t A i d ; and I compiled it from the Textbook as it lay open before me. Ever since 1 have acted on the same principle with the thousands of queries with which I have dealt down the years ; and 1 have at times been surprised to find that I had forgotten some of the facts and instructions in the Text book. Further, to-day I often include in my replies references to the Textbook, my intention being to compel those interested to turn to the Textbook for a more complete understanding of my replies. So take my advice and refer to the Textbook in season and out of season, and more particularly when difficulties arise as to appropriate treatment of cases. It is a sound and practical guide ; and, above all, it is written in simple language which all can understand. Finally, in your study and in your active practice of first aid, I wish you God-speed.

C a r b o lic

AID

A cid

P o iso n in g .

carbolic acid group constitutes one of the popular suicidal poisons. It is a non-specific poison ; and it causes loss of function and eventual cell death to any tissues with which it may be brought, if it is sufficiently concentrated or acts over a sufficiently long time. If the acid is concen trated, coagulation of the tissues will ensue, leading to mass death of the cells. After absorption the central nervous system is particularly susceptible, as with any fat-soluble depressant, leading to the typical descending type of func tional inactivity, with final failure of respiration. The kidneys deal with the poison in a relatively more concen trated form and over a longer period in the work of elimina tion. They are, therefore, very liable to damage ; and this constitutes a very serious danger. It must not be lost sight of that carbolic acid is a general tissue poison ; and that in any case of poisoning, especially if functional weakness or damage previously existed, other organs may be affected. The liver and heart are of special interest. As with most poisons the problem of treatment is divided into three parts. The first and most important is to limit absorption ; the second to help the body to withstand the effects of the poison ; and the third to assist in its elimination. Carbolic acid is much more soluble in oil than in water, and it leaves a watery medium for one of oil, in which it remains pharmacologically inert. Therefore, when the acid has been swallowed an immediate administration of a large quantity of oil to the stomach contents would certainly render unabsorbable much of the-acid. The 'most suitable substance for this purpose is ordinary medicinal liquid paraffin, which takes up the acid efficiently, and is non absorbable even by damaged mucous membrane, nor is it

A.R.P. A ir

R a id

P r e c a u t io n s

T o p ic s.

T r a in in g

B u l l e t in ,

No.

The second of the Training Bulletins (4d. post free) sets out many interesting alterations in training of personnel. We note that the chin strap of the steel helmet should be worn on point of chin and that when “ g a s ” position for the respirator is required, the strap is placed under chin with the right hand, and helmet placed at back of head with left hand. This instruction is somewhat different to those issued to some public bodies who have been told to (1) wear strap on point of chin, (2) when “ gas ” position is required, takeoff helmet, (3) replace helmet with strap at the back of the head. Neither instruction is quite satisfactory, as it is not easy to fit on respirator with steel helmet at back of neck, neither will there be much time to adjust the chin strap in the latter case. Drill for order of undressing when wearing anti-gas clothing with helmet, has been altered. First, the gloves and over-mittens are removed, followed by pushing the helmet to back of neck, removing respirator and then helmet with curtain. Should however, the hood be worn, this change does not apply, as in that event the chin strap is worn at the back of the head. Other anti-gas items discussed, include wearing of anti gas gloves, decontamination of clothing and pi otective equip ment, respirator drill (civilian duty and service), disinfection of respirators, testing the fit of civilian respirators with “ contex ” attached, etc.

T he

A.R .P.

D ia r y .

Although there is still over three months to the new year, Messrs. Jordan & Sons Ltd., of 116, Chancery Lane, London, W .C . 2, have already issued their A.R .P. Diary for 1941. This diary (pocket size) contains much essential in formation, together with drawings and illustrations, cover ing some sixty pages. There are a variety of bindings— Rexine 2/-, with pencil 2/6 ; leather 3/6 ; leather, refill style, 6/-. Another diary issued by this firm is the A.F .S. Diary. Here, again, useful data is given to members of the A.F.S. Prices are similar to those of the A.R .P. Diary.

V e n t il a t io n

t iie

B l a c k -O u t.

This is the title of a pamphlet issued by the Ministry of Home Security (3d. post free). The question of ventilation is an important one and the pamphlet shows how it can be provided without light showing outside the house. It describes and illustrates how ventilation may be secured by incorporating a light trap ventilator in a black out curtain ; how to fit a proper light trap giving proper consideration to the fact that there should be an inlet for fresh air and an outlet for foul air. It also gives particulars as to how windows and doors may be left open for ventilation purposes when curtains are secured in a certain manner, and methods of making screens, etc., for such purposes mentioned.

FIRST

M e c h a n ic a l Bv

D r.

G il b e r t

R e v iv ific a tio n .

B u rn et,

M.C.,

M .I .F ir e E .

Chief Surgeon to the National Fire Brigades Association. ( Concluded from page jq .J T he

B ragg

P aul

A pparatu s.

The principle of the Bragg Paul pulsator is the rhythmical application of pressure on to the exterior of the chest. At intervals corresponding to the desired rate of breath ing, air is pumped into a rubber belt which is comfortably adjusted around the chest wall. The pressure thus created, forces air from the lungs— an involuntary expiration. Re lease of the pressure allows the chest and the diaphragm to recoil on account of their elasticity, and thus produce inspiration. It is usually worked now-a-days by a small motor, but a water pump, or a hand pump, may be used if electricity is not available. Naturally, the amount of pressure of air in the belt determines the depth of respiration. This may be adjusted both by a tightening of the belt, and by tbe variation of the pressure exerted by the pump. The rate of breathing depends on the rhythmical release of the pressure. The machine caters for this in a manner which ensures both ease of alteration, and an unfailing regular rhythm. For prolonged cases of artificial respiration the apparatus is commendable on account of its ability to function in what ever posture the patient wishes to be. He can sit up for meals or lie down comfortably to sleep ; whilst the nursing of the patient is exceedingly simplified. It is similar in principle to the Reddo apparatus. There are two types of apparatus largely used in France (one invented hy Dr. Panis, the other by Dr. Cot). They employ the principle of external pressure by means of pads and levers. T h e

D r in k e r

A pparatu s.

The Drinker respirator, otherwise the “ iron lung,” designed by Dr. Phillip Drinker, of Harvard University, is extensively used throughout the world. It consists of a steel chamber large enough to accom modate the tallest man in a recumbent posture. It will, also, serve for the smallest child. The patient lies on a rubber mattress so that his head and neck extend beyond the chamber and rest on a padded head-rest. Around the neck is fitted a broad rubber collar to exclude the chamber from the outside atmosphere. The chamber is securely airtight, although at any time it may be rapidly opened for nursing purposes. The underlying principle of the apparatus is that of a vacuum ; the air of the chamber is alternately exhausted, and allowed to return to normal by the rhythmical action of an electrical-driven air bellows. Whereas, in the Bragg Paul apparatus expiration is produced under the influence of the air pump, in this machine the energy of the motor is expended in creating a vacuum in the chamber and thus causing inspiration. The rate and depth of respiration is easily controlled, and nourishment and sleep may be taken without interfering with the rhythmical movements of the machine. The apparatus is heavily built and suspended on a frame which allows movement of the whole machine, either in a horizontal, or tilted, position. P r in c ip l e s

Involved .

To appreciate the utility of mechanical breathing apparatus, it must be realised that asphyxia is caused by failure of the oxygen supply to the blood.

AID This is brought about by either deficiency of oxygen in the atmosphere breathed, or by arrest of the acts of breath ing. This latter condition includes not only mechanical obstructions to those caused by blockage of the air passages or compression of the chest, but also cessation of the chest movements caused by either failure of the respiratory centre, or paralysis of the nerves and muscles which the respiratory centre operates. , Of course, the final result is the same. Oxygen is not consumed, therefore carbon-dioxide is not produced ir, the blood, and consequently the respiratory centre, which requires this as a stimulant, ceases to function and so auto matic breathing ceases. Failure of the respiratory centre may be caused by direct injury to the brain cells, and by certain poisons which directly affect it by devitalising its cells ; but shock from injuries and electric shock may so interfere with its normal impulses as to cause arrest of breathing which, if not relieved quickly, will produce further failure due to lack of oxygen and consequent deficiency of its normal stimulant— carbondioxide. A s p h y x ia .

The types of asphyxia caused by sudden occlusion of oxygen, such as in drowning and strangulation, may be classified as acute asphyxia, and in all such cases the greatest urgency is immediate and continuous artificial respiration until such time as normal respiration can be restored. On the other hand, asphyxia may be caused by a much slower process as, for instance, when the blood cells fail to supply enough oxygen for bodily needs— sub-acute asphyxia. Sub-acute asphyxia is caused in two ways :— 1. Inadequate respiratory movements as, lor instance, in certain injuries to the muscles or paralysis of their nerves by disease, such as diphtheria, infantile paralysis, and so forth, when a sufficiency o f oxygen cannot be taken into the lungs. 2. Inadequacy of the oxygen-carrying cells of the blood, caused either by direct loss oj blood, or by direct poisoning of the blood cells so that they cannot carry oxygen as, fo r example, in carbon-monoxide poisoning. In sub-acute asphyxia artificial respiration is not necessary as an urgency, unless the oxygen lack goes so far as to produce carbon-dioxide deficiency with its subsequent respiratory centre paralysis and acute asphyxia. P h y s ic a l

C ollapse.

The most important factor of all asphyxias is the un consciousness, during which the brain cells, devitalised by lack of oxygenated blood, may become permantly damaged. In support of this it may be mentioned that post-mortem examinations of fatalities due to both electric shock and carbon-monoxide asphyxia show similar conditions on the brain— namely minute haemorrhages. There is no doubt that the symptoms, such as headache and double-vision, which persist for a long time after carbonmonoxide poisoning, are due to damage done by asphyxia and not to the persistence of carbon-monoxide in the blood. Consequently unconsciousness must be avoided when ever possible by preserving an adequate circulation of well oxygenated blood to the brain cells, and on all occasions the period of asphyxia must be made as short as possible. It is necessary at all times to maintain a clear concep tion of the influences of both oxygen and carbon-dioxide in treating cases of asphyxia, and to remember that neither oxygen nor lack of oxygen will stimulate the respiratory centre or resuscitate. This can only be accomplished by maintaining a sufficiency of carbon-dioxide in the blood. An unconscious person undergoing artificial respiration, is not working sufficiently to create a full quota of carbondioxide in his blood, and the administration of oxygen alone

w ill only delay resuscitation.

FIRST Consequently in all those cases of acute asphyxia, urgent and continuous artificial respiration with carbondioxide resuscitation and, perhaps, also stimulation by drugs, must be the first line of treatment. Even before removal to hospital or the adoption of any mechanical means of performing artificial respiration.

AID T he

T he term “ convulsions” covers a great number of widely different conditions. Broadly speaking, they are of two main forms— those which are a synonym for epilepsy and those of infantile convulsions. In each of these main classes there is an almost infinite variety of diseases, the complete description of which would cover many pages. It is, however, possible to outline some of the most important and interesting features of these diseases.

I n f a n t il e

C o n v u l s io n s .

At a discussion held in Paris a few years back it was discovered that infantile convulsions were declining in many areas, thanks to the educational activities to pre-natal and post-natal welfare and to the campaign against alcoholism. The public are firmly convinced as to the importance of the part played by the teeth and intestinal parasites in the genesis of infantile convulsions. Many mothers ask the question— “ Are the convulsions serious or not : are they the forerunner of epilepsy or some other serious disease of the brain ” ? The answer is reassuring. The convulsions which overtake a child between the third month and the third year of life nearly always pass off without serious consequences. A few infantile convulsion subjects become epileptics, but most infantile convulsions lead to nothing.

F ir s t

A id

A lp h a b e t.

stands for A R T E R Y ; blood is bright red. Stop it at once ; or your patient is dead. is for B U R N S ; give them all your best care. Use tannic acid and exclude the air.

stands for C U T S , the curse of each mine. Cleanse them with water, then use iodine.

for the Doctor, he knows all the tricks. Warn him at once, or you’ll be in a fix. for your E Y E S that get filled up with dust. Use castor oil, if touch them you must. stands for F R A C T U R E , a break of the bone. Splint on the spot, or else leave it alone.

E F G

E p il e p s y .

This condition was traced by our ancestors to the influence of heavenly bodies or to the invasion of the patient’s body by a demon. Its causes and also its manifestations are most varied. At the one extreme there is the full and fledged fit (grand mal) and at the other end there is the brief moment of mental confusion with automatic acts which easily escape notice. Transcient loss of consciousness without convulsants is commonly known as petit mal. The majority of epileptics, when given a proper chance, are able to live fairly normal lives, and the tendency towards mental deterioration can in some measures be combated by the maintenance of interest in life and by sensible adjust ment to the environment. The hereditary factor must not be ignored, although popular opinion has much exaggerated its importance. Predisposing causes of epilepsy than birth injuries and acci dents involving the brain later in life are certain infections, such as meningitis, encephalitis, syphilis, etc. Lead and alcohol poisoning may also predispose to epilepsy. Once atendency to epilepsy exists, a convulsion may be brought onby almost any irritation or stimulus— constipation, eye strain and the whole gamut of emotional storms. Therein lies the clue to preventive treatment. The patient whose environment is harmonious and whose physical and mental health is maintained at a robust level, may pass months or even years without a grand mal attack. The diet should be varied and, in the case of children, rich in fats and poor in starchy food is often very beneficial. Drugs are best left to the doctor’s decision.

M in e rs’

E xtract from First-aid letters issued bv the M ines Branch of tho Department o f Mines and N atural Resources , Winnipeg. A

C o n v u ls io n s .

is for G A SSIN G ; bring man to fresh air ; Apply respiration with infinite care. stands for H / E M O R R H A G E , bleeding, you know, A pad, with tight bandage, may stop the blood flow.

is for IN JU R Y, crush or hard knock, Send for the doctor, give treatment for shock.

stands for JO IN T, dislocation or sprain. Cold or hot compress, downs swelling and pain.

for the K N E E C A P . Should it go “ flop,” Back splint the fracture and ice on the top.

stands for L Y S O L , a germicide rare, For washing out wounds, but use it with care.

is for M A K E S H I F T , and here is a hint, Use coats for stretcher and drill steel for splint. for a N O S E B L E E D . Now, what should you do ? Digital pressure may carry you through.

N O

means OCCI PITA. Fracture will show Bleeding from ear, in case you don’t know.

is for PO ISO N . Act swift if you’re wise. For corrosives that burn you must neutralise.

for the Q U E S T I O N S , with tact you may ask If the patient is conscious, to lessen your task.

stands for R U P T U R E . You bring up the knees, Then cold applications to give patient ease.

is for SH O C K . You keep body warm And then stimulate to prevent further harm. is important ; it means T O U R N I Q U E T . Used to stop bleeding the pressure-point way.

T U V

means U N C O N S C I O U S N E S S . Place man on back. Head to one side and clothing quite slack. is for V E R T E B R A E , spine or backbone. If fracture’s suspected, leave patient alone.

W stands for W O U N D S , small or great. Offset infection and don’t seal your fate. X marks tbe spot where a workman was laid, For his partner knew nothing of simple First Aid. Y

is for Y O U , who have glanced through these rules. Will you learn and be wise, or reject and be fools.

stands for Zeal, or it may stand for ZE ST . In either case give us what in you is best.

■ — Canadian F irst A id .

The funeral took place on Friday, August 30th, at Brandon Village Churchyard, of Mr. Albert Winstar Cole, whose untimely death, at the age of 25, occurred after a brief illness. Mr. Cole was a keen member of the S.J.A.B.

FIRST

Our Nurses’ Page. COM PILED

C iv il

N u r s in g

AN A M B U L A N C E

SIS TER .

R eserve.

Full-time members of tbe Civil Nursing Reserve who are already employed in hospitals or on casualty trains may now apply for a guarantee of 12 months’ continuous employ ment provided they satisfy certain conditions, and undertake to serve full-time in any emergency hospital in Great Britain to which they may be sent. All members enrolled or accepted for training before the first of this month, but not yet called up for employment, will become eligible for this guarantee on the same conditions, on being called up for hospital service.

No.

S.J.A.B.

D is t r ic t ,

As the result of an appeal made recently by Lady Div. Supt. Miss Baxter, No. 64 (Ealing) Nursing Division, a hall large enough to accommodate the members has been found. It is the Ealing Congregational Hall, and the Division will be able to meet there on Tuesday evenings. The arrangement, however, is not a permanent one, and the Division is still without the suitably large premises which its work and growing membership require. W estern

No.

A r ea .—

S.J.A.B.

D is tr ic t,

D i v i s i o n . — On August 8th, Lady Anne Cavendish Bentinck, granddaughter of the Duke and Duchess of Portland, opened a garden fete in the grounds of Steetley Holme (kindly lent for the occasion by Mr. and Mrs. Norman Fricker) in aid of tbe newly-formed Nursing Division of the St. John Ambulance Brigade. Dr. W. J. Lawson presided, and thanks were expressed to Lady Anne by District Officers Captain Muschamp and L. Ward Walters. W h it w e l l

N u r s in g

H o p e V a l l e y N u r s i n g D i v i s i o n . — A meeting of this Division was held recently to nominate Divisional Officers. It was presided over by Assistant Commissioner H. C. Chambers, supported by Lady District Officer Mrs. Wood. Miss Helen Cox was appointed Lady Divisional Super intendent, Miss G. Potttr was elected Lady Ambulance Officer, and Miss G. Atkins, Divisional Treasurer, with Miss H. E. Ollerenshaw, Divisional Secretary. The appointment of Miss Cox in charge of the Division is very interesting. Her father, the late Mr. G. W. Cox, was the first Superintendent of the Hope Valley Ambulance Division, the efficiency of which was mainly due to his untiring efforts.

No. 8

D is t r ic t ,

S.J.A.B.

At a South-East Coast town, on Friday, August 16th, the funeral took place of Mrs. Helen Jane Barker, who was killed by enemy action on August 12th, while proceeding to duty. Mrs. Barker, who was 38 years of age, was a Nursing Auxiliary attached to a First Aid Post, and for several years had been a member of the local Nursing Division of the St. John Ambulance Brigade,

AID The coffin was draped with the Borough flag, with the uniform hat and gloves of the Brigade resting upon it. The flag of the St. John Ambulance Brigade was flown at halfmast from St. Andrew’s Church during the Burial Service, while a guard of honour was formed at the graveside by Ambulance Sisters and Nursing Auxiliaries. Members of the Ambulance Division of the Brigade acted as pall-bearers. Besides the family mourners, Corps and Divisional Officers and members of the St. John Ambulance Brigade, and representatives of the Borough and of First Aid Posts were present to show their sympathy and their respect for one who had given her life in the service of her country. There was a very large number of floral tributes. B arn staple

D etach m ent,

B.R.C.S.

The Annual General Meeting of this detachment, Devon 42, was held at its headquarters on Tuesday, August 27th, the Commandant and a large number of officers and mem bers being present. It was reported that owing to the war, the detachment’s activities had multiplied and its numbers increased, there now being 54 officers and members and 16 probationers. Lady Supt. Mrs. Clarke, bad had to resign from that position owing to pressure of work in connection with the school clinic, but remained with the detachment as trained nurse. Mrs. Brook had taken her place, and Miss Gammon had been appointed anti-gas officer. The M.O., Dr. Saunders, was called up in September, 1939, and Dr. Brook was deputising for him. Many members had been called up for duty at the North Devon Infirmary, and 20 members of the Civil Nursing Reserve had completed their training there. In March and April, the detachment staffed the Out-Patients’ Department for about eight weeks. The members of the A.R.P. Casualty Service had attended frequent exercises and held themselves in constant readiness. On June 13th, a hostel for evacuee children unsuitable for ordinary billets was opened, and from then until the end of July, when a permanent matron was appointed, the detachment organised and staffed the hostel, apart from catering and cooking, night and day. A total of 9,892 hours of duty had been put in by mem bers of tbe detachment during the year at the following places— 5,331 at the North Devon Infirmary, 2,888 at tbe evacuee hostel, 950 at tbe Orthopaedic Clinic, 313 on A.R.P. duty, 100 at the Medical Supply Depot, and 310 at the Infant and Dental Clinics and in giving lectures. These figures did not include time spent in training, organisation and attendances at lectures and practices. The second of the two National Fla g Days, held in con nection with the Red Cross and St. John Fund, resulted in tbe record collection for Barnstaple and district of .£271 17s. 3d. A liaison officer had been appointed to assist relatives and friends visiting sick and wounded in hospital. There had been four courses of lectures in first aid, home nursing, anti-gas, and home nursing again, which followed each other without a break. The attendances had been high and results of the examinations very satisfactory. After thanking officers and members who had carried out special duties, and non-members who had helped the detachment, the Commandant proceeded with the business of the meeting. Accounts of the detachment and supply depot showed expenditure to have been high, but receipts had increased in proportion owing to the generosity of many people. A vote of thanks to the Commandant and the Assistant Commandant was heartily accorded.

H ig h

W ycom be

D etach m en t,

Members of Bucks

B.R.C.S.

and Bucks

54 met

at the Health

FIRST

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NORMAN

HAMMER,

8 .Sc., M .R .C S., L.R.C.P. ; Major, R.A.M.C. Rtd. ; Major, 1st Cadet Battn.

TH E

AIR ED A LE

D O L T O N ’S FOR

PRESS,

R eliable

M E D A L 8, B A D G E S

The King’s Royal Ripe Corps ; Honorary Life Member, Lecturer and Examiner, The St. John Ambulance Association ; County Surgeon, The St. John Ambulance Brigade; Fellow, Air Raid Protection Institute; formerly Principal Medical Officer, The Legion o f Frontiersmen.

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E .C . 4 .

FIRST

Centre, H i g h W y c o m b e , on Sa tu rd a y , A u g u s t 1 7 th, to m a ke a presentation to Dr. Bliss on her retire ment as C o m m a n d a n t of the H i g h W y c o m b e detachm en t, and also to tw o members, Mrs. Britnell and Mrs. B rya n t, w h o w ere also retiring. Dr. Bliss is c o n tin u in g as the C o u n ty Medical Officer, B . R C .S . Mrs. K e ntis h, O . B . E . , C o u n ty Director, presided, and the co m p a n y present included Miss F ro w , Matron of H ig h W y c o m b e M em orial Hospital, and m a n y past members. After tea, Mrs. Kentish said she w as very pleased to he at the presentation, but she th o u g h t the a ctu al presenta tion should be m ade by the two new C o m m a n d a n ts , and a sk ed Miss L e igh to n , B u c k s 5 2 , to do this. Miss L e ig h to n said she had g r e a t pleasure in ha n d in g to Dr. Bliss a wireless set and a first aid case from the two de ta ch m en ts and m a ny past members, in appreciation of the g r e a t help, w o r k and interest she had a l w a y s g iv en to the B . R . C . S . in H i g h W y co m b e . Dr. Bliss had been C o m m a n d a n t since 1 9 2 6 . T h e m em bers of the R e d C ross in B u c k s w ou ld be g la d to k n o w that she w a s still co n tin uin g to act as C o u n ty Medical Officer. Dr. Bliss, to w h o m the presentation c a m e as a pleasant surprise, said that w hen she w a s invited to the H e alth Centre for the evenin g, she had been told that it w a s to be a c h r is te n in g party of the two de ta ch m m en ts under the two new C o m m a n d an ts . She w a s more than pleased w ith the w ireless set, and k n ew how she and her son would enjoy it. It w ould be a m em ento of the m a ny happy days spent with the members. A presentation w a s then made to Mrs. Britnell, Senior Section Leader, w ho joined the detachm en t in 1913 and is n ow retirin g. T h i s w a s m ade by Mrs. Sm ith, A. R. P .S ., C o m m a n d a n t B u c k s 5 4 , w ho sp oke of Mrs. B ritn ell’s lo n g service, and said she w a s g la d to hear that she would be allo w ed to be attached to B u c k s 54 as a R eserve Member. Mrs. Britnell served at the M ilitary Hospital d u r in g the G re at W a r, and she had g r e a t pleasure in h a n d in g her a leather a tta ch e ca se from the officers and members. Mrs. Britnell thanked all for their kind g ift w hich she would find most useful. S h e re m a rk e d on the go o d fortune of the m em bers of to-day w ho w ere a llo w ed to train at the W a r M em orial Hospital before t a k i n g up w a r n ursing, w h erea s she w ent s t ra ig h t into the hospital d u r in g the last w ar, and as a very ra w recruit w a s often reprim anded for d o in g the w r o n g thin g. She urged m em bers to be loyal to their officers and to the h ig h ideals of the Red Cross, and a l w a y s to see that n ew m em bers received a w a r m welco me. Mrs. B rya n t, Q u a r ter m a s te r, B u c k s 5 4 , w ho is also re tiring, w a s unable to be present to receive the g ift of a first aid ca se from the officers and m em b ers of the d eta ch ment. T o t t e r ih g e

D etach m ent

B .R .C .S .

Before about 150 residents of the villa ge , a n ew ,£ '5 5 0 a m b u la n c e w a s form ally handed over by Dr. P. Y H ick s, Medical Officer of this d e ta chm en t, to L a d y A nne B rocket, President of the H erts, B . R . C . S . , a t the T o tt e r i d g e First Aid Station on T h u r s d a y , A u g u s t 8th. It had been on view on the v i l l a g e gree n d u r in g the afternoon. Mrs. W a l l a c e Vernon, C o m m a n d a n t Herts 6 0 , presided on this occasion, and w a s supported by V ice-A dm iral S. G. G. Chilton ; C o u n ty Controller and Director, Mrs. M cM u r t r ie ; C o u n ty Secretary, Mrs. R o s s Collins, President of the T o t t e r i d g e Bran ch, and Mrs. Corfield. D r. H ic k s said that the c e re m o n y m a rk ed the clim a x of a g r e a t effort that had been m a d e d u r in g the last two month s. T h e y had in their midst a w o r k i n g party w hich at the o u tb re a k of w a r decided to m a k e co m forts for the troops. O v e r 6 0 0 articles had been m ade, and in M arch Mrs. E n o c k s u g g e s t e d that the p arty should w o r k for some specific object such as an a m b u la n c e w hich w ou ld bear the n am e of T o tt e r id g e . In a b o u t 10 da y s she and her fellow w o rk e rs had raised ;£ 4 0 0 by m ean s of such events as a bazaar,

AID ju m b le sale, w hist drive and a g o lf competition. Dr. H ick s praised the zeal of the w o r k i n g party and of their in d efa tig able leader, Mrs. Enock. In a ccep tin g the gift, L a d y B rock et paid tribute to those w ho had given so g e n ero u sly of their time and money to provide it. She said she had applied for the am b u la n ce to remain in T o tte ridg e, or if not, that the villa g e should have it b a ck after the war. Mrs. E n o c k w a r m ly th a n k ed the m em bers of the w o r k in g party, composed of members of the detachm en t and their friends, for their help w hich had resulted in the pur cha se af the am bulance. S o m e interesting experience s with a m bula nce s in F ran ce recently w ere related by Dr. W ilfred F ox, O fficer-in -Ch arge of No. 1 A m b u la n ce Corps C o m p a n y in France. After the presentation, L a d y B rock et inspected the first aid station.

Treatment of Boils. G e r m s entering the body are the cause of m uch trouble and a boil results when g e r m s k n o w n as staphylococci, rou nd shaped bodies a rra n ge d in clusters, establish themselves in the skin and in the tissues just under the skin. A t first there is a painful, red raised pimple, which g r a d u a l l y e n la rge s and turns a d a rk er red. T h i s is followed by the centre g e t t i n g soft and a y ellow ish colour, s h o w in g that pus is fo rm in g. T h e pus escapes throu gh the yieldin g of the stretched outer skin and, a little later, it is followed by w h a t is k n o w n as a “ s l o u g h ” or “ c o re .” T h i s is a solid m ass of dead ge rm s , dead tissue and dead white corpuscles. After this d is ch a rg e the inflammation g o e s dow n, the part heals, usually lea v in g a scar. T h e usual treatm ent by the home nurse is fomentations or poultices. T h e application of moist heat is sound because it attracts blood to the affected part and helps the local process of inflam m ation and hastens pus-form ation and resolution. So m etim es an e nthusiastic person will endeavour to hasten d is ch a rg e by squ e ezin g the boil. T h e moist heat, foments, etc., certainly help to a ttract more blood to the part and it also relieves pain, but should the moist d res s in g overlap the boil the su r ro u n d in g skin becom es wet and s o g g y and, therefore, unhealthy, and will itself be liable to be a tta ck e d by the ge rm s , thus lea d in g to a g r o u p of boils instead of one. N a tu re localises the infec tion by fo rm in g a r i n g fence of inflamed tissue (full of w hite co rpuscles and protective substances) around the infected spot. T h i s circle of cells and substances is w ea k e n e d by too m uch moisture, while s q u e ez in g it sim p ly b re a k s the rin g le ttin g the g e r m s from the boil run riot in the su rro u n d in g tissue. M a n y doctors will order that the boil shall not be fomented. T h e y m a y have it treated by various applica tions and m a y assist resolution by in cre a s in g the re sistance of the body as a whole. It should, therefore, be re m em bered that should the hom e nurse be instructed to apply a poultice or foment a boil such poultice or fomentation m ust not overlap too much and, further, a boil should never be squeezed.

O n S a tu rd a y , A u g u s t 17 th, Miss Joan F. W oolford, only d a u g h t e r of Mr. and Mrs. J. H. W oo lfo rd, w a s married to Corpl. D o n ald J. Lafferty, R . A . S . C . , y o u n g e s t son of Mrs. F. E. Lafferty. T h e bride, w h o se parents are wellk n o w n m em bers of the St. John A m b u la n ce B r ig a d e in East H a m , ga in e d the N u r s in g B o w l of the No. 1 District in 1939.

FIRST

AID

A D M I T T E D

T O

W O M E N ’S S U R G I C A L 1° & flash the accident had occurred. In minutes First Aid treatm ent w a s effected at the roadside. W ith in half-an-hour the patient w as x-rayed, anaesthetised, and the fracture set. So un d o r g a n i s a tion. And yet, it will t a k e three full m onths before Mrs. Jones will be able to finish the sh o p p in g she b e g a n that unfortunate afternoon. T h r e e m o m h s of daily m a s sa g e , daily re-educative exercises, daily a ttendan ce by a qualified masseur. B la ck-o uts, air-raids, weariness, carelessness, tho ughtlessness, are all in cre a s in g fracture cases to an a l a r m in g extent. And each fracture needs the prolonged care of a masseur. A nd there are 712 different fractures that m a sse u rs are called upon to treat. B u t fractures are only one g r o u p of over 400 different conditions that call for expert m a s s a g e treatment. Sprain s, dislocations, arthritis, paralysis, the list is truly inexhaustible. T h e de m an d is illimitable. First Aid men and w om en are p artic ularly adapted to this call to m a s s a g e , and with an h o u r’s r e g u l a r stu d y each day, coached and^prepared ca refu lly by experienced hospital tutors, and backed by the g r e a t e s t m a s s a g e school in e xis tence can, w ithin a few months, be fitted to serve in this new and prosperous profession. V a c a n c i e s are o ccu r rin g at every hour, and an u r g e n t need exists at this m o m e n t for trained men and w om en . T o - d a v is the d a y of the qualified w orke r. T h is chan ce is your chance. M a k e the b i g effort for b i g m o n ey N O W 1

TH IS C

W O N D ER FU L

FREE

To The Secretary, The SMAE Institute, Leatherhead, Surrey. Please send me without obligation, a copy of your free Booklet “ Manipu lative Therapy as a Profession.” N am e.

A d d r e s s .............

L E A TH E R H EA D " F .A ." S e p t., 1940.

S U R BE Y

BO O K LET

FIRST

Q u e r ie s to

and

A n sw ers

C o rresp o n d en ts.

Q ueries w ill be dealt w ith under the fo llo w in g rules :—

1. — L etters co n ta in in g Q ueries m ust be m a rk e d on the top left-hand corner of the e nvelope “ Q u e r y ,’’ and addressed to F i r s t A i d , 4 6 , Cannon-street, L on do n , E . C . 4 .

2 . — A ll Q ueries m ust be w ritten on one side of paper only. 3 . — All Q ueries m ust be a cco m pa n ied by a “ Q u e r y C oupon ” cut from the cu rrent issue of the Journal, or, in case of Q u eries from abroad, from a recent issue. 4 . — T h e T e x t b o o k to w h ich reference m a y be m a d e in this

co lum n is the 39 th ( 1937 ) Edition M a n u a l of F irs t Aid to the Injured.

S t in g s

o f

the

S.J.A .A .

I n sects.

N . G . (B a rn e h u r st).— T h e T e x t b o o k does not g iv e any difference in the treatm ent of the s tin g s of bees and w asp s. I ha ve been told that a bee’s s t in g is acid, w h ile that of a w asp is a lk ali, in w hich case soda w ould m a k e a w a s p ’s s t i n g more painful. In W e l l c o m e ’s Medical D i a r y the fo llo w in g treat m ent is s u g g e s t e d : Insect B ites— phenol (5 per cent.) lotion ; W a s p S t i n g s — A cetic Acid (dilute) ; B e e S t i n g s — a m m o n ia solution. D o you a g r e e w ith this ? T h e venom injected by the ant is k n o w n to be form ic acid. In all other cases the nature of the venom injected is not k n o w n ; but on the a n a l o g y of ant ve nom it has been presum ed that insects and plants produce their ill effects w ith acid venom s. Consequently, treatm ent by application of a lk a li s has a l w a y s been advocated. In these latter days, as you state, the ve nom injected by the w a s p has been proven by experim ent w ith litmus paper to be usually a lkalin e in reaction. T h i s justifies the old-time habit of the f a r m e r w h o is re puted a l w a y s to apply slices of onion (w hich is acid) to w a s p s tin g s ; and it therefore s u g g e s t s the a dvisab ility of a p p ly in g an acid solution to co un teract w a s p venom. Nevertheless, experience proves that the application of an a lka lin e solution often g iv e s relief even w ith a w a s p s t i n g as it m a y w ith a n y form of skin irritatio n .— N. C o r b e t F l e t c h e r . E x a m in a t io n

H ow ler.

D . S . (E a s t L o n d o n ).— A t a recent e x a m in atio n the doctor ask ed a ca ndid ate h o w he w ould proceed to e x a m in e an un con scious patient ; and he w a s con siderably am azed w h en the ca ndid ate replied : “ From the head upw ards.' Good !

N e xt, please 1 1— N . C . F .

F u n c t io n s

o f

U reter s.

R . E . ( K e i g h l e y ) .— A t a recent m e e tin g of our Divisio n of the B r ig a d e the discussion turned to the action of the k id n e y s and bladder. A question w a s a sk ed as to ho w the urine passes from the ureters into the bladder, b e cau se w h en a bla dder is removed from the bo dy there is only one n e c k and that is the exit. M y o w n contention is that part of, or the w ho le of, the surface of the bladder acts as a filter and a llo w s the urine to perco late th ro u gh . Is this assu m ption correct ? O r do the tw o ureters end m ysterio u sly and disappear

AID w h en the bladder is b ro u g h t into contact w ith the air. I should be very pleased w ith some e nligh te n m en t on this point as 1 ha ve heard the question raised m any tim es before. Y o u are w a n d e r i n g far beyond the limitations of first aid and have some s t ra n g e vie ws about the ureters and bladder 1 1 T h e rig h t and left ureters open into the base of the bladder th ro u gh tw o sm all apertures from w h ich urine from the kidneys is co nstantly e sca p in g in drops.— N . C . F . O rder

o f

B a n d a g in g

F ractu r es.

J.M . (Mill H ill).— T h e order of b a n d a g i n g for fractures of the thigh and k n ee ca p is such that the first tw o or three b a n d a g e s secure the splint to the injured limb, and then the fracture is, so to speak, secured to the splint (B a n d a g e s E and F for the th ig h and D for the k n e e cap). In the case of the leg, how ever, the first two b a n d a g e s (A and B) secure the fracture to the splin w hile the re m ainder C, D and E secure the splint to the ieg. C a n you kin dly explain the reason for this variation ? T h a n k you. In the th ig h the atta ch m e n t of the muscles is such that, if this bone is fractured, the upper fra g m e n t m ay be further displaced by movements or attem pts at m ovem ent on the part of patient or bystander. F or this reason our first endeavour is to keep the patient’s tru n k and lo w e r limb in the sam e line. T h i s is effected by s ecu rin g the splint at the outset of treatment. Sim ila rly , w ith a fractured kn eecap a ny m ovem ent or attem pts at m ovem ent w hich m a y cause flexion of the k n e e cap will cause further separation of the f ra g m e n ts with associated in ju ry to the tissues round the joint. T o prevent this and to k eep the lo w e r limb fully extended the limb is b a n d a g e d to the splint at the outset of treatment. O n the other ha nd w ith fracture of the l e g these da ng ers are not so p ressin g and so w e can safely put into practise the golden rule in the treatm ent of fractures— first, control the fracture , then control the splint (or splints) and, lastly, control the l i m b .— N . C F. C o m p r e s s io n

o f

A x il l a r y

A rtery.

D . S . (L o n d o n ).— L ik e all B r ig a d e S u r g e o n s w ho read F i r s t A i d , I a m perpetually g rate fu l to you for yo ur co lum n of A n s w er s to Queries. T h e r e are tw o questions which trouble m e w hen t e a c h in g ; and, like most doctors, I a m d o in g a lot ju s t now. M y first difficulty is w ith reference to the a xilla ry a rtery :— (1) I w onder h o w often in actual practice the need w ill arise to m a k e use of this pressure point. It is very difficult to stop the pulse by compre ssion of the a xilla ry a rtery in class practice ; and it can only be done with slender patients w h o are to ugh e n o u g h to put up w ith a very t i g h t ba nda ge. In a real case, sup po sin g there w a s haem orrh age from the a rm and direct pressure is contraindicated, surely the very schem e of the a x illa ry b a n d a g e would cause added injury to the w ound and prevent satisfactory dressing. D i g ita l pressure on the subclavian avoids all these difficulties. (2) I a m a l w a y s vexed to see compression of a x illa ry a rtery so often set in the e xam in atio n sheet of the A ssocia tion ; a n d I in variably c h a n g e it. A m I wrong ? ( 1) In a ctu al practice the need for compre ssion of the a x illa ry a rtery will, as you say, rarely toccur. Its value,

FIRST

AID

In t h e p r e s e n c e o f b lo o d

it is a m a r k e d p r o p e r t y o f ‘ D e t t o l ’ t h a t it m a i n t a i n s

h ig h g e r m i c i d a l e ffic ie n c y w h e n b l o o d o r p u s is p r e s e n t — e v e n in c o n s i d e r a b l e q u a n t i t y .

T h e v a lu e in e m e r g e n c y o f this

m o d e r n antiseptic— w h ich can b e used ra p id ly w ith o u t d a n ger, d i s c o m f o r t o r s t a i n i n g — is n o w e v e r y w h e r e a c k n o w l e d g e d .

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however, lies in the fact that if the injury be too near the shoulder to justify the application of a tourniquet on the brachial artery, instrumental pressure on the axillary artery will render unnecessary continuous application ot pressure on the subclavian artery. Further, this may prove of first rate importance because in many A .R .P . ambulances it is not possible for the attendant to stand beside the patient. Personally, I have never found any difficulty in com pressing the axillary artery since the day when I first used a billiard ball for this purpose. Conequently, in my lectures I alw ays insist on free exposure of the armpit and on placing in that very small triangular space a pad the size, shape and consistency o f a billiard ball, or, in other words, something small, round, smooth and hard, such as a billiard, golf or fives ball, a stone or the bowl of a briar pipe with its stem for ward. W h y the Textbook does not insist on baring the armpit, as it does the region above the collarbone for com pression of subclavian artery, I do not know ! Incidentally, some lecturers glibly tell their students to make a triangular pad out of a triangular bandage, and to insertthe apex thereof into the armpit, for compression of the axillary artery. On occasion I have told the candidate to do so while I kept my fingers on the radial pulse. Needless to add, this su g g e s tion always fails in its purpose. (2 ) If you regard any question in the examination sheet issued by the Association as unsuitable (and they sometimes overlap), you are within your rights in substituting another ; but you should amend the m arking sheet accordingly, so that in all truth and honesty you can sign the certificate on the summary page, namely, “ that the marks entered were a w a r d e d ........................ for the tests against which they are set.” — N .C .F .

T reatm ent

S nake

Recently there has been a tendency, more especially on the part of A .R .P . authorities, to sneer at the Textbook for including the treatment of snake bites as an item in its training of first aiders. These hostile critics either forget or are ignorant of the fact that, as you rightly suggest, the Textb ook circulates widely throughout the British Empire and for this reason must cater, as far as possible, for the very varying injuries and conditions which may arise within the Empire. In these circumstances, I feel that even with an adder bite the instructions of the Textb ook should be obeyed, provided that the first aider is taught to appreciate the urgent dangers associated with cutting off the circulation of a limb and provided that he releases his constriction within the prescribed period (Rule A . l , p. 132 ).— N .C .F .

an d

Its

Asphyxia (the root meaning of which is “ pulseless ” ) is the term used to indicate suspended animation and signifies a condition in which, as the result of interference with the act of breathing, the blood is in such a state that a suffi ciently free interchange of carbonic acid for oxygen is rendered impossible. In other words, the term covers all the causes of asphyxia ; and it is incorrect to speak of direct and indirect asphyxia. On the other hand, some authorities speak of indirect causes of asphyxia, namely those which produce this condi tion by interference with the act of breathing and of which you will find the list in Groups I and III on p. 156 of the Textbook. Similarly they talk of direct causes of asphyxia, namely those who produce this condition as the result of poisons introduced into the blood stream or by direct effects on the respiratory centre and of which you will find the list in Groups II and I V in the same page. — N .C .F .

C o n c u s s io n

S hock.

H.B. (Portsmouth).— ( 1) Does a knock-out blow on the chin cause, in a healthy boxer, concussion or shock ? Also (2) what is the essential difference indicated by these two distinct terms ? Your kind replies will be appreciated by myself who, a recent reader of F i r s t A i d , is greatly interested and enlightened by your answers to queries. ( 1 ) A knock-out blow on the chin results in a violent shake-up of the brain and causes what is termed concussion. ( 2 ) The essential difference between concussion and shock is that with the former there is either a history or evidence of some violence to the head which has caused a shake-up of the brain.— N .C .F .

B it e .

D .S . (London).— My second difficulty has reference to the treatment of snake bite. Supposing that an adder bites a patient’s finger would a first aider really have to ligature the arm tig h tly? Is not the old method of encouraging bleeding satisfactory ? 1 fancy that this paragraph was written for cases of bites by more venomous snakes in other parts of the world and, for my part, I should be loth to let a first aider practise so vigorously on me were I the patient. Am I wrong in that ? Meanwhile many thanks for all your help.

A s p h y x ia

AID

C au ses.

H.A. (Marylebone). — D urin g a discussion at our First Aid Post one of our members asked what was indirect asphyxia. Various suggestions were made by the rest of us but these were not satisfactory to the majority. So we ask if you will be kind enough to explain what the term signifies.

P in

T ongue

D u r in g

I n s e n s ib il it y .

M.C. (Potters Bar).— Y o u r reply to query published under the above heading in the June issue of F i r s t A i d still leaves me in doubt as to what should be done in the event of an unconscious patient with a broken neck. The head cannot be turned to one side. T o chase this controversy to a finish, I ask what must be done to an unconscious patient to prevent the air passages being obstructed, An A .R .P . Medical Officer under an order dated February 9 ch, 1940 , lays down the following procedure in this connection :— “ On no account turn neck. If tongue cannot be held forward with the fingers transfix tip of tongue with small sharp safety pin, and attach latter to top button of patient’s waistcoat.” Now what have you to say to bring this subject to a final conclusion. If you disagree, please say what should be done in such circumstances. T h a n k you. I have nothing to add to what was stated in the June issue of F i r s t A i d , except that, as a first aider, you must always carry out the instructions of the Medical Officer under whom you are w o rk in g.— N .C .F .

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44FIRST AID” QUERY and REPLIES COUPON. T o b e c u t o u t a n d e n c l o s e d w it h a l l Q u e r i e s .

Sept., 1940 .

FIRST

AID

oqSf u l R E V I V A L D E P E N D S SucC ON P R O M P T A C T IO N

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A I D

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SKELETO N S

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W r it e fo r leaflet “ P rom p t First-Aid T re a tm e n t of A sp h yx ia and o th e r R esp irato ry Failure E m erg en cies.” S ole M a k e rs : S P A R K L E T S L T D ., D e p t. 42 , E D M O N T O N , L O N D O N , N .I8

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T H E ST. JOHN A M B U LA N C E ASSOCIATION, I T S H I S T O R Y , A N D I T S P A R T IN T H E AMBULANCE MOVEMENT,

O I N T M E N T (1/3 & 3/-)

Of all Chemlsta throughout the British Empire. Sole Distributors:—

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TH E

N E W E D IT IO N — Revised in A ccordance w ith the 1938 S. J. A . Handbook.

CORBET

FLETCHER,

M. A. , M . B

M. R. C. S .

“ As a w ork of reference, the book w ill be extremely useful and should be in the lib rary of all ambulance w orkers.” — F ir s t A id . P r i c e , 3 /6 ; p o s t f r e e , 4 /-.

Manufacturing Chemists,

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A M BU LAN CE

A S S O C IA T IO N ,

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F IR S T

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By D ivision al S u p e rintendent S. Burnley, M.P.S. Th is little b o o k w ith q u estio n s and an sw ers is an e x c e lle n t m ethod o f en su rin g that yo u rea lly k n o w h ow to deal w ith th e g ra ve da n g er o f poison gases. W ith F o rew o rd by M ajor G en era l Sir John D u n can , C h ie f C o m m issio n e r S t. John A m bu lan ce B rigade. Price 6 d . Postage 2 d.

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IN C U R V E D E D G E O F SO CKET S . 1343 “ S A N O ID ” IN T E R L O C K IN G E X T E N S IO N SPLINTS W ith M etal s o c k ets fo r jo in tin g . 2 p ieces : 2 5/8 th s. in. x 3/ l 6 ths. in. x 15 in. 2 p ieces : 2 5/8 th s. in. x 3 / l 6 th s. in. x 13 A in. I p iece : 2 5/Sths. in x 3 /I6ths. in. x in. I p iece : 2 5 /8 th s. in. x 3/ l 6 ths. in. x 6 in. 2 W e b b in g Strap s w ith m etal buck les : 18 in. x I in. 2 W e b b in g Strap s w ith m etal buck les : 27 in. x IJ in. 3 s o c k ets. By th is in ven tio n Splints m ade in any c o n v e n ie n t len gth s m ake A rigid con n ectio n s by m eans o f in cu rved o p p o site ed g es o f th e m etal so c k e ts o r sleev es firm ly en gagin g w ith tra n sv erse g ro o v e s in the surfaces o f th e S p lin ts w h en pressed hom e in to t h e s o c k e t. U n like the o rd in a ry s o c k e tte d S p lin t, th is ty p e is rig id ly cou pled to g e th e r and held again st rela tiv e d isp la cem en t b u t can be disen gaged by pullin g ap a rt w ith sufficien t fo rce. N .B .— T o en su re p e rfe c t lo ck in g it is im p era tive th a t th e S p lin t should be c o rre c tly in serted in th e s o c k e t, i.e., BY M A K IN G C E R T A IN T H A T TH E IN C U R V E D EDGE O F M ETA L S O C K E T E N G A G E S W IT H THE T R A N S V E R S E G R O O V E O F THE SPLIN T. P rice : C o m p le te w ith tw o pairs o f strap s - - 4 / - p e r se t. W ith o u t strap s - - - - - 3 /- p e r set.

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For households of moderate means, the inexpensive bottle of Iodine, obtainable for a few pence from any chemist, is a sound recommendation for first aid appli cation in minor injuries. W rite fo r Free Em ergency Chart

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T h e ch ief featu re o f this ed itio n is th e m uch fu ller acco u n t given o f Gas Poisoning in W a rfa re . FIRST AID JOUR.— “ One o f the most concise works on the subject published at a popular price.”

JO H N

W R IG H T & B R IS T O L

SO NS I

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F IR S T A ID ilntapenAenf Journal jor the A m bulance ati6 3ftursincj ^ e n ricc s Editor :

N o . 5 5 6 .— V o l . X L V I L

N O T IC E

GEORGE

O CTO BER,

CRAFT

1940.

[ s ^ Z '^ L t A

A ll R eports, & c ., should be addressed to the E d itor at the address b elow , and should reach him before the 12th o f each m onth, and m ust be accom panied ( not necessarily for publication) by the nam e and address o f the Correspondent. Su bscription s, A d vertisem en ts and other business Com m un ication s connected w ith F I R S T A I D should be forwarded to the Publishers.

annon

t d

The

D A L E , R E Y N O L D S & C o ., L

w . p™ Ca U m H“

E D IT O R IA L

READERS.

F I R S T AID is published on the 20th of each month. A n n u al Subscription is 4s. post free ; sin gle copies 3d.

46, C

F i r s t A id in S c h o o l s .

m em orandum

issued

last

month by the Board of Education states that, in view of the greater intensity of air attack,

local authorities should consider how far they can provide for the teaching of some simple first aid measures to older boys and girls where it is not already given as suggested in the Board’s pamphlet on “ Health Education.”

S t r e e t , L o n d o n , E .C .4 .

The outbreak of hostilities has been respon

Telegraphic Address— " Twentv-four , London.’ ’ Teltphone— City 3 7 to.

sible for many things ; and we welcome this new instruction.

CON TEN TS

THIS

For

NUMBER.

many

years we have

urged

that

this

subject should be added to the curriculum of all senior scholars at all schools.

E d i t o r i a l :—

First Aid in Schools

...

A .R .P . First Aid Services ... ... The St. John Ambulance Association ... S.J.A B. Headquarters and District Reports Aspirin as a Poison ... ... ... London, Midland and Scottish Railway ... T he Meaning of Words ... ... Silvester’s Method of Artificial Respiration T he Duties of Ambulance Attendants ... T he Meaning of Words ... ... Poisons ... ... ... ... The Treatment of Wound Shock ... A .R .P . Topics ... ... ... Our Nurses’ P age ... ... ... Field Dressings ... ... ... M arking Sheet ... ... ... T he Spinal Column ... ... . . T he Nervous System ... ... ...

... ... ... ... ... ... ... ... ...

62 62 63 64 64 64 65

Q u e r ie s

an d

A n sw er s

...

66 67 67 69 69

is found in the existence of a curriculum of first aid training for scouts, guides and others, as well as in the. advent of cadet companies of the St. John Ambulance Brigade.” To-daythe modern boyand girl find themselves in a fuller and

more complex world

than

did

their parents, and if they are to be adequately prepared to meet the risks of to-day

they will

...

require different training to that received by the

ti ••• ... ...

child of yesterday.

72 74

W e do not for one

moment suggest a full

course of first aid is suitable

desirable, but

a little elementary instruction may prove a valu

C o r r e s p o n d e n t s :—

T h a n k s to the Editor ... ... T ) i n g of Loop Bandage ... ... Examination Howler ... ... Meddlesome First Aid ... ... Artificial Respiration with Crushed Chest Application of Thom as Sling ... Artificial Respiration with Fractured Ribs Treatment of Fractured Elbow Joint... Treatment of Fractured Metacarpus ... Treatment of Ant Sting ... ... Humour in First Aid ... ... Simple Fractures of Both Clavicles ...

In 1928 we wrote :

“ That there is some appreciation of their need

... ... ... ... ... ... ... ... ... ... ... ...

76 76 76 76 76 78 78 78 78 78 78

able

asset.

Such

instruction should

consist

mainly of “ do’s ” and “ don’ts ” ; and we would suggest that the syllabus given to St. John and British Red Cross Cadets would he ideal. A little knowledge may be a dangerous thing, but such knowledge may also be the means of saving

life in

an emergency.

Therefore,

training of boys and girls at school

this

should

looked upon as an urgent matter, and instructions should be given nomy without waste of time.

FIRST

A.R.P. First Aid Services. B y

O ur

S p e c ia l

C orrespondent.

O n e of the essential principles of first aid is that the patient should be removed from any active source of danger or vice versa. This prompts me to pay a few words of tribute to the w ork of the R.S . D. squads whose initial function is to fulfil this primary duty by rescuing and removing patients trapped by debris and fallen masonry. I have worked alongside these men for the last six weeks, and I am amazed not only at their courage and stamina, but also their gentle ness and skill in the handling of casualties and the rendering of immediate first aid under difficult conditions. The majority of the R.S. D. have received but little (if any) instruction in first aid, but they overcome this by working with a considerable amount of plain common garden sense. This Journal has always deplored the rigid stereotyped methods of teaching first aid either by means of copious memories, or dogmatic recitation of a chapter of the text book, both of which tend to lead to the “ one c h ap ter” or even “ one p a g e ” mind and relieve the student of all initiative. I remember that my colleage, Dr. White Knox, pointed out in these pages some little while a go that in his opinion adequate first aid could be taught in four hours, providing the knowledge gained was reasonably applied. The R. S. D.-squads have conclusively proved his theory to be right, and I suggest that the word “ Reasoning,” which so often appears in the caption of his articles might well be now recognised as one of the basic slogans of first aid. T he experiences of the last few weeks have enabled us to compile statistics which reveal rather interesting facts about the nature and disposal of air raid casualties. It would appear that while the hospitals are hard worked, the first aid posts, and even the mobile hospital units are handling far fewer casualties than might be expected. Some of the fixed first aid posts have scarcely handled a genuine war casualty, and I have reason to believe that the matter is causing some concern to the responsible authorities. It would also appear that all casualties automatically fall into one of two groups— either they are severely injured, or else are so very slightly harmed as to hardly need any attention— in other words, w alk ing casualties are few and far between. I was extremely interested to see this fact confirmed by a doctor writing in a lay paper a week or so ago, but I would point out that appearances are deceptive. It is the con sidered opinion of my colleague (who is jointly responsible with me for the activities of our two local mobile hospital units) and myself, that if casualties were to be sorted properly, actually at the site of the incident, all the medical services would receive their fair and full quota of work and and a proper balance be maintained. At the moment, the stretcher parties control the disposal of casualties unless a whole hospital unit is sent for, and in the vast majority of cases most of the casualties have been sent to hospital before the arrival of the doctor. While I have every admiration for the zeal and courage of the stretcher parties, I have for months warned the authorities that their general standard of efficiency was decreasing. Speedy and spectacular first aid is not necessarily good first aid, and hasty removal may a g g ra va te shock in certain cases. It is becoming apparent that the first aid services need their own “ medical incident officer” at each incident when casualties are suspected. The doctor so chosen would then supervise the disposal and treatment of each casualty, stating whether the patient should proceed to hospital, first aid post or home. He would render immediate “ medical first a id ,” such as the administration of morphia, etc., and finally should the incident warrant it, order out the mobile hospital unit, in the meantime m a kin g provision for its

AID suitable accommodation. On the arrival of the mobile hospital unit the M.O. in charge would automatically take medical control of the incident, the “ medical incident officer ” would then be free either to render extra assistance, if necessary, or return to the station so as to be available for a possible further incident. I suggest that this scheme is the only true way of co ordinating the A. R. P. first aid services. A similar scheme has been tried out in my particular borough with the greatest success.

St. John Ambulance Association. As the outcome of a report made by Sir Joseph Byrne (Director of Ambulance) to Chapter-General, a Committee was set up in July last to examine the question of more effective liaison between Headquarters and those engaged in instructional work in the Counties. The Committee, which consisted of Sir Joseph (Chair man), Mrs. St. John Atkinson (Lady Supt.-in-Chief), Major P. G. Darvil-Smith (Brigade Secretary), and Captain W. Goodley (Commissioner No. 1 District), made certain recommendations which have been accepted by Chapter. These recommendations are based on the understanding that they deal only with the war situation and not with any per manent alteration of the existing system, and that the Com mittee were concerned solely with the instructional work (teaching and examinations) of the Association. It is hoped that the other useful w ork performed by the Centres (medical comforts, etc.) will not in any way be effected by the recommendations, which, for the present, will be con fined to England. One of the main causes of complaints investigated was the absence of a single clearly defined authority in each county available to answer enquiries regarding formation and financing of classes. T he Committee, taking into account the fact that the St. John Ambulance Brigade has recently been organised on a County basis, therefore s u g gested a representative termed the “ Association County Secretary ” be attached to the staff of the County Commis sioner, Thus not only would the main object be attained but also a closer union between the Association and the Brigade. It is realised that this proposal may not be suitable for the closely populated Cities and Boroughs in which Centres already operate. Therefore, the Committee recommended that certain Centres should continue to function as before. T o sum up, the Committee recommended :— ( 1) that certain selected Centres continue to func tion as before ; (2) that outside such Centres Detached Classes should be the rule, and the regulations governing these classes should not at present be varied ; and (3 ) that an “ Association County S e c re ta ry ” should be attached for special duty to the staff of the Brigade Commissioner of a County— his office would in fact be in the nature of an information bureau. Should the scheme prove practicable, the Committee further su ggest that the question of the Association repre sentative nominating the Examiners from the general panel be investigated. As seated above, the recommendations have been accepted, and Sir Joseph Byrne has sent a letter to each County Commissioner a skin g him to submit names of those willing to undertake the position. On receipt of such information, it will be possible to get the scheme into w ork ing order.

FIRST

S t . J o h n A m b u la n c e B r ig a d e HEADQUARTERS

AND

DISTR IC T R EPO R TS.

N o. I (Prince o f Wales's) District W e are advised that the address of District Head quarters is now 12, Northwood Way, Northwood, Middlesex, where all communications should be sent.

W e much regret to announce the death of District Staff Officer William Arther Roust, due to enemy action, which occurred on September 26 th. Although aware of the danger from a bomb, he con tinued to give first aid to casualties trapped in a basement. Water poured into the shelter, rescue work was organised, and then the presence of a bomb was reported. There was only the faintest chance of saving the trapped victims, but Mr. Rouse took that chance. He was still there when a bomb exploded, and his injuries necessitated removal to St. George’s Hospital, where he passed away. “ Rousty,” as he was affectionately known, died the death of a hero— in a manner he would have wished— attending the wounded. His life was devoted to the first aid movement, and members of No. 1 District will ever remem ber his work in the Brigade. District Staff Officer Roust enrolled in the Brigade on September 7 th, 1909 , in the 70 (Hampstead) Division, and was later transferred to the 86 (Horseferry) Division. In 1933 he was appointed to Headquarters Staff. He was the proud possessor of the Service Medal and three bars, and as recent as this year he was honoured by T he Order of St. John by being promoted to Officer. In June, 1939 , he was appointed whole-time officer for the recruitment and training of stretcher parties in an im portant London Council and on the outbreak of war he took command of these parties. For the past few weeks his stretcher parties were much in evidence, and wherever they were there was their leader, advising and encouraging them. By day and by night he laboured with unflagging zeal at the work he loved and to which in the end he gave his life. T he funeral took place on October 2 nd at the Putney Vale Cemetery, and a large crowd watched the departure of the cortege. A G u ard of Honourwas formed by CommissionerCapt. W. Goodley, Asst. Commissioners S. J. Warren, and Capt. A. C. White Knox, District Staff Officers Burton, Green and Kemp, also District Officers Claridge, Haynes and Rushmere. The pall bearers were four members of the stretcher party. In addition to floral tributes from the family, there were many tokens from those associated with Mr. Roust’s activities, including No. 1 (Prince of W ales’s) District, the Hospitallers’ Club, the Sth West Middlesex Batn. Boys’ Brigade, and many others.

63 T h e ambulance will Command.

attached

the

Aldershot

N o . IV District Presentations of Service Medals and Certificates were made to members of the Lytham St. Annes Division, on September 16 tb. T he presentations were made by Dr. W. H. Carse to exSupt. G. Ralphs, Supt. A. S. Hall, Sergt. A. Hill, Corpl. T. Cartmell and Corpl. A. Grundy. Dr. Carse said it was fine to think that the recipients had the same spirit of service to the community as was instituted over 800 years a go by the Brotherhood of St. John of Jerusalem. Div. Surgeon Laurie Smith, who presided, expressed appreciation of the splendid w ork done in the division. Any thing he had asked for received whole-hearted support. Asst. Commissioner W. H. Gastall spoke of the readiness to serve, and stated than in an air raid alarm in the north west. 100 per cent, of the men turned up.

W e were pleased to learn that Col. C. J. Trimble (Inspecting Officer for No. 4 District) is still as active as ever and that the member of his A .R .P . first aid section are all volunteers. W e send our best greetings to the “ Grand Old Man of First Aid,” who is the best known first aider in Lancashire and perhaps throughout the country.

N o . VI District W h i t b y . — Four men of the Whitby Division were awarded Service Medals at a meeting of the Division held on Sept. 30 th. T he presentations were made by Div. Surgeon R. N. P. Wilson, the recipients being Sergt. H. N. Frater, Privates C. F. Tindale, J. W. Waters and Rowland Hill. Supt. W. R. K n a g g s, who presided, stated that County Commissioner F. P. Wilson, in forwarding the medals, expressed his congratulations, not only to the men, but also to the division. He hoped the men’s service was not ended yet and that they would go on with their work for humanity, and set an example to the young men who were coming on. Dr. Wilson said that since Whitby obtained their present headquarters, they had gone ahead considerably. They had done good service in dealing with casual accidents, and their w ork was recognised by the doctors in the neighbourhood. The work of the Division had enabled the A .R .P . service to show a measure of efficiency they could not have shown otherwise. It was not a question of individual effort ; it was the result of co-operative or team training, which had been inculcated by the organisation, no man wishing for personal kudos or reward.

N o . X District N o . II District On Thursday afternoon, Sept. Sth, Lady Louis Mountbatten, Hampshire County President of the St. John Ambu lance Brigade, presented a fully equipped ambulance to the Red Cross and St. John W a r Organisation on behalf of the Hampshire Brigade at Grosvenor-crescent, London. The D ow ager Lady Swaythling warm ly accepted the gift on behalf of the joint organisation ; and Major Tennyson Smith, the County Commissioner for Hampshire, added the grateful thanks of the Brigade for Lady Louis’ generosity.

K i n g ’ s L y n n . — Speaking at a whist drive and bridge drive, held on September 27 th, in aid of the newly-formed K i n g ’s Lynn Corps, Mrs. Donald F. Jackson gave particulars of the w ork of the Corps and the obligations of each member. T hey were pleased to have the support of the Mayor and Mayoress ; Lady Fermoy had consented to become Corps President. Mrs. Jackson, herself, and Mrs. S. T. Parker had been nominated Corps Officers. T he mobile canteen would be part of the w ork undertaken by this Corps, which it was proposed to call the W est Norfolk and K i n g ’s Lynn Corps of Nursing Divisions. T he inobile canteen would be in charge of Mrs. S. T. Parker.

FIRST

AID

Mrs. Jackson mentioned tliat they now had in hand

.£.125 towards the purchase of a mobile canteen, which would cost ,6 1 5 0 and another £ j 50 to equip and put on the road. They had bought the canteen and it would be staffed by their members, assisted by members of the Red Cross Society. It would operate within a 20 miles radius of Lynn. T h e Mayoress distributed the prizes at the drive and Mrs. Jackson afterwards thanked many helpers. Eire District. Commissioner Sir John Lumsden, at the formal opening of an exhibition of Chinese o ljetsd ' A r t, in aid of the Brigade and Irish Red Cross, held at Clerys, O'Connell-street, Dublin, said : “ W e have some little idea what is happening in England, and there is no doubt that A .R .P . workers there have been showing the utmost gallantry. If anything similar should occur here, even on a smaller scale, as it would be, I have no doubt that the members of the St. John Ambulance Brigade would play their part in the same w a y .” The collection was lent by Mr. James Cormack, Canadian Trade Commissioner in Dublin. Lady Carew, who performed the opening ceremony, mentioned the work being done by the Welfare Department of the Brigade. Its three dining-rooms, she said, provided meals for over 300 expectant mothers, who were also given clothes for themselves and their children.

Aspirin as a Poison. T h e latest report of the Registrar-General gives the number of deaths due to poisons in England and Wales in 1938 as 735 , about the same as in the year before. Of these, 591 are classified as suicide and 92 as accident, the remainder being doubtful. A fact clearly revealed by the report is that these deaths are mostly caused by readily accessible poisons— there is little evidence of ingenuity. In no less than 43 suicides— 25 women and 18 men— the drug used was aspirin. Aspirin was also the cause of 8 accidental deaths and of 14 of the un classified ones, so that altogether it was responsible for 65 in the year. This was twice the number recorded in 1936 , though only 4 more than in 1937 .

If the rise can be taken as reflecting the growth of the aspirin habit it is perhaps fair to assume that the consump tion of the drug is now reaching saturation point. H o w ever that may be, it is a curious position when a drug that is chosen by 43 people in a year for the definite purpose of m a kin g aw ay with themselves and is blamed by coroners’ juries for the deaths of 22 others is not a poison in the eyes of the law. If it were, some of the suicides who used it might have had enough difficulties put in their way to make them think again. On the other hand, it would need a brave legislator now to m ake aspirin purchasable on prescription only. Despite every effort to ensure punctuality, F IR S T A ID , in com m on w ith other periodicals, has been delayed ow in g to unforseen circumstances. F IR S T A ID regrets any inconvenience which m ay be caused to readers, and assures them that every effort is being m ade to avoid it. Readers are asked to co-operate with the P u b lishers either by placing a standing order w ith their newsagents or forwarding 4s. to cover cost o f 12 m onthly issues.

London, Midland & S cottish Railway. T he 15 th annual report of the L .M .S . Ambulance Centre in England and Wales has been recently issued. Awards : During the 12 months ended June 30 th, 1940 , 8,846 awards were gained, a decrease of 548 on the previous year. This figure is considered satisfactory, bearing in mind the conditions prevailing. Meritorious First Aid Certificates have been awarded to F. Askew, Signalman, Keswick ; A. Coleman, Examiner, C. & W. Kettering ; J. W. Fairy, Guard, Chesterfield ; G. E. Gornall, Porter, Heysham ; for exceptional first aid rendered. Since the formation of the Centre, 3,662 L o n g Service Medals have been awarded, in addition to 910 to members in Scotland. Bars have been awarded as follows : 20 years, 1,628 ; 25 years, 806 ; 30 years, 336 ; 35 years, 98 ; 40 years, 14. Honours : During the past 12 months, the services rendered to the Centre by 22 members, were recognised by the Order of St. John. Reference is made in the report to the passing of Dr. A. T. Lakin of Manchester, whose death occurred last November. Mr. Gilbert S. Hill, General Ambulance Secretary, again pays tribute to the invaluable help rendered by members of the Medical Profession, district secretaries and committees, class secretaries and instructors and Welfare Supervisors. The generous assistance provided by fhe Company is acknowledged ; also to officials of the St. John Ambulance Association and the Priory for Wales.

The annual report for Scotland for the 12 months ended March 31 st, 1940 , shows that 2,374 personnel received awards last year. This is an increase of nearly 200 over the previous twelve months. Fifty lecture classes were held under the auspices of the St. Andrew’s Ambulance Associa tion, and although no new sections were formed, the 81 existing sections have functioned in their respective districts. Awards : The total number of L o n g Service Medals and Bars awarded members in Scotland, now total 910 medals and 1,146 bars, which include 20 for 40 years’ service and 3 for 45 years. Twenty-eight members of the L .M .S . Railway Brigade were awarded the Voluntary Service Medal in recognition of 15 years’ efficiency service in the St. Andrew’s Ambulance Corps.

R o c h d a l e . — Mr. T. A. Jackson, goods agent, presided at a presentation of awards which took place on September 29 th. Mr. T. Suffell, station master, Rochdale, presented the awards which included vouchers, medallions and labels, also a gold medal for 18 years’ service awarded to Mr. A. Dyson Votes of thanks were extended to Mr. Suffell and Mr. Jackson.

The Meaning of Words. M a n y words are used by lecturers with which the average first aider is not fully acquainted. Therefore, we will give each month a list of selected words, the definitions of which will be found on another page. Antidote, Insidious, Periosteum, Retching, H a m o globin, Erythema. See page 67 for definitions.

AID

Silvester’s Method of Artificial Respiration. A c o r r e s p o n d e n t from Sale, Cheshire, has sent me a letter containing some very pertinent queries with reference to Silvester’s Method as the result of the article which was published on this subject in the July issue of F i r s t A i d . It is noteworthy that no reader has previously put these points before me ; and so, perhaps, a brief article is a better vehicle than the Query Column for conveying my replies and explanations. Here are his queries :— ( 1) To “ induce expiration ” (Textbook p. 151 ) it is assumed that the upper limbs, after being extended, are brought forwards, downwards and inwards and thus made to complete movement. T he article, however, in the July issue tells us to “ return the forearms by an identical path ” — that is, by the reverse of a half-circular movement. Which is the method to be definitely adopted, please ? (2 ) In Figs. 77 and 78 of the Textb ook the operator appears to change the position of his knees from “ a con venient distance behind the patient’s head ” to one close up to the patient’s head. Is this change of position intended, please ? (3 ) T he article also tells us to “ place a pad three inches thick (say of folded clothing) under the shoulder blades.” Have you any suggestions as to pad of clothing, please ? Unfortunately, with Silvester’s method (which dates back to 1857 ) there is no standard by which we may decide what is right or wrong according to the views of the originator ! Further, in the several later issues of Shepherd’s and the early editions of Cantlie’s Textb ook the description of the method was never exactly the same ! All authorities, however, agree that the main object of the method is to cause as complete an expansion of the patient’s chest as is possible, in imitation of inspiration, wherein lies its difference from Schafer’s method. Even the originator’s name has been (and still is) very frequently misspelt “ Sylvester.” This was the case in the several issues and editions of the Textb ook after the issue which for the first time gave a description of the method and credited it to Henry Robert Silvester ; and the error in the spelling of the name was only corrected in the 11 th ( 1908 ) Edition of the Textbook. In these circumstances every one carries out the move ments in accordance with his own views and teaching ; and on this account I rarely use it as a test in examinations for certificates and other awards of the St. John Ambulance Association. T he two most common methods which I have seen performed are :— (a) A complete circular movement o f the patient's elbows. This usually results in little or no traction on the patient’s upper limbs and consequently in little or no enlargement of his chest especially when, as often happens, its exponents make no attempt to bring the elbows to the ground, for which reasons this method stands condemned ; and (b) A half-circular movement to and fro of the patient's elbows (that is, a movement through a path at 45 degrees to the ground). Incidentally, this has been declared by a member of the Revision Committee to be the correct inter pretation of the instructions in the current edition of the Textb ook and is described in the article named as the one now recommended by the Royal Life Saving Society. On the other hand, the method which I was taught and have alw ays used in actual practice (before and after the introduction of Schafer’s method) dispenses with the assistant

who holds the patient’s tongue forward. This precaution, in my experience, is quite unnecessary if the patient’s head is turned to one side as is advised by the Textb ook in the treatment of all cases of insensibility. Keeping the patient’s forearms throughout at right angles to his arms (with my fingers outside and my thumbs inside) I grasp the forearms just below the elbows and carry them upward, outward and toward me in a half-circular movement until I press the elbows firmly on the ground above the patient’s head. By this means the chest is as fully expended as is possible ; and the conscious “ patient” feels the strain so severely that, to lessen it, he usually raises himself slightly on his heels. This done, I return the fore arms through the same half-circular path and finally press the elbows firmly on the chest wall. On the other hand, if with the patient’s forearms acutely flexed on his arms and placed parallel with each other on either side of the sternum, I grasp his forearms with my fingers outside his forearms and my thumbs inside that is, between forearms and arms, (as in Fig. 78 of the Textbook), I find that, when I bring the patient’s elbows to the ground above his head, the resulting expansion of his chest is about one-half of that produced by the method which I use. In this connection it is interesting to note that the instructions published in the 1885 issue of the Shepherd’s Textb ook read— “ D ra w the arms gently and steadily upwards above the head and keep them stretched (these words italicised) upwards for two seconds ” ; and that no mention is made of the elbows being made to touch the ground, although, in my opinion, this is a most essential part of Silvester’s method. Incidentally, the original instructions read “ Stand behind patient.” (2 ) No one has ever suggested that the operator should change the position of his knees during the movements. Indeed such change would interfere considerably with the efficient performance of the movements. I suspect, there fore, that the apparent change of position in Figs. 77 and 78 of the Textbook is a photographic illusion, such as occurs in Figs. 74 , 75 and 76 , in each of which the position of the operators’ thumbs, though identical, appears to be different. (3 ) When I demonstrate Silvester’s method, I always remove my (lounge) coat, fold it in tailor fashion and then double it on itself. This provides me with a pad some three inches thick which in normal circumstances is likely to be immediately available.— N .C .F .

Mrs. Woodherd, wife of Mr. Arthur Woodhead, of Rossett Green, Harrogate, has presented a new ambulance to the Harrogate Ambulance and Nursing Divisions, S .J.A.B . Mr. Woodhead is President of the Harrogate Boys’ Club. Mr. and Mrs. Harold Warner, of New Y o rk , have presented to the Red Cross Society, for use in Liverpool, a 35 h.p. motor ambulance. Mr. Warner was, until 1926 , head of the Liverpool and London and Globe Insurance C o .’s Liverpool office, and since then has been head of the concern in America. For the second year in succession the Wheldale Colliery team won the “ Harald P e a k e ” Cup at the Airedale Col lieries, Ltd., ambulance competition, held at Allerton Bywater, Castleford, last month. T h e tests related to air raid casualties, and the prizes were presented by Mr. Percy Greaves, deputy-chairman of the Company.

FIRST

The Duties of Ambulance Attendants. By

IR VIN E,

M.D.

M edical Officer o f Health, Shipley, Yorks.

G eneral

D o t ie s .

ambulance attendant is responsible for the care of the patients put into her ambulance until they arrive at the hospital or post and are handed over to the authorities there. In those areas in which the casualty hospital is some considerable distance from the scene of the incident this responsibility is no light one, for she is alone with the patients and cannot, or at least should not, ask for outside help, except in grave emergency, once the patients are on the w ay to hospital. These notes are intended for such workers. Her work is rather different from (perhaps a cross between) that of a first aider and that of the auxiliary nurs ing personnel at the post or hospital. The preliminary duties of an ambulance attendant include the preparation of blankets on the stretchers and of hot bottles and drinks if available. On arrival at the incident she should stay with the ambulance and await the arrival of her patients. The majority of stretcher cases will go straight to hospital, but in certain circumstances some may be referred to the post. T h e attendant has no responsibility with regard to the allocation of the cases. That is a matter for the first aid party leader, or a doctor if at the scene of the incident, but she must ascertain briefly from the party leader, or men, what injuries the patients have suffered, and she should herself know what complications may be encountered during the journey. Before the ambulance leaves the incident, the attendant should check the safety straps on the stretchers in their fitments. It would be a valuable help to the hospital or post personnel if the ambulance attendant were to make a brief note in respect of each patient, stating the name and address (if known) and the nature of the injury, and attach this note to the patient. There is no doubt that there will not be much time for the party men to do this. A calm, confident and sympathetic manner, combined with the necessary knowledge and skill, both at the time of reception and on the journey, will help many a patient through a difficult time. Gentleness is a prime necessity of any good nurse or attendant, and gentle handling of the patient greatly reduces the risk of shock. Clumsiness, e.g., knocking into stretchers, causes much unnecessary suffering. Again, keeping the patient warm and comfortable and reassured is more than half the battle in the ambulance journey. Most stretcher cases are, of course, kept flat, but many patients are more comfortable with the head and shoulders slightly raised on a pillow, and some, e.g., jaw fracture cases, need special attention. Drinks are generally useful, given in small quantities as required— they should never be given to unconscious persons, nor to those with internal injuries, though in this case the mouth should be kept moistened. It is alw ays comforting to patients to be talked to, neither gloomily nor foolishly cheerfully, nor yet too frequently. D urin g the journey, without fuss or excitement, the attendant should quietly but constantly watch the colour of the patients : this is not easy with poor lighting, and m ake up and lipstick may add to the difficulties ; the attendant should be careful not to shine a light direct into a patient’s eyes. From time to time, but not too frequently, she should eel the pulse ; a good steady pulse, or an improving pulse, An

AID is an indication that things are going well ; the converse is also generally true. She should take notice of any com plaints of feeling cold, severe pain, nausea, faintness, and watch in the appropriate cases for the occurence of haemor rhage. Oozing of blood through a dressing is not un common, and all that is usually necessary is the application of a further pad of wool and a bandage. Severe haemor rhage is not very likely to be missed. As a general rule, it is inadvisable in an ambulance to interfere with splinting or tourniquets. Unconscious patients require special attention lest a return to consciousness may he accompanied by un expected movement by the patient, with unfortunate results. When dealing with casualties contaminated by gas, the attendant must, of course, take adequate steps for her own protection : she should persuade cases of lung irritant poisoning to lie perfectly still, and at the hospital or post give such information as is available regarding the nature of the g a s used and the duration of exposure, etc. As a rule the removal of outer clothing contaminated by persistent gas will have been effected before admission to the ambulance, but the removal of inner clothing in these cases may' be possible in the ambulance itself. The main duties of an ambulance attendant then become :—

1. Prepare blankets for the stretchers, hot bottles, etc. 2 . Receive the patient, ascertain the injuries sustained and any particular directions of the party leader ; also its disposal (hospital, post); (these instructions and observations should be received out of hearing of the patient) ; check safety straps on the stretchers.

3 . Reassure the patient, give drinks where not contra indicated, keep the patient warm, watch the colour and pulse ; w'atch for complications including haemorrhage, shock, vomiting, suffocation by tongue slipping back, and apply the appropriate remedies. 4. Deliver the patient into the care of the hospital or post staff, and give such information as is available about the patient’s injuries and any complications that have been noted. S p e c ia l

D u t ie s

D e a l in g

w it h

C o m p l ic a t io n s .

The ambulance attendant should have some knowledge of the complications which may occur in wounded persons during transport ; naturally the longer the journey the greater is the risk. In any case, she must be prepared for them and able to deal with them. Important complications include :— Shock may present itself markedly in an ambulance, though it is more likely to be passing off as a result of pre viously applied remedial measures. In cases long exposed, or rescued a considerable time after the injury, secondary shock may manifest itself ; the treatment is warmth, re assurance and warm drinks if not otherwise contra-indicated. Vomiting may occur, especially in patients recovering consciousness after severe shock or head injury, or in patients who have swallowed blood. It is important to help by inclining the patient to one side, or lowering the head, par ticularly in unconscious persons, who may inspire vomited material and even suffocate. It may be necessary to remove vomited material from the throat by hand as an urgent first aid measure. Cases of fractured jaw need special care as the bandages obviously prevent the ejection of the vomited material. T he bandages must be loosened and the jaw gently supported. Hcemorrhage due to the slipping of a tourniquet is very unlikely ; re-application or tightening, as the case may be, is the treatment. A tourniquet is very rarely needed, and should only be applied when the bleeding is very excessive and local pressure by pad and bandage does not control it. Reactionary haemorrhage : haemorrhage occurring as a

FIRST result of improvement in the general condition, which, by raising the blood pressure, causes bleeding from vessels not occluded by clots, etc. T he treatment is that for ordinary haemorrhage— pad and bandage, etc. Suffocation by the tongue falling back in unconscious per sons or in persons with jaw injuries should be readily spotted. Pulling the ja w forward by finger pressure applied behind the angle of the jaw, in the one case, and releasing the first aid bandages and giving support, and ii possible, lowering the head in the other, will be effective. Gentle pulling for ward of the tongue itself may be necessary. Injury in the ambulance itself (under war conditions) cannot be ruled out and the treatment depends on the injury. The speed at which an ambulance is driven has a consider able effect on the patients’ comfort and consequently on their general condition. If an attendant should find a speed too great for the safety of the patients (though ambulance drivers in general, are instructed to take care in this matter) she should instruct him to proceed more slowly. Cerebral irritation which occurs as a complication of severe concussion and brain injuries may be encountered ; it will be appreciated that some patients may have been injured many hours before rescue is effected. In this condition the patient is irritable, excitable and very restless. All that the attendant can do is to endeavour to restrain the patient, and if necessary, call for help from the driver. She should appreciate the possibility of its occurrence so as to make no mistake in recognising it. Hysteria too, may be manifested in the ambulance, but on the whole, it is unlikely. A firm, though fundamentally, sympathetic attitude is necessary.

The Meaning of Words. T

fo llo w in g d efin ition s of th e

w ords

g iv e n

are

ta k en , by

kind permission, from Bailliere’s Nurses’ Complete Dictionary, the cost of which is 3/2d., post free. Antidote (an'-te-dote).— An agent which counteracts the effect of a poison. Thus alkalies neutralize the effects of acids. Insidious (in-sid'-e-us-).— Approaching by stealth. A term applied to any disease which comes on imperceptibly. Periosteum (per-e-os'-te-um).— The fibrous membrane cover ing the surface of bone. It consists of two layers, the inner, or osteogenetic, which is closely adherent to the bone and which forms new cells, by which it grows in ' girth ; and the outer fibrous layer, which gives the smooth surface. Retching (ret'-ching).— An involuntary and ineffectual spas modic effort to vomit. Haemoglobin (he-mo-glo'-bin).— The colouring matter of the red blood corpuscles. It contains globulin and haematin, and has a strong affinity for oxygen by reason of its iron content. Erythema [er-e-the'-mah) .— A superficial inflammation of the skin, occurring in red patches of variable size and shape ; it is not contagious. E . nodosum, an inflammatory patchiness of the skin with raised, round, erythematous nodules, sometimes indicative of a sub-acute rheumatic infection. T h e Irish Red Cross Society has received subscriptions for ambulances from numerous firms and their subscrip tions, together with those previously acknowledged, will buy 20 ambulances.

AID

Poisons.* N

erve

o iso n s

p ro d u cin g

are

those w h ic h

d ro w sin ess,

sleep

and

act on the n e rv o u s sy ste m , co m a , or co n v u lsio n s

and

d e liriu m .

T he most important are :— Opium and morphia, chloral hydrate, belladonna, alcohol, strychnine and aconite. O

piu m

and

o r ph ia

prussic acid,

Symptoms of poisoning come on in from a few minutes to some hours, according to the amount taken and the method of administration. They occur more rapidly after a hypodermic injection than when taken by the mouth. At first the patient is mildly excited. He complains of headache and giddiness, becomes drowsy and finally insensible. The breathing is slow and stertorous, the skin cold, pale and bathed in sweat, the lips and extremities blue, and the pulse feeble. The muscles are relaxed so that the limbs hang limp. One of the most important signs is the small size of the pupils, so small that they are called “ pin point pupils.” Death when it occurs is due to asphyxia. Treatment. — If the patient is already unconscious, the stomach syphon is used and the stomach thoroughly washed out with Potassium Permanganate (20 grains to the pint). If the patient is conscious, give mustard and water as an emetic, and keep him aw ake by sprinkling cold water on his face and by w alking him about. To do this properly, two nurses are required, one on each side. Do not continue if he becomes unconscious or much fatigued. When the breathing shows signs of failing, commence artificial respiration. Hot strong coffee injected slowly into the rectum is the best stimulant. Atropine sulphate l/ 30 th grain may be injected by the Medical Officer and repeated if necessary until j grain has been given. C

hloral

ydras

This salt is usually given in water (5 to 20 grains), or in the form of Syrup of Chloral (£ to 2 drams). Poisoning occurs when an overdose is taken. Symptoms.— T h e patient soon becomes unconscious. T h e skin is cold and moist, the face dusky, the pulse feeble, and the respirations slow. The smell of chloral may be detected in the breath. Death occurs from heart failure. Treatm ent.— Empty the stomach by the syphon or by emetics. Keep the patient awake, but do not 7valk him about. Stimulate him by warmth, and by hot coffee per rectum. H

yd r o cya n ic

cid

r u ssic

cid

Symptoms. — Insensibility occurs within a few seconds. The breathing is difficult and irregular, the pulse feeble, the skin cold and clammy, the eyes staring, and the smell of bitter almonds may be detected in the breath. Most cases are fatal. Treatm ent.— Empty the stomach and begin artificial respiration at once. Give oxygen. Apply cold water to the face. Keep the patient warm. B

elladonna

and

tr o pin e

Symptoms.— These commence with dryness of the throat * Extract from the Manual of Instruction for the Royal Naval Sick Berth Staff, reprinted by permission of the Controller of H .M . Stationery Office. Copies of the Manual can be had of H .M . Stationery Office, Adastral House, K in gsw ay, London, W . C . 2 , or any branch, price 4 /Sd. post free

FIRST

and delirium (talking and laughing) followed by insensibility. T he pulse is fast, the skin dry, and the pupils "dilated, sometimes a bright red rash appears on the skin. Treatment. — Empty the stomach, and give stimulants such as hot strong coflee or tea. Keep the patient warm. A c o n it e .

lliis drug may be taken in poisonous doses, or the plant from which it is obtained may be mistaken for horse-radish. Symptom s.— At first there is pain in the stomach and vomiting with numbness and tingling of the tongue and mouth. The pulse is irregular, breathing very difficult, the skin cold and clammy, and the limbs feel heavy to the patient. Treatm ent.— Empty the stomach, apply warmth, give stimulants. A lcoh ol

P o is o n in g .

Alcohol is a common and important nerve poison, having a depressing action on the higher centres of the brain. It is much more intoxicating when taken on an empty stomach than with food. Acute Alcoholism. — In the early stages there is excite ment (due to loss of the control which is normally exerted by the brain), varying in degree from a talkative condition to acute mania. The characteristic smell of alcohol may he detected. Following this the patient loses control of his muscles and speech so that he staggers and slurs his words. Later comes the stage of stupor and drowsiness, and possibly death. Delirium and convulsions are not un common. Treatm ent.— Empty the stomach, put the patient to bed and keep him warm. If the breathing is difficult perform artificial respiration. Hot coffee given by the rectum is the best stimulant. D e l ir iu m

T rem ens

This is a condition of delirium, which occurs after a heav\ drinking bout, in persons who regularly indulge in alcohol, and are suddenly deprived of it. Symptoms.— The patient is delirious, mutters to him self, and is often violent. He has hallucinations or “ sees things,” the commonest objects being rats, spiders, or reptiles of marvellous colours. His tongue, lips and hands are very tremulous and he does not sleep. He may have some fever, his tongue and mouth are dry and dirty, and there is difficulty in getting him to take food and to stay in bed. The disease lasts from three to five days and is always serious, especially when it occurs with other diseases such as pneumonia or enteric fever. Severe injuries in an alcoholic subject often brings on delirium tremens. Treatm ent.— T he patient is put to bed in a darkened room. T w o nurses are required, both by day and by night, to restrain violence and to keep him in bed" By placing a sheet folded like a draw sheet, over the legs and hips, and tucking the ends well in under the mattress, the lower limbs can be restrained without risk of injury, and the nurses can then attend to the arms. Avoid pressure on the chest, and do not strugg le with the patient, but allow him limited freedom. Feeding is most important. Beef tea, milk, and eg g s are given frequently in small quantities. T he Medical Officer may order a sedative. C h r o n ic

A l c o h o l is m .

The constant drinking of alcohol may cause degenerative changes in various organs without the patient showing signs of intoxication.

AID The most common of these conditions are tremor of muscles, dullness of intellect, chronic dyspepsia, neuritis and cirrhosis of the liver. S

tr ych n in e

This is obtained from nux vomica and is used in medicine. It is also contained in some “ vermin killers.” Symptoms.— T he patient may complain of the intensely bitter taste of the poison. T he muscles begin to twitch and then convulsions set in, lasting about a minute and alternat ing with periods of relaxation. D uring the attack (he hands and jaw are clenched, the body rigid and often arched, and eyes wild and terrorstricken. The patient does not lose consciousness, and death occurs from asphyxia or exhaustion. Treatm ent.— If possible empty the stomach, but this may be difficult, as any attempt to swallow may cause convulsions. T o prevent these, the Medical Officer may anaesthetise the patient, or give a dose of chloral. Apomorphine gr. 1/15 th may be given hypodermically if the stomach cannot otherwise be emptied. Artificial respiration and oxygen may be necessary. P

oison ou s

ases

T he chief poisonous gases are :--Carbon monoxide, carbon dioxide, coal gas, nitrous fumes, chlorine. C

arbon

o n o x id e

and

arbon

io x id e .

These gases may occur in enclosed spaces such as double bottoms of ships and unventilated storerooms, bakeries and carbon dioxide rooms. They are also produced by combustion and explosions, and are present in the exhaust gases from motor cars. Double bottoms should not be entered until the purity of the air has been tested by means of a miner’s lamp. A naked light should never be used owing to the danger of explosion. If it is necessary to enter spaces where poisonous or irrespirable gases are likely to be met with, a life line, or the Hall Rees diving apparatus must be worn. Symptoms. — In cases where the amount of ga s present isin large quantities, insensibility and death are almost instantaneous. Lesser amounts cause headache and giddiness, nausea and difficulty in breathing, followed by drowsiness and insensibility. Coal gas is dangerous, ow ing to the carbon monoxide and carbon dioxide present. Chlorine gas may be accidentally generated in sub marines if sea water gets into the accumulators, while nitrous fumes may follow shell explosions. Both are lung irritants and cause death by asphyxia. Treatment of Gas Poisoning. — Remove the patient immediately to the fresh air and commence artificial respira tion. Encourage the circulation by rubbing the limbs, give inhalations of oxygen if it is available, and keep the patient warm. Amb. Officer R. G. Winder, of the Brighton Town Division, S .J .A .B ., has been appointed Corps Secretary to the Brighton Corps. • -C--At the annual meeting of the Leverington, S .J.A .A ., Mr. G. F. B. Wace (Chairman) presided. T he resignation of the Secretary, ow ing to his being called up, was accepted with regret, and appreciation of his services during the past nine years was expressed by the Chairman.

FIRST

The Treatm ent of Wound Shock. T h e Committee on Traumatic Shock and on Blood T ran s fusion of the Medical Research Council have issued M .R .C . W ar Memorandum No. 1 under the above title, ( 5d. post free). First, “ Mechanism of Wound Shock ” is discussed. Primary shock is dealt with in a few lines. This is a condi tion of collapse which may follow soon after the receipt of injury and which is not due to haemorrhage, and responds to the recumbent position, warmth, relief of pain and administration of stimulants. Secondary or wound shock is next discussed in much detail. This condition developes insiduously some hours after injury and is characterised by weakness, pallor and raised pulse rate, and in advanced cases by lowered body temperature, sweating, low blood-pressure, rapid “ thready ” pulse, vomiting and intense thirst.

Wound shock, according to the Memorandum, closely resembles the effects of haemorrhage in its clinical features and is likewise a condition of circulatory failure, due to diminished blood volume, with a consequent fall in heart output and blood-flow through the tissues of the body. External haemorrhage, and loss of blood and blood plasma into the tissues, account for the decrease in bloodvolume in wound shock. Whereas haemorrhage is a rela tively simple disturbance, shock is known to be a state resulting from many factors in addition to blood loss ; fatigue, dehydration, pain and exposure to cold and wet may in individual cases all contribute to its origin. If shock is to be successfully prevented or treated, these contributory factors all demand attention and, in some instances, no further measures are required. In the majority of cases, however, active steps must be taken to restore blood volume. If measures to restore the blood volume are to prove effective, every effort should be made to apply them early. Under “ Clinical Recognition of Wound Shock ” it is stated that recognition of the condition in its advanced stages presents no difficulties. In addition to signs and symptoms already given, the lips, ears and nails may be cyanosed and the tongue dry ; consciousness may be impaired but it is important to realise that many even moribund patients (i.e., in a dying condition) are mentally alert. Recognition of shock in the earlier stages is by no means easy as pallor and increased pulse rate (the only constant signs of early shock) are not confined to this condi tion. It is, however, suggested that shock should be sus pected in every case where injury has been extensive, where much blood has been lost and exposure very prolonged, and where the skin is pale and cold and the pulse over 100. Treatm ent.— T h e most important single requirement for arresting the progressive deterioration in general condi tion which is such a feature of shock, is restoration of blood volume and thereby of tissue metabolism. Instructions are given on treatment before reaching either Military C.C .S. or Civilian C. R. H. For the control of haemorrhage, the most that can be done during active operations is to limit haemorrhage and plasma loss efficiently with either a firm bandage or tourni quet, which is described. T he wound should be protected from cold, water should be given freely (except to the unconscious patient or one suffering from abdominal wounds), blood transfusion and morphine should also be given. At the C .C .S . or civilian C .R .H . all these details will receive fuller attention, and particulars are given as to their application.

Appendix A gives particulars of the Army Blood T ran s fusion Outfits and instructions, together with diagrams of equipment; Appendix B, the Medical Research Council Blood Transfusion Outfit (as provided for the Sectors and Depots in London and the Home Counties); Appendix C, methods of Continuous Drip Blood Transfusion and Intra venous Infusion ; and Appendix D, the Reconstruction and Administration of Dried Serum or Plasma. T he Adminis tration of Ovygen with the B .L. B. (Boothby, Lovelace and Bulbulian) Apparatus is given in Appendix E ; whilst Appendix F gives Coinposition of Solutions.

A.R.P. Topics. A .R .P .

M em o ran d u m

No. 1 3 .

The second edition of the above which refers to Inspec tion and Repair of Respirators and Oilskin Clothing (3d. post free), has just been issued. It deals with inspection of such items. It is the duty of the wardens in each sector to visit the inhabitants of the sector once a month, and on such occasions the opportunity should be taken to ensure that the respirator has been properly fitted and that the straps of the harness have been pinned in the proper position. Where Contex is fitted, it should be examined to ensure that the correct method of affixing has been carried out. Respirators and oilskin clothing in store should be inspected at least once every three months. Equipment is to be classified as fo llo w s:— ( 1) “ S ” — serviceable; (2 ) “ R ” — repair locally; ( 3 ) “ B . L . R . ” — beyond local repair. A list of repairs that can be carried out locally to General Civilian, Small Children’s, Civilian Duty and Service Respirators, also Babies’ Anti-Gas H el mets, are tabulated ; and also repairs to oilskin clothing. T h e appendixes deal with Procedure for Return of Respirators and Oilskin Garments “ B . L . R . ” ; Instruction for Repair of Respirators, which is divided into five parts dealing with all varieties of respirators (many illustrations are given), and Instructions for Repair of Oilskin Garments made of Fabric D.

C a t e c h is m

o f

F ir s t

A id

for

G as

C a s u a l t ie s .

This is a little booklet published by John Bale Sons & Staples, Ltd, 83 -91 , Gt. Titchfield-street, London, W . l . Price 6d. T h e author, Sydney Burnley, M .P .S ., is a Divisional Superintendent of the S .J .A .B . and, Sir John Duncan, Chief Commissioner, in a foreword states that this catechism provides a valuable means by which all members of the Brigade, persons engaged on A. R. P. duties, or even those who look to their self-protection, may keep their knowledge of how to ensure protection against ga s attack. T he book is divided into eleven groups (Nature and Properties of W a r Gases, Nose, L u n g and Blister Gases, & c .) and is set out in clear type and in the accepted question and answer style. T h e context has been checked by Dr. W . C. Bentall, the Anti-Gas Staff' Officer of the Brigade.

T h e employees of Colville’s Ltd. (Dalzell and Mossend Works), have presented a motor ambulance to the St Andrew’s Ambulance Association for general service during the prriod of hostilities. T he ambulance has provision for four'stretcher cases and can be adapted for a full comple ment of sitting patients.

FIRST

Our N u r se s’ P a ge. C O M P ILE D

No. 4 D

is t r ic t ,

B Y AN A M B U L A N C E S I S T E R .

S .J.A .B .

T ow n N u r s i n g D i v i s i o n . — In s p i t e o f extra duties, air raid warnings and difficulties o f travelling, this Division continues to make good progress, and to work, in different w ays for the National cause. Many members are giv in g full-time service in hospital, others at first aid posts ; but they find time to attend classes in order to keep up their efficiency. On the Day of National Prayer, September 8th, many joined the Mayor, Councillors, Territorials and other bodies at Church, although some of the nurses had been working all night. Led by Lady Supt. Miss M. Luckett and Lady Ambulance Officer Miss G. Luckett, they looked very neat in their indoor uniform contrasting with the dark uniforms of the Forces. Messrs. Phythian and Hamilton, of the local A .F .S ., gave very interesting lectures, displays and demonstrations of fire fighting and life saving on August 13 th and September 3 rd. A large number of members were able to be present, and later donned overalls and rubber boots, formed into teams under their Superintendent, and with the stirrup pump put out fires caused by mock incendiary bombs. They also practiced life saving. All were very grateful to the two instructors, whose teaching has since proved beneficial when several members have been instrumental in putting out fires caused by real bombs. St.

H elens

N orthern

I reland

D is t r ic t ,

S .J.A .B .

D i v i s i o n . — The annual inspection of this Division was held on Tuesday evening, September 24 th, at the Unionists’ Headquarters, Glengallstreet. Mrs. W. O. Hume, Lady President of the Division, was in the chair. T he inspecting officer was Mrs. Wallace, Lady District Superintendent for Northern Ireland, and she was accom panied by Miss M. Dulfin, Lady County Officer for Belfast. Mrs. W allace congratulated Lad)' Div. Supt. Miss S. J. Irvine on the excellent turn-out and smartness of the parade, and on the efficient display of first aid and home nursing given by officers and members of the Division. Am ong those present were the Divisional Surgeon, Dr. D. P. S. Paisley and Mrs. Paisley. T h a n k s were expressed to Sergeant Burney, Royal Irish Fusiliers, for his help and instruction in drill to the members of the Division. B elfast

C entral

N u r s in g

D o n a g h a d e e N u r s i n g D i v i s i o n . — A Church Parade arranged by the Committee of this Division took place on Sunday, September 15 th, from Market House Hall to the Parish Church, Donaghadee. The members were accompanied by representatives of B angor Nursing and Ambulance Divisions and Newtownards N ursing Division. Mr. Beatty, J.P ., County Officer, was in command of the parade. Mr. A. Mann, Assistant Commissioner, was present, as also were Lady Smiles, Lady Div. President, and Mrs. W. Millikin, Lady Div. Vice-President. In the unavoidable absence of Lady District Supt. Mrs. Wallace, Lady District Officer Miss Duffin made an excellent deputy. T h e visiting officers and members were afterwards

AID entertained to refreshments in adjoining the Church.

M elton

M ow bray

D etachm ent,

the

British Legion Hall

B .R .C .S .

Her Royal Highness the Duchess of Gloucester paid a visit to Melton Mowbray, on September 24 th, for the purpose of inspecting the Red Cross depots and the depots of the Forces. Among those assembled to meet her Royal Highness, were the Duchess of Rutland, President of the Leicestershire Commissioners of the British Red Cross Society, Mrs. Paynter, County Director, Assistant County Director and City and County Organiser for equipment. T he Duchess showed great interest in the depots and also in the fact that each town and district representative obtains her own materials which are made up at her working party, the finished garments being returned to the depot for distribution to the British Red Cross Society and the Forces. Afterwards, the Royal visitor inspected the War Memorial Hospital, where the Duke of Gloucester and the D uke of Windsor have been patients after hunting accidents. She toured the wards and had tea before departing.

B .R .C .S . F u n d s . A concert in aid of the British Red Cross Society was given in Windsor Conservative Club on September 26 th, by the Floradale Academy of Music and Dancing, Alma Road, Windsor, of which the Misses Ella and Isabel Churchman are the principals. These ladies with their pupils sang and danced before an audience which, though not large owing to the black-out, fully appreciated a programme of nearly forty items. Songs, dances and recitations followed each other in pleasing sequence. There was also a competition for a Wheatstone concertina valued at ;£ 10 , presented by Miss Ella Churchman, and this was won by Miss Mary Davies. Miss E. Churchman danced twice, and her sister sang, adding to their reputations in their own particular spheres, while their pupils gave a good account of themselves and of the training they had received. As a result of the concert, the sum of ,£19 has been handed over to the British Red Cross Society, and it is expected that there will be a small additional amount to be forwarded when the accounts are closed. C o n c e r t in A id o f

S e r v ic e f o r A l l .

In these trying days when there is such an urgent call for service, all women with a knowledge of first aid, long to give their time and assistance in helping those who are suffering by reason of the war. Many with no ties are able to take up full-time hospital work in the Civil Nursing Reserve, or to give their whole time to A .R .P . duties. There are others, however, who are not free, who have dependants who cannot be left for long periods, and many of these women are feeling very despondent that they are unable to help in the National cause as there more fortunate sisters are doing. There is one way in which all women can give valuable assistance at this time. W e are all now in the front line, and no place appears to be safe from attacks from the air. Casualties are likely to occur around us at any time, among our friends and neighbours, or those in the immediate vicinity in which we find ourselves at any given time. Therefore we must be prepared to render assistance at any moment, and with whatever material is at hand. T he A. R. P. services are doing extremely well, but it may be that a stretcher party cannot get through immediately, while injuries are desperately in need of attention.

FIRST

AID

The first thing we must do is to see that we ourselves are efficient and are able to treat casualties with improvised material. This is not as easy as it sounds, but a little practice and forethought will make for proficiency. Then we can train others in simple first aid so that they, too, will be able to assist in an emergency. Many of our neighbours would be glad to help if a bomb fell nearby and caused casualties. Let us suggest to them that we form a first aid party am ong ourselves to help each other should the need arise ; and then teach them elementary first aid, just the treatment of those injuries which might be caused and which must be dealt with on the spot— how to deal with haemorrhage, burns, injuries to bones or joints, not forget ting the treatment of shock or hysteria, and the suppression of panic. There is need to spend money on bandages, dressings or splints, either for practice or for actually rendering first aid to those needing it. Old sheets make excellent band ages, old handkerchiefs and pillow cases can be used for dressings. They should be perfectly clean and wrapped in a clean piece of white material which can be fastened with a sterilised safety pin. Splints can be improvised, a sound leg can be used as a support for an injured one, and the trunk for an injured upper limb. In this way we shall be doing our country service, and if we are required shall be able to do good work until those of the A .R .P . Services can arrive on the spot and take over from us.

Field D ressings. M a n y people are of the opinion that field dressings, as issued to members of H.M . Forces, came into being during the Great W a r of 1914 - 1918 . It is therefore interesting to note that Dr. James E. Pilcher, Captain of the Medical Department of the United States Army, in his book “ First Aid in Illness and Injury,” published in 1892 , gave particulars of the “ First-dressing packet ” issue to members of the Hospital Corps of the U.S. Army. This was a flat flexible package, about 4 ins. square and from three quarters to seven eighths of an inch thick “ con taining all the necessary materials for an emergency dress ing, wrapped in a piece of gu tta percha cloth, nine inches square.” Printed on the cover was the following :— E s m a r c h ’s

F ir s t

H elp

fo r

W o u n d s.

Contents of Package. 2 antiseptic compresses of sublimated gauze in oiled paper; I antiseptic bandage o f sublimated cambric with safety pin ; I Esmarch's triangular bandage with safety pin, mode application illustrated on same.

Directions. Place one o f the compresses 071 the wound, removing the oiled paper. In cases oj large wounds, open the compress and cover the whole wound. Apply the antiseptic bandage over the compress. Then use the triangular bandage as shown by illustrations on same. , The antiseptic compresses were of cheese-cloth roller bandages, a yard long and three and a half inches wide, folded to two inches wide and three and a half long ; the antiseptic bandage being 2 yards long and 4 inches wide. Both were impregnated with corrosive sublimate, “ the most efficient germicide known to science.”

r e

f u

r e

U over the British Isles, W o rk s’ M an agers, F acto ry M an agers, C o llie ry M an agers and a ll la rge and sm all in d ustrial c o n cerns are now b usily seekin g the assistance o f fully trained F irst- A id m en in order to m aintain the efficiency o f their w ork-p eople. S p e cia l depa»tm ents are b ein g organized in most F acto ries, S h ip yard s, C o llieries, W ork sh op s, e tc ., w here injuries cannot on ly receive first-aid treatm en t, but upon b ein g disch arged b y the surgeons can receive m assace treatm ent and so decrease the reh ab ilitation Derind. S P E C IA L L Y T R A I N E D Resear, h has show n that the con valescen t period is reduced by as m uch as 80 per cent, w here a d e q u a 'e follow -u p th erapy is em p loyed, and first-aid m en are b ein g sp e cia lly trained b y the S .M .A .E . (S w ed ish M assage and E le ctrica l) Institu te to fulfil these requirem ents. N o w is you r opp ortu nity o f b ecom in g train ed for the great w ork w hich lies ahead in this vast field - every man and w om an sk illed in the art o f scientific M assage and M an ipu lative T h e ia p y w ill be a valu able asset. T R E M E N D O U S O P P O R T U N IT IE S Y o u r k n o w led ge o f first-aid w ill be ten tim es m ore valu ab ’ e if you can w ear the b ad ge o f the S .M .A .E . In stitu te— the b ad ge o f qualification. T rem en d ou s opp ortu nities lie before you in thi> gre a tly e xten d in g field w h ich is now open to you w ith o u t.h av in g to leave y ou r present w ork until you qu alify as an expert and can com m and an e xp ert’ s pay. F o r over 20 years the S .M .A .E . (S w ed ish M assage and E le ctrica l) Institu te has been te ach in g scien tific m assage and num bers am on g its graduates som e o f the m ost successful and h igh ly paid men and w om en in the realm o f M assage. N O T H IN G T O L O S E

W R IT E N O W fo r this in tere stin g b o o k le t, en titled “ M anip ulativ e T h era p y as a P ro fessio n .” It w ill be sen t to you free and p o st free and in v olve you / In no o b lig a tio n w h a tso e v e r.

A d d re ss: The S ecretary, 50, S M A E Institu te Leatherhead, Su rrey. “ A N IN V E S T M E N T IN K N O W L E D G E PA Y S T H E H IG H E S T D IV ID E N D S .”

FIRST

Marking Sheet. S t.

P ancras

B orough

C o u n c il

I n d iv id u a l

No. 1 .— State the haemorrhage.

C o m p e t it io n .

S e c t io n .

signs and symptoms for

internal 2 2 1 2 1 2 2 1 1 1 2 1 2

Total No. 2 .— Give the main causes of shock. treatment for shock.

Total

4 2 2 2 2 1 1 1 2 1 1 1 1 2 2 2 1 2

No. 3.— Treat this man for simple fracture of ribs (right side) and slight cut on forehead. ... ... ... ... ... ... ... ... ... ... ... ... ... ...

... ... ... ... ... ... ... ... ... ... ... ... ... ... Total

4.— Treat

2 2 1 2 2 1 1 2 2 1 1 3 2 2 24

this man for fractured patella or knee

cap. Place patient on back ... Raise and support head and shoulders Straighten and raise limb ... Splint at back, buttock to heel

... ... ... ...

No. 5 .— Make a stretcher out of material provided. Poles and rugs ... ... Poles and bandages ... Give suggestions for other material Tell these men how to form'seats Instruct them how to lift stretcher

... ... ... ... ...

... ... ... ... ... Total

3 3 4 5 S

The Spinal Column.

Give the full

Haemorrhage, pain Exposure to cold ... Mental anxiety before injury ... Fear of further injury Stop Haemorrhage if present ... L ay patient on back R u g underneath Head low and to one side Loosen clothing, neck, chest, waist and ensure fresh air Temporarily treat injuries Cover with rugs Raise lower limbs if practicable Smelling salts if available Encourage. No exitement Remove speedily to shelter Hot drinks if available Add plenty of sugar Extra for smartness

No.

2 2 2 2 2 1 2

Pad under hollow of leg to lift heel Bandage round thigh and leg Double 8 bandage round ankle Narrow bandage figure 8 round knee Cold compress on Joint Extra for mention of shock Extra for mention of medical aid Total

Pallor of face and lips Cold and clammy skin Rapid loss of strength Giddiness and faintness Especially when upright Breathing hurried and laboured With yaw ning and sighing Pulse fails May disappear at wrist Throw s arms about T u g s clothing, calls for air Finally unconscious Extra for smartness

Place patient flat with head low Loosen clothing, warn to keep still Speak encouraging words ... Cover warmly and blanket under Clean dressing and bandage for head Ask if foreign body or dirt (no) Ask if fracture present (no) ... Two broad bandages round chest Lower overlaps upper by half ... Correct for tightness ... Both knots correct ... Large arm sling correctly applied Extra marks for mention of shock For mention of medical aid ...

AID

1 2 2 2

spinal column, which is at times called the vertebral column or back bone, is formed by a number of small and irregular bones known as vertebrae. These are set one upon the other, being separated by discs of cartilage in the first three regions. This protective layer allows free move ments and assists in minimising the jar of any sudden force applied to the column. T he column is curved in four places : ( 1 ) forward in the neck ; (2 ) backward in the thoracic region ; (3 ) forward again in the the lumbar region ; and (4 ) backwards in the sacrum. In addition, there is a slight lateral curvature usually towards the right side, due, it is said, to the more frequent use of the right upper limb, as it has been found that the curvature in left-handed people is to the left. Each vertebra, of which there are 33 , consists of a body or bony mass, from which two bony wings, or pro cesses, jut out and meet to form a canal through which the spinal cord passes. From each side of this ring are projec tions, known as transverse processes, which fit on to similar parts in the vertebrae above and below. In addition, there is a further projection backwards called the spinal processes. T he column is divided into five regions, which, together with the number of vertebrae in each, are as follows :— Cervical (or neck) region, seven ; thoracic (or dorsal) region, twelve ; lumbar (or loin) region, five ; sacrum (or rump) region, five ; and coccyx (or tail) region, four. The last two regions are welded together. T he vertebrae in each region differ from those in other regions. In the cervical region the first vertebra is called the atlas. This differs from other cervical veretebrae in that it has no proper body, but, instead, has two large surfaces which support the w eight of the head and join with like surfaces situated on each side of the large opening (known as foramen magnum) in the base of the skull. These form the joint which allows the nodding movements of the head. T he second vertebra, the axis, again differs from its fellows, has a large tooth-like projection which fits closely against the inner surface of the atlas, and is kept in position by a transverse ligament. T hu s a pivot is formed around which the atlas revolves when the head is turned ; and a joint is formed which permits the side-to-side movements of the head. T he

T h e seventh cervical vertebra (w hich is k n o w n as the

FIRST

E Q U IP

YO URSELF

AID

FOR

W AR

Essential

E M E R G E N C IE S

k n o w le d g e ALL

tre a t

successfully,

possible in ju ries,

THE

HOUSEHOLD

PHYSICIAN

Describes in SIMPLE L A N G U A G E such necessary informa tion wi th helpful plates and diagrams.

AND

FOR

PEACEFUL

TIMES

The C O M P LA IN TS OF M EN, W O M EN A N D CH ILD R EN , Their w ith The

Cause, T r e a t m e n t c o m p le te

500

in s tru c tio n s

illustrations

and

and on

full-page

Cure

F ir s t

Plates

A id .

m akes

the re a d in g m a tte r m o r e e a s ily understood.

A C C ID E N TS A fe w o f th e S u b je c ts tr e a te d :

WAR EMERGENCI E S : Gas Wa r f ar e First Ai d Bandages Splints Burns Scalds Haemorrhage Fainting

PEACE TIME SUBJECTS Influenza,Colds,etc. Measles, Mumps Catarrh Corns and W a r t s Physical Cul ture W h a t to Do in Emergencies T r e a t m e n t for all Skin Diseases T h e Lungs, Pleurisy Hygiene, A n a t o m y , Pharmacy T h e Principles of Nursing Th e Eye, the Ear Th e Throat , the Nose T h e Chest, the Heart T h e Stomach, t he Liver Th e Te et h, the Muscles Infant We l f are Homoepathy, Neurasthenia 375 Prescriptions, etc., etc.

W h at

case

o f:

Bodily Injury, B u rns a n d S calds, C lo th in g Alight. F o r e i g n B o d ie s in Eyes, Ears, N o s e, T h r o a t . M a c h in e ry Accidents, Electricity Accidents. D ro w n in g , Suffocation, Bleeding, Poison, B ro k e n Bones, Fractures, Dislocations, Sprains, Fain tin g, Concussion, Etc. THE YO UN G W IF E will find just the information she requires. MOTHERS who wish their daughters to develop naturally will find exactly the teaching they need. W O M E N O V ER 40 will frankly discussed.

find

their

difficulties

regarding

health

BEAU TY CULTURE— Complexion Diets, Wrinkle Cures, Care of the liands, Mouth, Eyes, Hair, Recipes, etc. P R E S C R IP T IO N S —375 proved remedies. There are hundreds of subjects. T he muscles, teeth, digestion, hair, food values, Ju jitsu, Phrenology. H o w to diagnose diseases from appearance of head, face, neck, tongue, throat, chest, perspiration, etc.

F R E E MESSRS. VIRTUE & C O ., LTD., F.A. Dept., 19, 20, 21, THAVIES INN, L O N D O N , E .C.I. P le a s e sen d m e FREE B ooklet on “ THE HOUSEHOLD P H YS ICIA N ,” stating c a sh p rice, also m o n th ly te r m s of p a y m e n t without a n y obligation to p u rc h as e. NAME. (Send this form in unsealed envelope stamped Id.) A D D R E S S .........................................................................

FIRST

prominent vertebra) is peculiar in that it has a very long spinous process. The collar stud of a man usually finds the exact spot. Cervical vertebrae each have an opening in the trans verse process for the passage of the vertebral artery, vein and the sympathetic nerves. I he body of each is thin, and the spinous processes are bifurcated. T he thoracic vertebrae increase in size from above downwards ; the spinous processes are long, bayonet shaped, and are directed downwards. Further, each vertebra has a small facet (which signifies a small face or smooth surface) on each side for articulation with the ribs. T he lumbar vertebrae have very large bodies, and aie wider from side to side than from before backwards. The transverse processes are long, slender and horizontal, whilst the spinous process is thick, broad and somewdiat quadrilateral. T he sacrum, which is fixed between the hip bones and constitutes the posterior boundary of the pelvis, is a large triangular wedge-shaped bone ; and it is formed by the fusion of the five sacral vertebrae. Incidentally, the word means “ sacred ” ; and it is so called because the bone was offered as a sacrifice by the ancients. T he coccyx, which is so named because of its fancied likeness to a cuckoo’s beak, corresponds with the tail in the lower animals. It is a small triangular bone consisting of four vertebrae, fused together as in the case of the sacrum. The whole spine is strapped together by bands of strong fibrous tissue, known as ligament, which reaches its entire length.

Tlie Nervous System. T h e b r a in , s p in a l co rd a n d n e rv e s c o n s titu te th e n e r v o u s s y s te m ; th e first tw o b e in g c o n ta in e d in th e c r a n ia l c a v ity a n d th e v e r te b r a l c a v ity re s p e c tiv e ly . T h e n e r v e s p a ss o u t fro m e a c h to e v e r y p a rt of th e b o d y .

The brain is covered with three membranes, the inner most of which is known as the pia mater. This is very delicate in structure and contains blood-vessels which supply the brain. It is closely attached to the brain and passes into all its little fissues. The middle membrane, the arachnoid, secretes a clear fluid known as the cerebro-spinal fluid, which fills up the space between the brain and spinal cord and the bones which contain them. This fluid is situated mostly at the base of the brain and acts like a water-bed in preventing injury to the brain from a blow or jum p which would otherwise jar the brain against the bone. It ascends and descends from the spinal cord according to the amount of blood in the brain. An escape of this fluid through the ear is one of the signs of a fractured b^se of the skull. T he outer membrane, the dura mater, is tough and fibrous and lines the inside of the skull. It contains large vessels connected with the brain and skull, and also the scalp by small holes in the skull. T he brain is divided into four parts :—

1. The Cerebrum, or upper part, comprises three-quarters of the brain. It is divided by a large fissue into two hemi spheres, each of which is divided from the front backwards, into three lobes, the anterior, middle and posterior. 2 . The Cerebellum, or lesser brain, occupies the lower part of the brain and is divided into two hemispheres. Both the cerebrum and the cerebellum are composed of two sorts of tissues which make up the nerves and nerve cells. T he outer part is the grey matter, and the inner, the white.

AID 3. The Medulla Oblongata is just under the middle of the cerebrum, in front of the cerebellum, being about an inch in length. It consists of white matter on the outside and grey inside. 4 . The Pons Varolii is made up chiefly of white matter and nerve fibres. It connects the cerebrum and cerebellum with the medulla oblongata, which is continuous with the spinal cord. Tw elve pairs of nerves are given off from under the surface of the brain and each supplies various parts of the body, such as the optic nerve for the eye, the facial nerve to the face, the lingual nerve to the tongue, etc. T he spinal cord, like the brain, is formed of grey and white matter, the former being internal and the latter, external. The functions of the brain and spinal cord are to control the motions of the body, the blood supply, the secretions, etc. The forepart of the brain is the seat of consciousness, the will, the emotions and memory. In other parts of the brain there are areas for general sensation, sight, smell, taste and hearing, each of which receives impulses from the sense organ concerned and passes on the message to conscious ness. There is also the motor area which is under the control of the will and from which impulses are sent to the voluntary muscles of the body, which for the most part are situated on the surface of the body and limbs. The medulla controls the heart and lungs, and is there fore, a very important part of the brain. If injured, it usually proves fatal. Each nerve issuing from the spinal column is composed of delicate nerve fibres. The fibres spring from the anterior and posterior nerve roots. T he anterior nerves are motor nerves and the posterior, sensory. Should the anterior nerve root be injured, an impulse is unable to pass the injury and therefore no movement follows. Similarly, if the posterior root is injured, there is loss of sensation in the part of the body controlled by that nerve. Certain sensory impulses travel up the nerve to the spinal cord and produce other impulses, which in turn, travel down the nerve again by the motor fibres and cause movements called reflex action. Members of the St. Mary Division, S .J .A .B ., paraded to Fleckney Parish Church for the dedication of the banner, which has been worked and presented by Miss Williams, of Leicester, the leader of the section. T he dedication was performed by Canon Boughton, of Leicester. At the request of many local authorities in the London suburban areas the Red Cross has set up a number of reception and shelter establishments, mainly for the housing, feeding and sleeping of old people who cannot be moved to suitable billets in the country and whose homes have been rendered unusable. T he work has been entrusted to the County of Middlesex branch of the British Red Cross Society. Hornsey, Tottenham, and Finchley have been largely assisted in this way. Sick bays have been opened at Ealing, Uxbridge, and Wood Green, where thousands of blankets and other goods have been supplied, and transport has been provided for homeless people who wish to travel a distance to friends and relatives.

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Contents Include : POSSIBLE W AR INJURIES ; W O U N D SHOCK, PRIMARY & SECONDARY; HAEMORRHAGE; FRACTURES; BURNS & SCALD S; ASPHYXIA (including collapse of lung through blast) ; SUDDEN CHILDBIRTH, &c. &c.

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already in use.

This illustration shows the clear gangway for loading the lower stretcher when only one case Is being carried.

FIRST

Q u e r ie s to

and

A n sw ers

C o rresp o n d en ts.

2 .— All Queries must be written on one side of paper only.

AID ture of the thigh in middle of shaft, with protrusion of bone and arterial bleeding. Y o u r query lacks details which would influence your choice of treatment ; and so it can only be answered in a general way. Y o u would take immediate steps to control the arterial hremorrhage, and, this done, to protect the wound which you would dress at the earliest moment on the lines laid down in the Textbook. Next, you would fix the fractured femur as best you may in the special circumstances, but being very careful to avoid application of extension which might pull the protruding bone back into the wound. Finally, throughout your treatment you would deal with the shock which will be profound.— N .C .F .

3 .— All Queries must be accompanied by a “ Query Coupon ” cut from the current issue of the Journal, or, in case of Queries from abroad, from a recent issue.

4. — T he Textb ook to which reference may be made in this column is the 39 th ( 1937 ) Edition of the S.J.A.A. Manual of First Aid to the Injured.

Th anks to the Doctor. Every October it is our pleasing duty to offer Dr. N. Corbet Fletcher our heartiest thanks, and also those of our readers, for his invaluable help during the past twelve months as Honorary Medical Correspondent to F i r s t A i d . Unlike a vote of thanks given at meetings as a matter of course, our thanks are offered in all sincerely to one who has, and is, serving the ambulance world to the fullest extent. The rulings and decisions which appear above the initials “ N . C . F . ” are accepted as authoritative not only at home but throughout the world— wherever first aid is taught. W ith this year the Doctor has completed a quarter of a century’s service in answering queries. Who can estimate, or even endeavour to estimate the amount of time and energy expended in answering the 3,000 queries which have been submitted for his decision ? Month in, month out, no matter how busy or in what health, Dr. Corbet Fletcher has never let down the readers of this Journal. T h e Doctor is much against “ praise sin ging ” but we feel that all readers will join with us in saying “ T h a n k you, Doctor, for your valuable assistance for which we extend our sincerest and deepest gratitude.” — T h e E d i t o r .

T y in g

L oop

B an dage.

F. H. (Plymouth).— Please tell me if it is essential for us to tie a complete reef knot on top of the loop bandage. If the loop bandage is tied properly and efficiently as shown in first bandage of Fig. 34 of the Textbook, would the first tie of a reef knot be sufficient to hold the bandage ? It is most essential to complete the reef knot on top of the loop bandage as is clearly indicated in Fig. 34 . Other wise there is grave risk of the half knot becoming loose, especially during transport.— N. C o r b e t F l e t c h e r .

E x a m in a t io n

H ow ler.

P. S. (Cardiff).— In a recent examination, the doctor asked a candidate what she would do for a patient suffering from burns. He was much amused when she replied— “ / would immediately apply artificial embrocation I " Good!

Next, please! !— N .C .F .

C om pound

C o m p l ic a t e d

F racture

o f

T h ig h .

T. F. (Stoke-on-Trent) & G. B. (Bromley).— Please give me the correct treatment of a compound, complicated frac

M ed d leso m e

F ir s t

A id .

L. R. (Charlton P ark).— Herewith I send you a report of what you rightly call meddlesome first aid. D uring a recent air raid, a young woman (who is known to suffer from mild epilepsy) had an attack and slid gently to the ground off the chair on which she was sitting. Her father and brother rushed forward and with a vigorous effort replaced her on the chair. Afterwards she com plained of pain in her shoulders ; and the doctor on his arrival next morning diagnosed dislocation of both shoulders. T ut!

Tut !

A r t if ic ia l

What next ! !— N .C .F . R e s p ir a t io n

w it h

C ru sh ed

C h est.

A .L . (Finchley).— A group of us who are A .R .P . workers have discussed among ourselves for some considerable time whether or no we can give artificial respiration to a person with a crushed chest or any form of severe internal haemorrhage, and, if so, which method. As we cannot arrive at a decision, we have decided to abide by your ruling and thank you in advance for your help. Yo u r discussion has evidently arisen from the pos sibility of a man being trapped in the debris of a collapsed house and suffering from complicated fractures of the ribs and also, perhaps, from profuse haemorrhage within the abdomen. In such a case the patient would in all probability be beyond all human aid before your arrival at the place of the emergency. Further, this is confirmed by your suggestion that breathing had entirely ceased. Artificial respiration is indicated for all cases in which there is interference with the act of breathing. It can be of no value at all for cases in which profuse htemorrhage— external or concealed— is the main feature, and in which to first aiders the diagnosis of concealed haemorrhage is most difficult. Lastly, you will note that under the treatment of the latter condition the Textb ook (p. 137) makes no reference to artificial respiration. — N .C .F . A p p l ic a t io n

o f

T hom as

S p l in t .

M.M. (East Sheen).— On behalf of four members of a Mobile Unit I ask if you will please answer the following questions with reference to the application of the Thomas Splint for first aid purposes. ( 1) Should a pad be placed under the knee and a bandage below the knee so as to cause slight flexion of the joint, or should a bandage be tied over the kneecap so as to keep the limb perfectly straight? (2 ) W hat is the correct position for a stirrup shaped like a pear and having a small ring at the bottom ? (3 ) Is it the usual practice for a Mobile Unit to go out with unpadded splints ?

FIRST

AID

B A I L L I E R E ’S SAMPLE Page. [ 341 ] lim b to arrest bleeding from an artery. I t should be loosened after th irty minutes, or permanent in ju ry to muscle or nerves m ay result. I t should not be applied to the arm , as damage to nerves is more easily caused, the muscle protection being less. E s march* 8 t. is a rubber bandage which is tightly applied.

M ETALANCHORTOFIXTUBING T O U R N IQ U E T . tow {to). T h e coarse part of flax used for padding splints, etc. toxaemia {toks - e'- m e - a h ). Poisoning of the blood by the absorption of toxins. to x a m in s ( to k s '-a -m in s ). To x io substances said to be present in cereals which are antagonistic to v it a m in D. toxansemia {tolcs-an-e'-m ea h ). Anaunia due to the

D I C T I O N A R Y

? T O X /E M IA ?

TRA

effect of toxins in the blood. toxic (loks'-iJc). Poisonous, or produced by a poison, toxicity (to k s - is '- it-e ). Th e of virulence of a poison. toxicology {to ks-e-ko l' o-je). Th e science dealing with poisons, toxicosis { to k s-e-ko '-sis). Th e state of poisoning by toxins. T h y r o id t., due to excess absorption of th yro xin into the blood, toxin {to k s'-in ). A n y poison ous nitrogenous com pound, usually referring to that produced by bacteria. T . a n tito x in , a m ixture of diphtheria toxin and an ti toxin used to produce im m u n ity to the disease. Called T . A . m ixture. T. to x o id , containing both toxin and toxoid, toxoid {to k s-o id '). A formalinized toxin used to produce im m u n ity to d ip h theria. trabecula {tra h -e k'-u -la h ). A divid in g band or septum, extending from the capsule of an organ into its interior and holding the function ing cells in position, trachea { tra k-e'-a h ). Th e windpipe : a cartilaginous tube lined w 'th ciliated mucous mem brane, ex tending from the lower p art of the la ry n x to the

H o w f o o lis h y o u m e a n in g keep

fe e l if y o u

o f a w o rd !

B a illie r e ’ s

(p r ic e 3 / 2 ).

But you

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( 1) With a Thom as Splint the leg is kept straight ; and so there is no need to place either a pad under or a bandage over the knee joint. (2 ) As I have never seen a stirrup of the type named, I suggest that you take instructions from the Medical Officer in charge of your Mobile Unit. (3 ) The decision on this point also rests with the Medical Officer of the U nit.— N .C .F . A r t if ic ia l

R e s p ir a t io n

w it h

F ractured

R ib s .

F. P. (Sheppey).— In a case of asphyxia accompanied by complicated fracture of ribs, which method of artificial respiration would it be advisable to use ? This point was raised at a recent Divisional Practice, and we would value your ruling on the same. Of course you realise that the diagnosis of fractured ribs, and more especially of complicated fractures of ribs, in an asphyxiated person is a difficult proposition, and that they are often missed in an emergency, Be that as it may, I consider that Schafer’s method is the correct method of artificial respiration in the treatment of a patient suffering from asphyxia and complicated frac tures of the ribs because pressure is exerted on the loins (namely, on the space between lowest rib and crest of ilium) and not on the ribs. On the other hand, Silvester’s method (if properlyapplied) would result in a big pull on the ribs, and for that reason is positively contra-indicated, especially if the fractures of the ribs are already complicated.— N .C .F . T reatm ent

R.J.

F ractured

E lbow

J o in t .

(M azabukea).— Our surgeon-lecturer has told us in treatment of a fracture of elbow joint to “ place the in jured limb across the chest in an elevated position, to tie on a narrow bandage round the wrist, then to take the same round the neck, and to place the limb in a St. John S lin g .” This method, our lecturer maintains, would meet with approval from medical men, even though it is not in accordance with the instructions on p. 84 of the T e x t book. I welcome your views.

On your statement of facts I heartily disapprove the method suggested, partly because it encourages first aiders to flex the elbow joint, whereas the Textb ook method teaches them to leave the joint in a natural position with forearm at right angles to arm, and partly because it dispenses with the use of splints, which, in the treatment of fractures of the limbs by first aiders, are so necessary “ to keep the joints above and below the fractured bone at rest.” Another cogent reason against your adoption of the method (which some surgeon-lecturers ignore) is that, in a St. John examination the surgeon-examiner must adjudicate strictly in accordance with the instructions of the Textbook. In short, were I the examiner and a candidate treated a fractured elbow as suggested, I would plough him forthwith and without reference to the views of the surgeon-lecturer. Consequently, surgeon-lecturers should stick closely to the Textb ook in their instructions to students preparing for St. John examinations, and not— as so often happens, if rumour is true— give free play to their own fads and fancies. Otherwise, uniformity of instruction (which has always been regarded as a most important feature of the St. John Syllabus) would be ended.— N .C .F .

T reatm ent

o f

F ractured

M etacarpu s.

R .P . (Mazabukea).— In the treatment of fractured meta carpal bones of the hand our surgeon-lecturer suggests that, having placed a soft, yet large, pad on the patient’s

AID hand, we should gently close the fingers, tie off with a triangular bandage for the hand and place the arm in a sling. This method our lecturer prefers to treatment by splint as laid down on p. 86 of the Textbook, on the grounds that the natural roundness of the hand is maintained. Y o u r help will be appreciated. On your statement of facts I gather that your surgeonlecturer expects you to make an exact diagnosis in all cases of crushed hand. That being so, then his suggested method is sound. The Textbook, however, is not so certain of the powers of exact diagnosis on the part of first aiders. Consequently, it sets out on p. 86 a method which will satisfactorily control fractures of the metacarpus and also of the phalanges, whereby the task of the first aider is simplified and not complicated.— N.C. F. T reatm ent

A nt

S t in g .

C .B . (Kidlington).— Recently I had to treat a patient who had been stung on the lower lip by an ant. As the lip was considerably swollen, and as I did not like to apply ammonia so near the patient’s mouth, I painted it freely with iodine. This treatment seemed quite suc cessful, as there was no further trouble from the sting. T he Textbook says nothing about stings of the lips ; and so I wonder if my treatment was correct. No fault is to be found with your treatment, which was evidently successful, even though the application of tincture of iodine was omitted from the current edition of the T e x t book. Further, if the sting was on the dry and sensitive mucous membrane of the lip, the iodine might have proved irritating. For this reason I would have used one of the remedies now named in the Tsxtb ook (p. 181 ).— N .C .F . H umour

F ir s t

A id .

D .P . (Wembley).— Have you heard the answer which was given in an examination ? The candidate was asked to state how a Colles Fracture occurs ; and he replied :— “ A Colles Fracture results when a charwoman stands on a chair and throws herself on the ground on her w r is t!" Some charwoman ! ! Good !

Next, please ! !— N .C .F .

S im p l e

F racture

o f

B oth

C l a v ic l e s .

G. B. (Bromley).— Please tell me how we should treat simple fractures of both clavicles. I find no reference to this combination of injuries in the T extbook ; and so I ask your kind help. The treatment of this combination of injuries was last described in the 20 th edition of the Textbook, and was afterwards omitted, obviously because it was a very rare accident. T he instructions then read as follows :— “ When both collarbones are broken keep the shoulders back by narrow bandages tied round each arm close to the shoulder, passed across the back, over the opposite arm and tied together in front. T he forearms should be raised and supported by the bandages.” — N .C .F .

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Assistance Required A .R .P . First Aid Services Yorkshire Collieries Ambulance L ea gue ... St. Andrew’s Ambulance Association Are You Ever Stumped for a Word ? . . Pan American Red Cross Conference S .J.A .B . Headquarters and District Reports Dangers of the Tourniquet A .R .P . Topics “ First Aid for W a r Casualties ” Priory for Wales T he Meaning of Words Books for the Shelter ... Reasoning Railw ay Ambulance News Thanks to the Doctor ... Capt. S. T. Beard, O .B .E . Reviews Red Cross and St. John W a r Organisation Our Nurses’ Page Q u e r ie s

an d

A n sw ers

81 82 83 83 83 83 84 85 86 86

87 89 90 90 92 92 92 94

C orrespondents

The Saluting of Officers Examination Howler Application of Tourniquet ... Spats in Treatment of Fractured L e g Collapse of L u n g from Blast Schafer’s Artificial Respiration Cycle Tu b ing as Ligature ... Treatment of Shrapnel in Abdomen Disinfecting Fluid Poisoning Medal Ribbons

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CON TEN TS

NOVEM BER,

No. 557.— V o l . X L V II. N O T IC E

GEORGE

96 96 96 96 96 98 98 98 98 98

M e m b e r s of v o lu n ta r y first aid o r g a n is a tio n s are to-d ay lackin g tw o m ain t h i n g s — finance and a c c o m m o d a tio n . A t no p reviou s tim e has the e n t h u s ia s m for the m o v e m e n t been so g r e a t as it is to -d ay , but lack of e sse n tia ls is s e r io u s ly b e c o m in g acute. In Sheffield, for in sta n ce , w e are told that the w ork is h an d ic a p p e d by lack of a c c o m m o d a tio n , and that c la s se s h a v e had to be held in g a r a g e s and even the caretaker’s k itchen at H ead q u ar te r s. A g a i n , fu n d s are e s se n tia l to carry on the w ork. In peace tim e social f u n c tio n s did m u c h to increase the financial a sse ts, but to-day w ith early black -ou t, increased ta xatio n and the like, m a n y d iv is io n s are e x p e r ie n c in g a very t r y in g tim e in an e n d e a v o u r to m ake e n d s m eet. W i t h decreased in c o m e the w ork of the o r g a n isation has g r e a tly increased. A l t h o u g h the work u ndertaken is v o lu n ta r y , it m u st be r e c o g n ise d that o u t-o f-p o c k e t e x p e n s e s of in d iv id u a l m e m b e r s s h o u ld be repaid, and that th e y s h o u ld not be e x pected to g i v e their tim e free in ad dition to their k n o w le d g e , and to pay a lso for the p r iv ile g e of so A ssista n c e R eq u ir ed .

d o in g . M a n y local au th orities are fu lly aw are of the present c o n d itio n s and do all t h e y can to a s sist the d iv is io n in their district, either by p r o v id in g a c c o m m o d a t io n free of c h a r g e or m a k in g a g r a n t to the fu n d s. U n fo r t u n a t e ly , s u c h a u th o r itie s are few , and the m ajority of d iv is io n s h av e to carry on as b e s t th e y can. T h e c o u n tr y certain ly o w e s a g reat debt of g r a titu d e to a m b u la n c e a s s o c ia t io n s t h r o u g h o u t the B r itish Isle s. In 19 35 , w h e n th e H o m e Office ask e d them to u n d erta k e certain A . R . P . in str u c tio n s, th e y did so w ith a c h eerfu l heart. C o n s e q u e n t ly , the n u c le u s of A . R . P . s e r v ic e s w a s , e v e n th e n , an e s ta b lis h e d fact. T h e r e fo r e ,

FIRST

would it be too much to expect that the Govern ment will now reciprocate with financial assistance through the County Officials? Without

the voluntary ambulance

associa

tions the present A . R . P . services would be a very poor show ; therefore every assistance should be extended wherever possible.

A.R.P. First Aid Services. B y

O ur

S p e c ia l

C orrespon d en t.

month’s postbag- has been gratifyingly heavy, and it is now becoming practically impossible to reply to corres pondents individually ; nevertheless, both the Editor and I sincerely hope that readers will continue to send in their criticisms and remarks, so that we may put forward any useful suggestions to the responsible authorities. Readers will be interested to learn that these colnmns are lead regularly by several of the officials responsible for A. R. P. organisation, and we have good reason for believing that our comments have played an appreciable part in improving boih the efficiency and the amenities of the A .R .P . First Aid Services. Moreover, these columns constitute the only national “ public platform ” open to the personnel and, although all the criticisms and suggestions received may not in themselves be suitable for publication, nevertheless, they collectively enable us to keep our fingers on the pulse of the services and thereby obtain collective impressions which would be beyond the scope of a single local authority. Some time ago at a group regional meeting, I made the suggestion that in each area there should be a central clearing station for equipment. The need for this is becom ing more essential each day, because although the present scheme allows for the exchange of stretchers and blankets when patients are received by ambulance, it does not provide for the replacement of equipment such as hot-water bottles, splints, and even triangular bandages which might be used again. T he sister-in-charge of one of my local Mobile Hospital Units recently informed me that after attending two incidents, six hot-water bottles were missing and that there is difficulty in having these replaced. T he solution is quite simple. All equipment which cannot be exchanged or replaced at the time of transfer should be plainly marked with the name of the post to which it belongs. After the incident has closed, each post will examine the equipment in its possession and transfer all items marked with the name of other posts to the Central Clearing Station, where all such items can be sorted out and returned to their original owners. Several pertinent suggestions have been received from readers in connection with Stretcher Parties T he question of suitable clothing and the responsibility for its provision has been raised in more than one letter. Stretcher bearers have, in most cases, been supplied with just one suit of A .R .P . overalls, and apparently no more are to be issued. Overalls either enable the personnel to dispense with ordinary outer clothing, or at best to protect under-attire. No provision is made, however, for inclement weather which might result in all the individual’s clothing becoming wet, possibly compel ling him to wear his only “ respectable ” suit for working purposes on the next occasion— with possible serious detri mental effects. T he suggestion is tha each stretcher bearer should be provided with a spare suit of overalls, and that moreover, there should also be an issue of underclothing, socks and even boots, to enable the individual to change if necessary. Spare underclothing is provided to the men of the fighting forces, and to those readers who might query the T h is

AID advisability of the suggestion on the grounds that the A. R. P. Personnel are paid at a higher rate, I would point out that the relative “ gross ” remuneration of the men of the fighting forces and the A .R .P . workers was fully dealt with in a previous article, and that the value of the extra pay received by the latter is more than balanced by the benefits received by the former in other directions. A prominent A .R .P . official writes to say that he would like to see some sort of military organisation among the stretcher parties. He suggests that each four or six parties should be under the control of a sergeant, and that each eight to twelve parties should be under a warrant officer, who might even be an official of the local authority. More over, he further suggests that the leading men of each squad should be given extra pay, say 5/- per week, not only as a recognition of his extra skill and ability, but because of the psychological effect on the other members of the party, many of whom are unable to reconcile themselves to the idea that a man can be a superior N .C .O . and yet receive only the same rate of pay. For a like reason, the same correspondent finally writes that he would like to see the Medical Officer at each first aid post wear a uniform or overalls with special distinctive markings. I would add that my correspondent is also one of the outstanding figures in the world of first aid, and that he has modestly requested me to refrain from pub lishing his name. I must add, however, that any su g ges tion coming from such an experienced source, must be treated with the greatest of respect ; and I am sure my readers will endorse the views expressed. This month I want to deal with an aspect of first aid work which is causing much concern to first aid posts. These posts were established for the purpose of dealing with suitable war casualties, but certain factors were either not anticipated or taken into consideration. Firstly, the public fails to differentiate between a casualty due directly to an air raid, and one which simply occurs during the raid. The man in the street cannot understand why— should he slip off a kerb in the black-out— he is compelled to seek a doctor or go to hospital (no easy task when bombs are falling and the A.A. guns are in action), while the individual who receives even a minor injury as a direct result of enemy action, is welcomed with open arms in the first aid post. He might even argue that but for enemy action (even if only anticipated) there would have been no black-out and, therefore, presum ably, no fall. Certain officials endeavour to draw a dogmatic line between the war injury and the non-war injury but, un fortunately in practice, the problem is not quite so clean cut. One should remember that notices indicating first aid posts do not specify “ for war casualties only,” and often non-war casualties have been taken to these posts by passers-by, police and wardens. It seems somewhat inhuman to send these people aw ay to seek other medical aid— usually under conditions of great difficulty and danger— when all facilities are ready to hand, apart from the fact that the delay may seriously prejudice the patient’s recovery. Fortunately, most doctors treat the patients first and ask questions afterwards, but this does not overcome the fact that the scope of the first aid posts should be extended at least during an active air raid. In further support of this, it must be remembered that by lightening the work of the hospitals, the first aid posts are enabling them to devote more time to “ orthodox ” casualties, thereby increasing the efficiency of their services. Secondly, it must be borne in mind that the alert periods are of much larger duration than originally anticipated, and that therefore even w alking casualties may have to be detained at a first aid post for many hours, as one cannot reasonably expect them to proceed home or even shelter while the raid is still in progress. Many posts have no facilities for dealing with lengthy visitors, and are unable to afford either rest, shelter or refreshment. There is also the additional factor that heavy cases of minor shock reach the first aid posts— in some cases needing simply two or three

hours’ rest and warmth. It seems so unnecessary to burden the hospitals with these relatively minor cases and yet in many first aid posts there are simply no facilitites available. Lastly, there arises the question of after-treatment. Casualties are usually advised to see either their own doctor or to proceed to hospital for further advice and treatment. T h e hospitals are already working at full pressure, while in the “ r a i d ” areas the doctors are working hard under conditions of the greatest difficulty owing to their deputising for colleagues away on active service, interruption of trans port facilities, attendance at A .R .P . posts and the shorter number of available working hours because of alerts and early black-out, which have practically eliminated the even ing surgeries in the raid areas. The already busy practi tioner who devotes much time to re-dressing wounds will do so at the expense of the numerous other patients who will be waiting to receive attention— again to the general dis advantage of all concerned. As an example of the difficulties which arise in this connection, I would mention the further administration of anti-tetanus serum which is necessary in so many cases. Not one doctor in a thousand stocks the necessary fresh serum (owing to the difficulty of storing it and the wasteful ness which would ensue if the serum were not made within a short period of time). The patient is, therefore, referred either to the hospital or a first aid post ; and surely the first aid personnel would not refuse to re-dress a wound while the patient was actually attending the post for this injection. I strongly suggest that the time has arrived to revise the functions of the First Aid Posts in view of recent develop ments. They now form an important part of the scheme of the social services, and it will be a tremendous pity if their uses are limited purely because of technical reasons. The only thing that matters is the health of the population, and if the first aid posts can contribute towards this aim, they should be given every facility and encouragement.

Yorkshire Collieries Ambulance League. finals of the first year competitions were held at Don caster on October 26 th, Major H. J. Humphreys, H.M. Divisional Inspector of Mines, presided. The “ Lane Fox ” Shield was won by W ath Main with 240 marks (possible 299 ), followed by Dinnington, last year’s winners (204 ), and Frichley ( 180 ). T he individual “ Embleton ” Cup was won by J. W. Bourne (Wheldale). Dr. J. B. McKay, of Bolsover, who judged the work, congratulated the team on their proficiency. Mr. P. W. Ellis (General Manager, Dinnington Main Colliery), presented the shield to the winning team, whilst Mrs. Ellis presented the cup. The Chairman appealed for more ambulance volun teers. “ There is no doubt,” he said, “ that first aid work is more important than ever it was, because every shift lost through injuries weakens the national effort, whereas the sooner we get a man back to work it is helping the national cause.”

T he

T h e following lectures will be held at 181 , Maryleboneroad, N . W . l :— Home Nursing, every Monday and Th u rs day, commencing on Nov. 18 th, at 4 p.m. Lecturer, Miss Thomas, S .R .N . ; fee Ss. ; examination, Dec. 12 th. First Aid, every Tuesday and Friday, commencing Nov. 19 th, at 3.30 p.m. Fee Ss. ; examination, Dec. 13 th. Full particu lars from Div. Supt. W. V. M. Allen, 58/5 Division, S .J .A .B ., 181 , Marylebone-road, N . W . l .

St. Andrew’s Ambulance A ssociation. Mr. James H. H. Henderson, general secretary of St. Andrew’s Ambulance Association, attended a special parade of ambulances which had been presented to the Association at Ochilview Park, Larbert, on Saturday, October 12 th, and accepted on behalf of the Association two fully equipped w a gg o n s presented by the employees of Walter Alexander and Sons. The vehicles, named Bluebird No. 1 and Blue bird No. 2 , were handed over by Mr. Thom as M ’Main, traffic superintendent. Further handsome gifts to the Association were announced by Mr. Allan Hannah, Larbert, chief ambulance transport officer for the Southern Highland Command Area In addition to a fully equipped ambulance given by the directors of Smith and M’ Lean, Gartcosh, Mr. Hannah received a cheque for ;£/400 from Mr and Mr. W. F. Morrison, Crown Inn, Stenhousemuir, to purchase a w aggon which will be named “ T he Elizabeth Am bulance.” Stirlingshire No. 1 District Council (Bannockburn) have presented an ambulance to the St. Andrew’s Ambulance Association. This is the fourteenth ambulance for which funds have been raised in the county, from which a motor canteen has also been presented These gifts have been made at a cost of about ^£,5 , 600 . The South Highland Area of the St. Andrew’s Am bu lance Association have now taken over at Stirling 25 ambu lances presented by the Canadian Red Cross.

Are You Ever Stum ped for a Word? D o you know that new medical words are alw ays being coined ? T he number per year runs into thousands, and some of them are long, difficult to pronounce and still more diffi cult to understand. Some too are just super-technical jargon, such, for instance, as odontosmegma, which is nothing more than a technical name for tooth powder or paste, and of very little use to anybody. L ong words of this kind are often not understood even by doctors, and are rarely used, but there are many words in daily use which first aiders ought to know, and, as we announced last month, we are go in g to give a list of such words in each issue of the Journal. T hey will be all words you ought to be able to pronounce and understand, and it will be useful to study them and memorise their meanings. Here are six such words. See if you know them, and if not turn to page 88, where you will find them explained and with their pronounciation. Antitoxin. Sepsis.

Corpuscle. Stertorous.

Haemoptysis. Thermotaxis.

Pan American Red Cross Conference. P l a n s are being rapidly completed for the Fourth Pan American Red Cross Conference. T h e meeting will be held in Santiago, Chile, beginning December 5 th, 1940 . T h e Pan American Conferences are regional meetings organised by the L ea gu e of Red Cross Societies to bring together representatives of the Red Cross Societies of the Americas for discussion of the problems arising out of their similar geographic, economic and social conditions. Previous conferences have been held in Buenos Aires, Washington and Rio de Janeiro, and the fourth in Santiago, Chile, will be specially important in view of the problems associated with war in other parts of the world.

FIRST

S t . J o h n A m b u la n c e B r ig a d e HEADQUARTERS No

AND

D IST R IC T

R E P O R T S.

II District C h eltenh am .—

Asst. Commissioner H. J. Lewis recently inspected the Cheltenham Town Ambulance and Cadet Divisions. Mr. Lewis also took the occasion to present Service Medals to four members of the division— Sergt. W. Herbert, Corpl. A. Ford, Ptes. Morgan and F. Taylor. T he inspect ing officer said it was a great pleasure to him to visit his old division and to present the medals to the members who had not only given 15 years efficient service to ambulance work, but had by their comradeship received unhesitating recom mendation for their present honour. He recalled the pleasant times he had spent with the Division, many members of which were with the Services, he especially mentioned able seaman “ J o c k ” Taylor of H .M .S . Ajax. All members of the Division were engaged in A .R .P . work and many spent their nights staffing F. A. Posts. Mr. Lewis also congratulated the Cadets on their efficiency and smartness. • Supt. Thornbury in thanking Asst. Commissioner Lewis said that the one regret was the loss of Dr. McFarlane Pollard, who had been called to higher service. Corps Officer VV. Ball also congratulated the recipients of awards. He had given 35 years service to ambulance work and was certain that it kept him, as it did others, young in spirit. He thought that the cadets had started well on the w ay towards a life of assistance to those who were unable, through accident and illness, to assist themselves.' During the evening, certificates were presented to Ptes. Folca, Frieth, Matthews, Cressy, Adams, White, Robinson.

N o . IV District C l i t h e r o e . — A pleasant little ceremony took place at the headquarters of the Clitheroe Division last month, when Div. Surgeon J. Sepleton Cooper, a position he has occupied for 15 years, was presented with a silver medal to commemorate his valued services. Supt. N. Dixon presided over the large gathering, whilst Mr. L. King-Wilkinson, President of the Association, was entrusted with the presentation. The Mayor (Councillor Bentham) supporting, recalled the fact that it was 9 years since Dr. Cooper and himself fought a municipal election together, when the Doctor was returned by a large majority. After paying tribute to the sterling qualities of Dr. Cooper, the Mayor paid further tribute to the work of the Brigade. Expressing his pleasure at the receipt of the token, Dr. Cooper said that all through the fifteen years of his associa tion with the Brigade, he had received kindness and help from everyone. At the moment, the Brigade had a total membership of 120, with about an equal number of either sex, which was the largest in the history of the local corps. T hey were all helping in A .R .P . work, and periodically turned out when the sirens wailed, to spend many weary hours aw aitin g their dismissal. And nightly, two members were sleeping ot the First Aid Depot, so that there was somebody on the spot immediately an emergency arose. Th a n k s to the President and to the Mayor were pro posed by Dr. Murray and seconded by Lady Supt. Mrs. Allen.

N o . V District S a d d l e w o r t h .—

Recently members of the Saddleworth

AID Ambulance and Cadet Division gave a demonstration in aid of the local “ Spitfire ” fund. The Cadets commenced proceeding with simple frac tures after which the adult members followed with the more complicated fractures, including the application of the Thomas splint, and also artificial respiration. Councillor A. Wield, J.P., Chairman of the Council, presided and was supported by Councillor J. J. Burridge, J . P . , President of the Association. The Cadet Division was formed on May 7 th last, whilst a Nursing Division was formed on Sept. 4 th.

R u d d i n g t o n . — Although only registered in the spring of this year the Ruddington Division on October 16 th had the satisfaction of seeing permanent headquarters opened by District Officer A. G. Weller, who referred to the pleasure with which he had watched the growth of the Brigade in the Ruddington area, He paid tributes to the work done by Supt. Turney and Mrs. Turney, by Mr. Mahon, now with the Forces, and by Mr. John Smith, who was shortly to take over the duties of hon. secretary of the Division. He congratulated the Ruddington people on the success ful conversion of stocking frame rooms into ambulance headquarters, and said they must now aim at obtaining an up-to-date ambulance for service in the district, and the formation of an Ambulance Cadet Division, The nucleus of this latter had already been trained by Private S. Adams of the Gotham Division.

N o t t i n g h a m . — Awards gained by members of the Nottingham Corporation Electricity Division were presented by Corps Supt. F. Wilson-Moulds and Corps Secretary J. E. Potts, at a social function held on October 29 th. Mr. M. Wadeson, Deputy City Electrical Engineer, presided, supported by Dr. R. G. Sprenger and Supt. T. M. Ward. The awards consisted of 33 vouchers, four medallions and six labels. Ninety-six members of the Division, 24 of whom are now serving with the Forces, among other activities, pro vide orderlies and stretcher bearers at the General and other local hospitals, and assist in the ambulance training of air raid wardens, the casualty services, and Boys’ Brigade. Most of the members are enrolled with the city A .R .P . services. Fifty-four members of the department are registered donors under the Nottingham blood transfusion service and have so far given 18 pints of blood this year.

N o . VIII (D uke o f Connaught’s) District C h i c h e s t e r . — T he annual meeting of the Chichester Division was held on October 14 th, when the President, Dr. A. M. Barford, presided, supported by the Mayor (CounW. L. Stride), Drs. L. Heacock and A. Calcart, Supt. H. Bridle, Lady Supt. Mrs. Buxton, Hon. Secretary R. Gambrill and Hon. Treasurer L. Shepherd. Since the outbreak of war the division had performed ordinary duties and, in addition, new duties in connection with the evacuation of school children and mothers from London. A .R .P . w ork took up much of their lime, and many members spent hours at F.A. posts and hospitals. An increase in the removal of mothers to maternity hos pitals added to the work of the ambulances in the first month of the war, throwing a heavy strain on the depleted numbers of the Division, which was justly proud of its record of members serving in the Forces. New members had been enrolled, and with a strength of 50 active members

FIRST were able to maintain complete ambulance teams for week end duties. A total mileage of 12,670 was covered by the ambulances, and the number of cases attended was 682 . T he President congratulated the Division on really wonderful work, without which many lives would have been lost. He pleaded for more volunteers for first aid posts in the city. Supt. Bridle expressed gratitude for the assistance the Division had received, particularly from the Nursing Divi sion. That evening saw the realisation of a boyhood’s dream, for they had a “ full h ou se” of men’s and women’s divisions, and boy and girl cadets in training. In addition, the gift of ^J300 from the estate of Observer Sergeant Tony Catton would enable the Division to obtain post-war headquarters as a memorial to “ a fine young English gentleman.”

P o r t s l a d e . — To mark the passing of 1 8 months since their establishment the Portslade Division made a presenta tion to their Divisional Surgeon, Dr. E. N. G. Gorman. The presentation, which took the form of an electric clock, was done by Mr. F. Hillman, the President of the Division. A bouquet was handed to Mrs. Gorman. Mr. Hillman spoke of the excellent work done by the Division, which has now 33 members, and stated that the Commissioner had highly praised the efficiency of the Division and the standard of its equipment. Mr. W. E. Phillips, a Vice-President, spoke of Dr. Gorman’s work ; and the A .R .P . Officer, Capt. C. H. Siercombe, described the first aid work for A .R .P . as excellent.

W e regret to announce the death of Corps Secretary W. A. Ward, who passed away on Friday, October 25 th, at the a ge of 62 . Mr. Broad joined the Erith Brigade in 1906 , and, after being promoted Corporal, transferred to the Sheerness Divison in 1912 . Sergeant’s stripes followed in 1914 , and in 1921 he was promoted to Staff Sergeant. Three years later he became Ambulance Officer, and in May, 1935 , was appointed Super intendent of the Division. T w o years a go he was appointed Corps Secretary, and much of the progress achieved by the Corps and the Sheerness Division can be attributed to his untiring efforts. His efforts were recognised by the Order of St. John when, in 1936 , he was invested by the K in g at Buckingham Palace. He also possessed the Service Medal and three bars. Officers, N . C . O . ’s and men of the Sheppy Corps paid homage at the funeral, the coffin being draped with the Brigade flag and borne to the grave by members of the Corps. Is l e

o f

S iie p p y

C o r p s .—

N o . IX District H o n i t o n . — T he Mayor of Honiton (Mrs. J. M. Phillips) praised the w ork of Honiton Division when she distributed awards at the annual presentation. Supt. G. Hornett spoke of the satisfaction which had greeted Mrs. Phillips’ decision to accept the Mayoralty for another year. He pointed out that the Brigade was quickly gaining experience, and was more ready than ever to cope with any emergency. Members offered congratulations to their oldest member, Sergt. L. G. Hallett, who had received recognition of 12 years’ service. Proposing a vote of thanks to the Mayor, the President (Mr. G. K. Weeks) paid tribute to the work of the hon. divisional surgeon (Dr. H. D. Hoffman). All the 27 mem bers who entered the recent examination were successful.

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Dangers of th e Tourniquet. B y J O H N F. E U S T A C E , m . b . , d . p . h . , in the Irish Ambulance Gazette.

ideal tourniquet for First Aid W ork has yet to appear, and all existing types in use at the moment are not free from danger. These dangers are :— 1. Gangrene.— (Death of the tissues of the limb). It is easy to understand how, if the blood supply is cut off from the limb, the death of that limb will inevitably result. The time gangrene takes to appear varies in different individuals but it occurs more rapidly in the upper than the lower limb. It may appear in one hour in the upper limb and four hours in the lower limb. If the limb is kept cool, the onset of gangrene is delayed, as it retards the clotting of the blood in the limb and discourages the growth of bacteria as well. Gangrene appears first at the extremities (toes, fingers) and spreads upwards. If infection is present, wet gangrene will result and this makes the outlook much worse. T he

2 . Nerves.— As an artery is frequently accompanied by a nerve, excessive pressure from a hard pad against a bone can cause crushing of the nerve, giving rise to paralysis, either temporary or permanent. T he St. John tourniquet can be an offender in this category. 3 . Artery.— The same pressure may cause the coat of an artery to be injured, possibly resulting in clotting within the blood vessel. 4 . Bleeding.— Tourniquets may slip or not be applied sufficiently tight and they then d ose the veins but not the arteries causing swelling and blueness of the limb. Surgeons have been heard to say that they have stopped more bleeding by removing tourniquets than by applying them. 5 . Infection.— T he white blood cells are necessary to fight infection and if they are denied admission to a limb, as when a tourniquet is in position the bacteria can grow with greater freedom and sepsis will occur. 6. H e alin g.— T he blood normally brings the necessary food and oxygen supply to the body and if any part of it is cut off from its blood supply, the healing process will be delayed.

7 . Shock.— Some degree of shock is caused by the pain of the tourniquet and in cases where a hard pad is used, the resulting bruising of the tissues will increase the degree of shock. It is difficult to avoid all these dangers, in fact it is impossible to overcome some of them, so it seems desirable that the tourniquet should be used as seldom as possible and then only in cases of obvious arterial bleeding. It is as well to bear in mind however, the fact that though the tourniquet has disadvantages, it may and will save lives. T he ideal tourniquet should be broad, not narrow, and should exert elastic pressure on the limb, and the pad, if one is used, should be of some soft material, preferably rubber and should be applied above the wound of course, but as low down the limb as possible. One tourniquet which has received much praise and which is very simple, consists of six feet of a three inch wide elastic bandage, which is wrapped round the limb, each turn tightening on the preceding turn. This is an excellent device and requires no pad, but it is open to the objection that it is difficult to release to see if the bleeding has stopped at the end of twenty minutes. Most bleeding can be controlled by direct pressure or by continued digital pressure on the main vessel till the service of a surgeon can be obtained.

FIRST

A.R.P. Topics. Recent instructions issued by the Ministry of Home Security deals with numerous items. I n c e n d ia r y

B o m bs.

These, and fires caused by them, are best dealt with by the stirrup pump. T he spray deals with the bomb itself and the jet the fire caused by the bomb. No other device is so con venient, states the leaflet, because (1) the pump is cheaper than an extinguisher ; (2) it can be used by a person crawl ing towards the fire, as he should, or climbing a ladder, (3 ) it can be made to play upon the bomb or the fire at choice ; (4 ) the supply of water can be renewed by people out of range of the fire.

AID Q u e s t io n s

F ir e

E x t in g u is h e r s .

Not normally suitable for bomb as the contents, when recharged. Further, some designed to be thrown on a fire E x t in g u is h in g

dealing with an incendiary used, must be refilled and “ grenades ” or “ bombs,” produce poisonous gases.

P ow ders

These are of very limited value : they cannot deal with the fire caused by the bomb. G lass

S p l in t e r s .

Many casualties have been caused by glass flying in all directions and it is suggested that the best method to prevent this scattering is net fabric, like lace curtains, or fabric of any kind or transparent film or stout paper stuck to the whole surface of the glass and to a margin of the window frame. Another suggestion is strips of lace curtain or fabric of any kind or transparent film or adhesive tape stuck on at intervals of not more than 4 ins. each way. Paper strips are of little use unless the paper is thick and tough. A suitable adhesive is described as follows :—2 level tablespoonsful of plain or self-raising flour should be mixed with 3 tablespoonsful of cold water to make a smooth paste ; then mix in a piece of washing soda about the size of a large almond. Add half-a-pint of boiling water to mixture and stir briskly. Heat in a double saucepan for 10 to IS minutes. Use when fairly fresh. Liquid preparations vary in effectiveness. Buyers should know that of those tested a number have been found to be ineffective from the start, that very few of the remainder retain their protective value for more than two months. Only those preparations approved by the Building Research Station of the Department of Scientific and Industrial Research, should be purchased. M u star d

G as

B u rn s.

Bleach ointment should be bought for the treatment of mustard gas burns. Eyes should be washed with a solution of a teaspoonful of salt or bicarbonate of soda to a pint of warm water. Most extravagant claims are made for proprietary preparations. Some of the ointments and lotions sold are not better than the bleach ointment : others are not so good. Remedies which neutralise mustard g a s should not be applied to the eye. T he advice contained in the leaflet concludes with reference to the fact that in choosing appliances and pre parations for A .R .P . purposes it is safest to follow the advice given in pamphlets issued by the Ministry and, particularly, in “ Air Raids ; what you must know, what you must do ” (4 d. post free) and “ Y o u r Home as an Air Raid S h e lte r ” (4 d. post free).

A n sw ers.

What is meant by a true ga s ?

A. The term “ true g a s ” is peculiar to A .R .P . literature and is not a scientific term. There is no clear division between the liquid and solid states ; or between the solid and gaseous states. T he gaseous state is the most diffuse state of matter, in which the molecules have an almost unrestricted motion, so that a true gas may be defined as a substance of which the volume increases continuously and without limit as the pressure on it is continuously reduced. It is a ques tion of the cohesion of the molecules ; great cohesion, solids ; medium cohesion, liquids ; and diffuse cohesion, gases. Q.

C h e m ic a l

an d

The following questions were sent in by a reader and have been answered by Capt. A. C. White Knox, M.C., M .B ., Ch.B .

What qualities must a true gas possess ?

A. In A .R .P . literature the term is used to denote an aeroform fluid characterised by the property at ordinary temperature of occupying the total volume of any vessel into which it is introduced, Simply, a g a s is a vapour which occupies the complete volume of any container. Q.

W ha t other true gases are there other than Chlorine and Phosgene ?

A. During the 1914-1918 war about 3,000 chemical poisons were examined and a large proportion of these were in gaseous form. Of course, there are many gases with which every one is familiar, such as oxygen, hydrogen, nitrogen, carbon dioxide, carbon monoxide, and so on.

“ First Aid for War C asualties.” sales of the above book have been so great that a reprint, after a “ l i f e” of only five weeks, became necessary. This, in itself, is proof of the excellence and essential instructions contained in the book. One purchaser writes “ I thoroughly recommend it to first aid personnel and lecturers ” ; whilst others have expressed, in no mean terms, their satisfaction for the outlay of so little. Major Norman Hammer, the author, has certainly given first aiders that extra instruction so necessary for war time casualties. The contents include treatment of lung injuries caused by blast when artificial respiration is contra-indicated ; instructions on all types of wounds, fractures, the unconscious patient, etc., together with assistance that can be rendered to a woman in sudden child-birth. The cost of the book ( 1/8 post free) has been kept low and within everybodies’ reach ; and orders and remittances should be forwarded to Dale, Reynolds & Co. Ltd., 46 , Cannon Street, London, E . C . 4 .

T he

O w in g to enemy action, Messrs. J. A. Wylie & Co., Ltd., silversmiths and Medallists, have removed to 34 , Elyplace, London, E .C .I , where they will be pleased to receive orders from their clients. It was announced last month that Dr. G. McPherson has made a gift to the Jarrow Division of his second-hand Rolls-Royce car, which Supt. H. J. Hunting has announced will be converted into a new ambulance at a cost of about ^200.

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P r io r y fo r W a le s . A

C r e d it a b l e

Y e a r ’s

W ork.

In issuing the Annual Report of the Priory for Wales, Order of St. John, for the year ended 31 st December, 1930 , the Principal Secretary and Commissioner for Wales, the Hon. John H. Bruce, J.P., D .L ., has addressed an appeal for financial support for funds other than those to be e x pended on specifically war purposes. Priory Headquarters derives no additional benefit from National F lag Days, Special Efforts or other appeals on behalf of the Lord Mayor of London’s Red Cross and St. John Fund, so that it is very necessary at least to maintain income at pre-War standards in order to meet former as well as fresh responsibilities. T he length of the Report is necessarily curtailed in view of the need for economy, but a geographical chart of the thirteen counties illustrates in no uncertain manner the

Photograph by Courtesy]

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which we were prepared by training in the Technical Reserves of the Medical Forces of the Crown, A . R . P . , and more recent openings under the National Service Scheme. When all are doing their bit and pulling their w eight from high to low without thought of reward but as a patriotic duty, it is invidious to apportion praise and assign merit other than the consciousness of well-doing in selfless service. The fruits of action follow love of work for w ork ’s sake, nobly conceived and tenaciously executed. Our whole will is concentrated upon Victory in a just Cause ; and however long the struggle, Right will prevail. W e commend our efforts to the blessing of God in the sure knowledge that He cannot fail the World and His Universe in His own good time. “ The Mills of God grind slowly, but they grind exceedingly sm all.”

P r io r y

H eadquarter

C o m m it t e e s .

Dr. D. Rocyn Jones, C .B . E ., presided at a special meeting of the Ambulance Committee of the Priory for

[ Western M a il

South If ales A Tews

Penarth Nursing Division. Headed by County Officers Miss E. M. Pritchard Williams and Miss V. W. Rees, and Lady Div. Supt. Miss L. V. Davies, Penarth Nursing Division proceeding to a recent iir o li P a r a r l p

volume of work carried out during the past year. The total figures indicate a progressive year in all Departments, viz., 27,595 awards issued to successful examinees in First Aid and Home N u rsin g ; 4,963 A .R .P . awards of the Brigade gained by students trained in classes lectured by Brigade Instructors ; and 11,452 sick room comforts and invalid requisites issued from the Medical Comforts Depots. At the end of 1939 the membership of the Brigade numbered 14,434 (7,742 men, 2,029 women, 3,270 boys and 1,393 girls), of whom 400 male members had been mobilised in the R .A .M .C . in their capacity as Military Hospital Reservists, 1,562 were serving in A .R .P . First Aid Posts, while 277 had been enrolled as Nursing Auxiliaries in the Civil Nursing Reserve. The Report concludes with the following paragraph :— The past year has witnessed a transition from Peace to War, from a condition of preparation for the worst to a calm resolute adjustment to the ordeal of battle under the arbitra ment of force. T he Prior’s peaceful avocations have had to be aligned with responsibilities of a warlike nature, for

Wales, at Priory House, on the 5 th November, called to deal with matters arising from the publication of the new text book by the St. John Ambulance Association on the subject of First Aid in Mines. Members of the D rafting Committee set up by the Priory and the Superintendents of the Mines Rescue Stations in the South Wales Coalfield were associated in the discussion as to methods of popularising the study of First Aid and encouraging proficiency in the subject am ong the Officials and Workmen in the Coal-mining Industry. T h e Hon. John H. Bruce (Principal Secretary and Commissioner for Wales) suggested that the slogan “ Every Miner a First A id e r ” was capable of realisation even to the extent of a majority of workmen tak in g the advanced course, once it has been accorded a status comparablo to that of First Aid. Mr. Llewellin Jacob reported on the assistance given by the Colliery Owners to promote the study of Safety First am ong young boys entering the Industry ; and it was hoped that every inducement would be forthcoming from the various parties concerned to encourage continuity of interest

FIRST

in the more advanced subjects of First Aid and First Aid in Mines. Professor David Jones said there was ample evidence that the Industry welcomed the the new book, of which over 3,000 copies had been sold from the Priory Stores Depart ment ; and thought the Committee could look forward to receiving the fullest co-operation from the new Mining Advisory Committee, which would be dealing with the whole system of Mining education under the asgis of the Technical Advisory Council for South Wales. At the monthly meeting of the Ambulance Committee, held on the 22 nd October, it was reported that the number of examinations and re-examinations in First Aid and Home N ursing arranged by the Priory throughout the Principality during the first nine months of 1940 totalled 1, 131 . A report from the motor ambulance transport sub committee, which met on the 14 th October, revealed that the Priory ambulances had dealt with the removal of 5,034 cases, covering a total mileage of 83 , 816 , during the quarter ended 30 th September. For the first time on record, this total shows a slight decrease in comparison with previous quarters, due principally to the reduction of treatment cases carried ow ing to air raid conditions in certain areas. Sanction was given to the registration of new divisions of the St. John Ambulance Brigade as follows :— Ambulance (Men).— Cardiff Corporation Transport, Cefn Mawr and Llay ( Denbighshire), Neath G. W. R. (Glamorgan). Nursing (Women).— Morfa (Carmarthenshire), C w m grach (Glamorgan), Pontnewydd (Monmouthshire), and Ystrad Rhondda (Rhondda). Cadet N ursing.— Ely and Fairwater (Cardiff), and two provisionally formed nursing units in Carmarthenshire at Llanelly Y . W . C . A . and Dafen. It was decided by arrangement with the Almoner, the Viscount Tredegar, to call a meeting of the Almonry Com mittee, to review the position of the 92 Medical Comforts Depots operating under the Priory for Wales throughout Wales, which duping 1939 dealt with the issue of 11,452 medical requisites and sick room requisites. It is proposed to invite rhe Commissioner of each Centre within the Counties concerned to appoint a male and female representative to supervise the work of the Depots in their respective centres. More than ;£ 5,000 has been spent in the past few years on these Depots, involving responsibility for their proper administration and maintenance. Reference was made to a commendable performance of First Aid rendered during an Air Raid by Private George Mansell, a member of the “ John S u m m e r s ” Division, Flintshire, who continued to apply digital pressure through out a leg amputation in a manner which evoked the highest praise from the Surgeon who performed the operation.

Mr. Morthan G reggs, representing the American Red Cross Society, is staying at Brookby Hall, the home of Lord and Lady Beatty. He is in this country, on a mission of inspection on behalf of the American Red Cross, and has made himself acquainted with the work of the W .V . S. in Leicester. T h e ambulance for which the workers in the Giant Cover Department at Fort Dunlop raised ^J500 in seven w eeks was handed over recently during a lunch-hour in terval there to Colonel Sir Bertram Ford, as representative of the Red Cross and St. John Organisation. Sir Bertram then presented the ambulance to Colonel L. Chevenix-Trench, Officer Com m anding the troops in the area, and Group Captain W. C. C. Gell, of the Royal Air Force.

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The Meaning of Words. H e r e are the meanings of the six words in common medical use which it is suggested on page 83 you should know how to pronounce, how to spell, and what they mean. They are taken from Bailliere’s Nurses’ Complete Medical Dic tionary as this Dictionary is written for first aiders as well as nurses, and is therefore simply written so that all can understand. It only costs 3/2 post free, and is small enough to carry about in a pocket or bag.

Antitoxin / an-tc-toks'-in ) . — A substance produced by body cells, as a re-action to invasion by bacteria, and which neutralizes their toxins. Serum from immunised animals contains these antitoxins, and is used in the treatment of specific diseases, e.g. , diphtheria, tetanus, etc. Corpuscle (kor-p u s'-klj.— A small protoplasmic body or cell, as of blood or connective tissue. Haemoptysis ( lie-mop'-tis-is).-— Coughing up blood from the bronchi or lungs. The blood, being aerated, is bright red and frothy if in any quantity, and if effort is used in ejecting it. If from the lungs, the blood permeates the sputum ; if from the upper tubes, it is only streaked with it. Sepsis ( sep'-sis) . — A term used to describe the condition of infection of the body by bacteria which are pus-forming. Oral s., infection of the mouth which causes general illhealth by absorption of toxins. Puerperal s., that occurring during the puerperium (q.v.). Cf. Asepsis. Stertorus ( ster'-ior-us) . — S n o rin g ; applied to a snoring sound produced in the breathing, in case of cerebral compression, apoplexy, etc. Thermotaxis ( ther -mo-taks'-is) . — The regulation of body temperature by maintaining the balance between heat production and heat loss.

Books for th e Shelter. “ Lamb in Wolf’s Clothing ” by D. M. Wilberforce (Faber Popular Books, 7 /6 ). This book deals with the exploits of a young nurse, who on the eve of the battle of the Somme, disappeared from her hospital and reappeared as an ambulance driver. Later she became an R .A .M .C . Officer’s orderly, and as “ Chalkley,” spent many months at the front as an ordinary soldier until the detection of her sex was made by “ T he Major ” — an out standing character in the book. T he story is full of incidents true to life and makes pleasing reading.

“ The Black Out Murders ” by Leo Grex (George E. Harrap & Co. Ltd., 7 /6 ). Henry Holmes, a middle-aged air raid warden, while on patrol, finds a house with light blazing from an upstairs window. From this setting emanates a story full of interest. A man is found stabbed to death in the house, and Donald Sheldrake, a Journalist, sets out to get the truth from a dead man ! He runs foul of Mesmerico, who, although almost blind in daylight, turned night into day, and became the most dangerous crook in the war-time underground. Death and adventure race together in this gripping story of crime in the black-out, by the author whose Stolen Death was the basic story of the popular film Inspector Hornleigh Takes a Holiday.

FIRST

Reasoning. A n oth er

I n c id e n t B ased

B v C a p t a in

A. C.

for on

W h it e

S tretch er

P a r t ie s ,

F acts.

K nox,

m .c

., m . b . , c h . b .

“ F o l l o w i n g a hectic spell of bombing, you are ordered to a certain street, where two houses have collapsed and casual ties are expected. On arrival you find wardens and police present, and they have established that the only casualty alive is the father of the family, who has been blown up against the fire in the sitting-room grate and is lying groan ing and half covered with debris.”

F irst Reasoning. Do not commence a heated argument with the police and wardens as to whose case it is. Everyone must help ; and the futility of incomplete First Aid Training for wardens first on the spot, so ably pointed out by A .R .P . correspondent in August issue of F i r s t A i d , is obvious. I know of actual cases where the patient waited while this argument was settled. Humanity dictates that all must help first in freeing the unfortunate man and then in expediting his treatment and removal. Remember my previous advice to you in regard to gentleness. Body tissue is extremely delicate and resents unkind handling ; so work expeditiously but nevertheless carefully. Y o u quickly establish that the man’s face is burnt, and blood is showing running down the left sleeve and over his hand. No other injury is obvious. Establish sensibility immediately by speaking to the man. He hears you, but only moans in reply to your queries. Second Reasoning. Order one of your men to immediately cover the burn while you expose the wound. Covering the burn will pre vent aggravation of the pain ; while at the same time you suddenly realise how very difficult it is to say whether the blood is dark red or bright red without a comparative colour and how far apparent blood may travel from its source. Find the source at once by laying open the sleeve when immediately blood spurts out towards you and your diagnosis is obvious. T he wound is in the middle of the forearm and the broken ends of both Radius and Ulna are visible in it. Direct pressure is barred in case you cause further damage by pressing the sharp ends of the broken bones through some other tissue. Immediate indirect pressure is applied on the Brachial pressure point. It should be done by an assistant, leaving you free to carry on with further treatment, which is the application of your antiseptic dressing with the bandage tied lightly. It will be obvious that in most cases where a bandage can be tied only lightly that ir will not be sufficient to stop bleeding by direct pressure. T r y relaxing indirect digital pressure and watch whether blood soaks through the dressing. In this case it does, so replace your indirect digital pressure by means of a firm pad and bandage Note that the pad must be firm. Nine times out of ten they are made so loose that they are quite inefficient and the bandage has to be tied or twisted so tightly as to become in effect a “ S a m w a y ,” obstructing all circulation in the limb. Note also that the femoral artery is the only one that needs a tourniquet always. The brachial only when the arm is b ig and muscular. Though not quite according to book, this method of pad and bandage lash may often save time as your dressing may be sufficient to stop the bleeding and the pad and bandage is not required. l , T he application of your dressing will be done right away, even though the wound was covered with cement

AID

dust. It is futile to attempt the cleansing of a wound at this stage. Many first aiders think that when a bone or bones pro trude through the skin that the limb should not be straight ened. Certainly it should, only not extended. Many first aiders think also that a splint should not be used over the protruding bones, but remember that they do not stick out at right angles, but lie quite flat. Third Reasoning. Well pad the limb and splints so that they shall lie com fortably. Be sure that the forearm is bent at right angles to the arm to ensure there is no pressure at the bend of the elbow. Ensure also that the palm of the hand is towards the chest, so preventing crossing of the ulnar and radius. With lots of padding the splints can be tied quite firmly, and the arm supported in the large arm sling. Remember not to tie the knot at the back of the neck, so ensuring comfort when the patient lies down. Fourth Reasoning. No. 1 feels that the next treatment should be the burn on the face. It is a third degree burn, with the skin com pletely destroyed and no blisters. T he advantage of the dry treatment will be quite obvious in these conditions. Open out a large antiseptic dressing and squeeze from the tube the tannic acid jelly. Do not allow the tube to touch the burn dressing, but run it along in gridiron fashion. Remember your burn at this early stage is sterile. T he burning has destroyed all the germ s on the skin which is burnt, and you must try and keep it sterile by careful handling. When the dressing is applied to the burn, move it slightly to either side to ensure the strips of jelly becoming one whole. Thus you get a thick protecting dressing which seals up the area, prevents the entrance of germs, and the loss of lymph which is so valuable from the anti-shock point of view. This reminds you of the importance of warmth to the patient and you make sure that he is well wrapped up. Keep speaking to the patient. He is recovering, and quiet talking is very soothing. Don't shout at him but encourage him quietly and ask if he has any further pain. It is wonder ful how a patient can help in his own diagnosis and wonder ful how few first aiders really take advantage of this help. As it so happens this patient has no other injury, which you establish by quick examination. Fifth Reasoning. T he patient is an old man. He has suffered from a bad burn and loss of blood, causing considerable shock, there fore he must be moved on a stretcher though perhaps theoretically a w a lk in g case. T he use of the “ T r i g g L i f t ” is tremendously valuable in loading a stretcher in confined space and I find it used more widely than ever. It takes up little space and is quite the handiest lift that I have come across. Note the import ance of fastening your patient on to the stretcher by means of straps or bandages. All stretchers should have them where patients have to be moved over rough ground. Remember my axiom — “ T h e shorter the time between the ‘ incident ’ and the ‘ hospital,’ the quicker the recovery of the patient.” Which means that time must not be wasted in “ fiddling ” ; that all work done shall have an object and that object accomplished efficiently and expeditiously.

A branch of the St. John Ambulance B rigade has recently been formed in the Isle of Man. T h e Hon. Lady County President is Countess Granville, other officers being County Commissioner : Major J. W . Y o u n g , O B . E . ; County Secretary : Sergt. T. D. Lewis ; Lady County Officer : Mrs. M. Y o u n g . Three nursing divisions have already been formed.

FIRST

R a ilw a y A m b u la n c e N ew s. Great W estern. The annual report of the Centre Secretary discloses the fact that during the twelve months ended June 30 th, 1940 , tio fewer than 7,541 members of the staff passed an examina tion under the St. John Ambulance Association, this figure being in addition to a large number of members of the staff who have been unable to take their customary examination ow ing to war service with the Forces. Both at headquarters and in the provinces, large numbers of the staffhave attended the short course of first aid lectures, without taking an examination, in connection with A .R .P . and other activities. A gratifying feature of the year’s work has been the excellent services rendered by the Company’s trained per sonnel, both men and women, in connection with casualty clearings, A .R .P . duties, first aid posts, and in giving short courses of instruction. The ‘ ‘Athlone” Bowl, the trophy awarded to the Division gain in g the highest percentage of new members to the first aid movement in proportion to the total number of staff employed, has this year been won by the South Wales Docks Division with the creditable percentage, considering the difficulties of a w ar year, of 1 ' 88 . The Cardiff Division was the runner up with 1 0 1 per cent. The usual series of competitions organised by the Centre has been suspended until the conclusion of hostilities. During the period under review, one member of the staff has been promoted to the grade of Officer (Brother) of the Order of St. John, eight have been admitted as Serving Brothers and one as Serving Sister, and the Vellum Vote of Thanks of the Order has been awarded in a further case, in recognition of long and valuable services to the movement. T h e following statement shows the examination results achieved in the several ambulance Divisions, and the divisional secretaries are to be congratulated on the satis factory maintenance of the movement in face of war conditions. S um m ary

o f

E x a m in a t io n

R esu lts,

1939-40 .

(July 1st, 1939 to June 30 th, 1940 .) Division

Certificate Voucher

72 London A 10 London B 101 Swindon 22 Bristol A 13 Bristol B 20 Exeter Plymouth 20 21 Newport A 9 Newport B 92 Cardiff' 39 Swansea 2 Gloucester 3 Worcester 19 Birmingham 14 Chester 5 Central Wales *South Wales 108 D ocks Total

570

74 32 115 57 26

59 29 41 18 93 71 22

14 46 45 21

795

AID L i s k e a r d . — The Mayor of Liskeard, Signalman J . H. Pitts, presided at the annual ambulance gathering at the station on October 11 th, and presented examination awards to the class, of which he is a member. One of his first functions on becoming Mayor in 1937 was to preside at a similar function, and it was fitting that at the end of his third year, he should again do so. He expressed satisfac tion that railwaymen, as good citizens, could play their part in whatever emergency might arise. A presentation of a leather dressing case was made by Mr. F. H. Wherly, station master, on behalf of the class, to their secretary, Mr. P. D. L. Moss, who was received with musical honours. An interesting and varied musical programme was contributed.

London, Midland and Scottish. G u r n o s . — At a meeting held in the Girl Guides Hall on Sunday, October 6th, Mr. Thomas, District Instructor and Mr. C. H. Parnell, Agent, both of Gurnos, presented first aid and air raid precautions awards to members of the L. M.S. staff at Gurnos, Ystalyfera and Pontadawe. Mr. B. A. K ingham presided. Awards included 4 vouchers, 1 medallion and 14 labels for first aid and 5 General Public Service and 15 Certificates for A .R .P . A presentation of a shaving outfit was made to Mr. W. Hancock, in recognition of his services as A .R .P . instructor during the past year. Vote of thanks was accorded to Mr. H. Wolfe, Glais A .R .P . examiner and Mr. B. A. Kingham, for presiding.

Arrangements have been made for an L .M .S . Ambu lance Class to be held in the Railway Institute Centre Room, Huddersfield, on each Monday evening during the winter session. Mr. W. Cantwell, Engineering Dept., Huddersfield, is the class secretary.

Thanks to th e Doctor. W e have received numerous letters, and many have been sent direct, endorsing our thanks to Dr. N. Corbet Fletcher for his services as Honorary Medical Correspondent to F i r s t A id .

Medallion

Label

Total

A typical letter is as follows :—

36 18 53 31 13 48

309 315 295 505 227 360 346 296 196 563 618 224 216 403 329 241

491 375 564 615 279 487 415 373 237 785 757 262 242 491 422 280 375

“ 1 have read with interest in this months’ issue of A i d , that as Honorary Medical Correspondent, Dr. Corbet Fletcher has contributed invaluable help for the past 25 years. May I offer on behalf of all our local first aiders, Brigade and Railw ay members, our very sincere thanks and appreciation for his answers. “ As a regular reader of F i r s t A i d , and also from personal contact, 1 realise the value of all his kind assistance. “ W e have all gained much valuable information from these sources which has been of the greatest assist ance to us on numerous occasions ; it also helps to make the study of first aid such a pleasure to us all. “ May he carry on this great help for which we are all so indebted to him ! ”

15 14 37 29 14 9 23 34 13 24

431

211

5,655

7,451

* Winner of Athlone Bowl— South Wales Docks Division.

F ir s t

Tw elve evening classes in first aid and sick nursing have been formed in Edinburgh at various continuation school centres, which in most cases prepare students for the examinations of the St. Andrew’s Ambulance Association.

LOOK

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FIRST

Captain S. T. Beard, O.B.E. As announced in our September issue, Captain S. T. Beard, O .B .E ., has been promoted to the grade of Knight of the Order of St. John. His activities commenced in 1896 when he obtained his first aid certificate in a London and North Western Railway class. He was the founder, in 1898 , of the Brynmawr Ambulance Division of the Brigade, this Division being to-day No. 2 in order of seniority in the Welsh Priory. He joined as a Private and was immediately appointed divisional secretary, and received the following promotions— 1st Class Sergt., 1899 ; Div. Supt., 1 9 0 2 ; Div. Su'pt. Abergavenny Division, 1904 ; Corps Supt., South Wales Border Corps, 1906 ; Staff Officer, County of Monmouth, 1922 ; Asst. Commissioner, 1 9 2 6 ; Commissioner, County of Monmouth, 1933 . Thus it will be seen that he served through the ranks and various offices and so has knowledge of all sides of the work. From February, 1900 , to February, 1901 , he served as a member of the S .J .A .B . with a General Hospital in South

AID He is a member of Chapter of the Priory for Wales and serves on several of its Committees. For a number of years he was Hon. District Ambulance Secretary for the South Wales District of the London, Midland and Scottish Railway, of which Company he is still an official. Capt. Beard’s first aid activities are examples of devo tions to a most humanitarian and christian-like work ; and we trust he will long be spared to carry on.

Reviews. I NJURI ES

THE

J A WS

AND

FACE.

By W. W a rw ick James, F .R .C .S ., L .D .S . and B. W. Fickling, F .R .C .S ., L .D .S . London : John Bale and Staples, Ltd. Price i j s . net.

This excellent book on ja w and face injuries with special reference to war casualties will appeal strongly to operating and dental surgeons who will find it admirable. It seems to supply detailed literature on these injuries and their treat ment ; and it is based chiefly on the extensive experience which fell to the senior author during the last war. The book will also be interesting and instructive to the general surgeon who at the outset will have charge of the patients and who are advised to transfer them at the earliest moment to special hospitals or to special centres attached to the general hospitals. An endeavour has been made in the arrangement of the chapters to follow the sequence of events from the time when the injury is inflicted to the patient’s restoration to normal health. Though the title suggests the limited field of the jaw s and face, consideration of the neighbouring parts, such as nose orbits, pharynx and neck has been included. T he book is splendidly produced ; and its intrinsic value is further increased by some 200 photographs and radio graphs. Captain S. T . Beard, O .B .E . Knight of the Order of St. John. Africa. In 1909 he joined the Military Home Hospital Reserve and became Quartermaster, being mobilised as Lieutenant and Quartermaster in August, 1914 . He served on Salisbury Plain and later with a Field Ambulance of the 25 th Division in France, where he was promoted to the rank of Captain. He was admitted as Officer of the Order of the British Empire (Military) for services in France. He is the proud possessor of South African Medal (Queen’s) ; British W a r Medal, 1914-1918 ; Victory Medal ; 1911 Coronation Medal ; 1935 Silver Jubilee Medal ; 1937 Coronation Medal ; St. John Service Medal and Five Bars ; St. John South African Medal. Acknowledgment of his se ices in the first aid move ment has been given by T he Order of St. John. He was admitted as Hon. Serving Brother in 1909 , promoted to Officer in 1930 ; to Commander in 1935 , and then to Knight this year. He has a continuous efficient service in the Brigade from September, 1898 , up to the present time and was the founder of many divisions in Glamorganshire as well as in Monmouthshire.

Red Cross and St. John War Organisation. F u r t h e r generous gifts have just been received by the Red Cross and St. John War Organisation from the American Red Cross, whose committee in London is established at Brettenham House, Lancaster-place, W . C . 2 .

The gifts include 30 steam disinfectors, each w eighing two and a half tons, of which the first two are already in stalled in emergency hospitals One thousand Radius cooking stoves are being placed in hospital shelters, and 5,000 ampoule-syringes (Syrettes), containing morphia mix ture ready for use in any emergency, will be the means of quick alleviation of pain. In addition, the American Red Cross has given 50 motor-cycle side-car outfits, with all necessary spares, for use by Red Cross and St. John workers on the home front, and 15 one-and-a-half-ton lorries for quick transport of supplies.

FIRST

AID

A D M I T T E D W O M E N 'S

T O

S U R G IC A L

In a flash the accident had occurred. In minutes First Aid treatment was effected at the roadside. Within half-an-hour the patient was x-rayed, anaesthetised, and the fracture set. Sound organisa tion. And yet, it will take three full months before Mrs. Jones will be able to finish the shopping she began that unfortunate afternoon. Three months of daily massage, daily re-educative exercises, daily attendance by a qualified masseur. Black-outs, air-raids, weariness, carelessness, thoughtlessness, are all increasing fracture cases to an alarm ing extent. And each fracture needs the prolonged care of a masseur. And there are 712 different fractures that masseurs are called upon to treat. But fractures are only one group of over 400 different conditions that call for expert massage treatment. Sprains, dislocations, arthritis, paralysis, the list is truly inexhaustible. T he demand is illimitable. First Aid men and women are particularly adapted to this call to massage, and with an hour’s regular study each day, coached and prepared carefully by experienced hospital tutors, and backed by the greatest massage school in existence can, within a few months, be fitted to serve in this new and prosperous profession. Vacancies are occurring at every hour, and an urgent need exists at this moment for trained men and women. To-day is the day of the qualified worker. This chance is your chance. M ake the big effort for big money N O W 1

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To The Secretary, The SMAE Institute, Leatherhead, Surrey. Please send me without obligation, a copy of your free Booklet “ Manipu lative Therapy as a Profession.” N a m e .............................................................................

A d d ress.

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•F .A ." Nov.. 1940.

5 URR E Y

BOO K LET

FIRST

Our N u r se s’ P ag e. C O M PILE D

B Y AN A M B U L A N C E S I S T E R .

Her Royal Highness the Duchess of Kent has com pleted her 50 hours’ training at the University College Hospital, London, and is now a qualified Nursing Auxiliary. She is tak in g duty at the hospital on two days a week. While on duty Her Royal Highness has helped to bandage people injured in air raids. When the D uke of Kent visited the hospital recently his wife was presented to him as “ Sister K a y .”

T he

R oyal

C ollege

N u r s in g .

The Public Health Section of the Royal College of Nursing has just held its annual meeting. A report was then presented on its important investigations in London’s rest and feeding centres, shelters and underground railways during raids. As a result of this first-hand experience of conditions, the establishment of a 24 -hour service of trained nurses in all refuge centres, including the tube stations, was urged. Another valuable war-time activity of the Royal College of Nursing is its study of the health of munition workers. It was pointed out that the industrial nurse has an important part to play in maintaining the health of munition workers, and the college advocates the appointment of Public Health nurses of standing as Officers at the Ministry of Health to correlate the nursing services in connection with both air raids and war work. It is obvious that nurses with wide experience could be extremely helpful to the Ministry in the development of this work.

No. 10

D is t r ic t ,

S.J.A .B .

W i s b e c h N u r s i n g D i v i s i o n . — The becoming uniform of the St. John nurses added a refreshing touch to the dance held at the Rose and Crown Hotel, Wisbech, on Wednesday, October 16th. The event was in aid of Divisional Funds and was organised by the officers of the Division. Competition dances were won by several couples, the prizes being given by Dr. and Mrs. H. L. Groom and Mr. and Mrs. J. Friend. T he Mayor, Mr. H. J. Savory', attended during the interval and gave a short speech on the work being done by members of the St. John Ambulance Brigade. He announced that there was a wire-haired terrier for sale by auction. On bids being invited, many people made offers and gave the puppy back for re-sale. “ Chips ” was finally bought by a Lance-Corporal for £ 6 , and having brought in £ 20, was taken to his home. T h e total proceeds of the dance amounted to £ 55.

N orthern

I relan d

D is t r ic t ,

B elfast

N u r s in g

S o u t h B e l f a s t N u r s in g D i v i s i o n . — Members of the Division attended a meeting of the Windsor Unionist Association at Glengall-street, Belfast, on Wednesday even ing, October 16 th, and gave a demonstration of bandaging. T he audience was very appreciative, and the Division was subsequently warmly thanked for its services.

E a l in g

D iv is io n ,

B .R .C .S .

The Red Cross work parties have just completed a rush order for 1,000 triangular bandages, this work being finished in a fortnight. In addition to Rfm. White, two more prisoners of war have been adopted by the Division, L/Cpl. R. H. G. Hippie and L/Cpl. T. T. Poore, both of Ealing. Parcels of food are being sent out regularly' to all prisoners of war, and assurances of their safe arrival have been received. The sick bay' for evacuees from bombed areas, opened at 9 , St. Leonard’s-road by the local authorities, is now able to accommodate a large number of men and women. Patients are responding to the care and attention they are receiving from the local Red Cross personnel who are responsible for staffing the sick bay. T he Deputy Vice-President of the Division acknow ledges with grateful thanks gifts of money, blankets and other necessities to help the Division with its many activities. L ig h t w a t e r

D iv is io n ,

B .R .C .S .

The Assistant County Director, Col. C. H. D. Ryder, visited Lightwater on Wednesday, October 9 th, to present certificates to the officers of the newly'-formed detachment, Surrey 246 . They were presented to Mrs. Herbert, Asst. Commandant ; Miss Macdonald, Lady Supt. ; Miss Elizabeth Needham, Gas Officer ; and Miss Polfree, Quartermaster. Col. Ryder congratulated the detachment on the work it had done, and said he hoped the members would find many ways of helping in the near future. He referred to the heroism of the fighting forces which, he said, was an incentive to all British women to do their duty in nursing and similar ways. Commandant Mrs. Roberts proposed a vote of thanks to the Assistant County Director and also to Lady Webb, Vice-President of the Bagshot Division, for her presence.

During September 66 first aid certificates, 47 vouchers, 18 medallions, and 7 labels were awarded members attend ing classes of the Bournemouth Centre, S .J.A.B . An ambulance given by women members of the Order of the Eastern Star in Canada was presented on October 24 th to the Scottish branch of the Red Cross Society, along with another from the Central District Grand Chapter (Glasgow) Order of the Eastern Star. T he presentation took place in the transport headquarters, Trossachs-street, Glasgow. T he ambulances were handed over by Mrs. Jenny M ackay and Mrs. Mary Brown, of the Central District.

S .J.A.B .

D i v i s i o n . — T he Annual In spection of this Nursing Division of the Brigade was held on Tuesday evening, October 22 nd, at the Albert Hall, Shanklinroad. Lady District Supt. Mrs. G. L. Wallace was the Inspecting Officer, and those present included Lady County Officer Miss Duffin, Div. Surgeon Dr. E. J. A. Dougan and Lady' Div. President Mrs. Dougan. Over 50 members were on parade under Lady Div. Supt. Mrs. Moreton, and first aid teams gave a display, after whicb tea was served. N orth

AID

At the 23 rd annual meeting of the Yorkshire Collieries Ambulance League, held on November 2 nd, it was stated that the Wakefield Division had been re-established. It was also stated that a special certificate had been awarded to the ambulance men of Hatfield Main Colliery for the meritorious first aid work performed on the occasion of the cage accident at the colliery. A life-saving certificate had been awarded to Frank Cookson, of Frickley Colliery, and a certificate for meritorious first aid to T. W. Denton, of Thurcroft.

FIRST

Success

REVIVAL DEPENDS ON P R OMP T ACT I ON

AID A

C o m p le te

T e x tb o o k f o r

m b u la n c e

T H E

IV o rk ers,

F ir s t-A id e r s . a n d

N u rses

E L E M E N T A R Y

P R A C T I C E of N U R S I N G A New Work by the Author of “ A Complete System of Nursing ” : A. MILLICENT ASHDOWN, S.R.N. T h e First A id m an ’ s skill is unavailing if th e v ic tim ’ s resp iration is a llo w ed to fail — p ro m p t action w ith th e Sp ark lets R esu scitato r is vital to successful re c o v e ry .

SPECIAL AMBULANCE O UTFIT 85/" COM P L E T E ( B r / t/ s h / s / e s ) (A s used b y Red Cross and F irs t A id O rg a n iz a tio n s , P o lice Forces, F ire B rig a d e s, E le c tr ic ity U n d e rta k in g s , G as Com pa nie s, e tc .)

W r i t e fo r leaflet “ P ro m p t First-Aid T rea tm en t of A sp h yx ia and o th e r R esp irato ry Failure E m erg en cie s.” Sole M akers : S P A R K L E T S L T D ., D e p t. 42 , E D M O N T O N , L O N D O N , N .I8

Certificated King’s College Hospital and Royal London Ophthalmic H ospital ; Examiner to Charing Cross Hospital, Essex County Council, etc.; Formerly Examiner for the General Nursing Council, London County Council, Middlesex County Council, etc., and Lecturer at King’s College Hospital.

TWO AND

COLOUR

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IL L U S T R A T IO N S

126 P H O TO G R A PH S IN

MONOCHROME,

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FIR S T A ID and A . R. P. f First aid and im m ediate after| tre a tm e n t o f acciden ts and t in ju ries are d escrib ed in . detail and in clu d e, am on gst ^ o th e r th in gs :

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FIRST

Q u e r ie s to

and

A n sw ers

C o rresp o n d en ts.

Queries will be dealt with under the following rules :—

1.— Letters containing Queries must be marked on the top left-hand corner of the envelope “ Query,” and addressed to F i r s t A i d , 4 6 , Cannon-street, London, E .C . 4 .

4 .— T he Textb ook to which reference may be made in this column is the 39 th ( 1937 ) Edition of the S.J.A.A . Manual of First Aid to the Injured. T iie

S a l u t in g

o f

O f f ic e r s .

S.G . (Bourne).— In our Tow n we have a V .A . Detachment. Arguments have recently arisen with reference to the saluting of Lady Officers and Commandants. As a Private of the Brigade I ask you kindly to tell me what is the correct procedure when we are on duty. Paragraphs 203 to 208 of Brigade Regulations set out the purpose and methods of saluting. Further, par. 204 lays it down that “ Warrant Officers, N . C . O . ’s and Men, when in uniform will salute all Officers whom they know to be such . . . ” ; and it makes no distinction between male and female Officers. In other words, Brigade R e g u lations require you when in uniform, to salute all Lady Officers. — N . C o r b e t F l e t c h e r . E x a m in a t io n

H ow ler.

P .S. (Birmingham). — D urin g a recent examination of some Boy Cadets I asked one what powers the muscles possess. Y o u can imagine my amusement when he blurted out— “ M uscles possess lhe power of attraction ! ” Good !

Next, please ! !— N .C .F . A p p l ic a t io n

o f

T o u r n iq u e t .

S .G . (Bourne).— A cutting taken from a daily newspaper reads as follows :— “ Conversations I have listened to : A Nurse : ‘ When the British pilot came in he had a tourniquet on his leg and we couldn’t make out who’d done it. When he was well enough to talk we asked him, and he said, Oh, I fixed it as I came down by para chute after baling out.’ ” Do you think that this is possible or do we say— “ Good ! Next, please ! ! ” Perhaps you may ; perhaps you may not ! In either case truth is alw ays stranger than fiction ! ! — N .C .F . S pats

T reatm ent

o f

F ractured

L eg.

T .G . (Holmemoor).— H a vin g just been lent a copy of the February issue of F i r s t A i d , 1 was interested in a query published under the above title with reference to the use of spats in applying extension for fractures of leg and thigh. A letter in the B ritish M edical Journal of April 13 th from Dr. R. M. G reig seems to solve the problem.

AID The spat takes the place of the clove hitch as used with a Thomas splint. Quoting Dr. Greig, “ they ” (clips, skewers, clove hitches, etc.) “ make application too complicated, are unsuitable for civilian footwear, cannot be applied where a mustard ga s contaminated boot has to be removed, and may cause injury to patient or bearer. Also the clove hitch used with the average civilian footwear might easily produce considerable discomfort. At the Stevenson Aid Post a canvas spat is applied to foot and ankle, and laced by means of tapes. Attached to each side of the spat is a loop of strong tape. Each loop carrries the extension band of strong 1^-in. tape, and is so situated that extension is in the long axis of the limb. “ For convenience in first aid work the spat, with extension band is tied on to the splint along with the broad slings, and is then ready for immediate use. T he advantages of the spat are : it is easily carried, and is easily and quickly applied ; it can be used with or without a boot, and with any civilian footwear ; it could be applied even in certain cases of injury to ankle and foot ; it can readily be applied in the dark without risk of damage to patient ; and it is inexpensive to m ake.” While I believe that Dr. Greig refers to canvas spats specially made by the ladies of his Post, it is obvious that any ordinary spat is just as satisfactory. Major R. St. John Lyburn, M .D ., R .A .M .C ., advocates a similar thing using the web anklets which are now part of a soldier’s battle dress. I trust that these notes will prove interesting to the readers of F i r s t A i d . W e are grateful to you for your letter which, with its interesting information, is much appreciated. — N .C .F . C ollapse

o f

L ung

fro m

B last.

R .R . (Sherringham). — Herewith I send you a newspaper cutting which is based on a recent article in The Lancet and deals with injuries to the lungs caused by blast. This reads as follows :— “ The lungs can be damaged by blast without there being any injury to the body surface, but there may be delay before symptoms develop. “ In cases of asphyxia due to this cause, the Schafer method of artificial respiration will prove not only ineffective, but even harmful, and this will have to be made clear to first aid workers. “ When no adequate cover is available the effects of high explosive on the lungs can be greatly lessened by lying on the ground. “ Three naval doctors who had examined twentyseven victims of night explosive bombing found that in fifteen of the patients was ‘ b alloon ing’ of the lower part of the chest. There was no satisfactory explanation of this. “ Dr. S. Zuckerman describes explosion blast tests on rabbits whose trunks were clothed in various thick nesses of rubber. “ They showed that it is the pressure wave of blast which bruises the lungs by its impact on the body-wall. “ They also demonstrate that this effect can be prevented, or diminished, if the body is clothed in a suitable material which is able to take up and disperse the pressure wave. “ Blast injuries to the lungs will occur only when a .person is very close to an exploding bomb and directly exposed to the blast w ave.” It is correct that under certain conditions the lungs may have all or most of the air drawn from them by the suction effects which follow the wave blast ; and that there also occur cases in which the lung tissue is definitely torn.

FIRST

CO M PLETE M E D IC A L

B A I L L I E R E ’S

AID

D I C T I O N A R Y

SAMPLE Page. lim b to arrest bleeding from an artery. I t should be loosened after th irty minutes, or permanent in ju ry to muscle or nerves m ay result. I t should not be applied to the arm , as damage to nerves is more easily caused, the muscle protection being less. E s m a r c h 's t. is a rubber bandage which is tigh tly applied.

«ETAl ANCHORTOFIXTUBINC TO U R N IQ U E T . tow (/o). T h e coarse part of flax used for padding splints, etc. toxaemia (to ks - e' - m e - ah) . Poisoning of the blood by the absorption of toxins, toxamins(to k s '-a -m in s ). To x io substances said to be present in cereals which are antagonistic to v it a m in D . toxanaemia ( to k s-a n -e ’-m e a h ). Ansemia due to the

? TRACHEA ?

TRA

[ 341 ] 2

the

effect of toxins blood. toxic (to k a '-ik ). Poisonous, or produced b y a poison, toxicity (to k s - is '- it-e ). Th e degree of virulence of a poison. toxicology (toke -e-kol'-o-je). T h e science dealing w ith poisons, toxicosis (to k s-e -k o ' -sis). Th e state of poisoning by toxins. T h y r o id t., due to excess absorption of th yro xin into the blood, toxin (tok8f- in ). A n y poison ous nitrogenous com pound, usually referring to that produced b y bacteria. T . a n tito x in , a m ixture of diphtheria toxin and an ti toxin used to produce im m u n ity to the disease. Called T . A . m ixtu re. T. to x o id , containing both toxin and toxoid, toxoid (to k s-o id '). A formalinized toxin used to produce im m u n ity to d ip h theria. trabecula (tr a b -e k ' -u -la h ). A dividing band or septum, extending from the capsule of an organ into its interior and holding the function ing cells in position, trachea ( tr a k - e '-a h ). Th e w indpipe : a cartilaginous tube lined w ith ciliated mucous mem brane, ex tending from the lower part of the la ry n x to the

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With either group it would not, in my opinion, be possible for you as a first aider to diagnose this condition of collapsed lung, because the victims will to you present the appearance of simple asphyxia. Y o u r treatment, therefore, must be to apply Schafer’s artificial respiration pending the arrival of the Medical Officer with whom rests the decision as to future action. In this connection a leading authority on the subject (which is still under investigation) advises that first aiders should apply Schafer’s method in all cases of asphyxia except those in which there is either blood-stained froth in the nose or mouth, or a penetrating wound of the chest when they should transfer the patient immediately to hospital. T he practical test seems to me to apply gentle pressure on the loins and to note if any air is expelled thereby. If there is, then you are justified in persevering with artificial respiration. — N. C. F.

S c h a f e r ’s

A r t if ic ia l

AID Also (2 ) in such a case should the broad bandage be tied off at the side as for fractured pelvis or should it be tied in the middle line over the wound ? ( 1) You should look for an exit wound in case the shrapnel is no longer in the abdomen. If it is, your duty is to treat as for wound with internal haemorrhage ; and the fact that shrapnel is present in the abdomen is no concern of the first aider, who should obtain medical aid for patient at the earliest opportunity. (2 ) The Textbook does not lay it down that the knot of the broad bandage, used in treatment of fractured pelvis, should be tied at the side of the body. In the treatment of any wound it is good first aid to tie the knot of the bandage on top of the dressing and thereby to keep up pressure which will assist in controlling any bleeding. Incidentally, with fractured pelvis I think that the knot of the broad bandage should be tied in the middle line of the abdomen.— N.C. F.

R e s p ir a t io n

O.C . (Sale).— May I draw your attention to Fig. 75 of the Textbook ? The position of the thumbs appears to be at variance with Figs. 74 and 76 , and this is confirmed if Fig. 75 is inverted. In view of the instruction “ the thumbs as near each other as possible,” may I take it that Figs. 74 and 76 indicate the correct position ? In Schafer’s Method the position of the hands is as shown in Figs. 74 , 75 and 76 . In Fig. 75 , however, the angle at which the photograph has been taken gives the false appearance of the thumbs being in contact with the fingers, and in Fig. 76 of the thumbs being stretched and pointing somewhat upwards. T he hands are to be kept in a position of relaxation, and with fingers in contact. Consequently, the thumbs point towards the ribs and not directly upward. Further, the instruction which you quote would be better understood if it read “ the bases of the thumbs being as near as possible to each other.” — N .C .F .

D is in f e c t in g

C ycle

T u b in g

a s

L ig a t u r e .

Rubber tubing of any kind cannot correctly be described as a tourniquet which is a surgical instrument for compress ing arteries and is provided with a twisting apparatus. The word tourniquet is derived from the French verb “ to turn ” On the other hand rubber tubing (such as the Samw’ay) is used as a means of restricting the blood in all the blood vessels of a limb. Cycle tubing has the disadvantage that, when stretched, it is liable to tear and might (or might not) be effective in controlling the circulation of the lower limb. Incidentally, you are w rong in stating that the rate of the circulation varies in different parts of the body. A little thought w'ill convince you that, as the arterial circulation is the result mainly of the action of the heart and as the pulse can be tested in any superficial artery, it is obvious that the rate must be the same throughout the body.— N .C .F . T reatm ent

o f

S h rapn el

A bdom en.

F .M . (Batley). — Please tell me ( 1 ) how we should treat a patient who is found with a piece of shrapnel within the abdomen.

P o is o n in g .

From the article to which you refer, it is obvious that “ disinfecting flu id ” is a special preparation consisting of strong alkalies and supplied for use on ships. In these circumstances the special instructions contained in the R .N .S .B . Manual have to be followed and must not betaken as applicable to civilian life and emergencies.— N .C .F .

M edal

S. G. (Bourne).— Our Divisional Surgeon at a recent Prac tice demonstrated how a piece of cycle tubing could be used as a tourniquet for the brachial artery. My query is whether or no the tubing could be used to control the femoral artery, since the muscles of the lower limb are much stronger and the flow of blood much quicker than in the upper limb.

F l u id

W . N. (Rossendale).— On page 165 of the February issue of F i r s t A i d , under antidotes for disinfecting fluid poison ing, it says “ Oil, butter. On no account g iv e water.” Now, can you please kindly let me know the actual name of the disinfecting fluid referred to? Or, do the antidotes and remarks apply to any kind of disinfecting fluid ? On the same page, disinfecting fluid is mentioned as coming under the strong alkalies.

R ib b o n s .

B. G. (Oldham).— Will you please inform me whether a man is entitled to wear his Service Ribbon, which he received from the S .J .A .B ., on his army tunic. Presumably, this reader refers to the Service Medal Ribbon of the Order of St. John. If that be the case, it is quite in order for the ribbon to be worn on the tunic of his army uniform. — E d i t o r .

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Vol. XLVII.

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EDITORIAL.

FIRST AID is published on the 20th of each month. A n n u al Subscription is 4s. post free ; sin gle copies 3d.

The

D u r i n g the past few weeks there T he T r e a t m e n t has appeared in the medical and of

B urns.

general

press conflicting

evi

dence on the use of tannic acid

for burns, and consequently many readers are ask

Sub scription s, A d vertisem en ts and other business C o m m unications connected w ith F I R S T A I D should be forw arded to the Publishers.

injuries.

D A L E , R E Y N O L D S & C o ., L 46, C

annon

ing for information on the latest treatment of such Firstly, some readers are under the impression

S t r e e t , L o n d o n , E .C .4 .

Telegraphic Address — “ Twentv-four, London." Teltphone— C ity 3720.

that tannic acid has been condemned entirely for the treatment of burns.

This is not so, and the

answer is to be found in an article published else where in this issue.

CON TEN TS

THIS

NUMBER.

Secondly, one loses sight of the fact that we have to deal with the matter from a first aid view

E d i t o r i a l :—

The Treatment of Burns

...

A .R .P . First Aid Services ... ... ... S .J.A .B . Headquarters and District Reports ... Out of Print ... ... ... ... ... Books for the Shelter ... ... ... ... T he Meaning of Words ... ... ... A Method for First Aid T raining ... ... Durham, Cleveland and Westmorland Districts Ambulance L ea gu e ... ... ... Priory for Wales. ... ... ... ... Are W e on the Right Lines, or Are W e Off the Rails Railw ay Ambulance News ... ... ... Reviews ... ... ... ... ... T he Meaning of Words ... ... ... ‘ Hutt’s Harness ” Device ... ... ... S .J.A.B . Overseas ... ... ... ... Tannic Acid : A Scare About Scabs ... ... Our Nurses’ P age ... ... ... ... Q u e r ie s

a n d

A n sw ers

101 102 103 104 104 104 105 105 106 107 108 109 109 110 110 112 114

A s p h y x ia and Its Causes

...

Although first aid to-day is on a different footing than in pre-war days, it is, nevertheless, f i r s t a i d treatment we must deal with.

Frankly,

on the scene of an accident we are convinced that for burn cases all that can be done is to cover the part, thus excluding air.

Again, we must

not

forget that we also have to deal with burns in the home, in the workshop, etc. ; therefore a general treatment must be given as apart from instructions for A . R . P . first aid personnel. One treatment now suggested as new is a jelly composed of gentian-violet and merthoilate,

but

some years back we published a short article on

C o r r e s p o n d e n t s :—

Unnatural Mobility ... ... Examination Howler ... ... Blue B a g for Stings of Insects ... Treatment of Fractured Ankle ... Sling for Compound Fracture of Arm Transport for Crushed Chest ... Treatment of Multiple Double Fractures Treatment of Fractured L e g ... Meddlesome First Aid ... ... Treatment of Concussion ... ... Use and D osage of Morphia ...

point and not from a medical aspect.

... ... ... ... ... ... ... ... ... ... ... ...

116 116 116 116 116 116 116 118 118 118 118 118

the use of aniline dyes in the treatment of burns. One thing is definite : the ideal treatment for burns is yet to be found.

Whil st one preparation

is good for some degrees, it is not so efficacious in others.

It is, however, a sure sign that know

ledge is being gained when some members of the medical profession commence to condemn a pre paration which a few years back was hailed as th e ideal medium for the treatment of a specific com plaint.

102

FIRST

A.R.P. FIRST AID SERVICES. B y

O ur

S p e c ia l

C orrespond ent.

As might have been expected, after several comments in the ' lay press, several readers have written to the Editor and me, askin g us to clarify the position regarding the so-called “ l a t e s t” treatment of burns. Tannic acid in its various forms has recently been held up to be the “ wonder cure,” and now its use has been abolished in first aid posts for second and third degree burns. T he subject is too ex haustive to be dealt with in a topical article such as this, but in another column the reader will find the matter clearly discussed by an eminent doctor. The only com ments that I would make are that, firstly, tannic acid never has been a true first aid dressing, so that there is nothing revolutionary in recent instructions, and, secondly, the Revision Committee of the St. John Textbook have more than justified their position to refrain from introducing tannic acid into the body of the textbook. From time to time I have endeavoured in these columns to draw attention to the conditions under which the first aid personnel work, and this month I propose to again discuss some of the difficulties appertaining to first aid posts. T he personnel of these posts are in the main female, and officially they work a daily duty of eight hours. In the pre “ bl i t z” days, this entailed no hardship apart from the blackouts, but in the intensive raid areas, personnel now find difficulty both in leaving their posts and arriving for duty. This has resulted in their being on duty as many as sixteen hours at a time, while others have been unable to relieve them. Often, when relieved, they are unable to proceed home, and are therefore compelled to spend the night at the post, thereby materially contributing to the discomfort of all present. Various alternative times have been suggested for the purpose of solving this problem, that favoured by the male personnel being 24 hours on and 48 hours off. My medical col leagues strongly oppose this plan for several reasons. Firstly, it is open to abuse— cases have been noted in which individuals have been on the pay rolls of two different boroughs, or else in other regular employments, so that when on A. R. P. duty they are in no fit condition to be as efficient as might reasonably be expected ; secondly, it would create a very bad impression am ong the other A .R .P . services, and also the fighting forces, if it were known that first aid personnel only worked one day in three, a large proportion of the time being devoted to sleep and rest ; and, lastly, female personnel should not be asked to do 24 hour duties when other alternatives are available, particularly when it is remembered that an incident may conceivably occur towards the end of the period, and as a result the personnel would have to remain on duty over the 24 hours. I have introduced the follow ing scheme into my unit, and the personnel are unanimous in its praise. T he three shifts are referred to as A, B and C, and the periods of duty divided up into 8.m. to 4 p.m. and 4 p.m. to 8 a.m. 8 a.ni to 4 p.m. 4 p.m to 8 a.m. Saturday — A Sunday B C Monday A B Tuesday C A Wednesday B C T hursday A B Y o u will observe that in each period of three days one shift works 8 hours, 16 hours, and nil hours, in other words each third day is free ; moreover, no one attends for duty on a new shift before 8 a.m ., or leaves for home after 4 p.m., the advantage of this requiring no elaboration.

AID Incidentally, I would like to see an official welfare officer appointed in each borough or district for the purpose of looking after the personal needs and comfort of A .R .P . first aid personnel. In most cases this duty could be voluntarily undertaken by one of the local padres or senior officials of one of the local organised first aid bodies. As an extension of this scheme, it might even be possible to arrange for personnel in the less vulnerable areas to offer hospitality and rest to their jaded colleagues, say, from London and some of the Midland towns. I, personally, was able to arrange for one of my first aid workers to spend a much needed w eek’s holiday in Gloucestershire, and I have no doubt that there are numerous members of the B .R .C .S . and the S .J .A .B . who would be only too happy to throw open their homes for a short period to help those who have lost strength and vitality from constant duty in danger zones. T he Editor of this Journal is strongly in support of this idea, and has asked me to say that if any good Samaritans, who are interested in this scheme, would write to him, he would undertake to make the necessary contacts. Readers will be interested to learn that the British Medical Journal, in a recent issue, discussed the importance and value of first aid posts. Its observations were practic ally identical with those that have been appearing in these columns, particularly regarding the Mobile Hospital Units It likewise deplored the fact that the fixed posts had not been used to a greater extent in view of the total number of casualties. It is daily becoming more apparent that first aid under present conditions has taken on an entirely new meaning, and that the generally accepted standards and limitations must be modified to meet the new state of affairs. Pure first aid is, in some ways, insufficient to meet the demands put upon the first aider, and yet others it is too much. I have dealt with the latter factor in previous articles, when I stressed the fact that “ field ” first aid as opposed to the orthodox variety w as often the only kind either possible or expedient. T he form factor has, however, come into fresh prominence, owing to the fact that first aiders are now being called upon to carry out certain responsibilities in which for long periods they are expected to act upon their own initiative. As an example of this, I would refer to the first aid posts now being installed in some of the larger London shelters. These are visited as required by a doctor, but the nurse or first aider in charge (who in many cases has been transferred from a first aid post for the purpose) has to use her own discretion in several respects. T he only w ay in which he or she can honestly fulfil the duties entailed is to become efficient not only in first aid but also in home nursing. I would, however, warn both first aiders and the responsible local authorities against the danger of the “ shelter” first aid posts becoming converted into clinics. The only essential difference between the “ orthodox ” and the “ shelter” posts is that the latter will later be expected to attend to “ m edical” casualties in addition to the surgical variety. I regret to say that some nurses are abusing both their position and their privileges by prescribing for serious cases on their own initiative, and affording facilities for after treatment and dressings. I have been told by several patients that they had previously been treated for days by the “ shelter nurse.” As an example, I saw one girl who had twenty small pieces of elastoplast stuck directly over twenty sores supposed to have resulted from mosquito bites, T he treatment was putrid even had the diagnosis been correct ; but, in point of fact, the patient (along with nearly thirty others) was suffering from scabies or “ itch.” May I, therefore, warn my readers against the danger of too much initiative. A little knowledge is verily a dangerous thing. First aiders are always taught that their function is to hold the fort until the doctor is available. Never was that principle more true than to-day.

FIRST

St. John Ambulance Brigade H EADQUARTERS

AND

D IS T R IC T

REPORTS.

103

AID

clo ck which was the Division’s wedding gift to Amb. Officer Thom as Grace, a position held since the division’s inception.

N o . i n District. B ir m in g h a m C o u n t y .

N o . II District B u c k i n g h a m s h i r e C o u n t y . — County Circular No. 6 , issued by County Secretary N. Tebbitt, gives particulars of County activities. A Nursing Division has been formed at Wolverton (a name well known in the competition world) with Mrs. A. E. Henson of 9 , Jersey Road, as Acting Lady Supt. At Slough, a new Ambulance Division has been formed titled Upton Lea Ambulance Division. Mr. W. H. Collins, of VVexham Park has been appointed President and Mr. J. D. Palmer of 13 , Elmwood Road, Slough, Divisional Supt. A Nursing Section has been established at Ellesborough (a Cadet Unit is also being formed), an Ambulance and Nursing Division at Lane End, and a Nursing Section at Prestwood and District. The circular also gives particulars of appointments, etc., and we congratulate the county on its apparent efficiency and expansion.

C h e l t e n h a m ..— The County Commissioner, Dr. A. Barrett Cardew, M.C., accompanied by the Asst. Com missioners H. J. Lewis and Col. Stewart, inspected the men and cadets of the Cheltenham Friendly Society Ambulance Division. The men’s division was in charge of Supt. L. M. Starr, the cadets in charge of Cadet Supt. R Hawkins. Dr. Barrett Cardew was particularly interested in the Cadets, and congratulated the leader upon their smart appearance and abilities. A demonstration of first aid work and stretcher drill was given ; these also received the commendation of the inspect ing officers. Dr. Cardew said that he found very little room for criticism, and a very great deal that was praiseworthy. Never at any time was opportunity stronger than now for the personnel to show their worth in practical work. He was pleased that he had received from members of other organisations, letters of appreciation and praise for the manner in which ambulance men and women did their jobs when called upon. He was also glad to hear of the well-being of 12 of the members who were serving in H.M. Services, and was glad that the division remembered these men by sending them gifts of cigarettes, etc. It was with regret that he heard of the loss on active service of Pte. Mills. Recommendation had gone forward, and had received sanction, for the awards of Service Medals to Sergt. Barnfield, Cpl. Longstreeth, Pte. F. Field, and third bars to medals for Corps Officers W. Ball and H. Ballinger. Dr. Cardew was sorry they had not arrived in time for him to present them at this parade. Service Stripes were presented to Cadet Cpl. Hawkins, Cadets W. Holloway and J. Wright. Supt. L. M. Starr, in thanking the Commissioner for his remarks, said that all the members of the division were engaged in staffing first-aid posts and parties, and four mem bers of the division were on the staff of the mobile hospital unit. Am ong those on parade were Corps Supt. C. Cousens Eetch, Corps Officers T. H. Read, H. Ballinger, W. Ball, I m b . Officers A. Skinner and G. Hill.

T r i n g .— Div. Surgeon Col. P. L. O ’ Neill (Rtd.) and Commander H ig gis (Rtd.) paid a visit to the T r in g Division on November 18 th, and made a presentation of an inscribed

The Colour of the County of Birmingham was reverently deposited for safe keeping in the historic church of St. Mary’s, Temple Balsall, Knowle, on November 17 th. There was a representative muster of Brigade Officers headed by County Commissioner Col. Sir Bertram Ford. County Officers G. E. Kingsnorth and W. E. Ballard and Lady County Officer Mrs. T. Oliver Lee, Corps Supts. J. A. Simpson, S. H. Larner and H. E. Cooper ; Corps Officer J. E. Matthews, Corps Supt. Miss Locker were also present and in addition, officers, men and nurses of numerous divisions. T he Church of St. Mary’s was built in 1290 by the Military Order of the Knights Templars. When the Order was suppressed in 1311 , the property passed to the Knights of St. John of Jerusalem or the Hospitallers. In 1540 , the property was confiscated by Henry V I I I , who gave the Manor of Balsall to his sixth wife, Catherine Parr. Sir Bertram, addressing the vicar, the Rev. H. M. Crabbe, said it was an honour and privilege to bring the consecrated Colour of the Brigade to the church. The Brigade was a direct descendant of those Knights Templars for whom the church of St. Mary was built. He asked that the Colour should rest in the church in honour, reverence and security, until that day when it should please God to grant peace to the nation. T he vicar said the church would gladly take charge of the Colour during the war and he accounted it a privilege to have charge of such an emblem. In a subsequent address, the vicar recalled various periods in the history of the church of St. Mary. At the conclusion of the service, the Colour was taken from the altar and placed in repose on the north wall of the chancel, by men of the Brigade.

One of the founders of the Birmingham Corps, Mr. Frederick Gilbert, was buried on November 14th, his body being borne to the grave at Brandwood End Cemetery, bv members of the Corps. He was at one time chief superintendent of the B irm ing ham Centre and was admitted a hon. Serving Brother of The Order.

N o . VIII (D uke o f Connaught’s) District T u n b r i d g e W e l l s . — Amb. Officer O. Norman has succeeded the late Mr. S. J. Billenness as Superintendent of the Tunbridge Wells Division. Mr. Norman has 46 years’ service in the T unbridge Wells Division and is a Serving Brother of T he Order.

N o . X District H e r t f o r d . — T h e Mayor of Hertford, Councillor D. J. Rumbold, made presentations to members and auxiliary members of the Hertford Division on Sunday, November 24 th. The presentations consisted of 16 vouchers, 4 medallions and 12 labels. Supt. Durrant said that the Division manned one ambulance depot night and day since the outbreak of war, and three depots for 219 warnings. In addition to purely A .R .P . work 750 journeys, covering some 10,000 miles, had been made in the County Hospital ambulance. The Mayor, on behalf of the Town, thanked the mem-

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bers for their services and congratulated them on their efficiency. W i s b e c h . — T he Wisbech Cadet Division held a dance last month, when 120 persons were present. Supt. Hull acted as M.C. T h e proceeds were towards cost of uniforms.

Eire District. W aste paper collected in Dublin for the S .J.A.B . has realised ^£7165 according to a statement made at a recent meeting. Sir John Lumsden praised the work of Mrs. Nolan and her helpers and said that he would like the money collected to go towards the purchase of a mobile canteen for the use of the Brigade. The Cork City Ambulance and Nursing Divisions, together with A .R .P . Reserves, held their first church parade last month. All denominations were catered for. Catholic members marched to St. Francis Church and the Protestant members to St. Fin Barre’s Cathedral.

AID

Books f o r the Shelter. “ The Bedside B o o k ” by Arthur Stanley (Victor Gollancz Ltd., 3/6 ). This book is the first cheap edition of a collection of interesting passages in prose and verse, and contains 878 pages of excellent reading. The book offers a variety of consolation, information and entertainment which extends from the writers of Ancient Egypt to authors of the present day. “ Rebecca ” by Daphne Du Maurier (Victor Gollancz, Ltd., 3/6 ). This famous best seller, available in a cheap edition, is certain!}' well worth reading. The musings on the past are full of life, and one can picture the scenes of mental conflicts and victories, of happiness and of sorrow. Manderley will surely live for ever in every reader’s mind !

“ The Junior Week-End B o o k ” by J. R. Evans (Victor Gollancz, Ltd., 3/6 ). At the annual meeting of the Governors, Benefactors and Friends of the National Maternity Hospital, tribute was paid to the blood transfusion service of the St. John Am bu lance. “ Their organisation and co-operation are exemplary and have been most helpful in saving the lives of many of our seriously-ill cases,” said Dr. J. F. Cunningham, master of the hospital, in his report. Northern Ireland (Ulster) District. The first annual inspection of the Post Office Ambulance and Nursing Divisions, was held on Nov. 12 th, the inspect ing officers being Lady District Supt. Mrs. G. N. Wallace, County Officer D. Rodgerson and Lady County Officer Miss M. Duffin. Supt. R. J. Campbell, M .M ., was in charge of the men, assisted by Amb. Officer W m . Christie, Lady Supt. E. F. Slack being in charge of the nurses, assisted by Lady Amb. Officer E. M. Wilson. In the unavoidable absence of the President, Mr. H. S. Thompson (P. O. Regional Director for Northern Ireland), vice-President Mr. A. W a ke ly (Commercial Manager) welcomed the inspecting officers, also the guests including Mr. N. C. Goddard (P.O. Regional Finance Officer) and Capt. A. H. Gadd (Traffic and Sales Manager). The inspecting officers congratulated the officers on the bearing and efficiency of their Divisions.

O u t of Print. D u r i n g the past few months the publishers of F ir s t A id have had to refuse orders for copies, ow ing to the fact that several monthly issues of this year are entirely out of print. Whilst this is very gratifying to them they are sorry that readers have been disappointed. Unfortunately, owing to the stringent economy required in the use of paper it is not possible to print more copies than ordered and, therefore, we would urge all readers T O P L A C E A N O R D E R N O W either with their newsagents or by sending a postal order for 4 s., to cover cost of 12 issues, to the publishers. T his will ensure that a copy of each month’s issue is reserved for them. It has also been impossible to supply specimen copies to those requiring same and we trust they will appreciate our difficulty.

The publishers state that this book is for Boys and Girls and Parents ; and we endorse their view. It contains 576 pages, with 136 pictures, on games, songs, tricks, poems, puzzles, hobbies, adventure stories, sports and armchair science. No longer will parents wonder what to do with the children— this book will keep them quiet for hours, and at the same time increase their general knowledge. The book is divided into three parts : For any week-end (adventures, poems, songs, information, and puzzles) ; For out-door week-end (fauna and flora, camping and tramping, rivers and the sea, let’s make a garden, play !) ; For indoor week-ends (party and non-party games, things to do, to make and to collect, and sweet making), An ideal book for a Christmas Gift.

Th e Meaning of W ords. F o r this month w e have selected the following words from Baillieres Nurses’ Complete Medical Dictionary :— Epistaxis. Haemophilia. Ligament. Lymphangitis. Meninges. Pleura. Definitions and explanations will be found on page 109 .

At the annual meeting of the Barnstaple S.J.A.A ., the President, the Mayor of Barnstaple (Councillor Chas. F. Dart, J.P .) expressed his admiration of the work done, and also expressed on behalf of the Mayoress, appreciation for the support given to her Central Hospital Supplies Depot.

T he N u r s e ’ s P o c k e t E n c y c l o p a e d i a a n d D i a r y , 1941 . — Just as we go to press we receive from Messrs. Faber & Faber Ltd., of 24 , Russell Square, London, W .C . 1 , a copy of the foregoing. Apart from the actual diary, there are some 400 pages containing much essential knowledge. New subjects have been included in this issue, also articles have been brought up to date. The contents include too many subjects to mention here, but to readers we recommend the book, which at the cost of 2/6, is certainly value for money.

A Method f o r First Aid T r a i n i n g . B y D. G. D U F F , m . c ., f . r . c . s . (Ed.), of Denbigh, North Wales.

I h a v e been impressed in the past by the extraordinary realism attained in preparation of acci dent cases for St. John Am bu lance competitions. Dr. Pari H u w s’ cases, prepared with plasticine at last year’s Eisteddfod in Denbigh were note woi thy, while Dr. Hughes Davis at F.A. Post exercises has shown wounds of striking verisimilitude made from plaster of Paris. These, however, have required much time in preparation and were for use on one occasion only. To give practice in dealing with a Some applications of the prepared injuries, T he small bottle on right number of A .R .P . casualties, a contains Succus Allii and Tincture of Geraniums, and is used to method involving much less time imitate gas contamination. and trouble is necessary. At first, imitation wounds with scraps of Elastoplast were made, but this had obvious the underlying anatomy. T he patients need not be labelled defects. Lately, I have prepared small round or oval at all unless to indicate them as male and female. plaques about 3 in. by 2 in. or smaller, and consisting of Possibly this sort of this has been done elsewhere but four or five layers of plaster of Paris bandage. The visitors here have found novelty in it, so I put it on record. surface layers are raised in folds and, being suitably It is certainly a labour-saving method, for the placques can coloured with bright red paint or lipstick, give the appear be very quickly made, e .g ., a dozen in an hour, and can be ance of wounds of varying severity and extent, punctured, used in innumerable sets of different problems, without lacerated, etc. further labour. With the help of chips of beef bone, stuck in the folds, compound fractures are simulated ; rubber tubing may be used to show cut arteries ; charcoal powder— a charred D u r h a m , Cleveland and W e s t m o r l a n d electric burn, and so on.

D istricts A m bu la nce League.

These plaques have a backing of zinc and gelatine paste (U nna’s Paste, B .P .) about ^ in. thick, and this since this becomes “ F acky ” with very little warm ing or being held near a fire or over a lamp, will allow the “ wound ” to stick anywhere on patient’s skin or scalp. Sometimes the heat of the skin itself is enough to secure adhesion throughout the progress of the “ c a s u a lty ” through the hands of the F.A. Parties or Post to final reception practice in hospital. The plaques are quickly removed without leaving any stickiness of the skin. With, say, eighteen of these imitation wounds of different sorts a series of ten or twelve patients can be prepared in as many minutes, all kinds of problems being quickly concocted. Simulations of simple as well as com pound fractures, and penetrating and perforating wounds of head, chest or abdomen can be produced. Arterial haemor rhage is represented by a bright red rag, the corner of which is wedged under a plaster fold, the rag being removed or replaced according as the instructor judges that haem orrhage is controlled or recurs. Venous haemorrhage, for example, from the broad curving ink mark which stands for a varicose vein, is shown by a purple rag. Facepowder, to give the patient the pallor of shock ; Aq. Rosae, to simulate haemorrhage from the mouth ; red lipstick streaks for ear or nose bleeding, all help to give interesting practice cases.

have now been made for the annual compe titions held under the auspices of the above. All men engaged in mines and quarries in Durham, Cleveland and Westmorland are eligible to compete. T he competitions are for the “ Donald B a i n ” Shield for teams of S men, no team to include more than two members who have previously won the shield ; and the “ Elizabeth B a i n ” Shield for junior teams of S, four not to have competed in any senior compe titions, and one man who has been a member of a team which has not won the “ Donald Bain ” Shield. The following dates have been fixed :— “ Donald Bain ” divisional competitions, February 1st, 1941 ; “ Elizabeth Bain ,” February 15 th ; Finals, to be held at Durham, March 1st. Entries close January 11 th. Mr. W. J. Charlton, H.M . Inspector of Mines, has resigned the chairmanship of the League, and is succeeded by Mr. R. Yates, H .M . Inspector of Mines. T he Secretary is Mr. George Watkin, of 5 , Modelstreet, Murton, Co. Durham, who has now completed 57 years’ service in the ambulance movement, and has for 18 years been secretary of the League.

Our patients are usually St. John Ambulance cadets who co-operate keenly and themselves learn in criticising their elders. T h ey normally tell F.A. personnel where supposedly painful injuries are, and are adept at registering shock, unconscious states, hysteria, etc. T h e instructor can confine his attention to criticism or asking questions on

On petition minster District

A rrangements

Sunday, December 1st, a friendly “ r iv a lr y ” com was held at Worcester when a team from Kidder Rural District, lost to a team from Martley Rural by 92 marks.

io 6

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Priory for Wales. M e d i c a l C o m f o r t s D e p o t s in W a l e s .

As Almoner of the Priory for Wales, the Viscount Tredegar presided at a meeting of the Almonry Committee held at Priory House, Cardiff, on Monday, December 2 nd, supported by Sir Robert Webber, Assistant Almoner. T he Hon. John H. Bruce, Principal Secretary and Commissioner for Wales, gave a survey of the 96 Medical Comforts Depots operating under the Priory, which during the past year made an appreciable contribution to the relief of suffering by means of the issue on loan of sick-room com forts and medical requisites to 11,452 cases of illness. In 1920 the Priory for Wales launched the scheme for providing comforts for use in the homes of the sick who would otherwise lack such aids and comforts in a manner as simple in application as the lending library system ; and each successive year found a greater number of depots operating by divisions of the St. John Ambulance Brigade, particularly in the industrial areas. In 1938 the number of Depots was almost doubled as a result of a grant of ^ 3,500 from the Special Areas Fund negotiated by the Health Services Committee of the South Wales and Monmouthshire Council of Social Service. It was, therefore, incumbent upon the Priory to secure the proper administration and maintenance of Depots. For that purpose the Almonry Committee had co-opted representatives of the Centres and County Areas concerned, who had been entrusted with a general supervision of the staffing, maintenance, and financial management without interfering with the autonomy and responsibility of Depot Committees. H igh praise was given to the Committees for the great amount of time and energy devoted to this work in the issue, cleansing and care of the equipment. Viscountess Tredegar, who was present in the uniform of a Lady County President, was am ong those who under took supervisory responsibilites in connection with certain Depots, and reports on the w orkin g of the scheme in their respective Areas was given by Assistant Commissioner J. H. Davies (Rhondda), Lady County Officer Miss E. M. Gravenor (Caerphilly), Lady Corps Superintendent Mrs. M. Everson (Merthyr Tydfil), Acting Assistant Commissioner D. M. Jones (Bridgend), Corps Secretary A. Poole (Aberavon), and Lady Corps Superintendent Mrs. S. Evans (Barry). P r io ry H e a d q u a r t e r N o t e s .

Recognition of medical services within the Borough of Merthyr Tydfil Centre was granted by the Ambulance Com mittee of the Priory, which met under the chairmanship of the Director of Ambulance, Dr. D. Rocyn Jones, C .B .E ., J . P . , at Prion- House, on Tuesday, December 3 rd, when the following Brigade Surgeons were elected Honorary Members Corps Surgeon J. Ferguson, Divisional Sur geons E. Foster, J. Brennan and T. C. Dey. All candidates for the First Aid Certificate of the St. John Ambulance Association must receive a course of lectures from a member of the medical profession ; and the examination of 1,292 classes during the first eleven months of this year represents a valuable contribution of gratuitous service on the part of doctors associated with the Priory’s work. T h e Hon. Mrs. J. H. Bruce (Lady Staff Officer for Wales) announced at Ambulance Committee that oppor tunities are now offered to Nursing Members of the Brigade in W ales to volunteer for full-time w ork in the air raid shelters in London for minimum periods of a fortnight. Recent experience has proved the desirability of Nursing Members receiving some elementary knowledge on the sub ject of Midwifery ; and it has been decided to circulate notes for lectures for the use of B rigade Surgeons and Nursing

AID Officers in giving certain instruction to senior Nursing Members. Continued progress in Brigade development was re flected in the formation of the following new Divisions, which were sanctioned :— Ambulance : Llay Hall (Denbigh shire) ; Nursing : Rhosneigr (Anglesey) ; Cross Hands and Felinfoel (Carmarthenshire) ; Aberdulais and District (Glamorgan) ; Abertysswg (Monmouthshire) ; Abercanaid (Merthyr Tydfil) ; and Cadet Ambulance : Bedwas (Mon mouthshire). The resignation of Dr. E. W. M. Hubert Phillips as Assistant Commissioner for Aberavon County Area, tendered in consequence of increased claims upon his time and energy, was accepted with great regret ; and a temporary nomina tion was agreed for submission to the Sub-Prior, the Earl of Plymouth, P.C. It is a gratifying recognition of the appreciation of the benefits of membership of the Priory Ambulance Transport Service that a number of Colliery Lodges have given favour able consideration to the policy of a voluntary levy in addi tion to the agreed subscription, for a free call upon the ambulances in case of sickness or accident. D uring the month of October the ambulances operating under the Priory Scheme in the South Wales Coalfield dealt with the removal of 1,764 cases, involving a total mileage of 30 , 280 . R e d C ro s s a n d S t . J o h n W a r O r g a n i s a t i o n G lam o rgan Joint C om mittee.

At a meeting of the Glamorgan Joint Executive Com mittee of the Red Cross and St. John W a r Organisation held at Priory House, Cardiff, on Friday, November 25 th, Mr. Elfan Rees explained the functions of the Regional Register opened by the National Council of Social Service, to which enquiries about Air Raid casualties should be sent. A Regional Register is functioning in C a r d iff; and various methods were adopted for securing the co-peration of the Glamorgan Joint Committee through the services of its Liaison Officers in Glamorgan, who can be instrumental particularly in dealing with the problems associated with injured evacuees in hospital. The Glamorgan Joint Committee has undertaken re sponsibilities in every channel of service open to the County Committees. T he most recent developments are the open ing of four convalescent hospitals, with others in prospect, and the opportunities for employment as nursing members at these homes have been eagerly sought by the St. John and Red Cross personnel, who have been appointed on a fifty-fifty basis to staff them. The establishment of a Reserve Hospital Store in Car diff has been completed, commodious premises having been placed at the disposal of the Committee free of cost ; and this local supply of hospital equipment and comforts would be of inestimable value in the event of a need arising in circum stances which would preclude the opportunity of obtaining supplies from a distance. In past months the work of tracing the “ M issing,” delegated by Missing, Wounded and Relatives Department of the W ar Organisation to “ Searchers,” nominated by Joint County Committees, was carried out with conspicuous suc cess by the barrister appointed to work in this capacity at the hospital which at present accommodates nearly 50 per cent, of the service patients in hospital in the whole of Wales, and whose reports, following interviews with every officer and man in that hospital who was a member of the B . E . F . , proved of great value. As most of the “ battle casualties ” have left the hospital, the “ Searchers ” labours have diminished of late. On the other hand, the work of the Hospital Liaison Officers, another group of volunteers com in g under the same department of the W a r Organisation, has been extended to cover civilian casualties, which may easily assume considerable proportions in due course. The task of the Liaison Officers, of whom 27 have been

FIRST appointed to hospitals in Glamorgan, is to provide for the comfort of relatives visiting casualty patients in hospital, who are met at the railway station and helped in securing accommodation, if necessary with monetary aid from the W ar Organisation. Hospital Liaison Officers are being asked to accept re sponsibility also for notifying the Wounded, Missing and Relatives Department of the War Organisation of air raid casualties who have near relatives who are Prisoners of War, to enable the Organisation to send information by cable to the relative in a prison camp. The extension of hospital library services is being pro ceeded with, and it is hoped that in due course every hospital in the county will be well supplied with books and the services of honorary librarians. T he administration of the fund placed at the Committee’s disposal for the relief of distress caused by enemy air action has been delegated to the W. V. S. Organisers, and assistance has been given to a considerable number of people, who have been helped over a difficult interval between loss of home or goods and the receipt of statutory assistance, while other deserving cases which would not be eligible for official grants have been dealt with on compassionate grounds. The in vestigation of cases has been carried out with the greatest care, avoiding duplication of efforts and grants, while prompt aid has been given in innumerable cases where urgent needs could not be met from the slower moving machine of the Government or Local Authority.

A re we on the R ig h t Lines, o r are we off th e R a ils? Bv C A P T A IN A. C. W H I T E

KNOX,

m . c .,

m . b .,

c h . b.

A n y student of first aid is co nt in ually on the look-o ut for methods of im p r o v in g it, either by finding im pro ve m en ts on present methods, or by realis ing t h at present methods, t h o u g h theor etically correct, do not fit in to ac tu a l experience.

I think there is little doubt that present manuals of instruction fulfil their purpose extremely well under every day circumstances. There may be little things that certain people disagree with, and think that a variation of method would improve the result, but taken as a whole, the principle of first aid is on a sound basis. Some years ago, I began to be worried about the trend of our competitions. Though their sta gin g and action im proved out of all knowledge, the work of the competitor became the work of a specialist and seemed to me to be artificial in character. There were too many points given because a knot was tied here, or a bandage placed there, and too little notice taken of the efficiency of the result in regard to comfort and recovery of the patient. I say this, because I sincerely believe that it is the modern competition that has influenced recent first aid teaching and practice. It has been driven home to me very forcibly in the last three months in my association with stretcher parties who have been bearing the brunt of much hard, dangerous and essentially practical work in first aid. It may be well said that this type of work is not normal first aid, but at least it serves to show up in a very bad light the methods of teaching. I wonder how many of those responsible for the framing of our teaching methods, have taken the opportunity to be present at actual “ incidents ’’ and observe carefully the work done by our stretcher parties, or have ever taken the trouble to mix with and question them on the methods they actually practice, in contrast to what they are taught. Those who have done so, cannot fail to be struck by the fact that there are many things, which though theoretically correct, or

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apparently correct, are quite impossible of application in actual fact. It may rightly be said that the first aider must be recourceful and should be able to accommodate his work to the surroundings, but I have a strong feeling that if he were taught well the work that he can do, rather than the work that he might do, he would be of infinitely greater value to the unfortunate people who need his assistance. If it is agreed then, that the S. P. first aider is practising a different type of first aid to that normally taught from the official manuals (and of course it may not be agreed), where then lies the fault ? It would appear to lie at the feet of those who are responsible for their training, and by that, I do not mean the hard working people who have put in long strenuous hours in actually teaching the men, but those who laid down the policy and have failed to realise that it is not w orking accord ing to plan. I can realise the Medical Officer of Health’s pride when he can say that all his stretcher parties hold certificates of the great first aid organisations such as St. John, British Red Cross, L .C .C ., St. Andrew’s, etc. That is the standard of good first aid, and makes his unit perfect for the work it is doing. I wonder ! I think that the stretcher party will be the first to admit that it is impossible in many cases to faithfully fulfil the instructions which the holding of his certificate requires. This is not a criticism of the standard of present certifi cates, but it is the suggestion that a special certificate should be held by every rescue and stretcher party and every warden as well, for attaining proficiency in tbe special type of work they are doing. It would have been perfectly easy for the authorities to have faced facts, and laid down a curriculum for those men based on Standard First Aid but with the special alterations necessary for present conditions. I believe that that curriculum could cut out a mass of the frills which modern teaching and competition have encouraged and leave much more time for the students to practice Sane First Aid, and thereby be a more useful unitin this great work. I have been criticised before for saying that First Aid can be taught in abridged time, but the stretcher party has at least provided me with the material which demonstrates, I think conclusively, that it most decidedly can be done. Perhaps the Editor at some future time, will give me the opportunity of exploiting my theory, laying myself open again, for some further healthy criticism.

R e g u l a t i o n C a p .— In the advertisement of Messrs. Brooks & Co. (Uniforms) Ltd., there appeared “ Regulation Cape, 1/9 . ” This should have read “ Regulation Cap, 1/9 . ”

F o u n d . — Medallion No. 439174 in the Hornsey district. Owner can obtain same on application to Mr. J. Naughton, 20 , Downhills P ark Road, Tottenham, N . 17.

At the annual meeting of the Ayr and South Ayrshire Local Committee, S .A .A .A ., General Sir Charles Fergusson, Bart., who presided, appealed for funds to carry on the work. T w o large houses in East Bedfordshire are being con verted into convalescent homes under the auspices of the Red Cross and St. John Organisation. One is at Old W a r den Park and the other is the Old House, Ickwell Green.

FIRST

Railway Ambulance News. Great W estern. B r i s t o l . — Mr. Raymond W . Manners, motor driver, Bristol, now serving with the R .A .S .C ., received the Com pany’s gold medal and certificate for exceptionally efficient first aid rendered in a serious road accident at Bath in August, 1939 , at the hands of Mr. A. E. Murphy at Bristol station on November 23 rd. Mr. Murphy congratulated Mr. Manners on the very fine piece of w ork performed by him, and conveyed the thanks of the directors and officars of the Company for the impetus such achievements gave to the ambulance movement.

O s w e s t r y . — Another presentation of awards for ex ceptionally first aid rendered took place at Oswestry on November 15 th, when Mr. F. A. Kynaston and Mr. S. A. James received special framed certificates awarded by the Company. T he awards were presented by Mr. F. W. Harris, Div. Loco. Supt., who congratulated them on their excellent work. Mr. T. C. A. Hodson, divisional ambulance secretay, also added his appreciation of their service.

P a d d i n g t o n . — Am ong the activities carried on by women members of the Company’s first aid movement at Paddington is that of a creche for children of passengers during night air raid warnings. T he creche, which is in an underground subway, has been fitted with bunks, and here the children, ran gin g from a few days’ to fourteen years’ old, are brought by their mothers and cared for by the nurse in charge, while their parents obtain rest in an adjoining shelter. The facilities are proving a boon to long distance travellers. T he infant guest of the Company is undressed, bathed, and comfortably tucked up in his bunk by the nurse, who will look in every half hour to see that all is well, preparing a bottle from time to time. Upwards of 70 young children have thus been cared for during a night ; “ Irish Nights ” — Mondays, Wednesdays and Fridays, when the Irish boat train leaves— being the busiest. Sometimes mothers sleep pea'efully beside the children in the bunks, know ing that the nurse on duty will aw ake them in time for their morning train. In addition to outgoing passengers, many arriving dur ing an Alert leave their children to spend the night in the creche, and go to the passengers’ air-raid shelter, collecting their family next morning and continuing their journey.

London

and N orth

North E astern

Eastern.

A rea.

Ambulance work in the North Eastern Area Centre is forgin g ahead ; and once again the annual report shows that all previous records have been broken. T h e number of classes conducted during the year ended June 30 th, 1940 , was 240 , being just double the number for the year 1933 /34 . Successful students numbered 5 , 172 , an increase of 1,010 over 1938/39 session and an increase of 2 , 581 , or nearly double that of the 1933/34 session. Of the total awards gained 1,880 certificates were issued, 721 vouchers, 460 medallions and 2,111 labels. T he pleas ing feature of the increase is the fact that so many members

AID took their first certificate. Since the formation of the N.E. Area Centre 66,776 awards have been gained, including 20,118 certificates. During the year under review 67,995 cases were treated m aking a total of 2 , 010,754 since January, 1896 . Only 28 teams competed in the District Competitions, the “ Wharton ” Shield being won by Y o r k C. & W. Works team. During the year 45 gold medals for 15 years’ efficient service were approved ; 27 bars for 20 years’ service, 13 bars for 25 years’ service, 4 bars for 30 years’ service and 5 bars for 35 years’ service were also awarded. Mr. S. Cooper, the Centre Secretary, is to be congratu lated on a year’s splendid progress. That he has been ably assisted by the Centre President, Mr. C. M. Jenkin Jones, the District officers and secretaries, class secretaries, instructors and committees, is evidenced by the thanks extended to them in the annual report. In his final paragraph Mr. Cooper states : “ In view of the present emergency the necessity for a knowledge of first aid has never been more pronounced than it is to-day . . ” — a statement which we heartedly endorse.

Southern. H uVe . — Presentation of awards was held recently, Mr. L. Brett, Class Secretary, presiding over the meeting. The presentations were made by Mr. F. A. Trott, representing Mr. E. Uzzell, Welfare Officer, and he was thanked by Mr. L. Upton. Dr. Richardson, class lecturer, was the recipient of a pair of gold cuff links, being a small token of the members’ appreciation. B a r n s t a p l e . — Dr. Killard Leavey presided at the pre sentation of awards ; Mr. E. Uzzell, Welfare Officer, distri buted the awards. A short lecture was given by Mr. F. A. Trott, Ambu lance and A .R .P . Inspector, on First Aid, A .R .P ., and Roof Watching.

C h a t h a m a n d G i l l i n g h a m .— The awards gained by the members of this class were presented at Chatham recently by Mr. W. W. Hunt (Station Master), who heartily con gratulated the men on the proficiency and usefulness of their work ; he expressed pleasure in the fact that the member ship was increasing every year. Mr. Hunt was thanked on the proposition of Mr. C. Hodson (Div. Supt.), seconded by Mr. Beadle, the Class Secretary.

E a s t l e i g h . — At the annual presentation to members of the Eastleigh Running Shed Class, Mr. J. A. Long (Running Shed Supt.) presided, supported by the Deputy Mayor and Mayoress (Councillor and Mrs. J. G. H. Treherne), and Dr. and Mrs. L. Green. T he awards were presented by the Deputy Mayoress who received a bouquet from little Miss Dorean Taysome.

I s l e o f W i g h t . — Mr. H. Millichap (Station Master) Ryde) presided at the annual presentation of awards, being supported by Mr. R. G. Gardner (Asst. Div. Supt.) and Mr. Lee (Hon. Secretary). T he Chairman expressed the hope that more younger members would take an interest in the movement. It was essential that everyone connected with the Railway should have a knowledge of the work.

FIRST

1 09

AID

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F IR ST

A ID AN D H OM E N U RSIN G REMEMBRANCER. By J. M. Carvell, M .R .C .S ., L .S.A. London : John Bale & Staples, Ltd. Price 6ci. net. , by post, fid.

Carvell’s Folders have enjoyed a well merited popularity and an extensive sale ever since they were first published during- the Great W a r of 1914 to 1918 ; and they still do so. Three of them— “ First Aid in a Few Words,” “ Home Nursing in Few W o r d s ” and “ B andaging D i a g r a m s ” (triangular and roller)— are now presented in a single book let which can be carried in the pocket and read at odd moments or in an emergency. The folders were designed by their author to outline the main points of, and to serve as condensed treatises of, their respective subjects. Further, since the death of their author, they have been kept thoroughly up to date, and will prove a boon to the numerable body of men and women who in recent times have joined the noble army of first aiders.

Th e M eaning of W ords.

A C a re e r a fu tu re

ll over the British Isles, W orks’ Managers, Factory Managers, Colliery Managers and all large and small industrial con cerns are now busily seeking the assistance of fully-trained First-A.id men in order to maintain the efficiency of their work-people. Special departments are being organized in most Factories, Shipyards, Collieries, W orkshops, etc., where injuries cannot only receive first-aid treatment, but upon being discharged by the surgeons can receive massage treatment and so decrease the rehabilitation period. S P E C IA L L Y

W er e you able to give correctly the definitions of the words given ? In Baillieres Nurses’ Complete Medical Dictionary, which is of a handy size and costs but 3/3 post free, the following explanations appear :—

Epistaxis ( ep-e-staks'-is) . — Haemorrhage from the nose. Haemophilia (he-mo-fil'-e-ah) . — A disease transmitted by females only to their male and, very rarely, female off spring. Characterised by delay, or entire absence, of clotting power of the blood. Slight injuries may be fatal, and any operation is very dangerous. Remissions occur in the disease. Russell’s viper venom will often arrest minor surface bleeding, and transfusion of normal blood is useful. See Clotting Time. Ligament ( lig'-a-mentJ.— A band of flexible fibrous tissue connecting the ends of bones forming a joint. Orbital I., the ring-like band which fixes the head of the radius to the ulnar. Crucial /., crossed ligaments within the knee joint. Poupart's /., between the pubic bone and anterior iliac crest. Lymphangitis (lim f-a n -g i'-tisj. — Inflammation of lymph vessels, manifested by red lines on the skin over them. Occurs in cases of severe infection by inoculation. Meninges ( men-in'-jees) . — T he membranes covering the brain and spinal cord. They consist of three layers, the dura mater, arachnoid, and pia mater. Pleura ( plu'-rah) . — T he serous membrane, lining the thorax and enveloping each lung.

T R A IN E D

Research has shown that the convalescent period is reduced by as much as 80 per cent, where adequa'e follow-up therapy is employed, and first-aid men are being specially trained by the S .M .A .E . (Swedish Massage ard Electrical) Institute to fulfil these requirements. Now is your opportunity of becoming trained for the great work which lies ahead in this vast fie ld —every man and woman skilled in the art of scientific Massage and M anipulative Therapy will be a valuable asset. TREM ENDOUS

O P P O R T U N IT IE S

Your knowledge of first-aid will be ten times more valuable if you can wear the badge of the S .M .A .E . Institute— the badge of qualification. Tremendous opportunities lie before you in this greatly extending field which is now open to you without having to leave your present work until you qualify as an expert and can command an expert’s pay. For over 20 years the S .M .A .E . (Swedish Massage and Electrical) Institute has been teaching scientific massage and numbers among its graduates some of the most successful and highly paid men and women in the realm of Massage. N O T H IN G

LO SE

T h e v e r y m oderate tuition fee, w h ich can be p aid b y e a sy in stalm en ts, in cludes a ll n ecessa ry t e x t book s, ch arts, d ia g ra m s and ex am in a tio n fees, and rem em ber th a t w ith the S .M . A E . In stitu te yo u h ave n oth in g to lose, as it g u a r an tees to coach y o u u n til successful at the e x a m in a tio n an d y o u r D ip lo m a secu red , or return yo u r fees in full. W R IT E N O W f o r th is i n t e r e s t i n g b o o k l e t , e n t i t l e d “ M a n ip u l a t i v e T h e r a p y as a P r o f e s s i o n . ’ ’ It will be s e n t t o y o u f re e a n d p o s t f re e a n d i n v o lv e you in n o o b l i g a t i o n w h a t s o e v e r . A d d r e s s : T h e S e c r e t a r y , 50 , S M A E In stitu te L e a th e rh e a d , S urrey. “ AN PAYS

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VT.

The British-American Ambulance Corps, through its president, Mr. W. V. C. Ruxton, has presented 100 am bu lances to the Red Cross and St. John W a r Organisation. Mr. Ruxton was formerly Master of the Cattistock Hunt, and in view of his connection with Dorsetshire several of the ambulances are being sent for service in that county.

I t II T H E » H E ft P

SUR R E Y

FIRST

I IO

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“ H u tt’s H a rn e s s ” Device. “ Harness” is designed by Mr. A. Hutt, of Dysart, Fife, and is a device to secure a patient on to a stretcher— more especially the all-metal A .R .P . variety. As can be seen from the accompanying illustration, the harness is of canvas and is attached to the stretcher frame by straps. By the use of this device the patient can be speedily secured to the stretcher, giving security and assists in the treatment of shock, the heat being retained and the blankets kept dry. A patient can be carried in any position, and the harness can be adjusted so that pressure can be freed from any injured part. For examination of spinal in juries, the patient can be turned face downwards and the “ H ar ness ” undone, so allowing the removal of the stretcher, but can be replaced in a few seconds and the patient com fortably removed for his subsequent treatment. Already the device has been taken up by local authori ties, and has proved that it is of great assistance to First Aid Parties and Rescue Squads in their work. Mr. Hutt ( 3 , Rectory Lane, Dysart, Fife) will be pleased to send full particulars and prices to those interested.

T h is

S .J.A .B . C eylon

Overseas. P olice

C orps.

in 1912 with 132 members, this Corps now has a personnel of 2 , 363 . According to the annual report for the 12 months ended September 27 th, 1940 , 391 members hold the Service Medal, 118 hold First Bars, 20 hold Second Bars, and one member holds the Third Bar. Every station on the Island is equipped with first aid material and appara tus, and, in addition to motor and horse-drawn ambulances, a motor ambulance launch has been provided by the Port Commissioner for use in the Colombo Harbour. O w in g to extensive sea-board, lakes, rivers, etc , every member of the Force is required to have practical knowledge of Schafer’s artificial respiration. Royal Life Saving Society awards have been gained as follows Award of Merit (Silver Medal), 45 ; Teacher’s Certificate, 1 ; Instructor’s Certificates, 26 ; Bar to Bronze Medallion, 30 ; Bronze Medal, 527 ; Intermediate Certificate, 535 ; Elementary Cer tificate, 387 . T h e report contains instances of the value of first aid treatment, such instances including application of artificial respiration, treatment of electric shock, etc. Once again thanks are due to Dr. S. T. Gunasekera, Director of Medical and Sanitary Services, who is also the Assistant Commissioner, Ceylon, and to all Medical Officers in the Provinces, and to the Police Surgeon in Colombo for services rendered. T h a n k s are also extended to Mr. C. Weerasuriya, who has been responsible for the organising of training and re-examinations. W e take this opportunity of congratulating this Corps on F ounded

“ H u t t ’s H a r n e s s ” D e v i c e .

their excellent w ork and the upholding of the St. John traditions. P retoria C o r p s .

A large crowd gathered at the Caledonian Sports Ground, Pretoria, on October 23 rd, when the annual in spection of the Ambulance, Nursing and Cadet Divisions, Pretoria Corps, took place. Lt.-Col. F. H. Welsh, representing the DirectorGeneral of Medical Services, and Lt.-Col. G. E. Peacock, the Commissioner of the Transvaal District, inspected the various units drawn from the Sub-Districts of the Eastern Transvaal, S. A. Railways and Harbours, and Pretoria. T he parade was under the command of Acting Asst. Commissioners Lt.-Col. G. L. van D y k and Major L. Lever, Acting District Supt. G. Gemmell and Lady District Officer Miss G. C. Carney. At the conclusion of the inspection Service Medals were presented by Lt.-Col. Welsh to Lady District Sut. Supt. Mrs. G. E. Slade, Corpl. P. K. Smith and Pte. E. J. Platt. He congratulated the recipients and complimented all the units present on their general smartness and efficiency. Lady Corps Officer Mrs. K. A. Bevan, on behalf of the Nursing Divisions, handed to Lady District Supt. Mrs. Slade a cheque, being a special donation towards the St. John Convalescent Home for Soldiers in Saratoga Avenue, Johannesburg. The Deputy Mayor, Mr. P. L. Lievaart, who was accompanied by the Deputy Mayoress, commended the work of the Brigade. By kind permission of the Officer Commanding, Special Service Battalion, the band of the Permanent Defence Forces, conducted by Capt. W. E. H. Kealey, played the “ Brigade M a r c h ” when the Divisions marched past the saluting base, and other suitable selections of military music during the function. The British Red Cross Society announced on November

30 th, that eleven members of detachments— six women and five men— have been killed through enemy action. women member died from wounds.

Another

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This illustration shows the clear gangway for loading the lower stretcher when only one case is being carried.

FIRST

T a n n i c A c id : A S c a re A b o u t Scabs. What are the charges ?

A re they proved ?

What is the present first aid position about burns ? U n c e r t a i n t y has been caused in the minds of first aid workers (and even of some doctors) by reports that have appeared in the daily Press concerning latest medical opinion on the use of tannic acid preparations in the treatment of burns and scalds. Paragraphs have appeared purporting to reproduce the sense of recent articles in medical journals and recent proceedings of medical societies. Most of these news paper paragraphs were quite short, and they were certainly snappy ; but they did not report fully, and they did select for quotation brief and somewhat dogmatic dicta isolated from their proper contexts and from their counter-arguments. As a result the unconfirmed impression has got about that tannic acid is always, in every case and at every stage of treatment, dangerous ; and that its use by first aid workers, and by doctors, and in hospitals, should at once be discontinued.

AID very valuable “ with no pitfalls to avoid.” But it has now been claimed that some special types of cases treated in hospital by tanning (i.e., by the parts being covered with a coagulum or scab formed by tannic acid) have turned out badly. The cases referred to are those of severe burns of the hands and of the feet, and of the face affecting the region of the eye ; there has been loss of tissue and permanent stiff ness of joints, with loss of function ; and eyelids have retrac ted, being pulled aw ay by scar tissue from their normal position over the eyeball.

To this there have been several replies ; it was even suggested that it was the surgical technique of the care of the cases, and not the tannic acid, that had been at fault. (“ T o apply tannic acid to a severe burn and leave it at that, is as unreasonable as to expect a mobile joint after a joint operation if no after-treatment is carried out ” : Contrac tures must be controlled by skin-grafting and by movements at the appropriate stage, whether tannic acid is used or any other form of treatment— if they occur it is the fault of the surgeon and not of the tannic acid.” ) Another opinion was advanced that the loss of tissue and of function might have been due to the irreparable destruc That this is the case is by no means proved, and by no tion immediately caused by the initial burn, and hence not manner of means accepted by the medical profession as a connected with the form of treatment adopted. ( “ In many whole, at the moment of writing. It is understood that in war burns the patient puts his hands up to shield his face, some cases tannic acid jelly has even been withdrawn by and the prominent knuckles and the inter-phalangeal joints local medical officers from the contents of official first aid — as the projecting ears— catch the maximum burn. The pouches and haversacks (without any official instruction to joints are opened, but this only becomes apparent when the do so), and this has unfortunately added to the impression sloughs separate. There is often an over-granulated area at of doubt and mistrust created by “ newsy ” but unscientific this site : it resembles, but it is not, as is being stated, due to pressure of the tan. The tan is thin, pliable : you can paragraphs. stretch it with your fingers. If the affected area swells the Study of the original articles in the medical journals, tan “ g i v e s ” with the oedema. This can readily be shown and of the proceedings of medical societies, shows that the by inspecting a tanned surface. In a few days the tan has situation is not quite as simple and as definite as loosewrinkles and bulges. Constriction of the arterial blood thinking readers of the very scrappy, snappy paragraphs supply is equisite agony, and yet our experience has been in the lay Press might be stampeded into thinking. that it is exceptional to have to repeat morphine after the . It is true that certain disadvantages of continued treat initial cleaning in hospital. The burn, if deep, involves the ment by tannic acid in certain special types of cases were tendon-sheath, and this (and not the tan) results in the final alleged, but even in this restricted field of continued treat fixation not only of the local burned area hut of the whole ment (e g . , for days and weeks, and in hospital) of a small finger.” ) number of specified types, medical opinion, as expressed at 2. As regards the face, one of the surgeons whose pub the meeting reported, appears not to have been by any lished remarks have been quoted above includes in the same means unanimous. Subsequently, medical periodicals have article the statement that of 77 cases of face burns treated contained other articles and letters (e.g., by S. M. Cohen, by coagulation methods only two cases required skinM .A ., F .R . C . S . , and W . D. Park, M .D ., F .R .C .S .) ex grafting. (As regards the eyes themselves, of the 77 cases, pressing views contrary to those selected by the daily in only one was there slight corneal ulceration, which is papers for reporting. stated to have rapidly healed). Discussion and controversy in the medical profession 3 . All the above deal with the continued treatment of appears to be continuing, and it is expected that an official these hand, foot and face cases in hospital, and it will be pronouncement will shortly be issued to state a considered seen that even here, beyond the stage of first aid, it cannot view and give a clear lead, and to allay panic among those be said that a very strong argument has yet been made out who have to deal with cases of burns and who may have against tanning methods as such. been unsettled by the rather garbled reports they have heard. It is suggested that, in continuing treatment in hospital, Pending this pronouncement the matter is sub judice, in the in those cases for which it m a yb e considered necessary, such strictest sense of the term, since it is under consideration by divisions or incisions can be made in the tannic acid “ skin,” the august scientific body which can accurately be described pellicle, “ scab ” or coagulum as appear desirable to ensure as the jud ge of medical claims or refutations. that there is no undue pressure, e .g ., around fingers or toes (e.g., by slitting the scab along the sides of the fingers), and But first aid workers have been rattled ; and it may be no “ pulling back ” the flesh, e.g., around the e y e s ; that of interest to them if we set out the situation as it appears to if the parts become swollen under the scab the appearance stand at this moment, stating the (after all, quite limited) of local pain will indicate if pressure is caused, and suitable accusations against tannic acid methods and on the other steps can be taken ; and that movements, as after joint hand the answers and counter claims in its favour. Up to operations, should not be neglected. Obviously, the surgeon this moment, no mention by any of the controversialists of the should ask an opthalmic specialist to see with him cases first aid treatment of burns has been reported ; reference involving the eye-region. has been to subsequent continuing treatment. Let us see 4 . T o quote again : “ Many surgeons who regularly first what has been published in this connection. treat burns with tannic acid obtain as good results in burns A . — T a n n i c A c id T r e a t m e n t in H o s p it a l fo r B u r n s o f of the hand and face as elsewhere. T o them, such dogmatic th e H an d s, F eet and F ace. phraseology as ‘ tannic acid must never again be used for 1. It was stated that at the beginning of the war, tannic the hands and face,’ seems strangely out of place.” ( T o be concluded.) acid treatment for burns and scalds was regarded as being

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Here is a book that fills a long felt want—actual photographs, showing, step by step, how bandages should be applied. W e congratulate the author for the splendid lay-out of the whole work.—Ambulance Bulletin.

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ID E A L

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Well printed on excellent paper, the book con tains 290 admirable photographs which make the bandaging as natural and as near to actual results in practise as possible. We anticipate a very successful career for the book.— St. John Ambu lance Gazette.

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FIRST

Our Nurses’ Page. C O M P ILE D No.

B Y AN A M B U L A N C E S I S T E R . S .J.A.B .

D is t r ic t ,

N u r s i n g D i v i s i o n s . — Recently Mrs St. John Atkinson, Lady Supt.-in-Chief, called for volunteers from Nursing' Divisions in the County to carry out relief w ork in London. It is gratifying to note that there has been a quick response to this appeal. A number of St. John nurses have already offered their services, and are aw aiting further orders. N orth um berlan d

No. 8

D is t r ic t ,

S .J .A .B .

D i v i s i o n . — Full Brigade honours were accorded at the funeral of Lady Amb. Officer Mrs. Taylor. T he deceased lady met her death as the result of enemy action. The coffin was borne by the late officer’s fellow workers of the local first aid services, and many members of both Ambulance and Nursing Divisions paraded under their respective Superintendants to show a last mark of respect. At the cemetery were a number of Nursing Cadets of whose unit Mrs. Taylor had been appointed the officer only a few weeks ago. W o r t h in g

No. 9

S.J.A.B .

D i v i s i o n . — This Division has sus tained a great loss by the death of Lady Supt. Miss C. L. Thomas, who joined the Brigade a number of years ago. Ac the funeral, on Wednesday, November 13 th, m em bers of the local Ambulance and Nursing Divisions attended to pay tribute to one who had earned their love and respect while serving am ong them. N u r s in g

D i v i s i o n , B .R .C .S . Miss Beatrice Batten, O .B .E . , Director of the British Red Cross Society in this part of Kent, gave an interesting account of Red Cross activities, past and present, at a meet ing of Bromley P .S.A . on Sunday, November 10 th. She stated that, as a result of the suffering he had wit nessed on the battlefield of Solferino, a Swiss banker, Henri Dunon, suggested in 1859 the formation of the service in war-time that we now know as the International Red Cross. In 1863 the first international conference on the subject was held. T hat conference was the real prelude to the Geneva Red Cross Convention which formulated international rules of warfare. In 1919 a L ea gu e of Red Cross Societies was formed. T he Red Cross organisation now co-operated with the St. John Ambulance Brigade. T he British Red Cross Society had many war activities, am ong which were the care of war prisoners who were kept in touch with their relatives through its assistance. Locally the Society had opened a canteen at the Chislehurst Caves, where 2,000 cups of tea were served every evening ; a doctor and nurse were in attendance here. The Bromley Centre was at Rothwell, Sundridgeavenue, where any voluntary helpers would be heartedly welcomed. B rom ley

G lam organ

First Aid Post on Saturday afternoon, November 30 th, when the Countess of Plymouth paid a visit to present first aid and home nursing certificates to officers and members of Llandaff, Fairwater and Ely Division. Lady Plymouth was received by Miss Vachell, VicePresident of the Division, and Dr. Morgan Williams, Medical Officer of the Post. T he latter was presented with his certificate of appointment as Medical Officer for Llandaff, Fairwater and Ely Division, B .R .C .S ., and a tribute was paid to him for the part he had played in creating the happy relationship that existed between A .R .P . and B .R .C .S . personnel in the area. A life membership badge and a certificate of the B .R .C .S . were handed to Mrs. Thompson, Lady Supt. of Glamorgan 114 Detachment, in recognition of her valuable work for the Society. Miss Scourfield and Mrs. Crawshaw, Commandant and Quartermaster of Glamorgan 118 , the youngest detachment in the Division, also received certificates of office.

N u r s in g

D is t r ic t ,

F alm outh

AID

B ranch ,

B .R .C .S .

A guard of honour was drawn up at the Ely Clinic and

L e is t o n

D etach m ent,

B .R .C .S .

Lady Eddis presented certificates and badges to mem bers of this detachment, on Wednesday, November 27 th. Mrs. Sylvester, Commandant, said that when war broke out she offered the services of the detachment to the Town Council, and she was proud of the way all the members had worked. Congratulating the officers and members, Lady Eddis said she realised the vast amount of work nursing entailed. A knowledge of nursing was a great asset in peace-time, but was far more important in time of war. A vote of thanks to Lady Eddis was accorded on the motion of Mr. T. W. Girling, Chairman of the Leiston Urban District Council.

S O U T H W IC K

AND

PO RTSLAD E

DETACHM ENT,

B .R .C .S .

This detachment, Sussex 90 , celebrated its second birth day on Saturday, November 23 rd. From morning till even ing there were well-stocked stalls at the Red Triangle Club, and entertainments and dancing to amuse the large number of people who paid a visit there. In the morning visitors were invited to make purchases from the produce stall which was arranged by Mrs. K. Loder. The Hon. Mrs. Mitchell Anderson was present in the afternoon to open a sale of work. She was asked to accept a bouquet of carnations tied with the Anderson tartan, and was thanked for her kind services by Miss Gore Browne, R .R .C . Many people were present to make purchases and to have tea, and the session closed with the distribution of nearly 60 awards to members of the detachment. Lieut.General Cheeswright, of Southwick Home Guard, was chairman on this occasion, and the awards were presented by Miss Gore Browne. T he latter received a bouquet of carnations from the junior member of the Link. A cabaret and dancing in the evening brought a very successful day to a close. The detachment was indebted to members of the Home Guard who were in charge of the side shows.

The recently formed social section of Sheffield men’s detachment B .R .C .S ., opened with a dance on Dec. 5 th, when Asst.-Commandant A. E. Hardy, District Secretary A. Renniean and Mr. H. E. Raymond (Chairman, Social Section) were am ong those present.

FIRST

E Q U I P

Y O U R S E L F

AID

F O R

Essential

A R

E M E R G E N C I E S --------

knowledge ALL

treat

successfully,

possible injuries,

TH E

HOUSEHOLD

PH YSICIAN

Describes in SIMPLE LANGUAGE such necessary informa tion with helpful plates and diagrams. AND

FOR

PEACEFUL

TIMES

The C O M P LA IN TS OF MEN, W O M EN A N D CH ILD R EN , Their w ith The

Cause, T r e a t m e n t c o m p le te

in s tru c tio n s

500 i llu s t r a t io n s

and

and on

fu ll-p a g e

Cure

F irst

P la te s

A id .

m akes

th e r e a d in g m a tte r m o r e e a s ily u n d e rsto o d .

A C C ID E N TS A fe w o f the S u b je c ts tre a te d :

WAR EMERGENCIES:—

Gas Warfare First Aid Bandages Splints Burns Scalds Haemorrhage Fainting PEACE TIME S U B J E C T S : —

Influenza,Colds,etc. Measles, Mumps Catarrh Corns and Warts Physical Culture What to Do in Emergencies Treatment for all Skin Diseases The Lungs, Pleurisy Hygiene, Anatomy, Pharmacy The Principles of Nursing The Eye, the Ear The Throat, the Nose The Chest, the Heart The Stomach, the Liver The Teeth, the Muscles Infant Welfare Homoepathy, Neurasthenia 375 Prescriptions, etc., etc.

W hat

case

o f:

B o d ily Injury, B u rn s a n d Scalds, C lo th in g A lig ht. F o r e i g n B o d i e s i n Ey e s, E a r s , N o s e , T h r o a t . M a chine ry Accidents, Electricity Accidents. D ro w n in g , Suffocation, Bleeding, Poison, B ro k e n Bones, F racture s, Dislocations, S p rain s, Fa in tin g , C on cussion , Etc. THE Y O U N G W IFE will find just the information she requires. MOTHERS who wish their daughters to develop naturally will find exactly the teaching they need. W O M E N O V ER 40 will frankly discussed.

find

their

difficulties

regarding

health

BEAU TY CULTURE— Complexion Diets, Wrinkle Cures, Care of the Hands, Mouth, Eyes, Hair, Recipes, etc. P R E S C R IP T IO N S —375 proved remedies. There are hundreds of subjects. T he muscles, teeth, digestion, hair, food values, Ju jitsu, Phrenology. H o w to diagnose diseases from appearance of head, face, neck, tongue, throat, chest, perspiration, etc.

,- - - - - - - - - - - - - - - - - - - - - - - - F R

E E

MESSRS. VIRTUE & C O ., LTD., F.A. Dept., C ro w n C h a m b e r s , Upper P a r lia m e n t Street, N ottin gham , I P le a s e sen d m e FREE B ooklet on “ THE HOUSEHOLD | P H Y S IC IA N ,” stating c a s h p rice, a lso m o n th ly te r m s of I p a y m e n t without a n y obligation to p u rc h a s e. N A M E .......................................................................................................... (Send this form in unsealed envelope stamped Id.)

I A D D R E S S ....................................

-j j

FIRST

Q u e r i e s t o

a n d

A n s w e r s

C o r r e s p o n d e n t s .

Queries will be dealt with under the following rules :—

1.— Letters containing Queries must be marked on the top left-hand corner of the envelope “ Query,” and addressed to F i r s t A i d , 46 , Cannon-street, London, E .C . 4 .

AID T he term “ fractured a n k l e ” is vague and anatomically incorrect because the ankle is a joint and fractures occur in bones. W hat is usually understood by the term is a fracture of the lower end of tibia or fibula or a fracture of the anklebone. In either case it would be difficult for you as a first aider to make an exact diagnosis and, consequently, you should treat as for a fracture of the leg. The omission of B andage B seems to me to be optional, because it is not, as you say, placed on a fracture involving the ankle but lies above Bandage D which, as the Textbook states, is passed “ round ankles and feet.” — N .C .F .

2 .— All Queries must be written on one side of paper only. 3 .-— All Queries must be accompanied by a “ Query Coupon ” cut from the current issue of the Journal, or, in case of Queries from abroad, from a recent issue.

4 .— T he Textbook to which reference may be made in this column is the 39 th ( 1937 ) Edition of the S.J.A.A . Manual of First Aid to the Injured.

U nnatural

M o b il it y .

A.C . (Selby)..— Included am ong the General Signs and Symptoms of Fracture on p. 65 of the T e x t book is unnatural mobility (movement may be noticed at the seat of the fracture). Will you kindly amplify the meaning of this term ? “ Unnatural m obility” signifies movement at a part where no movement should exist. If a long bone is broken it is obvious that there may be a bending between two joints or that during handling of the patient some movement of the bone may be detected. The Textbook tells you of this, in order that, should you notice any movement, you may appreciate its origin and be even more careful in handling the injured part.— N . C o r b e t F i .E T C H E R .

E x a m in a t io n

H ow ler.

M .R . (Cannen St.).— A t a recent examination I asked a candidate how she would recognise a fracture-dislocation of the spine ; and I was much amused when she replied : “ B v the escape of blood or duid from the ear channel ! ” Good !

Next, please ! !— N .C .F . B lue

B ag

fo r

S t in g s

In sects.

P.S. (S lough).— Please be good enough to tell me how the wet blue b ag relieves pain when used for stings of insects. T h e blue b ag is useful in the treatment of stings of insects because it is composed of alkalies of which bicar bonate of soda is its chief constituent, and because an alkaline solution often gives relief with insect stings as it may with any form of skin irritation. — N .C .F .

T reatm ent

o f

F ractured

A n kle.

R .H . (Morley).— I have many a time been helped by and enjoyed your answers. So would you answer my query please ? At a recent re-examination a pal of mine was told to treat a fractured ankle. Th is gave rise to a dis cussion. I suggested treating as for a fractured fibula and tibia, but omitting Bandage B, because the figureof-eight bandage would act as the bandage below the fracture and because if you put on Bandage B it would be on the fracture.

S l in g

fo r

C om pound

F racture

o f

A rm .

A.C. (Selby).— T he instruction in the Textbook for a fracture of the humerus is “ apply a small arm sling.” If the fracture is compound with the bone protruding, would not this sling allow extension ? I have recently seen two team tests in which the judge in each case called for a large arm sling for this particular injury. Your opinion will be appreciated. With a fractured arm it is questionable how far the small arm sling does allow the weight of the limb, acting at the elbow, to cause extension of the fracture, but it is certain that the large arm sling might increase the over-lapping of the fragment of the broken bone. For these reasons I think that, when the fracture of the arm is compound and the fragments protrude, the selection of a large arm sling is strictly correct. Further, it would keep the whole limb at rest, an important point in the treat ment of a wound.— N .C .F . T ranspo rt

for

C rush ed

C h est.

G. B. (Gateshead).— As a member of the Brigade I would like to know if a person (who has his chest so crushed and pierced that he breathes through the wound) is a stretcher case or a sitting casualty. T he decision in this case rests on the general condition of this patient and the presence or absence of difficulty in breathing. Such patient will probably be suffering from profound shock and so must be removed on stretcher. Further, if he exhibits any serious difficuly in breathing, he must be raised into a half-sitting position, inclined to the injured side and supported thus by blankets or rolled coats. A large sterile dressing would, of course, be applied to the wound so as to prevent as far as possible the entry of air through the chest wall, but the chest must not be tightly bandaged.— N. C. F.

T reatm ent

o f

M u l t ip l e

D ouble

F ractu res.

T. B. (Bishop Auckland).— As a regular reader of F i r s t A i d I will be very much obliged if you will give me the correct treatment for the following double fractures, all being on the same side :— i. Humerus and Clavicle. ii. do and Radius. iii. Radius and Clavicle. iv. do and Scapula, v. Patella and Femur. vi. do and tibia. vii. Femur and do. While I shall appreciate an answer to my queries by post, I shall be content to read your replies in F i r s t A id .

Unfortunately, neither time no space are available for answering in detail the many queries contained in your letter which during the last 25 years constitutes a record in its search for knowledge from the Query column.

FIRST

SAMPLE Page. [ 3 41 lim b to arrest bleeding from an artery. I t should be loosened after th irty minutes, or permanent in ju ry to muscle or nerves m ay result. I t should not be applied to the arm , as damage to nerves is more easily caused, the muscle protection being less. E sm a rc h 'a t. is a rubber bandage which is tigh tly applied.

METAL ANCHOR TOnxTcarNo

T O U R N IQ U E T . tow (to). Th e coarse part of flax used for padding splints, etc. toxaemia (to ks - e' - m e - a h ) . Poisoning of the blood by the absorption of toxins, toxamins(to k s '-a -m in s ). To x io substances said to be present in cereals which are antagonistic to v it a m in D . toxanaemia (to k s-a n -e '-m e a h ). Anaemia due to the

]

TRA

effeot of toxins in the blood. toxic (to k s '- ik ). Poisonous, or produced by a poison, toxicity (to k s - is '- it-e ). Th e of virulence of a poison. toxicology (to k s-e -k o l'-o -je ). T h e science dealing with poisons, toxicosis (to k s -e -k o '-sis ). Th e state of poisoning by toxins. T h y r o id t., due to excess absorption of th y ro xin into the blood, toxin (to k s '-in ). A n y poison ous nitrogenous com pound, usually referring to that produced b y bacteria. T . a n tito x in , a m ixture of diphtheria toxin and an ti toxin used to produce im m u n ity to the disease. Called T . A . m ixtu re. T. to x o id , containing both toxin and toxoid, toxoid ( to k s-o id '). A forraalinized toxin used to produce im m u n ity to d ip h theria. trabecula (tra b -e k '-u -la h ). A dividing band or septum, extending from the capsule of an organ into its interior and holding the function ing cells in position, trachea (tr a k -e '-a h ). Th e windpipe : a cartilaginous tube lined w ith ciliated mucous m em brane, ex tending from the lower part of the la ry n x to the

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1 18

FIRST

As a broad principle, however, you have to decide which is the more serious and the more liable-to-aggravation fracture of the two. H avin g done so, you would concentrate on this fracture, modifying your treatment only when this conflicts with that of the second fracture. Unfortunately, replies by post cannot be entertained in view of the considerable increase in the number of queries which has developed during the last few years.— N .C .F . T reatm ent

o f

F ractured

L eg.

J.N. (Leyland).— At a recent Divisional Practice discussion turned on the treatment of simple fracture of the leg when no splints are available. The Textb ook (p. 92 ) tells us that in such circum stances the feet, ankles, knees and thighs should be tied together. Does this mean that we are to use four bandages, as is suggested by the presence of commas after “ f e e t ” and “ a n k l e s ” ? W e await your kind reply with interest. While 1 agree that the Textbook by the insertion of commas would seem to instruct you to apply four bandages in your treatment of fractured leg without splints, I am of the opinion that three bandages only should be used and that one of them should he applied as figure-of-eight round ankles and feet. This plan is consistent with the instructions elsewhere in the T extbook in this connection and would save a fourth bandage which may be urgently required for the treatment of another case. Further, rumour has it that in some recent air raids incidents there has been a shortage of equipment when the casualties have been numerous.— N .C .F . M ed d leso m e

F ir s t

A id .

A. B. (St. Pancras).— I am a member of a Stretcher Bearer Party ; and during a recent air raid I was proceeding to report for duty when, as I passed a tube station, I noticed a man and woman on the opposite side of the road assisting another man to get off the ground. As the patient was palpably in difficulties I crossed the road to offer my help. H aving enquired the history, 1 raised the patient and supported him by the human crutch method, but before we could step off a man in Red Cross uniform (complete with kit box, labelled “ F.A. P .” ) suddenlyintervened. Somewhat peremptorily he demanded to know what was wrong ; and to his question I answered innocently— “ O h ! Only a broken le g .'" At this my first aid colleague flared up and loudly declared that he could not permit the patient to walk across the road even though supported. Then, relax ing slightly, he agreed that we could carry the patient by the four-handed seat which, without further delay, he learnedly demonstrated. Still assum ing ignorance I obeyed his orders ; and so we carried the patient to safety in the tube station. At last, m y patience being exhausted, I said to my fellow bearer :— “ N e x t time do not be so bumptious ! The patient has broken his artificial l e g ! I ” Y o u would have laughed if you had seen the speed with which, without a word in reply, this meddlesome first aider disappeared ! T u t!

T ut! !

W ha t next ?— N .C .F .

T reatm ent

o f

AID cussion the head and shoulders should be slightly raised to assist this effect. On page 41 of his book on First A id for War Casualties, however, Dr. Norman Hammer says that if the face is pale the head should be kept low and the August number of F i r s t A i d on page 34 assumes the same treatment. 1 am aware that this latter treatment would comply with the General Rules for Treatment of Insensibility but have always understood that the general rule regard ing position of the head did not apply in this particular instance. If Dr. Hamm er’s treatment is adopted does it not tend to cancel out the effect of the application of cold to the head and warmth to the lower limbs, or have I completely misunderstood the Textbook on this point? Your interpretation of the special treatment of con cussion, given on p. 164 of the Textbook, is incorrect. There is no reference to raising head and shoulders of patient ; neither is such action intended. In point of fact Rule No. 2 (a) on p. 134 governs the point. Incidentally, I agree with those who deprecate the application of cold to the head in cases of concussion, though I believe that the Revision Committee advocate this step in treatment on the ground that compression may follow concussion. — N.C. F. U se

an d

D osage

o f

M o r p h ia .

M .R . (Ipswich).— I would be grateful for advice upon the use of morphia, particularly in the form of the ampoule, with special reference to the following points ;— (1) I understand that it should not be used in head injuries where fracture suspected, nor abdominal injuries where shock has already developed. Could you please confirm this and indicate the general principles for its use and also any contra-indications ? (2 ) W hat compounds or forms of morphia are used for deadening pain ? Y o u r queries are a flagrant breach of Principle No. 13 (Textbook p. 26 ), because the decision for or against the administration of morphia rests solely with a qualified medical practitioner— N .C .F . A s p h y x ia

an d

it s

C au ses.

S .W . (Old Trafford).— In your reply to a query published under the above heading in the September issue of F i r s t A i d you name Groups 1 and 3 on p. 136 of the T e x t book as being indirect and Groups 2 and 4 as being direct causes of asphyxia. In your Common Errors in First A id , however, you say that the narcotic poisons and the nervous affections (Group 4 ) are indirect that the Groups 1 , 2 and 3 are direct causes of asphyxia H o w do you reconcile these two descriptions, please ? In point of fact the difference is of no importance, provided that direct and indirect causation be recognised ; and if you will re-read the answer published in the September issue you will note that I was quoting “ some authorities." Much depends on the approach to the question ; and doctors do differ !— N .C .F .

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C.B . (Hampton Hill) — I should value your advice as to the intention of the Textbook with regard to the treatment of concussion. I have alw ays understood that Rules No. 2 and 3 on page 164 of the Textbook were intended to have the effect of discouraging the circulation of blood in the head and that therefore in cases of con

** FIR ST

AID ” QUERY and REPLIES COUPON. T o be c u t o u t a n d e n c lo s e d with, a l l Q u e r ie s . Dec.. 1940.

FIRST

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Jnbepenbcnt Journal for ttjeAmbulance aw) ftursirccj JSenrieesr 3

No. 559.

Vol. XLVII.

JANUARY. 1941.

P r i c e 3d.

SECOND

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F I R S T

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Contents Include : POSSIBLE WAR INJURIES ; W O U N D SHOCK, PRIMARY & SECONDARY; HAEMORRHAGE; FRACTURES; BURNS & SCALDS; ASPHYXIA (including collapse of lung through blast) ; SUDDEN CHILDBIRTH, &c. &c. AN

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THIS

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E d i t o r i a l :—

121

Activities Overseas A .R .P . First Aid Services

122

S.J.A .B . Headquarters and District Reports Readers’ Appreciations Tannic Acid : A Scare About Scabs Practical Points Reviews Honours Asphyxia : Signs, Symptoms and Causes... Starting a Quiz Red Cross and St. John W ar Organisation Our Nurses’ Pages General Nursing A .R .P . Topics Q u e r ie s

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46,

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JA N U A R Y , 1941.

. XLVII.

N O T IC E

nub GEORGE

123 124 124 125 126 126 127 128 129 130 130 134

A ctivities O verseas .

D uring the past year we have been so occupied with activities at home that our colleagues overseas have been pushed into

the background. However, the receipt of the Report of the Chief Commissioner of the St. John Ambulance Brigade, for 1939, reminded us that there were others doing good work in addition to those in this country. Colonel J. L. Sleeman, the Chief Commis sioner, in his report congratulates all Units upon their magnificent spirit which has animated their officers and members since the outbreak of war. We, in turn, would also like to congratulate them on their enthusiasm and their efficiency. It is with pleasure we note that personnel increased by 6,612 and divisions by 162. It is with greater pleasure, however, we find that the Cadet Movement is also expanding by the increase of 36 divisions and 1,559 personnel. On these boys and girls will fall the responsibility of carry ing on the work of The Order in years to come. During the year 162 Service Medals and 115 Service Medal Bars were awarded ; 54 Grand Prior s Cadet Badges ; 524 Service Chevrons and 217 Cadet Proficiency Badges being issued.

C orrespond ents

Artificial Respiration with Fractured Ribs Examination Howler Fractured Spine and Wound of B ack Fractures of Both Clavicles... Fear of Blood Treatment of Burns Treatment of Compound Fractured L e g Collapse of L u n g from Blast Humour in First Aid Colour of Face in Asphyxia... Compound Fracture of Femur and Tibia Plaint of a Competitor

136 136 136 136 136 136 136 138 138 138 138 138

As one reads the individual reports of District activities, the importance of the work is brought into greater significance. In New South Wales nearly 80,000 cases were attended ; whilst in India the personnel has increased by nearly 3,000 members. Abroad, as at home, more and more duties are being undertaken by personnel and the war has by no means lessened the voluntary task. Many expressions of appreciation have been

122

FIRST

received from officials of local authorities and the like, for the wonderful work carried out. W e take this opportunity of extending to our colleagues overseas our sincerest wishes for the future.

A .R .P. B y

F IR S T AID O ur

S p e c ia l

SERVICES.

C o rrespond ent.

T h i s month I have selected one letter in particular from my postbag. It was written by the superintendent of one of the largest first aid party depots in Essex, and I can do no better than to repeat an extract. “ My present trouble is lack of penalties for infringing rules ; coming in late ; not turning up according to iota on the ‘ alert,’ and similar cases not necessarily sufficient to warrant giv in g the offender notice. In any case, I am getting too short ot staff for safety and I cannot afford to dispense with staff and, of course, the men know it.” I have the deepest sympathy with my correspondent and, unfortunately, his experience is all too common. It will be observed that he is not concerned with petty tyrrany, but solely with ensuring that the services under his care are efficient. T he vast majority of my readers will not need to be reminded that very occasionally in their midst there appears a misfit who refuses to pull his weight either because of laziness, bumptiousness, or the lack of a sense of responsi bility. Discipline is necessary in these cases, but usually the type of individual concerned looks upon discipline as a personal affront and, consequently, it has precisely the opposite effect from that which it was intended. One is naturally loathe to dismiss a man from his employment, and yet unless strong measures are taken to prevent a recurrence one’s kindness of heart is construed for weakness, and so the vicious circle goes on. T he “ blitz ” has been made the excuse for so many things which deviate from the normal that one is beginning to feel that it can be put forward as a reasonoble excuse for any error or inefficiency. If it upsets our discipline, it auto matically upsets our morale and, therefore, succeeds in its evil purpose beyond its wildest expectations. Now that we have been initiated into active service and have had time to readjust our ideas after the initial excite ment, I suggest that this is a good time to put our houses in order. I would like to address myself particularly to first aid posts, especially those containing male members among the personnel. T he general public particularly observes the little things. T hey are not impressed with slovenly attire, sm oking while actually on duty, or lolling about corridors with hands in pockets. One must remember that our brothers (and sisters) attached to the fighting forces are constantly observing us, and while they are fully appreciative of the courage and fine work displayed by the first aid A .R .P . services, it would never do to give them the entirely erroneous impression that life in first aid posts was so much easier than theirs. This, in fact, was the gu id in g principle which prompted me to turn down the suggestion submitted to me that personnel should w ork a duty of 24 hours on and 48 hours off. I mentioned the suggestion to some of the lads who had re turned from D unkirk and were eagerly aw aiting the oppor tunity' to go into action again. Their comments were such that my somewhat extensive vocabulary received a few new additional words, which I need hardly say I daren’t print ! W hat, therefore, is the solution to my correspondent’s problem? Happily, in most cases, an appeal to the indi

AID vidual’s better self will prevent a recurrence of the misde meanours, but occasionally it is not enough. One cannot suspend a man, because his services are needed ; one cannot fine him, because his w a ge is already pitifully low. The solution would therefore have to be on these lines :— Give special concessions to good and loyal personnel, e.g., a small bonus, or occasional leave when possible. A bonus could be withdrawn either partly or completely should occa sion arise. Another suggestion is the giving of special badges for merit, which one should be encouraged to prize and treasure ; but the best suggestion of all is the developing of a sense of responsibility and team work, which can only be accomplished by the maintenance of kindly but efficient discipline. Last month I mentioned the new duties undertaken by first aiders in connection with shelters, and warned the local authorities against the danger of the first aid posts be coming converted into “ clinics.” I ’m afraid my premoni tions in this matter have become all too true. Cases have been brought to my notice in which the first aid personnel have actually collected sums of money in the shelters, with which they purchased bottles of ready-made medicines, which they then proceeded to dole out lavishly to all and sundry entirely on their own initiative. I personally have seen patients who were seriously ill, who gave as their reason for not seeking earlier medical attention that they didn’t think it necessary as they had been treated by the “ Shelter Nurse ” — which is all the more surprising when it is realised that a doctor is always available if required in this particular shelter. Finally, I would like to refer to the article written by Dr. White Knox in last month’s issue of this Journal. I strongly suspect that he wrote the article with a twinkle in his eye (or should I say pen) for the purpose of arousing healthy and helpful controversy. I have always made the point that the first aid administered to casualties would be of a graduated variety ranging from the attention given by the R .S .D . squads to the stretcher parties, perhaps ambu lance personnel and finally first aid post or hospital. One’s conception of first aid must therefore be elastic and modified to meet the needs of one’s own particular sphere of activity, e .g ., in the case of a stretcher squad functioning under active air raid conditions, one would expect the barest essential minimum of first aid, whereas in a first aid post, one’s first aid is in many cases well in advance of the generally accepted limitations. Is our normal first aid teaching on the right lines, and are first aid competitions spoiling our first aiders by giving them a wrong conception of the real meaning of the subject ? I say that we are on the right lines because it is better to teach a man to do all that he should when circumstances make it possible, even should those circumstances seldom arise. Moreover, competition work is the finest method of teaching and learning first aid, because apart from the realism of the incident, it teaches the individual to think, act and improvise for himself, and if a bandage has to be applied and there is a right way of applying it— well, why not apply it the right way ? Yes, I can almost hear Dr. White Knox chuckling !

Captain Charles Thorne, general secretary of the Heavy Woollen District Centre of the S.J.A .A . for 28 years, retired on December 29 th at the fixty-sixth annual meeting of the Centre, and was presented with an illuminated address and a cheque. He received his first aid certificate in 1892 , and has been an honorary Serving Brother of the Order of St. John since 1907 . He served throughout the Great War.

FIRST

St. John Ambulance Brigade H EADQUARTERS

AND

D IS T R IC T

REPORTS.

AID

123

Surgeon Burrows and a Warrant of Appointment to Div. Surgeon Rosen. The function was arranged by Sergeant A. Whittaker (Div. Secretary).

N o. V District

N o . II District B u c k in g h a m s h ir e .

County orders give particulars of Personal Injuries (Emergency Provisions) Act 1939 and Personal Injuries (Civilians) Scheme 1940 . The Chief Commissioner has been advised that members of the Brigade not enrolled in Civil Defence Organisations are in the same position as Civilians under the Scheme. Attention is drawn to the need for care in preparing the annual returns for 1940 which should be sent to the County Commissioner not later than January 31 st, 1941 . Mention is made of the “ Meritorious Service ” Certifi cate, instituted by the Chief Commissioner, to be awarded to those who have rendered conspicuous service in connec tion with air raids. The County Commissioner desires to place on record his high appreciation of the valuable support and co-operation of County and Area staffs ; Divisional Officers and other ranks in carrying out their duties in the face of many difficulties during the year.

At the annual meeting of the Slough Social Centre Division a wallet was presented to Sergt. F. C. Fry, in appreciation of his work in helping to form the Division.

Isle

o f

W ig h t .

Lady Corps Officer Mrs. M. F. I. Spicer has been appointed treasurer for the Isle of W igh t Area. T he Chief Constable, Mr. R. G. Spicer, has presented a cup for inter-divisional competition in the Area. The con test to be known as the “ Spicer ” Challenge Cup Competi tion, will take in the general efficiency of Divisions and will include a team test to be held early in the year. Details are being prepared for the Challenge Shield presented in 1904 by Dr. Victor Blake. The competition will be for Privates and will deal with stretcher work.

N o. HI District. W o l v e r h a m p t o n .— A series of lectures have been arranged by the Wolverhampton and District Corps for members of the Brigade and A .R .P . Casualty Services. Each lecture commences at 7.30 p.m. (held alternate Tuesdays) at the A .R .P . Headquarters, Railway Street, and they have been arranged with the view of stimulating further interest in already trained first aiders. The subjects chosen are varied, whilst the lecturers are all well-known in the medical profession. The final meeting is a demonstration of the application of the T h o m a ’s Splint and the Lowmoor Jacket.

No. IV District S t . H e l e n s . — At the annual tea and presentation of awards of the St. Helens T ow n Division, Mr. E. C. Weeks (Station Master, Thatto Heath, L .M . & S . R . ) presented the awards gained during the 1939/40 session. Supt. A. Warren presided, and am ong the guests were Dr. and Mrs. J. R. Burrows, Dr. I. Rosen and Miss Gilray. The presentations included a box of cigarettes to Div.

B a t l e y . — The Batley Division has lost, by death, Pte. Ronald Bean who was a very hard w orking member of the Division. At the funeral the coffin was draped with the Brigade F la g and the cap and belt of the departed member was rested on top. T he bearers, under the command of Amb. Officer Thornton, were Corpl. Durrans, Ptes. L. Fullerton, A. Moore, A. Swift, R. Exley, C. W hittaker and T. Heeley. Amb. Sisters Mrs. Stead and Miss H. Auty, represented the Nursing Division.

B i n g l e y . — On December 13 th, Mr. J. W. Minnikin, Chairman, Bingley Council, presented awards to members of the Bingley Division. T he presentations took place during a social function over which Dr. J. M. O. Wilson presided. Mr. J. P. O. V allow presented A .R .P . first aid certifi cates.

N o . VIII (D uke o f Connaught’s) District H o r s h a m . — T he annual competition for Privates of the Horsham Division was held last month. Commissioner E. A. Richards judged the work, which was of a satisfactory nature, more especially as most of the competitors were comparatively new recruits. T h e “ Alexander Clark ” trophy was won by Pte. G. A. Radford, who gained the cup in 1937 , the last time the competition was held. Pte. F. Nye was second and Pte. L. Weller, third.

N o . IX District S i d m o u t h . — T he need of headquarters was stressed at the annual meeting of Sidmouth Division by Supt. Irish who reported that, generally speaking, each section was ade quately equipped. D urin g the year the ambulance dealt with 174 cases. Supt. Irish paid tribute to the indefatigable work of Driver L ightw ood to whose efforts the efficiency of the work was in a great measure due. Tw elve members of the Division were with H .M . Forces. Col. J. E. H. Balfour presided over the meeting. He said it was a difficult matter at present to find a suitable site for headquarters.

T o t n e s . — A successful year was reported at the annual meeting of the Totnes Division, over which the Mayor (Ala. G. C. Edgcumbe) presided. Supt. W. T . Hall reported that the ambulance had attended 36 accidents and travelled 420 miles and had carried 180 removals entailing a mileage of 4 , 583 . D urin g the year no case had been refused although there had been difficulties.

N o . X District C a m b r i d g e . — On December 5 th, L ad y Supt.-in-Chief Mrs. St. John Atkinson, officially declared open the new S .J .A .B . Corps Headquarters.

1 24

FIRST

Mrs. Atkinson said she had been very impressed by what she had seen and heard of the energy and enthusiasm of the County Divisions, and her report to the Chief Commissioner would greatly please him. Members of the Nursing Divisions were serving in the C. N. Reserve and other A .R .P . Services, and reports were constantly reaching headquarters praising their enthusiasm and efficiency. Members of the Ambulance Divisions were playing their part in the R .A .M .C . and R .N .S .B . Reserve, and there w'ere many reports of their courage and self devotion, and several cases of real heroism. Men and women of the Order were doing good work in London Air Raid Shelters and she asked for volunteers from the provinces to allow London workers to have a holiday. A vote of thanks was extended to Mrs. Atkinson on the proposition of Corps Surgeon C. Walker, seconded by County Officer Mrs. Manley. A bouquet was handed to the LadySupt.-in-Chief by Cadet Cooley. Lord Fairhaven, County President, presided and was thanked by Lady Corps Officer Miss Kennett, seconded by Corps Supt. S. S. Dicker. An inspection followed, of the Divisions on parade, which included Borough Division (Supt. G. Walker, Amb. Officer C. Sargent), Borough Nursing Division (Lady Supt. Miss Doggett, Nursing Officer Mrs. Warrington), Gas W orks Division (Amb. Officer S. Mann), Trumpington Nursing Division (Nursing Officer Mrs. M. Palmer), Post Office Nursing Division (Miss C. Chad) and the Cadet Divi sion (Supt. W. Edsler). The function was well organised thanks to Lady County Officer Mrs. Manley, Corps. Supt. S. S. Dicker and the Corps Secretary, Supt. A. J. Lusher.

AID

T a n n ic A c id : A S ca re A b o u t Scabs. What are the charges ?

A re they proved ?

What is the present first aid position about burns ? (Concluded from page 1/2.)

B . — T a n n ic

A c id

T h ir d

D egree

I t is a l w a y s a p l e a s i n g f e a t u r e to r e c e i v e a p p r e c i a t i o n s fr o m r e a d e r s a n d t h e f o l l o w i n g , r e c e iv e d d u r i n g t h e p a s t m o n t h , a r e e s p e c ia lly g r a t if y in g .

“ Enclosed please find postal order 4 /- for a further 12 months’ subsciption. It is well worth it, even if the price was further increased. I value it.” — H. (Oxfordshire). “ T h a n k you for the regularity of F i r s t A i d under such strain. I think it wonderful and trust the coming year will bring with it peace and prosperity, and ever our F i r s t Am Journal ” — J.M. (Herts.). “ I wish to congratulate you on the wonderful regularity which F i r s t A i d reaches me in New Zealand, at a time when London is subject to trouble night and day. I consider it a great achievement and wish every member of the staff safety from these attack s.” — G. H. Griffiths (Greymouth, New Zealand).

T he Bootle Civil Defence (Emergency) Committee have authorised the air raid precautions officer to purchase a film dealing with first aid for use in connection with the training of civil defence personnel in the Borough. T he annual inspection of the Derby Ambulance Division, S .J .A .B ., was carried out last month by Asst. Commissioner Sir Dudley E. B. M ’Corkell, M .B .E ., D .L . T he parade was in charge of Supts. W. J. Williams and Amb. Officer W. Duncan. Div. Surgeons W. R. Abervethy and M. F. Leslie were also present,

W h erever

One surgeon considered that in the case of third degree burns, the grow ing of new skin, was prevented or impeded by the use of tannic acid. T o this the reply was that “ tannic acid cannot be expected to produce, like magic, epithelium over a large third degree burn. Skin grafting will practic ally always be necessary (whatever the application) ; but surely this is no condemnation of tannic acid, which does most effectively overcome shock, and frequently leaves a granulating surface ready for skin-grafting ; even if sloughs are present, I doubt if preliminary tanning for about a fort night has ever done anything but go od .” C .— T

a n n ic

A c id

an d

I n f e c t io n .

The accusation may be made that the tanning method encourages infection in burns. On this point one of the letters mentioned states “ I can say with McCollum of Harvard (American Journal of Surgery, 1938 , 39 , 27 S) that infection is not the normal sequence in the tannic acid treatment of burns.” D .— G e n e r a l : B u rn s

Readers’ Appreciation.

B urns

S it u a t e d .

H o s p it a l .

Sufficient has been said to indicate to the first aid reader of this article that it is not yet either proved or accepted that tannic acid, as considered in the hospital stage, should be condemned. E .— T

a n n ic

A c id

F ir s t

A id .

Although no reference has been made to first aid work, still thefirst aid worker wants to know where he stands, now, at this moment, in connection with his first aid treatment of burned or scalded casualties. When in due course an authoritative pronouncement is published he will be on firm ground. At present, in some instances, he feels uncertain, but he is rightly sure that it is his duty to avoid any possible risk of danger or damage to his patients. T he following seems clear :— ( 1) “ Wilson, Underhill and others have shown that it is not principally sepsis, ’ toxins,’ or the absorption of brokendown proteinsthat accountforthe shockand toxsemiaof burns. It is loss of watery serum, and Professor Wilson quotes Under hill as being of the opinion that no absorption, but only excre tion (watery discharge) takes place for the first forty hours after the burn. T he importance of sealing-off this loss by tan is so well recognised that to have to plead for its con tinued use seems absurd.” The first aider has been taught that the prevention of loss of body-fluid (including watery discharge from burned or scalded surfaces) is an important part of his first aid measures in connection with shock. He is taught that shock is marked in burns ; and he has been told that in burns this watery loss is very great. Tannic acid jelly applications “ scab-over ” the affected surface ; protect exposed and sen sitive nerve endings and prevent pain j seal up any poisonous products of tissue-destruction, and hence prevent their ab sorption, even after the forty hours mentioned ; and, above all, check the loss of body-fluid which is described above as so prominent a factor in causing shock in burned cases. For the first aider entirely to abandon the use of tannic acid jelly, which doesall these things in thedirection of prevent*

FIRST ing 01 at the least minimising that disaster of secondary shock, which it is impressed upon him he must always try to com bat, would appear to be foolish and wrong unless and until it is clearly shown that to use it for first aid does real harm. But none of the criticisms to date refer to the first aid stage, and it is proper for the first aider to say “ 1 see these great advantages of tannic acid, considered simply in the first aid stage ; now, tell me, does its use in the first aid stage in any way bind the surgeon as to his continuing treatment after the case is in his hands in hospital ?” The answer surely is that (excluding special circum stances such as in small craft or submarines not carrrying a medical officer, and not returning to shore or to a parent ship for days or weeks) cases of burns are handed over to professional care within a short time of having had instant first aid treatment ; and that the first aid use of tannic acid does not bind the surgeon to leave the initial scab intact, or unaltered, or unremoved, if he later finds it necessary to remove it. That scab has done a lot of good from the time it was applied, during initial moving, during the journey to hospital, while waiting in the hospital’s reception block, and until the surgeon is ready to deal with the case in the theatre or in the ward ; and it has done no kind of harm.

AID

1 25

it. It is said that it can be carried by the first aider in a small tin box without deterioration. It is understood that jellies, stated to form a softer scab than tannic acid jelly, are being suggested. One such jelly contains gentian-violet and merthiolate ; another “ triple-dye” (gentian-violet, brilliant-green, and flavine). These are antiseptics. They7 should not be used near the eyes. Pending the issue of some kind of official advice, it is probably wise for the first aider not to use the tulle or these jellies, except under direct professional orders. F .— F in a l l y .

T he case against and for tannic acid is being investiga ted. T he matter is still sub judice. The newspaper reports were garbled and one sided, picking out “ headline ” dogmaticstatements, and not giving either all the arguments or even all the dogmatic statements. An official pronouncement is expectedshortlyto be made, and it m aybethatthe useof tannic acid will be officially justified. In the meanwhile, don’t be hurried or tempted into violent oral or written criticism of tannic acid, however dashing and knowledgeable it may make you feel. As regards your first aid work, keep on the safe side as suggested in “ E , ” but of course obey any specific orders given directly by medical officers. (2 ) But, in the present situation, the individual first aid If, in the end, tannic acid is cleared of all charges, and worker must keep completelyon the safe side. Criticisms have we are told to go ahead with it— all well and good. If, on been made ; doubt has been caused ; his responsibility is the other hand, it should happen that the charges are in the great. The following is suggested as his plan of campaign end considered as proved, and we have to abandon it for for the present, pending the issue o f orders :— burns of hands, feet and face, or even for all third degree burns, it will have been a good thing that we have learnt (i) For the present, avoid the use of tannic acid for fairly early and before widespread harm has resulted. In burns of the hands, the feet and the pace. For burns in these either event, it has done us all good to have had to think regions the first aid treatment as set out in the 39 th Edition a bit. Clear thinking is a jewel. of the St. John “ First Aid to the Injured ” is perfectly correct and perfectly safe. T o be meticulously and scrupulously on the safe side, to “ avoid even the appearance of evil,” avoid even the use of strong warm tea mentioned as 3 (b) (ii) on page 179 . P r a c t ic a l P o in ts . (ii) For any burns of any other part of the body except The Editor invites Notes on actual Cases— with special reference to the hands, feet and face, the St. John treatment is applicable. good and bad points in Treatm ent— for inclusion in this Column. (iii) The use of tannic acid in third degree burns has been called into question : see B of this article: the answer to this criticism is there stated. The first aider should weigh up the situation for him self ; tanning combats shock ; it is shown that neither tan ning nor other treatment can be expected in extensive burns to grow7 new skin by magic, and its use does not either pre clude skin grafting or make it more necessary ; if anything, it may prepare the surface for it. If however the first aider wants to be “ so safe that it hurts,” he can avoid the first aid use of tannic acid for all third degree burns wherever situated. (iv) Remember the instructions given under “ A ” on page 178 of the St. John book. If the patient can fairly readily be got to hospital or aid post or treated at home by a doctor without delay, the burned surfaces may be covered closely with any suitable clean, dry, soft dressing; bandaged (not too tightly); the part supported; and the patient pro tected from chill. He should have plenty of fluid to drink, preferably hot drinks sweetened. Morphia, given by any medical officer on the spot, may be valuable. Remove all cases of burning or scalding, except the most trivial ones, as stretcher cases, suitably blanketted. The use of “ tulle g r a s ” has recently been advocated This is material like curtain net, of two millimetre mesh, specially prepared including soaking in a mixture of soft paraffin 98 parts, halibut oil 1 part, and balsam of Peru 1 part. It is claimed that it can be used for any type of burn anywhere and that it has the advantages that it can readily be removed at the hospital if necessary, and that alter natively other applications (e.g., of saline, or even of tannic acid or other coagulants or scab-formers) can be put on over

K il l e d

G as

b y

F u m es.

T he dangers associated with the use of ga s in the home were illustrated in a recent fatal accident in our neighbour hood where an old man was found dead at his house kneel ing in a bath overflowing with water. At the inquest death was certified as one of coal g a s poisoning, and it was due to incomplete combustion of gas consequent on a cloth having been placed over the heater to dry.— J.L. (Tottenham). K il l e d

b y

B ee

S t in g .

That small things may cause fatalities was proven during the summer months. A woman driver of a car, travelling along the Findon bypass, Sussex, was stung in the face by a bee. T he car mounted the grass verge by the roadside, struck and killed two elderly women, turned a double somersault and came to a standstill in an adjoining field. T he driver escaped serious injury.— A.B . (Worthing). K il l e d

b y

E a t in g

G r ass.

At an inquest held here some months a g o it was dis closed that the death of an elderly man (aet 60 ) was due to his fondness for eating grass. His widow stated that deceased was alw ays eating grass and that he alw ays kept some in his pocket. Medical evidence was that, eaten over a period of years, the grass had caused intestinal obstruction which resulted in death. I am wondering how often death has been due to such a curious cause,— J.B . (Ipswich).

1 26

FIRST

R e v i e w s .

S U T H E R L A N D ’S

FIR ST AND

AID

IN JU RE D

S IC K .

Revised and Re-written by Halliday Sutherland, M.D. Edinburgh : E. & S. Livingstone. Price 6d net., by post, 8d. This little book was first published in 1887 by the father of the present editor, and it continues its triumphant career, this being its 43 rd edition and representing a sale of 190,000 copies. Its information is set out in sections and is clear, concise and correct. Further, it includes a section on air raid gases ; and it is so small that it can be carried in the waistcoat pocket. The descriptions of Schafer and Silvester methods of artificial respiration dififer in certain particulars from those usually taught ; and we note that the latter name is still misspelt. Those of our readers who have not yet seen this vest-pocket vade-mecum of first aid are advised to purchase a copy forthwith.

W AR -TIM E

NURSE.

Edited by J. M. Mackintosh, M.D. Edinburgh : Oliver & Boyd. Price j 'i , net. This is not a textbook of general nursing but rather a collection of ideas about the nursing of certain war casualties. Such being the case, it is not the w ork of one author but a unique series of 12 articles written by experts in the various subjects, both doctors and trained nurses ; and its purpose is to demonstrate how war has modified nursing and given rise to new conditions in nursing. First there is an article on “ the new nurse,” her train ing and duties. Then the management of head injuries and of eye cases are fully described. Next come articles which deal with plastic surgery, in cases of injuries and wounds of the chest and also of the abdomen. Next the nursing of orthopaedic cases, of burned patients and of those suffering from mental illness is set out in detail. Next the duties of the midwife and of the health visitor in war-time are care fully defined ; and, finally, the book closes with an article on diet. The book is essentially practical, since doctors and trained nurses contribute their points of view ; and the result is a happy combination of technical detail, sound advice and practical wisdom.

T H E N U R S E ’S D I C T I O N A R Y . Revised by Florence Taylor, S .R .N ., I.S .T .M . London : Faber & Faber, Ltd. Price ys. net. This most useful pocket dictionary of medical terms nursing treatments, which is now in its 17 th edition, long since proven its value to nurses for whom it originally compiled. The definitions are brief but at same time accurate and complete ; and their correct nunciation is set out by a system which is both simple effective.

and has was the pro and

The dictionary proper is prefaced by lists of abbrevia

-AID tions of medical degrees, diplomas and titles and of terms used in prescriptions, by tables of comparative weights and measures, and by a compariser of Centigrade and Fahrenheit thermometric scales. It ends with a series of appendices which will be most valuable to nurses and includes urine testing, poisons and their treatment, measurement of drugs and lotions, first aid, and lists of instruments required for different operations. Incidentally, the inclusion of Marshall H a ll’s method of artificial respiration is noted with surprise. The dictionary as a whole has again been thoroughly revised for this edition to ensure that its contents are both comprehensive and up to date. New terms replace those which are now obsolete and new theories are quoted regard ing the courses of certain diseases ; and the most recent knowledge of vitamins and new drugs is also included.

IO D IN E

FACTS.

London : T he Iodine Educational Bureau, Stone House, Bishopsgate, E . C . 2 . This interesting and instructive pamphlet contains 47 brief articles based on facts and reports form many and varied sources on the history and uses of iodine in medicine and surgery, on the farm and in the factory. It tells us in how many different ways iodine has been used since its discovery in 1813 ; and it is surprising to learn that iodine was first employed as an antiseptic in the treatment of wounds in 1839 . The Iodine Bureau, which publishes the pamphlet, was established in London two years ago and seeks to gather and correlate the vast body of iodine information which is constantly being expanded by scientific research and practical experience. In its introduction it states that its resources are available to professional men and to the public and that enquiries are at all times welcomed.

Honours. I n the New Y e a r ’s Honours List, we were pleased to notice the following, to whom we offer our congratulations. Officers of the Order of the British Empire : Lady (Eleana) Bennett (Regional Officer, Central Hospital Supply Service, Red Cross and St. John War Organisation) ; Captain Arthur Nigel Cahusac, M.C. (Chief Secretary, St. John Ambulance Association). Members of the Order of the British Empire : Miss Eva Katherine Baddeley, for services to first aid and to the work of the Order of St. John of Jerusalem ; Miss Milicent Elinor Buffer, Divisional Director, Chelsea Division, British Red Cross ; Mrs. Florinda Elizabeth Hayes, Lady County Super intendent for Hampshire, St. John Ambulance Association ; Miss Florence Mary Furneaux Stokes, County Secretary, Sussex Branch, British Red Cross Society. W e also offer our congratulations to Asst. Commissioner George Abbiss, Metropolitan Police, on his admission as a Kn ight Bachelor. He has given every assistance to the first aid training of the members of his force and is a well-known figure at competitions.

An ambulance w aggon of the latest American type, costing ;£4 5 0 , was presented to the St. Andrew’s Ambulance Association at Denny last month. Provost J. Sawers handed over the w aggon, the fund for which was raised by public subscription, to Colonel Donald Mackintosh.

FIRST

Asphyxia:

Signs, S y m p t o m s Causes.

and

Prepared for ARDEER By

DR.

FACTORY H.

AM BULANCE

C L A SSE S

R O B E R T S of Ardrossan, Ayrshire.

W h e n circumstances prevent the blood circulating through the lungs from freely exchanging Carbonic Acid for Oxygen, a condition called Asphyxia is set up. This state it not relieved will cause death, which may ensue quickly. Asphyxia may arise because of direct obstruction to breathing with consequent shutting down of oxygen supply, or may be due to conditions which permit breathing but render this act ineffective as a means of the blood obtaining oxygen. It is apparent that the essential feature of Asphyxia is some form of interference with normal respiration. The varying causes will be more readily understood if we first consider which factors are essential in order to carry on breathing and then deal with Asphyxia according to which factor is awanting. All of the following conditions are indispensable for normal respiration, and the lack of any one will induce asphyxia :— (a) An airway through the nose or moulh and throat on to the lungs. (b) Air containing adequate oxygen (normal = 21 percent). (c) Movements of chest and diaphragm. (d) A control called the Respiratory Centre acting from the brain. (e) Blood containing haemoglobin circulating in the lungs. E xam ples

o f

A sp h y x ia

from

A bsen ce

o f

C o n d it io n

(a ).

Impeded airway states :— ( 1) Choking from foreign body blocking entrance to throat. (2 ) Occlusion of throat by diphtheritic membrane. ( 3 ) Swelling of throat and larynx after swallowing scalding or irritant liquid. (4 ) Blocking of air passages to lungs by foreign fluid, e.g., drowning. (5 ) Compression of airway by h a n g in g,* strangling and throttling * Not judicial hanging. S ig n s o f

an d

S ym ptom s

C o n d it io n

o f

A s p h y x ia

w h en

C au sed

b y

L ack

(a ).

( 1) Choking: Violent and sudden obstruction of normal breathing by choking produces unmistakable appearances which in the order of happening are :— Immediate extreme distress and fright. Great inspiratory efforts, struggling for breath. Increase in pulse rate. Blueness, appearing in lips and at lobes of ears. Clutching or tearing at the throat. Prominence of veins in the neck. Lividity of face. T he above group constitutes a stage which lasts a very short time, certainly not beyond 5 minutes. If the patient is not treated a second stage sets in characterised by :—■

AID

12 7

Collapse. Inability to perform any muscular movement. Bewilderment. Semi consciousness. Unconsciousness. Convulsive movements. Stoppage of all breathing efforts. Heart beats continue for 5 minutes. Death. The withholding of oxygen from the blood because of lack of air together with the inability of the blood to get rid of the carbonic acid it contains has destroyed life. ( 2 ) From Diphtheritic Membrane : This form of obstruction comes on gradually, and the intensity of the first stage of asphyxia already described is absent or greatly modified. In inspiration a strident noise is heard as the air whistles through the lessened aperture of the larynx. The stage of collapse and unconsciousness is of longer duration and is aggravated by toxa'mia. The whole body assumes a leaden hue, and death from asphyxia occurs if the obstruction to inspiration is not removed. (3 ) From Scalding or Irritant Liquids : As for No. 2 above. In certain circumstances sudden swelling of the membrane lining the larynx may occur. This is called cedema of the glottis, and is rapidly fatal. Its onset would present the features described under (1). (4 ) Drowning : Although the obstruction to breathing is here both violent and sudden the signs of lividity and of clutching at the throat described in No. 1 are absent in the apparently drowned. Where the whole body has been submerged quick exhaustion from stru gg lin g will arise, causing fainting when the fight for existence ceases. Unconsciousness therefore in the apparently drowned is far from indicating that the asphyxia has proved fatal. Although drowning usually refers to submersion of the body the first aider must know that it is sufficient to consti tute drowning if only the mouth and nostrils are submerged and if the person concerned cannot free himself. ( 5 ) H anging, Strangling and Throttling : H a n g in g is almost invariably suicidal, although acci dental cases are not unknown. Both strangling and throttling are homicidal acts. In h a n g in g and strangula tion the constriction encircles the neck, exerting pressure both on the windpipe and blood vessels. In throttling there is direct compression principally of the windpipe. There is seldom evidence in suicidal hanging of attempt by the suicide to rid himself of the constriction. T he suicidal mind is doubt less a reason, but a greater one is that fatal h a n g in g may occur without great force being applied to the windpipe. T h e stoppage of blood circulation to the brain by compres sion of the veins and arteries in the neck induces uncon sciousness before the restricted breathing causes distress. In throttling and strangulation, however, scratches may be found on the neck, or there may be signs on the fingers of attempts at freedom. T he facial appearance in fatal hanging, strangling and throttling may not show in either colour or expression indications of distressful asphyxiation. Indeed, in suicidal h a n g in g the face is frequently calm and without discolouration. T he mise en scene will show what has happened, as will the characteristic m arking on the neck. In strangulation this has a circular course round the neck and is indefinite at one particular part, which varies— it may be the front or back or at one side. It is exceptional for the circular mark to be complete. In throttling, marks are found at the sides of the windpipe corresponding to a thumb mark on one side and a larger and linear mark, or series of marks, on the opposite side, from compression by the fingers.

128

FIRST

The first aider should note the site of all marks and their characteristics. Throttling might be the cause of death and the body afterwards placed in suspension to simulate suicide. Likewise signs of injury to other parts of the body and scratches in face or neck are important particulars. He will have noted under Signs and Symptoms that the heart beats for some time after stoppage of breathing. He should therefore in all cases relieve whatever constrictiction is present and administer artificial respiration. E xam ples

o f

A s p h y x ia

from

A bsen ce

o f

C o n d it io n

(b) :

The air is deficient in oxygen content. This may range from a minor degree to conditions where the atmosphere breathed contains no oxygen at all. V ary in g degrees of oxygen deficiency are seen in the examples below :

AID ing nitrobodv. Soot particles give rise to intense irritation, necessitating continual coughing. Simple Asphyxiants : By contrast with the signs and symptoms described in class (a) asphyxia here is subtle, sudden and surprising. The victim may be unaware of symptoms. Immediate un consciousness is commonly the first sign, and if symptoms are obtained they may refer to slight nausea or trifling giddiness. The simple asphyxiants are invisible and odour less, and herein, with their rapid attack, lies the danger. ( T o be concluded.)

( 1) Mountain Sickness: Altitude Sickness : At heights of 10,000 or 20,000 ft. the air is thin, and in breathing a greater volume is needed to obtain the full ration of oxygen. The strain thus thrown on respiration induces headache, mental depression, memory confusion, nausea and weakness. These symptoms and others vary with the height reached. For example, at 12,000 feet nose breathing is inadequate. Altitude sickness is not asphyxiating, since the body can acclimatise itself to a rarefied atmosphere. ( 2 ) Smoke from Burning B uildings : The oxygen is consumed and also displaced by soot particles and other products of combustion, (3 ) Fum es and Invisible Gases: All gases, however different, mix together. Air (Nitro gen g a s + oxygen gas) will mix with carbon di-oxide, nitro gen, methane (fire damp in mines) and acetylene, wherever these gases are present. These are termed simple asphixiants, that is, they are inert gases from the physiological standpoint exerting no action upon the blood and acting only by excluding oxygen from the lungs. (4 ) Sewer Gas : This contains a high concentration of carbon di-oxide from decomposing organic material. Also contains methane and frequently a poisonous gas called sulphuretted hydrogen. Asphyxiation by sewer g a s is due to these gases. Carbon di-oxide alone is also highly asphyxiating. (5) Deep Wells : l Tals in D istilleries : Carbon di-oxide present only, no oxygen. (6) Black Damp pound in M ines : No oxygen present. Black Damp is composed of the asphyxiants nitrogen and carbon di-oxide in the proportion of Nitrogen 87 per cent., Carbon di-oxide 13 per cent. Fatal cases commonly occur in (4 ) (5 ) and (6). In this class, stoppage of breathing is not antecedent to the onset of asphyxia, therefore the two-stage group of signs and symptoms described under (a) does not apply. Mountain and Altitude Sickness : If the change to altitude is sudden, particularly in the case of one not acclimatised to great heights, or if the ascent involves exertion, distressing respiratory efforts set in, lead ing to fainting, muscular weakness. Mountain sickness although not a true asphyxia may be very serious, and is included here because it arises from oxygen want. Smoke Asphyxiation : Smoke may contain soot particles only, or may be mixed with the asphyxiating gases, and also with gases emanating from the burning structures, e .g ., nitrous fume from burn

S ta rtin g

a Quiz.

“ Quiz ” paragraphs are nowadays a lamiliar feeature of many publications; and the B .B .C . have popularised this subject. For the first aider a little time spent each week on questions and answers is an excellent method of acquiring new information and also keeping old information fresh in one’s memory. Whilst aw aiting cases at F .A .P . or even at divisional practices, a “ Quiz ” can be started. All that is required is a copy of a good dictionary. An excellent one for this pur pose is Baillieris Nurses’ Complete Medical Dictionary, for it not only defines words but also fully explains them. Further, many illustrations are given. T a k e the word “ Haem aturia.” T he plain definition is “ Blood in the Urine,” but the dictionary definition, however, gives that useful little bit more, and reads “ Blood in the urine, due to injury or disease of any of the urinary organs. When the bleeding arises in the bladder or urethra, the urine is red in colour ; if from the kidneys, it may be very red and dark, or when present only in small quantities is described as smoke-coloured.” T o start a “ Q u i z ” one member acts as questioner and picks out words and asks their meanings. If everyone has a copy of the dictionary each can check the answers. Questions can also be asked on a wide variety of subjects coming within the scope of the first aider. These, too, can he based on the Dictionary as it contains many appendices of information on various subjects. Here are some ten questions to start your “ Quiz ” The figures given are the pages on which the answers can he found in Bailliere’s Complete Medical Dictionary.

1 . W hat is the difference between an antiseptic and a disinfectant? (Pages 22 and 95 ). 2 . What are (a) the advantages ; and (b) the disadvant ages of open wove cotton bandages 'P a g e 477 ). 3 . Describe the two classified forms of epilepsy ? (Page 110 ). 4 . W ha t are the symptoms of shock ? (P age 446 ). 5 . W hat is the patella ?

(P age 240 ).

6. How do you recognise Mustard Gas ?

(P age 464 ). 7 . W hat are the general principles of first aid treatment of fractures? (P age 452 ). 8. What do the following letters mean after a doctor’s name : M .D ., M .R .C .P . ? (Page 469 ).

9 . What is a louse ? Is there more than one kind ? Is a louse connected with any disease ? (P age 196 ). 10. Pronounce and explain the meaning of the following five words beginning with the letter “ A ” :— Abscess, acetabulum, acidosis, acne, aeration

FIRST

R ed C r o s s a n d S t . J o h n W a r Organisation.

AID

„ Oc s f o l R E V I V A L D E P E N D S S u cc 6 ON P R O M P T A C T IO N

On January 3 rd., Field-Marshall Sir Philip Chetvvode, Chair man Executive Committee, broadcast an address on the Work of the Organisation in the War. The general public, said Sir Philip, have generously supported the work, such support not only coming from those at home but also in full measure from all our Domin ions, Colonies and Dependencies, especially from Canada. America also, through the good offices of the American Red Cross, the British W a r Relief Society and the Allied Relief Fund and many other supporters, have helped more gener ously than could have been believed possible. The fund left over from the last war is being applied for the object for which it was raised, namely, for the benefit of the sick and disabled of the Great War and their dependents.

T h e F i rs t Aid m a n ’s skill is u n a v a il in g if t h e v i c t i m ’s r e s p i r a t i o n is a l l o w e d t o fail —p r o m p t action w ith the Sparklet; R esuscitator is vita l to s u cce ss fu l recovery.

^ , 206,000 had been spent on W orking Parties, and a very large sum of money had been found by members them selves, and they had supplied over 2\ million hospital g a r ments and an enormous number of swabs and bandages.

S P E C IA L

O U T

(As used by Red Cross and First A ii O rganizations, P olice Forces, Fire Brigades, E lectricity Undertakings, Cas Companies, e tc .) W r i t e f o r le a fle t “ P r o m p t Fi rst -A id T reatm ent of Asphyxia and other R e s p i r a t o r y F a ilu re E m e r g e n c i e s . ” Sol e M a k e r s : S P A R K L E T S LTD, D e p t . 42. E D M O N T O N , L O N D O N , N . I 3

Approximately three quarters of the Organisation’s total funds received, have already been spent or allocated. T he fiercest criticism of our work, continued Sir Philip, has been that we did not get the food and clothing, paid for by the public, through to our prisoners of war. All com munications, of whatsoever sort, ceased between us and the Continent when France was defeated, and it was only after prolonged negotiations by the Post Office and the Red Cross that the present unsatisfactory route through Lisbon, Spain and unoccupied France, was established.

A M B U LA N C E

F I T 8 5 / - C 0 M P L E T E f B r /t ,s/, Isles)

THE

SPARKLETS

R E SU SC IT A T O R

The International Red Cross at Geneva are doing their very best, but they are overloaded. They are trying to get food and clothing to two million Polish prisoners ; more than one million French prisoners ; 44,600 English and many others, and they are actually dealing with 60,000 letters a day. W e have already spent over a million pounds on food and clothing for our prisoners of war. Another big demand was from the Ministry of Health, who asked that 20,000 beds be established in Auxiliary Hospitals and Convalescent Homes. Already 203 houses have been taken, of which 62 are open and in operation and 69 rapidly approaching completion. Over 100 ambulances have been distributed to the F ight ing Forces, and over 120 from Canada, as well as 220 from America. As soon as intensive air attacks on London and E n g land began, a quarter of a million pounds was set aside to assist the victims. T he object of the Red Cross work is not to supply basic requirements for the sick, wounded and injured, whether service or civilian. T hat is the business of the Government. But the public of the world have alw ays insisted on supple menting that minimum of help in war, and it has always been the Red Cross in every country which has been the vehicle through which the public have satisfied their desire to do more for the sick and wounded, prisoners and the miser able, than any Government can be expected to do.

The services of Dr. John Lees, lecturer, and Mr. Gordon M’ Intosh, demonstrator, were recognised by the Hillside Section, S .A .A .A ., last month, when Commandant William Latto presented the doctor with a medical instrument and Mr. M’ Intosh with a half tea-set.

T h e ‘ Elastoplast ’ F irst A id O utfits, N os. I and 2, consist in each case o f a neat, strongly-m ade cardboard box, containing an assortm ent o f F irst A id Dressings. T h e y are designed prim arily for use in factories and w ork shops, and are a useful addition to the ordinary First Aid C abin et for the A m bulan ce R oom . E ach dressing consists o f an antiseptic gauze pad m edicated w ith Bism uth Subgallate 2-3% on the ‘ E la sto p la st5 elastic adhesive base, affording an elastic support and ensuring com fort and protection in use. B oth O utfits are available through you r usual surgical supplier at 6 /- each. W rite for further details to : T . J. Sm ith & N ephew , L td . (D ep t f . a . x \ N eptun e Street, H ull.

T R AD E MARK

F I R S T

BRAND

A I D

O U T F I T S

FIRST

Our Nurses’ Page. C O M P ILE D

No.

AN A M B U L A N C E S I S T E R .

(W estern) D istrict,

S .J.A .B .

W o r c e s t e r N u r s i n g D i v i s i o n . — T he report for 19-10 shows that this Division has been very busy during the past year. Membership has increased to 45 under the able leader ship of Lady Div. Supt. Mrs. Hammond, S .R . N. At the outbreak of the war, the Division was given charge of Holy Trinity Aid Post, and to assist with the duties there, members helped to train about thirty volunteers attached to the Post. Other members have taken up full time hospital work. D urin g the year some 200 comforts have been knitted at the Aid Post for the three Services, and parcels have been sent to a prisoner of war. T h e Division is fortunate in being able to use the Aid Post for social activities, this privilege having been granted by Dr. Griffin, Medical Officer for the City.

AID No. 5

D is t r ic t ,

S.J.A .B .

D i v i s i o n . — At the annual general meeting held on January 2 nd, Lady Div. Supt. Miss Prince said there were two pleasing duties to perform. One was a presentation of a fitted suit case to Div. Surgeon S. Prior, for his loyal and long service of twenty-five years’ voluntary work. The other presentation was to Miss L. B. Fisher on the occasion of her marrriage to Mr. G. Webb, and this took the form of an oak clock. In m aking the presentation to Dr. Prior, Miss Prince said that it had always been a pleasure to work with him ; whenever she had sought his help he had never refused to give it if it were at all possible. Asst. Commissiouer H. L. Thornton also paid tribute to the untiring service which Dr. Prior had given, and said that after a hard day’s work he had always been ready to devote time and energy for the good of the members of the Nursing Division. Dr. Prior thanked the officers and members for their kind thought, and said it had been a pleasure to do all he could to train them to help in caring for the sick and wounded. The presentation to Mrs. Webb was made by Dr. Prior, Mrs. Webb suitably replying. W estgate

N u r s in g

No. 6 D i s t r i c t , S.J.A .B . No. 3 ( E a s t e r n ), D

istrict

S.J.A.B .

M a r k e t H a r b o r o u g h N u r s i n g ' D i v i s i o n . — The Annual Competition for the “ B a r n sle y ” Challenge Cup took place recently, at the Ambulance Headquarters, Abbey Street, bive teams competed, and after a very keen competition, Dr. Reuvid adjudged the winning team to be that led by Ambu lance Sister E. Gardiner. Lady County President Lady Zia Wernher presented the cups to the winning team, and expressed her pleasure at being present. Lady County Officer Mrs. Pelly, donor of the individual cups, was unable to attend ow ing to illness. Dr. Reuvid congratulated Lady Div. Supt. Miss F. Harris on the efficiency shown by the teams.

No. 4 D i s t r i c t , S.J.A.B . N e w t o n ( C h e s t e r ) N u r s i n g D i v i s i o n . — The Annual Inspection of this Division took place at Newton New School. The Inspecting Officer was Corps Surgeon William Hughes, who was accompanied by Lady Corps Officer Mrs. M. G . Hibbert. Members were drawn up on parade under their officers, Div.' Surgeon Mary E. Russell, Lady Supt. E. Murphy, Lady Amb. Officer E. Musgrave and Nursing Officer Mrs. A. Dawson. Dr. H ughes said that it was with great pleasure he came to inspect the youngest Division of the Corps, their inaugu ration having taken place just as war broke out. He spoke of the objects and aims of the Brigade, and hoped those pre sent and future members would so get the love of the work in their blood that they would continue to uphold its tradi tions, not only throughout the war, but long after. Much credit was due to the officers of the Division, and also to the members for their smartness and efficiency. While Dr. H ughes g a v e tests in bandaging and artificial respiration, Mrs. Hibbert inspected the books and Divisional records. Nursing Officer Mrs. Dawson has been acting as Sister in Chester Infirmary for some time, while other officers and members are w orking at the First Aid Post and at hospital in the Civil Nursing Reserve. T w o have taken up nursing as a career and are serving as probationers. A vote of thanks to Dr. H u ghes and Mrs. Hibbert was accorded on the motion of the Div, Surgeon Mary Russell.

Fifty Y e a r s’ Service in the Brigade.— Miss Edith Hardy of Hull has just completed fifty years’ active membership in the St. John Ambulance Brigade. Her interest is such that in recent months she has attended drills in a bath-chair, while only a few months ago she delivered a lecture on the treatment of wounds and haemorrhage. Miss Hardy joined on December 15 th, 1890 , when there was only one Division in Hull for men and women, meeting in Bond-street. This was later divided into an Ambulance and a Nursing Division. Then came other Nursing Divi sions, but Miss Hardy remained with the Central Division for 22 years, being an officer for the last ten. On the formation of Reckitt’s Nursing Division, she was invited to become the first Lady Superintendent, hold ing this post for 15 years. D uring the last war, Miss Hardy qualified at Leeds for her demonstrator’s certificates in first aid and home nursing, subsequently taking classes at Reckitt’s, Peel House, the Y . P .I . and Hedon. She also helped at Reckitt’s Hospital, and the Cottingham Road Hospital. Through her efforts, St. John members were allowed to work at the local hospitals. They were first admitted to the Baker-street Dispensary where she herself also took duty until 1924 , for the latter part of the time as a full-time worker. In 1927 Miss Hardy transferred to the Y . P . I . Nursing Division as Lady Superintendent supernumary to establish ment, and about three years a g o was placed on Reserve. Her interest, however, has remained, and she has attended drills right up to the present time. This is a fine record of public service, calling for much self-sacrifice, and Miss Hardy is entitled to the many congratulations which have been showered upon her in celebration of this anniversary. No. 8

D is t r ic t ,

S .J.A.B .

H ove N u r s in g D i v i s i o n . — The death of Lady Div. Supt. Miss E. M. Worseldine took place last month. She joined the Hove Nursing Division in March, 1933 , as a Nursing Officer and Asst Commandant of Sussex 192 V .A .D ., and in 1938 she was appointed Lady Supt. and Commandant. She was very popular with her members ; and am ong her duties was officer-in-charge of arrangements made for the F.A. P. at the Hove Baths. Acting Lady Supt. Miss Atkins, 2 officers and 13 mem-

FIRST

AID

not incur any waste products and even removes them when they are present. It is the most wonderful treatment for injured and sick.

you are prepared to study for an hour or so each day during the dark evenings you can become an expert prac titioner in Swedish M assage and play your part in the service of the N ation and enjoy the status, remuneration and com forts of the professional worker.

M O NEY

FO R

YO U

N o w is your opportunity of becom ing trained for the great work which lies ahead in the field of Therapeutics. Every man and woman skilled in the art of scientific massage w ill be a national asset.

T h e proper study of m ankind is man. Study the most absorbing subject in good company under the guidance of the S .M .A .E . Institute and turn your interest in First A id work and your hobby into channels that mean money for you and health for others.

Y O U R K N O W L E D G E O F F IR S T A I D

A n investment in know ledge pays the highest dividends.

w ill be considerably enhanced if you wear the badge of the S .M .A .E . (Swedish M assage and Electrical) Institute w hich is recognised as an em blem of sound and efficient training in scientific subjects. T h e holder is thereby known to have satisfied a Board of Examiners that he or she possesses a most compre hensive know ledge of human anatomy and physiology and can satisfactorily treat all kinds o f conditions that are amenable to massage and m anipulative therapy. If you are interested in First A id you w ill at once appreciate the value of massage, it w ill build up the muscular and^nervous system in exactly the same w ay as exercises, but does

W R I T E A T N oc a ONCE TO 3U

For over 20 years the S. M . A. E . (Swedish M assage and Electrical) Institute has been teaching scientific M assage and numbers am ong its graduates some of the most success ful and h igh ly paid men and wom en in the realm of Massage. Write N O W for this interesting booklet entitled “ M A N I P U L A T I V E T H E R A P Y AS A P R O F E S S IO N ,” it w ill be sent to you F R E E and post free and involve you in no obligation whatsoever. Address :— T h e Secretary, 50, S .M .A .E . Institute, Leatherhead, Surrey.

SMAE INSTITUTE LEATHERHEAD

SURREY

FIRST

f32

bers formed a guard of honour at the funeral ; Supt. L. Beacher represented the Men’s Division. No. 10

D is t r ic t ,

S .J.A.B .

The Lady Superintendent-in-Chief at March.— On Thurs day, December Sth, Mrs. St. John Atkinson, Lady Supt.-inChief, paid a visit to the first aid post at March, and in spected the March Nursing Division, Wimblington Nursing Division, and members of the British Red Cross Society of March. Mrs. St. John Atkinson was accompanied by Lady County Officer Mrs. Manley. She said she was delighted to see not only members of the Brigade, but also of the Society. T hey were w orking together in a common cause, although they were keeping to their own regulations and uniforms. She would like to see more members joining the Civil Nurs ing Reserve, but she realised the difficulties. She was delighted to see such a splendid parade. In addition to Lady Div. Supt. Miss Lefevre and Lady Ambulance Officers Mrs. Shepperson, Mrs. Bidwell and Mrs. Heaton of March; Lady Div. Supt. Miss Broker and Lady Ambulance Officer Miss Morris, of Wimblington ; Com mandant Mrs. Tibbett, Quartermaster Mrs. Clark, B .R .C .S . ; there were also present Mrs. Truman, President of the March Nursing Division, S .J .A .B ., and Miss Golden, VicePresident, March B .R .C .S .

General C are

o f

th e

Nursing.*

P a t ie n t .

Bed M a k in g .— Hospital bedsteads are made of iron with a fixed wire mattress. The beds of patients allowed up should be made daily and the mattress turned. T he beds of patients confined to bed should be made twice daily. A bed is made up as follows :— A hair mattress is placed on the wire one and covered with a blanket, which must be tightly tucked in all round. Over this is placed the under sheet which is also tucked in all round. The upper sheet is tucked in at the foot only, leaving sufficient at the head of the bed to turn down over the quilt. One, two, or more blankets are similarly arranged and with the upper sheet, are then tucked in at the sides. Over all is placed the quilt, which should not be folded over at the upper end, but at the foot of the bed. The upper sheet is turned down over the quilt. T w o or more pillows are well shaken and arranged at the head. A D raw Sheet, which should be used for all patients confined to bed, consists of a sheet folded lengthways and laid across the under sheet, so that the patient’s buttocks will lie on its centre. T h e fold should be upwards and the free edges downwards, the ends being tucked in at the sides. It is used to prevent soiling of the under sheet, as it is much more easily changed. In cases of incontinence of urine and fseces a mackintosh must be placed under the draw-sheet. T o change the draw-sheet, the ends are released, the patient raised or rolled over and the sheet drawn more to one side. If soiled by excreta it must be completely removed and replaced by another. A W ater Bed consists of an indiarubber bag, the size of the bed, containing warm water. It is placed either on * Extract from the Manual of Instruction for the Royal Naval Sick Berth Staff, reprinted by permission of the Controller of H .M . Stationery Office. Copies of the Manual can be had of H.M . Stationery Office, Adastral House, K in gsw a y, London, W . C . 2 , or any branch, price 4 /Sd. post free

AID fracture boards or on another mattress, and then filled about two-thirds full. It is used for the prevention of bed-sores. Water and Air Cushions, which are smaller than a water bed, are used for the same purpose. A Bed Cradle is used to keep the bed-clothes off a patient’s legs, or trunk, and consists of iron hoops fixed to a frame. The iron should be covered with a roller bandage to prevent the cold metal from coming in contact with the patient. B ed

M a k in g

for

H elpless

P a t ie n t s .

To Change the Under Sheet. — All the upper bedclothes except one blanket, are removed. The patient is then gently rolled on to one side and the dirty sheet rolled up lengthways against his back. The clean sheet is then rolled up for half its width, and then rolled up part is also placed against his back, the remainder of the sheet being spread out over the near side of the bed. The draw sheet should then be rolled and spread in the same manner. The patient is now rolled to the opposite side, the soiled sheet removed from under him, and the clean sheet and draw sheet unrolled. In cases where the patient cannot be rolled on to one side, as in fractures of the bones of the leg, it is better to roll up the soiled sheet from the foot and introduce the clean one in the same way, passing both upwards under the body. T he patient may be able to raise himself by the chain attached to the head of the bed. T o Change the Upper Sheet.— All the upper clothes are removed except one blanket, and the clean sheet is placed over this. T he blanket is then drawn out and placed over the clean sheet, and the other bed clothes replaced. A Knee Pillow is used to relax the abdominal muscles. A hard pillow or bolster is placed in a sheet folded length wise and arranged under the patient’s knees. The ends of the sheet are twisted and tied to the sides or the head of the bed. Fowler’s Position. — Under certain conditions it is advantageous to keep the patient half sitting up in bed. This is called Fowler’s position and is chiefly used to assist drainage from the abdominal cavity and to prevent infection from spreading into the upper part of the abdomen, as, for instance, after an operation for abscess of the appendix. The patient is propped up in bed with pillows or a back rest, and a pillow folded in a sheet, is placed under the thighs, the ends of the sheet being tied to the side or the head of the bed to prevent slipping. The head of the bed may also be raised by blocks placed under the legs of the bed. Dressing the S ick .— When taking off the clothes in the case of an injury to the arm, remove them from the sound side first. When putting on the shirt, etc., put the injured limb into the sleeve first. The same rule applies to trousers and pyjamas. YVashing the S ick .— Patients not confined to bed should have a hot bath at least twice a week. Those confined to bed must have a blanket bath night and morning. B lanket

B ath .

(a) Prepare the sponge, soap, warm water, two dry towels, methylated spirit, dusting powder, and two blankets (which should be kept for the purpose). (ib) Close the windows and place screens around the bed. (c) Remove all the upper bed clothes and the patient’s shirt. Place one of the special blankets over and the other under the patient. (d) Place one towel under the head and wash the face, ears, and head, afterwards drying them carefully with the other towel. (e) Turn down the blanket from the waist and wash the neck and chest. (/ ) Replace the blanket, and wash each arm in turn, returning them under the blanket when dried.

FIRST

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FIRST

134

(g) Raise, but do not remove the blanket and wash the abdomen and groins. Be careful not to wet the blanket and to thoroughly dry the groins. (h) Uncover each leg in turn, wash, dry, and re-cover with the blanket. (i) Roll the patient on to his side and wash the back and buttocks. (j ) Rub the back and buttocks with methylated spirit, and dust with the powder. Cut and clean the finger and toe nails. (k) Remove the two special blankets, put on the shirt, and replace the bed clothes. Always sponge in one direction, rubbing up and down irritates the patient. Turpentine is useful to remove ingrained dirt on the hands and feet. When washing a patient, look for scabies, pediculosis or rashes. G eneral

R u les

for

th e

U se

o f

B ed

P ans

an d

U r in a l s .

Never keep a patient waiting for a bed pan, and remove it as soon as he has finished with it. W arm the bed pan by rinsing in hot water and carefully dry it. T o place, lift the patient with the left hand placed under his pelvis and insert the bed pan carefully with the right hand. To remove, lift the patient well up before attempting to take a w ay the bed pan. Clean the patient with pieces of tow and afterwards wash and carefully dry the part. Cover the bed pan with a cloth before removing from the ward. If the stool is not to be kept for the Medical Officers’ inspection, the bed pan should be emptied and washed at once. Urinals should be carried through the ward covered by a cloth. Empty as soon as possible after use, and wash. Bed pans and urinals must be well washed daily with soda and hot water. C are

o f

th e

S k in .

Patients who are confined to bed for a long time, and especially cases of paralysis, are very liable to the formation of bed-sores. T hey occur over the sacrum, heels, and shoulders, and are due to pressure combined with a wet and dirty condition of the skin.

AID A little olive oil well rubbed in softens the skin and prevents it becoming rough and cracked. In cases where the bed is being wetted continually, ointment may be used instead of spirit and dusting powder. The ointment should be well rubbed in.

A .R .P . A ir

R a id

T o p i c s .

S h elters.

H. S. Circular No. 290/1940 (Sd. post free) sets out notes on shelter design. These notes contain modifications which in the light of actual experience it has been found to be desirable to introduce in the standard designs of surface, trench and basement shelters, together with observations as to certain measures which it is considered should be under taken as regards existing shelters of these types. A new design is given for brick and concrete surface shelters which embodies certain important changes, viz. : (a) use of re-inforced brickwork in place of ordinary brick work ; (b! the introduction of a bituminous damp proof course ; and (c) the introduction of the principle of oversail ing the roof. Trench shelters should not be used unless strengthened according to new instructions ; whilst with basement shelters it has been found that they are being used by a greater number than intended, and that consequently individual compartments are accommodating more persons than is admissible. Action should be taken in such cases and adequate subdivision undertaken. An appendix sets out waterproofing treatments for exposed surfaces of brick and concrete surface shelters. A .R .P . i n S c h o o l s . T he Board of Education have issued a pamphlet (Circu lar 1535 , December 18 th, 1940 , 3 d. post free), dealing with Air Raid Precautions in Schools and Other Problems Arising out of the War. It has been thought that it would be of assistance to have available in a single document the more important items of advice which the Board have given from time to time on the protection of school children against air attack and other coguate problems arising out of the war. The present circular therefore, while in part a codification of advice previously given, includes a body of new advice based on actual experience of present conditions.

Prevention of Bed Sores :—

1 . A well made bed.— There must be no creases in the under blanket or sheet, no bread crumbs nor rucking up of the night shirt. A water-bed, water-cushion, or air-cushion may help, while grummets (rings of cotton wool or tow surrounded by a spiral bandage) may be made for the heels and head. 2 . Cleanliness and dryness.— Patients with incontinence of urine and faeces are especially liable to bed-sores. As soon as the draw-sheet is soiled it must be changed, and the patient’s skin washed and dried.

3 . C hange of position.— If the nature of the case per mits, do not let the patient alw ays lie in the same position, but occasionally roll him on to the opposite side. 4 . Hardening the skin.— After each blanket bath, the back is rubbed with methylated spirit, and dusting powder applied. Dusting powder consists of equal parts of zinc oxide and starch. It is useless to apply these unless the patient's skin is kept clean and dry.

Prolonged use of spirit tends to make the skin too dry.

Mr. J. H. Bolwell, instructor at first aid classes, held at Dunkerton, received a landing net and creel from members of the class as an appreciation of his voluntary services. Mr. William Ewart Belcher, ticket collector, Supt.’s Dept., Doncaster (G.N. Section), London and North Eastern Railway, has been admitted as Serving Brother of the Order of St. John for services rendered. Mr. Belcher has 25 years’ service and has acted as Ambulance Secretary to the Doncaster class for many years. S.J.A .A . C o u n t y S e c r e t a r i e s . — T he following have been appointed : Dr. F. Wolverson, Public Health Offices, Sittingbourne (Kent County) ; Corps Officer H. A. Went, 275 , Southwell-road West, Mansfield (Nottinghamshire County) ; Mr. R. Waterworth, of Bingley (West Riding of Yorkshire, except Leeds, Sheffield, York, Wakefield and Keighley).

FIRST

E Q U I P

Y O U R S E L F

135

AID

F O R

E s se n tia l

A R

E M E R G E N C I E S

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A C C ID E N TS A fe w o f the S u b je c ts tre a te d :

WAR EMERGENCIES:—

Gas Warfare First Aid Bandages Splints Burns Scalds Haemorrhage Fainting PEACE TIME S U B J E C T S : —

Influenza,Colds,etc. Measles, Mumps Catarrh Corns and Warts Physical Culture What to Do in Emergencies Treatment for all Skin Diseases The Lungs, Pleurisy Hygiene, Anatomy, Pharmacy The Principles of Nursing The Eye, the Ear The Throat, the Nose The Chest, the Heart The Stomach, the Liver The Teeth, the ;Muscles Infant Welfare Homoepathy, Neurasthenia 375 Prescriptions, etc., etc.

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I A D D R E S S ...................................................................................................

[ 1

136

FIRST

AID F ractures

Q u e r i e s t o

a n d

A n s w e r s

C o r r e s p o n d e n t s .

Queries will be dealt with under the following rules :—

1 .— Letters containing Queries must be marked on the top left-hand corner of the envelope “ Q uery,” and addressed to F i r s t A i d , 46 , Cannon-street, London, E . C . 4 .

4. — T he Textbook to which reference may be made in this column is the 39 th ( 1937 ) Edition of the S.J.A.A .

o f

B oth

C l a v ic l e s .

F. M. (Batley).— With tractures of both clavicles, would you apply the method laid down in the Textbook for one fracture except that, instead of securing the limbs to the trunk by broad bandages, you would use only one bandage passed round both elbows for this purpose ? I will gladly welcome your ruling on this point. If you think again, you will realise that with fractures of both collarbones, you cannot support the limbs in St. John slings because these will exert pressure on the broken collarbones. This combination occurs so rarely that reference to it has wisely been omitted from the Textbook. If, however, you should have to treat this combination, you can follow the instructions which used to figure in the Textbook and which read as follows :— “ When both collarbones are broken, keep the shoulders back by narrow bandages tied round each arm, close to the shoulder, passed across the back, over the opposite arm and tied together in front. The forearms should be raised and supported by the bandages.” — N .C .F .

Manual of First Aid to the Injured. F ear A r t if ic ia l

R e s p ir a t io n

w it h

F ractured

R ib s .

W . Y . (Palmers Green).— As a consequence of the reply given under the above heading in the October issue of F i r s t A i d , I sent you a query ; but, though I enclosed the requisite coupon, I do not see any answer in the November issue. My query is that in your reply you make no refer ence to Laborde’s method and that I would like to know if this method is now discarded. It is one of the methods of artifical respiration in the Manual of Instruc tion for the R.N . Sick Berth Staff. Meanwhile best thanks in advance for your answer. The rush of queries during recent years has been such that these can only be dealt with in rotation. Further there is a limit to the available space and my spare moments. Consequently, correspondents must not be disappointed if the replies to their queries do not appear in the next issue of F ir s t

A id .

With reference to your query the facts are that Laborde’s method is much less efficacious than Schafer’s method and that, even if the former had still figured in the Textbook, my previous answer would have (and does) hold good in all particulars.— N . C o r b e t F l e t c h e r . E x a m in a t io n

H ow ler.

M .R . (Cannon St.). — In a recent examination the doctor asked a member of our class how he would recognise a complicated fracture, He was considerably amused when the candidate replied— “ / would, suspect a com plicated fracture if, after a blow, the patient could not sit down ! Good !

Next, please! !— N .C .F .

F ractured

S p in e

an d

W ound

o f

B ack.

M. M. (Cheadon).— Will you please tell me the position for carrying a conscious patient suffering from a fractured spine in the lumbar region and from a wound complica ted by arterial bleeding alongside the fracture ? Y o u r difficulty is not appreciated. T he patient, being conscious and suffering from a fracture of spine in lumbar region, must be removed in face-downward position. Con sequently you can easily expose and treat a wound in the back alongside the fracture of spine ; and you should, of course, do this before the patient is removed to shelter.— N .C .F .

o f

B lood.

R. R. (Sheringham).— Can a person suffering from hematophobia be cured so as to become a useful first aider ? What course would you suggest, please ? Few of us can look at blood without being more or less disturbed when first we are called upon to treat patients suffering from bleeding or to deal with wounds ; and some of us have a positive fear of blood whether seen at operations or in actual emergency or portrayed in coloured diagrams. The vast majority of us— whether would-be doctors or first aiders— learn to control our feelings and by perseverance and practical experience overcome our natural aversion to the sight of blood. Some, however, never do this, and so cannot become either qualified doctors or first aiders. Incidentally, which is the better term— fear of blood or hematophobia ?— N .C .F. T reatm ent

o f

B u rn s.

G. D. (Hoddesdon).— At a recent lecture, our doctor advised us to use tannic acid for burns of body, limbs and face. When I pointed out to him the treatment laid down in the Textbook, he disagreed with the remedies suggested. My difficulty is that we have some new members and that these are quick to pick up points of disagreement. Of course, as I am instructing the class, I stick to the Textbook and I shall welcome your comments. As I wrote in these columns in the October issue, it is unfortunate that some doctors, when giving lectures which are supposed to be based on the Textbook, depart from its instructions. They forget that surgeon-examiners are pledged to judge replies given by candidates on the basis of the Textbook. Consequently the latter run a grave risk of being ploughed when they give replies which are not taken from the Textbook. So point out this fact to the members of your class and continue to teach according to the instruc tions of the Textbook.— N .C .F . T reatm ent

o f

C om pound

F ractured

L eg.

A .F . (Ealing).— In a recent issue of F i r s t A i d it was stated that in the treatment of a compound fracture the leg should be straightened. Do you agree with such treat ment ? Is it to be inferred that, “ to place the limb in as natural a position as possible,” is the same as straight ening the limb ? On p. 37 of the Textbook the words “ straighten i n g ” and “ extension ” are interchangeable. Is it to

FIRST

B U Y

13;

AID

B A I L L I E R E ’S

M E D I C A L D ic tio n a ry

SAMPLE Page. [ 279

rectum (r e k '- turn). Th e lower end of the large intestine from the descend ing colon to the anus, rectus (r e k '-tu s ). S traight ; JR. m u scles o f the e y e , the four straight muscles which move the e y e b a ll; B . fe m o r is , the straight muscle of the thigh ; part, of the quadriceps extensor ; R . a b d o m in is , the straight muscle passing up the front of tne abdomen from the pubis to the ribs, recuperation ( re-ku -'p er-a ' s h u n ). Convalescence, recurrent [re-Jcur'-rent) O c curring again. B . fe v e r , relapsing fever {q.v.). R. haem orrhage, that which recurs after an interval, when the blood pressure rises ; sometimes called reactionary haemorrhage. B . b a n d a g e, a pattern in bandaging used for stumps of limbs, fingers, etc., when the bandage is made to tu rn back over itself in order to cover in the part, red lotion. A cleansing astringent lotion used for application to granulating wounds. Composed of zinc sulphate, and tincture of lavender, reduce. T o restore to its norm al position ; a term applied, e.g., to a hernia or dislocation, reduction en masse { r e -d u k ' sh u n on m a ss). A

]

failure to reduce a hernia to its norm al position by taxis {q.v.). Th e whole sac is pushed back intact, so the bowel remains strangulated and the con dition is not relieved.

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can’t

In A,

GRANNY KNOT. REEF KNOT.

reef knot. A secure knot used in surgery which does not slip. C f. “ grann y” knot. referred pain. T h a t whioh occurs at a distance from the place of origin, whioh is usually in the viscera. reflex {re'-fleks). Reflected or th row n back. R. a c tio n , an involun tary action following im m e diately upon stim ulation of a sensory nerve, e.g. the knee jerk , and the w ithdraw al of a lim b from a pinprick. R . a rc , the sensory and m otor neurons which are necessary to carry out a reflex action. R . o f a cco m m o d a tio n , when

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FIRST be understood that they are interchangeable when used on pp. 66 and 67 ? In other words, is the following interpretation of the instruction at the end of Rule 4 on p. 67 a correct one ? “ Do not attempt ‘ str a ig h te n in g ’ in the case of compound fracture when the bone protrudes.” While I cannot trace the reference which you quote from a recent issue of F i r s t A i d , 1 agree that in the Textbook the terms named are interchangeable, though to the surgeon extension is the force which must be applied to straighten a fractured limb. With a compound fracture first aiders must avoid all attempts at straightening the limb if thereby the protruding fragment (or fragments) might be pulled back into the wound. Y o u r interpretation therefore of the instruction at end of Rule 4 is perfectly correct provided that the limb cannot be straightened (as stated elsewhere in Rule 4 )— (1) with great care (2) without using force, and (3 ) without letting g-o until the limb is controlled by splints. — N .C .F. C ollapse

L ung

fro m

B last.

W. B. (Portsdown). — H avin g obtained a copy of F irst A id for W ar Casualties, I have been interested in the condi tion known as “ lung collapse ” and note that First Aid Parties are urged to be on the alert for this particular form of injury. Unfortunately, however, although the cause is clearly stated— and treatment suggested— no information is given of the all important signs and symptoms. One doctor whom I consulted on this point, could only suggest sounding the lungs by tapping the chest, and mentioned complications due to burst blood vessels in the lungs. In these circumstances, I wondered if you could su ggest any other method of diagnosing this apparently common and dangerous condition. Y o u have probably ere this, read the replies which under the above heading in the November issue of F i r s t A i d , 1 gave to another correspondent on these same points. I have nothing further to add except that “ sounding the lungs ” is, in my opinion, definitely am ong “ the duties and responsibi lities of a doctor ” (Textbook p. 26 ) on which a first aider may not (and indeed cannot) encroach !— N .C .F . H umour

F ir s t

A id .

D. S. (Aveley). — Did you ever hear the reply which a can didate gave in examination when he was asked how he would treat a patient suffering from heatstroke ? He replied :— “ / •would place him inbedw ith a patient suffer in g from frostbite ! ” Good !

Next please ! !— N .C .F . C olour

o f

F ace

A s p h y x ia .

M.N. (Cardiff). — It has alw ays seemed strange to me that nowhere does the T extbook describe the colour of the face in an asphyxiated person. In short, the only signs and symptoms of asphyxia are given on p. 156 where it states that continuous want of pure air will result in asphyxia which will cause insensibility. I agree, and as a fact, in my lectures and books I have alw ays found it a useful aid to memory to speak of “ red, white and blue faces ” and in this way to classify the common varieties of insensibility. Incidentally, when long years a g o a study of the causes (which produce insensibility through lack of pure air) was instituted, difficulty was found in selecting a generic term which would include all the various items. Consequently, the word “ a s p h y x i a ” — the root meaning of which is ‘ pulseless ” — was invented.— N .C .F .

AID C om pound

F racture

o f

F em ur

an d

T ib ia .

R .H . (Netherfield). — In a recent A .R .P . First Aid Test our team was called upon to treat a patient suffering from a compound fracture of the left femur with limb flexed at seat of fracture, and with fragments protruding, and also from a compound fracture of the right tibia with fragments protruding. H aving first treated the wounds, we straightened the left lower limb alongside its fellow, applied a long splint to the left femur and two splints to the right tibia, and then tied the two limbs together. Afterwards we were told that the femur should have been treated as found. W e would, therefore, be obliged if you would kindly pass your opinion upon our action in drawing the left limb down from its flexed position. On your statement of facts, I suspect that it was utterly impossible to straighten the limb without pulling the frag ments back in to the wound. Nevertheless, as the wound was fully exposed, you might have partially straightened the limb with great care and without using force, stopping short immediately when you saw any tendency for the frag ments to be pulled back into the wound. This done, you should have fixed the limb as best you could, using the un broken limb as a natural splint. At any rate, that is how I would first aid such a case in actual circumstances ; and as a judge in a practical test I would give competing teams a hint when the fragments were likely to be drawn into the wound in any attempt partially to straighten the limb. On these grounds, a hint ought to have been given to the members of your team in their test that the fragments were being indrawn. — N .C .F . P l a in t

C o m p e t it o r .

A .K . (H ighbury).— Your advice and consideration are asked on behalf of my Stretcher Bearer Party and myself their leader. W e are considered good ; and new men are continually being given to me to train. Yesterday we had a competition which was judged by our instructor, and as the result of which I am a disappointed man and my Party considerably surprised. There were three casualties, each with label attached. One read : “ Severely crushed chest on left side ; left arm severed above forearm ; nothing else.” No statement was made as to consciousness. I asked if doctor was available and was told not. I then asked if patient was breathing or if there were signs of con cussion, and was told to make my own decision. Con sequently, I treated patient for crushed chest and severed arm as per Textbook and marked him as a priority case for dispatch for hospital. Our instructor, however, gave us no marks, and said that, the patient being dead, I had wasted time unjustifiably. As the Textbook (p. 23 ) tells us that first aiders should not assume death because signs of life are absent I ask your kind ruling, which will be appreciated by all concerned. On your statement of facts, I suspect that on this occa sion you slipped up in your examination of the patient. This, however, is no cause for depression ; and after all we learn more from our failures than from our successes. So cheer up and keep the good work go in g !— N .C .F .

1A A l i l W . l 2.

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01890210050510

FIRST AID ‘( R j e

I n b e p e n t a n l J o u r n a l J fb r

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N o. 560.

Vol. XLVII.

a n b

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FEBRUARY, 1941.

J > e n r ic c s r

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E d i t o r i a l :—

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Wartim e First Aid A .R .P . First Aid Services

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Honours S.J.A .B . Headquarters and District Reports

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Another Useful Quiz

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A Laym an Answers Queries Railw ay Ambulance News

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Asphyxia : Signs, Symptoms and Causes...

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CON TEN TS

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F E B R U A R Y , 1941.

X L V II.

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G E O R G E ' E.

C o r r e s p o n d e n t s :—

Tannic Acid Jelly for Burns

156

Examination Howler

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Artificial Respiration and Advanced Pregnancy

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Injury Due to Compressed Air

158

Performance of Schafer’s Method

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Treatment of Scalds and Burns

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Treatment of Swollen Throat

158

I n our December, 1940 issue, we W artime published an article by Captain F irst A id . A. C. W hite Knox, in which reference was made to the teach ing of first aid in wartime as against peacetime instruction. This received applause from some quarters, but exception was taken by others. It is an acknowledged fact that to-day a some what different syllabus of instruction is necessary to fulfil wartime first aid activity, but we do not agree that the present textbooks of the teaching organisations (St. John, British Red Cross, St. Andrews) are obsolete and useless. I hey are excellent publications for the work. A suggestion has been put forward by the Joint Committee of a provincial town that a school be set up at which students should receive 14 days intensive training as instructors, in a like manner as the Government Anti-Gas School at Falfield. This is, however, useless until such times as members of the medical profession undertake to become first aiders. Then, and only then, would it be possible for individual doctors to become expert teachers in the subject. Further, no matter what textbook is used, and those already in circulation are well suited, it must be borne in mind that whether the instructions are for wartime or peacetime first aid, the basic princi ples of the subject must be of the present high standard. There are some who advocate the teaching of treatments only, whilst others would omit anatomy and physiology from their syllabus. W e contend that both schools are wrong. W hen one is taught to drive a motor-car, instructions are also given as to the workings of the engine. In a like manner, if a person is taught treatments, that person should have even an elementary knowledge of the work ings of the human body.

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For many years, voluntary organisations have undertaken the teaching of first aid to the general public, and those same organisations should still be entrusted to teach the subject, not only to the general public, but also to the members of the Civil Defence Services. Modifications and addi tions in teaching, could be made to suit the personnel concerned, with but little trouble.

A .R .P. B y

F IR S T AID O ur

S p e c ia l

SER VICES.

C orrespond ent.

I n my article of last month, I referred to the question of discipline in the A .R .P . first aid services, but even I never realised that the problem was causing- so much concern to those responsible for administration. I have received several letters all dealing with the same subject and they unanimously endorse the opinions expressed, and confirm the fact that similar difficulties are being encountered throughout the country. One rather pertinent letter comes from a member of the armed forces who was formerly attached to a first aid post. He writes as follows : “ I read in the newspapers, that men over a certain a ge who register for military service, are being given the opportunity of expressing a preference for civil defence duties. If this means that they will be able to carry on in the somewhat free and easy undisciplined way that I was allowed to in my A .R .P . days, it would act as a rank injustice to those of their colleagues who elect to join the fighting services.” My correspondent, while perhaps being a little too emphatic in his method of expressing himself, has neverthe less raised an extremely important point. If we, as civil defence workers, are not prepared to put our own house in order, we lay ourselves open not only to criticism, but also to the possibility of the tightening up of our administration by the authorities. It is frankly time that we were honest with ourselves, and asked the question “ Are the A .R .P . first aid services g iv in g their full quota of value to the national effort in this time of grave emergency.” Frankly, I am of opinion that our services might be tightened up and I suggest that the following facts be taken into consideration : (a) T he selection of the personnel, (b) The scope of the work to be done and its interchangeability where necessary with that of the allied services, (c) T he morale and discipline of the personnel. R e (a). I think it must be generally admitted that in the early days, the authorities were more concerned with numbers than individual merits, and consequently many individuals crept into the service more because it affected a job of work, than for any other reason. On many an occasion I have heard the phrase “ Oh, you can always get a job in the A . R . P . , ” and I am afraid it was all too true. Untrained personnel was recruited somewhat indiscriminately, and what was even more appalling than the lack of an intelligence test, was the complete absence of even the most cursory medical examination, or investigation into such important matters as temperamental suitability. Those responsibile for teaching and training were then given the uphill task of licking the nevy material into shape with considerably varying results, only to find that the younger male members were gradually being called up for military duties, etc., as soon as they had been trained. This in turn, led to the recruiting of older and less agile personnel, and gradually resulted in a deterioration

AID in the efficiency of the services, particularly in the stretcher parties. I have personally medically examined members of the S. P. personnel who have suffered from such important physical defects as serious defective vision, flat feet and in ability to stand for more than short periods, heart disease, etc., and in some cases, they have even admitted to me that they have been “ covered ” by their mates while on duty, one man in particular, telling me that he had to be led about in the dark ! I need hardly state that I persuaded these men to resign, and in fact assisted them to do so, by furnishing the necessary medical certificates. The remedy is therefore obvious. All recruits to the first aid services should be medically examined before acceptance and should be graded for duties accordingly. This would rectify the present peculiar state of affairs in which relatively young and able bodied men are attached to first aid posts, performing relatively light duties and working easy hours, while others less fit, are attached to stretcher parties with their longer and more onerous duties. R e (b). Even in the heaviest of blitzed regions, the vast majority of w orking hours are spent in preparing for, and anticipating the actual raids. I am afraid that in most cases, more hours are spent in anticipation than in preparation, with the consequent result that boredom has become rife. The usual methods of recreation have lost their flavour, and tempers become strained. Worse of all, a sense of lassitude descends upon certain types of individuals, so much so, that they studiously examine every instruction given them incase they are expected to do something which may not quite be within the actual bounds of what they conceive to be their strict terms of employment. T he result of all this is a tremendous waste of man power. L ong ago, I suggested that first aid personnel might conceivably be utilised during waiting periods, in some form of productive work. Recently, in the London area, an attempt was made to solve part of the problem by inviting members of the S. P. personnel to assist the R .S .D . parties during the day and during non-alert hours, by performing light tasks such as assisting to salve property, hold ropes, etc., it being under stood that they would not be called upon to do dangerous or heavy work. As these duties would be performed during ordinary w orking hours, it might be expected that the S. P. personnel would be only too glad to perform useful service during the monotonous hours of waiting ; but my informa tion to date indicates that, as a volvntary scheme, it is dis appointing. What, therefore, is the solution to this appreciable waste of man power ? I do not anticipate that there will be any difficulty in finding useful and essential tasks compatible with the ordinary duties of the personnel, but I cannot visualise any scheme succeeding unless it is put on a compulsory basis. R e (c). I have previously dealt with the subject of dis cipline and its effect upon morale, but defects of morale are sometimes seen in individuals who are not necessarily un disciplined but who go about their duties with a complete lack of sense of responsibility. Only a few days ago I heard a male dresser at a first aid post inform the doctor in charge that, unless the hours of duty were altered (yes, it was again the vexed question of 24 hoiirs on duty and 48 hours offi), he and other members of the personnel would resign. This, of course, w as no more or less than a threat, but the foolishness of it is all the more apparent when it is realised that male members of first aid posts cannot leave without the express permission of the Medical Officer of Health. What concerns me more, however, is the fact that there are individuals who are totally devoid of a sense of reality and patriotism that they think they can, from personal motives, alter the normal daily routine as laid down by responsible officials. There is still, however, another loophole to be tightened up in this direction, namely, the question of

FIRST female personnel. At the moment, they cannot be com pelled to remain in the services should they wish to leave. When the “ blitz” first commenced, several individuals promptly handed in their notices, notwithstanding- the fact that they had drawn salaries for practically a year. Another example which came to my notice was that of a driver in a mobile unit who was asked to transfer to another department in the same organisation in which her services might be more profitably used. Not only did she promptly resign, but those of her colleagues from the same shift followed suit “ out of sympathy,” thereby not only creating vacancies which were difficult to fill at short notice, but also giving no return to the county tor the salaries they had previously drawn. Recent announcements in the press in dicate that, in the near future, women will be called upon to make an additional contribution to the national effort, and this in itself may be the means of solving the problem of the irresponsible female worker in civil defence. Finally, I would ask my readers not to take my remarks amiss. The strength of a chain is invariably that of its weakest link, and it is the weak link that I am trying to eradicate. The honest and sincere first aider must surely agree with my opinions, because they have all been ex pressed to me in one form or another by workers who are not only proud to be attached to our important auxiliary branch of the art of healing, but also realise that in times like these everyone must give of his best in every conceivable manner.

Honours. W e are pleased to publish a list of Honours granted to members of the St. John Ambulance Brigade Overseas by His Majesty the K in g ; and to offer the recipients our sincerest congratulations.

Kn ight B atchelor: Alexander C. Badenock, C .S .I., C .I.E ., Chief Commissioner of the Empire of India. C .B .E . : Mrs. K. Ardill Brice, M .B ., Lady District Officer, New South Wales District. M .B .E . : T . H. Henderson, District Officer for New South Wales ; J. G. Leslie, Ambulance Officer, Kenya Police Division. Kaiser-I-Hind Medal : Mrs. Munro, Lady District Supt., No. 11 District, In dia; Mrs. Shuffi Tyabji, Lady Div. Supt., Bombay (Muslim) Nursing Division, India. K i n g ’s Police Medal : Capt. E. G. Fish, District Supt., Zanzibar District ; Lt.-Col. A. I. Sheringham, Asst. Com missioner, U ganda District. In addition, the following, who are connected with the work of the St. John Ambulance Association or of the Brigade Overseas, have also been honoured :— C .B .E . : Ho Korn T on g, Finance Committee, Hong Kong. K i n g ’s Police Medal : Capt. D. S. Gowing, Centre Secretary, Gibraltar Centre ; W. C. C. King, Commandant of Police of Nigeria.

The annual inter-team ambulance competitions of the North Skelton and Longacres Mines were held last month, B team gained first place with 209 marks ; E team were awarded the stretcher bearer medals ; C. Richardson won the individual advanced medal, and J. T. Burke the other individual medal.

AID

St. John Ambulance Brigade H EADQUARTERS

AND

D I S T R IC T

REPORTS.

Brigade Headquarters C e r t if ic a t e s o f H o n o u r . — The Chief Commissioner has had brought to his notice many acts of gallantry and unselfish sacrifice by Brigade members in areas attacked by enemy bombers. In the past these actions have been acknowledged by a personal letter, but the Sub-Prior has now approved of the granting of a “ Certificate of Honour ” in such cases. Sir John Duncan, in his notice to County Commis sioners, w r it e s :— “ To carry out this idea I would like Commissioners to submit to me the names of members of the Brigade, both men and women, who have distinguished themselves. In order that this Certificate of Honour should be of real value, it is important that it should not be granted too freely, and should only be given for outstanding con duct. As Commissioners are aware, such acts of gallantry as might earn the George Cross and George Medal have to be submitted in the case of members w orking in the Civil Defence Services through the A .R .P . authorities, but I consider they should also be submitted to Brigade Head quarters for the award of the Certificate of Honour. Those names already submitted will be dealt with, and need not be re-submitted.”

N o . I (Prince o f W ales’s) District W e regret to announce the death of Asst.-Commissioner Charles J. Fitch, whose passing on January 27 th deprived the Brigade of one of its oldest members and the No. 1 District one of its best-known officers. Mr. Fitch joined the No. 4 Division on February 15 th, 1896 , and last year qualified for his sixth Service Bar. He became 2 nd Officer in 1906 ; Superintendent, 1925 ; District Officer, 1927 , and Asst Commissioner, Eastern Area, last year. In 1939 he was appointed Assistant County Controller of Essex V.A. D. In spite of failing health be carried out his Brigade duties until a week before his death. His untiring efforts, his sympathetic understanding, his strictness on parade endeared him to all members of the Eastern Area. His work for humanity was recognised in 1933 when he was admitted as an Officer of The Order. On February 1st a large number of officers, men and nurses, led by Capt. W. Goodley, the Commissioner, paid their last repects to a beloved colleague. T he pall-bearers were District Officers Green, Haines, Licence, Howard, Corps Supt. Ambler, Supts. Dean, Norman and Bandy. Floral tributes included those from No. 1 District, the Eastern Area, the Hospitallers’ Club and numerous divisions. S o u t h a l l . — T he funeral took place recently of Mr. Edwin Charles Thatcher, one of the original members of the Southall Division. At the formation, in 1909 , of the Southall Section of No. 44 (West London) Division, Mr. Thatcher was transferred to the section as member in charge with Dr. E. J. Manning. At the funeral service the Division was represented by Supt. J. E. Taylor, Amb. Officers H. S. K in g and R. S. Elines, and Pte. R. Woodward ; Amb. Sisters Mrs. Wilmot and Mrs. Cross represented the Nursing Division.

Mr. C. F. Collins, President of the Ambulance D ivi sion, has announced that ;£10 was gained for the Building Fund as the result of a social and dance arranged by the office staff of Messrs. Poulton and Noel Ltd.

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The Fund is making- steady progress, and as soon as hostilities cease it is hoped to commence building on a site 94 ft. by 64 ft., which the local Borough Council has granted the Division a lease for 99 years at a nominal rent. T w o members of the Brigade were married recently. The bridegroom was Mr. Edward John VVootton, a member of the Ambulance Division ; the bride being Miss Lily Annie Elizabeth Grove, a founder member of the Southall Nursing Division. N o . HI District. W o r c e s t e r s h ir e C o r p s . — We regret to record the death of Corps Sergt.-M ajor H. Webb, a Serving Brother of the Order, who had over 38 years’ service in ambulance work. Although he had been on the Reserve for two years, he undertook duties when the war broke out. He began his service with the Brigade in 1904 , serving with the R .A .M .C . during the Great War. In 1921 he was admitted to the Order, and was Corps Sergt.-M ajor until he went on the reserve in 1938 . Many Brigade officers (including Asst. Commissioner P. H. Schofield) were present at the funeral to pay their last respects to an efficient and esteemed comrade.

Supt. T . Skey presided at the annual meeting of the Droitwich Spa Division which has now com pleted 19 years’ service. D urin g the year 77 cases received attention and 60 road accidents in conjunction with the Droitwich ambulance. The President, Aid. C. H. Everton, had completed three years of office and it is hoped that he will continue. Many members, including Div. Surgeon J. W . T. Patterson, are now with H .M . Forces. D r o it w ic h

S pa .—

S t r a t f o r d - o n - A v o n . — In the unavoidable absence of Aid. R. M. Smith (President), Dr. A. R. McWhinney pre sided at the annual meeting of the Stratford-on-Avon Divi sion. Those present included the Mayor (Councillor J. H. Knight) and Councillor E. P. Ray. The Secretary (Mr. Oliver H. Smith) stated that twothirds of the personnel at the F A. Posts were manned by uniformed St. John members. Members had shown great interest in their work some had attended 52 duties out of 52 and, in addition, some members had a record of 90 A .R .P . duties. The Mayor paid tribute to the good work of the mem bers. Whenever he asked for men to be sent to a function, however inconvenient it may have been, not a grumble or grouse was heard and the duty was performed.

N o. V District B e e s t o n . — D urin g the dinner and dance of the Beeston Division, held on January 9 th, first aid was given to the manager of the cafe who scalded his face and hand. Mr. A. H. Shapeero (President) presided, supported by District Officer A. G. Weller, Div. Surgeon S. M. Reddick, Corps Supt. C. Lewenden, Amb. Officer G. W. O ’ Brien and Nursing Officer Mrs. Gent. A badge of office and warrant of appointment was pre sented to Mr. Shapeero by District Officer Weller, who also handed Dr. Reddick his warrant as divisional surgeon. The President, in proposing the toast “ T he Order of St. John of Jerusalem,” said that what had impressed him most was the unselfish devotion shown by all, particularly Ambulance Officer O ’Brien. Mr. Weller, in response, recalled that there was a divi

AID sion in Beeston during the last war. The present division was fortunate in having a president like Mr. Shapeero. T he speaker compared the A. R. P. casualty service with the Brigade. Ambulance Officer O'Brien also responded. During 1940 abridged first aid lectures had been given, at which 160 people had attended, H a r r o g a t e . — Div. Surgeon H. Mathers presided at the annual meeting of the Harrogate Division. Supt. A. Ridsdale said that 30 members were serving with the Forces. A welcome had been given to evacuated Civil Service personnel who were members of other divisions. D urin g 1940 the members had performed 2,000 public duties and attended 200 cases. He sincerely thanked Mrs. A. Woodhead for her kindness in presenting a motor ambu lance which, with the co-operation of Amb. Officer Wain and various members of the Division, was ready for service, day or night. Sergt. W. Booth, secretary, thanked the members for their assistance in helping to fix up the public duties. Attention was drawn to the Social Committee which, in spite of the black-out, had an anged some very enjoyable functions.

N o . V m (D uke of Connaught’s) District A d d i s c o m b e . — At the annual meeting of the Addiscombe Division Amb. Officer F. H . K in g stated that over 100 members had sat and passed at the annual re-examination, whilst all who took the anti-gas course were successful. Over 3,060 cases received attention during the year. T he blitzkrieg had resulted not only in increased work during raids, duties at various public shelters, etc., but also, unfortunately, in the loss of the parade hall by enemy action. Many members were working in stretcher parties and at first aid posts under the A .R .P . , while others had done yeoman service in assisting the authorities— so much so that in several instances the Police Commissioner and the Mayor of Croydon had seen fit specially to commend certain members. Tribute was paid to Amb. Sister C. Prew for her work in the “ John Jetton ” dressing station. Amb. Officer C. L. Crispin read a report on the work of the Addiscombe Motor Ambulance Service which clearly showed that a great service was being rendered to the community. District Officer E. J. Prew, who presided, acknow ledg ing the expressions of appreciation, thanked all members for the splendid co-operation they had afforded.

C h ertsey an d A d d lesto ne D i v i s i o n . — T he annual meeting took place last month, Supt. Gristock presiding. The Div. Surgeon’s report was read by Amb. Officer Hampshire in the unavoidable absence of Dr. Vaile. Supt. Gristock thanked the men for attendance every night at Chertsey depot and other points. A 5/- parcel and two half-crown postal orders had been sent each of the 14 members serving with H .M . Forces. He referred to Amb. Officer Hampshire’s promotion and praised Sergt. Hooks (secretary) for his fine efforts on behalf of the Division. He gave details of the American ambulance loaned by the Joint W ar Organisation. T he Div. Secretary reported the activities of the year. A .R .P . and cinema duties were carried out but the annual inspection was not held. Night duties under the A .R .P . scheme were carried out at Chertsey, Addlestone and Woodham F.A. Posts. Early in the year Cadet Supt. Hedges was called for active service and Pte. W. F. Turner tock over the Cadets. Thirty-eight cases were attended. T h a n k s were due to Dr. McQuade for his assistance. Before the meeting closed Mrs. Street, of Addlestone

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Nursing Division, presented Sergt. Hooks with a clock as a wedding present from the Division. N o. IX District C u l l o m p t o n .—

During 1940 the ambulance attended six accident cases and 91 removals, covering 3,160 miles. First aid was rendered on 39 occasions, and 991 public duties undertaken by members. Nurses’ hospital attend ances totalled 634 hours. Pte. A. Hainsworth (Grade 1 Instructor) gave a series of lectures, and members gained their A .R .P . certificates. Members and nurses co-operate in staffing the local first aid point during alerts. Seven members are on actual service. N o. X District C a m b r i d g e . — A successful and enjoyable New Y e a r ’s party and dance was held last month by the Cambridge Corps. A variety of games was played during the evening, followed by dancing. Corps Supt. S. S. Dicker thanked all present for their attendance, and said that the party was given especially to the wives of the Brigade members who had for the last twelve months waited patiently for their menfolk out on duty. Those present included Corps Surgeon C. W. Walker, Corps Secretary Supt. A. J. Lusher and officers of numerous divisions of the Corps. The duties of M.C. was carried out by the Corps Secretary.

A n o t h e r Useful Q uiz. D i d you do last month’s quiz? If not, you missed some thing which was really useful and interesting. The good first aider, like the good doctor, is the man or woman who “ knows his stuff.” So much depends on memory, for it is the lot of a first aider to be suddenly confronted by a case and to have to act immediately. No time then to look up books : you either know what to do or you don’t. This is where a quiz turns out to be so valuable. It makes you think quickly. “ What is a Pott’s fracture is am ong the questions this month. “ E asy,” you say, “ I know that o n e ” — but if you are wise you will go a little further and ask yourself “ Do I know what to do for a patient with Pott’s fracture” ? You see, one question leads to another. Yo u can do the quiz by yourself or with a number of persons. If each one has a book to check the answers, so much the better. Here are ten quiz questions, the answers to which will be found in Baillier6s Complete Medical Dictionary on the pages shown in brackets after each question. One of the helpful things about using this dictionary to check your answers is that it tells you how to pronounce the words should you have forgotten or be uncertain. It also has many practical illustrations which makes everything clear. 1 . What are the four classifications of the known gases used in chemical w arfare? (p. 461 ) 2 . W hat is Pott’s fracture ? (p. 261 ) 3 . What are the signs and symptoms of loss of blood ? (p. 447 ) 4 . How would you apply an improvised tourniquet? (p. 449 ) 5. What is the femur ? (p. 122 ) 6. What kind of infection is gas-gangrene ? (p. 134 ) 7 . How would you give an en em a? (p. 108 ) 8. Describe the signs and symptoms of a dislocation. What treaiment would you give ? (p. 4 SS) 9 . How do you sterilize sharp instruments ? (p. 376 ) 10 . Give the pronounciation and explain the mean ings of the following words Brachial, Bronchadenitis, Bacillaemia, Benzoic Acid, Bistoury.

r45

A L a y m a n Answers Queries. reading the December, 1940 , issue of F i r s t A i d , a Divisional Superintendent from the Priory for W ales writes that he was greatly struck by the query which was pub lished therein under the heading— “ T r e a t m e n t o f M u l t i p l e D o u ble F ractu res.” This I answered in general terms only and regretted that time and space were not available to deal with all the seven problems presented under cover of one query which constituted a record in its search for k n o w ledge from the Query Column. It would seem, however, that time and space must now be made available if only in response to the enthusiam of the Divisional Superintendent. T o quote his own words he has ventured to try his hand with the problems and submits for my criticism his suggested treatment of the seven double fractures, all injuries being on the same side of the body. He adds that he has done this to increase his own knowledge because likes to train the members of his Division to the best of his ability. In these circumstances I hope he will not feel hurt if I point out that instruction in first aid is the job of the D ivi sional Surgeon and that the layman who can teach first aid in all its aspects is not yet born ! Here are the several problems with respect to the fractures of :—

A fter

H um erus

an d

C l a v ic l e

(a) If the fracture of humerus was close to the shoulder I would place a broad bandage across the chest and support the arm in a large arm sling. (b) If the humerus was fractured in middle of the shaft 1 would use three short splints and two bandages and place the arm in a large arm-sling, because this sling would give rest and support to the humerus and clavicle until the arrival of the doctor. C r i t i c i s m . — In the suggested solution of this problem, I note two errors. First, the use of a large (or small) sling for this combination of injuries is definitely contrary to the instructions of the Textbook, because it will cause increased pain, will exert pressure on and may convert a simple into a complicated fracture of the clavicle ; and secondly the term “ a r m ” is loosely used here and elsewhere whereas “ upper limb ” would be more anatomically correct. T h e solution of the problem depends on the degree of shock present. If this is marked, the best line of action would be to concentrate on its treatment. Consequently the patient should be kept (and removed) in recumbent position ; and the injured limb should be extended alongside the body, being fixed with broad bandages round elbow and body and round lower end of forearm and body. If shock is not marked and the patient is a w alk ing casualty, I would regard the fractured arm as the more serious injury and concentrate thereon. Consequently I would treat this injury as laid down in the Textbook— with broad band a ge round upper end and trunk for fracture in upper third and with three splints for fracture in middle of shaft. Then, in place of an armsling, I would steady the limb (flexed to a right angle at the elbow) with another broad bandage which I would pass round elbow and trunk and tie in front in such a manner that it affords support to the wrist. This line of treatment obviates the necessity to under take active treatment of the fractured clavicle which never theless will be kept strictly under control.

II.

H um erus

a n d

R a d iu s .

With this combination of injuries I would use a trian gu lar splint reaching from the armpit to the tips of the fingers and fix it with two bandages above the elbow (one above and one below the fractured humerus) and two bandages round forearm (one above fracture and one figure of eight round

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wrist and hand). This done I would apply a large armsling for rest and support. C r i t i c i s m . — The suggested solution of this problem might prove satisfactory, even though it does not commend itself to me, except with reference to the new designation of a right-angled splint. Frankly I do not quite trust such im provised splint for a combination of injuries. Further, with two or more such injuries I believe (and have always taught) that first aiders should treat each separately as far as circum stances allow and so facilitate the task of the surgeon to whose care the patient is transferred. Such action directs attention to multiple injuries and also allows opportunity of dealing with the same, one at a time. Consequently, here again I regard the fractured humerus, whether in upper or middle third of the shaft, as the more serious injury. I would, therefore, fix the fractured forearm as laid down in the Textbook and then treat the fractured arm with a broad bandage round upper end and body for fractures in upper third and with three splints for fracture in middle third of shaft. Finally in each case I would support the limb in a small sling which, unlike the large sling, is not so likely to cause further displacement of the fragments of the fractured humerus.

III.

R a d iu s

an d

C l a v ic l e .

With this combination of injuries 1 would place the arm in a natural position, apply two splints to the forearm and use two bandages (one above fracture and one figure-of-eight round wrist and hand). T he radius being secured, I would raise the arm by flexing the elbow, insert a large pad in armpit, place in a St. John sling and apply a trunk bandage around elbow. I do not think that the trunk bandage or placing the arm in a St. John sling would agg ra va te or injure the fractured radius because the arm would be in a natural position. C r i t i c i s m . — The suggested solution of this problem is sound ; and the writer has correctly concentrated on the fractured clavicle as the more serious injury. Further, I agree with his comments, especially as the ulna is uninjured and, as a natural splint, will contribute its share in the fixation of the fractured radius.

IV .

R a d iu s

an d

S capu la.

With this combination of injuries 1 would treat the fractured radius with two splints and two bandages (one above fracture and one figure-of-eight round wrist and hand), raise the arm from the elbow across the patient’s chest, apply a broad bandage round scapula and place in a St. John sling. I do not think that the placing of the arm in a St. John sling would agg ra va te or injure the fractured radius. C r i t i c i s m . — The suggested solution of this problem is also sound ; and the fractured scapula is probably to be regarded as the more serious iniury. T he description, how ever, is a bit faulty ; and I assume that “ the broad bandage round scapula ” is applied (as laid down in the Textbook) as figure-of-eight and tied off in opposite armpit. Here again the uninjured ulna will play its part in fixing the fractured radius. V. P a t e l l a a n d F e m u r .

With this combination of injuries I would place the leg in a natural position, draw ing the broken leg to the same length as the sound leg. 1 would then apply one bandage figure-of-eight round the feet, a short splint at back of knee and a figure-of-eight around knee. I would next place a long splint reaching from armpit to feet and treat the broken femur as usual. C r i t i c i s m . — T he suggested solution of this problem contains two errors. First, in this and the following section, the term “ l e g ” is sometimes loosely used, whereas “ lower

AID l i m b ” would be more anatomically correct ; and, secondly, the figure-of-eight bandage, to be effective, must be applied “ round ankles and fe e t” and not, as stated, “ round the feet.” Further, I question the value of the short splint at back of knee and, I wonder, how the short splint can be fixed with a figure-of-eight bandage round the knee in view of the fact that at the outset of treatment the legs were tied together at ankles and feet. My treatment of these injuries would depend on the material available. If bandages were scarce, I would be content to apply one as figure-of-eight round the patella and knee joint (which as the result of shock and the fracture of femur the patient is not likely to flex or even attempt to flex) ; and this done I would treat the fractured femur as laid down in the Textbook. If, however, bandages were plentiful, I would first treat the broken patella with long back splint and four bandages for the reason given above in Section II ; and this done I would proceed to treat the fractured femur in the usual way. In short, I agree with the suggestions that we must concentrate on the femur as the more serious injury and that we may not raise head and shoulders and lower limb as is usually done with a broken patella. VI.

T ib ia

an d

P atella.

With this combination of injuries I would use three splints, one on each side of leg and one under the leg. 1 would then place a figure-of-eight bandage around knee after drawing the foot into a natural position and before placing the side splints in position. I would then place the usual five bandages (A, B, C, D and E) in position and secure the side and under splints in the usual way, except that Bandage D would serve as the double figure-of-eight bandage. Con sequently I would use six triangular bandages and although the Textbook does not say anything about the box splint, I should make one. C r i t i c i s m . — If I read the suggested solution correctly, treatment of the two injuries is, in this instance, to be com bined whereas from a first aid view point I am firmly con vinced that each injury should be treated separately. Con sequently, I have no use for the box splint in its usual form, though in my second solution I suggest what practically amounts to a box splint. Here again my treatment of these injuries would depend on the material available. If bandages were scarce, I would apply one as figure-of-eight round the patella and knee joint for reasons stated in Section V ; and, this done, 1 would treat the fractured leg as laid down in the Textbook. If, how ever, bandages were plentiful, I would first treat the broken patella with long back splint and four bandages ; and, this done, I would proceed to treat the fractured leg in the usual way. Further, in both instances I would raise and support the head, shoulders and lower limbs of the patient during treatment and transport to prevent possible muscular traction on the upper fragment of the broken patella.

V II.

F em ur

an d

T ib ia .

With this combination of injuries I would extend the leg, place a figure-of-eight bandage round the feet, apply the bandages B, C, D, E, F, G, H, with an extra bandage above the fracture of tibia. I would then place the long splint in position from armpit to feet and tie off the bandages using the sound leg for splint well packed between legs. C r i t i c i s m . — T he suggested solution of the problem repeats the two errors already noted above in Section V. It also combines the treatment of the two injuries which action, as just stated in my comments in Section V I does not com mend itself to me. Here again my treatment of these injuries would depend on the material available. If bandages were scarce, I would treat the fractured femur as laid down in the Textbook ; and I would know that further harm would not result to the fractured tibia to which the unbroken fibula would give some

FIRST support. If, however, bandages were plentiful, I would first treat the broken leg and then the broken femur, padding the long external splint (as and where indicated) to secure uniform pressure along the lower limb.— N .C .F.

Railway Ambulance News. G reat W estern. P a d d i n g t o n . — Miss R. A. Marsh, of the Casualty Clear ing Station, Paddington, was presented with the insignia of Serving Sister of the Order of St. John of Jerusalem by Mr. Charles J. Hambro, Chairman of the Company. Mr. Hambro, who has recently accepted the Presidency of the Great Western Railway Ambulance Centre in succession to the late Viscount Horne, heartedly thanked Miss Marsh for her services and spoke in terms of high appreciation of the grand work that the staff at the station were carrying out.

S w a n s e a D o c k s . — The annual meeting of the Swansea Docks ambulance class was presided over by Mr. H. W. Morgan, dock manager, who referred with much satisfaction to the fact that membership of the class had increased by more than 25 per cent. Mr. S. Rust, principal first aid warden of the Swansea Docks A. R. P. scheme, presented a casserole dish to Dr. L. W. Hefferman on behalf of the class in appreciation of his services over a period of years. Thanks were also expressed to the class secretary, Mr. F. E. Saunders, and to Messrs. Y orke and Dennis, class instructors.

graciously pleased to sanction the granting of the D ignity of Serving Brother of The Order of St. John to Dr. Charles D. Wilson, Darlington ; Mr. Edward Dodds, Gateshead ; Mr. Wilfred B. Webb, York. Dr. Wilson has been associated with the Railway ambulance movement for sixteen years as lecturer, examiner and competition judge, and his enthusiasm for promoting a knowledge of first aid is outstanding. It will be particularly pleasing to the Darlington Faverdale Works Class to learn of the honour conferred upon Dr. Wilson, who has given a series of lectures for 15 continuous years to this class. Mr. E. Dodds and Mr. W. B. Webb have given yeoman service in many capacities for a long period of years and their recognition is well merited.

T he annual meeting of the Brampton Junction, L . N . E . R . Branch, was held last month, Mr G. W a u g h , Heads Nook, presiding. Dr. H. P. Nelson, of Brampton, is giving a course of lectures. Mr. T. Rowe (treasurer) and Mr. David Kennedy (Secretary) presented their annual reports which were considered satisfactory.

Asphyxia:

Signs,

Sym ptom s

and

Causes. P r e p a r e d for ARDEER By DR.

Mr. W. G. Randall has recently been pro moted as an Officer (Brother) of the Order of St. John in recognition of his services to the Gloucester Centre, S.J.A.A. Mr. Randall is a retired G .W .R . signal inspector and is vice-President of the G .W . R. Gloucester Ambulance Corps. Mr. L. M. Starr, one of the oldest members of the Cheltenham G .W .R . ambulance class, has recently been promoted as Corps Superintendent of the Cheltenham Divi sion, S.J.A.B . Mr. Starr holds the gold medal of the Great Western Railway Centre for 25 years’ ambulance efficiency, and was elected a Serving Brother of the Order of St. John in 1936 .

147

AID

FACTORY H.

AM BULANCE

CLASSES

R O B E R T S of Ardrossan, Ayrshire.

H o n o u r s. —

Sir James Milne, General Manager, presented the Insignia of Serving Brother of The Order of St. John to Mr. W. H. Teagle, at the Solicitor’s Office, on January 27 th, at Paddington station, when am ong those present were Mr. C. FI. Whitelegge, Solicitor ; Mr. Salcombe and Miss C. A. Ault, Centre Secretary. Sir James congratulated Mr. T eagle on his excellent first aid record of 42 years. Apart from his close association with the Company’s ambulance movement Mr. T ea gle holds the L .C .C . first aid and nurs ing medallions and has been a member of the St. John Ambulance Brigade for 27 years. He served throughout the last war and went overseas with the R .A .M .C . as Sergeant. His services as instructor in first aid have been in demand in various quarters, and he has instructed classes of railwaymen, police, scouts and other organisations.

London

and

N orth

Eastern.

(Concluded from page 12S.) E xam ples

o f

A s p h y x ia

from

A bsen ce

o f

C o n d it io n

(c) Suffocation, Asphyxia from fixation of the chest arises from accidents of the undernoted types : Pressure by panic stricken crowds. Collapse of buildings or trenches. Hoist accidents. Being caught in quicksands or snow. T h e signs when observed will be strenuous inspiratory effort followed by exhaustion and unconsciousness. It death ensues before the fixation is relieved, the face will usually be congested and discoloured ; the tongue may pro trude, and froth may be seen at the nostrils and mouth. These signs vary, and will, in large measure, be determined by the rapidity and completeness of the suffocation ; thus, they may be striking or again hardly noticeable. In the very young the elasticity of the chest wall allows it to submit to pressure great enough to stop respiratory movements without injuring either the ribs or the contents of the thorax. Smothering of infants by bed clothes, heavy rugs or by juxtaposition of the parents’ bodies (overlying) may be brought about in this w ay without the infant’s mouth or nostrils being occluded. The death appearance in such cases may be normal, a bluish tint seen in the nails of the fingers and toes being the only external evidence of asphyxiation. (d) Failure of the Control ( Respiratory Centre).

It will give great satisfaction to members in the North Eastern Area to learn that His Majesty The K in g has been

All respiratory acts are governed by a control situated in the brain, and called the Respiratory Centre. From this

1 48

FIRST

centre power is transmitted to all the mechanism concerned with breathing, and this transmission ot power is carried on at a rate and intensity both of which depend on the quantity of carbonic acid in the blood. When the quantity of car bonic acid is normal, respiration works with a steady and comfortable frequency and uniform force, but if the carbonic acid in the blood increases, either through not being eliminated or from want of oxygen, the respiratory centre immediately emits more powerful stimuli and causes the respiratory movements to become quicker and deeper. It is a see-saw arrangement thus automatically regulated, and holds equally good for conditions opposite to above, i.e., if the carbonic acid in the blood is lowered below normal, the breathing rate will also be lowered below normal until the carbonic acid has accumulated and reached normal. Anyone can test this by taking a number of very deep inspirations much beyond the usual, and so for the time being over-ventilating his lungs. He will then find that quite a pause will ensue before he has any inclination to draw a breath. The respiratory centre may be poisoned or shocked, and become unable to function, notwithstanding the great need which may arise. Poisons capable of such effect are separately dealt with, and here we shall refer only to Electric Shock. When this is of sufficient severity to cause bodily insensibility, the respiratory centre has been shocked into insensibility also. The body appearances are those of death, which may or may not be present. It is frequently impossible to differentiate. Quite often the death is an apparent one only, and in such cases immediate correct restoiative measures will in time succeed. Although breathing ceases, the face does not become bluish, because circulation has almost ceased simultaneously with arrest of breathing, and the blood containing carbonic acid has not been circulated to the skin. Although other centres are in volved, unconsciousness in electric shock is to be regarded as a case of Asphyxia. (e) Chemical Asphyxiants. T h e Simple Asphyxiants act, as the first aider has been informed, by shutting out oxygen from the lungs. By contrast there are two gases which permit of oxygen being taken to the lungs, but which are nevertheless power fully asphyxiating. These are : ( 1) Carbon Monoxide Gas, and (2 ) Prussic Acid Gas, and they are termed Chemical Asphyxiants. Each has a different mode of attack. T he Simple Asphyxiants, by m ixing with the air, thin out the oxygen content to a level below human require ments, or, as in wells, vats, mines and sew'ers, displace the oxygen altogether, but the Chemical Asphyxiant may be present in unappreciable quantity so far as air dilution is concerned, and yet be highly dangerous to life. They arrest respiration by chemical action— not mechanical means. Carbon Monoxide Poisoning. This gas, when inhaled, means immediate vicious and stubborn union with the blood in the alveoli (lung cells). There, with the htemoglobin of the red cells, it forms a new substance called methatmoglobin to the com plete refusal of oxygen. Oxygen is not debarred from ad mission to the lungs, but the blood there can neither absorb nor transport it. This respiratory defect holds good for so long as the union of carbon monoxide with the blood cells lasts. If the combination of these two becomes undone (e.g., by treatment), the red blood cells can re commence their function. T h e y are then undamaged and as free to take and carry oxygen as if they had never met with carbon monoxide. The importance in induetrial first aid of carbon mon oxide poisoning demands that the signs and symptoms form a special chapter. L argely this importance is due to the fact that fatal cases are not uncommon, because of the

AID ubiquitous distribution of the hazard in the community and throughout industry. Some sources of carbon monoxide poisoning are indicated below :— r Gas Fires. Escape of coal gas containing | Gas Cookers. carbon monoxide ga s from ] Gas Engines. c Gas Illumination Fumes from motor exhaust. Producer gas in factories. Blast furnace gas. Fumes from lime and cement kilns. Fumes from bakers’ ovens through broken tiles. Fumes from blaise (iron waste heaps). Fumes from coke ovens and charcoal braziers. Smoke in burning buildings under certain conditions. The terms Poisoning and Asphyxiation have been used here as if synonymous, because vis-a-vis first aid an unconscious state caused by carbon monoxide is a case of Asphyxia. P iu ssic A c id :

Hydrocyanic A cid '. Cyanides-.

Prussic Acid causes fatal asphyxiation in a very special manner. It places no hindrance to oxygen reaching the lungs, nor does it interfere with the blood carrying oxygen to the tissues, but it stops the tissues from using it. D am age of a chemical nature has been inflicted by the prussic acid ga s on the tissue cells, and has paralysed them into utter inactivity. O xygen supply by the blood circula tion has been rendered useless. Internal respiration, i.e., the give and take in the tissues of carbon di-oxide for oxygen, has been arrested, and this constitutes tissue asphyxiation, and is evident in imme diate and profound results. Prussic acid behaves in this way to all forms of animal life, arresting their vital processes immediately, and for this reason is frequently used as a disinfectant in ridding ships of vermin and delousing property. Regarding “ S ig n s,” rarely will the first aider witness the occurrence, but should he do so, he would observe im mediate unconsciousness, the victim falling, perhaps giving a preliminary gasp or convulsive movement, death superven ing with dramatic suddenness. Prussic acid ga s and hydrocyanic acid gas are names for the same substance. The cyanides are compounds of hydrocyanic acid, and act similarly on the body. Cyanides can be eaten or drunk after solution, but these methods and inhalations all act on the body in a similar manner.

L e tt e r s

t h e

E d ito r .

W e are in no way responsible for the opinions expressed, or the statements made, b y Correspondents.— E d i t o r . K ILLE D

G AS

FUMES.

D e a r S i r ,—

W e beg to confirm our telephone conversation this morning with reference to article on page 125 of your publication F i r s t A i d , dated January, 1941 , relating to fatality by gas poisoning. W e consider that the statement in its present form is likely to be detrimental to the use of gas in the home and in our view it should be pointed out that the accident was the result of neglect or carelessness on the part of the user. Yours faithfully, Jas.

R obertson,

District Supt., Southern Area, February 5 th, 1941 .

Tottenham & District Gas Co.

FIRST

Our Nurses’ Page. CO M P IL E D

D ress

B Y AN A M B U L A N C E S I S T E R .

R e g u l a t io n ,

S.J.A .B .

The Chief Commissioner lias issued (he following order :— “ O w in g to the difficulty experienced by manufac turers in obtaining supplies of metal, it has been decided that the present hat badge worn by nursing personnel will be restricted, for the period of the war, to Officers ; and B adge No. 12 B will be supplied, in future, to Ambulance Sisters in lieu of the metal hat badge.”

No. 1

D is t r ic t ,

O b it u a r y .—

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happy one, and the Rev. John Smith, who conducted the Memorial Service held in the Congregational Church on Sunday afternoon, February 2 nd, spoke in the highest terms of her leadership. He concluded by sayin g that Miss H an s ley Smith handed him a paper one afternoon and asked him to read the few lines she had written to his W om en’s Meet ing if he though it worth while. There had been no such meeting, so he had brought these lines to read at the Service :— T h e night has come upon us, and the window blinds are drawn, The house must be in darkness until the break of dawn ; T h e terror of the blackness is all around at night, But God is in Heaven and we are in His Sight ; So, though the guns are booming and bombs and shrapnel fall, God has us in His keeping and heeds us when we call.

S .J.A .B .

The Brigade has suffered a great loss in the death of Lady Div. Supt. Miss A. Hansley Smith, whose record of service, both for length of time and for honours received, can rarely have been surpassed. She died on January 28 th and was buried on January 31 st in Cornwall, whither she had gone on account of the illness of her brother. Miss Hansley Smith enrolled in No. 9 (Kensington) Nursing Division in 1899 . She was transferred to No. 18 (Whitehall) Nursing Division on its formation in 1912 (in which year she was promoted to the rank of Lady Ambu lance Officer), and in 1918 to No. 14 (Craigs Court) Nursing Division. In 1927 Miss Hansley Smith was asked to take charge of No. 13 (Croydon) Nursing Division as its Lady Superintendent, and with it was merged at that time No. 41 (Brixton), O w in g to the constant succession of First Aid Classes arranged for the purpose of obtaining recruits, a Streatham Vale Section of the Division was formed, with the result that in 1927 the Division had increased to the extent of becoming too widespread, and was therefore divided, Miss Hansley Smith electing to retain charge of the Brixton and Streatham Vale members under the original No. 41 , while No. 13 , with the Croydon members, was taken over by her senior Lady Ambulance Officer. Throughout her career Miss Hansley Smith was always ready to undertake any duty or work in which help was required, and as a Divisional Supt. could always be relied upon to supply personnel for a public duty at short notice if by any means possible. Miss Hansley Smith was awarded the Service Medal in 1914 , and the appropriate bars 1919 , 1924 , 1929 and 1934. the fifth bar being due for 1939 . She held the K in g Edward V II and K in g George V Coronation Medals and the Silver Jubilee Medal issued in 1935 . She was appointed a Serving Sister of the Order in 1925 , and promoted to the grade of Officer in 1937 . For her work in Devonshire House in the last war she received her decoration of M. B. E. In the years 1909 and 1910 Miss Hansley Smith won the Nurses Chal lenge Bowl for the London District, and in 1923 led the London team which won the Perrott Shield in the Brigade Competitions. She took the Annual Re-examination every year without exception during her long service, and when Anti-gas lectures were made part of the Brigade training, she obtained Grade II Certificate in 1935 , Grade I in 1936 , qualified at Winterbourne Gunner in 1937 , and L .A .G C. in 1938 . For the last 18 months Miss Hansley Smith has been Commandant of No. 5 First Aid Post, attached to Streatham Hill Congregational Church in Christchurch-road, where her work has endeared her to large numbers of helpers and friends ; again in competition with other Posts her teams liave been successful. T he Post has been an exceptionally

No. 46 ( E n f i e l d ) N u r s i n g D i v i s i o n . — O w in g to his military duties, it was impossible for the President, Mr. Derek Parker Bowles, to be present at the annual meeting of the Division which was held at its headquarters at Lancaster Hall, Silver Street, on Wednesday, January 15 th. He sent a letter expressing his regret, and conveying his best wishes for 1941 . He was confident that the very high standard of efficiency always displayed by the members would show itself in the great efforts which lie before them. The Divisional Secretary gave an interesting survey of the year’s work, showing' that five courses had been held in first aid, one in home nursing, and one in A. R. P. (anti-gas), the lecturers being the Divisional Surgeon, Dr. J. G. B. Brass, Nursing Officer Miss Oates, and Lady Div. Supt. Mrs. Phypers. T he Treasurer’s report showed a satisfactory balance in hand. Some Defence Bonds had been procured, and a sub scription given to Enfield Air Raid Distress Fund. In her remarks, Lady Div. Supt. Mrs. Phypers stated that several new members had been enrolled, and one Nurs ing Officer had been obliged to resign ow ing to ill-health. All the officers, members and probationers were busy carry in g out hospital duties, w orking at First Aid Posts or at the S ick Bay, besides rendering first aid on many occasions to their fellow-workers and other injured persons. To celebrate the 21 st anniversary of the formation of the Division, 21 hot water bottles had been subscribed for and presented to the Central Hospital Supply Service. The Medical Comforts’ Depot had been maintained and many had been glad to avail themselves of the useful and often expensive articles which are loaned out at a reasonable figure. Miss Fiske continues to be the secretary of the A .R .P . Auxiliary Reserves attached to the Division, most of whom are w orking at First Aid Posts in the locality. O w in g to the blackout and enemy action, meetings are now held on Saturday afternoons instead of on Monday evenings, but evening meetings will be resumed in the spring. T h e Division is now training the members of the Enfield Youth Service Corps, a very keen set of young people, and it looks forward to another successful year.

No. 2

D is t r ic t ,

S.J.A.B .

Lady County Officer Mrs. W eaver Adams is forming a new Nursing Division at Slough, which will be in the charge of Miss Schoof whose father was for so many years Transport Officer and Secretary to the South B ucks Corps. The need for S.J. A. B. nurses is greater than ever, and it is hoped that any woman between the ages of 18 and 60 who can possibly m anage to accept training and offer service in

FIRST this way will at once get in touch with Miss Schoof at hi, K in g Edward-street, Slough. The w ork is interesting and varied, as in addition to A .R .P . , public duties at cinemas, sports meetings and other functions, and occasional full dress parades, it is customary for a nurse always to accompany the civil ambulance car on its journeys to accident and invalid cases. All this work is part-time and voluntary. It is alw ays interesting, and in the event of serious air raids, may well become of paramount importance to the town, and indeed, the whole district. No. 8

D is t r ic t ,

S .J.A .B .

B r i g h t o n N u r s i n g D i v i s i o n . — Members of this D ivi sion met together at the Union Hall on Saturday, January 18th, for their annual social evening. T he majority of the local members not on duty in the town’s Civic Defence Ser vices were present. Games and competitions of a most ingenious variety were organised and compered by Miss Trill, the popular Nursing Cadet Officer, and made the evening a great suc cess. Miss Cocks, with the help of the members, provided an attractive supper in spite of war-time difficulties. Lady Supt. Miss H. Theobald, who is recovering from an opera tion, sent her best wishes. It was pleasant to note how many girls of school age had joined the cadets. The St. John Ambulance Brigade has alw ays provided a training ground for girls who are attracted to nursing, and membership of the cadets is fre quently the first step in a nursing career. Am ong those present during the evening were District Officer W. J. Noble and many other friends of the local Divisions.

No. 9

D is t r ic t ,

I n s p e c t io n

S .J.A .B . a t

P lym outh

b y

th e

L a d y - S u p t -in - C h ie f .

— Tributes were paid to the Plymouth and neighbouring Nursing Divisions of the S .J.A.B . by their Lady Supt.-inChief, Mrs. St. John Atkinson, when she inspected them and the Nursing Cadet Divisions at Plymouth on January 25 th. T he units present were Nursing Divisions : Plymouth CoOperative Society, Devonport, Friary, Sherwell, Ford, Ply mouth Central, Plymouth Post Office. Nursing Cadet Divisions : Ford, Plymouth Central, Sherwell, Friary, Central Hall Plymouth, Plymstock British Legion. Mrs. St. John Atkinson was accompanied by Lady Dunbar Nasmith (Lady County President), Lady County Supt. Mrs. R. Balsdon, County Commissioner H. Miller, County Surgeon Lt.-Col. J. P. S. Ward, Lady County VicePresident Mrs. H. Vellacott, and Mrs. W . J. W. Modley, the Deputy Lady' Mayoress of Plymouth. After the parade a demonstration of practical work was inspected by the Lady Supt.-in-Chief, who then presented a Second Bar to the Service Medal to Lady Ambulance Officer Miss M. Phillips, Plymouth Co-Operative Nursing Division, for 25 years’ efficient service in the St. John Ambulance Brigade.

AID The following awards were presented : 48 pendants, 29 labels, 19 medallions and 98 ce. tificates. No. 10

D is t r ic t ,

S a x m u n d i i a .m N u r s i n g D i v i s i o n . — The Annual General Meeting was attended by the Lady Divisonal President, the D ow ager Countess of Cranbrook and Lady County Supt. Miss Parker. The accounts showed a small balance in hand, and in her report the Secretary said the F lag D ay had provided £ 94 4 s. 3d., which had been divided among the various war funds. T he strength of the Division had been maintained dur ing the year. Members had undertaken duties at social events, had attended trains used for the evacuation of children, while all those resident in Saxmundham were attached to the A .R .P . Mobile First Aid Posts, and those in the country districts to First Aid Posts. During the year forty lectures and practices had been held. The Benham Cadets were very keen, and had taken a course in first aid. Presentations of awards for efficiency were made by the Lady Divisional President, and thanks were accorded to the Divisional Surgeon and Lady Div. Superintendent for their untiring services. At the close of the meeting, Lady County Officer Mrs. Colson gave an interesting address on the work of the St. John Ambulance Brigade in Calcutta.

St . A lbans N u r s i n g D i v i s i o n . — Members held their Annual General Meeting on January 28 th, when Dr. D. Lamont presided. A report was presented by Lady Div. Supt. Mrs. Evans, who stated that it was with regret that they had had to transfer Lady Ambulance Officer Williams to Bournemouth. She was succeeded by Miss Eva Handscomb, who was also acting as Divisional Secretary. In March, Dr. Margaret Wells became Lady County Officer, and they thanked her for her advice and help. Nursing Officer Mrs. Evans became Acting Lady Div. Superintendent, Dr. Lamont had been appointed Divisional Surgeon, and Miss Mouncey, Nursing Officer. Miss Joan Ryder had become Vice-President. After reference to the visit of the Countess of Lytton, the County President, the report went on to state that co-opera tion with the B .R .C .S . members had been very close, much help in this direction being given by Miss Glossop, Com mandant of Herts 70 detachment. It was hoped that the weekly practices would restart shortly with practical work and lectures in anatomy and physiology by Dr. Lamont. Membership had increased by six. The officers had had a difficult year and many adjustments had been necessary, but they appreciated the loyal support of the members. The Treasurer reported that they now had in hand, and at the bank, £ 7 7 18s. Id. with the proceeds of one of the joint flag days to come.

S h o r e iia m

W e y m o u t h N u r s i n g D i v i s i o n . — At the presentation of awards held on January 15th, Lady Supt. Mrs. Bartlett pre sented County Surgeon R. V. S. Cooper with a table lighter as an appreciation from the members in recognition of his w ork as Div. Surgeon. Others present included Lady County Supt. Mrs. Cooper, Mrs. Sherwell (President), Mrs. Davison (Vice-President), Councillor Biles (Deputy Mayor). The Secretary (Miss Long) in her report, stated 999 hours hospital duty had been undertaken, 1,320 hours voluntary duty at F. A. Posts, 940 public duties, including assistance given with refugees.

S.J.A .B .

D etach m ent,

B .R .C .S .

This detachment has acquired a lecture hall and social centre in New Road, adjoining the Public Library, being a part of St. Mary’s Hall. The detachment of which Miss Frith is the Commandant, has doubled its numbers during the past year, and the head quarters which have now been acquired will be of great ser vice. A social for the flourishing Junior Red Cross of which Miss C. M. Jones is the leader, inaugurated it, and the members spent a happy time. This Red Cross “ h o m e ” is very bare at present, and gifts of furniture and fittings will be gratefully received. It is hoped to run some socials to help raise funds to meet expenses,

FIRST

AID

Associate members would be welcomed as well as those willing to become nursing members. Associate members would be those not desiring to take up Red Cross work themselves, but who are in sympathy with the movement, and would make an annual donation to the funds.

" LEARN

P o i s o n s — P i t f a l l s in D i a g n o s i s . By

H. G R A N V I L L E T H O M P S O N ,

EARN BIG MONEY

H ull.

F ir s t aiders are t a u g h t that poisons m a y be t ake n “ ac ci dently or in te ntio nally — by the mouth, t h r o u g h the nose . . . or by injections under the s k i n . ”

Injection could well be subdivided into “ inunction ” or absorption. This would especially apply to metallic poisons contracted by workers in copper, brass, etc., namely industrial dermatitis. It is not intended, however, to enlarge upon the man}' ways in which poisons can be introduced into the body, but rather to point out the interesting and often confusing similarity of signs and symptoms of certain poisons and the signs and symptoms of other injuries and diseases. W e have been taught to differentiate between poisoning caused by such opposite agents as, say, decomposing food and the convulsants or between poisoning by iodine and carbolic acid. For practical purposes the first aider places poisons into definite groups and gives the appropriate treatment. For academic purposes however, let us consider how closely the symptoms of certain diseases, etc., simulate the symptoms of certain forms of poisoning. Thus, the convulsions accompanying tetanus, epilepsy and meningitis are also present in strychnine poisoning. Dilated pupils typical of optic atrophy or defect of the oculo-motor nerve also follow poisoning by the belladonna group, cocaine and gelsemium. Contracted pupils are present in tabes ( “ tay-bees,” a wasting disease), but are also a feature of poisoning by opium, morphine and heroin. Carbon-dioxide, paraldehyde, opium, the barbitals— all give a scate of coma : yet, so is the case of cerebral haemor rhage^ epilepsy and injuries to the brain. T he delirium found in cases of organic brain diseases and nephritis, etc., is uncannily doubled by the administration of atropine, cocaine, “ hasheesh ” and similar poisons. Opium and its derivatives, nitro-benzine, etc., produce cyanosis, but so do diseases of the cardiac and respiratory systems. Paralysis follows cyanide and carbon monoxide poisoning, yet it is also produced by brain tumour and apoplexy. Reverting to respiration, opium gives slow respiration ; as also does cerebral haemorrhage and uraemia. The belladonna group of poisons cause rapid respiration such as is found in hysteria and conditions involving the medulla oblangata. The symptoms of gastro-enteritis, ulcerated duodenum, cholera, acute acidosis and uraemia, are almost identical with the symptoms of arsenic, aconite, antimony, digitalis, mercurial and corrosive poisons. The signs and symptoms of many of the lesions men tioned may not be new information to an advanced student, but they assume great importance when brought into ju x ta position with the corresponding signs and symptoms of cases of poisoning. They should be studied, as they may prove to be real pitfalls for the uninitiated.

MASSAGE

and f you are prepared to study for an hour or so each day during the dark evenings you can become an expert practitioner in Swedish Massage and play your part in the ser vice of the Nation and enjoy the status, remu neration and thecomforts of the professional worker Now is your opportunity of becoming trained for the great work which lies ahead in the field of Therapeutics. Everyman and woman skilled in the art of scientific massage will be a national asset.

YOUR KNOWLEDGE OF F IR S T AID will be considerably enhanced if you wear the badge of the S. M. A. E. (Swedish Massage and Electrical) Institute w’hich is recognised as an emblem of sound and efficient training in scientific subjects. T he holder is thereby known to have satisfied a Board of Examiners that he or she possesses a most comprehensive knowledge of human anatomy and physiology and can satisfactorilytreat all kinds of conditions that are amenable to massage and manipulative therapy. If you are interested in First Aid you will at once appreciate the value of massage, it \Vill build up the muscular and nervous system in exactly the same way as exercises, but does not incur any waste products and even removes them when they are present. It is the most wonderful treatment for injured and sick.

MONEY FOR YOU T he proper study of mankind is man. Study the most absorbing subject in good company under the guidance of the S .M .A .E . Institute and turn your interest in First Aid work and your hobby into channels that mean money for you and health for others. An investment in knowledge pays the highest dividends. For over 20 years the S .M .A .E . (Swedish M assage and Electrical) Institute has been teaching scientific M assage and numbers am ong its graduates some of the most successful and highly paid men and women in the realm of Massage. Write N O W for this interesting booklet entitled “ M anipu lative Therapy as a Profession" it will be sent to you F R E E and post free and invoive you in no obligation whatsoever.

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! 52

In ju rie s Caused to th e by B l a s t .

FIRST

H u m a n Body

Bv D r . J o h n F. E u s t a c e , in the Irish Ambulance Gazette. E v e r since the discovery of gun-powder, injuries to the Human Body have probably been caused by “ Blast,” the first scientifically recorded case being an ear injury, caused by the discharge of a musket close to the ear in the year 1593 , but attention was not drawn to it to any extent until the High-Explosive Shell was developed in the last war. Even then, little was known of its mechanical effect, and with the end of the war the matter lapsed into obscurity until August, 1940 , when a very complete account of the effects of “ B l a s t ” was described in a paper by Professor Zuckerman, the information being obtained for the most part from animal experiments. Let us first consider what is meant by “ Blast.” This consists of a compression and suction wave set up by the detonation of high explosive. At every point in the neigh bourhood of an explosion there occurs first a momentary wave of high pressure, and this is followed by a suction wave of negative or reduced pressure ; neither of these waves persists for more than a fraction of a second. As far as the human body is concerned the compression wave seems to be responsible for the major part of the damage caused to it. Certain fairly constant factors are now known about the conditions which govern the severity of “ Blast ” injuries, and they are :—

( 1) The closer the person to the explosion, the greater the effect. At distances greater than fifty feet from the site of the explosion, no effect is likely to be produced to the human body by “ Blast.” (2 ) The effect is greater in the erect position than if the person is lying down. This is due to the fact that the com pression wave tends to be directed upwards by the sides of the crater produced by the bomb, which penetrates the ground to some depths before exploding. Therefore the harder the substance on which the bomb lands the less the penetration, and consequently the closer blast wave will approximate to ground level, and the greater the effect of the blast wave to persons on ground Jevel. (3 ) If a person is shielded from the direct compression wave by a wall or building, the effect is largely rendered harmless. In this category falls the case of people sheltering in an “ Anderson S h e lte r ” when a bomb landed within ten feet of it, displacing the shelter a distance of twelve feet, and yet none of the six occupants suffered from a blast injury. (4 ) With regard to the explosive itself, the thinner the casing of the explosive, the greater the blast wave. A thinwalled high-explosive bomb dropped from an aeroplane pro duces a greater blast wave than thick-walled shell of equal charge, as some of the pressure wave is used up in bursting the wall of the shell. ( 5 ) In a confined space, as when a bomb penetrates into a building before exploding, the blast effect is magnified considerably, as dispersal of the pressure wave is difficult. It must, however, be remembered that cases of injury produced by blast alone are comparatively rare, as injuries from shrapnel, fragments and burns are also likely to be present. A few cases were described in Barcelona of people being found dead with little or no external signs of violence, and the cause' of death was assumed to be blast. While this can take place, it is the exception rather than the rule. Land Mines.— These are dropped from bombers with a parachute attached, and consequently descend rather slowly (40 m.p.h.). T h e y are magnetic and will explode at the level

RID of the roof-tops, frequently being activated by metal gutters or steel buildings. However, if they descend to ground level without coming into a metallic field, they will explode on contact. As they weigh anything up to two and a half tons, they do tremendous destruction, and produce a terrific blast effect, and will occasion blast casualties at much greater distances than ordinary high-explosive bombs. The parts of the Human Body likely to be injured by “ Blast ” are :— I. The Chest. II. T he Abdominal Contents. III. The Ears. I.

T he

C h est.

There are three theories as to the causation of injuries to the chest by “ Blast,” and they are :— (a) That the destruction is produced by the suction wave acting through the air passages on the alveoli, causing them to rupture. (&) That the lungs are distended by the compression wave acting through the air passages. (c) That the damage is produced by the impact of the pressure wave on the chest wall. As a result of Professor Zuckerman’s experiments, it now seems clear that (c) produces the greatest injury, but that some effect of (b) is also present. Let us consider now what occurs when a person is ex posed to a blast compression wave. For a very small frac tion of a second the air pressure is very greatly raised. This pressure makes itself felt by acting on the chest wall, endeavouring to force it in. T he ribs on the whole resist the pressue well, but it forces in the tissues between the ribs, while at the same time the lungs are inflated by the pressurewave acting through the air passages. This produces a rupture in the walls of the alveoli in this part of the lung, and as the walls of the alveoli contain many blood-vessels, bleeding takes place into the alveoli. In severe cases of blast the person is found more or less injured from splinters, and a thin stream of blood trickles from the mouth and nose. T he blood differs from the usual case of bleeding from the lungs in that it is not coughed up and consequently is not frothy. In less severe cases, no bleeding may appear on the surface, but it is present in the lungs, and if any violent exercise is taken, this, by accelerating the flow of blood through the lungs, will increase the bleeding, and this may cause collapse of the injured person. As a result of this, it is very dangerous for a person who is believed to have been exposed to blast to have a general anaesthetic. Treatment.— A person who is known to or suspected of having been exposed to blast should be kept absolutely at rest, lying down and kept very warm. If it is available, oxygen should be administered. I I .—

T he

A b d o m in a l

C o n ten ts.

Injuries produced to the abdominal contents include haemorrhage from the surface of the liver and bleeding into the stomach and intestines. These are usually present, in addition to the injuries to the chest already described, and the treatment is on the same lines. I I I .—

T he

E ars.

The human ear is a delicate mechanical device, so constructed that we are able to perceive sound waves of certain frequency. On the outside we find the pinna or the ear of the layman, and this aids in hearing. In certain animals— the hare, for instance— the pinna is capable of being moved, and this helps to locate the origin of the sound heard. However, the human has lost this ability, but com-

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FIRST

pensates for it by moving the head to fix the location of a ound. Leading into the skull from the pinna is the ear open ing, and across this is stretched, completely closing it, a parchment-like membrane, the ear-drum. It is the vibrating of this drum, in response to sound waves, that enables us to hear. Inside the drum is called the inner ear, and this is the place where the vibrations of the ear drum are trans mitted to the sensitive nerve endings, which in turn forward the impulses to the brain, which distinguishes in certain frequencies familiar sounds. Injuries to the ear occur to the drum or to the inner ear, and they are brought about by the violent displacement of air following an explosion. One or both ears may be affected, more often one, and this is sometimes the ear on the opposite side, especially if the burst occurs in a confined space. The factor determin ing the injury would seem to be the position of the ear opening in relation to the bursting bomb. Symptoms. — Deafness and a roaring noise in the ears are the most constant symptoms. T he deafness is immediate and may be complete so that no sound can be heard at all ; the patient describes himself as dazed and confused, and complains of a loud continuous roaring in the ears. After a time, two hours to two days, the roaring usually subsides in one ear, but may persist in the other ear, com bined with a complete deafness for a long time. Giddiness and pain may also be present, but are not so constant. T h e ear drum may be burst by the pressure wave and this may give rise to bleeding from the ear. This perforation is a serious proposition, as infection of the inner ear may result. Treatment.— Ear injuries may be prevented by the wear ing of suitable ear plugs. T he qualities which a satisfactory ear plug must possess are : ( 1) That it should fit the in dividual ear opening firmly, and yet be sufficiently plastic not to inflict any injury upon it ; (2) it should not contain any skin irritant ; (3 ) it should not crumble in use and allow fragments to remain lodged in the ear, and (4 ) it should be cheap. Very many protective materials are adequate, but probably the most simple and economical is cotton-wool impregnated with vaseline or candle grease. Another variety of protective device is a saucer-shaped pad of sponge rubber which fits over the entire pinna, and has the advantage that hearing is only slightly impeded. If bleeding occurs, no attempt should be made to plug the ear, and the person should not be allowed to lie down with the bleeding ear uppermost.

P riso n e r of W ar. S i r Joiin D u n c a n , Chief Commissioner, S .J .A .B ., has asked us to include the following name and address :—

Kriegsgefangenenpost, Gunner H. Myers, 7 , 357 , 836 , British Prisoner of War, Prisoner’s No. 6123 , S ta la g X X I B . H . 39 , Germany. T lie above is a member of the Birmingham City Divi sion, and it is hoped that in this w ay his friends would learn of his address and write to him. Should further names and addresses be available, we shall be pleased to insert them in subsequent issues.

AID

Books f o r the Shelter. “ Sandfall ” — A Channel story', by Nevil Shute. Heinemann, 8/-)

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This is not an actual sea story, but of a pilot in the R.A. F . , serving with the Coastal Command, whose job is to patrol the Channel. His exploits with a submarine tends to mar his career, but subsequent events bring forth good results. The author has written a most fascinating story, which grips the reader from the very commencement. In fact, once started, it is a hard job to leave off reading until the end is reached. The story is amusing, exciting in places, pathetic ; but throughout the author’s intimate knowledge of routine service operations is apparent. Readers will enjoy reading the exploits of Roderick Chambers— called Jerry for short.

D ry Dressing. in a recent issue of The Lancet, J. G. Bonnin, of Hammersmith, stated :— For some time I have been advocating a dry dressing or no dressing at all in the treatment of wounds which one wishes to heal by so-called first intention. T he unpleasant appearance and frequent infection of wounds which are dressed for the first time with a moist compress or left for some time under an airtight covering should be better appre ciated. The wounds I have seen lately which have been treated at a first-aid post or elsewhere have provided striking proof of the value of the dry dressing. Some multiple abrasions or lacerations have defied the ingenuity of the dressing stations to cover them entirely, and the healthy appearance of the uncovered wounds contrasts so markedly with the moist white unhealthy appearance of the enclosed wounds that no one would hesitate in choosing which was the more effective method. T he enclosed wounds are usually covered with a compress of acriflavine and water, and sealed over with strapping, sometimes alone, but more often with gauze, whereas I am convinced that the best dressing of a wound for the first time, after preliminary cleaning, and certainly if cleaning is to be left to the casualty clearing station, is a dry gauze of ga m g ee pad. Moisture washes dirt into the wound, prevents the rapid clotting of blood (hindered still more by antiseptics), provides a warm, moist nidus for bacterial multiplication, and produces sodden white unhealthy wound edges. W e have progressed so far in our treatment of serious war in juries that, after offering what assistance we can in the removal of debris, we leave the rest to nature ; in less serious wounds this principle should be borne in mind, and nature’s efforts should not be hindered by the use of watery antiseptics in the first twenty-four hours. Other solutions, such as iodine or Dettol cream, have not the same objec tions ; though they have their drawbacks, they are some times extremely useful. Of course once infection is established, or granulation tissue present, the objections to the use of water does not apply. The important thing is, during the first 28-40 hours, to avoid water, and— what amounts to the same thing— to avoid the airtight enclosure of a wound so that it becomes sodden from skin sweat. W r it in g

Mrs. T. P. Easton, wife of the T ram w ays General Manager, presented awards to members of the Newcastle Tram w a ys Ambulance and Cadet Divisions on January 29 th.

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1 .— Letters containing Queries must be marked on the top left-hand corner of the envelope “ Query,” and addressed to F i r s t A i d , 4 6 , Cannon-street, London, E . C . 4 .

4 .— T h e Textb ook to which reference may be made in this column is the 39 th ( 1937 ) Edition of the S.J.A .A . Manual of First Aid to the Injured. T a n n i c A ci d J e l l y f o r B u r n s .

G .H . (Paddington).— I shall much appreciate your observa tions on the above in view of the controversy as to the advisability of substituting gentian violet jelly for tannic acid jelly from a first aider’s point of view and treatment which should be given at a First Aid Post. Y o u will realise that articles which have appeared in the press recently, give rise to a deal of discussion and although I appreciate fully when tannic acid should not be used, i.e., in very extensive burns resulting in char ring of the tissues, your views on the subject would be welcomed. Attached herewith is a copy of instructions which refer to this matter and which have recently been passed to us. Personally I have always held the opinion that the T e x t book is right in not advocating the use of tannic acid, even in the form of a jelly, in the treatment of burns and scalds ; and from the first aid standpoint 1 still prefer the simple remedies which it suggests. The question for or against the use of gentian violet does not really arise, because the instructions which have been issued to you and which you enclose, state that for burns of the hands “ Saline compresses or intermittent Saline baths should be continued for at least one week ” and because first aid is concerned only with treament at the time of the accident. On the que stion as to w h ether or no g e n t ia n violet should be s ub stitu te d for tan nic acid je lly in the first aid treatm ent of burns and sca lds gen er ally, I re-affirm m y preference for sim ple re m edie s. — N. C o r b e t F l e t c h e r . E xamination

H owler.

G .C . (Surbiton). — In a recent examination the doctor asked one member of our class what he knew about the larynx. W e were all highly amused when the candidate replied : ‘ ‘ The larynx is the voice box ; and it shuts up when we swallow it." Good !

Next, please! !— N .C .F . K a o l i n fo r B r u i s e s .

C. H. (Paddington).— T h e use of Kaolin has also been advised in the treatment of bruises. According to my way of thinking, however, this is definitely incorrect treatment. W hat are your views on this point, please ?

I agree with you.—N.C.F.

R e s p ir a t io n

an d

A dvanced

P regnancy.

A.C. (Portsmouth).— As a member of the Brigade I shall be grateful if you will assist me in one or two problems which puzzle me ? T he first concerns artificial respiration applied to a female who is known to be in an advanced stage of pregnancy. Is Schafer’s method harmful to the expec tant mother, the child, or to both ? If so, assuming a first-aider to be alone and no other person available (admitedly a remote possibility) to assist him in resort ing to Silvester’s method (wherein the tongue is required to be held), what else can be done? Y our letter raises problems the solution of which not one of my circle of colleagues can supply as the result of personal experience. It is, however, generally agreed among us (1) that in the treatment of an asphyxiated woman in an advanced stage of pregnancy and indeed when a state of pregnancy is obvious to tbe first aider, Schafer’s method should do